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It is very clear to me that many of our foundational truths about preventative medicine is changing. And I’m not talking about the health care reform bill. I am speaking about the benefits and harms of screening tests.
For years, patients and physicians have understood that preventative medicine, which includes cancer screening saves lives. Celebrities, politicians, the media, advocacy groups and even US postal service stamps have embraced the notion that screening was not just a decision, but morally imperative.

But now, we are starting to question this simple message about cancer screening. “Take the test not the chance.”

Screening is not simply about benefits. There are some trade-offs involved. An example of this is demonstrated in the new guidelines for breast cancer screening set forth by the US Preventative Services Task Force in which mammograms are recommended less frequently. This is due to the high rate of false positive results and unnecessary over treatment causing much frustration and anxiety, especially in women under age 40 (Mammogram Guidelines Under Debate, Nov. 22, 2009).

The same holds true for prostate screening and the prostate specific antigen tests (PSA). This test may tell us more about inflammation then about cancer itself. The decline in prostate cancer-related mortality may not be attributable to screening but rather to aggressive new treatments. In other words, we are finding cancers that may never threaten a person’s survival and would otherwise undergo spontaneous remission before becoming clinical disease. The reality is that prostate cancer as well as breast cancer is a disease of aging.

The bottom line is that we have screening tests that are modestly accurate that may or may not make a real difference. And a normal value gives us false comfort that we do not harbor prostate cancer or breast cancer in our bodies, when in fact that may not be the case — especially as we get older.

We clearly need to develop predictive markers to determine which cancer cells will regress and which will be more aggressive. This may not be far from the future considering there is a biochemical marker currently being tested to help predict which colon cancers are more aggressive and likely to spread to other parts of the body. Differentiating low and high risk cancers will provide useful tools to guide physicians and patients in informed decision making in determining which patients need a minimalist approach and which individuals require a more aggressive treatment plan.
Until that time comes, discuss the pros and cons with your clinician and make a screening choice based on individual need and what’s best for you.

Blood Test May Predict Colon Cancer Spread: “”

(Via .)

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Heart disease is a major health problem that can take hold even in our youthful 20’s. How we take care of ourselves physically, mentally and emotionally in our younger years will have an impact on our risk for heart disease, and each decade has it’s own unique challenges as our bodies age.

More than 1 million cases of new and recurrent heart attacks occur each year in the U.S. and they are responsible for one out of every five deaths, according to the National Heart, Lung, and Blood Institute (ABC News Health, Aug 8, 2009).

Here are some great ways to reduce your risk for heart disease at any age.

Protect Your Heart at Every Age on Yahoo! Health: “”

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I’m not big on federally regulating every little thing in our lives. I believe there should be some freedom in each state of what’s best for it’s citizens. But what’s happening with health insurance policy price hikes is out of control! A 39% price hike expected for Anthem Blue Cross policy holders is way over the top. Not just Blue Cross, but Humana and most other insurance policies across the board are raising their prices. There needs to be a limit to insurance costs.
These guys have way too much control and something needs to be done. Their reasoning for the price hike is less clients due to the recession and loss of jobs (and coverage), and the high cost of health services, which includes hospitalizations, and medications. Maybe instead of raising prices for CEO’s to make more profit, they should lay off some of their employees to save money instead of their policy holders “bailing” them out.
It looks to me like the the most greedy, corrupt players in this health care crisis are coming face-to-face; health insurances and pharmaceutical companies. Hospitals and pharmaceutical companies need to take reductions this time around. We’ve got to get these 2 conglomerates under control, or more people will not afford insurance except for the rich, and we will see our health care crisis spin further out of control.
Health care spending hit $2.5 trillion last year, growing faster as a part of the economy than at any time in a half century. The results of this spending compares poorly with other advanced countries spending less (see the Sad Cost of Health Care, Jan. 4, 2010 blog). If this doesn’t get taken care of, government programs — mainly Medicare and Medicaid — will soon cover more than half the nation’s health care tab, which is a huge burden for federal and state budgets. Talk about socialized medicine!

Can’t wait to hear the health care debate on February 25th.
Stay tuned…

Anthem Blue Cross, California’s largest for-profit health insurer, expressed confidence that its new premiums would pass state scrutiny even as it delayed the increase.

Read the rest of this post from NYT > Health

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Tamoxifen (Nolvadex), is a well known anti-estrogen medication commonly used to treat breast cancer. It is known as a selective estrogen receptor modulator, or SERM. This hormone interferes with the activity of estrogen, which can stimulate the growth of breast cancer. Tomoxifen is also recommended by many physicians to women whom are at high risk for breast cancer (breast cancer genes BRCA1 or 2, women who have precancerous lesions, and women with a significant family history of breast cancer).
Depression is a common medicated condition is this country. About 11% of women and 5% of men take antidepressants. When women use Tamoxifen to treat or prevent breast cancer, they often have side effects such as hot flushes, irritability and other mood changes. They are often prescribed antidepressants to alleviate these side effects. Now some studies are cautioning patients (and doctors) to be careful of which antidepressants to use when taking Tamoxifen. Paxil and Prozac may actually do more harm than good.
Other research indicates Tamoxifen can also cause more cognitive dysfunction than other cancer treatment drugs. After a year of taking Tamoxifen, women in one study scored lower on tests of verbal memory and other cognitive skills than women taking another breast cancer drug, Exemestane (Aromasin) (Yahoo news, 2/11/10 9:48 PM health).

Breast cancer patients who take the antidepressant Paxil at the same time as tamoxifen face an increased risk of dying from their disease, a new study shows….

Read the rest of this post from WebMD Health

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Just had to send you this article on chocolate and the sweet benefits of those flavonoids. Enjoy every bite!

Analysis: Chocolate may reduce stroke risk – USATODAY.com: “”

(Via .)

Autism is a range of conditions that effects speech delay and impaired social activity. Nearly 1 in 100 American children is diagnosed with autism. Many parents of an autistic child believed that vaccines were the cause of the disease. This was due to a controversial study by British physician Andrew Wakefield in 1998. He claimed that the MMR (measles, mumps and rubella) vaccine when given to infants was linked to autism. Follow up research was not able to repeat the findings. Now Dr. Wakefield is amid charges of dishonesty and violations of research ethics when they found out that he was being payed off by lawyers to have parents of children given the vaccine sue the drug companies. The medical board is moving to revoke Dr. Wakefield’s license.

The disturbing part of all this is how this doctor gained the trust of worried parents desperate for an answer to why their child had autism. This small study of 12 children was misleading and ignited fearful and desperate parents to form ant-vaccine groups and leaders like Jenny McCarthy, the mother of an autistic child, to lead others to disregard vaccines.

The cause of autism is yet unknown, but multiple genes are being investigated. There may also be a genetic susceptibility to environmental triggers. Hopefully, more scientific research will reveal potential causes of this disease so that effective treatment can be available.

The British doctor who led a study suggesting a link between the measles/mumps/rubella vaccine and autism acted “dishonestly and irresponsibly,” a U.K. regulatory panel has ruled….

Read the rest of this post from WebMD Health

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Antidepressants have shown to be an effective treatment to treat hot flushes for women who cannot use estrogen therapy (ie. breast cancer patients) or who choose not to use hormones.
Integrative therapies have a role in improving quality of life of cancer patients and those suffering from hot flushes. A randomized controlled study was performed to determine whether acupuncture would be effective in helping women whom were symptomatic.
Women were assigned to 12 weeks of therapy with acupuncture vs a popular antidepressant, venlafaxine (otherwise known as Effexor).

The results were impressive. Both treatment groups had similar outcomes with decreases in not only hot flushes, but other menopausal quality of life symptoms including depression. Both groups had a 50% decrease in hot flushes; however, 2 weeks after treatment, hot flushes in the Effexor group increased while in the acupuncture group, symptoms remained low. Also, there were no side effects in the acupuncture group vs the drug group in which some women experienced nausea, headache, difficulty sleeping, and dizziness.
Acupuncture is an important option for women suffering from hot flushes and other menopausal symptoms.

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So you just got your license and you want a new car. Well, your safety behind the wheel may have something to do with whether you own the car and parenting style.
Parenting styles make a big difference in how teens drive according to a national representative survey of approximately 5000 students in grades 9-12. The categories for parental style consisted of authoritative (high support, high control), authoritarian (low support, high control), permissive (high support and low control) and uninvolved (low support and low control).
The results showed that teens who were the primary drivers of a vehicle were twice as likely to be involved in a crash during the past 12 months than teens who reported shared access to a vehicle.
Also, teens who reported their parents were authoritative (high control, but high support) were significantly less likely to report being involved in a car accident in the past 12 months than teens of parents who were categorized as uninvolved.
Teenagers describing their parents as authoritarian or authoritative were significantly more likely to were seat belts as drivers and passengers as those with uninvolved parents.

So what’s the bottom line?
Support your kids, but give them boundaries (rules) and structure. The combination of love and discipline goes a long way. Take the time to stay involved and be consistent and don’t acquiesce to all requests despite protests. It may save your kid’s life.

Reference: Ginsburg KR et al. Associations between parenting styles and teen driving, safety related behaviors and attitudes. Pediatrics 2009 Oct; 124:1040.
Garcia-Espana JF et al. Primary access to vehicles increases risky teen driving behaviors and crashes: National perspective. Pediatrics 2009 Oct; 124: 1069.

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Migraines are very common. In 1999, there were 28 million migraine sufferers in the U.S. and numbers now are in the $30 millions. It counts for $24 Billion in direct and indirect costs. Most headache sufferers have 1-4 migraines per month and miss 4-8 day/ year. Enough with the statistics….

The frustrating issue with migraines is that they are often misdiagnosed due to the array of symptoms that it presents. In other words, not everyone with a migraine has head pain. About 45% of people with migraines have sinus congestion and sinus pain. These people are often misdiagnosed with sinus infections or allergies. Other migraine symptoms may include runny nose, nausea, dizziness, or one sided facial pain.

The important thing to know about migraines is that it’s genetic. Migarines cannot be cured, but they can be managed. This article addresses ways to treat migraine symptoms and what to discus with your practitioner. One of the main things I stress with my patients is keep a headache diary. It is much easier and more effective to treat migraine symptoms if you know what the triggers are. It will especially help women determine if their migraines are related to their menstrual cycles. Common migraine triggers are food sensitivities, lifestyle changes, medications and weather changes to name a few.

The other point to make is that if you are taking a medication to treat migraines, don’t wait too long to take it. Many people feel pain starting, but think they can handle it, or that this one won’t be too bad, and get hit with a severe disabling migraine. The key is to take migraine medication within 30-60 minutes of onset which has a 90% effective rate.

Also, a deficiency in magnesium has been associated with migraines and headaches. Ask your practitioner to get a blood test called an intracellular magnesium level or you can take magnesium citrate in capsule or powder form. Start with a low dose and work your way up. If you develop diarrhea, then lower the dose.

Migraines with aura increases the risk of stroke. So pay attention to symptoms, and talk to your practitioner about effective treatment.

Patient Money – Migraines Force Sufferers to Do Their Homework – NYTimes.com: “”

(Via .)

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There have been several epidemiological studies that have indicated a relationship between the incidence of cancer and obesity, as well as an increased risk of malignancies associated with obesity and excess body fat.

More research is being conducted to explain the mechanisms causing this association. Some of the possibilities include insulin, estrogen and adipocytokines. The interesting thing is that fat (adipose tissue) is not a storage organ as we once thought, but is considered an endocrine organ with lots of functions. Fat tissue consists of free fatty acids with well defined physiological and pathological effects on glucose balance and on proteins called adipocytokines that act to control many metabolic functions. These proteins have been implicated in the development of insulin resistance which leads to diabetes and heart disease.

Obesity not only puts people at greater risk for malignancies, but it makes screening for and treating cancers harder which increases cancer mortality.

Reference: Levitan, D. “Obesity and cancer: Effects on risk screening and mortality” HemOnc today, Volume 11-Number 1, Jan. 10, 2010.