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Medical
Research : Believe it or not ?
Forget pills,
eat healthy: US group |
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To cancer docs,
cure's a 4-letter word
MILWAUKEE, Wisconsin -- There wasn't any doubt six
years ago that Mr Doug Jensen had cancer.
The Oregon engineer's blood was clogged with the immature cells that are
sure signs of leukaemia. Treatment with a new wonder drug, Gleeve, made them
disappear.
Since then, doctors repeatedly have searched his blood, even individual
molecules, for bits of DNA and other substances that would reveal he still
had the disease. None has been found.
Is he cured ???
"They don't use that word," said Mr Jensen, who would dearly love to hear
it. Ironically, at a time when more people are cured of cancer than ever
before, fewer doctors seem willing to say so.
They call the cancer undetectable, or in remission. They tell patients they
can quit seeing cancer specialists. they quote statistics and say chances
are slim that the disease will come back. they say these things because the
simple truth is, they can't tell when or if someone has been cured. even the
most widely used benchmark -- being alive five years after diagnosis -- has
no real basis in science, experts admit.
There's a label for people like Mr Jensen who are in cancer limbo --
"survivor". nearly 10 million Americans have battled cancer, including 1.4
million who had it more than 20 years ago and are called "long-term
survivors" by those afraid to call them cured. "The medical community has
backed off the term 'cured'," said Ms Julia Rowland, a psychologist who
directs the federal Office of Cancer Survivorship, which was started in
1996.
The reasons involve more than just semantics, she said. Cure is a term with
emotional and medical meanings about which there is little agreement. To
many people, it means that cancer is gone and is not going to come back. But
some cancers -- certain lymphomas and leukaemias in particular -- never go
away completely yet are controlled so that they're no longer
life-threatening. Some call that a remission, but others consider it a cure.
Other cancers look like they've gone away -- no signs of them can be found
by exquisitely sensitive and sophisticated tests -- but recur many years
later, suggesting that they weren't really cured after all. breast cancer is
notorious for this. complicating matters is the risk of second cancers. Some
of the very treatments used to cure cancer, like chemotherapy and radiation,
actually can trigger new cancers down the road. People with an inherited
genetic flaw that predisposed them to cancer still have that underlying
problem after being treated successfully.
Mr Jensen is one of the few chronic myelogenous leukaemia patients who show
absolutely no sign of cancer. "They say it's undetectable," he said of his
cancer. "I'd like to have them say I'm cure."
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Medical
Research : Believe it or not ?
In a society rife with conflicts of interest, disclosure of
such conflicts is usually a good tonic.
In finance, we can read the fine print and decide whether to invest or seek
other advice.
But in medicine, where decisions on treatment can have lasting effects, mere
disclosure isn't enough. Patients need advice they can act on without having
to calibrate how likely it is to be biased.
Physicians and scientists with financial ties to the pharmaceutical industry
should not just have to disclose conflicts - they shouldn't be permitted to
issue guidelines at all.
But they are permitted, and they do so routinely. The most prominent recent
example of this is how the US federal government came up with and then
defended new recommendations on cholesterol levels for individuals with a
hidh risk of heart disease. It's an enlightening - and depressing - story.
On July 13, the US national Cholesterol Education Programme (NCEP), part of
the National Institutes of Health (NIH), unveiled tougher guidelines for
cholesterol levels - guidelines so stringent that millions of Americans at
risk of heart disease would have to take costly statin drugs to meet the new
lower limits.
What the NCEP didn't unveil was that the recommendations had been written by
a panel of doctors, most with financial ties to the pharmaceutical companies
that stood to gain enormously from increased use of cholesterol-lowering
statins.
Critics immediately complained about the hidden financial ties and demanded
disclosure.
Within days, the respected sponsors of the cholesterol guidelines - the NIH,
the American Heart Association and the American College of Cardiology -
posted the disclosure online.
The extent of the connections was stunning: Of the nine panel members, six
had each received research grants, speaking honoraria or consulting fees
from at least three and in some cases all five of the manufacturers of
statins.
If all the members with conflicts had recused themselves, only two would
have been left.
That didn't look too good, so another note appeared on the NCEP site,
explaining that the draft proposals had been "subjected to multiple layers
of scientific review", first by the NCEP's coordinating committee,
"consisting of 35 representatives of leading medical, public health,
voluntary, community, and citizen groups and Federal agencies", and then by
the scientific and steering panels of the heart association and the college
of cardiology.
"Altogether approximately 90 reviewers scrutinized the draft," the note
said. The message to the public: No need to worry about pro-industry bias.
The heart association whose journal Circulation had published the guidelines
sent an e-mail to its board of directors, its national strategic team, its
communications advisory team and more than 30 prominent physicians who have
worked closely with the organization.
It reminded them of the association's conflict of interest policy, namely
that "if in any situations, a pane
list has a current
relationship that could unduly influence guidelines or statements, that
individual recuses himself from that aspect of the work of the writing
panel".
"This process ensures that the guidelines are not inappropriately influenced
in any way." (Apparently, none of the panelists felt his drug-company
connections required recusal.)
But patients deciding whether to take these drugs, and physicians deciding
whether to prescribe them, still don't know whether the NCEP panel members
consciously or subconsciously coloured their analysis in favor of statin
manufacturers Merck, Novartis, AstraZeneca, Pfizer and Bristol-Myers Squibb.
Cholesterol guidelines have broad impact. They help doctors decide how
aggressively to prescribe drugs. When the guidelines promote greater use of
statins, they also raise the cost of care. And in some cases, statins cause
liver and muscle injury; in rare cases they have led to kidney failure.
So why did three major organizations choose such a conflicted panel to write
the guidelines ?
Quite likely the panelists were experts in the field. Most had helped to
write the preceding round of cholesterol guidelines three years earlier.
Is it imaginable that using conflicted experts is the best way of getting
unadulterated assessments of clinical data ?
I don't think so. The best collective decisions arise from divers and
independent views. The Washington Post
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Forget pills,
eat healthy: US group
Washington - People hoping vitamins can protect their
hearts need to eat healthy foods instead of popping pills, the American
Heart Association said on Monday.
A review of various studies on whether supplements can reduce heart disease
risk shows they have virtually no effect, the group said.
"At this time, there is little reason to advise that individuals take
antioxidants supplements to reduce their risk of cardiovascular disease,"
said Prof. Penny Kris-Etherton from Pennsylvania State University who led
the study.
Antioxidants are molecules that work to reduce the damage done to cells and
to DNA by free radicals - charged chemicals particles found in the
environment and caused by everyday biological processes.
It is clear that foods rich in antioxidants can reduce the risk of cancer
and heart disease, and scientists have been working to isolate the
particular compounds resposible. Vitamins, such as A and C, are
antioxidants.
But several research studies have shown that people who took supplements did
not have a lower risk of cancer or heart disease, and one important Finnish
study showed that male smokers who took supplements actually had a higher
risk of lung cancer.
Nutritionist and doctors now argue it is probably a combination of compounds
in foods that give the healthy antioxidant benefits.
"The American Heart Association continues to promote a diet rich in fruits,
vegetables, whole grains, fish, legumes, poultry and learn meats to derive
antioxidant vitamin benefits," the group said in a statement published in
its journal Circulation. - Reuters
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