January 10, 2006
NO MORE BROKEBACK HOSPITAL? (via Bruce Cleaver):
Study Questions Prostate Cancer Screening (CARLA K. JOHNSON, 1/09/06, Associated Press)
Two widely used tests for prostate cancer failed to save lives in a new study, adding to the debate over whether men should be screened for the disease. [...]The researchers looked at two screening tests that are performed millions of times a year in the United States: a blood test that measures prostate specific antigen, or PSA, and a digital rectal exam, the rubber-glove test in which a doctor feels for abnormalities in the prostate through the rectal wall. [...]
Doctors have long known that some cases of prostate cancer can be so slow-growing that they never cause symptoms, much less death. In addition, surgery and radiation treatment for prostate cancer can cause incontinence and impotence. So for some men, detecting prostate cancer early through screening can do more harm than good.
In addition, the PSA tests can yield ambiguous results. Most men who undergo a biopsy because they have elevated PSA levels do not have prostate cancer. And some men with low PSA levels do have cancer.
All that scientific progress and so little advancement....
MORE:
Letter: DEATH OF TB (Richard C. Lewontin, Reply by Lewis Thomas, January 25, 1979, NY Review of Books)
In response to The Big C (November 9, 1978)To the Editors:
In his zeal to propagate the claims of modern scientific medicine, Lewis Thomas (NYR, November 9) has badly distorted the history of tuberculosis and, by implication, of the other major killing diseases of the past. The impression given by Dr. Thomas is that tuberculosis was a great scourge of the 1930s ("Everyone lived in fear of tuberculosis, but it was not much talked about") and that its final conquest as a serious killer was the result of scientific medicine beginning with Koch's discovery of the tubercle bacillus in 1882 and ending with the discovery, a few years ago, of isoniazid. "The conquest of tuberculosis became, at last," he writes, "a stunning success."
But the historical truth is rather different. In 1828, when causes of death were first systematically recorded in Britain, the death rate from tuberculosis was nearly 4,000 per million. The rate can only be appreciated in contrast to the present death rate in the US and Britain from all causes of only 9,000 per million. By 1855 the death rate from tuberculosis had fallen to about 2,700 and continued to fall steadily so that by the turn of the century it had reached about 1,200 per million. Koch's discovery of the causal bacillus in the 1880s had no effect whatsoever on the rate of decline, and by 1925, after the Flexner revolution in medical schools, the rate was about 800, only 20 percent of its value in 1838. Totally unaffected by the arrival of modern medicine, the death rate continued its steady drop to 400 per million until 1948 when the introduction of chemotherapy on a broad scale did indeed accelerate the decline to its present negligible level. It is important to note that 57 percent of the decline had occurred by 1900 and 90 percent of the decline had occurred by the time of the introduction of chemotherapy. Extrapolation of the trend predicts that by 1970 death from tuberculosis would have reached its present low value even in the absence of chemotherapy.
The history of tuberculosis is the history of nearly all the major killers of the nineteenth century. Whooping cough, scarlet fever, and measles, all with death rates in excess of 1,000 per million children, and bronchitis, all declined steadily with no observable effect of the discovery of causative agents, of immunization or of chemotherapy. The sole exception was diphtheria which began its precipitous decline in 1900 with the introduction of anti-toxin and which was wiped out in five years after the national immunization campaign. The most revealing case is that of measles which killed about 1,200 in every million children in the nineteenth century. By 1960, despite the complete absence of any known medical treatment, it had disappeared as a cause of death in Britain and the US while in much of Africa it remains the chief cause of death of children.
The causes of the tremendous decline of mortality from infectious diseases in the last 100 years are not certain. All that is certain is that "scientific medicine" played no significant part.
Bird flu may be more common, less deadly (LINDSEY TANNER, 1/09/06, AP )
As bird flu cases rise at a disturbing pace in Turkey, new research offers a bit of hope - it's likely that many people who get it don't become seriously ill and quickly recover.Posted by Orrin Judd at January 10, 2006 9:38 AMAlthough not definitive, the new study suggests the virus is more widespread than thought. But it also probably doesn't kill half its victims, a fear based solely on flu cases that have been officially confirmed.
"The results suggest that the symptoms most often are relatively mild and that close contact is needed for transmission to humans," wrote Dr. Anna Thorson of Karolinska University Hospital in Stockholm and colleagues who conducted the study. It was published in Monday's edition of Archives of Internal Medicine.
While usually not mentioned, the biggest health benefit to society is not from doctors, but garbagemen and sewer workers. Almost all major improvements in societal health were caused by better sanitation, not medicine. This does not mean that medical advances were meaningless, but it does put things in perspective.
Posted by: Chris Durnell at January 10, 2006 10:39 AMSanitation, hygiene, & nutrition.
Posted by: oj at January 10, 2006 10:43 AMRichard Lewontin, God Bless him*, has argued for years what Chris Durnell is arguing - sanitation and laws contributed greatly to increasing lifespan, and the advance of antibiotics contributed the rest. All other medical advances have had insignificant statistical contributions.
*Irony alert.
Something like 80% of men who die of old age have some form of prostate cancer.
Posted by: Tom C. Stamford, Ct., at January 10, 2006 10:52 AMI'm afraid I don't understand the studies that show PSA testing doesn't save lives. Statistically that might be true, but surely PSA testing saves SOME lives. I was tested when I was 45, the results were high, a biopsy showed a fairly aggressive cancer, and surgery showed that the cancer cells had progressed to the margins of the gland. I and my doctors are absolutely certain that the cancer would have metastasized by now had I not had a PSA test. So while statistically there may be no decrease in mortality, in specific cases there certainly is a decrease.
Posted by: Tom at January 10, 2006 12:08 PMAll statistics are is adding up all the specifics.
Posted by: oj at January 10, 2006 1:07 PMTom-
You must have had traditionally detectable symptoms which were confirmed by the PSA. I hope you are doing well.
Posted by: Tom C. Stamford, Ct., at January 10, 2006 2:59 PMAnti-biotics helped also. At least I'm alive and that's good enough for me.
Seriously, for once.
*And let's not forget Drs. Salk and Sabin.
Posted by: Mikey at January 10, 2006 3:08 PMTo see how far we've progressed in health care, scan pre-WW2 medical book designed for the home. Just a few of the life-threatening conditions we've almost forgotten about are pneumonia, tuberculosis, dysentery, leprosy, whooping cough, malaria, boils (carbuncles) and other infections of all kinds including tetanus.
Sanitation, hygiene and nutrition are a vital first step, but we've progressed a great deal beyond that in understanding and curing diseases like heart trouble and cancer. When I was a kid, cancer was so frightful, even saying the word was taboo.
Posted by: erp at January 10, 2006 5:24 PMerp:
You didn't hear it less just because it was a scary word.
Posted by: oj at January 10, 2006 5:30 PMI, my mother, at least one of my sisters-in-law, and at least one of my nieces & nephews would definitely be dead by now, previous to 20th century medicine & medical technology, even if we had still enjoyed 20th century hygiene, sanitation, and nutrition.
Everyone eventually dies of something, so mortality rates aren't the last word on the effectiveness of modern medicine.
Added years and an improved quality of life are also valuable effects.
http://www.thefactsaboutfitness.com/research/tomato.htm :
[All emph. add.] The causes of prostate cancer are not well understood. It's very difficult to explain why one man gets prostate cancer and another doesn't. Other than skin cancer, it's the most common type of cancer in men in the United States.Of all the men who are diagnosed with cancer each year, more than one-fourth have prostate cancer. In the United States, prostate cancer is found mainly in men over age 55. The average age of patients at the time of diagnosis is 70. [...]
The good news is that there's an exciting body of evidence to show that several components of the humble tomato act together to help fight prostate cancer. It had been thought just one chemical, lycopene (pronounced lie-co-peen) was responsible. But researchers at the Universities of Illinois and Ohio State found lycopene's effect is boosted by other chemicals in the fruit.
The study, published in the Journal of the National Cancer Institute, suggests lycopene-only dietary supplements have a limited effect. [...]
[S]ays researcher Professor John Erdman: "This study suggests that lycopene is one factor involved in reducing the risk of prostate cancer. But it also suggests that taking lycopene as a dietary supplement is not as effective as eating whole tomatoes."
Lycopene, the substance that makes tomatoes red, is effective at mopping up particles called free radicals, which can damage the body's tissues.
Free radicals are molecules with an unpaired electron. Although they've been implicated in many diseases, free radicals are a normal part of your body chemistry, and can help to keep you healthy. White blood cells, for example, use free radicals to "attack" viruses and bacteria.
Optimal health, however, requires a balance between free radical generation and antioxidant protection. One of the functions of an antioxidant is to "quench" these free radicals before they create too much damage.
Slice an apple in half, and watch it turn brown. That's an example of free radical damage. Dip the apple in lemon juice, and the rate at which it turns brown is slowed. That's because the vitamin C in the lemon juice slows the rate of oxidative damage.
The researchers exposed laboratory rats to a chemical that causes prostate cancer, and then fed them on diets containing whole tomato powder, pure lycopene or no lycopene at all. [...]
By the end of the study, prostate cancer had killed 8 out of 10 of the control group, 7 out of 10 of the lycopene-fed rats and 6 out of 10 of the rats fed tomato powder.
The researchers also found that restricting the amount of food given to the rats cut their risk of developing prostate cancer, regardless of which diet they were on.
To effectively absorb lycopene, the tomatoes must be cooked, so tomato sauces are best, and it must be eated with fats or oils.
Therefore, Italian foods are the best at providing lycopene.
Posted by: Michael Herdegen at January 10, 2006 6:27 PMTomato Sauces, Rich in Lycopene,
May Reduce Risk of Prostate Cancer
By Jack Challem
[All emph. add.] Edward Giovannucci, MD, examined the dietary habits and health of 47,894 male health care professionals. Between 1986 and 1992, 812 of the men were diagnosed with prostate cancer. When Giovannucci analyzed 46 vegetables and fruits in the men's diets, he found four foods associated with a low risk of developing prostate cancer: tomato sauce (on spaghetti), pizza (with tomato sauce), tomatoes, and strawberries. [...]Despite their red color, strawberries do not contain lycopene. Their inverse relationship to prostate cancer may have been due to [...] some other nutritional component (such as a flavonoid)[*].
Men who ate 10 or more servings of tomato foods weekly were 45 percent less likely to develop prostate cancer. Those who ate four to seven servings of tomato foods were 20 percent less likely to develop the disease.
Giovannucci's findings are consistent with other studies that have reported a low incidence of prostate cancer in southern Mediterranean countries, including Italy and Greece, where tomato consumption is high.
Diets with abundant tomatoes cooked with oil - such as spaghetti sauce - were more readily absorbed than other forms of tomato. Pizzas and raw tomatoes were also protective against prostate cancer, but tomato juice was not.
The reason was twofold, according to Giovannucci. First, cooking broke down the tomatoes' cell walls, releasing more lycopene. Second, the oil enhanced absorption of the fat-soluble carotenoid. (It's possible that the oil in salad dressings enhances lycopene absorption with raw tomatoes.)
Other carotenoids, such as beta-carotene, did not affect the risk of prostate cancer, although they may very well influence the risk of other diseases. Dietary intake of vitamins C and E was not a factor in prostate cancer either...
* Strawberries are a top source of antioxidant phytonutrients such as anthocyanins, which support healthy brain function. Tufts University researchers have found in several studies that rat diets supplemented with strawberry were effective in slowing and even reversing age-related deficits in the brain, such as a loss of short term memory. A study from Cornell University found that a strawberry phytonutrient, quercetin, may protect against Alzheimer’s by protecting brain cells from the oxidative stress suspected in the disease.
Blueberries are also a top-notch memory-enhancing, age-fighting food.
Learn more at Dole superfoods - an extremely useful site, geared to the layperson.
erp, you especially may want to visit here.
Also:
Scientists at Seoul National University in Korea successfully used kimchi Sauerkraut to treat chickens infected with Avian Flu according to a BBC report in October 2005. The researchers fed kimchi to 13 chickens infected with avian flu, and within a week 11 of them had started to recover.Posted by: Michael Herdegen at January 10, 2006 7:15 PMKimchi is the Korean equivalent to Sauerkraut, made by fermenting cabbage, which in turn produces high levels of the Lactobacillus bacteria, thought to be the key element in preventing Avian Flu. More...
Richard Lewontin is a hard core marxist andperhaps the angriest man not in a mental hospital. Quoting him on anything weakens your case.
Posted by: Robert Schwartz at January 11, 2006 2:33 AMTo Tom C. of Stamford -- I had no symptoms, traditionally detectable or any other kind, except a high PSA. I was lucky my doctor thought to test me. And I am doing fine, thanks. But my point is that statistical studies might show that PSA tests overall do not lead to a decrease in mortality, but nevertheless PSA tests do save some men.
Posted by: Tom at January 11, 2006 11:37 AM