Tom Faranda's Folly

Remember, IRS will be responsible for healthcare law implementation

HA! And who's going to be running the department?

From ABC News -

The Internal Revenue Service official in charge of the tax-exempt organizations at the time when the unit targeted tea party groups now runs the IRS office responsible for the health care legislation.

Angelina Jolie on her double mastectomy: "My Medical Choice"

An op ed this morning in the NY Times. Well worth reading in it's entirety. 

My Medical Choice

MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.

We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.

My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.

Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.

Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.

Jolie then goes into some detail about the procedures, and finishes with this -

I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.

Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.

I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.

Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.

Health Update

It's great that I so rarely feel the need to post about my health, considering this weblog was originally begun to let people know how I was doing with my lymphoma treatment.

Had my six month lymphoma check-up last week - sort off. I had a CAT scan a couple of weeks earlier, but when I went to Sloan Kettering to meet with Dr. Zelenetz, they were so backed up that after waiting over ninety minutes past appointment time - and with no real end in sight - I left.

He called me later in the day and we went over everything on the phone, which was good enough.

I'm fine - oh and have lost close to 12 lbs in the past 15 weeks. Another seven or so to go. This app is very good My Fitness Pal !

The new gene therapy for leukemia - very promising

This idea of turning on the person's own immune system to fight cancer has been considered the gold standard/promised land for cancer researchers.

The pretty much accepted theory today is that cancer is a failure of the immune system; we have abnormal cells in our body that are cleaned up by the immune system, but with cancer something happens to switch off the system, or the cancer cells are masked from being recognized by our system.

A treatment that genetically alters a patient’s own immune cells to fight cancer has, for the first time, produced remissions in adults with an acute leukemia that is usually lethal, researchers are reporting.

Eight days later, his leukemia was gone. Even the doctors were shocked, Dr. Brentjens said. They repeated the lab tests just to make sure there was no mistake.

Once he was in remission, Mr. Aponte had a bone-marrow transplant, as did three of the other patients in the study. Another had medical problems that made a transplant impossible, and it was he who relapsed and died. The researchers think he may have relapsed because the steroids he needed to treat the cytokine storm may have wiped out the T-cells before they could do their job.

For the other patients, it is not known whether the transplants were really needed; in theory, the T-cells alone might have produced a long-term remission or even a cure. Patients treated at the University of Pennsylvania were not given transplants, and most have stayed in remission. But the technique used there involves a different viral vector and different genetic programming from the one at Sloan-Kettering.

In any case, Dr. Brentjens said, the T-cells are still experimental, whereas transplants are the standard of care in acute leukemia because they have been shown to give many patients the best odds of survival. So the transplants were done for ethical reasons. The study is continuing, and as more patients are treated, answers may emerge as to whether the T-cells alone will be enough for some patients.

Theoretically ?? it should be possible to learn how to turn on the immuned system for other types of cancers.

No kidding - quality healthcare via your smartphone!?

This NBC feature was sent to me by my friend Ellen.

Really hard to believe - and quite amazing to me.

Visit NBCNews.com for breaking news, world news, and news about the economy

An important study on overian cancer treatment

An excellent article in the NY Times. Really very important, since most ovarian cancer is not caught early. Well worth reading the entire piece.

The conclusion: go to a major cancer center for ovarian tumors.

"Widespread Flaws Found in Ovarian Cancer Treatment"

“If we could just make sure that women get to the people who are trained to take care of them, the impact would be much greater than that of any new chemotherapy drug or biological agent,” said Dr. Robert E. Bristow, the director of gynecologic oncology at the University of California, Irvine, and lead author of the new study presented on Monday at a meeting of the Society of Gynecologic Oncology in Los Angeles.

The study found that only a little more than a third of patients received the best possible care, confirming a troubling pattern that other studies have also documented.

******

What works best is meticulous, extensive surgery and aggressive chemotherapy. Ovarian cancer spreads inside the abdomen, and studies have shown that survival improves if women have surgery called debulking, to remove all visible traces of the disease. Taking out as much cancer as possible gives the drugs a better chance of killing whatever is left. The surgery may involve removing the spleen, parts of the intestine, stomach and other organs, as well as the reproductive system.

The operations should be done by gynecologic oncologists, said Dr. Deborah Armstrong of Johns Hopkins University, who is not a surgeon. But many women, she said, are operated on by general surgeons and gynecologists.

And there's more - hit the link above.

Good article on knee pain/arthritis

From the always good NY Times health and fitness section.

I had my left knee 'scoped over seven years ago (deteriorating meniscus needed to be cut back, so I lost about 60% of the knee cushioning on the inner aspect) and yes it bothers me. Sometimes quite a bit. Several months ago I stopped walking on the treadmill (used to go 4 - 4.5 mph) and now just use the ellyptical machine (and occasionally the concept 2 rower) in the gym That has helped.

Unfortunately, knee osteoarthritis, a condition characterized by a slow, steady loss of the knee’s cushioning cartilage, is progressive and, at the moment, incurable, says Dr. Michael Parks, an orthopedic surgeon at the Hospital for Special Surgery in New York City, who specializes in knee replacements.

But there are ways to slow the progression. “The most important,” he says, “is activity modification.” While long-distance running, for instance, doesn’t seem to directly cause arthritis in most people’s knees, it may speed the condition once it starts, Dr. Parks says. “It’s best, once you have a diagnosis of knee arthritis, to limit repetitive impacts on the joint,” he says. So switch from running to cycling or low-impact elliptical training. Swimming is also good, he says, although the breaststroke, with its whippy frog kick, may stress the knee and should be avoided. “Water aerobics are also very good, especially for people who are older or overweight,” Dr. Parks says. “The buoyancy of the water unloads the knee.”

The whole article is good, and only totals seven paragraphs.

Seventh anniversary of my autologous stem cell transplant

When I had all that chemotherapy seven plus years ago, my lymphoma guru, Dr. Zelenetz said that mantle cell lymphoma 100% recurs within ten years. Then about three + years ago, when I asked him about it, he said "well we just wrote a paper saying that the treatment you had may in certain patients and situations be curative." Or words to that effect.

So ... who knows? I'm thankful I've been around for the seven years, for my family.

Here's what I posted last year (arrogant to quote myself, but... saves time)

Yup. Great health professionals, chemotherapy and prayer.

Here's what I posted last year on the fifth anniversary.

I could never quite figure why having your stem cells returned to you constituted a transplant, but that's what they call it.

Anyway, the idea is to re-build your immune system, after the high dose chemo has (hopefully) killed off the remaining lingering cancer cells. The side effect is that the chemo gives your immune system a drubbing, and hence the need for the stem cells - and they know what to do - isn't nature wonderful! - to rebuild.

Here's five years ago at Sloan Kettering. The precedure is very simple - like receiving a blood transfusion. I dozed off afterwards for a couple of hours, and Brigid said she enjoyed the peace and quiet ... What was she getting at?

Here - http://tomfaranda.typepad.com/folly/2006/01/transplant_went.html#tp

or here - Transplant went well

 

NY City to tie physicians pay to performance; but how do you measure it?

Hmmm. And then there's this really bad idea. Bloomberg with another unnecessary, idiotic rule - restricting availability of painkillers

From Saturday's NY Times.

In a bold experiment in performance pay, complaints from patients at New York City’s public hospitals and other measures of their care — like how long before they are discharged and how they fare afterward — will be reflected in doctors’ paychecks under a plan being negotiated by the physicians and their hospitals.

In the wake of changes laid out in the Affordable Care Act, public and private hospitals are already preparing to have their income tied partly to patient outcomes and cost containment, but the city’s plan extends that financial incentive to the front line, the doctors directly responsible for treatment. It also shows how the new law could change longstanding relationships, giving more power to some of the poorest and most vulnerable patients over doctors who run their care.

“I would expect that we’re going to see this become more and more prevalent in compensation arrangements,” said Alan Aviles, president of the city’s Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, handling more than 1 million emergency room visits a year.

The corporation’s plan would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea.

Still, doctors are hesitant, saying they could be penalized for conditions they cannot control, including how clean the hospital floors are, the attentiveness of nurses and the availability of beds.

And it is unclear whether performance incentives work in the medical world; studies of similar programs in other countries indicate that doctors learn to manipulate the system.

“The consequences in a complex system like a hospital for giving an incentive for one little piece of behavior are virtually impossible to foresee,” said Dr. David U. Himmelstein, professor of public health at the City University of New York and a visiting professor at Harvard Medical School, who has reviewed the literature on performance incentives. “There are ways of gaming it without even outright lying that distort the meaning of the measure.”

Over the next few years, the federal government will financially reward or penalize hospitals based on how they perform on benchmarks that are believed to be correlated with better patient outcomes. By aligning doctors’ pay to the same benchmarks, city hospitals hope to perform well enough to qualify for federal bonuses.

There's a bit more; hit the link.

Miss USA candidate will have prophylactic breast surgery because of family history

A very interesting short interview. I believe this is being done by women with family breast cancer histories more and more frequently.

 

Bloomberg with another unnecessary, idiotic rule - restricting availability of painkillers

Dr. Michael Bloomberg? What an arrogant guy.

New York City to Restrict Prescription Painkillers in Public Hospitals’ Emergency Rooms

“Abuse of prescription painkillers in our city has increased alarmingly,” Mr. Bloomberg said in announcing the new policy at Elmhurst Hospital Center, a public hospital in Queens.

******

But some critics said that poor and uninsured patients sometimes used the emergency room as their primary source of medical care. The restrictions, they said, could deprive doctors in the public hospital system — whose mission it is to treat poor people — of the flexibility that they need to respond to patients.

“Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians and senior vice chairman of emergency medicine at Lehigh Valley Health Network in Eastern Pennsylvania. “It prevents me from being a professional and using my judgment.”

While someone could fake a toothache to get painkillers, he said, another patient might have legitimate pain and not be able to get an appointment at a dental clinic for days. Or, he said, a patient with a hand injury may need more than three days of pain relief until the swelling goes down and an operation could be scheduled.

Of course. But Bloomberg is smarter than all the doctors in New York the world, combined.

 

Good NYT Wellness column; less can be more

The Gretchen Reynolds column in the health/science section of the NY Times is almost always worthwhile.

Here she sums up her last year's columns.

The past year in fitness has been alternately inspiring, vexing and diverting, as my revisiting of all of the Phys Ed columns published in 2012 makes clear. Taken as a whole, the latest exercise-related science tells us that the right types and amounts of exercise will almost certainly lengthen your life, strengthen your brain, affect your waistline and even clear debris from inside your body’s cells. But too much exercise, other 2012 science intimates, might have undesirable effects on your heart, while popping painkillers, donning stilettos and sitting and reading this column likewise have their costs.

        Similarly, in a study from Denmark that I wrote about in September, a group of pudgy young men         lost more weight after 13 weeks of exercising moderately for about 30 minutes several times a         week than a separate group who worked out twice as much.

“These data certainly support the idea that more running is not needed to produce extra health and mortality benefits,” Dr. Carl J. Lavie, a cardiologist in New Orleans and co-author of the study told me. “If anything,” he said, “it appears that less running is associated with the best protection from mortality risk.”

Similarly, in a study from Denmark that I wrote about in September, a group of pudgy young men lost more weight after 13 weeks of exercising moderately for about 30 minutes several times a week than a separate group who worked out twice as much.

The men who exercised the most, the study authors discovered, also subsequently ate more than the moderate exercisers.

Even more striking, however, the vigorous exercisers subsequently sat around more each day than did the men who had exercised less, motion sensors worn by all of the volunteers showed.

“They were fatigued,” said Mads Rosenkilde, a Ph.D. candidate at the University of Copenhagen and the study’s co-author.

******

But the inverse of that finding proved to be equally true: not fitting periods of activity into a person’s daily life also affected life span. Perhaps the most chilling sentence that I wrote all year reported that, according to a large study of Western adults, “Every single hour of television watched after the age of 25 reduces the viewer’s life expectancy by 21.8 minutes.”

I am watching much less television these days.

But not all of the new fitness science I covered this year was quite so sobering or, to be honest, consequential. Some of the more practical studies simply validated common sense, including reports that to succeed in ball sports, keep your eye on the ball; during hot-weather exercise, pour cold water over your head; and, finally, on the day before a marathon, eat a lot.

But when I think about the science that has most affected how I plan my life, I return again and again to those studies showing that physical activity alters how long and how well we live. My days of heedless youth are behind me. So I won’t soon forget the study I wrote about in September detailing how moderate, frequent physical activity in midlife can delay the onset of illness and frailty in old age. Exercise won’t prevent you from aging, of course. Only death does that. But this study and others from this year underscore that staying active, even in moderate doses, dramatically improves how your aging body feels and responds.

Exercise and your brain

From the best section of the NY Times, the health and fitness section.

Anyone whose resolve to exercise in 2013 is a bit shaky might want to consider an emerging scientific view of human evolution. It suggests that we are clever today in part because a million years ago, we could outrun and outwalk most other mammals over long distances. Our brains were shaped and sharpened by movement, the idea goes, and we continue to require regular physical activity in order for our brains to function optimally.

The role of physical endurance in shaping humankind has intrigued anthropologists and gripped the popular imagination for some time. In 2004, the evolutionary biologists Daniel E. Lieberman of Harvard and Dennis M. Bramble of the University of Utah published a seminal article in the journal Nature titled “Endurance Running and the Evolution of Homo,” in which they posited that our bipedal ancestors survived by becoming endurance athletes, able to bring down swifter prey through sheer doggedness, jogging and plodding along behind them until the animals dropped.

******

The broad point of this new notion is that if physical activity helped to mold the structure of our brains, then it most likely remains essential to brain health today, says John D. Polk, an associate professor of anthropology at the University of Illinois at Urbana-Champaign, and co-author, with Dr. Raichlen, of the new article.

And there is scientific support for that idea. Recent studies have shown, he says, that “regular exercise, even walking,” leads to more robust mental abilities, “beginning in childhood and continuing into old age.”

Of course, the hypothesis that jogging after prey helped to drive human brain evolution is just a hypothesis, Dr. Raichlen says, and almost unprovable.

        But it is compelling, says Harvard’s Dr. Lieberman, who has worked with the authors of the new         article. “I fundamentally agree that there is a deep evolutionary basis for the relationship between         a healthy body and a healthy mind,”

Ibuprofen and it's use by athletes

Ibuprofen (advil, motrin, nuprin) is quite commonly used by athletes (and former ones like moi) as a pain reliever and anti-inflammatory - frequently prophylactically before a workout.

But, according to this research, not helpful and perhaps harmful.

From the always worthwhile health and fitness section of the NY Times.

“The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder,” Dr. Nieman said. “But that belief is simply not true. There is no scientifically valid reason to use ibuprofen before exercise and many reasons to avoid it.”

Dr. van Wijck agrees. “We do not yet know what the long-term consequences are” of regularly mixing exercise and ibuprofen, she said. But it is clear that “ibuprofen consumption by athletes is not harmless and should be strongly discouraged.”

I report, you decide.

 

Health Update

Had my six month check-up/exam at Sloan Kettering with Dr. Zelenetz.

Boring ...

Which is good! We don't need any health excitement.

Everything looked fine. I was told when I started my chemo that it would treat the lymphoma but not eradicate. It. That within ten years there's 100% recurrence.

Well, I started my chemo in September, '05 - seven years ago.

And for the last couple of years, they've been hedging - maybe it won't come back.

We'll see.

 

Breast cancer in Britain - fourfold increase by 2040

This is from the Telegraph (UK). A revealing brief interview. The oncologist speaking says that "We know that the UK is not as good as other countries in managing older people with breast cancer."

Why might that be? Here's an older posting of mine which reveals that if you have virtually ANY cancer Cancer, politics, and pundits, you get better treatment in the USA then virtually anywhere else.

 

Major breast cancer study should produce future effective therapies

Of course it may be several years in the future before the results of the study provide practical benefits. But this still seems to be a big deal.

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers.

These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.

The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.

“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study.

Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.

Another cancer screening test gets thumbs down

To go along with past studies showing no benefits for PSA tests (prostate CA) and mammograms (very controversial).

“There is no existing method of screening for ovarian cancer that is effective in reducing deaths,” said Dr. Virginia A. Moyer, the chairwoman of the expert panel, the United States Preventive Services Task Force. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery

        The advice against testing applies only to healthy women with an average risk of ovarian cancer,         not to those with suspicious symptoms or those at high risk because they carry certain genetic         mutations or have a family history of the disease.

The recommendations are just the latest in a series of challenges to cancer screenings issued by the panel, which has also rejected P.S.A. screening for prostate cancer in men and routine mammograms in women under 50. The task force is a group of 16 experts, appointed by the government but independent, that makes recommendations about screening tests and other efforts to prevent disease. Its advice is based on medical evidence, not cost.

Comprehensive study on CPR in hospitals

The study indicates that there are benefits to prolonging/not giving up on resuscitation efforts.

When a hospital patient goes into cardiac arrest, one of the most difficult questions facing the medical team is how long to continue cardiopulmonary resuscitation. Now a new study involving hundreds of hospitals suggests that many doctors may be giving up too soon.

The study found that patients have a better chance of surviving in
hospitals that persist with CPR for just nine minutes longer, on
average, than hospitals where efforts are halted earlier.       

There are no clear, evidence-based guidelines for how long to continue CPR efforts.       

The findings challenge conventional medical thinking, which holds that
prolonged resuscitation for hospitalized patients is usually futile
because when patients do survive, they often suffer permanent
neurological damage. To the contrary, the researchers found that
patients who survived prolonged CPR and left the hospital fared as well
as those who were quickly resuscitated.    

    The study, published online Tuesday in The Lancet,
is one of the largest of its kind and one of the first to link the
duration of CPR efforts with survival rates. It should prompt hospitals
to review their practices and consider changes if their resuscitation
efforts fall short, several experts said. 

Hit the link for the whole article.      

 

 

Study: Marriage causes women to drink more than men

The results of a new study indicate that marriage can cause women to drink more, and men to drink less.

The study found that, while men drank more during divorce, women upped their alcohol intake while wed.

******

“We find that unmarried and divorced women actually drink less than their continuously married counterparts,” Reczek was quoted as saying. “For men, those who were recently divorced have the highest number of drinks and men who are married have the lower number.”

jus like my house!

Treadmill stress tests on the way out?

Maybe, or at least used less often. From the always worthwhile NY Times health and wellness section.

The usefulness of the stress test has been questioned for some time, and in April, a group of nine medical specialty boards included it on its list of 45 common tests and procedures that doctors should perform less often. Their reasoning, like that of the task force, was that problems associated with the test can outweigh its benefit in many people, perhaps even leading to unnecessary harm.

Further proof there is a God: having dessert with breakfast HELPS when dieting

Magic! From the Daily Mail (UK)

Although both diets had the same number of daily calories - about 1,600 for men and 1,400 for women - one included a large breakfast with a sweet treat such as a doughnut while the other allowed for a larger meal later in the day.

They found that halfway through the eight-month study,
participants in both groups lost an average of 33 pounds per person.

However, in the last four months of the study, the small-breakfast group regained an average of 22 pounds while the participants who ate the dessert with breakfast went on to lose another 15 pounds each.

Lead author Dr Daniel Jakubowicz, said: 'The goal of a weight loss diet should
be not only weight reduction but also reduction of hunger and cravings,
thus helping prevent weight regain.'

The study subjects who ate the dessert with breakfast diet reported feeling less hunger and fewer cravings compared with the other group.

Subjects' food diaries showed that the dessert with breakfast group had better compliance in sticking to their calorie requirements.

Marathon running and heart attacks

Too quote this NY Times fitness article:

"The science suggests that, over all, distance running and racing are extremely unlikely to kill you — except when, in rare instances, they do."

It's a pretty good short piece.

 

 

 

 

Obesity #'s rising

From USA Today. Of course this adds to the nation's health costs.

The new projection, released here Monday, warns that 42% of Americans may end up obese by 2030, and 11% could be severely obese, adding billions of dollars to health care costs.

"If nothing is done (about obesity), it's going to hinder efforts for health care cost containment," says Justin Trogdon, a research economist with RTI International, a non-profit research organization in North Carolina's Research Triangle Park.

• MORE: BMI calculator

As of 2010, about 36% of adults were obese, which is roughly 30 pounds over a healthy weight, and 6% were severely obese, which is 100 or more pounds over a healthy weight.

An organ donor story - a tragedy

A very sobering story from CNN. Well worth the read.

As Lorraine sat in the waiting room with Susie that May morning two years ago, she prayed her husband's liver lobe would cure her brother-in-law. She prayed for her husband, too, but she was less worried about him, since she says the surgeons had reassured them while liver donation wasn't without risks, it was safe for Paul, a 56-year-old man in good health.

Neither of Lorraine's prayers came true. Tim died less than a year later, after receiving the transplanted part of Paul's liver. He was 58. Her husband died that very day on the operating room table.

******

"I want everyone to know what a generous, wonderful man Paul was. When he found out Tim needed a liver, he didn't hesitate to say yes," said Lorraine, a school bus aide for children with special needs in Tampa, Florida. "They weren't blood relatives, but they were a perfect match, and he felt privileged that God was going to let him help Tim regain his health."

A story where you really wonder, how could this happen?

Aspirin as a cancer preventative

Only PBS could turn what ought to be a fascinating discussion into something a bit tedious, but they do. They also have the sound out of sync with the video (I don't even know how you can do that anymore).

Nevertheless, worth hearing/watching -

 

Low I.Q. as a predictor of heart disease

A study from Britain, and they are very smart in Britain ...

In a new study, a low I.Q. score was a stronger predictor of heart disease than most traditional risk factors, second only to smoking. The study tracked 1,145 men and women in Scotland over 20 years, documenting I.Q., weight, education and income as well as traditional heart risk factors like obesity, high blood pressure and smoking.

Low physical activity doubled the risk for heart attack, whereas risk was about three times higher for people with high blood pressure or low income.

However, low I.Q. was a much stronger predictor than these traditional risk factors. People with lower I.Q.’s had four times higher risk of heart disease. By comparison, smokers were nearly six times more likely to have heart problems ...

******

Why would low I.Q. predict heart risk? Researchers pose a number of theories. It may be that some of the factors in early life that lead to low I.Q. may also lead to poorer heart health.

Daily aspirin as heart attack preventative not necessarily a good idea

In the NYT health section.

Over all, for every 162 people who took aspirin, the drug prevented one nonfatal heart attack, but caused about two serious bleeding episodes.

So would you rather bleed gastrointestinally, or have a heart attack? hit the link for more info.

Sixth anniversary of my stem cell transplant

Yup. Great health professionals, chemotherapy and prayer.

Here's what I posted last year on the fifth anniversary.

I could never quite figure why having your stem cells returned to you constituted a transplant, but that's what they call it.

Anyway, the idea is to re-build your immune system, after the high dose chemo has (hopefully) killed off the remaining lingering cancer cells. The side effect is that the chemo gives your immune system a drubbing, and hence the need for the stem cells - and they know what to do - isn't nature wonderful! - to rebuild.

Here's five years ago at Sloan Kettering. The precedure is very simple - like receiving a blood transfusion. I dozed off afterwards for a couple of hours, and Brigid said she enjoyed the peace and quiet ... What was she getting at?

Here - http://tomfaranda.typepad.com/folly/2006/01/transplant_went.html#tp

or here - Transplant went well

For heart health - interval training is as effective as endurance work

This is a several years old article I came across in the NYT health section -

... the researchers found that the intense sprint interval training improved the structure and function of arteries as much as traditional, longer endurance exercise.

But, the study was of a small group with an average age of 23, so maybe irrelevant to the rest of us?

Another study that says prostate cancer screening (the PSA test) doesn't save lives

And of course the study is controversial.

If you have a prostate, or know someone who does, this is worth the < five minutes it takes to read.

The P.S.A. test, often given to men starting at age 50, detects a protein called prostate-specific antigen and can identify the presence of cancerous cells in the prostate. Although about 12 percent more cancers were found among men in the screening group, the risk of dying of prostate cancer in the study was about the same for each group, whether the cancer was detected through screening or because a man developed symptoms. The findings suggest that the type of cancer typically detected by screening is so slow-growing that it often is unlikely to cause harm before the man dies of another cause.

“Despite additional follow-up, there is no demonstrable mortality benefit for the men who had P.S.A. testing compared to the usual care group,’’ said Dr. Gerald L. Andriole, the lead author and chief of urology at Washington University School of Medicine in St. Louis.

BUT -

Even so, the findings are unlikely to resolve the debate around P.S.A. testing. Many doctors argue that the trial was seriously flawed because about half the men in the non-screening group ended up getting one or more P.S.A. tests during the trial period, making it difficult to determine the real effect of screening.

After the study was finished, additional analysis also raised questions about whether certain younger, healthy men might benefit from P.S.A. testing. Although only about 300 men out of the 77,000 studied ended up dying of prostate cancer, the test appeared to have saved a few extra lives among younger men who didn’t have other health problems like diabetes or high blood pressure.

Wall Street Journal: Great editorial on cancer rates, research, & paying for it

Typical WSJ editorial as they get to the heart of things -

... the five-year survival rate, the share of all patients who are still alive a half-decade after their diagnosis. That measure has climbed to about 68% for all cancers from 45% in 1975, according to the National Cancer Institute. Another way of putting it is that two-thirds of patients can live many productive years with a chronic condition and in many cases even be cured.

Progress is particularly evident against the four most common cancers: For prostate cancer, the five-year survival rate has surged to 99.9% today from 67% in the 1970s. Survival rates have been rising for breast cancer since 1983 and for colorectal cancer since 1975. Even for lung cancer—the No. 1 cancer killer—the survival rate has been rising since 1988, though it is still less than 20%.

If the pace of anticancer progress has been remarkable in some areas, more modest in others, that's because Nixon's formulation had it wrong. This is a war against cancers.

Today we have a far more sophisticated and profound understanding of the biology of cancers, to the point where they are less medically defined by the location in the body where they happen to begin. There is no such thing as "lung cancer," but rather a constellation of different cancers with diverse biologies and behaviors. Treatment is now guided by cancer "panomics," the individual combination of genes, proteins and molecular pathways that drive the uncontrolled growth of malignant cells.

******

One problem is that the next generation of anticancer medicines is being delayed by a regulatory system that is far too rigid and controlling. A 2010 Institute of Medicine report noted that the traditional Food and Drug Administration clinical trials system, which was designed in the 1950s and has barely changed, is too slow, complex and inefficient. For progress to continue it needs to be modernized—most of all with so-called adaptive trial design.

That model evolves as a trial proceeds to incorporate new knowledge and recognizes that often only narrow patient subgroups will have a specific molecular defect and thus respond. But the FDA rejects such methods as insufficiently pure and its institutional culture continues to adhere to only a few crabbed measures of the value of a new treatment.

******

One of the great ironies of the post-1971 cancer era is that the failure to reform Medicare and Medicaid is devouring the money available for the basic medical and scientific research that is a proper role for government. The cancer revolution will continue if government allows it.

Your resting heart rate as a biomarker

Turns out, the key is not so much what your resting heart rate is; rather whetehr it's been rising over the years, and by how much.

From the always-useful NY Times health section

A large study has found that a rise in resting heart rate over a decade may indicate an increased risk of death from coronary artery disease.

Compared with those whose heart rates remained stable at 70 beats per minute or less, those whose rates increased to 85 or more were almost twice as likely to die of heart disease. For those with resting rates between 70 and 85 beats per minute at the first test, an increase to greater than 85 was associated with an 80 percent increase in death rate.

There was no direct decrease in heart disease risk with decreasing resting heart rate, but among the 7,000 people whose heart rates had decreased from between 70 and 85 to below 70 beats a minute, risk for death from any cause was reduced by 40 percent.

Here's the original article from the Journal of the American Medical Association -

Temporal Changes in Resting Heart Rate and Deaths From Ischemic Heart Disease

 

 

More on exercise and aging

Just posted this a couple of days ago. Good news for older runners - and people doing most any cardiovascular exercise

Now here's a video from CBS - they do not allow embedding of their youtube vids. 

"Living Proof that Exercise Works"

Good news for older runners - and people doing most any cardiovascular exercise

The New York Times Fitness and Health sections are the best parts of the newspaper.

For Older Runners, Good News and Bad

... goal was to assess running economy, a measure of how much oxygen someone uses to run at a certain pace. Economical runners can continue at a given speed longer than inefficient striders, outdistancing them.

Going into the study, the researchers had assumed that runners past age 60 would be less economical than youthful athletes, since older runners, as a group, are slower than younger ones. But as it turned out, when scientists fitted the volunteers with masks that measured their oxygen use as they ran on a treadmill and then compared the results by age group, the runners 60 and older were just as physiologically economical as younger runners, even those in their 20s and 30s.

So ... why do we slow down as we age?

Dr. Quinn’s group, too, found that some physiological parameters did worsen with age. Older runners scored poorly on tests of upper-body strength and lower-body flexibility, both of which can affect the ability to compete.

“You need upper-body strength to pump your arms and generate power and velocity, especially on hills,” Dr. Quinn said. Similarly, flexible tendons and muscles in the lower leg allow full, easy strides. “We didn’t measure step length,” he said, “but my guess is that it was shorter” among the runners who were 60 or older. With tighter tissues, older runners are constrained to choppy strides and, in general, a slower pace.

The entire not-very-long article is worth reading.

England news headline: "Shortage of family doctors leaves healthcare in crisis"

Yeah, the great national health service. I have friends living by the myth that the British health system (single payor, socialist nirvana) is superior to ours (Of course, they live here, and not in Britain).

For all our problems, that's total nonsense.

From the UK Telegraph:

The NHS is facing a chronic shortage of family doctors after official figures showed some GPs were responsible for 9,000 patients.

Dr Michael Dixon, chairman of the NHS Alliance, which represents the UK’s primary care trusts, said it was a question of whether doctors were “able to cater as well for each patient with a list once they get much over 2,000 or 3,000”.

There are similar problems in the US; too many specialists, not enough internists, pediatricians, etc. But nothing like this.

Think it doesn't matter? Here's a posting I put up way back in September, 2007 from a feature in the Wall Street Journal -

Cancer outcomes in the U.S.A vs. the U.K. - and other countries

Last month, the largest ever international survey of cancer survival rates showed that in the U.S., women have a 63% chance of living at least five years after diagnosis, and men have a 66% chance -- the highest survival rates in the world. These figures reflect the care available to all Americans, not just those with private health coverage. In Great Britain, which has had a government-run universal health-care system for half a century, the figures were 53% for women and 45% for men, near the bottom of the 23 countries surveyed.

A 2006 study in the journal Respiratory Medicine showed that lung cancer patients in the U.S. have the best chance of surviving five years -- about 16%. Patients in Austria and France fare almost as well, and patients in the United Kingdom do much worse with only 5% living five years. A report released in May from the Commonwealth Fund showed that women in the U.S. are more likely to get a PAP test every two years than women in Australia, Canada, New Zealand and the U.K., where health insurance is guaranteed by the government. In the U.S. 85% of women ages 25-64 have regular PAP smears, compared with 58% in the U.K.

The same is true for mammograms. In the U.S., 84% of women ages 50-64 get them regularly, a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63% of women in the U.K. The high rate of screening in the U.S. reflects access as well as educational efforts by the American Cancer Society and others.

And it goes on - hit the link above for more.

In moderation: Beer and martinis as good as wine for increasing longevity

Further proof there is a God!

Now an analysis in the January issue of The Journal of Studies on Alcohol and Drugs suggests that martinis and beer may be just as effective at extending life. Wine may have appeared to be better only because the people who choose it are generally healthier.

 

From the NY Times, by a physician: "When the Dr. Gets Sued"

Within months of completing my training, I received the call that every doctor dreads.

"You've been named in a malpractice lawsuit," said the hospital administrator on the other end of the line.

The family of a patient I had seen briefly a year before believed that a colleague's decision not to operate hastened her demise. Now their lawyers, combing through the medical records, believed that a single sentence in my note brought that doctor's decision into question. As a second or maybe even third opinion, I had written that the woman was a "possible candidate" for surgery.

The truth was that when I saw her she was a possible candidate, but only tenuously so. In fact, her health deteriorated so rapidly that by the time she finished seeing all the specialists and returned to her original surgeon, the chances of her surviving any treatment, no matter how heroic, were almost nil.

Though I knew all that, in the weeks after that telephone call I couldn't help questioning myself, going over the case in my mind as soon as I woke up, then again and again late into the night. I froze with fear every time I was asked for my opinion on a diagnosis or treatment plan and became a master at evasion, littering my assessments and write-ups with words like "maybe," "perhaps" and "will await further work-up." And I wondered if my colleagues knew, if the blot on my record had already soaked through the fabric of my professional reputation.

In the end, the family dropped the case; I never met with any lawyers or went to court. But memories of the all-encompassing threat of a claim came flooding back when I read a recent study of how litigation affects doctors.

Hit the link for the rest of the article.

FDA revokes use of Avastin for breast cancer

I've posted about this issue before, most recently here.  Breast cancer and the drug Avastin This article quotes a WSJ editorial.

And I think it's the wrong decision. Very wrong.

Your government at work.

From the Washington Post -

FDA says Avastin should no longer be used for breast cancer, citing no proof it extends life

If you are interested in this issue, I suggest not only reading the Washinton Post article, but the other  posting as well, and then folllow the links.

Aging and exercise

An encouraging article in the excellent NY Times health section. hit the link for the whole article - after all, it's your body. 

(FULL DISCLOSURE: I graduated from my fifties this past summer.)

Is physical frailty inevitable as we grow older? That question preoccupies scientists and the middle-aged, particularly when they become the same people.

... a growing body of newer science suggests that such decline may not be inexorable. Exercise, the thinking goes, and you might be able to rewrite the future for your muscles.

Then some interesting results of recent studies, and the final musings -

Other questions about the impacts of exercise on aging muscle also remain unanswered. “We don’t know what kinds of exercise are best,” Dr. Wright says and, in particular, whether endurance exercise is necessary for muscle sparing or whether weight training might be as good or better. Scientists also haven’t determined just how much activity is required to maintain muscle mass, or how intense it needs to be.

“What we can say with certainty is that any activity is better than none,” Dr. Wright says, “and more is probably better than less. But the bigger message is that it looks as if how we age can be under our control. Through exercise, you can preserve muscle mass and strength and avoid the decline from vitality to frailty.”

Embryonic stem cell research firm ends it's studies

Good.

As a person who benefitted tremendously from an autologous stem cell transplant (where I was given back my own previously harvested stem cells to rebuild my immune system after chemotherapy) I'm delightedthat they are giving up immoral research to concentrate on something that can actually help people.

Embryonic stem cell pioneer Geron exiting such research to focus on cancer drug tests

The company doing the first government-approved test of embryonic stem cell therapy is discontinuing further stem cell work, a move with stark implications for a field offering hope of future medicines for conditions with inadequate or no current treatments.

The Washington Post article continues, with the standard BS about how embryonic stem cell research shows "great promise", etc, etc, with a little lip service to it being "controversial". Some of us do object to creating, raising and then killing human embryos. ...

Meanwhile here's Benedict XVI (that's the Pope) a couple of days ago, on Embryonic stem cell research -

"It Is Tempting for Scientists and Policy-Makers to Brush Aside Ethical Objections"

The pragmatic mentality that so often influences decision-making in the world today is all too ready to sanction whatever means are available in order to attain the desired end, despite ample evidence of the disastrous consequences of such thinking. When the end in view is one so eminently desirable as the discovery of a cure for degenerative illnesses, it is tempting for scientists and policy-makers to brush aside ethical objections and to press ahead with whatever research seems to offer the prospect of a breakthrough. Those who advocate research on embryonic stem cells in the hope of achieving such a result make the grave mistake of denying the inalienable right to life of all human beings from the moment of conception to natural death. The destruction of even one human life can never be justified in terms of the benefit that it might conceivably bring to another. Yet, in general, no such ethical problems arise when stem cells are taken from the tissues of an adult organism, from the blood of the umbilical cord at the moment of birth, or from fetuses who have died of natural causes...

 

Nice article on older New York lifeguards, keeping fit over 60

From the NY Times a few days ago. Very interesting. For some reason they put it in the retirment area of the business section, instead of in health and fitness.

“We’re really proud of our older lifeguards,” said Mr. Gorman of the New York State office of parks. “To me, these guys are like Jack LaLanne.”

In order to return for another season of sun, surf and rescues (on average, a lifeguard at these popular beaches is involved in about 15 to 20 rescues a season, said George Gorman, deputy regional director of the New York State office of parks) the experienced lifeguards have to pass a state-administered rehire test every spring. The exam is meant to test their speed in the water and on land.

The test consists of a 100-meter pool swim that must be completed in 1 minute, 20 seconds and a quarter-mile run in 2 minutes, 10 seconds.

“If you don’t pass, it doesn’t matter how many years you’ve been there,” said Bruce Meirowitz, 60, a retired high school art teacher from Sound Beach, N.Y., who has been a lifeguard since he was 17.

Weight loss and heart disease

Specifically, if young people who are overweight loss weight in middle age, does their risk of heart disease go down.

Answer: yes.

Previous studies have linked being overweight as a teenager or young adult to deadly consequences later in life, including an increased risk of heart disease. But it was unclear if the risk was higher simply because heavy teenagers become heavy adults, or because being overweight or obese as a young adult causes irreversible damage.

... when the researchers factored in middle age, adjusting for the subjects’ weight at that time, they found that the risk changed. The men who started college overweight or obese but were of normal weight in middle age no longer had a higher risk of dying of heart disease.

Body mass index in middle age was a strong predictor of dying of heart disease, the study showed. Being overweight in middle age increased the risk 25 percent, and being obese raised it 60 percent.

mammograms and the limits of breast cancer detection

This is a pretty good article from the NY Times health section a couple of days ago. Timely for me since another of my own clients was just diagnosed last week with a slow-moving breast tumor and is having a lumpectomy.

Excerpts below, but hit the link for the whole article.

Mammogram’s Role as Savior Is Tested

At a time when medical experts are rethinking screening guidelines for prostate and cervical cancer, many doctors say it’s also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women’s health advocate. And women who skip a mammogram often beat themselves up for it.

“You can’t expect from mammography what it cannot do,” said Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco. “Screening is not prevention. We’re not going to screen our way to a cure.”

******

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

******

“Most breast cancers are not lethal, however found,” Dr. Berry said. “Screening mammograms preferentially find cancers that are slowly growing, and those are the ones that are seldom deadly. Getting something noxious out of the body as soon as possible leads women to think screening saved their lives. That is most unlikely.”

Dr. Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, says the scientific understanding of cancer has changed in the years since mammography screening was adopted. As a result, she would like to see less emphasis on screening and more focus on cancer prevention and treatment for the most aggressive cancers, particularly those that affect younger women. Roughly 15 percent to 20 percent of breast cancers are deadly.

“There are still 40,000 women dying every year,” Dr. Love said. “Even with screening, the bad cancers are still bad.”

 

Rugby: The New Zealand flyhalf (that's a position) is 22 years old and a cancer survivor

Aaron Cruden, who wasn't even in the original World Cup team, but was called into the national side when the first two choice players were injured during the tournament.

Cruden Triumphs Adversity Again

It should not surprise anyone that first five-eighth Aaron Cruden had the mental and physical fortitude to guide the All Blacks into their first World Cup final in 16 years.

After all, Cruden has already taken on one of the biggest opponents the game of life can offer – testicular cancer.

He won on that occasion, barely out of his teens but showing a fighting spirit that would reveal itself to the world only two years later.

He was at it again in an icy-cool performance in the red-hot atmosphere of a semi-final against Australia in front of more than 60,000 expectant Eden Park fans.

Most 22-year-olds would not have been up to it.

But the time the final whistle blew, in a 20-6 victory, it had almost been forgotten that this precocious talent had been only the third-choice pivot for his country behind the injured Dan Carter and Colin Slade.

It was as if ice had been siphoned through his veins back in those frequent hospital visits to rid himself of the dreaded disease.

While they weren't apparent, Cruden said the nerves were 'definitely there' in the biggest Test of his life – at least in rugby terms.

Interested in a very comprehensive first aid text? Here's a link to a free online book.

The title is

Where There is no Doctor: a Village Health Care Handbook

the 2010 edition, and it actually goes WAY beyond first aid. It's 503 pages long (the index is 14 pages), but why not download or save it onto your computer? you never know ...

Large doses of Vitamin E increase prostate cancer risk

According to this study - of great interest to people with prostates, or who know someone who has one ...

Large daily doses of Vitamin E, long touted as a virtual wonder drug that could protect against cancer, heart disease, dementia and other ailments, actually increase the risk for prostate cancer among middle-aged men, according to a large federal study released Tuesday.

The analysis of data from more than 35,000 healthy men concluded that those who took Vitamin E every day at the large dose levels commonly sold in drug, grocery and health food stores were 17 percent more likely to develop prostate cancer.

“You really have to question now how taking Vitamin E will help someone,” said Eric A. Klein, a Cleveland Clinic prostate cancer expert who led what had been hoped to be a cancer-prevention study. “Not only is it unlikely to help them, it apparently could hurt them.”

The findings, published in the Journal of the American Medical Association, are the latest in a series of carefully designed experiments that have found that for most healthy people who eat a balanced diet, vitamins and other dietary supplements are unnecessary and, at high doses, possibly sometimes dangerous.

Central planning and cancer care rationing

Good editorial from the Wall Street Journal referencing a study in the medical journal The Lancet -

...The authors lament that the therapy costs roughly $100,000 a head. "The treatment is proven to be effective," muses the report, "but how shall we determine its value?" The report's royal "we" returns again and again to such questions, claiming that "we overdiagnose, overtreat and overpromise." And the main cure the report proposes lies not necessarily in more or better medicine, but in more allegedly enlightened forms of rationing and price controls.

The obvious answer is that "we" ought to have no business determining value, since the choice properly belongs to the patient, his family and care givers. But a government that puts itself, as Britain's has, in the role of providing—and withholding—medical care must make such choices in the patient's stead.

"Countries seeking to provide universal access to health care for all its citizens," wrote the U.K.'s rationing body NICE in a statement accompanying the Lancet report, must consider the "opportunity costs often incurred by use of some expensive new anticancer drugs that offer modest benefits."

Those choices are especially stark in Britain, which maintains one of the most comprehensive publicly funded health-care systems in the world. But the United States may not be far behind. The authors hope that ObamaCare's various commissions will "lead to a wider application of cost-effectiveness based criteria for determining treatment entitlements in America." They even recommend integrating cost-effectiveness with the Food and Drug Administration's clinical approvals, along with tighter regulation of off-label drug use, which would be a disaster for terminally ill patients.

The reality is that cancer care accounts for merely 5% of total U.S. health spending, and making progress against one of the world's leading causes of death is a leadership role that the world's rich countries should be playing. Costs will come down and benefits will improve as genomic science allows doctors to better target therapies to subsets of patients.

One of the report's co-authors, Karol Sikora of CancerPartnersUK, tendered an opposing view in a Daily Telegraph op-ed, writing that "society has to decide how much to put on the price of life." A telling word that "society." The tragedy of Britain's socialized medical system, and perhaps soon of America's, is that "society"—government—is now burdened by moral dilemmas that properly belong in the realm of individual choice.

Gym Jones: "The Cult of Physicality"

An eye-opening look at a gym that trains athletes, special forces (some who were among the 30 men killed in the copter crash recently in Afghanistan), and actors, including the cast of "300."

Very interesting. Oddly, it was in the Fashion & Style section of the Friday NY Times.

A must-read for fitness buffs. Some great links to the Gym Jones website and to Men's Health for the "300 workout." 

 But probably a bit much for people who graduated from high school in 1969 to actually handle!

The Twights generally require an interview or a referral from a current Gym Jones client, the completion of a written application that’s more of a fitness SAT than anything and, if you pass that step, a workout with Mr. MacDonald, a world champion mixed-martial-arts fighter. “If I’m surrounded by substandard people, I’m not going to work that hard myself,” Mr. MacDonald said. Again, it’s right there on that full-of-itself Web site: “We choose clients. Clients don’t choose us.”

Gym Jones has another reason to guard its privacy: its military customers like it that way. Although the Twights refuse to talk much about this side of their business, which occurs inside the gym and in the nearby mountains, it appears to be considerable and to involve people who are supposed to be invisible. Six of Mr. Twight’s former students, for instance, were among the 30 Americans — most of them Navy Seals, including members of the team that killed Osama bin Laden — who died in Afghanistan in August when their helicopter was shot down.

But don’t push for more details: “ ‘No’ is a complete sentence,” Ms. Twight said. “I don’t need to give a reason.”

Bonus! Here is the "300 workout", as oulined in Men's Health magazine. Want Hollywood muscle? Try this 300-rep Spartan workout—used by the cast of the movie—for a full-body transformation

I'd never even heard of a "floor wiper" until I saw the "300 workout".

On CNN, former VP Dick Cheney shows off his "heartmate"

Which keeps him alive.

Of course many people suspected Cheney had no heart. ...

CNN does not allow embedding of their videos; you'll have to hit the link.

Cheney shows off his 'HeartMate'