Cure for cancer just might be prevention

Some of the world's leading experts in nutrition epidemiology have cast a resounding vote in the decades-long debate between treating or preventing cancer: Prevention wins.

Their report, being released today, argues strenuously for diet and exercise as the keys to fighting cancer. It calls research and spending on the treatment of cancer "necessary but not sufficient," and contends that a far better strategy for reducing the world's annual tally of 11 million cancer cases would be to develop a public-health policy aimed at preventing people from getting the disease in the first place.

The report, issued by the World Cancer Research Fund/American Institute for Cancer Research, is based on an exhaustive review of nearly 7,000 scientific studies into whether cancer rates are influenced by diet, obesity and exercise.

Based on this review, it concludes that cancer "is mostly preventable," estimating that about one-third of all cases in advanced countries like Canada could be eliminated by diets that aren't loaded with fatty, sugary foods, by people exercising regularly and, if they are obese, by slimming down to an appropriate weight. Among the cancers with links to these factors are those of the breast, prostate, mouth and colon.

Another third of cancers are due to smoking, indicating that well over half the cases of the disease could easily be prevented.

"It's a very compelling case" that cancer incidence could be cut dramatically through prevention, said Shiriki Kumanyika, an epidemiologist at the University of Pennsylvania in Philadelphia and a member of an expert panel that oversaw the writing of the report. Also on the panel were such nutrition luminaries as the Harvard School of Public Health's Walter Willett.

Dr. Kumanyika said scientific evidence strongly supports the estimate that poor diet, obesity and lack of exercise cause one out of three cancers. "I definitely feel confident that it's at least that much," she said.

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Too much PlayStation may cause painful lumps | Technology | Reuters

Gamers beware: Keeping too tight a grip on the console and furiously pushing the buttons can cause a newly identified skin disorder marked by painful lumps on the palms, Swiss scientists said on Tuesday.

Called "PlayStation palmar hidradentitis" by the scientists, the skin disorder can cause painful lesions on the palms similar to patches found on the soles of children's feet after taking part in heavy physical activity, they said.

"The tight and continuous grasping of the hand-grips together with repeated pushing of the buttons produce minor but continuous trauma to the (palm) surfaces," Vincent Piguet and colleagues at University Hospitals and Medical School of Geneva reported in the British Journal of Dermatology.

A spokesman for Sony Corp, which makes the PlayStation, noted the study involved one person and said the company had sold hundreds of millions of the consoles since the product was introduced in 1995.

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http://www.reuters.com/article/technologyNews/idUSTRE51N4GY20090224

Social websites harm children's brains: Chilling warning to parents from top neuroscientist | Mail Online

Social networking websites are causing alarming changes in the brains of young users, an eminent scientist has warned.

Sites such as Facebook, Twitter and Bebo are said to shorten attention spans, encourage instant gratification and make young people more self-centred. 

The claims from neuroscientist Susan Greenfield will make disturbing reading for the millions whose social lives depend on logging on to their favourite websites each day.

But they will strike a chord with parents and teachers who complain that many youngsters lack the ability to communicate or concentrate away from their screens. 

More than 150 million use Facebook to keep in touch with friends, share photographs and videos and post regular updates of their movements and thoughts. 

A further six million have signed up to Twitter, the 'micro-blogging' service that lets users circulate text messages about themselves.

But while the sites are popular - and extremely profitable - a growing number of psychologists and neuroscientists believe they may be doing more harm than good.

Baroness Greenfield, an Oxford University neuroscientist and director of the Royal Institution, believes repeated exposure could effectively 'rewire' the brain.

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Lose Weight While You Work - Wired How-To Wiki

Most visitors think they've walked into a gym when they walk into
"Office of the Future." It's creator, Dr. James Levine is quick to
correct them. "This is a fully functioning office. My entire staff works
here," he explains as he walks on a moving treadmill that serves as both
desk and computer platform. "The idea is to introduce an environment
that will encourage activity in the workplace. Just as it's hard to be a
couch potato without a couch, it's hard to sit all day at work without a
chair or a conventional desk or cubicle."

"We have meeting rooms, but for small groups we prefer the track," says
Levine. He's referring to a two-lane walking track that circles most of
the 5,000-square-foot floor. "So when my colleagues and I 'take a
meeting' we also take a walk."

This scientifically designed office environment is the practical
realization of a decade of research at Mayo Clinic. Levine, an
endocrinologist, has spent his career studying how humans expend energy.
His recent research findings (Science, Jan. 27, 2005) show that genomic
and biological differences impact how many calories a person burns
during everyday tasks. It proved the long-discussed concept of a "slow
metabolism" as a factor in obesity. It also showed that people can
increase their caloric "burn rates" by integrating more movement into
their daily regime. Dr. Levine calls this process "non-exercise activity
thermogenesis" (NEAT).

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http://howto.wired.com/wiki/Lose_Weight_While_You_Work

2008 Compendium of Evidence-Based HIV Prevention Interventions

The evidence-based interventions, listed in this 2008 Compendium, have been identified by PRS through a series of efficacy reviews. These interventions represent the strongest HIV behavioral interventions in the literature to date that have been rigorously evaluated and have demonstrated efficacy in reducing HIV or STD incidence or HIV-related risk behaviors or promoting safer behaviors.

http://www.cdc.gov/hiv/topics/research/prs/evidence-based-interventions.htm

Anger really can kill you, U.S. study shows | Reuters

Anger and other strong emotions can trigger potentially deadly heart rhythms in certain vulnerable people, U.S. researchers said on Monday.

Previous studies have shown that earthquakes, war or even the loss of a World Cup Soccer match can increase rates of death from sudden cardiac arrest, in which the heart stops circulating blood.

"It's definitely been shown in all different ways that when you put a whole population under a stressor that sudden death will increase," said Dr. Rachel Lampert of Yale University in New Haven, Connecticut, whose study appears in the Journal of the American College of Cardiology.

"Our study starts to look at how does this really affect the electrical system of the heart," Lampert said.

She and colleagues studied 62 patients with heart disease and implantable heart defibrillators or ICDs that can detect dangerous heart rhythms or arrhythmias and deliver an electrical shock to restore a normal heart beat.

"These were people we know already had some vulnerability to arrhythmia," Lampert said in a telephone interview.

Patients in the study took part in an exercise in which they recounted a recent angry episode while Lampert's team did a test called T-Wave Alternans that measures electrical instability in the heart.

Lampert said the team specifically asked questions to get people to relive the angry episode. "We found in the lab setting that yes, anger did increase this electrical instability in these patients," she said.

Next, they followed patients for three years to see which patients later had a cardiac arrest and needed a shock from their implantable defibrillator.

"The people who had the highest anger-induced electrical instability were 10 times more likely than everyone else to have an arrhythmia in follow-up," she said.

Lampert said the study suggests that anger can be deadly, at least for people who are already vulnerable to this type of electrical disturbance in the heart.

"It says yes, anger really does impact the heart's electrical system in very specific ways that can lead to sudden death," she said.

But she cautioned against extrapolating the results to people with normal hearts. "How anger and stress may impact people whose hearts are normal is likely very different from how it may impact the heart which has structural abnormalities," she said.

Lampert is now conducting a study to see if anger management classes can help decrease the risk of arrhythmia in this group of at-risk patients.

Sudden cardiac death accounts for more than 400,000 deaths each year in the United States, according to the American College of Cardiology.

http://www.reuters.com/article/latestCrisis/idUSN23265425

Diagnosis - Feverish Times - NYTimes.com

"O.K., I'm glad it's not lupus," the middle-aged man said with a sad, rueful smile. He turned to look at the medical student who brought him the news of yet one more disease that it turned out he didn't have. For months now, he had a high fever off and on and low blood counts. His liver wasn't working well; he felt weaker every day, and yet none of his doctors could figure out why. Upendra Maddineni, a third-year medical student doing a rotation at the Memorial Sloan-Kettering hospital in New York, had the unenviable task of bringing the patient the near-daily reports of unrevealing test results. "I'm sure we'll find something soon," the student added, his voice fading to nearly a whisper.

The patient, who is 39, was healthy until a year earlier, when lymphoma, a cancer of the immune system, was diagnosed. But he received dose after dose of chemotherapy, and finally, six months later, his doctor told him that he was in remission. The cancer was gone. Indeed, when the fever first hit, he was packing for a weeklong "mission accomplished" vacation in Florida with his wife and 3-year-old daughter. Now it was unclear whether they would ever take that trip.

The fever frightened him. Why wasn't he healthy now that the cancer was gone? It worried the doctors as well. He spent almost a week in a hospital near his home in Pittsburgh, as his doctors looked for an infection they could not find. What they found instead were abnormally low levels of white blood cells and red blood cells. Was this because of the chemotherapy? Had his cancer made a comeback? Or was this something else? No one knew.

After several days of intravenous antibiotics, the fever resolved, and his cell counts seemed to be coming up, so he went home — relieved but without a diagnosis. Over the next two months, he was in the hospital four times. Each episode was the same — the fever, the low red- and white-blood-cell counts, the unrevealing work-up, the intravenous antibiotics. The last time the blood counts never rose, and he just stayed. After two more weeks, his doctors suggested he transfer to Sloan-Kettering. They worried that these fevers and low blood counts could represent a recurrence of his cancer.

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http://www.nytimes.com/2009/02/22/magazine/22wwln-diagnosis-t.html?ref=magazine&pagewanted=all

What's Wrong With Summer Stiers? - The Medical Detectives - NYTimes.com

Her breasts are beautiful. This is a surprise. Seeing them looking so healthy and normal reminds you how young this patient is and what her life might be like if her body hadn't started to disintegrate in her childhood. If all you could see were her breasts, you would think she were perfectly fine. But that would be like the blind men trying to describe the elephant when each one focuses on a single part. Look at the rest of this patient's torso, and you start to get a sense of the fuller story. A little bit higher, near the left clavicle, you notice a bump beneath the skin marking the implantation site of her vagus-nerve stimulator, which delivers an electrical impulse to her brain every three minutes to stave off the seizures that would otherwise plague her. A little lower, on the right-hand side of her abdomen, you see a hole and a permanently implanted tube through which she has hooked herself up to peritoneal-dialysis equipment every night for the past five years, to flush out the toxins that her ruined kidneys cannot.

The metaphor of the blind men and the elephant applies not only to the landscape of this woman's body but also to the approach of just about every specialist who has seen her in the 20-plus years that she has suffered from her mystery disease. The limitation of this method is what took this patient — a petite, feisty, 31-year-old woman from Oregon named Summer Stiers — to this consultation room at the National Institutes of Health on a Thursday in early December, stripped down to her panties. Stiers was being examined by a dermatologist, Maria Turner, who is among the dozen or so specialists who would see her before the week was out. And even though Turner and the others are part of the innovative new Undiagnosed Diseases Program at the N.I.H., and even though they collectively represent the very best that American medicine has to offer, they still began by approaching the big picture of Summer Stiers the way most specialists do: like the blind men, one piece at a time.

The Undiagnosed Diseases Program was designed to move past that halting first step — the inevitable result of the organ-by-organ orientation of most medical specialties — to achieve a more coherent view. Under the direction of William Gahl, a longtime N.I.H. investigator who is also the clinical director of the National Human Genome Research Institute, the program brings together scientists from most of the N.I.H.'s 27 research institutes and centers on a collegelike campus in Bethesda, Md. Organizationally, it creates a kind of superdiagnostician, whose orientation would be to look at not just one piece at a time but at the whole darn elephant.

The program's methodology is still evolving, but for the first dozen or so patients it worked this way: A primary-care physician sent in a letter describing the case, followed by reams of records documenting the diagnostic dead ends the patient had already confronted. Gahl personally reviewed all the cases and discarded about three-quarters of them, usually because the problem was insufficiently documented, seemed to be psychosomatic or, for some other reason, left Gahl with the impression that the N.I.H. had little new to offer. Then he took the most promising cases to his medical-review board, made up of several dozen clinical investigators from all over the N.I.H. The board reviewed 10 or so cases at each monthly meeting, out of which it accepted just a handful, the ones that seemed most likely to lead to a new insight into a known disease, or, even better, to a diagnosis of a disease never before seen. Then Gahl's staff arranged to bring in each patient for a week of assessment in Bethesda. There, the patient would meet an array of specialists who did physical exams, took histories and conducted whatever additional tests they needed: ultrasound scans, M.R.I. scans, X-rays, electroencephalograms, maybe a spinal tap or a biopsy of skin or other tissue.

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