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?

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.

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.

Worse yet, three of the first four ingredients in the cereal are not exactly those which we associate with health: rice, sugar, cocoa processed with alkali, and semisweet chocolate. Before you run me out of town for allowing my kids to eat Cocoa Krispies, though, I should add that our kids (usually) supplement their cereal with fresh fruit or yogurt.

The dubious “immunity” claim comes at a vulnerable time for parents. The spread of H1N1 flu has triggered several Chicago-area school closures, including our neighborhood Catholic school. Unfounded fears of viral vaccination have parents looking in other directions. Breakfast cereal, however, should not be one of them.

Interestingly, this is not the first time Kellogg’s has made false claims about the benefits of their cereal. Just this past July, the Federal Trade Commission (FTC) filed a formal complaint against Kellogg’s for their marketing claim that Frosted Mini-Wheats have been “Clinically shown to improve kids’ attentiveness by nearly 20%.” Here’s a link to the full version of the FTC complaint.

Just for kicks, I sent a note to Kellogg’s, asking for references to the scientific study or studies that support their “immunity” claim. I’ll post their response.

So what can you do to keep your body’s immune system healthy? Getting a good night’s sleep, and exercising are both options that have real scientific data behind them.

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 fall I am teaching a seminar at Northwestern called, “Who Discovered HIV?”  It is a historical retrospective of the first 10-15 years of the AIDS epidemic.  Last year, the Nobel Prize in Physiology or Medicine was shared between three scientists.  Two of them, Francoise Barre-Sinoussi and Luc Montagnier, won for discovering HIV.  The award in Physiology or Medicine was controversial last year because many people felt that the Nobel Committee should have also recognized Robert Gallo, an American biomedical researcher.  Why wasn’t he recognized?  That is one of the questions we will be trying to answer in class this fall.  When I meet with the class next week I plan to share with them the information that Charlie gave me about his clinic in Minneapolis.  But before hanging up on Charlie, I had the chance to share some information with him that I have learned from the students in my class.  I thought I would share it with you as well.

Last week I had the students in my class fill out a questionnaire.  I wanted to gauge their base-line knowledge of HIV & AIDS.   What I found out, and what I shared with Charlie on the phone, was surprising to me.  Some of the answers I found to be the most interesting were:

When asked if they thought condoms offer protection against the spread of HIV, 27% of the class answered that condoms did not offer protection or they did not know whether or not they did.

When asked if they thought HIV could be transmitted by kissing an individual with AIDS, 29% of the class said that they thought it could happen or they did not know if it could happen.

When asked if they thought that HIV could be transmitted by sharing eating utensils with an AIDS patient, 41% of the class said that it could be transmitted or they did not know if it could be transmitted by sharing eating utensils.

After being surprised by some of the questionnaire responses, I asked my seminar class what kind of sex education they had in school before coming to college.  Almost to a person, everyone in the class said that IF they had sex education, they had to bring a signed permission slip from their parents that allowed them to attend the classes.  If the parents did not sign the permission slip or, as was the case with some of the students in my class, the permission slip was lost, the students were sent to the library to study.  If you didn’t have a permission slip for whatever reason, the default was to miss the class.  When I was in school, sex ed. was mandatory and if you missed the class you were marked as absent.  A friend of mine recently told me that nuns taught him sex ed.  In his words, “They were embarrassed and visibly uncomfortable, but they taught it all.”  Not having children of my own, I really had no idea how things have changed.  Is withholding information that could save their child’s life someday something that some parents support these days?  If it is the case that parents want to be able to teach their children the information at home, what happens when the parents aren’t teaching the most up-to-date, scientifically accurate information?

Again, what the heck is happening in Minneapolis?

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.

It works like this: the gene for GFP is inserted alongside a gene, let’s say, that encodes a protein involved in the formation of the neural system. GFP “tags” the protein of interest, allowing it to be followed in real time inside living cells, with UV light as the trigger. It’s an incredibly powerful technique for revealing how and when genes are turned on, and how proteins move inside the cell.

In Chalfie’s case, he uses the tiny soil worm C. elegans as a model for human neuron development. C. elegans and the GFP technique have proven invaluable for studies in areas as diverse as neuroscience, organ development, and cancer.

Below is a nice 10-minute video from BBC News, telling the GFP story. It includes a few clips of live, green worms.

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For the technically inclined, video of Chalfie’s Nobel acceptance speech is here. The 2009 Nobel awards will be given in early October.

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.

1. The United States spends more than 17% of its gross domestic product on health care, a cool $2 trillion. That’s 50% more than any other developed nation on the globe. And yet the overall quality of our health care ranks somewhere in the middle of the pack or below, especially in treatable or preventable conditions. Tens of millions of Americans have no coverage at all.

By 2015, the cost of American health care is expected reach nearly $4 Trillion. This rise in cost is beyond unsustainable.

2.  The tiresome refrain from conservatives that government-run health care represents (gasp) socialized medicine is nothing new. In the 1960’s, when then-US President Lyndon Johnson was developing Medicare, conservatives led by none other than Ronald Reagan used this fear-based scare tactic. He went so far as to say,

“[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

Given that Medicare is widely credited with helping seniors live longer, healthier lives through improved access to care, and reducing the number of seniors living below the poverty line, it is without question a successful program. Ironically, many of the “no socialized medicine” voices in the over-65 group are concerned that government-run health care might reduce their Medicare benefits.

As an aside, NPR recently featured a historian’s perspective on the political maneuvering involved in the birth of Medicare.

3. Ondra shared a story about a young patient of his who, after beating a spinal tumor, lost her job and ended up in another position without health insurance. She skipped her yearly followup visits, unable to afford them. When she finally returned several years later for a checkup, this time in a job with health benefits, the tumor had returned. Instead of catching the tumor recurrence early and removing it via a minor procedure, she needed a massive, costly, and life-changing three-stage procedure.

The bottom line is that health care reform can’t come a moment too soon.  This is common sense.

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.

What better way to spark a sense of wonder, amazement, and self reflection on what it means to be human than to present an authentic look at the human form? A particularly thoughtful review of the exhibit is here. Moreover, any exhibit that can bring public discussion about end-of-life issues, altruistic organ donation, and the evils of smoking and obesity is a good thing. That a young adult might be inspired to look further into a career as a nurse, doctor, or scientist is laudable.

Kersten’s not done, though. After some additional rhetoric about science reducing human beings to commodities, she ends her column with a quote from Lutheran bishop and critic Ulrich Fischer:

When taboos along life’s boundaries have been broken, has it not led in the end to man’s assuming power over human life in ways that our limited human abilities should preclude?

The idea that taboos should guide our moral thinking is just plain absurd. It plays on the idea of fear – that which we do not know, accept, or understand is to be avoided, suppressed, or outright banned. Scientific findings often challenge the very essence of our core beliefs (we’re too young to remember the Earth as the center of the universe). Is she insinuating that we regulate science to the point of restricting inquiry?

Had we historically followed this flawed logic – that gut instinct should serve as moral compass – vaccinations would have been outlawed on religious grounds, organ transplants forbidden, and genetic technology that produces nearly all the insulin for those suffering from diabetes banned. And this doesn’t even begin to scratch the surface of racism, bigotry, and other reprehensible acts that were justified in the name of “this just isn’t right.”

In some cases we do need limits for how scientific technology is applied, or to whom access is given. It’s a fine balance. The UK’s limits on reproductive technology are a good example of where most agree that the balance works. But in this case, displaying real human bodies, artfully preserved and in an educational setting, is far from denigrating humanity. I would argue the reverse – it celebrates and informs it.

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.

This field of study, relatively new, was addressed last week by dozens of researchers from National Academies last week. Called epigenetics, it addresses the possibility of certain chemicals altering our genes into being expressed at the wrong times, or switched off when they should be on. Relief may be found in that testing for epigenetic effects won’t be much different from current chemical testing. According to Professor William Farland from Colorado State University, all that is needed are new “endpoints” to current tests. The way these chemicals work to alter our genes is their ability to enable methyl groups that attack the genes, turning them on or off inappropriately, and/or uncoiling parts of the chromosome, also expressing genes at the wrong times.

There is a good side to epigenetics, and studying these gene-altering substances. By determining which chemicals affect us and how, we may not only be able to remove them from use, but also find new ways to prevent or treat diseases, psychological conditions, even genetic disorders. Successful clinical trials for epigenetic treatment of certain cancers have already been successful, according to Professor Karl Kelsey from Brown University. Instead of killing cells, they change how the cancerous cells act, essentially changing their cancerous nature.

There is still much that is not known about this area, but that is not seen as much of a setback for scientists – the National Toxicology Program is already starting to incorporate epigenetic testing into their programs. As for how this affects you, next time you go to the doctor for a health complication, it may be far more important what you were exposed to when you were born, instead of what you are eating now. Who knows, maybe it’s your mother’s fault.