Archive for the ‘Cancer’ Category

Gardasil Vaccine for Boys: Health Blog

September 24th, 2009

Gardasil for Boys

Flim-flam artists could learn something from the pharmaceutical industry. An FDA advisory panel just recommended approving Gardasil vaccines to prevent genital warts in boys as young as age nine. Never mind that genital warts are about as common among middle-school boys as opera buffs are. Never mind that the vaccine hasn’t undergone extensive long-term testing, that the long-term effects (and effectiveness) of vaccinating young kids won’t be known for decades, or that it costs an average of $500 per series of shots. And never mind that Gardasil may cause as many problems as it prevents. The fact is that Merck, the Gardasil manufacturing company, has somehow convinced plenty of people that the vaccine not only is good but also necessary, leading some two dozen states to seriously consider mandating it for girls starting at age 10 (before parent groups in most of those states shot the idea down). You can bet boys will be next on the bill.

Leading up to the approval, the FDA committee reviewed three studies involving 5000 boys, aged 9-26, from various countries. The researchers found that Gardasil was 89% effective in preventing genital warts related to the sexually transmitted disease HPV — at least for subjects who were free of HPV at the time of vaccination. Those who had been exposed to HPV experienced no such benefit. But why vaccinate to prevent warts, which, though ugly, hardly constitute a medical crisis? The rationale is that HPV can also lead to throat and anal cancers later on, and so better safe than sorry. Plus, infected men can spread HPV to women, and infected women have a higher risk of cervical cancer.

But scientists don’t really know if the vaccine prevents cancer in men down the road; they only know that it prevents warts in the short run. According to Dr. Janet Englund, an infectious disease pediatrician and chair of the HPV Working Group of the CDC’s Advisory Committee on Immunization Practices (ACIP), “It is true we don’t know for sure about the vaccine’s long-term ability to prevent high-grade cancer. My assessment, my personal viewpoint, is there is very good evidence for both reduction of [precancerous] cervical intraepithelial neoplasia — it is really clear — and that there is reduction of genital warts.”

But this statement may be a bit overblown. A closer look at the research indicates that, in fact, the vaccine doesn’t even protect against all strains of HPV virus. In fact, according to Dr. Charlotte Haug who edits the Journal of the Norwegian Medical Association, “If it were a perfect vaccine you would never have to think about cervical cancer again. But it is effective against two of the strains of the virus, and there are at least 20 cancer-causing strains out there. It is true these strains cause 70% of cervical cancers, but what happens when we take these two strains away? If you kill the weeds in your lawn, there will not always be a hole there. Something will take their place.”

But back to boys, who don’t get cervical cancer. Reports estimate that about 250,000 men develop genital warts each year. Anal cancer, however, affects only about 5,300 people annually, and penile cancer accounts for only 0.1% of deaths from cancer in US males. So given the numbers, the chief benefit — and only proven benefit — of administering Gardasil to boys is possible wart prevention and perhaps some residual benefit to the girls those boys have sexual relations with — as long as that sex happens within a few years of the vaccine.

According to a “former” Gardasil advocate and vaccine developer, Dr. Diane Harper of Princeton University, the vaccine might, in fact, wear off in as little as five years. That means that the vaccinated nine-year olds better have sex by ninth grade in order to get their money’s worth. Dr. Harper cautions (and this is a biggie), “The rate of serious adverse events is on par with the death rate of cervical cancer. Gardasil has been associated with at least as many serious adverse events as there are deaths from cervical cancer developing each year.“

If that’s true, the fact that Gardasil is not only widely prescribed for girls but now is on the way to being approved for boys is mind-boggling. The researchers insist that the vaccines cause only minimal health risks, with fever, injection site reactions, and headache the most common adverse effects. But up to seven percent of girls receiving the vaccine have had serious reactions, including fainting and blood clots according to data provided by VAERS (the vaccine adverse event reporting system). The actual number of serious reactions probably runs much higher. VAERS only includes incidents reported after the fact, and many events probably go unreported.

And Dr. Harper points out that risk of death from the vaccine can’t be ignored. “Parents and women must know that deaths occurred,” she said. “Not all deaths that have been reported were [made public], one-third of the death reports were unavailable to the CDC, leaving the parents of the deceased teenagers in despair that the CDC is ignoring the rare but real risk of death surrounding the administration of Gardasil.”

All of these factors led Pharmaceutical Executive to give Gardasil the 2006 “brand of the year” award for “creating a market out of thin air.” Even the Journal of the American Medical Association recently ran an editorial claiming that Merck influenced professional medical associations to overstate the vaccine’s benefits. Apparently, the drug company teamed with these associations to create “educational material” that was then widely distributed to doctors, who, according to researcher Dr. Shirley Rothman, “May not know that this education is not being done by a group of experts in the field but that it is all being orchestrated by the drug company.”

You’ve gotta hand it to them. Those drug companies do know how to create markets — aiming to scare parents of fourth graders into wanting to vaccinate their boys against genital warts. And you’ve really got to wonder what the members of that FDA committee smoked before making their recommendation for approval.

:hc

Cell Phones Back in the Frying Pan: Health Blog

September 19th, 2009

Cell Phones, Brain Tumors

Every few months, a new report comes out that once again raises the alarm about the cell-phone/brain-cancer link. There’s usually a short-lived flurry of concern in the wake of such reports, and then amnesia seems to set in, and the use of cell-phones keeps growing and growing. It doesn’t help that for every scary report blaming cell phones for brain tumors and other dread conditions, another comes out insisting that the phones are just as safe as stuffed teddy bears, after all. But those reassuring studies have come under fire from two independent sources in the last few weeks. First, the International EMF Foundation just issued a 37-page report claiming that the major research to date on cell phone safety grossly underestimates the dangers that cell-phones pose. The report lists an extensive and impressive list of authors, including the former director of the University of Pittsburgh Cancer Institute; the director of the Institute for Health and the Environment at the University at Albany; faculty from Columbia University and other US universities; plus top scientists from 13 countries worldwide.

The EMF cites 15 concerns about cell-phone safety, including the fact that even the major industry-funded studies have found significant increased risk of brain cancer and genetic damage, with that elevated risk hovering around 20 percent for each year of cell-phone use. The report also cites an independent Swedish study that found that risk of brain cancer increases by five percent for every 100 hours of use and that those who start using cell-phones as teens increase their risk of brain cancer by 420 percent. Incredibly, there has been only one other non-industry funded study, and that study also found increased risk.

The fact that only two independent studies have been completed is, in itself, reason for concern. According to the EMF report, the telecommunication industry essentially “bought” governments worldwide back in the 1990’s, pumping huge dollars into cell phone safety research and asking governments for matching grants. In other words, governments spent all their money partnering with the telecomm industry and had none left to give to independent researchers…or no desire to.

Other concerns cited in the report include the fact that FCC exposure limits fail to consider the effects of non-thermal radiation from mobile phones, “assuming the only danger from microwave radiation would come from temperature increases in our brains,” a position that, according to the report, is absurd. Also, the report claims that cell phones damage DNA and cause the blood-brain barrier to leak. And, cell phones compromise male fertility.

Finally, the EMF report says the largest study on cell phone safety to date has 11 serious design flaws. That study, funded by the telecomm industry and known as Interphone, began in 1999 with the purpose of investigating brain tumor risk. Countries worldwide participated, but publication of the results has been delayed for four years because researchers can’t come to consensus on how to interpret the data. The flaws cited include excluding certain types of brain tumors from the analyses, excluding children and young adults from the data pool, defining “regular use” as using a cell phone once a week for six months or more, and so on.

Simultaneous with the publication of the EMF report, the Environmental Working Group published a report advising consumers to exercise caution when using cell phones. The report summarizes 10 months of research analyzing 200 peer-reviewed studies, government advisories, and industry documents. Cell phone dangers cited in the report include increased incidence of brain tumors and celluloid lung cancer, increased risk of hyperactivity in children, salivary gland tumors, migraines and vertigo. The report notes that the FCC’s emissions standards for cell phones are outdated and far too generous for safety given the body of research, and that the implications for children are particularly worrisome, as kids are far more vulnerable to radiation. Lead author Dr. Olga Naidenko, says, “We would like to be able to say that cell phones are safe. But we can’t. The most recent science, while not conclusive, raises serious issues about the cancer risk of cell phone use that must be addressed through further research. In the meantime, consumers can take steps to reduce exposure.”

To that end, the EWG has published a comprehensive database listing emission levels for 1000+ cell phones. In fact, the emissions level does vary widely from one phone to the next. For instance, the lowest-emission phone on the list, the Samsung Impression, has a maximum radiation level of 35 W/KG, whereas the highest emission phone, the Motorola MOTO VU204, has more than four times that, at 155 W/KG.

The EWG recommends that cell phones should be sold with information about their emissions posted on the label, but in the interim, consumers need to do their homework and buy low-emissions phones. Other steps you can take to protect yourself include using a bluetooth device or headset (although they, too, theoretically could present problems), keeping the phone a safe distance away from your body, staying off the phone when you have a weak signal, limiting time that your kids use cell-phones (children are far more vulnerable to radiation), using the speaker instead of holding the phone to your ear, and texting instead of calling (as long as you’re not driving or operating a train).

In spite of this avalanche of warnings regarding cell phones, many scientists remain unmoved. According to Dr. Michael Thun of the American Cancer Society, “Basically the idea that there is a sea change in the evidence in the past two or three years is incorrect. Essentially this [EWG] report focuses on studies that support their hypothesis that cell phones increase brain cancer risk. The description of the evidence selectively emphasizes the studies that suggest the risk and omit the evidence that suggests no risk.”

“Selectively” being the operative word here.

With that in mind, it’s interesting how Dr. Thun “selectively” omits the fact that virtually all studies to date have been funded by the telecommunications industry, and that nearly all those studies have found at least some risk. But you can bet that the majority of cell-phone addicts out there will be reassured by remarks such as his.

On a final note, I should probably acknowledge the primary knock on all the Cassandras  of cell-phones. “If cell-phones are causing brain cancer, then why aren’t we seeing a big increase in brain tumors. It’s not like cell phones haven’t been in heavy use for a number of years now.”

And the simple response to that argument is that while we are not yet seeing an “epidemic” of brain tumors, the incidence in brain tumors is decidedly “surging” among certain demographics.

:hc

Tamoxifen, Killer “Cure”: Health Blog

September 12th, 2009

Tamoxifen

The breast cancer drug Tamoxifen might well be marketed with the slogan, “If it doesn’t kill you, it will cure you”– except that would be an overstatement. The truth is that it probably won’t cure you of anything, but may very well kill you, as yet one more study makes clear. According to that study, just published in Cancer Research no less, long-term use of tamoxifen ups the risk of getting aggressive cancer in the other breast by 440 percent. In spite of this finding, researchers insist that women should keep taking the drug because, they say, the benefits outweigh the risks. Then again, they’re not the ones at risk.

Tamoxifen has been used for over 25 years both to treat breast cancer, as well as to prevent it. Most breast cancers spread when exposed to estrogen, and since tamoxifen inhibits estrogen receptivity, it has been the standard treatment, although recently aromatase inhibitors, a new class of drugs, have taken precedence. Tamoxifen also has frequently been prescribed to high-risk women who don’t have breast cancer as a prophylactic measure to stave off tumors. And, it’s been used to treat osteoporosis, bipolar disorder, and prostrate cancer.

But problems with tamoxifen have been surfacing for years, and now this study shows the drug causes an even more deadly version of the disease it supposedly cures. The tumors negatively associated with tamoxifen use do not feed on estrogen, no drugs on the market have been effective in treating them, and the prognosis for cancers featuring these tumors is worse than for estrogen-dependent cancers.

The study followed 1100 women aged 40-79 who received treatment for estrogen-receptive breast cancer between 1990 and 2005. Those who took tamoxifen were 60 percent less likely to develop estrogen-dependent breast cancer in the other breast compared to those not taking the drug. But those women who took the drug for more than five years, as already mentioned, had a hugely increased risk of developing estrogen-negative tumors. The study did not include women who took the drug long-term to prevent breast cancer in the first place. If it had included that group, the risk most likely would reflect far higher numbers.

So, you might conclude, since the drug does seem to provide significant short-term protection, you can safely take it for the recommended five years (that’s the standard regimen) and then stop, thus reaping the benefits and avoiding the risks. Doctors point out that in the study, the overall numbers of women developing the aggressive breast cancers remained small (an interesting double standard as we’ll discuss in a moment). The tumors appeared in only 14 of the 358 women treated for longer than five years. But, two troublesome key points make those arguments look lame. First, tamoxifen causes life-threatening problems other than breast cancers. Also, studies have found that while tamoxifen may prevent estrogen-dependent breast tumors, it does very little, if anything, to prolong life expectancy, at least when used as a cancer preventative. Let’s examine these issues in a little more detail.

First, the other health problems associated with tamoxifen include blood clots, strokes, uterine cancer (about double the risk), ovarian cancer, liver cancer, gastrointestinal cancers, and cataracts among them, as well as the usual chemotherapy discomforts — nausea, vomiting, headaches and so on. “Any sort of treatment has risks and benefits, and the benefits for tamoxifen are very clear, particularly with respect to reducing mortality,” says lead researcher Christopher Li, MD, of the Fred Hutchinson Cancer Research Center in Seattle. But are they? A huge study of 13,000 women by the National Cancer Institute back in the 1990’s found that while tamoxifen did indeed cut “the incidence” of breast cancer by 30-50 percent in the high-risk group of women who took it as a preventative, seven years into the follow-up, women in the no-tamoxifen control group had fewer deaths from breast cancer than those in the tamoxifen group — marginally fewer, but fewer none-the-less.

And, as I’ve written before, those statistics touting the huge percentage reductions in new tumors from tamoxifen’s effects do not hold up on closer inspection. About ten years ago, newspapers cited studies proving the efficacy of tamoxifen that consistently read something like “The National Cancer Institute’s Breast Cancer Prevention Trial reported that there was a 49 percent decrease in the incidence of breast cancer in women who took tamoxifen for four to five years.” That’s stunning. If your doctor told you that using tamoxifen cut your chances of getting breast cancer by 49%, would there be any question in your mind on whether or not to use it? But if you look past the statistics, the truth is that according to the study, your odds of getting breast cancer without using tamoxifen were only 1.3%. With tamoxifen it dropped to .68%. And yes, that could be represented as a 49% difference between the two numbers. But the reality is we’re talking about a difference of just 86 women out of 13,388, or just a little over one-half of one-percent (0.64%) in real terms.

If you already have breast cancer, it’s your call whether or not to take on the risks tamoxifen brings. On the other hand, if you’re going the mainstream medical route, you may want to consider the fact that aromatase inhibitors beat tamoxifen in terms of survival rates, plus they have far fewer side effects. The only proviso here is that these drugs work only for post-menopausal women, and they cost more than tamoxifen.

But if you’re taking tamoxifen as a cancer preventative, you might want to think very carefully about the payoff versus the potential cost. And you might want to view the following statement made by Dr. Li regarding his recent study with a skeptical eye: “Certainly none of the data has suggested that we stop using tamoxifen or change the way we apply it.”

Keep in mind that there are natural alternatives available that are at least as effective as tamoxifen — alternatives that not only strengthen your body and reduce your vulnerability to cancer and other deadly diseases but that have the added benefit of not triggering even more vicious diseases than those you seek to fend off. In fact, the self same Dr. Li just released the results of another study a few days ago that found that a simple change in diet can drop your risk of breast cancer by 40%. That makes it virtually as effective as tamoxifen, but with only beneficial side effects.

:hc

Does Medical Imaging Fry Patients?: Health Blog

September 8th, 2009

Medical Imaging Dangerous

For years I’ve been saying that many medical procedures are far less “proven” and far more dangerous than most people think. And now we can add another one to the list — one so commonly used, in fact, that its very commonness may be its biggest problem.   I’m talking about medical imaging procedures, which doctors annually prescribe to about four million people under the age of 65.  The typical patient, having received the work order, rushes over to the hospital to get the images taken, grateful for the sophisticated technology that can diagnose incipient internal problems. But according to a study just published in the New England Journal of Medicine, tests such as CT scans and nuclear imaging may be provoking cancers without providing any real benefits. (You might want to reread that last sentence again.)

The study analyzed medical records of about one million adults under 65, and found that two-thirds of them had undergone at least one imaging test between 2005 and 2007, not including “low-dose” dental X-rays. Eighty percent of the imaging procedures were performed on people who weren’t in hospitals, and 30 to 40 percent were administered to patients under age 50. While 71 percent of the tests were regular X-rays, the remaining tests included high-dose CT and nuclear imaging radiation scans. CT scans emit 50 times the amount of radiation you’d get from a regular X-ray. You get even more radiation from nuclear stress tests, also known as myocardial perfusion imaging, which doctors prescribe to search for cardiovascular problems. 

It may seem obvious to any non-doctor that exposing people to high levels of radiation isn’t good, but study director Dr. Reza Fazel of Emory University School of Medicine seems to think that lots of physicians haven’t figured that out. She says, “We don’t want to scare people and have them refuse necessary procedures, but physicians and patients need to be aware that radiation is not benign. Our study shows that a lot of people are getting high doses of radiation.”

And that radiation, according to experts, leads to at least two percent of new cancers in the US (about 29,000 cases a year). Keep in mind, that two percent applies only to cancers caused by CT scans, without accounting for the cancers related to nuclear imaging and other forms of medical radiation. Also, keep in mind that people don’t typically receive just one scan. They may have multiple images taken at a single time or have repeat sessions of imaging, and the impact of radiation is cumulative over time.

“The risk in individual patients is small, but when you start totaling up millions of people getting these kinds of doses, it adds up, and the population risk starts to become concerning,” says Dr. Fazel. It’s interesting that the data show women get imaging tests at a greater clip than men — 79 percent of women versus 58 percent of men had such tests during the study period. Not surprisingly, then, women also contract radiation-induced cancers at a greater rate.

Experts have noticed it’s possible that the risks outweigh the benefits, at least in some cases. “We are exposing people to significant amounts of radiation and on the other hand we do not have evidence that [the scans lead to] improvement of health,” says Dr. Michael Lauer, a cardiologist with the National Heart Lung and Blood Institute. The fact is that studies haven’t been done to determine if all this scanning actually saves lives, prevents heart attacks, or leads to health improvements. (As I keep saying, medicine is not as scientific as you might think.) And experts particularly worry about exposing children to imaging, since kids are about 10 times more sensitive to radiation than adults are. Elderly people, who were not included in the study, get the most imaging done, but the reports seem to dismiss this fact. Perhaps the thinking is that they’ll die soon anyway, so who cares? But at least the cost of the procedure is covered by Medicare.

In addition to the health concerns, the report cites exorbitant costs associated with imaging. According to the Radiological Association of North America, $17 billion may be paid annually in unnecessary imaging in cases of acute trauma. Doctors get paid for each service they perform, and so they may be ordering tests for which the need is questionable. The Government Accountability Office issued a report saying that Medicare spending on imaging more than doubled to $14 billion between 2000 and 2006, with most of that increase going to the highest-dose, most dangerous tests. (And we wonder why health care costs keep climbing).

Unquestionably, scanning can reveal hidden problems, and sometimes that does indeed lead to remediation and healing. Certainly, the American College of Radiology (ACR) sees the issue differently. In a rebuttal, the ACR calls the NEJM study “ill-advised and misinformed.” The rebuttal claims that, “The patients who experienced the higher doses of radiation (and repeated exams) outlined in the study were almost certainly cancer patients and others with chronic illnesses whose conditions necessitated repeat exams to gauge effectiveness of their treatment and/or help ensure their short term survival.” (It’s useful to remember here that if those patients weren’t cancer patients going into the exam, they probably were down the road as a result of the tests.) Also, the ACR refutes the claim that most imaging turns up nothing because the procedure isn’t called for, saying that, “Negative exams are of value. They preclude further costly and invasive exploratory techniques, rule out disease, provide a baseline to monitor patient health, and provide the patient with peace of mind.”

Really?? Perhaps they missed the studies that demonstrated that mammograms have up to a 90% false positive rate!! That means that 90% of mammograms actually lead to “further costly and invasive exploratory techniques,” give false confirmation of disease, provide a totally erroneous baseline to monitor patient health, and unnecessarily destroy patient peace of mind!

While the medical community slugs it out, it might help you to know that MRI tests and ultrasounds don’t use radiation, nor does thermography. Always opt for the non-radiation test where there’s a choice.

:hc

Oral Sex and Throat Cancer: Health Blog

August 6th, 2009

Oral Sex, Cancer

Those cynics who say that everything pleasurable causes cancer now have a new argument on their side. According to a recent study, it turns out that oral sex may cause cancer. Apparently, there’s been a dramatic spike in rates of oral cancers among young people in recent years, which researchers attribute to increased indulgence in oral sex. All jokes or moral judgment aside, this raises some very interesting health issues.

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Mammogram Mania: Health Blog

July 28th, 2009

Mammogram, Breast Cancer

If there’s one thing most women agree on, it’s the fact that going for the routine mammogram is about as distasteful as doing the annual tax return — which may be one reason fewer and fewer women show up for it. Back in 2000, 70 percent of women in the US had regular mammograms, but that figure slipped to 66 percent by 2005, and the downward trend continues. Plus, a huge study reviewing Medicare records of 146,669 women nationwide found that far fewer actually had mammograms than claimed they did, dropping the real percentage to more like 61 percent — which leaves almost 40 percent of women without screening. 

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Fatty Diet and Pancreatic Cancer: Health Blog

July 9th, 2009

Pancreatic Cancer

If the prospect of inviting diabetes, heart disease, and obesity into your life doesn’t discourage you from eating that Philly cheese steak, perhaps this will. A new study has found a dramatic rise in the likelihood of getting pancreatic cancer among those who indulge in high-fat foods.  And pancreatic cancer is a particularly nasty disease, with median survival rates of three to five months and five-year survival rates dipping below five percent.

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Colon Cancer Rate Rises in Young: Health Blog

June 30th, 2009

Colon Cancer, Colorectal Cancer, Incidence, Cancer Epidemiology Biomarkers and Prevention

While the medical establishment has been patting itself on the back because colon cancer rates in the US have declined in the past 20 years, an insidious trend has been brewing. A new study shows that young people under the age of 50 have experienced rising rates of colon cancer in every age category; it’s only the older folks who are getting it less. 

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Major Life Insurers Support Tobacco Industry: Health Blog

June 16th, 2009

Tobacco, Insurance Companies

If any industry should know the statistics verifying the deadly impact of smoking, that industry would be the life insurance industry. Insurers know that smokers have double to triple the mortality rate compared to non-smokers — which is why companies like Prudential won’t even grant life insurance to those who smoke, or else they charge smokers exorbitant premiums. And yet, demonstrating an extraordinary degree of cynicism, some of the world’s largest life insurance companies invest heavily in tobacco. In fact, insurance company investments in tobacco industry stocks amount to $4.5 billion.

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People Ignore Cancer Advice: Health Blog

June 4th, 2009

Cancer Prevention

We’ve all heard the cancer prevention advice: eat plenty of fruits and vegetables, avoid grilled meat, lose weight, don’t smoke. But then again, we’ve also heard opposing voices telling us that fruits won’t ward off the “big C”; meat is just fine, a few extra pounds won’t hurt, and so on. No wonder a recent study in Great Britain found that a huge segment of the population simply ignores cancer-prevention advice, finding it too fickle.

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