Thursday, March 15, 2012

Another classic of untested medical "wisdom"

Heather Justice was just 25 when cervical cancer struck. To save her life, surgeons had to perform radical — and distressing — surgery to remove her womb and vagina, but unfortunately that wasn’t the end of her ordeal.

For Heather’s surgeon had been struck by the fact that hers was a particularly rare and aggressive type of cervical cancer only usually seen in post-menopausal women.

Further investigations led to the start of one of Britain’s longest-running and most shocking drug scandals. Heather, now 59, was the UK’s first confirmed case of DES-related injury.

DES, or diethylstilboestrol, was prescribed to pregnant women — including Heather’s mother Gladys — from the Fifties to the Seventies in the mistaken belief that it prevented miscarriage. Instead, it left behind a hidden legacy of damage to the foetus.

The drug is now making headlines in Britain because a leading American compensation lawyer, Aaron Levine, has announced that he plans to coordinate a UK-wide hunt for women like Heather Justice — ‘DES daughters’ — to launch a class-action claim.

Up to 300,000 Britons may have been exposed to the drug, but the vast majority will be unaware of this risk to their health. DES was discovered in 1938 by British researchers and developed as a cheap, super-strong form of the female hormone oestrogen.

It was given widely to women at risk of miscarrying, as it was thought to bolster their reproductive systems. But by the Fifties, studies showed DES did not improve the chance of a successful pregnancy. Then scientists found it could even be dangerous and might cause breast tumours.

However, GPs prescribed it until 1971, when the drug’s makers finally admitted it could have a profound impact on the health of those exposed to it in the womb — causing cancers and gynaecological abnormalities in women and testicular problems in men.

Heather’s mother, Gladys, was put on DES pills in the early Fifties because she had miscarried once, before becoming pregnant with Heather. No one thought any more of it until Heather was 25. She had just given birth to her second son and had a routine smear test.

‘They found something suspicious,’ she remembers. ‘Doctors did more tests and found I had a form of cervical cancer normally only seen in post-menopausal women.’

The cancer, called clear-cell adenocarcinoma, was so invasive that surgeons had to perform a hysterectomy and partial vaginectomy. Heather, a mother-of-two from Jarrow, Tyne & Wear, said: ‘I was only 25 — so young to be going through all of this. It was late December when the doctors discharged me, and my husband, David, wondered if they were letting me out to have one last Christmas.’

Instead, thanks to the doctors’ skill, Heather has been cancer-free for more than three decades. ‘The hysterectomy left me very ill and weak for three months,’ she says. ‘I felt lucky, however, that I’d had my two boys when I was so young. I needed a lot of help initially, but you can’t be ill for long with two under-fives around. If I hadn’t had my sons, I’d have been a lot more depressed.

‘My mother was quite upset about it, though. She did not want to have done anything to harm me. She was only doing what the doctor told her. Like me, she has always blamed the drug companies.’

It was only by chance that her surgeon, John Monahan, had worked with American experts who had discovered the link between her rare cervical cancer and maternal exposure to DES. Mr Monahan rang the hospital where Heather was born and got her mother’s case notes, which confirmed that Heather’s mother had been prescribed DES.

It was a rare find: NHS hospitals used to keep obstetric records for only 25 years before they were destroyed. The records of countless other DES victims’ mothers have been lost this way. But crucially — as is typical with the vast majority of surviving case notes — Gladys’s record does not say which company had made the drug she was prescribed.

DES was never patented in the UK. It was prescribed so casually that patients’ notes may record it only sketchily, if at all.

Since then, the results of this carefree attitude have become terribly evident. Studies show that DES daughters face a 40-times greater risk of cervical cancer. And up to a third have suffered some form of abnormality of the cervix, uterus or fallopian tubes, resulting in an increased risk of infertility, ectopic pregnancies, miscarriages and premature births.

Furthermore, DES daughters are 50 per cent more likely to start the menopause early and have an increased risk of auto-immune diseases such as lupus and rheumatoid arthritis. And DES was not only used on women as a ‘pregnancy wonder drug’. It was also given to pubescent girls who were predicted to grow ‘too tall’. It is estimated that tens of thousands in Europe, almost certainly including Britain, were treated this way from the Fifties to the beginning of the Seventies.

But again, medical note-keeping is too lax for anyone to be certain.

Many doctors at the time believed growing taller than 5ft 8in should be considered a medical malady in young women because their ‘gawky’ size would make it hard to find husbands.

The pills were supposed to propel girls through puberty faster, giving their bones less time to grow. In fact, no one knows if the drugs even had that effect because no proper follow-up studies were performed. Last year, Dr Emile Hendriks of the Erasmus Medical Centre, Rotterdam, studied 239 women in the Netherlands who had been left growth-stunted by DES.

Her research published in the Journal of Clinical Endocrinology & Metabolism found the women were 15 per cent less likely to have successfully become pregnant and around 20 per cent more likely to have stillborn babies than women not been given the drugs.

Tests showed women given DES as girls were almost three times as likely to have failing ovaries. And it is not just women who have been affected: boys whose mothers took the drug while pregnant are also likely to pay a heavy cost because it may also damage men’s fertility. It was used in 1944 as the first ‘chemical castration’ agent, forcibly given to rapists and other male sex offenders to kill their sex drives.

Studies in the U.S. show that the sons of women who took DES while carrying them have a higher risk of genital problems, such as undescended or underdeveloped testicles, cysts on the back of the testes and lowered sperm count. However, because of poor NHS record-keeping, thousands of potential victims may never know for sure that their problems with cancer and fertility were caused by DES.

But even when people in Britain have discovered their mothers took DES during pregnancy, they have not been able to seek compensation through UK courts. Under Britain’s legal system, each victim is required to sue the exact drug company that made their mother’s pills, even though their NHS notes do not identify them. Similar victims in the U.S. and Australia have won compensation because their countries’ legal systems do not demand this information.


Dying for a sausage? As yet another study says too much red meat could kill us, the truth is you needn't give up that juicy steak after all

I had Forfar Bridies (a meaty Scottish pasty) for dinner last night and cevapi (Yugoslav skinless sausage) for dinner the night before that. For tonight? Probably a Tandoori platter -- JR

Don't choke on your bacon buttie, but in the medical profession’s relentless quest to find ever more things that may kill us, health officials are turning up the heat on red meat — again.

A major new study of 120,000 people has shown that reducing the amount of beef, pork and lamb in our diet to 1½oz a day could prevent one in ten early deaths in men, and one in 13 premature deaths in women. The Harvard University findings are just the latest in a long line of studies suggesting that our love of juicy red meat is slowly killing us.

Some anti-cancer campaigners say the evidence is so damning we should avoid processed meat altogether. No crispy bacon for breakfast; no sausages on the barbecue; no ham sandwiches and no burgers topped with ketchup.

But other nutritionists say the risks are exaggerated and that cutting out red meat from our diets could do more harm than good.

So who’s right? And what is the confused cook supposed to eat?

The latest research found that eating one extra portion of steak, lamb or pork every day — about the size of a pack of cards — increased a person’s risk of dying from heart disease by 16 per cent, and raised their chance of developing a fatal cancer by 13 per cent.

Processed meats — such as hams, sausages and burgers — were more deadly. Adding two rashers of bacon or a sausage to breakfast increased the chance of premature death by 20 per cent. But how much red meat should we be eating?

The Department of Health recommends we all have no more than 2½oz (70g) of red meat a day. For example, that would be three sausages on a Monday, three slices of lamb on Tuesday, a quarter-pounder on Wednesday, a small steak on Thursday and fish or poultry over the next three days. But the Harvard authors say even that is too much.

This anti-bacon backlash will have surprised many meat lovers. After all, human beings have been happily devouring red meat for millennia.

Marks found on fossilised animal bones in Ethiopia show that one of our ancestors — the ape-like Australopithecus afaransis — was butchering antelope and cattle 3.4 million years ago.

Meat is a rich source of fat and protein, and many anthropologists believe mankind needed to switch to meat-eating to give us the nutrition essential to evolve bigger, smarter brains.

However, we shouldn’t follow the example of our ancestors too closely.

For much of human history, most people would have died from infectious disease, childbirth, injuries or malnutrition long before they had to worry about cancer and heart disease — illnesses of middle and old age. So our forebears could have eaten slabs of bison to their hearts’ content — something else would have killed them by the age of 30.

So what is it in red meat — and particularly processed meat — that is so harmful? The evidence is far from conclusive.

All types of red meat, whether processed or unprocessed, contain a form of iron called haem — the pigment that gives red meat its colour. Iron is an essential nutrient.

However, haem can also trigger the formation of a class of harmful chemicals called ‘nitroso compounds’ (NOCs) in the body and some types of these chemicals have been linked to bowel cancer.

Barbecued or chargrilled meat is thought to be particularly bad for us. For, when meat is charred, compounds called Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) are formed. Again these are thought to increase the risk of bowel cancer.

The worst type of meat is that which has been cooked and processed. These contain cancer-causing haem, HCAs and PAHs as well as preservatives called nitrates and nitrites, which also increase the risk of bowl cancer. However, the links between red meats and heart disease are less clear.

Some nutritionists believe the high doses of salt in processed food may be to blame. Professor Frank Hu of Harvard School of Public Health in Boston, author of the new research, blames the saturated fats in all red meat for clogging up arteries.

But not all nutritionists are convinced. Many believe the benefits of red meat are too often overlooked.

Laura Wyness, of the British Nutrition Foundation, says: ‘The evidence for an association between red meat consumption and risk of cardiovascular disease is inconclusive.

‘Although red meat contains saturated fat, it also provides nutrients that can protect against cardiovascular disease such as omega 3 fatty acids, unsaturated fats, B vitamins and selenium.’

In fact, red meat contains many nutrients such as selenium and vitamins D, B3 and B12.

Wyness warns that some of these are already in worryingly short supply in the diets of some sections of the population. Too little iron in the diet causes anaemia while zinc is essential for growth in childhood and fighting off infections.

Richard Young, of the Soil Association, believes British consumers should be careful when drawing conclusions from U.S. studies.

‘Not all red meat is the same,’ he said. ‘In America, most cattle are fed large amounts of grain. In Britain, the majority are fed on grass and that makes a big difference to the quality of the meat.”

In studies, grass-fed cattle have been shown to have higher levels of beneficial omega 3 fatty acids compared to grain-fed livestock — nutrients that can protect against heart disease.

The most recent data suggest that in Britain, most of us meet the guidelines laid out by the Department of Health. Men consume an average 2½oz (70g) of red meat each day while women eat 2oz (52g). However, a third of the population are still red meat gluttons, devouring more than 3½oz or 100g a day.

Jessica Harris, health information manager at Cancer Research UK, said the risks should be put in context.

‘The risks of smoking massively outweigh these risks,’ she said. ‘Red meat isn’t as important as being overweight or drinking alcohol. But that’s not to say it isn’t making a significant contribution.

‘Eating less red meat and processed meat doesn’t guarantee that you don’t get cancer, but it makes sense to control the things we can control.

‘We don’t want to be kill-joys and eating meat a few times a week isn’t likely to cause any great problems. But if people are having lots of processed meat and red meat every day, they should think twice.’

As the anti-red meat movement grows stronger, carnivores will inevitably feel their lifestyles are under threat. The Department of Health is under pressure to reduce its recommended red meat intake even further. But for some health campaigners, that won’t be enough.

How long before health campaigners lobby for laws which would ban children from burger bars, or before workplace canteens are ‘encouraged’ to phase out traditional breakfast fry-ups?

Smokers have already been forced out on to the streets. How soon before they are joined on the pavement by office workers clutching illicit bacon butties?


1 comment:

Wireless.Phil said...

DES, Prescribed between 50s and 70s?
Started in the 40s.
Guess I was lucky!

Diethylstilbestrol (DES, former BAN stilboestrol) is a synthetic nonsteroidal estrogen that was first synthesized in 1938.

It is also classified as an endocrine disruptor. Human exposure to DES occurred through diverse sources, such as dietary ingestion from supplemented cattle feed and medical treatment for certain conditions, including breast and prostate cancers. From about 1940 to 1970, DES was given to pregnant women in the mistaken belief it would reduce the risk of pregnancy complications and losses. In 1971, DES was shown to cause a rare vaginal tumor in girls and women who had been exposed to this drug in utero. The United States Food and Drug Administration subsequently withdrew DES from use in pregnant women. Follow-up studies have indicated DES also has the potential to cause a variety of significant adverse medical complications during the lifetimes of those exposed.[1] The United States National Cancer Institute recommends[2] women born to mothers who took DES undergo special medical exams on a regular basis to screen for complications as a result of the drug. Individuals who were exposed to DES during their mothers' pregnancies are commonly referred to as "DES daughters" and "DES sons".