March 10th, 2011 by Shantanu Nundy, M.D. in Health Tips, Research
Tags: Actual Causes of Death, American College of Preventive Medicine, Behavior Change, Behavioral Medicine, BeyondApples.org, Cardiology, Cause-Attributable Fraction, Disease Risk Factors, Dr. David Katz, Dr. Shantanu Nundy, Family Medicine, General Medicine, Heart Disease, Internal Medicine, Leading Causes of Death in the U.S., Lung Cancer, McGinnis and Foege, Mortality Data, Oncology, Preventive Health, Primary Care, Public Health, smoking, Stroke, Tobacco Use, U.S. Mortality Rates, U.S. Preventive Services Task Force, USPSTF
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What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.
In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die of but rather what the causes of these are. Instead of chalking up the death of an older man to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.
When looked at the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke are the leading causes of death, respectively. This accounting may help us understand the nation’s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the actual causes of death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number one cause of death in America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption. Read more »
*This blog post was originally published at BeyondApples.Org*
March 9th, 2011 by AndrewSchorr in Better Health Network, Research, True Stories
Tags: Andrew Schorr, Autoimmune Disease, Clinical Trials, Drug Companies, EGID, Eosinophilic Gastroenteritis, Gastroenterology, House MD, Magic Bullet, New Medications, New Treatments, Niche Science, Oncology, Pancreatic Cancer, Patient Power, Pharma Scientists, Pharmaceutical Industry, Pharmaceutical Research, Science and Medicine, Targeted Medicine
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Maybe you read the other day in The New York Times that the pharmaceutical industry has a problem. Big blockbuster drugs like Lipitor are going off patent and the industry leaders don’t have new blockbusters showing promise to replace them. So the big companies search for little companies with new discoveries and they consider buying them. Industry observers think the days of $5 billion-a-year drugs to lower cholesterol or control diabetes may be past for awhile, and the companies will have smaller hits with new compounds for autoimmune conditions and cancer.
When I saw my oncologist for a checkup yesterday — the news was good — we chatted about the article and the trend toward “niche science.” We welcomed it. We didn’t think — from our perspective — the world needed yet another drug to lower cholesterol. We need unique products to fight illnesses that remain daunting, some where there are no effective drugs at all. For example, my daughter has suffered for years from what seems to be an autoimmune condition called eosinophilic gastroenteritis (EGID). Her stomach gets inflamed with her own eosinophil cells. They would normally be marshaled to fight a parasite in her GI tract but in this case, there’s nothing to attack. So the cells make trouble on the lining of the stomach and cause pain and scarring. Right now, there’s no “magic bullet” to turn off these cells. My hope is some pharma scientists will come up with something to fill this unmet need.
In the waiting room before I saw my doctor at the cancer center in Seattle I overheard a woman on the phone speaking about her husband’s new diagnosis of pancreatic cancer. I was sitting at a patient education computer station nearby. When she was finished I introduced myself and showed her some webpages to give her education and hope: pancan.org and our Patient Power programs about the disease. She was grateful. I did tell her — and she already knew — that there was no miracle drug for pancreatic cancer and that it was a usually-fatal condition. But that there were exceptions and, hopefully, her husband would be one. Of course, wouldn’t an effective medicine be best? Read more »
*This blog post was originally published at Andrew's Blog*
March 9th, 2011 by RamonaBatesMD in Opinion, Research
Tags: Breast Cancer Surgery, Breast Reconstruction, Dr. Ramona Bates, Healthcare Decision Making, Informed Medical Decision Making, Journal of Plastic and Reconstructive Surgery, Patient Education, Patient Knowledge, Personal Health Decisions, Plastic Surgery, Post-Mastectomy, Shared Medical Decision Making
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An outcomes article in the January 2011 issue of the Journal of Plastic and Reconstructive Surgery asks the question: “Are patients making high-quality decisions about breast reconstruction after mastectomy?”
The objective of the study was to “measure women’s knowledge about reconstruction and to evaluate the degree to which treatments reflected patients’ goals and preferences.” Their conclusion (bold emphasis is mine):
Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients’ goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.
Granted the study was small, but it left me wondering if we the medical community fails to educate these women.
The study involved a cross-sectional survey of early-stage breast cancer survivors from four university medical centers. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. Only 84 patients participated (59 percent response rate). Participants answered only 37.9 percent of knowledge questions correctly. Read more »
*This blog post was originally published at Suture for a Living*
March 8th, 2011 by Medgadget in Better Health Network, Research
Tags: Benign Dermal Nevi, Cancer Detection, Cancerous Skin Moles, Diagnostic Imaging, Disease Detection, Duke University Center for Molecular and Biomolecular Imaging, Dysplastic Nevi, Eumelanin, Laser Technology, Medgadget, Melanocytic Nevi, melanoma, Oncology, Pheomelanin, Pump-Probe Imaging, Science Translational Medicine, Skin Biopsy, Skin Cancer, Skin Cells, Skin Pigment
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Duke University scientists have been successfully testing a new laser system they developed to identify cancerous skin moles. Two lasers in the system are used to identify the presence of eumelanin in biopsy slices and a future version of the device may work directly without having to sample the mole. According to an article in Science Translational Medicine, “the ratio of eumelanin to pheomelanin captured all investigated melanomas but excluded three-quarters of dysplastic nevi and all benign dermal nevi.” From the press release:
The tool probes skin cells using two lasers to pump small amounts of energy, less than that of a laser pointer, into a suspicious mole. Scientists analyze the way the energy redistributes in the skin cells to pinpoint the microscopic locations of different skin pigments.
The Duke team imaged 42 skin slices with the new tool. The images show that melanomas tend to have more eumelanin, a kind of skin pigment, than healthy tissue. Using the amount of eumelanin as a diagnostic criterion, the team used the tool to correctly identify all eleven melanoma samples in the study.
The technique will be further tested using thousands of archived skin slices. Studying old samples will verify whether the new technique can identify changes in moles that eventually did become cancerous.
Malignant melanoma under the new laser light. Clear deposits of eumelanin (red) appear in unhealthy tissue.
Press release: Lasers ID Deadly Skin Cancer Better than Doctors …
Abstract in Science Translational Medicine: Pump-Probe Imaging Differentiates Melanoma from Melanocytic Nevi
Flashback: Diagnosing Skin Cancers with Light, Not Scalpels
*This blog post was originally published at Medgadget*
March 8th, 2011 by AnnMacDonald in Health Tips, Research
Tags: Adolescent Health, Ann MacDonald, Association Vs. Causation, Disease Risk, Drug Addiction, Harvard Health Blog, Harvard Health Publications, Harvard Medical School, Harvard Mental Health Letter, Harvard University, Illicit Drug Use, Marijuana, Mental Health, Mental Illness, Normal Brain Development, Psychiatry and Psychology, Psychosis, Psychotic Disorder, Schizophrenia, Smoking Pot, Teen Health, THC, Young Adults
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Teenagers and young adults who use marijuana may be messing with their heads in ways they don’t intend.
Evidence is mounting that regular marijuana use increases the chance that a teenager will develop psychosis, a pattern of unusual thoughts or perceptions, such as believing the television is transmitting secret messages. It also increases the risk of developing schizophrenia, a disabling brain disorder that not only causes psychosis, but also problems concentrating and loss of emotional expression.
In one recent study that followed nearly 2,000 teenagers as they became young adults, young people who smoked marijuana at least five times were twice as likely to have developed psychosis over the next 10 years as those who didn’t smoke pot.
Another new paper concluded that early marijuana use could actually hasten the onset of psychosis by three years. Those most at risk are youths who already have a mother, father, or sibling with schizophrenia or some other psychotic disorder.
Young people with a parent or sibling affected by psychosis have a roughly one in 10 chance of developing the condition themselves — even if they never smoke pot. Regular marijuana use, however, doubles their risk — to a one in five chance of becoming psychotic.
In comparison, youths in families unaffected by psychosis have a seven in 1,000 chance of developing it. If they smoke pot regularly, the risk doubles to 14 in 1,000. Read more »
*This blog post was originally published at Harvard Health Blog*
