WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?

In a the article A systematic review of the effect of diet in prostate cancer prevention and treatment Journal of Human Nutrition and Dietetics, May 2009 the authors suggest that the dietary recommendations for patients diagnosed with prostate cancer [ PC] are similar to those aiming to reduce their risk of PC.

Bottom Line
• Although conclusive evidence is limited, the current data are indicative that a diet low in fat, high in vegetables and fruits, and avoiding high energy intake, excessive meat, excessive dairy products and calcium intake, is possibly effective in preventing PC.

• Caution must be taken to ensure that men do not take excessive amounts of dietary supplements because there may be adverse affects associated with their over consumption, say the authors.

Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for MORE PATIENTS WITH STROKES DIE ON WEEKEND HOSPITAL ADMISSION .

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

Cancer Care too Expensive

NEWLY INAUGURATED PRESIDENT SARAH PALIN DISCLOSES HER WINNING ELECTION STRATEGY WITH LADIES HOME JOURNAL WHITE HOUSE CORRESPONDENT AND EX-CBS NEWS ANCHOR KATIE COURIC

“I’ve always maintained, that if you give the Democrats enough rope they’ll hang themselves” said the triumphant new President of the U.S. Sarah Palin. The last straw was denying cancer treatment to her former running mate John McCain when his melanoma returned to the left side of his face. The treatment was denied because of his age by the head Washington D.C. agency established for Equitable Health Distribution (EHD) under the Obama Health reform acts. They did because of his advanced age of being past 70 years old and on the basis of these four developments which in retrospect dynamically converted many pro-lifers into pro-choice.
The inevitable shift in public opinion tipped the balance to Palin’s pro-life winning election theme. Unfortunately it was too late for the former war hero and presidential candidate McCain.


1. First “IOM released top 100 comparative effectiveness priorities”
The stimulus bill "earmarked $400 million for 'comparativeness effectiveness research,'" HHS "asked the Institute of Medicine (IOM), created by Congress to provide advice to policymakers, health professionals, the private sector, and the public, to identify the top priorities on which [healthcare services] to spend the money." In a report , the IOM "listed the top 100 areas of medicine in which research is needed to determine which treatments or preventive measures work best. One of the major areas was cancer treatment. The IOM's research priorities include "remedies for back pain, obesity, and preventing falls in the eldery, as well as studies about how to disseminate the findings to doctors and patients." The 100 recommendations "were selected from some 2,600 suggestions submitted to the committee from professional groups, policy makers and the public

The NYT praised the IOM's "report as one of the first concrete steps in a broad effort by administration officials and health experts to shift the focus of medical practice toward scientific evidence -- rather than a physician's personal views or treatments promoted by medical product companies.". Insurers, unions, consumer groups, and "many medical researchers" are cited as proponents of comparative effectiveness research, who "say such studies are essential to curbing the widespread use of ineffective treatments."

2. This was followed by the NEJM.1056/NEJMp0904133) published on June 30, 2009, which stated “This unique opportunity to invest in a major component of the scientific infrastructure for improving health care delivery will be indispensable for achieving a health care system that delivers affordable, high-quality care for all Americans. Physicians and patients deserve the best patient-centered evidence regarding what works, so that Americans can receive care of the highest quality and the best possible outcomes can be achieved.” Also the NEJM explained (10.1056/NEJMp0905631) that the American Recovery and Reinvestment Act of 2009 (ARRA). “which was the $787 billion economic stimulus package that President Barack Obama signed into law on February 17, 2009, included $1.1 billion for Comparative Effectiveness Research [CER]. The research priorities developed by the IOM committee — delivered as Congress requested only 19 weeks after Obama signed the measure — must be taken into account by the DHHS as it allocates $400 million in support of CER projects over the next 2 years. (A Federal Coordinating Council for Comparative Effectiveness Research, a new advisory group created by the ARRA, is also providing input to the DHHS [http://hhs.gov/recovery/programs/cer/cerannualrpt.pdf].)

3. The third article was a successful trial balloon from the NIH -- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute (TF), and Department of Bioethics, The Clinical Center (CG), National Institutes of Health, Bethesda, MD. Tito Fojo of the National Cancer Institute and Christine Grady at the National Institutes of Health. wrote [Fojo.T.et al How Much Is Life Worth: Cetuximab, Non–Small Cell Lung Cancer, and the $440 Billion Question] that “The high price of some of the newest cancer medicines are coming under scrutiny as part of an effort by lawmakers and health officials to rein in overall medical costs.”. Fojo is calling into question the widespread use of expensive cancer drugs to prolong patients' lives by just weeks or months. Fojo states that a study showed that "treating a lung-cancer patient with Erbitux [cetuximab], a drug that costs $80,000 for an 18-week regimen, only prolongs survival by 1.2 months." The authors noted that "based on that estimate, extending the lives of the 550,000 Americans who die of cancer annually by one year would cost $440 billion." The authors argued that "health professionals and researchers cannot ignore costs in setting treatment standards.These authors also "questioned the cost-benefit calculus for other big cancer drugs " calling "for changes in the testing and practice of medicine—despite the fact drugmakers say this article exaggerated the overall costs of their treatments because few patients are on them for extended periods of time."

4. Going even further the NIH authors stated that “Studies of cancer drugs that are expected to find survival advantages of two months or less should be undertaken only if the treatment costs less than $20,000.” Otherwise, they say the research community will waste valuable resources pursuing therapies that the healthcare system can't afford to provide. "We naturally avoid confronting the tension between not wanting to put a value on a life and having limited resources. But the spiraling cost of cancer care in particular makes this dilemma inescapable."They continued, "We must stop deluding ourselves into thinking that prescribing expensive chemotherapies and tests is an aberration, a temporary deviation from an otherwise reasonable cost trajectory."More than 90% of all new anticancer drugs receiving FDA approval in the past four years cost more than $20,000 for a 12-week course of treatment, they said.Drs. Fojo and Grady even rejected the argument that cost-benefit ratios will improve through identification of patient subgroups who are more or less likely than average to respond to a given drug.

5. Drs. Fojo and Grady recommended a series of policies that were immediately implemented with the new health reform acts.:

• Anticipated treatment costs should be coupled to trial designs, such that the endpoint benefit should cost no more for a quality-adjusted life-year than renal dialysis -- currently $129,000.

• Drugs that work for a particular patient subset "should be advocated, approved, and prescribed for that subset only."

• Clinicians should not prescribe beyond FDA-approved indications -- such as giving treatment-resistant or refractory patients a drug approved only as first-line therapy.

• "The all too common practice of administering a new, marginally beneficial drug to a patient with advanced cancer should be strongly discouraged. In cases where there are no further treatment options, emphasis should be first on quality of life and then cost."

• Toxicities should receive extra scrutiny for drugs with marginal benefits.
Fojo T, et al "How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question" J NATL CANCER INST 2009; DOI: 10.1093/jnci/djp177.


Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

* Tune in tomorrow for How to Find a Good Hospital.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

Should End Of Life Patients Smoke?

I’m in complete sympathy with Peter A. Ubell, MD ,director of the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan who writes that “Eighteen years out of training, and I still find myself struggling to understand the moral imperatives of medical practice.”

“Not long ago,” he relates, “as part of my hospital duties, I cared for a man who could no longer swallow. This dysphagia was his only medical complaint, one that had sneaked up on him over the course of a month. He simply couldn’t find the muscular strength to propel food and liquid down to his stomach. After some investigation, the medical team discovered he had metastatic lung cancer. That explained the dysphagia: cancer had stimulated his immune system to attack his swallowing muscles.

While the cancer was incurable, we hoped we could slow its progression and give him a few extra months of life — small solace for a man in his mid-50s with a loving wife and several children ready to start new families, but the best we could offer. On rounds the morning after he received a feeding tube, I stopped by to see how he was doing — checking his abdomen for signs of infection and, more important, assessing his fragile mood. I tried to keep things upbeat, making small talk while examining his belly. But something about his response, and the look he gave his wife, was troubling.

I looked up and asked him how he was feeling, keeping purposely vague about whether I was posing a medical, or a social question. His wife replied— angrily. She lashed out at her husband for having sneaked off that morning for a cigarette. He glared back and told her to mind her own business. She looked toward me for support — I was the physician, after all — and I found myself in a common medical quandary.

According to this new paradigm of preference-sensitive decision-making, doctors like me shouldn’t tell patients what to do (Take your pills! Stop smoking!), but rather should educate our patients about the risks and benefits of their options. So going by the book, I should have informed my patient about the pros and cons of tobacco. But I couldn’t stand by, in the role of a dispassionate educator, and let this man hurt himself. Instead, I felt compelled to give him advice that would promote his best interests.

I advised him to smoke. Then I turned to his wife. “I know that you are trying to keep your husband from smoking because you love him and don’t want him to get sicker, but those cigarettes aren’t going to hurt him now. If anything, they’ll help him relax.”

Medical decisions these days are increasingly recognized as being more than simply medical, with the right choice depending in part on the patient’s preferences. My duty as a physician, says Ubell is to improve my patients’ lives. And if I can do that by sharing my perspective with them, however strange or uncomfortable it may sound, then that is what I must do. Even if it means encouraging them to smoke.

This anecdote brought me back a few decades when my father was also at his end of life. He was in his room at Johns Hopkins Hospital for several weeks suffering from Chronic Obstructive Lung Disease [COPD]-after a lifetime of cigarette smoking-Lucky Strikes, unfiltered to keep the taste strong. Every breath was an effort. But he managed to breathe “better” while smoking, he said.

I was a resident physician at the hospital which made it easier to visit with him 3-4 times per day. Oxygen tanks for his oxygen treatments every 2 hours were in his room- so smoking and matches in his hospital room were out of the question.

My father understood this.

So when no one was looking-or he thought no one was looking-- he wheeled his chair into the visitors lounge. His engaging good nature always managed to get him a cigarette- from either a patient or guest. Today smoking is banned in offices and workplaces and even banned in many bars but those were the days when smoking was not banned even from hospitals.

He smoked in the hospital visitors’ lounge-but quickly put it out and hid it when nurses were close. One nurse whispered to me about his secret violations of the medical regimen and insisted that I stop his smoking or she would tell his pulmonologist who happened to be my boss.

What was I to do? Smoking is contra-indicated in everybody-especially those ravaged by the terrible effects of tobacco in the lungs. But was cessation of smoking now going to help him after 50 years of the habit resulting in death approaching in weeks if not days?

My duty as a physician is to improve patients’ lives. Moreover, like Ubell strange as it may sound, even if it means enabling them to smoke.

I made the same decision. In fact, I aided and abetted him by getting him an occasional cigarette and wheeling him to the outside deck of the Marburg floor where he could privately smoke in peace in the early Baltimore Spring.

He understood and was grateful. His eyes told me even though he would not say it for fear of incriminating me in the crime.

His pulmonologist also understood. He never mentioned anything about it to me.

My father died later that spring.

Does Cancer Screening Really Help All?

No evidence so far that it helps with certain cancers reports Robert W. Rebar, MD [Journal Watch General Medicine, 2009].

As much one would like to believe that early detection for all automatically leads to better care, that is not always the case. Although it is true that finding and treating cancer at an early stage will help in some cases — such as colon cancer and Pap smears that reduce deaths from cervical cancer — the data are less conclusive for at least three other cancers.

Ovarian carcinoma
Ovarian carcinoma is the leading cause of death from gynecologic malignancies in the U.S., reports Robert W. Rebar, MD largely because diagnosis usually is not made until disease is advanced.

In a study funded by the National Cancer Institute, of more than 30,000 women in the study’s screening arm who underwent at least one annual screen, 11.1% had at least one positive test result. The positive predictive value of the tests ranged from 1.0% to 1.3% during different screening rounds, and 4.7 to 6.2 cancers per 10,000 women were identified with screening. The ratio of surgeries to detected invasive ovarian cancer cases was 19.5 to 1.

Unfortunately 72% of cancers were late stage. Because the prevalence of ovarian cancer is low, false positives are numerous and screening leads to surgery for many women who do not have cancer. The benefits of screening will outweigh the harms seems unlikely.

Prostate cancer
In an op-ed in USA Today (4/23/09), Kevin Pho, MD, a primary-care physician in New Hampshire, questions whether "early screening" is "always in the patient's best interest." Dr. Pho cited two studies appearing in the New England Journal of Medicine that examine "the effects of prostate cancer screening."

In one study, "sponsored by the National Institutes of Health," researchers "found that such screening did not decrease deaths." Meanwhile, "the second study showed that for every death prevented, 50 men would suffer from over-diagnosis." To put the problem in context: Only 3% of men die from prostate cancer; 97% will die from something else.

Almost one-third of those treated for prostate cancer suffer from significant side effects, including impotence and urinary incontinence. Taken together, the study found that the benefit was minimal, and far from definitive.

Breast Cancer[see Part II in my series of article on Mammagraphy http://drperryhookman.blogspot.com/2009/05/mammography-different-after-age-65-full.html]

Dr. K.Pho notes that "similar issues influence breast cancer screening decisions" and that physicians "cannot be sure of which cancers are dangerous." As a result, "for every life saved from breast cancer, 10 more lives will be affected by" biopsy or breast surgery. He concludes, There cannot be a one-size-fits-all approach" to preventive care.Because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. For every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures.

Other cancers
The uncertainty surrounding tests is true of other cancers, including lung, skin (malignant melanoma), testicular and pancreatic (pancreatic adenocarcinoma), where little compelling evidence has shown that early screening is beneficial.

My opinion
The problem associated with these studies showing questionable or no benefit to a longer life for cancer victims is the statistics themselves. Statistics are still statistics and you are you. Some lives have been saved from early screening. But for every inspiring story of a person cured from cancer made possible by early detection, there are untold stories of many more who suffer from the side effects of unnecessary invasive procedures stemming from false positive test results.

But when only 1% of a certain population of 100 benefits that 1% may be you-and as far as you’re concerned you are 100% of the study.

Another example is that mammograms detect a number of slow-growing tumors that will never be harmful. But because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. Although it’s true that for every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures, yours may be the life that’s saved.

Unless you believe with Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who says, "I place considerable value on not suffering the side effects of treatment" and "death is not the only outcome that matters," you may choose not to undergo these uncertain screening procedures.

But at least you will be making an informed decision. As Dr. Pho states “patients must be better informed of the potential consequences either choice can bring.”

Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Farrah Fawcett Documentary

This Friday May 15 former "Charlie's Angels" actress Farrah Fawcett will appear on most NBC TV stations in her documentary about her terminal disease. Please be sure to see it. Fawcett has been working on this documentary, "A Wing and a Prayer," for NBC about her cancer battle. Ms Fawcett age, 62, received a diagnosis of anal cancer in 2006.

he American Cancer Society estimates that 5,000 new cases of anal cancer are diagnosed each year and about 680 people die from it annually. Meanwhile, colorectal cancer has 148,000 new cases and about 50,000 deaths each year. Anal cancer it treatable, but becomes more difficult to treat if tumor spreads Anal cancer affects more women and the illness is usually found in people who are in their early 60's.

What are the symptoms?

• More than half of anal cancer patients experience bleeding as a symptom. Others have no symptoms or report common conditions, such as “hemorrhoids, fissures, or warts.”

• Symptoms also include itching or pain in that area. The most common thing people think it's a hemorrhoid and unfortunately do nothing significant about it.

• changes in the diameter of stool,

• abnormal discharge,

The following stages are used to describe anal cancer:

In stage 0, abnormal cells are found in the innermost lining of the anus. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called “carcinoma in situ.” In stage I, cancer has formed and the tumor is 2 centimeters or smaller. In stage II, the tumor is larger than 2 centimeters. In stage IIIA, the tumor may be any size and has spread to either: lymph nodes near the rectum; or nearby organs, such as the vagina, urethra, and bladder. In stage IIIB, the tumor may be any size and has spread: to nearby organs and to lymph nodes.

In stage IV, the tumor may be any size and cancer may have spread to more distant lymph nodes or organs and has spread to distant parts of the body.
What are the risk factors for anal cancer?

• A suppressed immune system,[e.g.HIV, certain medications]
• HPV, [human papilloma virus], Thus getting vaccinated is a step in prevention.
• STDs [sexually transmitted disease]
• Being over 50 years old

People tend to view anal cancer negatively, because they associate the cancer with a few of its publicized risk factors -- such as sexually transmitted diseases or anal sex—but it is only one of the risk factors, not the only risk factors.

When anal cancer is caught early, chemotherapy and radiation are highly effective. But if the cancer doesn't respond to treatment and spreads to other areas of the body, the five-year survival rate plummets to less than 20 percent.


Please remember, as with all our articles we provide information, not medical advice.

For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.