tagged w/ The Lancet
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December 12th, 2010
07:15 PM ET
Uterine cancer screening effective, but not yet recommended
A diagnostic screening test may be able to detect with more than 80 percent accuracy the early warning signs of uterine cancer in postmenopausal women who show no symptoms, suggests a new study published Sunday in the journal The Lancet.
Researchers in the United Kingdom gave transvaginal ultrasounds to more than 37,000 women who had gone through menopause, and found a strong correlation between having certain abnormal levels of thickness in the uterine wall and a subsequent diagnosis of endometrial cancer.
Despite the promising results, researchers are hesitant to recommend the screening test for all women.
Endometrial cancer forms in the tissue lining the uterus and is the most common cancer of the female reproductive organs according to the American Cancer Society. Each year more than 43,000 women learn they have the condition, and there are nearly 8,000 deaths.
Currently in the U.S., yearly endometrial cancer screenings are recommended only for women who suffer from Lynch syndrome, a rare condition that puts people at increased risk for certain cancers.
The authors of the Lancet study conclude that even though their findings are of "immediate value" and show that an transvaginal ultrasound can detect endometrial cancer before symptoms appear in a high proportion of women, "there are a number of issues that need to be addressed before population screening for endometrial cancer can be proposed."
They note, for example, the possibility of false positives, which they say can be reduced by limiting the diagnostic test to women at high risk for the disease.
"These results are promising," says Robert Smith, director of cancer screening for the American Cancer Society. "But a decision to recommend screening is predicated on determining the right target group and making sure the early diagnostic really makes a difference with a minimal level of harm."
Smith says though routine screening is definitely worth thinking about more carefully, nearly 15 percent of women who undergo the transvaginal ultrasound may require further evaluation that won’t result in cancer, and he says biopsies are intense and expensive. He suggests, however, that if a physician is already doing transvaginal ultrasound for other purposes, then taking note of the endometrial thickness levels found in this study can be used as an indication that further evaluation is needed.
More than half of all endometrial cancer cases are diagnosed in women between ages 50 and 69, and the condition has a high survivability rate when detected early. However Smith notes many postmenopausal women receive a late diagnosis because they overlook a very important warning sign. "The American Cancer Society places a great deal of emphasis of being aware that postmenopausal bleeding is not normal and if it occurs, contact a doctor immediately," he advises.December 12th, 2010
07:15 PM ET
Uterine cancer screening effective, but not yet... more
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November 26th, 2010
09:08 AM ET
Secondhand smoke kills 600,000 worldwide annually
1 in 100 people around the world die from secondhand smoke each year, a new study reveals, and nearly two-thirds of the deaths occur in children.
Health officials have known that more than 1 billion people around the world smoke and 5 million people die each year from tobacco-related illness, according to the World Health Organization. That's about one person dying every six seconds.
But just how many people are sickened by secondhand smoke has been less clear, which led researchers to try to investigate how big the problem is. Based on 2004 data gathered from 192 countries, researchers estimate "as many as 40 percent of children, 35 percent of women, and 33 percent of men are regularly exposed to secondhand smoke indoors," according to a WHO study published in the British medical journal The Lancet.
"Tobacco use is one of the biggest public health threats the world has ever faced," says the WHO. More than 80 percent of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. The study authors estimate that 165,000 children under the age of 5 die each year from lower respiratory infections caused by second-hand smoke – and most of these deaths occur in Africa and south Asia.
Just two months ago, the Centers for Disease Control and Prevention released a report that found more than half of children in the United States, between ages 3 and 11 show signs in their blood of exposure to secondhand smoke. Previous studies have found that even extremely low levels of exposure to cigarette smoke produced detectable abnormal genetic activity in these cells.
The more than 1 billion smokers are exposing billions of non-smokers to one of the top indoor pollutants according to the WHO. Researchers believe more needs to be done to create complete smoke-free indoor environments at work, in public places and on public transportation. Jonathan Samet and Heather Wipfli, two leading public health experts from the University of Southern California say their research from 31 countries found that 88 percent of parents who smoked did so at home and that over 80 percent smoked near their children. In an accompanying commentary, they emphasize the need for smoke-free homes, which can help lower the number of people sickened and dying from someone else's smoke.
Wipfli and Samet say educating and empowering women can make a big difference is protecting children and non-smoking adults from the deadly effects of secondhand smoke. "Few sources of indoor air pollution can be completely eliminated. However, smoking indoors can be eliminated," they say.November 26th, 2010
09:08 AM ET
Secondhand smoke kills 600,000 worldwide annually... more
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By Brian Walker, CNN
June 20, 2010 3:59 a.m. EDT
Photo caption: A new study published in British medical journal The Lancet says that up to 77 million people in Bangladesh are being exposed to toxic levels of arsenic.
(CNN) -- It could be the worst mass poisoning in history. And the terrible irony is that it may all be due to an idealistic push to clean up drinking water for some of the world's poorest people.
A new study published in British medical journal The Lancet says that up to 77 million people in Bangladesh are being exposed to toxic levels of arsenic, potentially taking years or decades off their lives.
An international team of researchers from Chicago, New York and Bangladesh followed 12,000 people over the past decade, monitoring their arsenic intake and mortality rates from contaminated wells.
By the end of the study, one in five deaths were determined to be directly related to elevated arsenic levels in their system. Stretch that over the entire population that takes its water from wells, and the impact is daunting.
The problem has been known about for years, if not the overall deadly impact.
As far back as a decade ago, the World Health Organization called it "the largest mass poisoning of a population in history... beyond the accidents at Bhopal, India, in 1984, and Chernobyl, Ukraine, in 1986."
Well-meaning development groups had encouraged remote villages across Bangladesh to dig wells over the past decades, rather than rely on potentially contaminated surface water and dirty rivers. But now potentially a much worse problem has been found far below the surface.
Arsenic is a deadly poison with a history of use in intrigue and assassination. Some have even theorized that Napoleon Bonaparte succumbed to long term poisoning with the substance by his enemies while in exile on the island of St. Helena.
But the element and its derivatives are also used in many industries, such as metal smelting and as a component in products ranging from insecticide to micro-chips.
And unfortunately, it is also found in abundance in the soil and rock in Bangladesh. It's leached up through the water table in tens of millions of water wells across the country.
The study showed that the top quarter of those exposed had a 70 percent higher mortality rate than would be expected in the population as a whole.
The authors hope for more study, and a long term plan to deal with the damage already done. But a solution for those already poisoned may remain decades away.
Other long term health studies have shown it takes 20 years for the negative morbidity effects of arsenic poisoning to dissipate, even after they stopped using contaminated wells.By Brian Walker, CNN
June 20, 2010 3:59 a.m. EDT
Photo caption: A new study... more
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This guest post is a commentary from Dr. Sanjeev K. Sriram, MD, MPH a member of the National Physicians Alliance. This is a follow-up to his post about the decision by medical journal The Lancet to retract a controversial 1998 research paper suggesting a link between the MMR vaccine and autism.
My last post about the Lancet retracting Andrew Wakefield’s garbage article suggesting a link between MMR vaccines and autism got some interesting feedback. Some important comments were made about the vagueness of the metaphor I had drawn, so I felt I should clear the air.
Like many responsible pediatricians, I agree with an overwhelming body of scientific evidence that there is NO connection between any of the childhood vaccines and autism. For the parents of children with tough diagnoses, I empathize with the bewilderment they experience with the medical community’s apparent inconsistencies. Doctors seem to make miracles happen for many children, but we seem less capable with others. For pediatricians and child psychiatrists, there is still a lot to be discovered and learned about autism, learning disabilities, and other disorders. But in our determination to find answers, it is unacceptable to rush to quick and easy answers, and/or to perform sloppy work, all of which was the case for Andrew Wakefield.
In my last post, I referred to the “orchard” of the scientific and medical research establishment, and the “apples” of scientists and studies it produces. While the overwhelming majority of this orchard is producing great work, it is a very large establishment. Andrew Wakefield’s lapses of ethics and shoddy research methods demonstrate how there are places in the scientific community that could use more transparency and vigilant enforcement of basic ethical principles.
The scientific community does a disservice to struggling caregivers and families when research like Wakefield’s is published and then perpetuated. To me, the Lancet’s retraction is a day late and a buck short. Scientists who say one thing today and then reverse it tomorrow leave the public feeling dismayed. Parents who care for children with complex health problems have enough to worry about. They do not need their efforts and spirits to be burdened with distrust in their doctors and scientists. By restoring our commitment to integrity and standards of excellence, the scientific research establishment can make up for the damage wrought by Andrew Wakefield and his fellow “bad apples.”
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This guest post is a commentary from Dr. Sanjeev K. Sriram, MD, MPH a member of... more
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This guest post is a commentary from Dr. Sanjeev K. Sriram, MD, MPH a member of the National Physicians Alliance. Dr. Sriram is discussing the decision by medical journal The Lancet to retract a controversial 1998 research paper suggesting a link between the MMR vaccine and autism.
As a pediatrician and public health advocate, when I learned that the Lancet was finally retracting Andrew Wakefield’s bogus article that suggested a link between MMR vaccines and autism, I thought to myself, “Great, so we finally got rid of Wakefield’s bad apple, but what about the rest of the orchard?”
There is no doubt that Wakefield is one bad apple, and he must absolutely face the consequences for his disregard of basic ethics. According to the UK’s General Medical Council, Wakefield paid children 5 pounds at their birthday parties in exchange for their blood samples. By discrediting the old MMR, one of Wakefield’s side projects, a new vaccine he was inventing, would have made huge profits. The funding behind his “research” in the Lancet article was provided by a group of lawyers who just so happened to be suing the makers of MMR. These are more than just conflicts of interests, they are assaults on the trust between the general public and the scientific community. And for that, Wakefield deserves to have his medical license revoked, at the very least.
But I am weary of Wakefield becoming a scapegoat, which is often the result of too many authorities adopting the adage “one bad apple spoils the bunch.” Instead, I think we need to recognize that bad apples like Wakefield are the products of inattentive farming and inadequate sunlight in the medical-industrial research complex.
Though the scientific community may be frustrated every now and then by the mundane procedures of their institutional review boards (IRB’s), we need these ethics committees to be vigilant for the interests of patients and families. The pressure to produce profitable and popular answers to urgent questions is relentless. But in a world where the Supreme Court bestows corporations with the same rights as people, the scientific community must value the public’s trust above any individual researcher’s reputation, and above any industry’s revenue.
So in our justifiable criticism of Wakefield and the Lancet for their individual actions, I hope the medical establishment takes the time to realign its collective integrity.
This guest post is a commentary from Dr. Sanjeev K. Sriram, MD, MPH a... more
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An injection given to diabetics is more effective than leading anti-obesity drug Orlistat for weight loss, a new study has found.
The downside? The jab has to be given daily and a six month course will set you back £500. Saying that, just think how much money morbidly obese people will save on their grocery bills!An injection given to diabetics is more effective than leading anti-obesity drug... more
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