Sunday, July 15, 2007

Israelis oppose HRT panic

The UK-based International Menopause Society (IMS), headed for the past two years by Israeli menopause specialist and Tel Aviv University (TAU) Professor Amos Pines, announced good news this month for women around the world: controversial estrogen replacement therapy in fact decreases the chances of heart disease among its users during the early postmenopausal period.

Research like this and continuing education on women's health issues are the mission of the IMS. It is this research and education, Pines suggests, that is in danger of being smothered in political issues.

An active member of the IMS for the past 12 years, Pines, a member of TAU's Sackler Faculty of Medicine, was voted in as IMS president for a three-year term by the society's board. It was his academic merit and enthusiasm for education on women's health that made him an obvious choice. A board of 12 international members voted him in.

One of the most meaningful and recent projects the IMS has undertaken is to reverse public opinion on the risks of hormone replacement therapy. After a 2002 Women's Health Initiative (WHI) study was published, more than half of menopausal women everywhere stopped using this effective anti-hot-flash and mood-balancing therapy prescribed by their doctors.

"Some people called it a tsunami," recalls Pines, "It was a catastrophic event in the history of menopause. And we were the only society to raise our voices against the new NIH guidelines. We believed that the interpretation of the study was not right and led to the wrong conclusions and misleading media coverage. Too many women stopped taking hormones and they suffered for no valid scientific reason."


Some good sense in the press release from Prof. Pines below:

Response to the Lancet paper on ovarian cancer in the Million Women Study

The Million Women Study (MWS) has reported new data on the risk of ovarian cancer in postmenopausal hormone users1. The study showed a 20% increase in risk when current users were compared with never users. No increase in risk was recorded in women using HRT for less than 5 years, and past users had the same risk as never users. Risk did not vary significantly with types of HRT.

While the data derived from the MWS are not much different from several other studies, such as the Nurses’ Health Study, the Women’s Health Initiative study did not show an increased risk of ovarian cancer2. The IMS would like to comment:

* Following the previous analysis of the MWS on breast and endometrial cancers, there were many reservations concerning the methodology and these are still pertinent

* Most epidemiologists would consider that a relative risk of 1.2 is of minimal clinical significance but will inevitably reach statistical significance with very large numbers.

* Risk is far better reported in absolute numbers rather than relative risk or percentage. The absolute risk for ovarian cancer in the MWS was only one extra case per 2500 women after 5 years and mortality was one per 3300 over 5 years.

It is most regrettable that the risks for all gynecological cancers have been added together to produce an estimated increase in risk of 62% for hormone users. Endometrial cancer should be prevented by combined hormone therapy, and adding percentages is inappropriate and will inevitably cause further unnecessary distress to the many women who are benefiting from HRT.

"Fat tax" proposal shows a severe case of imaginitis

Once you make unproven assuptions, all sorts of crazy conclusions are possible. More crazy epidemiology

A "fat tax" on salty, sugary and fatty foods could save thousands of lives each year, according to a study published on Thursday. Researchers at Oxford University say that charging Value Added Tax (VAT) at 17.5 percent on foods deemed to be unhealthy would cut consumer demand and reduce the number of heart attacks and strokes. The purchase tax is already levied on a small number of products such as potato crisps, ice cream, confectionery and chocolate biscuits, but most food is exempt.

The move could save an estimated 3,200 lives in Britain each year, according to the study in the Journal of Epidemiology and Community Health. "A well-designed and carefully-targeted fat tax could be a useful tool for reducing the burden of food-related disease," the study concluded. The team from Oxford's Department of Public Health said higher taxes have already been imposed on cigarettes and alcohol to encourage healthy living. They used a mathematical formula to estimate the effect of higher prices on the demand for foods such as pastries, cakes, cheese and butter.

However, they said their research only gave a rough guide to the number of lives that could be saved and said more work was needed to get an exact picture of how taxes could improve public health. Any "fat tax" might be seen as an attack on personal freedom and would weigh more heavily on poorer families, the study warned. A food tax would raise average weekly household bills by 4.6 percent or 67 pence per person.

Former Prime Minister Tony Blair has previously rejected the idea as an example of the "nanny state" that might push people away from healthy food.

The Food and Drink Federation has called the proposed tax patronizing and says it would hit low-income families hardest. It suggests that people eat a balanced diet. The British Heart Foundation said it does not support the tax. "We believe the government should focus on ensuring healthy foods are financially and geographically accessible to everyone," it said.


Laser improves corneal transplants

Patients who need sight-saving eye surgery could get their vision back more quickly and avoid infection with a revolutionary laser-surgery technique, surgeons say. Corneal graft surgery, one of the earliest forms of transplant operation, has been performed for more than 100 years without any fundamental changes to the methods used. But although the operation itself is fairly straightforward, recovery often takes a long time.

By using the latest technology designed for laser eye surgery, surgeons can now achieve a better fit for grafts, putting the pieces together like a jigsaw puzzle and helping to accelerate the healing process. Patients can recover perfect vision with or without their spectacles or contact lenses after about six months, roughly halving the recovery time.

The surgery involves the removal of the central part of the cornea, the clear front window of the eye, and its replacement with a corneal graft - about only 0.5mm thick - from a donor. Traditionally surgeons have done this under the microscope using a "cookie-cutter" knife, with the circular graft being secured to the eye with tiny stitches. But the latest femtosecond lasers can cut the cornea into a precise tongue-and-groove pattern to achieve a better fit with the graft, meaning that surgeons need to use fewer sutures and can remove them more quickly after the operation.

Each pulse of light from the lasers is extremely short, lasting only 50 to 1,000 femtoseconds (or quadrillionths of a second). These ultra-short pulses are too brief to transfer heat or shock to the material being cut, which means that extremely fine cuts can be made with no damage to surrounding tissue.

Previously, patients have had to attend regular check-ups for at least a year to ensure that the stitches did not slip out of place and allow bacteria to infect the eye. Sheraz Daya, an eye surgeon who has pioneered the use of the technique in Britain at the Centre for Sight clinic in East Grinstead, West Sussex, said that patients also recovered their sight more quickly than usual after the operation. Of six NHS and private patients whom Mr Daya has operated on using the technique, most recovered perfect vision after six months, he said, including two who now no longer need to wear spectacles.

He suggests that the lasers could be used in about half of the 2,500 corneal transplant operations carried out in Britain each year. "Rather than trying to attach the flat surface of the eye to a flat surface, with the femtosecond laser we can precisely cut the graft to fit on the eye, forming a stronger bond," Mr Daya told The Times. "This means fewer stitches are required, and they can be taken out after just a few months. Patients can cut down on the time off work and also recover their vision quicker, as it is usually fuzzy or misty in the affected eye until the cornea settles down. Most get an acceptable degree of vision back within three months, which becomes perfect by about six months." Dr Daya added that the new technique also reduced the chances of fragile cornea grafts being torn during the cutting process.

Larry Benjamin, honorary secretary of the Royal College of Ophthalmologists and an eye surgeon at Stoke Mandeville Hospital, in Buckinghamshire, said that the new technique could also avoid astigmatism, where the transplanted cornea becomes misshapen, producing blurred images, and may require further surgery.



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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