Sunday, August 31, 2008

The undead

Trapped inside their bodies, apparently switched off to the world, but still alive: they are the undead. Or so we thought. Forty per cent of patients in a `vegetative state' are misdiagnosed. Now British scientists are leading the field in trying to put that right

Kate Bainbridge is a lively 37-year-old former schoolteacher. We are communicating in the conservatory of her parents' home in south Cambridge. She has expressive eyes and a broad and ready smile, but she can utter only occasional single words with difficulty. She sits in a wheelchair "speaking" with the aid of a letter-board, using her left forefinger to spell out words individually.

Ten years ago, Kate went into a deep coma and was on a ventilator for several weeks. She had suffered severe brain inflammation after contracting a viral infection. When she came out of the coma, she opened her eyes and could breathe naturally, but she was unresponsive to speech and visual stimuli, and appeared to lack all conscious awareness. She was still in this condition four months after falling ill, and was later diagnosed to be in a persistent vegetative state, or PVS: in other words, persistently unaware. But the diagnosis was wrong.

Although Kate could not speak, or hear properly, or make any kind of signal, or take in sustenance except through a tube into the stomach, she was sometimes aware of herself and her surroundings. She had a raging thirst that was not alleviated by the ward staff. She was racked with pain. Sometimes she'd cry out, but the ward staff thought it was just a reflex action. Kate suffered so much pain and despair that she tried to take her own life by holding her breath.

Then a Cambridge neuroscientist called Dr Adrian Owen put her in a special kind of scanner and performed an unprecedented experiment. It revealed evidence of fluctuating levels of brain activation when she was presented with pictures of her parents. From that point, she started her long journey back into the world. This is a story about brain-impaired patients who come gradually out of coma into "minimal awareness" after being misdiagnosed as being in PVS: breathing, appearing to be wakeful, yet deemed to be dead to themselves and the world. It is also about the disastrous consequences of such misdiagnoses, estimated in the UK and other countries to be running at two in five cases. And, crucially, it is about a neuroscientific research programme that is set to transform the prospects of diagnosis, treatment and rehabilitation of brain-injured people the world over.

Only an estimated 20% of patients return, like the Top Gear presenter Richard Hammond after his car crash in September, to fully functioning normality after serious brain injury. The range of disability following brain damage is hugely varied in type and severity. It is not known how many PVS and minimally conscious patients there are in this country, since no central registry exists. It is likely, according to a canvass of many neurology professionals, to be in the tens of thousands. More certain is the grim reality of hospital wards and long-term care homes where the persistently vegetative and the minimally conscious languish, sometimes for decades.

To write this article I have had the sobering experience of witnessing the plight of patients with severely impaired consciousness - the intubations, the double incontinence, the stricken semicircle of wheelchairs parked before the unwatched day-room TV. And I have met the anguished families of those who are denied final grieving and closure for a loved one condemned to what appears a living death. All too often I have spoken to a wife or husband, or mother or father, who will travel anything up to two hours each way by taxi, every day, to spend time with an unresponsive child or spouse.

But here's at least one mordantly amusing and true story told to me by a psychologist at Putney's Royal Hospital for Neuro-disability. "Young man with motorbike head injury in a coma. His mum, a keen evangelical, comes every day with friends to sing Onward, Christian Soldiers by his bedside. She's hoping to stimulate his brain into action. It works: he comes round, but he can't speak. So they fit him up with one of those Stephen Hawking-type laptops, and the first words he speaks are: "For God's sake, Mum, shut it!" That's about as funny as it gets on a brain-injury ward, but there's a serious take-home message. Even minimally aware patients can retain emotions, personality, a capacity to suffer - and, as the young biker showed, attitude.

The biggest, most tragic clinical myth about brain injury today is that PVS can be reliably diagnosed by bedside observation alone. It has in fact been known for at least a decade, ever since a key survey of brain-injured patients, that misdiagnosis of the condition runs at more than 40%, a statistic originally calculated by Professor Keith Andrews, former head of the Putney hospital, and confirmed by recent surveys in Europe and North America. This means that valuable rehabilitation strategies are routinely neglected, and misdiagnosed patients end up on unsuitable wards or in care homes where their needs are neither understood nor met.

Up to 12,000 people under 40 in this country suffer traumatic brain injury every year, and there are serious deficiencies in their rehabilitation, according to Professor John Pickard, head of neurosurgery at Addenbrooke's hospital, Cambridge: "The tendency for patients to be left to languish on general medical, surgical and orthopaedic wards continues to their detriment." The shocking term being used by campaigning neurologists and neurosurgeons is that unknown numbers of patients are being just "warehoused".

Christine Simpson, a mother of two in her mid-fifties, and her husband, Colin, encountered the PVS misdiagnosis phenomenon two years ago. After suffering a brainstem stroke, Christine was first admitted to the intensive-care unit at the Princess Alexandra hospital, Harlow, then transferred to a general respiratory ward, where she remained for about a month.

"I was told that she would probably get a chest infection and not survive more than a few weeks," says Colin. "Even on the respiratory ward I was told she was still in coma, though she was communicating with me at times through her eye movements. Only because myself and our two grown-up sons were constantly at her bedside did she get proper attention. "On one occasion I found her lying flat with a deflated tracheotomy cuff. She was blue in the face and having difficulty breathing."

Other instances of poor care, Colin claims, involved a catheter bag infrequently changed, and a gastric tube not replaced routinely according to clinical guidelines. He also contends that Christine was prematurely discharged from intensive care as a result of the PVS misdiagnosis. His formal petition that the hospital has not done enough to resolve his complaints was upheld by the Healthcare Commission on November 9.

Much more here

Reading faces

PHYSIOGNOMY, the art or science of predicting inward character from outward form, has had its ups and downs over the years. A century ago, the idea that a person's character could be seen in his face was more or less taken as given. It then fell out of favour, along with the idea that behaviour is genetically determined, as Marxist ideas of the pliability and perfectibility of mankind became fashionable. Now, it is undergoing something of a revival. It has been found, for example, that women can predict a man's interest in infant children from his face. Trustworthiness also shows up, as does social dominance. The latest example comes from a paper just published in the Proceedings of the Royal Society by Justin Carre and Cheryl McCormick, of Brock University in Ontario, Canada. This suggests that in men, at least, it is also possible to look at someone's face and read his predisposition to aggression.

The thesis developed by Mr Carre and Dr McCormick is that aggressiveness is predictable from the ratio between the width of a person's face and its height. Their reason for suspecting this is that this ratio differs systematically between men and women (men have wider faces) and that the difference arises during puberty, when sex hormones are reshaping people's bodies. The cause seems to be exposure to testosterone, which is also known to make people aggressive. It seems reasonable, therefore, to predict a correlation between aggression and face shape.

To test their thesis, Mr Carre and Dr McCormick looked at the fine, old Canadian sport of ice hockey. This is, famously, not a gentle game. It is also a game in which the rules provide a plausible proxy for aggressiveness, namely the amount of time a player spends off the ice in the penalty box for such infringements as knocking his opponent's teeth out with a well-aimed stick.

The two researchers obtained photographs of several university and professional ice-hockey teams, and measured the facial ratios of the players. They also obtained those players' penalty records. Just as they expected, the wider a player's face, the more time he spent in the cooler.

Ice hockey, though, is mostly a man's game (women might argue that they are too sensible to get involved, although the Canadian ladies did win a gold medal at the last winter Olympics). To find out whether the theory was true for females as well, Mr Carre and Dr McCormick turned to that stock experimental subject, the university undergraduate. They recruited several dozen of both sexes and got them to play a game against what they thought was a person in another room but was actually a computer. Various measures of aggression taken during this game suggest that men are the same everywhere, be they students or sportsmen. Aggression was not, however, predictable in women students-or, at least, not from the shapes of their faces.

It seems, therefore, that facial ratio in men is a biologically honest signal of aggressiveness. Honest signals are those, such as luxuriantly feathered tails, that cannot be mimicked by individuals who would like the benefits without the costs. In the case of aggressiveness, the benefit to the aggressive individual is, paradoxically, that he will not have to get into fights in order to prove the point. The fear induced by his face should be enough by itself. At least, that is the hypothesis. The experiment to prove it has yet to be done.


Saturday, August 30, 2008

Britain: Regulating quack medicine makes me feel sick

If alternative remedies are either untested or ineffective, why are we promoting them?

It is fashionable to think things are true for no better reason than you wish it were so. The latest sign of this trend is a report to the Department of Health from Professor Michael Pittilo, Vice-Chancellor of the Robert Gordon University, Aberdeen. His May report - on acupuncture, herbal medicine, traditional Chinese medicine and the like - recommends that these therapies should have statutory regulation run by the Health Professions Council, and that entry for practitioners should "normally be through a bachelor degree with honours". Consultation is supposed to begin around now.

Both of the ideas in the report are disastrous. The first thing you wanted to know about any sort of medical treatment is: "Does it work?" One of the criteria that must be met by groups aspiring to regulation by the HPC is that they "practise based on evidence of efficacy". That evidence does not exist for herbal and Chinese medicine, which remain largely untested. For acupuncture the evidence does exist and it shows very clearly that acupuncture is no more than a theatrical placebo.

Placebos can, it is true, make you feel better; and if there is no better treatment, why not use them? That's fine, but it raises huge ethical questions about how much you can lie to patients, and how much you can lie to students who are training to use the placebos.

New Labour has often said that its policies are guided by the best scientific evidence, but the problem is that the answer you get depends on whom you ask. Pittilo's committee consisted of five acupuncturists, five herbalists and five representatives of traditional Chinese medicine (plus eleven observers). There was not a single scientist or statistician to help in the assessment of evidence. And it shows: the assessment of the evidence in the report was execrable.

Take one example, the use of a herbal preparation, Gingko biloba, for the treatment of dementia. On page 25 of the report we read: "There have been numerous in vitro and in vivo trials on herbal medicine... which have established the benefits of single ingredients such as gingko...for vascular dementia". That is totally out of date. The most prestigious source of reliable summaries of evidence, the Cochrane Collaboration, says: "There is no convincing evidence that Ginkgo biloba is efficacious for dementia and cognitive impairment". The NHS Complementary and Alternative Medicine Specialist Library (compiled by alternative medicine people) says: "The evidence that ginkgo has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unconvincing." Since then another large trial, funded by the Alzheimer's Society, concludes: "We found no evidence that a standard dose of high purity Ginkgo biloba confers benefit in mild-moderate dementia over six months."

The Government's answer to the problem is, as always, to set up more expensive quangos to regulate alternative medicine. That might work if the regulation was effective, but experience has shown it isn't. It makes no sense to regulate placebos, especially if you don't admit that is what they are. The Government should be warned by the case of chiropractors about the dangers of granting official recognition before the evidence is available. The General Chiropractic Council already has a status similar to that of the General Medical Council, despite it being based on the quasi-religious idea of "subluxations" that nobody can see or define. Recent research has shown it to be no more effective, and less safe, than conventional treatments that are much cheaper.

The problems that Professor Pittilo's recommendations pose for universities are even worse. You cannot have universities teaching, as science, early 19th-century vitalism, and how sticking needles into (imaginary) meridians rebalances the Qi so the body systems work harmoniously. To advocate that degrades the whole of science.

The vice-chancellors of the 16 or so universities who run such courses presumably do not themselves believe that vitalism is science, or subscribe to the view that "amethysts emit high yin energy", so it is hard to see why they accept taxpayers' money to teach such things. Thankfully, the University of Central Lancashire abandoned its first-year homoeopathy course this week because of low numbers.

Fortunately there is a much simpler, and probably much cheaper, solution than Pittilo's: enforce the laws that already exist. It is already illegal to sell contaminated and poisonous goods to the public. It is already illegal to sell goods that are not as described on the label. And, since May 2008, new European laws make it explicitly illegal to make claims for any sort of treatment when there is no reason to believe the claims are true. At the moment these laws are regularly and openly flouted on every hand. Enforce them and the problem is solved.


BOOK REVIEW of "Trick or Treatment" by Simon Singh and Edzard Ernst


When I was practicing medicine in the Elmhurst section of New York about five years ago, my colleagues and I confronted an epidemic of liver damage among the recently arrived Chinese immigrants who live there. We put these patients through an exhaustive battery of tests for conventional sources of hepatitis, the most likely culprit, but found none. The mysterious illness, we decided, must have been caused by the folk therapies, usually herbal, that our patients often used but rarely disclosed to their doctors. There was little we could do but counsel them to stop. Instead of following our professional advice, though, they usually just added new herbs to their regimen, hoping to solve their liver problems but sometimes making themselves even more ill.

The Elmhurst epidemic was a classic example of the clash -- both cultural and scientific -- between "alternative" and conventional medicine. In this case, the inability of doctors to treat a liver ailment strengthened the false faith of patients in other cures. Usually, alternative medicine is a harmless distraction. And some treatments actually do offer benefits. But going outside modern medical practice also carries dangers.

Luckily, hundreds of studies have examined the purported benefits of various alternative-medicine treatments. In "Trick or Treatment," Simon Singh and Dr. Edzard Ernst report on the results. Ginseng has been proposed as a cure-all for everything from cancer to common colds, but there's no evidence that it does any good. Shiatsu massage appears to be a "waste of effort and expense," the authors say. Many aspects of traditional Chinese medicine, like the use of the herbs aristolochia and liquorice, are potentially harmful. Aromatherapy can relieve stress, but there is not a lick of evidence that it can treat a specific illness. Chelation therapy -- a legitimate method of removing heavy metals such as lead or mercury from the body, but now pitched in alternative-medicine circles as a cure for heart disease and other ailments -- is "disproven, expensive, and dangerous," according to Mr. Singh and Dr. Ernst. They urge patients "not to use this treatment."

Some alternative remedies, it should be said, do appear to have value. There is evidence that St. John's Wort can help mild depression, although probably not as well as conventional antidepressants. Echinacea may be able to help relieve symptoms of the common cold, and perhaps reduce the length of illness, but so can many better understood conventional remedies that are sold over the counter. "It seems bizarre," the authors note, in light of the disappointing results, "that alternative treatments are touted as though they offer marvelous benefits."

Dr. Ernst is not a dispassionate observer. He is a pioneer in the field of complementary medicine -- a branch of the medical profession whose practitioners prescribe selective alternative treatments. But he is also a scourge of too-large claims made for his field. Based at the University of Exeter in England, he leads a research group that has spent 15 years studying alternative remedies, trying to separate snake oil from science. Mr. Singh, his co-author, is a science journalist whose books include "Fermat's Enigma" and "Big Bang." Together they conclude, after cataloging the evidence, that most of the popular forms of alternative medicine are "a throwback to the dark ages." Too many alternative practitioners, they say, are "uninterested in determining the safety and efficacy of their interventions."

And safety is a real concern. "Chiropractors who manipulate the neck can cause a stroke . . . some herbs can cause adverse reactions or can interfere with conventional drugs." The authors are particularly hard on homeopathy, the practice of using ultradilute solutions of common substances. The solutions are so dilute, though, that they are often little more than water. "Homeopathic remedies, which of course contain no active ingredient, can be dangerous if they delay or replace a more orthodox treatment," Mr. Singh and Dr. Ernst write, calling homeopathy "the worst therapy encountered so far -- it is an implausible therapy that has failed to prove itself after two centuries and some 200 clinical studies."

"Trick or Treatment" includes a brisk history of our evidence-based approach to medicine, tracing the development of the modern clinical trial from its earliest days, when scurvy was shown to be caused by insufficient vitamin C and bleeding was debunked as a medical cure. Unfortunately, the evidence of clinical trials is largely ignored when it comes to alternative medicine.

So the treatments persist: Americans spend an astonishing $3 billion annually on chiropractors and about $1.5 billion on homeopathy, not to mention billions more for herbal remedies. Government is complicit: Most states mandate health-insurance coverage for chiropractic visits, and many states direct insurers to cover the cost of acupuncture -- another remedy with far fewer benefits than are commonly claimed for it.

Why is there so much blind faith? Mr. Singh and Dr. Ernst blame media hype, celebrities and even certain doctors -- complementary-medicine doctors for shading facts but also, importantly, conventional doctors whose high-handedness breeds patient frustration, opening the door to the seductions of alternative medicine.

"Alternative medicine is not so much about the treatments we discuss in this book," the authors write, "but about the therapeutic relationship. Many alternative practitioners develop an excellent relationship with their patients that helps to maximize the placebo effect of an otherwise useless treatment." To bring all treatments in line with rigorous science, an "excellent relationship" between doctor and patient is a good place to start.


Friday, August 29, 2008

Aussie men eating more meat pies

Note for American readers: Most pies sold in Australia contain minced or cubed meat, not fruit. The meat pie is Australia's national food. I LOVE meat pies and eat them frequently -- both for breakfast and for dinner. They are FULL of salt and fat too! Yummy! They are so widely eaten in Australia (together with a lot of other fatty food such as sausage rolls) that they have to get some credit for the long lifespans that Australians characteritically have -- that is if we concede that diet has any effect on lifespans at all

DOWNTRODDEN blokes are biting back and sending meat pie sales soaring. One of Australia's biggest pie maker, Patties, has announced a 10 per cent jump in sales and says fed-up men are fuelling the surge. "Blokes are sick of being told what they can and can't eat," Patties marketing manager Mark Connolly said. "They've had a gutful of it and are going back to living by their own rules. "If they feel like having a pie and a few beers, they'll have a pie and a few beers."

Patties holds over half the Australian market for pies, sausage rolls and pasties. Its brands include Patties, Herbert Adams and the iconic Four'N Twenty range. The Melbourne-based firm reported an 8.6 per cent overall profit rise in the 2007-08 financial year. Pie sales were slightly down the year before, in a fall blamed on unusually hot weather.

The success of its blokiest brand, Four'N Twenty, follows an advertising campaign ridiculing salads. Mr Connolly called meat pies "the nearest thing we've got to a national cuisine". He said strong sales at supermarkets were matched by a 10 per cent jump at sporting venues, despite a constantly growing range of alternatives. "Pies keep selling and selling," Mr Connolly said. "At the end of the day they can't move the more trendy stuff."

Road worker Grant Dye said there was nothing better than a hot pie on a cold day. "A good meat pie is chunky and nice and tender," Mr Dye said. "It doesn't worry me what brand it is as long as it's nice and fresh."

Spotless, which caters for the Melbourne Cricket Ground, said pies were only one of a broad range of food options now, but remained a staple seller. Any growth in sales would reflect the growth in attendances, a spokeswoman said. "There are more people going to venues and more events held at the MCG. "If it is due to anything, it would be due to the increased patronage."

But Mr Connolly said tradition and tighter economic times were also factors. But it was more about manpower. "They're not that complicated. They just want to be left to their own devices," Mr Connolly said.


High cholesterol levels drop naturally in children on high-fat anti-seizure diet

Another confirmation of the unimportance of diet to serum cholesterol

Elevated cholesterol levels return to normal or near normal levels over time in four out of 10 children with uncontrollable epilepsy treated with the high-fat ketogenic diet, according to results of a Johns Hopkins Children's Center study reported in the Journal of Child Neurology. The study appears online ahead of print here.

In the four-year study, the Hopkins Children's team followed 121 epileptic children with intractable seizures on the high-fat, low-carbohydrate ketogenic diet designed to control such seizures. While most children developed high cholesterol after starting the diet, cholesterol gradually improved in nearly half of them, returning to normal or near-normal levels, with or without modifications to their diet to reduce fat intake.

In fact, researchers point out, diet modifications-including reducing total fat content or certain types of fats called saturated fats and adding nutritional supplements-reduced high cholesterol just as much as doing nothing. High cholesterol is defined as total cholesterol greater than 200 mg per deciliter of blood, bad or LDL (low-density lipoprotein) cholesterol greater than 130, triglycerides greater than 130, and good or HDL (high-density lipoprotein) lower than 35.

Researchers prescribed dietary modifications to increase "good," polyunsaturated fats in the diets of 15 children with elevated cholesterol. Dietary modifications decreased cholesterol by 20 percent in 9 out of the 15 (60 percent) children whose diets were modified. Surprisingly, cholesterol also dropped by at least 20 percent in 41 percent of the 37 children whose diets remained unchanged. The findings, while encouraging overall, also mean that relying on diet changes alone may not do much for those children in whom cholesterol remains persistently elevated, and that new approaches for these patients are needed, researchers say.

The findings should come as comforting news to pediatric neurologists, general pediatricians and parents of children treated with the ketogenic diet, and reassure them that, in most patients, increases in cholesterol may be short-lived, researchers say. Previous long-term studies by the Hopkins group of children who were on the diet between six and 12 years echoed these findings. The ketogenic diet, believed to work by triggering biochemical changes that eliminate seizure-provoking short-circuits in the brain's signaling system, is used in many children with hard-to-control epilepsy and in those whose seizures do not respond to traditional anticonvulsant medications.

"We are greatly encouraged by our findings because the nearly half of the children on the diet were either able to maintain healthy cholesterol or gradually metabolized the extra fat and returned to somewhat normal cholesterol levels," says senior investigator Eric Kossoff, M.D., a pediatric neurologist at Hopkins Children's. "This means the benefits of the diet-a diet that is lifesaving in many children and therapeutic in most of them-continue to outweigh the risks."

Noting that 40 percent of children maintained normal cholesterol even after starting the diet, researchers found that children fed a formula-based, liquid-only ketogenic diet were nearly three times less likely to develop high cholesterol. Researches attribute this finding to the nearly zero fat content in commonly used ketogenic diet formulas.

In the group with normal cholesterol, 78 percent of children (31 out of 40) were fed formula-based ketogenic diet. This finding, while requiring further study, points to another possible treatment for high cholesterol, Kossoff says, by switching children with persistently elevated cholesterol to formula-based ketogenic diets at least some of the time. The formula-based ketogenic diet contains only one-third the amount of saturated fats-the worst kind in terms of cholesterol-of the solid food version of the ketogenic diet. Because doctors can tweak the ratio of fat vs. carbohydrates depending on each child's severity of seizures, the investigators examined whether higher-fat versions of the ketogenic diet raised cholesterol additionally, but found that higher-fat ratio did not make cholesterol worse than a lower-fat ratio.

Some of the other findings:

One-fourth of 121 children had elevated total cholesterol before starting the diet, which increased to 60 percent (59 out of 99 children at follow-up) after the initiation of the diet.

18 percent (22 out of 119) had triglycerides over 130 before the diet, which increased to 51 percent (49 out of 96) after starting the diet.

19 percent (21 out 110) had bad cholesterol over 130 before the diet, which increased to 53 percent (48 out of 93) after starting the diet.


Thursday, August 28, 2008

Study suggests low-level arsenic exposure may be linked with Type 2 diabetes

Some reasonable caution in this report. Just a small personal note: As a result of past medical "wisdom", I am full of arsenic and yet I test out fine on diabetes tests.

A new analysis of government data is the first to link low-level arsenic exposure, possibly from drinking water, with Type 2 diabetes, researchers say. The study's limitations make more research necessary. And public water systems were on their way to meeting tougher U.S. arsenic standards as the data were collected. Still, the analysis of 788 adults' medical tests found a nearly fourfold increase in the risk of diabetes in people with low arsenic concentrations in their urine compared to people with even lower levels.

Previous research outside the United States has linked high levels of arsenic in drinking water with diabetes. It's the link at low levels that's new. The findings appear in Wednesday's Journal of the American Medical Association. "The good news is, this is preventable," said lead author Dr. Ana Navas-Acien of Johns Hopkins Bloomberg School of Public Health in Baltimore.

New safe drinking water standards may be needed if the findings are duplicated in future studies, Navas-Acien said. She said they've begun a new study of 4,000 people. Arsenic can get into drinking water naturally when minerals dissolve. It is also an industrial pollutant from coal burning and copper smelting. Utilities use filtration systems to get it out of drinking water.

Seafood also contains nontoxic organic arsenic. The researchers adjusted their analysis for signs of seafood intake and found that people with Type 2 diabetes had 26 percent higher inorganic arsenic levels than people without Type 2 diabetes. How arsenic could contribute to diabetes is unknown, but prior studies have found impaired insulin secretion in pancreas cells treated with an arsenic compound.

The policy implications of the new findings are unclear, said Molly Kile, an environmental health research scientist at the Harvard School of Public Health. Kile wrote an accompanying editorial in the journal. "Urinary arsenic reflects exposures from all routes - air, water and food - which makes it difficult to track the actual source of arsenic exposure let alone use the results from this study to establish drinking water standards," Kile said.

Also, the findings raise a chicken-and-egg problem, she said, since it's unknown whether diabetes changes the way people metabolize arsenic. It's possible that people with diabetes excrete more arsenic. The United States lowered arsenic standards for public water systems to 10 parts per billion in 2001 because of known cancer risks. Compliance was required by 2006, years after the study data were collected in 2003 and 2004.


Are You Sure You Want Fries With That?

Mandatory calorie counts cross the line between informing and nagging

In a 2007 survey of California voters, 84 percent said they thought the government should force restaurant chains to display calorie numbers on their menus and menu boards. That may happen soon: The state Assembly is considering a bill, already approved by the state Senate, that would make California the first state to impose such a menu mandate.

Yet the desires that people express in polls are often at odds with the preferences they reveal in the marketplace. The restaurant business is highly competitive. If customers really were clamoring for conspicuous calorie counts, restaurants would provide them voluntarily. A legal requirement is necessary not because consumers want impossible-to-ignore nutritional information but because, by and large, they don't.

Since they overestimate the demand for nutritional information, advocates of menu mandates also overestimate the impact of making it more visible. "Menu board labeling has the potential to dramatically alter the trajectory of the obesity epidemic in California," the California Center for Public Health Advocacy claims, projecting a weight loss of nearly three pounds a year per fast food consumer. The New York City Department of Health and Mental Hygiene, which began enforcing a calorie count requirement last month, predicts it will stop 150,000 people from becoming obese and prevent 30,000 cases of diabetes during the next five years.

Both estimates are based on a study conducted by New York's health department before the city's menu rule took effect. The researchers asked about 7,300 customers at fast food restaurants in the city whether they had seen and made use of nutritional information, which is typically displayed on posters, brochures, tray liners, or counter mats (as well as on the chains' websites). They also examined the customers' receipts so they could calculate the calorie content of the food they purchased.

The only chain where a substantial share of customers said they noticed nutritional information was Subway, where 32 percent reported seeing it, compared to 4 percent at the other chains. Since Subway promotes a subset of its menu as lower in calories and fat than its competitors' offerings, using a pitchman who lost hundreds of pounds while eating at the chain every day, this disparity is not surprising.

But even at Subway, calorie information seemed to make a difference for just one in eight customers. Of those who reported seeing the calorie information at Subway, 37 percent-12 percent of all Subway customers-said it affected their purchases. Subway customers who said they used calorie information bought about 100 fewer calories than those who said they didn't see it and those who said they saw it but didn't use it.

Notably, "there was no significant difference in mean calories purchased by patrons reporting seeing but not using calorie information and patrons who reported not seeing calorie information." In other words, simply making people aware of calorie content is not enough to affect their food choices.

The information's influence may be limited to people who are predisposed to count calories. If so, the impact of menu mandates will depend on the extent to which those people are not taking advantage of less obtrusive nutritional information already provided by restaurants.

The importance of pre-existing preferences also suggests that it's risky to extrapolate from Subway customers (who, given the chain's marketing, are probably especially weight-conscious) to fast food consumers in general. Another unresolved question is whether people compensate for fewer calories consumed at McDonald's or KFC by eating more at home or elsewhere.

Even if menu regulations don't make any difference on balance, Yale obesity researcher Kelly Brownell recently told the Los Angeles Times, "there's still the issue of the consumer's right to know." What about the consumer's right not to know? The same research that supporters of menu mandates like to cite indicates that most consumers prefer to avoid calorie counts, enjoying their food in blissful ignorance. There's a difference between informing people and nagging them.


Wonders of the human immune system: Blood of survivors of 1918 flu still protects against disease

Nearly a century after history's most lethal flu faded away, survivors' bloodstreams still carry super-potent protection against the 1918 virus, demonstrating the remarkable durability of the human immune system. Scientists tested the blood of 32 people aged 92 to 102 who were exposed to the 1918 pandemic flu and found antibodies that still roam the body looking to strangle the old flu strain. Researchers manipulated those antibodies into a vaccine and found that it kept alive all the mice they had injected with the killer flu, according to a study published online Sunday in the journal Nature.

There's no pressing need for a 1918 flu vaccine because the virus has long since mutated out of its deadly form and is extremely unlikely to be a threat anymore, experts said. What's more important in this research, they said, is that it confirms theories that our immune system has a steel-trap memory. "It's incredible. The Lord has blessed us with antibodies our whole lifetime," said study co-author Dr. Eric Altschuler at the University of Medicine and Dentistry in New Jersey. "What doesn't kill you, makes you stronger."

This is the longest that specific disease-fighting cells have lasted in people, said study lead author Dr. James Crowe, a professor of microbiology and immunology at Vanderbilt University Medical Center in Nashville, Tenn. But these antibodies don't just survive; they have mutated tremendously and now bind tighter to disease cells than other antibodies. That makes them more potent, he said.

Crowe said he hopes to use similar techniques to boost the potencies of vaccines that would be more useful now against newer bird flu strains that could become epidemics.

The 1918 flu killed about 50 million people worldwide and nearly everybody else was exposed to the virus, Crowe said. The specific 1918 virus was lost to the world for decades, until it was reconstructed about three years ago using genetic material from victims. When scientists tested the antibodies from survivors on infected mice, they did so in a high level biosecurity lab at the Centers for Disease Control and Prevention in Atlanta.

The idea for the new study came from an old TV show, said Altschuler. In an episode of the since-cancelled TV series "Medical Investigation," a town improbably gets infected with the 1918 flu and the doctors treat everyone with the reluctantly donated blood of an old butler who survived the original pandemic, he said.

That prompted Altschuler, a professor of rehabilitation medicine who doesn't normally study flu, to look into the idea of testing people more than 90 years old for antibodies. The National Institutes of Health, which paid for much of the study, connected Altschuler with experts in the field and he found the elderly antibody donors.

The findings make sense, said Dr. Anthony Fauci, director of the National Institute for Allergies and Infectious Diseases in Bethesda, Md., who wasn't involved with the study. Recent studies have estimated that the human immune system should last many decades, but this gives real proof, he said. "This is the mother of all immunological memory here," Fauci said.


Wednesday, August 27, 2008

Caesarean babies at risk of diabetes

The usual arrogance about assigning direction of causation below. That babies delivered by Caesarian are on average more sickly to start with is completely ignored. Fetal distress is a common reason for Caesarians

Babies delivered by Caesarean section have a significantly higher risk of developing diabetes in childhood than those born naturally, a study suggests. A review of 20 studies on children with type 1 diabetes found those delivered by Caesarean section had a 20 per cent increased risk of developing the condition. The rise in the number of children suffering from type 1 diabetes may be explained by the high rates of the procedure, the researchers say.

The finding adds to the body of evidence about the risks of Caesareans, which now account for nearly 25 per cent of deliveries in Britain. The rate recommended by the World Health Organisation is 10 to 15 per cent.

Jane Jimenez, 33, of Woodford Green, northeast London, had her daughter Lauren, now 5, by Caesarean section after struggling to give birth naturally. As a community paediatric nurse, Mrs Jimenez was quick to spot the first signs of type 1 diabetes. She was cautious about concluding that her daughter's condition was down to her delivery alone, "but perhaps that increased the chances", she said.

There is a strong genetic component to developing diabetes - as well as other known risk factors - but the link between delivery method and diabetes persisted even when these factors were taken into account. It is believed that exposure to bacteria during natural childbirth is key to the development of a child's immune system and that without such exposure a baby may be predisposed to illness - such as diabetes.


Living alone bad for you?

Hard to know what to make of the article below. In the absence of references to any specific research it is no more than an expression of opinion. That poor health may CAUSE isolation rather than isolation causing poor health seems not to be considered. Routine stupidity

RECENT research has discovered that living in isolation may be more destructive to your physical well-being than smoking cigarettes. Statistics proving that people who co-habit with others live longer than those who are alone have been around for several decades.

But the latest research takes this a step further. This doesn't mean that if you are happily enjoying the single life you're going to die prematurely, but it does make you think about life and love a little differently. Those who have survived conflict-laden relationships may well find it easier to take care of just themselves, and perhaps their children or pets. Dealing with another person's vicissitudes can be exhausting, especially if that individual gives you a hard time in the process.

However, if you enjoy sharing your life and bed with someone but also require your space, you need to get creative and discover some of the many ways to maintain your individuality and sanity while having a close relationship with another adult. Many couples not living together take nights off, where they have established safe boundaries that allow them to have their own time without making their partner feel insecure. Usually a phone call before the night off, followed by a catch-up conversation ("Did you sleep well?"), is enough to maintain a good connection.

If the person you love withdraws on a regular basis, and you have to go hunting for him or her, it could be time for a deep conversation. Those who sequester themselves away from even their closest loved ones may also be dealing with depression and/or anxiety. Somehow there's an illusion that being alone makes it all better.

Not everyone who chooses to be alone has a mood disorder, but if you are feeling a little blue you should get yourself checked out by a professional. Being disconnected from the rest of the human race may make you feel safe or empowered, but it's only temporary. We are social beings, and life is much more meaningful when you have someone to share it with


Birth control pill a miracle cure-all?

Drospirenone is a synthetic progestin with an action similar to the natural progesterone so the article below is a bit overblown. It does however seem to be an incremental improvement over other formulations

A new type of contraceptive pill that treats premenstrual tension as well as acne and weight gain will be available in Australia next week. The low-dose pill called YAZ will also reduce the length of a woman's monthly period. The hormone drospirenone used in the pill and a new regimen which has women using sugar pills for just four instead of seven days in their monthly cycle is the secret.

It is the first and only pill to be approved to treat a severe form of premenstrual tension called premenstrual dysphoric disorder (PMDD). Symptoms include pain, mood swings, depression and anxiety and decreased interest in daily activities.

Sydney gynaecologist Gabrielle Casper said the pill will also help women who have less severe premenstrual stress. "These are women who feel a little sad or anxious and the next day they get their period," Dr Casper said. She said the new pill is low dose, using just 20 micrograms of the oestrogen hormone compared to 30, 35 or 50 in many others on the market.

The hormone in it has a mild diuretic effect, preventing bloating and fluid retention. It also makes it less likely the testosterone in a woman's system will affect their skin, Dr Casper said.

Sexual Health and Family Planning Australia spokeswoman Dr Christine Read said the regimen, where women take 24 active pills instead of the usual 21, is what helps with premenstrual tension.


Tuesday, August 26, 2008

Polygamists live longer

The usual stupid causal inferences. That you might have to start out more robust in various ways to acquire and keep plural wives seems not to be considered. And the data have to be suspect anyway. All the really long-lived nations (Such as Australia, Japan and Finland) practice monogamy

Men with more than one wife live longer, a new study of longevity has found. Research published in New Scientist magazine found that polygamy may be the key to a long life, with men from polygamous cultures living 12 per cent longer those from monogamous ones.

A team from the University of Sheffield in the UK came to the conclusion after studying older men from 140 countries that practise polygamy to varying degrees and those from 49 mostly monogamous nations. The lead researcher, ecologist Virpi Lummaa, said the explanation could be both social and genetic. Men who continued fathering kids into their 60s and 70s could take better care of their bodies because they had mouths to feed, Dr Lummaa said.

But evolutionary forces acting over thousands of years could also account for longer-lived men in polygamous cultures, a conference in New York was told.


Articles in Prominent Medical Journal Doubt Worth and Benefit of HPV Vaccines

Note that there have been some pressures to make use of these vaccines compulsory for young girls (e.g. here). More "wisdom" from the health Fascists

The New England Journal of Medicine posted two articles this week that asked why two human papillomavirus vaccines have been so widely distributed given their unproven effectiveness and high costs. Gardasil by Merck Sharp & Dohme, which has already received tremendous criticism for the severe and fatal side-effects experienced by users, and Cervarix by GlaxoSmithKline were the two drugs called to question.

As reported by the New York Times, Dr. Charlotte J. Haug, editor of The Journal of the Norwegian Medical Association, whose editorial appeared in Thursday's issue of The New England Journal, said, "Despite great expectations and promising results of clinical trials, we still lack sufficient evidence of an effective vaccine against cervical cancer. With so many essential questions still unanswered, there is good reason to be cautious."

Both vaccines were tested for relatively short periods of time, revealed Dr. Haug, and researchers are yet to prove whether or not the vaccines offer lasting immunity and if a user's natural immunity to other strains not eliminated by the vaccines will be compromised. Dr. Haug said it is not certain if the protection offered by the vaccines will even lead to reduced rates of cervical cancer.

Jane J. Kim and Dr. Sue Goldie of Harvard, who likewise had a study published in this week's issue of the medical journal, also brought up the fact that the vaccines have not been proven to offer life-long protection. They said that until this is certain, the cost of the vaccines cannot be justified.

Furthermore, the costs of the vaccines cannot be offset by eliminating Pap smear screening because the test is still needed to identify HPV strands that the vaccines do not protect against.

These studies criticizing the effectiveness and cost of the HPV vaccines could not come at worse time for Merck - the drug giant is under fire because of a reported 9,749 cases of severe side-effects and 21 deaths associated with Gardasil.


Why Safe Kids Are Becoming Fat Kids

Just when we thought playgrounds were accident-proof -- no more merry-go-rounds, high slides, jungle gyms, seesaws or pretty much anything that's fun -- it turns out that safety itself can be dangerous. A recent heat wave in New York exposed a new playground risk: The ubiquitous rubber safety matting gets hot, not as hot as McDonald's coffee, but hot enough to scald tender feet. The outrage was immediate. "Playgrounds should be designed with canopies," one park- safety advocate declared. "How many burn cases will it take," Betsy Gotbaum, the city's public advocate asked, "before the city wakes up and acts?"

The headlong drive for safety has indeed created dangers, but not those identified by the safety zealots. Risk is important in child development. Allowing children to test their limits in unstructured play, according to the American Association of Pediatrics, "develop[s] their imagination, dexterity, and physical, cognitive, and emotional strength." Scrapes and bruises are how children learn their limits, and the need to take personal responsibility.

The harmful effects of our national safety obsession ripple outward into society. One in six children in America is obese, and many of them will face a lifetime of chronic illness. According to the Center for Disease Control, this problem would basically cure itself if children engaged in the informal outdoor activities that used to be normal. But how do we lure children off the sofa? One key attraction is risk.

Risk is fun, at least the moderate risks that were common in prior generations. An informal survey of children by the University of Toronto's Institute of Child Studies found that "merry-go-rounds . . . anecdotally the most hated piece of playground equipment in hospital emergency rooms -- topped the list of most desired bits of playground equipment." Those of us of a certain age can remember sprinting to get the contraption really moving. That was fun. And a lot of exercise.

America unfortunately is going in the opposite direction. There is nothing left in playgrounds that would attract the interest of a child over the age of four. Exercise in schools is carefully programmed, when it exists at all. Some schools have banned tag. Broward County, Fla., banned running at recess. (How else can we guard against a child falling down?) Little Leagues forbid sliding into base. Some towns ban sledding. High diving boards are history, and it's only a matter of time before all diving boards disappear.

Safety is meaningful only in the context of other benefits and risks. Safety always involves trade-offs -- of opportunities, of scarce resources and, especially in the case of children's play, of learning to manage risk. The question is whether the trade-off makes sense. Soft rubber matting will cushion any fall. This is probably a good thing, at least in situations where children may fall on their heads. But rubber matting also gets hot.

There's only one solution. Someone on behalf of society must be authorized to make these choices. Courts must honor those decisions. Otherwise, the pious accusations of safety fanatics, empowered by the nearly universal fear of being sued, will guarantee a cultural spiral downwards toward the lowest common denominator. For America's children today, that means spending more than six hours per day staring at a screen. Is that the way we want our children to grow up?

"A little common sense goes a long way," observed Adrian Benepe, New York City's parks commissioner. "Children should wear shoes. They're foolproof protection against hot surfaces." Shoes have undeniable virtues in an urban setting -- a small but useful lesson for young children.

I have an additional idea as well. Why not replant a few of the trees that were cut down, or radically pruned, in an effort to create a controlled play environment? The shade from the trees would keep the rubber matting a little cooler. Who knows, maybe we would even allow children to climb them.


Monday, August 25, 2008

Australian teens' risky drinking "linked to" infertility

But not shown to CAUSE infertility -- as Queensland's Nick Martin points out -- deflating a finger-wagging American puritan

Heavy drinking by females in their teens and 20s may reduce their chances of motherhood later in life, new research has found. Previous studies have linked teenage drinking with risky sex and early motherhood. Now a study of Australian twins has shown that alcoholism in women resulted in later childbearing. The study by Washington University's school of medicine analysed the drinking habits and reproductive histories of two groups of Australian twins, born before and after 1964.

Researchers found female alcoholics in both groups had children later in life - a trend not repeated in male alcoholics in the groups. In the first group, comprising people born before 1964, 64per cent of female alcoholics had children compared with 78per cent of other women. In the second group, 38per cent of alcohol-dependent women had children, compared with 49per cent of other women. The study confirmed increasing alcoholism in women. Only 4per cent of women met the criteria for alcohol-dependency in the group born before 1964, compared with 15per cent for the group born after. The study did not consider what amount of alcohol consumption affected fertility.

Lead researcher Mary Waldron, of Washington University, said the study, to be published in Alcoholism: Clinical And Experimental Research in November, served as a warning against excessive alcohol consumption. Previous research examined risks to teens or adults but not both, Professor Waldron said. "Our findings highlight a risk associated with [alcohol dependence] in women that is not widely recognised - a risk that has assumed increasing importance given the increased rates of alcohol misuse by women, and particularly young women. "Young women who drink alcohol may want to consider the longer-term consequences for later childbearing. "If drinking continues or increases to levels of problem use, their ability and opportunity to have children may be impaired."

Nick Martin, a professor at Queensland Institute of Medical Research who took part in the study, said the links between alcohol and fertility were not conclusive. "This was about women with persistent drinking problems," Professor Martin said. "The observation is that they will have less reproduction and delayed reproduction. "While the affect may be hormonal, women with alcohol-dependency probably don't make good partners - that's another possible explanation. I think we have to consider the direct behavioural consequences of alcohol too."


Medical experts expose ADHD misdiagnoses

Two of Australia's most senior medical experts have blown the whistle on the misdiagnosis of ADHD, with at least one in three children wrongly diagnosed with the condition.

The alarming figure comes as a leading psychologist warned there was no evidence of the long-term benefits of medication such as Ritalin. Dr Jon Jureidini told The Daily Telegraph yesterday that the misdiagnosis figure could even be higher, with some children with learning difficulties wrongly prescribed drugs for Attention Deficit Hyperactive Disorder. Dr Jureidini is among a group of experts who have made powerful submissions to the Federal Government's ADHD review panel, which will rewrite guidelines for the diagnosis of the condition.

His warning comes at the same time as a push to ban GPs from diagnosing attention deficit hyperactivity disorder. Some child education experts are concerned doctors are "too readily" labelling children with ADHD and prescribing Ritalin, potentially putting them at risk of dangerous side effects. In their submission, a group of 14 academics has called for multi-disciplinary teams of psychologists, doctors and experts to replace GPs and have sole responsibility for diagnosing the condition. The influential group, from seven universities, including the University of Sydney and the University of Wollongong, has also urged the Federal Government not to declare ADHD a "disability" and allocate special funding for schools based on the number of students suffering it.

A similar move in the US led to an explosion of 600 per cent in the diagnosis, or misdiagnosis, of ADHD as schools competed for the extra grants, the group said. "It is a diagnosis that should not be used in anything other than a tiny fraction of cases in which it is made," Dr Jureidini, head of the Department of Psychological Medicine at Adelaide's Women's and Children's Hospital, said.

The Royal Australasian College of Physicians, which is reviewing the outdated guidelines at the request of the National Health and Medical Research Council, has been accused of taking too narrow a view. Dr Jureidini said that about 30 per cent of boys and girls diagnosed with ADHD do not even meet the current diagnostic criteria, which includes being inattentive and easily distracted. He said up to 90 per cent of those diagnosed would be better off with other treatment.

Two of the RACP's controversial draft recommendations include education programs for teachers on dealing with ADHD pupils and special funding for schools with ADHD students. The group of academics said this would mean children with significant disabilities, including cerebral palsy and autism, would miss out on funding and teaching time.

One of the group, Trevor Parmenter, foundation professor in developmental disability studies in the faculties of education and medicine at Sydney University, said ADHD was too complex to be diagnosed in a GP's office. "It is a very complex issue that goes beyond the symptomology," he said. "If a child has been diagnosed with ADHD, a teacher may think they should be put in a special class. They could be disadvantaged." He said too many children were being diagnosed with ADHD by lazy doctors who did not properly investigate the child's problems.


Why I refused to let my child be weighed

The British government's fat-headed policy on obesity should be boycotted

It appears my wife and I have upset the Government, as part of the small minority of parents who refused to have our 11-year-old child weighed and measured in school last term. The authorities worry that it was the parents of fat children who opted out. Or it could have been parents like us, who object to being conscripted into a fat-headed crusade against child obesity that is heavy on political intrusion and light on proven effectiveness.

Letters are to be sent to parents whose children were weighed, giving a "mark" ranging from "underweight" through "healthy weight" to "very overweight". There has been a predictable PC-gone-mad reaction to the Department of Health's predictably stupid decision to drop the word "obese". But whatever words they use, the message is clear: that the authorities have the right to decide whether or not our children are living "healthy lives". They want to measure not only body mass but moral worth, to decide whether our children fit the State's model. The most likely results will be to produce miserable kids and anxious parents.

Despite overegged talk of a child obesity "epidemic", the real extent, causes and health consequences of children being overweight remain uncertain. What is more certain is the lack of hard evidence that campaigns of intervention in school or family life have any beneficial effects. But whatever the intentions, they do single out kids for more pressure, harassment and ridicule - which is all that our body-conscious pre-teens need.

Yet the authorities throw their substantial weight behind every stunt from policing lunchboxes to weighing children like little piggies. At a time when governments have lowered horizons from creating the Good Society to moulding the Healthy Citizen, the anti-obesity crusade legitimises public monitoring of private behaviour. Ours is an age when bullies can no longer call children fatty in the playground. Yet it is deemed legitimate for government to bully them and their parents, using obesity as a bogeyman in scary stories about how we are killing our kids.

It will be a joyless world for children if we turn the pleasures of food, drink and play into problems of "healthy living". At the Museum of London yesterday, my daughters learnt about the statue Fat Boy of Pie Corner, erected where the Great Fire of 1666 ended to warn Londoners that it was caused by "the sin of gluttony". Today the pious warn us about our unhealthy lifestyles rather than our sins. Back home, the children borrowed a neighbour's Wii Fit game. The first thing it does is decide whether you are ideal, overweight or obese. What fun!


Sunday, August 24, 2008

Australia: Couple flee to avoid compulsory medical treatment

Another case of DOCS (child welfare agency) harassing good parents over minor infractions while ignoring feral parents. Decent people are a lot easier to deal with, you see.

And the record of compulsory medical treatment is not at all good. The medical wisdom of today is often the iatrogenic disaster of tomorrow. Take the example of compulsory blood transfusions for Jehovah's Witnesses. It was eventually discovered that JWs had a higher survival rate WITHOUT transfusions than did people who got transfusions. As a result, use of transfusions is now much more guarded than it once was.

Fear of vaccines is widespread and objections to it should be regarded as a basic civil liberty in my view. How would YOU like people coming and injecting into you something you did not want? I myself know of no proven harm done by vaccines but people should be allowed to make up their own minds in such a contested area. I have myself had Hep B vaccinations

A Sydney couple are in hiding after the Department of Community Services (DoCS) took out a court order to have their three-day-old boy vaccinated against hepatitis B. The parents, from Croydon Park, fled their home on Thursday to avoid police and DoCS officers after refusing to have their son vaccinated at Royal Prince Alfred Hospital. They told Fairfax newspapers they believe aluminium in the vaccine can cause him more damage than contracting the disease.

The infant's mother, who is from China, was diagnosed with hepatitis B several years ago, but both parents believe the illness, which can cause liver cancer and cirrhosis, can be managed more effectively than any potential neurological damage from the vaccine.

Vaccinations are not compulsory in Australia but it is NSW Health policy that babies born to hepatitis-B mothers are given the immunoglobulin within 12 hours of birth. The treatment is followed up with four more doses of the vaccine over six months.

The father, a financial adviser, is seeking an injunction against the court order. He told Fairfax doctors and midwives on the post-natal ward told him he and his wife would be arrested and they would lose custody of their child if he left the hospital without being vaccinated.

The Supreme Court order, obtained by DoCS, states the baby must be vaccinated by midnight on Thursday but the father is adamant they will stay on the run indefinitely.


Australia: Crooked medical journal

Refuses to print urgent warning to save embarassing medical bureaucrats

A taxpayer-funded medical journal has been accused of suppressing criticisms of flaws in patient medicine handouts that could have fatal consequences for thousands of Australians. The criticisms in a paper by five medical specialists reveal that alleged problems with the official advice for the drugs Cortate and Hysone are still unresolved, more than a year after the concerns were first publicised.

In the case of Cortate -- like Hysone an essential treatment for people with Addison's disease and some other hormonal conditions -- the consumer medicine information (CMI) handouts still advise patients not to take the drug if they have an uncontrolled infection. The paper by the five specialists says this is "dangerously incorrect" and patients taking the drug in fact need to double or even treble their dose to avoid serious illness. "If followed, such advice could lead to life-threatening consequences within 24-36 hours for some thousands of Australians who depend on glucocorticoid replacement," the paper says.

But the journal Australian Prescriber, part of the government-funded National Prescribing Service, faces claims it "nobbled" attempts to alert medical experts to the issue "to avoid a few red faces in Canberra", after it refused to publish the paper. The journal and its editor, John Dowden, may also face accusations they breached internationally accepted publishing procedures, by allegedly sending the five experts' paper to the Therapeutic Goods Administration for comment before the journal had decided whether to accept it. The TGA not only has ultimate responsibility to ensure CMI leaflets are accurate, it is entirely funded by fees charged to drug manufacturers.

In its response to Australian Prescriber, the TGA's national manager Rohan Hammett said a "careful review" of the CMI should allay any concerns over misinformation. The advice in Cortate's CMI regarding infections was not misleading, Dr Hammett said, because this appeared beneath a sub-heading "Before you take Cortate" -- which Dr Hammett said indicated it was only relevant to patients starting the drug, not those already on it.

The lead author of the rejected paper, Jim Stockigt -- a professor of medicine at Monash University -- said the approach of Australian Prescriber had been "amazing", and the journal had "fought tooth and nail to prevent dissemination" of concerns. "It's my feeling that this submission may have been suppressed or nobbled to avoid a few red faces in Canberra and to preserve the impression that all is well with Australian pharmaceutical product and consumer medicine information," Professor Stockigt said. "For those who depend on adrenal replacement for their survival, it is simply dangerous nonsense for the advice 'Do not take Cortate if you have an uncontrolled infection' to remain on the books."

In a letter to Professor Stockigt, Dr Dowden said the paper had been rejected because it was referring to letters printed in other publications a year earlier, it was not related to an article in Australian Prescriber, it was too long, allegations were included in the paper and an "external review did not support all the interpretations made in the correspondence".

After the paper's rejection Professor Stockigt consulted the British-based Committee on Publication Ethics for its views on Australian Prescriber's actions. The COPE's chairman, Harvey Marcovitch, replied that Australian Prescriber had either breached confidentiality by sending the paper to the TGA or, alternatively, the journal had "breached fundamental rules on the potential conflict of interest of reviewers".

A spokesman for Australian Prescriber said the journal had "robust and ethical editorial processes". "The decision not to publish in this case was made by the editorial executive committee and a full explanation was given to the authors," the spokesman said. "The committee stands by this decision."


Cholesterol drug linked to cancer deaths

A cholesterol lowering drug may increase the risk of cancer, according to new findings. The drug called Inegy is taken by thousands of people in the UK and the drug regulator is studying research which has linked to indicated a link to increased cancers and deaths from cancer. It is a combination of the statin simvastatin and ezetimibe for use in patients whose cholesterol cannot be controlled by one drug alone. Just under 300,000 prescriptions were dispensed for Inergy in the last two years in England and Wales, official figures show.

The American Food and Drug Administration issued a statement saying preliminary findings from a study has shown found the drug did not reduce cardiovascular problems as expected and a larger percentage of patients on the drug were diagnosed with and died from all types of cancer than those on the placebo during the five year study.

The FDA did not say how big the alleged increased risk of cancer was and said is not advising that patients should come off the drug nor that doctors should stop prescribing it. Its statement said other trials have shown no increased risk of cancer in patients using the drug. The final report from the trial should be available to the FDA in three months and it expects the analysis to take further six months after that.

A spokesman for the Medicines and Healthcare Products Regulatory Agency in the UK, said: "The MHRA is aware of the issue. Any regulatory action that may be necessary to minimise harm to patients will be taken once the new information has been carefully reviewed."

A statement from the makers of the drug Merck and Schering-Plough said the finding was likely to be an "anomaly". It said: "Based on the information presented by the study investigator and the analyses conducted independently by the University of Oxford Clinical Trial Service Unit and Epidemiological Studies Unit, MSP believes the cancer finding is likely to be an anomaly that, taken in the light of all the available data, does not support an association with Vytorin (also known as Inegy). "We are committed to working with regulatory agencies to further evaluate the available data and interpretations of those data; we do not believe that changes in the clinical use of Vytorin are warranted. Of course, patients taking Vytorin should talk to their doctor if they have questions."


Saturday, August 23, 2008

HRT 'boosts quality of life'

Nice to see an admission of how vanishingly small any risk is

Six years after widespread panic about hormone replacement therapy causing cancer and strokes, research suggests it improves quality of life. One of the world's longest and largest trials of hormone replacement therapy has found it can improve sleep, sexuality and joint pain in post-menopausal women. Published today by the British Medical Journal, the results are from a study by the WISDOM research team (Women's international study of long duration oestrogen after menopause). The study involved 2130 post-menopausal women in Britain, Australia and New Zealand, and assessed the impact of combined oestrogen and progestogen hormone therapy on the quality of life.

The average age of women in the study was 63, and 70 per cent of participants did not have menopausal symptoms of hot flushes and night sweats. University of Adelaide obstetrics and gynaecology Professor Alastair MacLennan, who led the Australian arm of the research, said the results were interesting but he was not recommending that women with no symptoms use HRT. "Our results show that hot flushes, night sweats, sleeplessness and joint pains were less common in women on HRT in this age group," he said yesterday. "Sexuality was also improved. Overall, quality of life measures improved. Even when women did not have hot flushes and were well past menopause, there was a small but measurable improvement in quality of life and a noted improvement in sleep, sexuality and joint pains."

Professor MacLennan said studies such as those conducted by WISDOM enabled the risks of HRT to be reduced and benefits maximised when the treatment was tailored to the individual. Early side effects could usually be eased by adjusting the treatment, he said. For most women with significant menopausal symptoms, the benefits of HRT outweigh the risks.

In 2002, an eight-year HRT trial was stopped after five years because researchers concluded the risks were too great, with evidence of more cancers and strokes. The news caused women around the world to abandon HRT, with Australian women reacting more strongly than most. In Europe, about 5 per cent of women stopped treatment, compared with up to 40 per cent in Australia, although many have since returned.

Professor MacLennan said the most recent analyses of the main long-term randomised control trial of HRT - the Women's Health Initiative - showed breast cancer incidence did not increase with oestrogen-only HRT and was only increased in women using combined oestrogen and progestogen HRT after seven years of use. This increased risk was less than 0.1 per cent [That's one tenth of one percent] per year of use. If a woman feels that HRT is needed for quality of life, then doctors can find the safest regimen for her, Professor MacLennan said. She can try going off HRT every four to five years, and can then make an informed choice about whether she takes and continues HRT.

The WISDOM research is independent of the pharmaceutical industry and has been funded by UK, Australian and New Zealand government research bodies. Australian Medical Association state president Dr Peter Ford said women should weigh up the known risks and benefits of HRT. Those with acute menopausal symptoms could gain considerable relief from the therapy. When people are really in distress from those symptoms, its a godsend, quite frankly, to be able to offer it, he said.


A disgusting example of `junk television'

BBC3 has given us yet another helping of mechanically-generated TV designed to scare us about what we eat.

Cheap food is often not very good. Sometimes it might look the part, but the content is frequently sickly and leaves a nasty taste in the mouth. How appropriate, then, that a programme `revealing' this fact should have been shown on BBC3 - the Beeb's yoof TV channel which produces documentaries that seem like a tasty treat on the outside but are actually stuffed with crap.

Britain's Really Disgusting Foods, presented by the mildly amusing Alex Riley, was the search for the worst thing you could eat that is legally available in shops. Riley has thick, black-rimmed glasses and could probably do with a haircut. He looks like a dork and has a vaguely northern accent, but his management calls him `tall, sleek and unconventionally handsome'. Whatever.

He went in search of foods that had the most `stuff' added to them. Unsurprisingly, this didn't mean organic parsnips, but the kind of food churned out by big food processors and sold in your local cash-and-carry.

His first target was something called `cheese alternative'. This is an `analogue', a substance that contains some of the qualities of cheese - it even contains some skimmed milk - but isn't actually produced in the same way as cheese. Instead, it is created by the block load to pad out cheap supermarket food and takeaway pizzas and is packed full of `E' numbers - that is, artificial additives. And it doesn't taste of anything very much, never mind cheese.

If the `cheese' is full of additives, the chicken breasts are full of water. Riley managed to find some in his local Booker cash-and-carry store (yes, bizarrely, it is the same Booker that sponsors Britain's most famous literary prize) which contained just 60 per cent chicken and lots of water. You won't find chicken breasts like this in the local supermarket, but you might find them in your restaurant-bought chicken fried rice or chicken vindaloo. A trader in Smithfield, London's main meat market, told Britain's Really Disgusting Foods that chicken breasts stuffed full of water are popular with Chinese and Indian takeaways.

Another unsurprising target were sausages. They're absolutely full of rubbish, right? Well, actually, not as much as you might think. Riley was most disappointed to find that eyelids, scrotums, anuses and ears aren't allowed into any product labelled `sausage'. In fact, sausages must be 32 per cent meat at least, and most good-quality sausages contain 80 per cent or more.

However there's lots of other stuff you can put into meat products - like connective tissue - which might otherwise be thrown away. You'd have thought in an era of waste-not-want-not eco-frugality that the efficiency of the meat industry in this respect would have been praised. Many processed products are also bulked out with ingredients that are a hell of a lot cheaper than real meat: rusk, soya, colouring, etc. Confront people with the raw ingredients and they will turn their noses up. Offer samples of such a sausage at the posh nosh exhibition the Good Food Show, as Riley did, and people seem to think they're actually quite nice. Just don't mention what's in them.

This only goes to show the pragmatic attitude we Brits have to our food. As long as someone can assure us that what we eat isn't harmful, we'll happily munch away. Restaurants perform much the same trick. It doesn't really matter what you're eating - if it's cooked with half a pack of butter and seasoned well, it's going to taste good. We just love salt and fat, whether it's fine dining or the local takeaway after a heavy session.

As is often the way with this kind of TV show, Riley pulled in an expert or two to suggest that eating this kind of rubbish is responsible for the `wave of degenerative disease' in Britain, without actually detailing why that might be the case (or even proving that it is true). Like the pies he created to show off the worst of British processed food practices, Riley's film didn't have a lot of meat in it.

He did, however, manage one good thing. Booker's magazine for the Good Food Show featured a column by potty-mouthed celebrity chef Gordon Ramsay, which apparently extolled the virtues of Booker's wares to the catering trade. No doubt Ramsay was mortified to be featured in a programme on crap sausages and dodgy chicken; these are the type of catering practices he attacks in shows like Ramsay's Kitchen Nightmares. But that's what you risk if you whore your reputation as a multi-Michelin starred chef to all-comers - just the kind of thing that a young, up-and-coming chef called Gordon Ramsay was railing against 10 years ago.

Britain's Really Disgusting Foods was another prime cut of the kind of no-need-to-watch factual programming mechanically generated by BBC3 and, indeed, by every other channel these days. From Honey, We're Killing the Kids to It's Shit Being an Indian Sweatshop Worker (okay, I made the last one up), factual television has been reduced to junk telly, as obvious and unsatisfying as a Pot Noodle. Yummy!


Century-old drug might cure Parkinson's

A study with mice suggests a century-old drug, methylene blue, could slow or even cure Alzheimer's and Parkinson's disease in small doses, researchers say. "To find that such a common and inexpensive drug can be used to increase and prolong the quality of life by treating such serious diseases is truly exciting," said Bruce Ames, a coauthor of the study at Children's Hospital & Research Center Oakland, in California.

Led by Hani Atamna at the center, researchers studied the drug's effects on laboratory-cultured cells and mice. In very low concentrations -- the equivalent of a few raindrops in four Olympicsized swimming pools -- the drug slows cellular aging and enhances the function of cellular "power plants" called mitochondria, the experimenters said. Their results appeared in the March issue of the Federation of American Societies for Experimental Biology Journal.

The group found methylene blue could prevent or slow mitochondrial decline, specifically that of an important enzyme called complex IV. Mitochondria are the main energy suppliers to animal and human cells.

"The results are very encouraging," said Atamna. "One of the key aspects of Alzheimer's disease is mitochondrial dysfunction, specifically complex IV dysfunction," he went on. Methylene blue seems to expand the brain's "mitochondrial reserve," he added, "essential for preventing age-related disorders."

Discovered in 1891, methylene blue is used to treat methemoglobinemia, a blood disorder. But because high concentrations of methylene blue were known to damage the brain, no one thought to experiment with low concentrations, Atamna's group said. Also, drugs such as methylene blue don't easily reach the brain.

Atamna said methylene blue could become another commonplace lowcost treatment like aspirin, prescribed as a blood thinner for people with heart disorders.


Friday, August 22, 2008

You better eat your . . . Frosted Flakes?

The food puritans are critical but you will note the total lack of any double-blind evidence that there is anything wrong with Frosted Flakes. Given the way in which double-blind studies overturn conventional wisdom, I would not be surprised if Frosted Flakes are in fact good for you. It appears to be their sugar content that is drawing objections but if sugar is bad for you we should all be dead

Olympic legend Michael Phelps will appear on boxes of the Kellogg's brand sugar cereal, drawing sharp criticism from health experts worried about the message he'll be sending to children across America. "I would not consider Frosted Flakes the food of an Olympian," said nutritionist Rebecca Solomon of Mount Sinai Medical Center. "I would rather see him promoting Fiber One. I would rather see him promoting oatmeal. I would even rather see him promoting Cheerios."

The announcement yesterday that Phelps, 23, winner of a record eight gold medals at the Beijing Olympics, would grace Frosted Flakes and Corn Flakes boxes instead of the traditional athlete's choice of Wheaties left many perplexed. Frosted Flakes has three times the amount of sugar as Wheaties and 1/3rd the fiber.

This doesn't matter much to a virtuoso swimmer who consumes 12,000 calories a day. Still, in a country where childhood obesity is an alarming issue, Phelps' iconic image sharing space with Tony the Tiger sends the wrong message, experts say. "For a guy like Michael Phelps who isn't worried about obesity because he's burning thousands of calories as an athlete...eating Corn Flakes and Frosted Flakes every so often is not an issue," Solomon said.

The Phelps-emblazoned cereal boxes hit supermarket shelves in mid-September.


Taking your tablets with fruit juice limits the effect

Anyone taking medication should beware of drinking fruit juice, Canadian researchers have found. Grapefruit, orange and apple juice can all have a significant effect on the uptake of drugs - either lowering or increasing their effectiveness. While the influence of grapefruit juice is already well known, and some drug labels caution against drinking it with medicines, the latest research has extended the need for care.

Results presented to the American Chemical Society meeting in Philadelphia yesterday by David Bailey, Professor of Physiology, Pharmacology and Medicine at the University of Western Ontario, show that fruit juices can limit the effects of several drugs, including three beta-blockers used to treat high blood pressure, the cancer drug etoposide and some antibiotics.

In tests, healthy volunteers took fexofenadine, an antihistamine. They swallowed the drug with either grapefruit juice, water containing naringin - the chemical that causes the fruit's bitter taste - or plain water. When the medicine was taken with grapefruit juice, only half as much of the drug was absorbed into the body as it was with water.

Naringin and similar substances in orange and apple juices appeared to block a "transporter" molecule called OATP1A2 which helped to shuttle drugs from the small intestine to the bloodstream.

Drugs whose levels in the body were boosted by grapefruit juice were affected by a different mechanism that prevented them being broken down. Professor Bailey originally discovered the drug-boosting effects of grapefruit 20 years ago. He said: "I'm sure we'll find more drugs that are affected in this way." Most medicines should be taken only with water, he said.


Breakthrough could end reliance on blood donations

HUMAN blood has been grown in the laboratory for the first time in research that promises an almost limitless transfusion supply. The achievement by scientists in the US could lead to trials of the blood within two years, and ultimately to an alternative to donations that would transform medicine.

If such blood was made from stem cells of the O-negative blood type, which is compatible with every blood group but is often in short supply, it could be given safely to anybody who needs a transfusion. Stem-cell-derived blood would also eliminate the risk of transmitting the pathogens that cause hepatitis, HIV and Creutzfeldt-Jakob disease through transfusions.

Scientists behind the advance said that it has huge therapeutic potential and could easily become the first application of embryonic stem-cell research to enter widespread clinical use. "Limitations in the supply of blood can have potentially life-threatening consequences for patients with massive blood loss," said Robert Lanza, of Advanced Cell Technology in Massachusetts, who led the experiments.

"Embryonic stem cells represent a new source of cells that can be propagated and expanded indefinitely, providing a potentially inexhaustible source of red blood cells for human therapy. The identification of a stem cell line with Onegative blood type would permit the production of compatible 'universal donor' blood."

Blood comes in four groups, A, B, AB and O, and in two rhesus types, positive and negative, and only some of these are compatible with one another. A person with type A, for example, can donate to people with type A or AB, and receive blood of type A or O. Only O-negative blood can be given to any patient. While there is no national shortage of donated blood in Britain, O-negative blood sometimes runs low. It is also used widely in military medicine.

The research also has more immediate clinical promise for efforts to turn embryonic stem cells into other types of tissue, to treat conditions such as diabetes and Parkinson's. One of the biggest safety hurdles that must be cleared before stem-cell therapies enter clinical trials is the risk of uncontrolled cell growth causing cancer. Red blood cells, however, do not have nuclei that carry the genetic material that goes wrong in cancer, and thus should not present this danger. "This could be one of the biggest breaks for the early clinical application of embryonic stem cells," Dr Lanza said. "There is still work to be done, but we could certainly be studying these cells clinically within the next year or two."

While a few red blood cells have been created from embryonic stem cells before, the ACT team is the first to mass-produce them on the scale required for medical use. They also showed that the red cells were capable of carrying oxygen, and that they responded to biological cues in similar fashion to the real thing. About two thirds had no nucleus, which suggests that they are fully fledged adult red blood cells, and the researchers hope to bring this closer to 100 per cent. Details of the research are published in the journal Blood.

Though embryonic stem cells were used in this experiment, it may be possible to create blood from reprogrammed adult cells, also known as induced pluripotent (IPS) cells. These would circumvent some ethical objections to the use of embryonic tissue.

Independent scientists welcomed the work. Professor Alex Medvinsky, a blood stem cell expert at the University of Edinburgh, said: "The problem with relying on donated blood is that there are always shortages. The ability to generate red blood cells in very large numbers would be a very big thing."


Thursday, August 21, 2008

Psychologists find video games 'not all bad'

PLAYING video games improves manual dexterity among surgeons, making them faster and less likely to make mistakes, researchers have found. The findings were contained in a raft of research about how video games effect the people who play them, discussed at the Annual Convention of the American Psychological Association in Boston.

"The big picture is that there are several dimensions in which games have effects," including their content, how they are played, and how much, said psychologist Douglas Gentile of Iowa State University. "This means that games are not 'good' or 'bad' but are powerful educational tools and have many effects we might not have expected they could."

Dr. Gentile presented several studies on video games including one involving 33 surgeons specializing in laparoscopy, the use of a thin lighted tube to inspect and treat various conditions in the pelvic and abdominal cavities. Laparoscopic surgeons who played video games were 27 per cent faster at advanced surgical procedures, and made 37 per cent fewer errors, compared to their non-gaming colleagues, the study found.

Studies involving high school and college students confirmed previous findings about the social effects of playing violent video games, the Iowa State researchers said. Students who played violent games were more hostile, less forgiving, and more apt to view violence as normal, than peers who played non-violent games. But students who played "prosocial" games got into fewer fights at school and were more helpful to other students, the researchers reported.

Yet another study at Fordham University measured the effect of learning a new video game on problem-solving skills in middle-school-age children and found that "playing video games can improve cognitive and perceptual skills." "Certain types of video games can have beneficial effects improving gamers' dexterity as well as their ability to problem-solve - attributes that have proven useful not only to students but to surgeons," the researchers found.


Fortifying bread with folic acid is 'no protection from heart disease'

Taking vitamin B or folic acid supplements does not prevent death in patients with heart disease, a study has shown. The research is the latest to demonstrate that money spent on vitamins is often wasted. But it also suggests that fortifying bread with folic acid - a measure under consideration in Britain to prevent birth defects - would not have the additional advantage of protecting the nation's hearts.

Earlier work suggested that folic acid, either alone or combined with vitamins B12 and B6, reduced levels in the blood of homocysteine, an amino acid linked to a higher risk of heart attack. Proponents of vitamin supplements argued that lowering homocysteine levels through supplements would also reduce heart attacks. But the new study seems to disprove that.

While homocysteine levels did fall by 30 per cent after a year of treatment with folic acid and B12, there was no corresponding fall in heart attacks or strokes. In the group given folic acid, there was a decline in strokes, but an increase in cancer, though neither was significant.

The study, published in the Journal of the American Medical Association, involved more than 3,000 patients in two Norwegian hospitals between 1999 and 2006. Patients were given folic acid plus vitamin B12 and vitamin B6, or folic acid plus B12, B6 alone, or a placebo. "Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease," the team concluded.

Since folic acid fortification of flour began in the US and Canada ten years ago, deaths from stroke have fallen faster than in England and Wales, where fortification has been discussed endlessly but never implemented.


Alexander Technique effective for back pain

An alternative therapy used to improve posture and to help women to cope with labour pain can be more effective at treating backache than conventional treatments, a study suggests. Combining exercise with practising the Alexander Technique could significantly reduce back pain and improve mobility, researchers found.

The technique was developed by the actor Frederick Alexander (1869-1955) to help his vocal and breathing problems. It is designed to change the way people move their bodies, with an emphasis on balance, posture and co-ordination. A team from the universities of Bristol and Southampton compared the effectiveness of massage, exercise and the Alexander Technique in 579 patients with back pain. Those who had received 24 lessons in the Alexander Technique reported 18 fewer days of back pain over four weeks compared with those who had been taking exercise alone, according to the study published online by the British Medical Journal today.


Wednesday, August 20, 2008

Basic mathematical ability appears to be innate

Those pesky genetics again! Note that the findings concern differences between Aboriginal groups, not black/white differences. Note also that once again culture is not found to be the explanation for ability differences that Leftists routinely claim. Leftists would have predicted that the more acculturated blacks would have done better. The finding of zero differences due to culture makes it very hard to assert that culture is the explanation for lower black average IQ. Mathematical ability is of course a major component of IQ

Basic mathematical ability appears to be innate, or hard-wired into the human brain, according to an international study. The research found that outback Aboriginal children with only a few number words in their language can still "count" just as well as English-speaking children.

The results of the joint study by University College London and Melbourne University, challenges notions that we need language in order to think and count. It also suggests that mathematical disabilities such as dyscalculia, the little known maths version of dyslexia, is a genetic or neurological disorder rather than a memory or language deficiency. The results have been published this week in the Washington-based journal Proceedings of the National Academy of Sciences.

Study co-researcher Bob Reeve, associate professor at Melbourne University's School of Behaviourial Science, said the findings may have implications for early maths teaching as well as the early identification and treatment of dyscalculia. "The (teaching) language needs to support or focus on the more basic concepts and that may be slightly different to what is going on now," Professor Reeve told The Australian.

The study tested 45 indigenous children aged between four and seven years old. Researchers contrasted children of the Walpiri language group in the Central Desert and that of the Anindilyakwa language group on Groote Eylandt in the Gulf of Carpentaria with a group of English-speaking indigenous children in Melbourne.

Using simple tasks with sticks, counters and play-dough, the study found that the outback children, despite having just three or four generic number words such as "one", "two" and "more than two", still demonstrated strong numeracy skills matching the English-speaking children in Melbourne. This contradict earlier results that found that some indigenous communities in the Amazon with similarly few number words in their language had difficulty with some basic mathematical tasks.

Professor Reeve said the Australian findings suggested that while language is needed for more complex mathematical tasks, humans nevertheless have an innate "starter kit" for mathematics that is likely in the genome. "Nobody is disputing the fact that you need language to build a more complicated set of ideas, but (language) isn't the starter kit," he said. "There is a clear basis on which children can build, but it isn't a linguistic basis."

One of the co-authors is UCL's Professor Brian Butterworth who has written about dyscalculia in his book The Mathematical Brain, and and has written a test to screen for the disorder. Studies have suggested that dyscalculia, in which sufferers are unable to carry out basic mental arithmetic without a calculator, could affect between 3.4 and 10 per cent of the population. "Whether we can remedy the situation (for dyscalculacs) by particular forms of instruction is interesting, but recognising the problem is the first point here," Professor Reeve said.


Breast cancer hope as brittle bone drug gets clinical trial in UK

A treatment for brittle bones can have a dramatic effect on breast cancer when combined with chemotherapy, research has shown. Scientists found that the two drugs acted together to slow down the growth of tumours. In mice given the therapy, growing breast tumours were almost stopped in their tracks.

A clinical trial is under way in the UK that could lead to the treatment becoming widely available to patients. Since both drugs are already well established, and need only the terms of their use to be changed, this may not take long, the researchers suggest. The therapy involves the breast cancer chemotherapy agent doxorubicin and the bisphosphonate drug zoledronic acid.

In the mouse study, doxorubicin was given first, followed 24 hours later by zoledronic acid. When the order was reversed, or the drugs administered on their own, the treatment had little effect. The scientists said that the chemotherapy drug appeared to "prime" the tumour and make it sensitive to the bisphosphonate. Tests showed that the treatment triggered a "suicide" response known as apoptosis in the cancer cells, causing them to self-destruct. It also blocked angiogenesis, the process by which blood vessels are created that fuel tumours with oxygen and nutrients.

The researchers, from the University of Sheffield and the University of Kuopio in Finland, published their findings in the Journal of the National Cancer Institute.

Bisphosphonates are normally used to prevent bone thinning in patients with osteoporosis. They also protect bones from the destructive effects of tumours. For this reason they are sometimes given to men with prostate cancer, which has a habit of spreading to the bones. The new study showed that zoledronic acid can have a powerful direct effect on breast cancer without any bone involvement.

The results of the clinical trial, led by Professor Robert Coleman, of the University of Sheffield, should be known this year.