Medicine/Health

As I’m sure many of you are aware, the US Preventive Services Task Force issued new recommendations yesterday regarding regular mammograms for breast cancer screenings. Among their recommendations are the following:

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.
The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)
The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

For women like myself who were brought up to think that early detection saves lives, these guidelines are hard to accept. At first I was comforted by reading that they don’t apply to women in high-risk groups. Then I learned that the high-risk group only included women “at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.” Again, having been taught early on that a strong family history of breast cancer (even without the known genetic mutation) puts one in a higher-risk category, I was shocked to learn that even these people might be counseled to follow the new recommendations. So then I took a closer look at their reasoning.

Turns out the guidelines are based on the idea that routine mammograms for women in their forties (and yearly versus biennial mammograms for women in their fifties) can actually do more harm than good. In their words, “the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age.” So we’re looking at “small” vs. “moderate” here. These “moderate harms” include “psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results.” They also determined that the number of lives saved by early screening is not enough to counterbalance these harmful effects. For women in their forties, one life is saved for 1904 women screened; for women in their fifties, one life is saved for 1339 women screened. This boils down to a 15% and 14% risk reduction, respectively.

Ok- I am by no means an expert, but I can tell you that I would much rather undergo the “inconvenience of a false-positive,” or what turns out to be an unnecessary biopsy, rather than die of a tumor that could have been detected, had I only found the lump via a self exam or went in for a mammogram at age 48.  I realize that the financial costs (in addition to the psychological costs) of unnecessary imaging tests and biopsies are high, and that one life saved for every 1904 women screened is a very small number.  But, when that one life saved turns to be your mother, or your wife, or your best friend- or YOU- it seems a lot bigger, doesn’t it?

Responding to a firestorm of criticism, Kellogg’s claim that eating Cocoa Rice Krispies will “support” your immune system has been withdrawn.  In a press release posted yesterday, the company announced it would, “…discontinue the immunity statements on Kellogg’s Rice Krispies cereals.”

Oddly, Kellogg’s maintains that, “…science shows that these antioxidants help support the immune system.” I sent them a note last week, requesting literature citations supporting this position. No reponse yet.

Nurition and health expert Marion Nestle has been blogging about the Krispie fiasco, and even has a letter from the San Francisco City Attorney, demanding evidence for the immunity claim.

While at my family’s breakfast table over the weekend, a Kellogg’s Cocoa Krispies box caught my eye.  “Now helps support your child’s immunity,”  the box blares.  On the back, Snap, Crackle, and Pop are in superhero form – masks, fighting poses and all.

The trouble is, the claim is not supported by any real scientific evidence.  Yes, vitamins and antioxidants in natural foods like fresh fruits and vegetables are part of a healthy diet. But exactly what role vitamin-fortified foods play in helping your immune cells fight disease is not understood. (Read more…)

The 2009 Nobel Prize in Physiology or Medicine was awarded on Monday to three American scientists: Elizabeth H. Blackburn (University of California, San Francisco), Carol W. Greider (Johns Hopkins University), and Jack W. Szostak (Harvard). The three discovered telomeres, short sequences of DNA at the end of each chromosome that act as a protective cap, helping to limit how many times a cell can divide. This New York Times article has a nice description of telomeres and the broader significance of this work for cancer therapies and aging research.

So how much federal funding was invested in this Nobel Award?  According to the National Institutes of Health, approximately $32 million between the three researchers. To the average reader, this sure sounds like a lot. But when you consider that an average 4-year research grant to support a small lab can easily total $1.5 million, and many labs have two or more, it’s actually a bargain.

It’s also worth pointing out that the economic burden of cancer illness and deaths in 2004 alone was nearly $200 billion.

The recognition that telomeres play an important role in aging and cancer – which was not foreseen – serves as yet another reminder why research dollars invested in “basic research” are dollars invested wisely.

As an aside, every time I think of telomeres I recall one of my favorite Saturday Night Live skits, “Stand Up and Win.” It’s the one featuring Jerry Seinfeld as M.C. of a game show. The winner receives a year’s supply of the plastic thingies that protect the ends of shoelaces. Seinfeld exclaims, “They don’t have a name!”

This morning, I was speaking to a friend who works for the Minnesota Department of Public Health.  His job there involves HIV/AIDS testing, awareness, and education programming for the Minneapolis area.  He told me an interesting fact.  In Minneapolis, over the past year there has been a 100% increase in the number of HIV infections among people tested in his clinic.  When I asked him if the number of people being tested had increased during the same testing period, I expected him to say, “Yes.”  One could argue, therefore, that the increase in HIV(+) people being tested was not truly a 100% increase.  I was surprised and dismayed when he responded that the number of people being tested was actually smaller than the previous reporting period.  If the number of cases doubled over the previous year but the number of people being tested was actually lower, what does that mean?  My friend, Charlie, and I simultaneously said over the phone, “What the heck is going on in Minneapolis?” (Read more…)

This week, the New York Times published a nice profile on Nobel Laureate Martin Chalfie at Columbia University. Chalfie shared the Nobel Prize in Chemistry last year for his work on an amazing protein found in jellyfish called Green Fluorescent Protein, or GFP. The article is a great reminder of how very basic research on jellyfish and worms, of all things, yields invaluable scientific tools and knowledge.

GFP has the natural property of absorbing invisible ultraviolet light and producing green light – a discovery made in 1961 by Osamu Shimomura (who also shared the 2008 Nobel Award with Roger Tsien and Chalfie).

Chalfie’s “aha” moment, in 1989 at a department seminar, was a recognition that the light-producing properties of GFP could be harnessed as a sort of molecular flashlight. (Read more…)

In advance of President Obama’s national speech on health care reform tonight, I thought I’d direct your attention to a cleverly-written piece in the New York Times a few weeks back, “A Common Sense American Health Reform Plan.” Author and economist Uwe Reinahardt pokes a little fun at the idea that our health care reform plan should be guided by good ol’ American common sense.

My favorites on his tongue-in-cheek All-American Wish List for Health Reform:

4. Cost-effectiveness analysis should never be the basis of any coverage decision by public or private third-party payers in health care, for to do so would put a price on human life — which, in America, unlike everywhere else, is priceless.

7. Government should stay out of health care. Specifically, government should not control health care prices, nor should it increase its spending on health care, which is out of control.

On the topic of health care reform, NU’s medical school recently hosted Dr. Stephen L. Ondra, spinal surgeon and Senior Policy Advisor for Health Affairs in the Department of Veterans Affairs. Ondra delivered the keynote address at our medical school convocation, making several key points. (Read more…)

While in my home state of Minnesota last week on vacation, I read a very troublesome editorial in the Minneapolis Star Tribune. On display at mall: Human indignity, written by columnist Katherine Kersten, takes to task Bodies… The Exhibition, a Body-Worlds-type exhibit that opened recently at the famed Mall of America.

For those unfamiliar with Body Worlds, this traveling anatomical exhibit of real human bodies has proven very popular and successful in demystifying our inner workings. It respectfully showcases the elegance of our anatomical structure, and provides visual lessons about the destructive outcomes of smoking and obesity. The smoker’s lung is not pretty.

Kersten’s opening salvo:

If you’re heading to the Mall of America this weekend, you’ll find something new to gawk at, along with the lacy lingerie at Victoria’s Secret and the sea horses at Underwater Adventures. It’s “Bodies … the Exhibition,” a show that features human cadavers.

Really? C’mon. Comparing an aquarium, a human physiology/health exhibit, and scantily-clad Victoria’s Secret models is the beginning of, well, a scantily-clad argument.

She goes on to use terms like “high-falutin’” when describing the exhibit’s educational goals.  She criticizes the choice of location for the exhibit, the Mall of America, as being too commercial (shouldn’t exhibits be held where the people are?). The issue of whether or not the exhibit bodies were procured according to accepted medical standard, raised midway through the article, is a very valid and important concern. Kerstens, however, quickly returns to the crux of her argument:

At “Bodies … the Exhibition,” we sense the danger of a line being crossed. The issues the show raises intersect with many of the important questions we face about the nature of humanity in our scientific age.

In short, she thinks the exhibit is in poor taste and that it markets death as entertainment. I don’t see it that way at all. (Read more…)

So, you exercised today? Good. You followed your low fat, low carb diet? Good.  Your parents lived in New York City? Bad. Very bad.

Health, it seems, has more to do with what stuff you were exposed to while being born than previously thought, according to Bette Hileman from Scientific American. Diseases and disorders, such as diabetes, cancer, depression, and even obesity are much more likely to occur after exposure to gene altering substances. What are these substances? Chemicals we are all exposed to daily, as much a part of our society as we are, that reside in our food, our water, our air. Children in New York City exposed yet unborn and at a young age to contaminants in the air (common air pollutants from traffic) were much more likely to develop asthma than those who were not. This statistic is staggering: in NYC, a full 25% of children are born asthmatic. What’s more, these effects are compounded by the fact that they persist and accumulate from generation to generation. In other words, chemicals your grandmother was exposed to while pregnant with your mom could still affect you severely. That means that all that bad stuff government agencies have been banning over the years could still be affecting us today. And it certainly helps explain the rapid increases in health problems worldwide. (Read more…)