Chemotherapy fog a real problem

On an Internet chat room popular with breast cancer survivors, one thread - called "Where's My Remote?" - turns the mental fog known as chemo brain into a stand-up comedy act. One woman reported finding five unopened gallons of milk in her refrigerator and having no memory of buying the first four. A second had to ask her husband which toothbrush belonged to her. At a family celebration, one woman filled the water glasses with turkey gravy. Another could not remember how to carry over numbers when balancing the checkbook.

Once, women complaining of a constellation of symptoms after undergoing chemotherapy - including short-term memory loss, an inability to concentrate, difficulty retrieving words, trouble with multitasking and an overarching sense that they had lost their mental edge - were often sent home with a patronizing "There, there". But attitudes are changing as a result of a flurry of research and new attention to the after-effects of life-saving treatment. There is now widespread acknowledgment that patients with cognitive symptoms are not imagining things, and a growing number of oncologists are rushing to offer remedies, including stimulants commonly used for attention-deficit disorder and acupuncture.

"Until recently, oncologists would discount it, trivialize it, make patients feel it was all in their heads," said Dr. Daniel Silverman, a cancer researcher at the University of California, Los Angeles, who studies the cognitive side effects of chemotherapy. "Now there's enough literature, even if it's controversial, that not mentioning it as a possibility is either ignorant or an evasion of professional duty."

That shift matters to patients. "Chemo brain is part of the language now, and just to have it acknowledged makes a difference," said Anne Grant, 57, who owns a picture-framing business in New York City. Ms. Grant, who had high-dose chemotherapy and a bone marrow transplant in 1995, said she could not concentrate well enough to read, garbled her sentences and struggled with simple decisions like which socks to wear.

Virtually all cancer survivors who have had toxic treatments like chemotherapy experience short-term memory loss and difficulty concentrating during and shortly afterward, experts say. But a vast majority improve. About 15 percent, or roughly 360,000 of the nation's 2.4 million female breast cancer survivors, the group that has dominated research on cognitive side effects, remain distracted years later, according to some experts. And nobody knows what distinguishes this 15 percent.

Most oncologists agree that the culprits include very high doses of chemotherapy, like those in anticipation of a bone marrow transplant; the combination of chemotherapy and supplementary hormonal treatments, like tamoxifen or aromatase inhibitors that lower the amount of estrogen in women who have cancers fueled by female hormones; and early-onset cancer that catapults women in their 30s and 40s into menopause. Other clues come from studies too small to be considered definitive. One such study found a gene linked to Alzheimer's disease in cancer survivors with cognitive deficits. Another, using PET scans, found unusual activity in the part of the brain that controls short-term recall.

The central puzzle of chemo brain is that many of the symptoms can occur for reasons other than chemotherapy. Abrupt menopause, which often follows treatment, also leaves many women fuzzy-headed in a more extreme way than natural menopause, which unfolds slowly. Those cognitive issues are also features of depression and anxiety, which often accompany a cancer diagnosis. Similar effects are also caused by medications for nausea and pain.

Dr. Tim Ahles, one of the first American scientists to study cognitive side effects, acknowledges that studies have been too small and lacked adequate baseline data to isolate a cause. "So many factors affect cognitive function, and the kinds of cognitive problems associated with cancer treatment can be caused by many other things than chemotherapy," said Dr. Ahles, the director of neurocognitive research at Memorial Sloan-Kettering Cancer Center in New York. The new interest in chemo brain is, in effect, a testimony to enormous strides in the field. Patients who once would have died now live long enough to have cognitive side effects, just as survivors of childhood leukemia did many years ago, forcing new treatment protocols to avoid learning disabilities.

"A large number of people are living long and normal lives," said Dr. Patricia Ganz, an oncologist at U.C.L.A. who is one of the nation's first specialists in the late side effects of treatment. "It's no longer enough to cure them. We have to acknowledge the potential consequences and address them early on."

As researchers look for a cause, cancer survivors are trying to figure out how to get through the day by sharing their experiences, and by tapping expertise increasingly being offered online by Web sites like www.breastcancer.org and www.cancercare.org. There are "ask the experts" teleconferences, both live and archived, and fact sheets to download and show to a skeptical doctor. Message boards suggest sharpening the mind with Japanese sudoku puzzles or compensatory techniques devised to help victims of brain injury. There are even sweatshirts for sale saying "I Have Chemo Brain. What's Your Excuse?"

Studies of cognitive effects have overwhelmingly been conducted among breast cancer patients because they represent, by far, the largest group of cancer survivors and because they tend to be sophisticated advocates, challenging doctors and volunteering for research

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Top-level alarm over Ritalin in Australia

THE Iemma Government will launch an unprecedented statewide investigation into attention deficit hyperactivity disorder (ADHD), amid warnings that doctors are creating a Ritalin generation. Health Minister Reba Meagher has also called for a national inquiry into the issue, citing concerns among medical experts about the use of the controversial drug to treat ADHD. The move follows accusations by Judge Paul Conlon, revealed by The Daily Telegraph, that doctors had created a generation of Ritalin children now committing violent crimes and coming before the courts.

Last year there were more than 264,000 Ritalin prescriptions issued in Australia compared with 11,114 in 1992. Australia's diagnosis rate of ADHD is among the highest in the world and 32,000 NSW school children are now on medication for it. "Community concern is escalating around prescriptions and use of these types of drugs to treat conduct disorders of children," Ms Meagher said. In a speech to be delivered to the ALP Business Dialogue Health Policy Forum this morning, Ms Meagher will reveal that talks with health professionals had raised "significant debate" about the use of the drug. "But it was clear in my discussions with stakeholders that significant debate in the clinical community exists about treatment for attention deficit hyperactivity disorder," she said. "I have therefore established a review committee to carefully consider current practice in NSW public health services."

Spearheaded by the Clinical Excellence Commission, the committee will:

* COLLATE evidence and practice in the treatment of ADHD;

* ADVISE on the current development of clinical guidelines for treatment of ADHD and on treatment with the prescription of dexamphetamine, methylphenidate and atomoxetine; and

* ENSURE current practice considers appropriate clinical guidelines.

The review committee will comprise some of the state's top clinicians, including Clinical Excellence Commission chief Professor Clifford Hughes. It has been instructed to report to the minister within three months. Ms Meagher also backed federal Labor health spokeswoman Nicola Roxon's call for a national inquiry. "The availability and prescription of these drugs is largely a matter for the commonwealth so we believe this is best looked at at a national level," she said.

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Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.

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