Long before John Collins Warren, M.D., thought up The New England Journal of Medicine and Surgery and the Collateral Branches of Science in 1812 or, more recently, PLoS One revolutionized top-tier peer-reviewed journals by becoming open access, a bunch of scientists were building much of the foundation for science across its myriad disciplines at the Royal Society of London. Three-hundred-and-fifty year’s worth of foundation in fact.

And now, to celebrate its steadfast roots in science, the society is offering 60 historic papers online, as blogger Sarah Zielinski at Smithsonian.com reports. And they are truly awesome. In fact, don’t haul your butt to that tedious 9 a.m. Friday intro biology lecture. Just shuffle over to your laptop and visit the Trailblazing Web site where the papers are offered and bone up on canine blood transfusions. Or read about the father of microscopy’s, Antonie van Leeuwenhoek’s observations of “little animals,” some of which we now call bacteria and protozoa. Here’s van Leeuwenhoek reporting on his discovery:

In the year 1675, I discovered living creatures in Rain water, which had stood but few days in a new earthen pot…. This invited me to view this water with great attention, especially those little animals appearing to me ten thousand times less than those represented by Monf. Swamerdam…

Take that Monf. Swamerdam! But seriously, this image is likely to stick with me — any maybe you? – far longer than some rote description of said little animals in the second edition of Campbell’s Biology weighing down my desk. (No offense, Campbell. It’s me, not you.)

Or read about the 1775 adventures of Charles Blagden, then intrepid Secretary of the Royal Society, who hung out in a sweltering 260 degree Fahrenheit room unscathed for eight minutes, thanks to the cooling power of sweat. He also took a dog with him. There seems to be a recurring canine theme here.

Women scientists, such as astronomer Caroline Herschel and her sighting of multiple comets, are also featured. And lest you think the Royal Society is stuck back in the days of funny powdered wigs, the collection of historic papers also includes some modern classics, like that of Stephen Hawking and Roger Penrose pondering black holes and singularities or scientist James Lovelock thinking about grand geoengineering ideas to reverse global warming.

Enough gushing. Go check it out and report back on your faves. Or read more about the marvelous marriage of science and history with a few of these HowStuffWorks.com classics:

How Charles Darwin Worked
How Isaac Newton Worked
10 Science Experiments That Changed the World
10 of the Biggest Lies in History

Sir Patrick. I know your Cutler Walpoles and their like. Theyve found out that a man’s body’s full of bits and scraps of old organs he has no mortal use for. Thanks to chloroform, you can cut half a dozen of them out without leaving him any the worse, except for the illness and the guineas it costs him. I knew the Walpoles well fifteen years ago. The father used to snip off the ends of people’s uvulas for fifty guineas, and paint throats with caustic every day for a year at two guineas a time. His brother-in-law extirpated tonsils for two hundred guineas until he took up women’s cases at double the fees. Cutler himself worked hard at anatomy to find something fresh to operate on ; and at last he got hold of something he calls the nuciform sac, which he’s made quite the fashion. People pay him five hundred guineas to cut it out. They might as well get their hair cut for all the difference it makes ; but I suppose they feel important after it. You cant go out to dinner now without your neighbor bragging to you of some useless operation or other.

Gorge Bernard Shaw The Doctors Dilemma

What is the appropriate interval for breast cancer screening in 40 – 49-year-old women? Could this be a part of the ”government” conspiracy to limit early detection of breast cancer in an effort to further the “culture of death“? Conversely, are certain mammograms akin to removing the “nuciform sac” in that they accomplish nothing other than extracting money from patient’s health insurance? What’s a doctor (and a patient) to do?

If only it were an easy problem. Mammograms, as it turns out, are not a “prevention” technology but are used for “early detection”. The US Preventive Services Task Force, a group of scientists (some of whom I consider my friends) who specialize in looking at the risks and benefits for various preventive and early detection methods that the average citizens (not patients or people with known problems) should be exposed to. It is because of the task force that we know the benefits of early detection for hypertension (very high benefit, very low risk) and as opposed to those of screening for heart disease (very little benefit to early detection, lots of risk if positive screening turns out to be untrue (a false positive)). They have critically looked at the literature and have created a tool that allows one to determine which prevention and early detection measures are right for them.

Why the problem with early breast cancer detection? The New England Journal of Medicine points out that direct problems include the very low risk from the radiation exposure, along with pain, anxiety, and psychological distress related to the procedure. False positive results are particularly problematic in this age group, with one study suggesting that for every case of breast cancer detected in women 40 to 49 years of age, 556 women have mammography, 47 have additional imaging, and 5 have biopsies. Part of the problem is the very low rate of breast cancers in these women, with only 15/1000 developing cancer between 40 and 49, 2 dying of cancer, and 21/1000 dying of everything else. This is half of the rate in subsequent decades. The other problem is that cancers are less likely to be detected in younger breasts (false negative tests) and some cancers are so rapidly growing in this age group. Even mamograms every 6 months wouldn’t result in any benefit from early detection for women with rapidly growing tumors and mamograms every other year would be sufficient for those with slower growing tumors (length bias, see picture above).

Turns out that what we want to do well is prevent disease (hence that push for immunizations). It is also important to detect and intervene in cases where the person would develop disease if left to their own devices (such as smokers, and people with early hypertension). While we would like to believe that early detection is always preferable to late detection with regards to treatment, that is not always the case. It is clear that the average woman of average risk benefits from early detection when older than 50 until about 70. For women from 40-49 it turns out that knowing the patient’s  family history and genetics and as a physician-patient team making sure that the correct test is ordered is equally important. Another arguement for the medical home?

While researching for my TED topic I came across a lot of information about diets. At first I was mostly interested in other dieters reviews of diets. There are many blogs and sites dedicated to just that. Dieters give each other advice, information, and suggestions on how to be successful on diets. They also share stories of success or hardships on the diets. The resources and support groups on the internet for dieters are numerous. But I got to thinking, why do certain diets seem to have success for more people than others? What diets work the best for the masses, and why do they?

This led me to investigate deeper into the diet world, deeper than just the dieter’s reviews of what works, I went looking for scientific research about diets that work. I am across an article in the New England Journal of Medicine entitled, “Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates.” In this study overweight adults were assigned to one of four diets. Each of the diets varied in amount of fat, protein, and carbohydrates the participants were permitted to intake, however, the foods they ate were similar. The participants were offered group and individual instructional sessions for 2 years to help them stay on track with the diets. After two years the researchers compared the dieters progress based on the diet they were on. They concluded, “reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize,” meaning, that it did not seem to matter if the diet had more fat, protein, or carbohydrates to be effective; rather the effective way to loose weight is to reduce the number of calories being taken in.

This research makes a lot of sense when I think about my experience with the Special K Challenge. Even though I was eating more often throughout the day, I was actually eating less. I reduced the number of calories I was eating by almost half. This drastic decrease in calories is the reason that weight can be lost in such a short period of time.

But don’t take my word for it. Take The New England Journal of Medicine’s:

There is clear evidence that the way we pay for health care stimulates cost growth. A “no” vote in Congress will leave these policies undisturbed. The Congressional Budget Office (CBO) projects that under existing approaches to payment, federal spending on Medicare and Medicaid will exceed $10 trillion over the next decade. In 2017 — the year the Medicare trust fund is expected to be exhausted — the CBO estimates that Medicare and Medicaid will drain $1.2 trillion from the federal budget.

Adults who can’t get coverage through work, are too young for Medicare, and don’t qualify for Medicaid have only one option — individual health insurance. Consumer Reports describes the individual insurance market as a “nightmare” for consumers: “more costly than the equivalent job-based coverage, and for those in less-than-perfect health, unaffordable at best and unavailable at worst. Moreover, the lack of effective consumer protections in most states allows insurers to sell affordable plans whose skimpy coverage can leave people who get very sick with the added burden of ruinous medical debt.”⁵ In recent years, several states have attempted to reform the individual health insurance market, with little success.

Coverage matters. On average, uninsured Americans get about half the preventive services and medical care that insured Americans receive. Studies have shown that uninsured people with cancer, heart disease, stroke, lung diseases, and other conditions are more likely to have poor health and to die prematurely than similar people with coverage. Existing safety-net services are insufficient to overcome the gap between those who have health insurance and those who do not.

The economic consequences of a lack of insurance are equally grim. If even one family member lacks coverage, the entire family is exposed to the financial burden of severe illness or injury. In 2009, 20% of uninsured adults used up all or most of their savings paying medical bills.

When many people lack insurance, everyone’s access to care is compromised.

For better or worse, we basically have two choices left right now: The current health-care reform bill, or something almost identical to it; and doing nothing. There’s no third plan out there, no Republican alternative; the only big questions left are will the bill have a public option and will it restrict women’s right to obtain an abortion.

And doing nothing will take more lives and cost more money than enacting the plan we’ve got. That’s not me talking, that’s the docs. And it really is that simple.

If you or your loved ones take any of the following drugs: Zetia, Vytorin or Inegy, you may need to see your doctor as soon as possible to have your medications evaluated.

A new study, just published in the New England Journal of Medicine, evaluated the addition of either Extended-Release Niacin (also known as vitamin B3 or nicotinic acid) or Ezetimibe (found in the above named drugs) to statin therapy for reduction of cardiovascular risk factors.  The study found that despite the fact that Ezetimibe was designed to further lower bad cholesterol levels, the end result was thickening of the arteries (a bad thing!) and increased rates of cardiovascular events.

Authors of the study state: “Thus, we believe that prudent clinical practice currently favors the avoidance of ezetimibe, with consideration of further restriction on its use in lieu of clinically validated regimens, until its net effect on clinical outcomes can be fully ascertained.”

It is important that you not change your medication without seeing your doctor first.  It is also important to know that if you can tolerate Extended-Release Niacin, this may be a better choice for reduction of cardiovascular risk factors, as we have previously recommended.

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NEJM, Nov 15, 2009, Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness, Taylor et al

“Speaker of the House Nancy Pelosi told her Democratic House Caucus last month:  “If it were up to me, we’d have single payer.”  Uh, excuse me Madame Speaker – It is up to you!

That’s why Single Payer Action is focusing on the Democrats in Congress. Because – it is up to them. More precisely, it’s up to the House Single Payer Caucus — The 88 members of Congress who have co-sponsored HR 676 – the single payer bill in the House.

If only half of them stood with us in opposition to Obamacare — it would go down in flames — as it deservedly must.  And everybody in, nobody out single payer would be national news. (continue reading below)…

In recent weeks, we have been traveling around the country calling on single payer activists — doctors, nurses, patients, insurance consumers — to come together to pressure the Single Payer Caucus to vote against Obamacare.

Obamacare is nothing but bailout to the insurance industry.  It will force uninsured Americans to purchase health insurance — whether they can afford it or not – from corporations designed to rip them off.  The so-called public option is half-baked — whether opt out, opt in, triggered, linked to Medicare rates or not — it will be an abject failure.  It won’t control costs.  It won’t cover everyone.  It won’t stop the wave of medical bankruptcies.  It leaves the insurance corporations in the driver’s seat.  And it will probably strengthen them by taking the sickest and most expensive patients off their hands.

Activists from Vermont and Massachusetts tell us that they now regret not working to defeat similar half-baked measures for reform in their states.  Passages of those reforms did more harm than good and set back the movement for single payer in their states for years.  Let’s not make the same mistake at the national level.

Call your member of Congress — Congressional switchboard: 202.224.3121 — and urge them to vote against Obama’s bailout of the insurance industry.  Urge your member of Congress to launch a national debate on single payer, everybody in, nobody out health insurance.”

Dr. Marcia Angell — former editor of the New England Journal of Medicine — called single payer not only the best health care reform — but the only health care reform that will both control costs and cover everyone

I’m sure someone reading this understands the following explanation…

Video

A 39-year-old woman with a 1-year history of Stage IV melanoma presented with progressive shortness of breath, fatigue, and edema in the legs, which had developed over the course of the previous week. At the time of the melanoma diagnosis, a mediastinal and right supraclavicular mass had been seen without identification of a primary tumor. The patient had been treated with five cycles of biochemotherapy and then with antibodies against cytotoxic T lymphocyte antigen 4. Subsequently, the superior vena cava syndrome and tracheal compression had developed, which had required stenting. The patient had then received radiation therapy. Integrated positron-emission tomography and computed tomography continued to show active and spreading disease. The physical examination revealed hypotension, tachycardia, jugular venous distention, pulsus paradoxus, and distant heart sounds. The blood pressure was 82/64 mm Hg, and the heart rate was 110 beats per minute. Transthoracic echocardiography showed a large pericardial effusion with swinging of the heart (see video) and collapse of the right atrium (RA) and left atrium (LA) in end diastole (Panel A, arrows) and diastolic collapse of the right ventricle (RV) (Panel B, arrows), which was consistent with pericardial tamponade. Pericardiocentesis yielded 1.6 liters of bloody fluid; the fluid was subsequently shown to be a malignant effusion. Swinging of the heart that is due to a large pericardial effusion is responsible for the beat-to-beat shift in the axis, amplitude, and morphology of the QRS interval (electrical alternans) on electrocardiography. In this patient, the condition resulted in a “pseudo” 2:1 atrioventricular-block pattern, with an absent QRS interval after every other P wave (Panel A, arrowheads), despite ventricular contraction on echocardiography. Follow-up echocardiography over the next 2 days showed no reaccumulation of effusion. Paclitaxel was administered, but the patient died within 2 months after the initiation of therapy.

Source

The announcement last month that the controversial $105 million trial carried out in Thailand had unexpectedly been successful took experts by surprise and sparked excitement around the world amid speculation that the steady spread of HIV/Aids could before long be checked.

However, it is now clear that this is a long way wide of the mark.

The full results, presented at the Aids vaccine conference in Paris and published immediately online by the New England Journal of Medicine reveal that:

- The vaccine did not protect those at high risk of HIV infection, such as sex workers and intravenous drug users.

- The protective effect was greatest in the first 12 months and then seemed to diminish.

- When those who did not get all six vaccine shots were taken out of the analysis, the positive result was statistically insignificant.

Results hailed

Some scientists and campaigners in Paris nevertheless hailed the results, if not as a triumph, then as a beacon of hope. Dr Nelson Michael of the US army — the US military had run the research programme with the Thai government — said scientists would now be working intensely to pick up clues to future Aids vaccine development from the results of the trial. “It is a signpost for vaccine development,” he said.

“This was a yes-we-can moment: the opportunity to become enthusiastic. The door has cracked open. We are all going to try to collectively crash through it.”

But Seth Berkley, president of the International Aids Vaccine Initiative, which evaluates and channels funds into trials, said he thought the regime tested in Thailand would be taken no further.

The vaccines involved — AidsVax, which previously failed in a trial in Thailand on its own, and Alvac — were 15 years old.

The controversy

“That’s why there was scientific controversy about starting this trial,” he said. “If you were going to start again, you might use one of the more robust vaccines we have [in the lab] today.

“We don’t have a vaccine on the horizon. It isn’t the Thai one or one of the others. That’s why we have to have the patience for this marathon rather than a sprint.”

The Thai trial, given the name RV144, was controversial from the start because it involved two vaccines given together, one of which had previously failed to protect people from HIV while the other had not been tested alone.

Many people felt the $105million it cost could be better spent.

More than 16,400 Thai men and women aged 18 to 30 who did not have HIV were recruited and randomly assigned to receive the vaccine or a placebo.

They were given six shots over six months: two of Alvac followed by two more sessions where they were injected with both vaccines. They were tested for HIV every six months, and counselled on how to avoid it for the next three years.

By the end of the trial only 125 people had become infected with HIV. In the announcement of the headline results last month, it was said that 51 of those given the vaccine had become HIV positive compared with 74 in the placebo group, which gives a statistically significant efficacy of 31 per cent.

Size shrunk

But many volunteers did not get all six vaccinations, taking the numbers down from around 8,000 in each group to around 6,000. Removing those who did not get all the six vaccinations was done in accordance to the protocol.

Among those people, there were 50 infections on placebo and 36 on the vaccine, which gives an efficacy of 26 per cent but is not statistically significant, meaning it could happen by chance.

NEW ENGLAND JOURNAL OF MEDICINE: A single “precursor” cancer cell may be responsible for the spread of prostate cancer and eventual death of the patient, according to a paper in the latest Journal.

A recent study by Liu and colleagues has shown that metastases in prostate cancer have a common origin — that is, they originate from the same clone.

If the single lesion harboring this metastatic clone could be accurately identified and then targeted, it seems likely that the side effects of treatment for prostate cancer would be reduced.

The key question thus remains: Does the index lesion harbour the single precursor cell that gives rise to progression, metastases, and death?

Even if the index lesion is not the culprit, researchers must now focus on identifying the one  that does harbor the metastatic clone.

Once a means of identification can be determined, clinical trials will be warranted to investigate the effect of ablating that single lesion.

A positive result would have important implications for men with prostate cancer who currently endure much treatment-related harm.

We all know that CT scans, even when given appropriately, CT scans expose patients to a lot of radiation. But a mistake at Cedars-Sinai Medical Center in Los Angeles meant that more than 200 patients were exposed to eight times the normal level of radiation, the Los Angeles Times reports.

CT scan causing hair to fall out?

Just recently the medical community had complained that the “correct” amout of radiation from a CT scan was bad for you.

The findings come just months after a New England Journal of Medicine report suggested that about one third of all CT scans are unnecessary and that overuse of these tests may be a significant factor in raising the total public risk of cancer deaths in the coming decades. The Columbia University researchers noted that while the individual risks of cancer from CT scans remain low, the increased incidence of cancer may be considerable. To balance image quality with these safety concerns, radiologists use a protocol known as the ALARA principle, short for As Low as Reasonably Achievable. It’s meant to ensure that “CT dose factors are kept to a point where risk is minimized for maximum diagnostic benefit,” says Arl Moore, president of the American College of Radiology.

Both studies raise the question of when CT and other diagnostic exams are necessary. “There are times when performing a scan is very valuable and absolutely worth the risk,” says Timothy Bullard, lead author of the current study and chief medical officer at Orlando Regional Medical Center. In the case of diagnosing acute appendicitis, for example, CT scans have become an almost indispensable tool, reducing the chances of removing a healthy appendix from 24 percent down to just 3 percent. Similarly, with life-threatening or potentially debilitating problems from head trauma, “the obvious risks from radiation are outweighed by the benefit of the test,” says Lynn Massingale, an emergency physician from Knoxville, Tenn., and CEO of Team Health, a company that provides ER doctors to more than 260 emergency departments nationwide.

There are times, however, “when we need to ask if it’s worth exposing someone to this radiation and if doing so will actually give us the medical information we seek,” says Bullard.

This August, a patient told the hospital he began losing his hair after a CT scan. It turns out the hospital had made a mistake when it changed the settings on a CT scanner more than a year earlier. As a result, 206 patients who received a test used to diagnose strokes received the radiation overdose. (The test is called a CT brain perfusion scan.) When the hospital contacted patients to alert them to the error, officials learned that 40% of the patients had suffered patchy hair loss, and many also had reddening of the skin.

“There was a misunderstanding about an embedded default setting applied by the machine,” the hospital said in a statement cited by the LAT. “As a result, the use of this protocol resulted in a higher than expected amount of radiation.” GE, which makes the scanner, put out its own statement, which said the machine had “no malfunctions or defects,” the LAT said.

The FDA issued an alert last week that referred to the mistake but did not name the hospital.

The agency said “the magnitude of these overdoses and their impact on the affected patients were significant. This situation may reflect more widespread problems with CT quality assurance programs and may not be isolated to this particular facility or this imaging procedure.”

Il dr. Giuseppe Di Pasquale illustra lo studio sul dabigatran

Al Congresso Europeo di Cardiologia (ESC) di Barcellona sono stati presentati i risultati sulla sperimentazione del dabigatran etexilato, un farmaco preventivo che permetterà di ridurre l’incidenza dell’ictus di 9 mila casi all’anno.
Il farmaco agisce sui cardiopatici colpiti da fibrillazione atriale e che sono per questo ad alto rischio di ictus. Roberto Ferrari, presidente dell’ESC, afferma: «Si tratta di una molecola destinata a cambiare radicalmente la prevenzione dell’ictus nei pazienti con fibrillazione atriale, un problema che hanno 500 mila persone in Italia, cui si aggiungono 60 mila nuovi casi all’anno».
La fibrillazione atriale è un comune disturbo del ritmo cardiaco che comporta la paralisi dell’atrio con un relativo ristagno di sangue. Questo ristagno causa la formazione di piccoli coaguli che, entrando in circolo, vanno a chiudere piccole arterie. Se le arterie interessate sono quelle cerebrali, ecco che si ha l’ictus, che nei soggetti con fibrillazione atriale è 7 volte più frequente che nel resto della popolazione.
Finora la terapia preventiva dell’ictus consisteva nella somministrazione di anticoagulanti con lo scopo di impedire la formazione dei letali coaguli. La terapia classica funziona, riducendo il rischio di ictus del 65%, ma è onerosa per il paziente che deve sottoporsi ad un esame del sangue ogni pochi giorni all’inizio della terapia e poi uno ogni tre settimane per stabilire prima e controllare poi che il potere di coagulazione sia ridotto entro i limiti di sicurezza, altrimenti si rischiamo emorragie interne anche fatali. Il paziente, inoltre, deve evitare attività a rischio di traumi e modificare l’alimentazione evitando molti cibi che interferiscono con il trattamento. Tra analisi del sangue e cure delle complicazioni ogni paziente costa 3 mila euro l’anno.
Il farmaco sperimentato si è rivelato innovativo perchè, oltre a ridurre ulteriormente il rischio di ictus, viene somministrato a dosi fisse che non richiedono continui controlli o modifiche nello stile di vita del paziente.
La ricerca, pubblicata in contemporanea sul New England Journal of Medicine, ha coinvolto più di 18 mila pazienti in 45 Paesi, Italia compresa, confrontando la nuova molecola con la cura standard rispetto alla quale il nuovo farmaco ha ridotto i casi di ictus del 34% e il rischio di morte del 12%.
Il dabigatran etexilato è già disponibile in tutta Europa dall’inizio del 2008 in seguito alle ricerche che ne dimostrarono l’efficacia contro la tromboflebite venosa. Bisognerà attendere i primi mesi del prossimo anno per l’autorizzazione al nuovo uso.

Early detection of prostate cancer is a two edged sword. To be sure, as with all cancers, your odds of not dying from prostate cancer are improved with early detection.  Still, questions remain about the amount of screening, diagnostic testing and treatments that need to be carried out to realize substantive gains in survival.  Yet, survival remains an individual issue with each patient.  So early detection (a preferred term over screening, which implies shopping mall testing) along with treatment remain a personal decision between patient and doctor.

One thing which does jump out in this study is the fact that many men have cancer but have small prostate volumes meaning they likely have few if any symptoms.  The study also focused on men with what would be termed normal PSA levels (< 3.0) and yet found that a large number of these men not only develop cancer but develop clinically significant, high grade cancers.

An additional alarming note was that even in men with negative biopsies initially, they were at a higher risk of having a second or third biopsy be positive, and with a higher grade (worse) cancer.

In the end, we are still lacking that “magic bullet” of a test, one which will with a high degree of certainty, identify which men who have prostate cancer, are actually likely to progress and die from prostate cancer.  Until that test becomes available, early detection and treatment remain the key elements in any strategy to deal with prostate cancer . . . ben kazie md

Men with small prostate volumes and high initial prostate-specific antigen (PSA) levels have a greater risk for cancer detection and aggressive disease than other men.  Prostate biopsy is the standard method for the early detection of prostate cancer, but prostate volume may affect the detection rate on traditional sextant biopsy and current screening protocols may consequently result in missed cases.

The study (see reference below) enrolled 182,000 men between the ages of 50 and 74 years through registries in seven European countries. They were randomly assigned to a group that was offered PSA screening once every 4 years or to a control group that did not receive such screening.  During a median follow-up of 9 years, the cumulative incidence of prostate cancer was 8.2% in the screening group and 4.8% in the control group. The rate ratio for death from prostate cancer in the screening group, as compared with the control group, was 0.80 (95% confidence interval [CI], 0.65 to 0.98; adjusted P=0.04). The absolute risk difference was 0.71 death per 1000 men. This means that 1410 men would need to be screened and 48 additional cases of prostate cancer would need to be treated to prevent one death from prostate cancer. The researchers concluded that PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis.

Also of great note in this study was the finding that men with a smaller prostate volume, who had, at the initial screening round, an indication for biopsy and a negative biopsy result, were at greater risk of being diagnosed with prostate cancer, and of aggressive prostate cancer, during the 8 years of follow-up

Prostate cancer detection and aggressiveness raised in smaller prostates – http://www.medwire-news.md/46/84390/Oncology/Prostate_cancer_detection_and_aggressiveness_raised_in_smaller_prostates.html

Screening and Prostate-Cancer Mortality in a Randomized European Study  (NEJM, Vol 360:1320-1328 March 26, 2009 #13) – http://content.nejm.org/cgi/content/full/NEJMoa0810084

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A lot of people sincerely try to lose weight, get in shape and try to build muscles while consuming considerable amount of alcohol. In a previous article entitled “Alcohol’s Effects on Weight Loss”, we looked at the effects of alcohol on fat metabolism and weight loss in general. In this article lets us review the effects of alcohol on testosterone.

Testosterone Exists in Both Men and Women

Testosterone is thought to be a male hormone but it exists in both genders and fulfills numerous functions. Women produce up to 2% of what a man would produce. It is produced in the testes of men and in the ovaries of women. In both sexes, testosterone aids in bone and muscle development and blood cell turnover amongst its many functions. It also influences libido in both men and women.

Testosterone’s Role in Burning Fat and Building Muscles

Testosterone’s effect on building muscles mass  and reducing body fat levels have been well researched and documented (Journal of Clinical Endocrinology, Journal of Endocrinology Invest) .

Research has found that testosterone can affect fat metabolism in the following ways;

• Testosterone apparently blocks the effects of the Lipoprotein lipase enzyme.  This is an enzyme that enables body’s fat cells to store fat. When fat cells are exposed to testosterone in test tubes, the activity of the lipoprotein lipase enzyme has been shown to be dramatically reduced.
• Testosterone is able to increase fat metabolism by increasing certain key receptors on the fat cell-membrane to release fat as documented in the Journal of Metabolic Disorders.
• Testosterone has been proven to increase insulin sensitivity (Journal of Endocrine Practise) and fat metabolism via the mechanisms explained above. It also enhances growth of muscle fibers.

As such, for someone trying to lose weight and gain muscles, it is vital to maintain optimum levels of testosterone.

Courtesy of stock.xchng by LotusHead

Alcohol and How its Metabolized

Alcohol can be categorized as a depressant drug. When consumed, approximately 20% is absorbed in the stomach and 80% in the small intestines. Like other depressant drugs, it slows down the pace of the brain. Approximately 90% of ingested alcohol is metabolized in the liver. The rest is excreted via breath and urine. Once the consumption of alcohol stops, blood concentration of alcohol decreases slightly every time the blood passes through the liver. An average person can eliminate approximately 15 ml of alcohol per hour. As such, a person would need an hour to remove alcohol from a can of beer with 5% alcohol content.

Alcohol Suppresses Testosterone

In a study published in the Journal Alcohol, healthy adult males were administered a dose of alcohol and observed for a period of 48 hours. It was found that the maximum decrease in testosterone was observed at 12 hours after consuming alcohol. Testosterone levels remained dipped for a period of 24 hours there after. Simultaneously, the levels of the hormone cortisol increased and stayed elevated for as long as testosterone levels were suppressed. Similar findings were also recorded in an article published in 2009 in the Bone Journal.

Why Does Alcohol Suppress Testosterone Production

Research has shown that alcohol suppresses testosterone by;

• Increasing the breakdown and removal of testosterone from the blood
• Decreasing testosterone production rate

A research articles published in the New England Journal of Medicine documents this. Although the study was extreme as the participants were given a daily alcohol dose of 220 grams, it clearly showed how testosterone was effected by alcohol.

Why Does Testosterone Breakdown Increase in The Presence of Alcohol

In an article published in the Journal Science, it was mentioned that the rate of breakdown of testosterone in the liver depends on an enzyme called testosterone reductases. Alcohol increases the activity of this enzyme to increase the breakdown activity of testosterone in the liver.

Why Does Testosterone Production Diminish in the Presence of Alcohol

Alcohol is broken down  to acetaldehyde. Acetaldehyde is rapidly converted to acetate by other enzymes and is eventually metabolized to carbon dioxide and water.

Although the liver is the primary site for breakdown of alcohol, the testes also possesses the enzymes necessary for alcohol breakdown. This ability of the testes to breakdown alcohol to acetaldehyde is documented in articles published in the Alcoholism and  Chemical Pathology and Pharmacology. Apparently, the enzymes that help breakdown alcohol are also required for testosterone production. In the presence of alcohol, these enzymes in the testes are diverted to alcohol breakdown rather than facilitate testosterone production. This leads to a reduction in testosterone levels over time.

Cortisol released from Alcohol Consumption Suppresses Testosterone

Courtesy of Stock.xchng by stevekrh19

According to the study in Journal Alcohol and in the Bone Journal, alcohol consumption resulted in elevated levels of the stress hormone cortisol  4 hours after the first drink. Cortisol remained elevated for 24 hours. Cortisol acts directly on cells in the testes to inhibit the production and release of testosterone. Stress hormones in our bodies help us during panic situations or “fight or flight” situations. In such conditions, the body shuts off the reproductive system by suppressing testosterone in order to channel blood into the muscles. This helps someone flee from an oncoming tiger and I am sure that reproduction is the last thing on one’s mind in such a situation. Testosterone levels will stay suppressed as long as cortisol levels are elevated.

Why is it That Some People Consume Alcohol But Still Have a Respectable Physique

As the research has shown, alcohol affects everyone. Every male testes has the ability to breakdown alcohol and as such testosterone production will be suppressed. There will be those who will be able to make respectable gains in losing fat and building muscles while consuming alcohol. But these same people can achieve more without alcohol. For the others who may have plateaued in their weight loss or muscle-building efforts, should take a step back to examine if alcohol could be having a detrimental effect on their training regime.

For further reading – AMSA document on Alcohol

Tags: alcohol, testosterone, alcohol and weight loss, alcohol and fat burn, women testosterone, building muscles, alcohol metabolization, depressant drug, acetaldehyde, testes, ovaries, cortisol, fight or flight, New England Journal of Medicine, testosterone suppresses alcohol

Daniel Engber, senior editor of Slate, writes:

A fat tax, then, discriminates among the varieties of gustatory experience. And its impact would fall most directly on the poor, nonwhite people who tend to be the most avid consumers of soft drinks and the most sensitive to price. Under an apartheid of pleasure, palatable drinks are penalized while delicious—or even hyperdelicious—products come at no extra charge. What about the folks who can’t afford a $5 bottle of POM Wonderful? No big deal, say the academics writing in the New England Journal of Medicine; they can always drink from the faucet. Here’s how the article puts it: “Sugar-sweetened beverages are not necessary for survival, and an alternative (i.e. water) is available at little or no cost.” So much for Let them eat cake.

We’ve known for a long time that any sin tax is likely to be a burden on the poor, since they’re most prone to unhealthy behavior. (James Madison fought the snuff tax on these grounds way back in 1794.) But you might just as well say that poor people have the most to gain from a sin tax for exactly the same reason. It’s also possible that revenues from a fat tax would be spent on obesity prevention—or go back to the community in other ways. There’s a knotty argument here about the vexing and reciprocal interactions among health, wealth, and obesity. It’s not clear whether, and in what direction, a soda tax might redistribute wealth. Whatever you think of the economics, though, raising the price on soda—and offering water in its place—will redistribute pleasure.

Click here to read the entire article.

I drink a lot of soda.

I mean, a lot of soda.  In fact, the only beverages I seem to drink any more are Coke products, coffee and tea.  I drink at least one glass of water every day, but most of what I drink is some form of manufactured beverage.

According to a report in the New England Journal of Medicine, I should have to pay a great deal more for what I drink.  Last night, I bought two 2-liter bottles of Coke products.  They cost me about $3.  If we were to adopt the 1-cent-per-ounce tax on sugary beverages recommendation of the NEJM, I would have to pay another $1.38 for those 2-liters.  The argument they make is that, like cigarette taxes, the tax on sugary beverages would reduce consumption and improve America’s overall health.

From the Wall Street Journal:

The paper, by seven experts in nutrition, public health and economics, called for an excise tax of a penny per ounce on caloric soft drinks and other beverages that contain added sweeteners such as sucrose, high-fructose corn syrup or fruit-juice concentrates. Such a tax could reduce calorie consumption from sweetened beverages by at least 10% and generate revenue that governments could use to fund health programs, the authors said.

“The science base linking the consumption of sugar-sweetened beverages to the risk of chronic diseases is clear,” the authors wrote. “Escalating health-care costs, and the rising burden of diseases related to poor diet, create an urgent need for solutions, thus justifying government’s right to recoup costs.”

There’s just one problem:  Caloric intake is not the sole measure of “poor diet,” nor is poor diet the sole reason for poor health.  Lack of physical activity, other habits like smoking, drinking, drug abuse, chronic dehydration, lack of minimal sun exposure (for Vitamin D) and others also have a cumulative lifetime effect on people’s health.  Simply cutting people’s intake of sugary beverages will not, on its own, solve the obesity problem in the United States.

Further, if caloric intake is such a serious problem, why not go after the source?  Why not tax refined sugar, high-fructose corn syrup and other high-calorie additives?

The answer is obvious:  The agricultural industry would throw a fit!  Most of those additives are actually refined agricultural products.  Taxing them directly would earn the ire of that industry, which can be political suicide.  Attacking the beverage industry, however, is politically feasible, just as attacking “Big Tobacco” by cigarrette taxes was easier than taxing tobacco farming directly.

Adding this tax would seriously affect the soft-drink industry, which produces not just soft drinks but sports drinks, coffee drinks, fruit drinks and bottled water.  With higher prices will come reduces sales, which will cause thousands of people in that industry to lose their jobs.

Again from the Journal:

Beverage-industry executives vehemently oppose the idea, which experts say would result in significant price increases. Coca-Cola Co. Chairman and Chief Executive Muhtar Kent called the proposed tax “outrageous” in a speech Monday in Atlanta, saying it reminded him of his days as a Coke executive in the former Soviet Union, when he watched the government dictate consumers’ choices by stocking only one type of fruit in a store at a time. “I have never seen it work where a government tells people what to eat and what to drink,” he said. “If it worked, the Soviet Union would still be around.”

Well, that’s a bit of an exaggeration, but the basic concept is sound:  Central planning of anything by those who are not directly affected by the results never works.  This results in unhappy consumers and shortages of desired goods.  The article continued:

“A penny per ounce would have a seriously negative impact on the industry, as it could potentially raise prices on key packages by 40% to 50%,” said John Sicher, editor and publisher of Beverage Digest, an industry publication.

PepsiCo Inc. and Coke referred questions on Wednesday’s report to the American Beverage Association, a trade organization. Spokesman Kevin Keane said a federally funded study, also published earlier this year in the NEJM, supports the notion that all calories count, and the key to a healthy lifestyle is balancing consumption with exercise.

“It makes no sense to single out one particular food product as a contributor to obesity when science shows that’s not supportable,” Mr. Keane said.

Taxing soft drinks only makes sense if it is a prelude to attacking all “unhealthy” foods.  Simply reducing soft-drink intake is not going to cure the nation’s obesity ills.

No matter how many people exchange soft drinks for other beverages, the costs will be massive: Lost jobs, lost productivity, reduction in economic output and greater dependence on government to make our choices for us.

So just ignore the idea of personal responisibility.  Just ignore the idea that people should be allowed to make their own choices and live with the consequences.  Just ignore the fact that lifestyle (such as exercise and other habits) has more to do with health than soda consumption.  None of that matters.  We have an obesity crisis, and the only way to cure it is to stop people drinking soda!

Oh, all that soda that I mentioned earlier that I drink?  The vast majority of it is artificially sweetened.  This tax would not affect me.

Cross-posted at TMR.

According to ABC News,

Several of the nation’s leading health experts are calling for a tax on soda as a means of curbing America’s obesity-epidemic.

Their paper, appearing in the most recent issue of the New England Journal of Medicine, calls for a tax on “sugar-sweetened” drinks in order to reduce the consumption of the drinks and lower health costs as well as fund government-run health programs.

“A tax on sugar-sweetened beverages is really a double-win,” said Dr. David Ludwig, a co-author of the paper and director of the Optimal Weight for Life program at Children’s Hospital, Boston.

“We can raise much-needed dollars while likely reducing obesity prevalence, which is a major driver of health care costs, the paper states. “Ultimately the government needs to raise more money to cover the deficit, and in terms of ways of raising that revenue, a tax on sugar sweetened beverages is really a no-brainer.”

Unfortunately for the health experts who wrote the report, the effects of soda taxes have already been studied. Below is an excerpt from a paper by Jason Fletcher (Yale University), David Frisvold (Emory University), and Nathan Tefft (Bates College):

Our results, based on state soft drink sales and excise tax information between 1988 and 2006 and the National Health Examination and Nutrition Survey, suggest that soft drink taxation, as currently practiced in the United States, leads to a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high calorie drinks.

By Calvin Palmer

Most doctors in the United States approve of President Barack Obama’s “public option” to supplement private health care insurance, according to a poll published today in the New England Journal of Medicine.

Of the physicians who participated in the survey, 62.9 percent said they favored a public option, or government insurance plan, against 27.3 percent backing a private system alone.

The doctors backing a private system must all live in northeast Florida if the Letters Page and opinion columns of The Florida Times-Union are to be believed. On an almost daily basis some physician puts pen to paper to air statistics, which are never substantiated, to show how Obama’s “socialist” reforms will destroy the finest health care system in the world.

These testaments to the status quo also trot out the usual mantra of big government and comparisons between the government-run United States Postal Service and how it compares unfavorably and inefficiently to the privately-owned FedEx.

The Florida Times-Union will be perplexed to the point of a catatonic trance, no change there then, to learn that another 9.6 percent of the physicians in the survey favored a completely government-owned health care coverage system.

“It’s clear that the majority of U.S. physicians support both public and private options to expand coverage,” NEJM said, noting that between 52 and 69 percent of Americans favor a supplemental public option.

The journal described physicians as “critical stakeholders” in health care reform.

The poll also found that 58.3 percent of physicians favor expanding Medicare, the public health insurance plan for seniors over 65 years old, to people aged 55 and over. This option is among a set of proposals being considered by the Senate Finance Committee.

In the traditionally more conservative South, 58.9 percent of U.S. physicians favored a public option, compared to 69.7 percent in the generally more progressive Northeast.

The journal surveyed 2,130 general physicians, specialists and surgeons who work in a private practice or with hospital groups.

A Washington Post-ABC News opinion poll shows 46 percent of Americans in favor of the proposed changes and 48 percent opposed.

The Florida Times-Union will no doubt take comfort that its right-wing Republican propaganda, and misinformation, is having some success.

Given the parlous financial state of Morris Publishing Group, publisher of The Florida Times-Union, the right-wing members of its editorial board may wish to tone down the virtues of the free market because it could prove to be their nemesis and leave them without a job and without health care insurance; exactly the kind of people Obama’s reforms are designed to help.

Wouldn’t that be just one of the best examples of Schadenfreude in recent times?

[Based on a report by AFP.]

NEW ENGLAND JOURNAL OF MEDICINE: Some 350 cancer genes have so far been identified by researchers, but there may be as many as 2000, says Dr James R Downing, Memphis, in an analysis of cancer genome research. READ MORE>

…although the landscape of cancer genes will get substantially more complex, clinically relevant diagnostic, prognostic, and predictive markers and therapeutic targets will emerge long before our understanding of the cancer genome is complete.

The things people get lodged in their bodily cavities is astounding!  Watch a video of this thing being removed…

Unilateral Epistaxis

A 44-year-old man presented with a 7-day history of epistaxis on the left side. He reported that he had washed his face in a freshwater stream 7 days before the onset of symptoms. A suspected blood clot was seen in the left middle turbinate on anterior rhinoscopy, although endoscopic examination showed that the possible clot was a living leech. After lidocaine nasal spray was applied to the left nasal cavity, the leech was retrieved with an aspirator (video). The epistaxis subsequently resolved. Although leech infestation is not a common cause of nasal bleeding, it should be considered when an exposure that is consistent with such infestation has occurred.

Source

by Manuel Villacorta

Recently The New England Journal of Medicine released a two-year study on the Comparison of Weight-Loss diets with Different Compositions of Fat, Protein, and Carbohydrates.

Popular media outlets took this 2 year study and drastically over-simplified the findings into something as simple as “Reducing Calories leads to weight loss regardless of what you eat.”  Look at these sample headlines from a quick search on the web.

“Weight loss bottom line: Fewer calories Carbohydrate, protein, or fat content doesn’t play a key role” – Harvard Science

“Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content” – Science Blog

“Fewer Calories Equal Less Weight, Regardless of Carb, Fat, or Protein Content” – Medscape by WebMD

“Study of diets shows what truly counts: calories” – LA Times

The study results included great information that confirms what Nutrition for You experiences with our members  However, by over-simplifying this important study into simply cutting calories to lose weight, we’ve lost many very important details. This study is not giving the green light to eat whatever you want as long as it reduces calories.

Here is what you should know

1. This study was not only about counting calories

The subjects were divided into four groups and were given a macronutrient distribution (ratio of carbohydrates, protein, and fat) to follow throughout the study. The study showed that regardless of the macronutrient distribution; everyone lost weight.   All four diets had a 750 calorie deficit with different nutrient composition of calories.  None of the study groups were just counting calories.

2. Important facts were all but ignored by most reports on this study

One important fact ignored by most was that all diets were required to eat 20 grams of fiber per day, they used whole grains for the carbohydrates and saturated fats were at 8% or less.  All diets were considered “heart healthy” diets so it is natural that someone eating a heart healthy diet will experience those benefits.

3. Record Keeping and Counseling was part of the study

All participants were doing record keeping and participants either had group or individual counseling sessions.   The study demonstrated that those that participated in group or individual counseling sessions, lost more weight.

4. The study ignored the quality of the weight loss, and the long term sustainability

The study only reported weight loss and did not look at muscle retention and fat loss. The quality of the weight loss does matter in the long run.

You can’t simply reduce and count calories.  If you were to simply do that you could have a slice of pizza and four chocolate chip cookies and meet your calories for the day.  With this scenario you would be lacking vital nutrients, including protein, which will decrease your metabolism in the long run.

Participants only exercised 90 minutes per week and the type of exercise (cardio or weight training) was not reported.  As a result the study ignored the relationship of macronutrient distribution and how it contributes to muscle mass retention while losing weight.

5. The study makes a very important point for weight loss.  Losing weight is 80% nutrition and 20% exercise

The participants were only asked to perform 90 minutes of moderate exercise per week.  The fact that very little exercise was required to obtain weight loss benefits demonstrates that the majority of your weight loss occurs because of what you eat and not how much you exercise.

Our experience and our opinion

Nutrition for You’s experience validates the actual study, but not the way much of it was portrayed in the media. This study validates and reinforces what Nutrition for You does every day.  We have always known that weight loss occurs because of a deficit of calories.  However unlike the reports of this study we recognize and address all aspects of your nutritional well-being.

Our program starts and continually works with our members to determine the amount of energy (calories) your body needs each day.  Once we understand your caloric needs we find the right calorie deficit to help you lose weight.  We go beyond simple calorie reductions to make sure you are getting the right balance of nutrients carbohydrates, protein, and heart healthy fat so that your body has everything it needs for proper brain function, muscle retention, fat loss, and healthy nutrition.

As with the study participants we provide tools to our members such as  record keeping, and personalized support by our expert nutrition staff.  In addition we teach you lifestyle changes and self awareness in your eating habits.  These tools are incredibly important in the long run.  Losing weight is not enough. If you do not keep the weight off, then you will lose all of the benefits of your weight loss.

In conclusion, understand that you must eat a healthy balanced diet with a deficit in calories for weight loss that takes into account more than just your calorie count.