Thursday, June 14, 2007

Affluence does NOT give you skin cancer

Refreshing to see an epidemiological study that did NOT leap to the apparent conclusion. Even epidemiologists can think sometimes

Wealthier people are more than twice as likely to develop the deadliest form of skin cancer, research suggests. A study of more than 23,000 patients in Northern Ireland has shown a 20 per cent rise in patients suffering from skin cancer over a 12-year period. The research, published today in the British Journal of Dermatology, showed that women living in richer areas were 29 per cent more likely than people living in disadvantaged areas to suffer from basal cell carcinoma, and 2« times more likely to suffer from malignant melanoma, the most dangerous form of the disease. Men were 41 per cent more likely to suffer from basal cell carcinoma if they lived in an affluent area and 2« times more likely to suffer from malignant melanoma.

Every year there are estimated to be more than 100,000 cases of the more easily treated skin cancers in the UK, and just over 8,000 cases of malignant melanoma. The scientists, from the Royal Group of Hospitals and Queen's University Belfast, said that two explanations were most likely - that middle-class people took more holidays in sunny places, or were simply more likely to go for treatment when they developed suspicious-looking damage to their skin. Olivia Dolan, a co-author of the study and consultant dermatologist at the Royal Victoria Hospital, Belfast, said: "It's probably a combination of the two." Older people now developing skin cancers tend to be those from families who were rich enough to holiday overseas when they were young, when the skin is most vulnerable to such damage.

Analysis of the data, which came from the Northern Ireland Cancer Registry at Queen's University Belfast and covered the period from 1993 to 2004, indicated a 20 per cent increase in patients and a 62 per cent increase in skin cancer samples processed by pathology laboratories. Affluence did not seem to affect squamous cell carcinoma. This may be because numbers of this cancer were small, Dr Dolan said. She added that the results showed that skin cancer incidence was systematically underestimated, because only the first instance was recorded and many patients developed multiple cancers. "It would be very helpful if every cancer were recorded," she said.


A promising surgical development

WHICH would you prefer: a surgical procedure that left you in pain, incapacitated and scarred, or one that was virtually painless, involved no recovery time and left no visible scar at all? It may sound too good to be true, but a radical improvement in surgery is the promise held out by a new technique, called "natural-orifice translumenal endosurgery", or NOTES. Rather than operating on the abdomen by making incisions in the skin, it involves passing flexible instruments through the body's orifices and entering the abdomen from the inside.

One of the most widely studied approaches is "transgastric" surgery, in which the instruments are passed through the mouth and into the stomach. From there, the surgeon cuts a hole in the stomach wall to enter the abdominal cavity and perform the operation. Once it is complete the instruments, along with any removed tissue, are drawn back out through the stomach and mouth and the access incision is stitched up. Similar approaches involve entering through the rectum, the vagina and even the penis.

It may sound somewhat drastic, but the rationale for doing this goes well beyond the desire to avoid leaving a scar. NOTES could have many medical benefits over conventional surgery, and even over laparoscopic or "keyhole" surgery, in which the operation is performed via a small number of external incisions. NOTES could reduce the risk of post-operative infections. It does not require a general anaesthetic, making it an attractive option for the elderly or infirm.

Post-operative convalescence normally involves recovering from the access incisions made in the abdomen. NOTES should mean shorter recovery periods, since the stomach wall has relatively few pain receptors, says Paul Swain, an endosurgeon at Imperial College London who is one of the British pioneers of the technique. "Patients theoretically would be able to go back to work the next day, rather than taking a week or two off," says Lee Swanstrom, director of minimally invasive surgery at the Oregon Clinic in Portland, Oregon.

In recent months several surgical groups have reported early successes using NOTES to carry out procedures such as gall-bladder and cancer-tumour removals, and diagnoses of pancreatic cancer. In animals even more complex procedures have been demonstrated, such as fallopian-tube resections, organ-bypass procedures, reconstructive stomach-reduction procedures and even the draining of coronary arteries. Yet for NOTES to become as widespread and successful as traditional laparoscopic surgery, an arsenal of new surgical instruments will be needed. Answering this call, physicians and medical-device companies are falling over themselves to develop innovative new tools. "There's an explosion in patent filing in this area," says Dr Swain. "This is one of the great periods of medical innovation."

What makes NOTES so difficult is having to carry out surgery via a single and very narrow point of access. Open surgery doesn't have this problem, because the abdomen is laid bare to the surgeon, and even laparoscopic surgery involves placing at least three (and sometimes as many as five) separate instruments into the abdomen from different directions, through different incisions. This makes it possible to triangulate when cutting, sewing or manipulating tissue, says Eugene Chen, the boss of USGI Medical, a surgical-instruments firm based in San Clemente, California. "We have to create instruments that allow us to do the same thing," he says.

With NOTES, however, all the instruments have to be fed in parallel through a single orifice, and then through a single internal incision. This makes manipulating tissue much more difficult and also limits the surgeon's viewpoint. With existing instruments designed for gastro-intestinal procedures, the camera is attached to the same instrument tip as the grasping and cutting tools, which creates problems. "As soon as you have to move your instrument to grasp something, it changes your view," says Per-Ola Park, another pioneer of NOTES who is based at Sahlgrenska University Hospital in Gothenburg, Sweden.

Furthermore, surgical tools for NOTES need to be able to manipulate, cut and repair kinds of tissue that are very different from those normally found in the gastro-intestinal tract, says Kurt Bally of Ethicon Endo-Surgery, another surgical-tools firm, based in Cincinnati, Ohio. So Ethicon, USGI and other firms are developing entirely new instruments.

More here


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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