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or consultations by Telephone/email where appropriate,
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17 May 2015
ADAPTING AND ADOPTING BANTING FOR BABIES a la Canadian-WHO recommendations and age-old good practice. canada-guidelines-advise-meat-as-baby-first-food/ Health Canada clarifies stance on meat for babies
Prof Tim Noakes’ team asks for all to sign petitions supporting his argument. We can doubt he needs it since he knows better than most how strong the evidence is.
When us Seniors’ generation was born around WW2, as in ancient times we were from > 6 months age gradually weaned off breast onto and brought up on real fresh food- butter, cream, home-grown veggies, fresh fish and pasture-fed meat /hens (and thus eggs and whole cows’ milk); with a tsp of codliver oil a day as the quintessential brainfood for those of us not brought up on oily ie pelagic sea fish..
Food was produced (like us humans) – especially by us mostly poor – without antibiotics. GMO, pesticides, and packaged, dressed without plastic, let alone massive electromagnetic exposure (TV, computers, cellphones and then WiFi). Like most on the planet, we had no cars or TV, so we also got plenty of sunshine- vits D3, and C (from abundant organic sun-drenched fresh fruit) – and exercise walking/ cycling to transport/ school/ sport or outdoor work as herders, farm/ building labourers etc if not the minority of us in shops/ factories/ office. Basic education and care – literacy-numeracy and hygiene – was provided mostly by state schools competing widely with mission schools, staffed from dedicated teachers’ /nurses/theological training colleges with intensive community experience; and (if mostly from the bible) literate parents from church/ libraries and radio.
But in our >50 years in medicine, all those aeons-old social foundations have increasingly been wiped out , especially in Africa by the ever-more corrupt advertising (especially on TV) and Fast Food- GMO- Disease Industry in partnership with corrupt oligarchy government that closed teachers’ and nurses training colleges; and rural /farm depopulation with mass migration driven by government-led poverty to city ghettoes. .. .
Already by 1970, teaching hospitals- following USA -devised corrupt industry factory-farm-food marketeering (not science and nutritional evidence-based) – started (by the non-medical Ancel Keys) nagging us via our medical school cholesterol clinics to start cutting cholesterol ie meat- dairy- fat intake in exchange for increasing intake of factory mass-produced refined and then genetically modified and insecticide-laden carbohydrates (sugar, maize, soya) and unproven synthetic hydrogenated seed-oils; and cholesterol-busting drugs like clofibrate, the statins, and aspartame – none of which were ever scientifically validated, and have been increasingly incriminated like sugar, fructose and smoking the past 30 years as major health pollutants. .
The scientific evidence has never the past 50 years shown benefits even matching harms from the profit-driven junk marketing of cholesterol-busting drugs and diets – artificial low-animal -fat cholesterol high carbs diets , and synthetic omega6 hydrogenated plant oils like “margarines” and Cremora, and sunflower cooking oils – for any common disease let alone average lipidemias. But the American public was bludgeoned into obeyance/obeisance and then silence, and have suffered increasing obesity and disease ever since – to the joy of the profiteering Fast Food and Disease Industry and their lobbyists in and outside governments. Now the SA Dieticians’ Association attack Noakes (and thus pre-1960s healthy normal world practice, and still Canadian guideline) diet promotion of more animal fat calories than carbs calories for weaning infants;
but the milk comparison the Dieticians quote in their attack- like the figures in the breastmilk Wiki review – shows remarkable conformity between UK mothers’ breast milk and eg Bantu mothers (1950)- milk has about 26% more calories/100gm from animal fat ie +- 38cals than from milk carbs +- 30cals, with protein ~1.1g%.. Obviously, LCHF promoters do not preach no-carbs diets since there is no such real food free of carbs.
The message has always been to take more fat calories than carbs calories, especially not refined empty calories like sugar and commercial fructose-laden drinks and GMO maize. Laymen have difficulty grasping that these refined simple sugars are slow cumulative poisons like longterm smoking, aspartame (Canderel) , oral synthetic sexhormones, fluoride, aluminium, mercury, lead, excess iron, etc. And obviously with poverty and dependency increasing in RSA due to almost worst- in-the -world State schooling since 1994, infant mortality from joblessness and thus stress, violence , malnutrition are increasingly rife in the Born-Frees ie those born in the new South Africa since 1990.
The Diet Association fals to ask simply: where are the references for promoting protein-and fat-rich food for weanlings? They are listed abundantly in the social and medical literature of the past century, especially the current literature we seniors have read weekly the past 50 years from the 1960s; and conveniently now analyzed in depth by medical journalist Nina Teicholz and her numerous experts of the past 50 years she interviewed, in chapters 5 and 6 of The Big Fat Surprise 2014 (Scribe Pubs, Australia & UK);
following in the footsteps of contrarian ie high-carbo-sceptic investigative nutritionists like the archetypal insulin-resistant William Banting 1869 (ironically a distant kinsman of Fred Banting the Nobel-winning discoverer of insulin 50 years later) and his physician Dr William Harvey; Vilhjalmur Stefansson from 1923; Arthur Pennington 1949; Robert Atkins since 1963, Gerald Reaven from 1965 (Syndrome X); WPU Jackson & George Campbell in Cape Town from 1968, Denis Burkitt and Tom Cleave in Africa from 1970, James le Fanu since 1984 (the Rise and Fall of Modern Medicine 2001); Gary Taubes since 2001 (Good Calories Bad Calories 2007); Rooseboom ea 2006 (The Dutch Winter Famine of 1944-45); and Sam Feltham Slimology 2014, the 25 RCTs so far from many universities reported between 2000 and 2014 that Feltham et al detail eg ( in his book Slimology) by numerous contrarian academic clinician experts; all these authorities show that for health and reversing obesity in adults, the LCHF diet is uniformly more successful than the HCLF diet.
Increasing adverse experience with antibiotics, multiple vaccines, factory foods eg formula milk powders, GMO crops, tap water, doctored dairy milk, aspartame, pesticides like DDT and Roundup glyphosphate, crops grown in heavily polluted but nutrient-exhausted soil, and grain/antibiotic/hormone grown foods partly explains why we should avoid as far as possible exposing (future and current) pregnant women and infants to antibiotics, sugar, concentrated fructose, commercial dairy and processed refined cereal products, and aluminium-mercury-tainted vaccines, as far as possible.
In conclusion: it is sad that ADSA the Association for Dietetics in SA, attacks evidence-based Banting proponents personally instead of rebutting in academic scientific robust debate – the scientific media- the best scientific references and policies as thoroughly assessed and promoted by real-world experts below. Clearly, ADSA cannot quote any good science to support its contrary destructive commerce-based policy (of the past ~40 years ) about diet providing the majority of energy as sugars and hydrogenated omega6 – (it and the local medical schools havent done so) instead of low carbs high animal-fat natural food- so now it hides behind the sub judice rule.
Gwyneth Paltrow 2013 has provoked the wrath of the dietetic establishment by saying that she avoids feeding her children bread, rice and pasta, because she believes that these carbohydrate foods aren’t good for them. Paltrow was writing in her new low-carb, gluten-free cookbook, It’s All Good, which is out in April, and whose recipes are said by her publisher to “form the basis of the diet Gwyneth goes back to when she’s been overindulging, when she needs to rebuild, or lose weight.” Dieticians who subscribe uncritically to government nutritional guidelines have been wheeled out to testify to how ‘vital’ carbohydrate is in the diet, and warn in the bleakest terms of the dangers of restricting it. “Paltrow is putting her children, aged eight and six, “at risk of nutrient deficiencies”, warns one. Her children “won’t be able to think straight as their brain won’t be functioning”, says another. In the same Daily Mail piece, it is even observed that Paltrow’s children are thin – shock horror! – as if this was automatically cause for concern. So accustomed are we to the sight of overweight children, thin ones are beginning to look unusual …… read on
Dr Sheila Innis’ recent review Impact of maternal diet on human milk composition and neurological development of infants Am J Clin Nutr. 2014;99:734S-41S. http://www.ncbi.nlm.nih.gov/pubmed/24500153 from Univ British Columbia, Vancouver, Canada concludes unequivocally what vast evidence shows: that animal fat especially Omega3 marine DHA & EPA are crucial for neurodevelopment and all membranes – such natural saturated animal fats make up some 20% of adult brain. Maternal nutrition has little or no effect on many nutrients in human milk; for others, human milk may not be designed as a primary nutritional source for the infant; and for a few, maternal nutrition can lead to substantial variations in human milk quality. Human milk fatty acids are among the nutrients that show extreme sensitivity to maternal nutrition and are implicated in neurological development. Extensive development occurs in the infant brain, with growth from ∼ 350 g at birth to 925 g at 1 y, with this growth including extensive dendritic and axonal arborization. Transfer of n-6 (omega-6) and n-3 (omega-3) fatty acids from the maternal diet into human milk occurs with little interconversion of 18:2n-6 to 20:4n-6 or 18:3n-3 to docosahexaenoic acid (DHA) and little evidence of mammary gland regulation to maintain individual fatty acids constant with varying maternal fatty acid nutrition. DHA has gained attention because of its high concentrations and roles in the brain and retina. Studies addressing DHA intakes by lactating women or human milk amounts of DHA at levels above those typical in the United States and Canada on infant outcomes are inconsistent. However, separating effects of the fatty acid supply in gestation or in the weaning diet from effects on neurodevelopment solely due to human milk fatty acids is complex, particularly when neurodevelopment is assessed after the period of exclusive human milk feeding
. The Canada guidelines The Canadian statement 2013 reads unequivocally: POSITION STATEMENT Weaning from the breast: Barbara Grueger; Canadian Paediatric Society , Community Paediatrics Committee Paed Child Health 2013: updates the similar previous Canadian Paediatric Society position statement 2004. ” – “North American parents have traditionally introduced rice cereal as a first food. There seems to be a movement away from this practice in the general mama community, especially white rice cereal. Baby-led weaning is a method of foods introduction wherein the baby is offered whole foods. The baby has complete control with this method. For example, you steam a whole artichoke, place it on baby’s tray and allow him to decide what to do with it. Infant cereal, pureed meats and fish are recommended as first foods by the American Academy of Pediatric AAP, Canadian Paediatric Society (CPS), Dieticians of Canada, Breastfeeding Committee for Canada, Public Health Agency of Canada, and Health Canada. CPS also identifies poultry, cooked egg yolk and well-cooked legumes (beans, lentils, chick peas) to be good sources of iron and suitable for first foods”.) Exclusive breastfeeding provides optimal nutrition for infants until they are six months old. After six months, infants require complementary foods to meet their nutritional needs. This is when weaning begins. Weaning is the gradual process of introducing complementary foods to an infant’s diet while continuing to breastfeed. The timing and process of weaning need to be individualized by mother and child. Weaning might be abrupt or gradual, take weeks or several months, be child-led or mother-led. Physicians need to guide and support mothers through the weaning process. “Breast milk is the optimal source of nutrition in infancy. Breastfeeding protects infants from a wide array of infectious and noninfectious diseases. With few exceptions, healthy term infants require only breast milk (with vitamin D supplementation)  to meet all their nutritional requirements until they are about six months old. The Canadian Paediatric Society, Dietitians of Canada, Health Canada and the WHO recommend exclusive breastfeeding for the first six months of life and continued breastfeeding with complementary foods for up to two years and beyond (no upper limit has been defined). Iron from meat has the best bioavailability and can be readily absorbed from the gastrointestinal tract. After six months of age, when breastmilk alone cannot provide enough, additional protein sources (such as meat, fish, egg yolk, tofu, lentils and cheese) are needed. Roughage should also be introduced to the diet, although it is not clear when adding fibre becomes necessary. There is no conclusive evidence that delaying the introduction of eggs, fish and nuts (including peanuts) beyond four to six months of age helps to avoid food allergies. As a greater variety of solids and liquids are introduced to a baby’s diet, weaning will progress. “A review of the literature using MEDLINE (1966 to 2012), the Cochrane database and relevant websites, WHO, the Canadian Paediatric Society, Health Canada and the American Academy of Pediatrics, concluded: Given the limited nature of evidence on weaning, the recommendations in this statement are based largely on expert opinion and consensus. “Generally, infants were breastfed longer in ancient times than in Western societies today. Mothers in Zulu societies have traditionally breastfed their infants until 12 to 18 months, at which point a new pregnancy would be anticipated. Ancient Hebrews completed weaning at about three years. Around the world it is not uncommon for children to be completely weaned at two to four years of age. Anthropological studies have described final weaning at the following points: when the infant reaches four times his birth weight; when the infant’s age is six times the length of gestation (ie, 4.5 years); or when the first molar erupts. “The early introduction of mixed feedings began in early 19th-century Western society. Prominent contemporary physicians such as American Pediatric Society founders Drs. Luther Emmett Holt and Job Lewis Smith recommended that weaning begin at around nine to 12 months of age or when the canine teeth appeared. Smith recommended against weaning during the summer months because of the risk of “weanling diarrhea”. As weaning was recommended earlier and earlier, infant mortality increased. Introduction of weaning foods was an important cause of infant mortality in the 19th century. In the early 20th century, mothers were encouraged by the medical community to raise their children scientifically or “by the book”. In the 1920s, the United States government published Infant Care, referred to at the time as the “good book” and read by women from all socioeconomic groups. It recommended cod liver oil, orange juice and artificial feeding. “In 2008, according to the Public Health Agency of Canada, 87% of children were breastfed for some period of time while only 16.4% were exclusively breastfed for six months. Still, this figure represents a steady increase in breastfeeding rates over the previous five years. Breastfeeding duration varies depending on maternal age. Only 11% of infants of mothers aged 25 to 29 years continue to breastfeed exclusively for six months, compared with 20% of infants of mothers 35 years or older. The most common reason mothers give for weaning is a perceived insufficiency in milk supply. Women who breastfeed for longer than three months most often cite return to work as their reason for weaning. Canadian breastfeeding practices may continue to improve because many mothers receiving employment insurance can delay their return to work for 12 months postpartum. Nutritional and developmental issues : At around four to six months of age, most infants are developmentally ready to handle puréed foods. They are developing the oral motor coordination necessary to accept different food textures. However, they are at risk for choking on chunky food pieces such as nuts, whole grapes and hot dog wheels that require advanced oral motor coordination not achieved before three years of age. “Sucking and chewing are complex behaviours with reflex and learned components. The learned component is conditioned by oral stimulation. If a stimulus is not applied while neural development is occurring, an infant may become a poor eater. There is a relationship between prolonged sucking without solids and poor eating. While it is ideal for infants to be exclusively breastfed for six months, it is also true that after a certain age, human milk alone cannot supply all of an infant’s nutritional requirements. Individual circumstances may make it appropriate for some infants to start complementary feedings as early as four months of age. “Age-appropriate intake of calories and micronutrients is important for growth, motor and mental development. Delaying the introduction of nutritional solid foods much beyond six months of age puts an infant at risk for iron deficiency anemia and other micronutrient deficiencies. Picciano et al followed older weaning infants (12 to 18 months of age) by collecting data on dietary intake and growth. Many of the study children were ingesting less than the recommended levels of fat (less than 30% of total calories), iron and zinc. Grains, whole milk, dairy products and meats were identified as important sources of iron, vitamin E and zinc. By four to six months of age, iron stores from birth are diminishing, necessitating the introduction of iron-containing foods at six months of age for all infants. Iron supplementation after the first weeks of life or at four months of age for the exclusively breastfed infant has been recommended by some groups. When there is a delay in introduction of iron fortified foods, oral iron supplementation needs to be considered. The process of weaning While the best method for transitioning from fully breastfeeding to complete nutritional independence is not known, the process should meet the needs of both baby and mother. Physicians may refer mothers to the La Leche League’s website and the Canadian Paediatric Society’s Caring for Kids website (see Resources for parents, below). Weaning can be either natural (infant-led) or planned (mother-led). Gradual weaning (infant-led weaning) occurs as the infant begins to accept increasing amounts and types of complementary food while still breastfeeding on demand. With gradual weaning, the complete wean usually occurs between two and four years of age. In Western cultures, there remains a relative intolerance to this type of weaning and many mothers who breastfeed their older baby or child become “closet nursers”. Closet nursing takes place privately, at home. This relative secrecy tends to compound erroneous beliefs about appropriate breastfeeding duration.
http://www.thestar.com/news/canada/2012/09/24/hold_the_pablum_’give_that_baby_some_meat’_new_canadian_guidelines_advise.html : Megan Ogilvie Health Reporter, 2012 Forget squash and sweet potatoes; steak is now recommended for baby’s first solid food. In a major departure, new Canadian guidelines say parents should be offering their six-month-old infants meat, fish, poultry or meat alternatives two or three times a day.. these iron-rich foods should be the first that babies consume when being introduced to solids. The recommendations, part of a joint statement quietly released last week by Health Canada, are sure to give some parents pause. Previously, it was recommended that babies start out eating infant cereals, followed by fruits and vegetables, as they transition to solid foods.
Healthy Pregnancy, Baby & Child by Sarah TheHealthyHomeEconomist One of most misguided and damaging pieces of advice coming from the vast majority of pediatricians, dieticians, and other “experts” is to give rice cereal as a baby first food around the age of 4-6 months. This advice is extremely harmful to the long term health of the child, contributing greatly to the epidemic of fat toddlers and the exploding problem of childhood obesity. Rice cereal is never a healthy baby first food. Not only is it an extremely high glycemic food when eaten alone (spikes the blood sugar) but it also contains ample amounts of double sugar (disaccharide) molecules, which are extremely hard for such an immature digestive system to digest. The small intestine of a baby mostly produces only one carbohydrate enzyme, lactase, for digestion of the lactose in milk. It produces little to no amylase, the enzyme needed for grain digestion until around age one.Now, at least one governmental body is waking up to the harmful notion of cereal grains as the “ideal” baby first food. Health Canada in collaboration with the Canadian Pediatric Society, Dietitians of Canada and Breastfeeding Committee for Canada has issued new guidelines for transitioning a baby to solid food and two of the first weaning foods recommended. Meat and eggs! While these guidelines are certain to rile vegetarian and vegan groups, the fact is that meat and eggs are indeed perfect weaning foods for a baby. Not only are these animal foods extremely easy to digest compared with cereal grains, but they also supply iron right at the time when a baby’s iron stores from birth start to run low. The inclusion of meat in these baby first food guidelines is in line with the wisdom of Ancestral Cultures which frequently utilized animal foods for weaning. A traditional first food in African cultures is actually raw liver which the mother would pre-chew in small amounts and then feed to her child. The guidelines specifically note the role that ancient wisdom played in the decision to no longer recommend cereal grains and instead suggest meat: “While meat and fish are traditional first foods for some Aboriginal groups, the common practice in North America has been to introduce infant cereal, vegetables, and fruit as first complementary foods.” Soft boiled egg yolks are also an ideal choice as a baby first food as they supply ample iron as well as choline and arachidonic acid which are both critical for optimal development of the baby’s brain which grows as its most rapid rate the first year of life. Unfortunately, while the suggestion of meat and eggs is a good one, the joint statement from Health Canada also inexplicably includes tofu and legumes which are both a terrible choice as a baby first food. The starch in legumes would cause the same digestive problems as rice cereal and the endocrine disrupting isoflavones in tofu would be a disaster for baby’s delicate and developing hormonal system. But, let’s give credit where credit is due. At least meat and eggs are appropriately included on the baby first food list. Good on you Health Canada! Perhaps your neighbor country to the South will wake up and get a clue about how to properly feed babies based on your lead. I’m not holding my breath. Sarah, The Healthy Home Economist
Int J Obes (Lond). 2005;29 Suppl 2:S8-13. How much protein is safe? Agostoni C1, Riva E. ea University of Milan, Italy Since breastfeeding and human milk seem to prevent, while high dietary proteins in the first 2 yr of life seem to promote later overweight, questions have been raised on the safe levels of proteins in the early years. How much protein (as a percentage of total calorie intake) is safe RESULTS: We should move from the figure of 7-8% in the 4-month exclusively breastfed infants up to the maximum acceptable levels of 14% in 12-24-month-old infants. When protein supply represents less than 6% and energy is limited, fully breastfed infants are likely to enter a status of negative nutrient balance. Over the limit of 14% energy from proteins in the 6-24 months period, some mechanisms may begin to operate, leading young children towards an early adiposity rebound and overweight development, beyond any genetic predisposition. Preliminary data seem to indicate a causal role for whole cow’s milk proteins. CONCLUSION: We suggest maintaining breastfeeding as long as possible, and, in case human milk is insufficient, to introduce infant formulas, appropriate for age, up to 18-24 months, in order to keep protein intakes in the safe range of 8-12% within a diet adequate in energy and balanced as far as macronutrients.
Health Canada clarifies stance on meat for babies By Global News with files from Jennifer Tryon Health September 25, 2012 Health Canada is clearing the air about what kind of solid foods babies should be introduced to. The clarification comes after some media outlets reported Tuesday that the agency changed its list of recommended first foods for Canadian babies to include meat and meat alternatives – like eggs, tofu and legumes – to help meet nutritional needs. For the record, Health Canada has not recently modified these guidelines. Since 2004, the agency has recommended iron-rich foods, such as meat and iron-fortified cereal, as a baby’s first solid foods, because iron is crucial to brain development. Most baby cereals now contain iron. There is no scientific evidence suggesting meat is harder on a baby’s digestive system, but parents are reminded to puree the meat with water or breast milk, so it’s easier for the child to swallow. Registered dietitian Cora Rosenbloom also tells Global National‘s Jennifer Tryon that there’s no reason to withhold eggs. “There’s really no evidence to say that food allergies are going to be more common if eggs are introduced earlier.” Link to Health Canada’s current recommendations. Follow Jennifer on Twitter: @JenTryon
BENEFITS OF SCREENING Screening for breast cancer means looking for signs of breast cancer in all women, even if they have no symptoms. The goal of screening is to catch cancers early. Early-stage cancers are easier to treat than later-stage cancers, and the chance of survival is higher. Routine screening for breast cancer lowers one’s risk of dying of breast cancer.
Screening for breast cancer is done by mammography. A mammogram is a special series of x-rays taken of the breast. A doctor looks for any abnormal signs or patterns on the mammogram that might be breast cancer. These signs usually show up on the mammogram before any lump can be felt in the breast. If there is anything unusual on the mammogram, more tests have to be done. These tests can include another mammogram, an ultrasound, or a biopsy. Studies have shown that women who have routine mammograms have 10% to 25% less chance of dying of breast cancer than women who do not have mammograms.
Another possible harm of screening is overdiagnosis. This means finding something on a mammogram that is breast cancer or has a chance of becoming breast cancer, but is such a low-risk type of tumor that it would never have caused any health problems if left alone. Instead, because it was found on mammogram, standard cancer treatment, such as surgery and radiation therapy, is recommended. In cases of overdiagnosis, these treatments are unnecessary and costly and can have both physical and psychological side effects. It is difficult to know exactly how often overdiagnosis happens, but some studies estimate that 1 in 5 breast cancers found on mammograms are overdiagnosed and lead to unnecessary treatment.
12 February 2015 Why I’m Opting out of Mammography JAMA Intern Med. at a routine appointment a few days after my 40th birthday, my gynecologist gave me a prescription for a mammogram. There was no discussion, no explanation. Just a slip of paper, handed to me without a word as I left the examination room. When I asked the doctor what she’d just given me, she told me it was an order for a mammogram. I could call the number to schedule an appointment. “Wait—why should I get a mammogram?” I asked. “Because it could save your life.” Her voice conveyed a note of impatience… read on..
24 Jan 2015 early diagnosis ( by screening the well), and treatment of pre-cancer of eg breast and prostate is increasingly discredited as dangerous, especially for women at ~10years younger prime-of life ( and much higher risk than men) due to menopause. .
Commentary: Prof Peter Gøtzsche Nordic Cochrane, Denmark. Int. J. Epidemiol. Jan 2015: SCREENING- A SEDUCTIVE PARADIGM THAT HAS GENERALLY FAILED US: “Screening healthy people has face value and great public and political appeal. It looks so simple, and yet screening is fraught with difficulties. These start already with the terminology, and common slogans like, ‘Catch the disease early, before it has produced any symptoms!’ are misleading on two counts.
First, disease means lack of ease, which is not what we understand by being healthy; but people who work with screening tend to forget that they deal with healthy people. For example, women being invited to mammography screening are often called patients in scientific articles. The second error is the assumption that the disease is caught early. That is rarely the case, and breast cancer is again a good example. If we assume that the growth rate for a particular cancer is constant, then the women have harboured the cancer for 21 years on average before it is large enough to be detected by mammography screening.1 Finding precursors to cancer is of course an entirely different matter.
A third problem with screening is that it always causes harm. Sometimes it also leads to benefits, and sometimes the benefits are sufficiently large to outweigh the harms. The main focus in screening trials should therefore be to quantify the harms, but this has rarely been the case, if ever. Screening trials focus on disease-specific mortality, which may seem natural, but it is the wrong outcome. Screening leads to overdiagnosis, and interventions that are beneficial for real patients can be lethal for healthy overdiagnosed people. Radiotherapy of overdiagnosed women may kill at least as many as those who are spared dying from breast cancer by attending breast screening.2
Total mortality should therefore be the primary outcome in screening trials of mortality, and Saquib et al. report a systematic review in this issue of the journal that aimed at clarifying whether screening lowers total mortality for diseases that carry a high disease-specific mortality.3 They focused on cancer, cardiovascular diseases, type 2 diabetes and chronic obstructive pulmonary disease. They did not find any screening trials for hypertension or chronic obstructive pulmonary disease. Disease-specific mortality was reduced with ultrasound for abdominal aortic aneurysm in men, mammography for breast cancer and faecal occult blood test and flexible sigmoidoscopy for colorectal cancer, but the risk ratio point estimates for all-cause mortality were all very close to 1.00 (range 0.98–1.03).
Screening proponents often say that disease-specific mortality is the right outcome, arguing that in order to show an effect on total mortality, trials would become unrealistically large. I believe this argument is invalid, for both scientific and ethical reasons. We do randomized trials in order to avoid bias, and our primary outcome should therefore not be a biased one. Drug interventions are usually more common in a screened group, and they tend to increase mortality for a variety of non-disease related reasons.4
From an ethical perspective, it is problematic to screen the whole population in a certain age group without knowing whether this makes people live longer, while knowing almost certainly that it makes people less happy. It took 50 years after the first randomized trial of mammography started before we knew what the psychological consequences are of the many false-positive findings.5 A specially designed questionnaire was developed using focus groups and women who had attended screening were followed up for 3 years. Even after so long a time, those who had experienced a false-positive diagnosis had an anxiety level (and other psychological problems) that fell between that for women with breast cancer and women who had always been told they did not have cancer. This study showed for the first time that the psychological harms of breast screening are substantial and long-lasting, and they affect a huge number of healthy women, as the cumulative risk of a false-positive result after 10 mammograms ranges from about 20% to 60%.6 Added to this comes the psychological harm inflicted on all the overdiagnosed women who do not know that they are overdiagnosed but think that they suffer from a fatal disease. It is therefore pretty clear that any utility analysis that takes the psychological harms of breast screening into account will come out negative, as was recently reported by the Swiss Medical Board.7
It is worth noting that when screening does not work, it might be because beneficial effects are outweighed by harmful ones. Diabetes drugs, for example, are approved on the basis of their glucose-lowering effect without knowing what they do to patients. And the only large trial of tolbutamide ever performed was stopped prematurely because the drug increased cardiovascular mortality.4 Rosiglitazone was once the most-sold diabetes drug in the world, but it was taken off the market in Europe in 2010 as it causes myocardial infarction and cardiovascular death; and pioglitazone has been linked to heart failure and bladder cancer.4
Screening is popular, but we need to be much more careful in the future when we contemplate approaching healthy people with our screening tests, and should demand much stronger evidence than when we treat patients.”
September 16, 2014 — A U.K. clinical trial examining whether mammography screening should be offered to a broader range of women must be halted due to ethical and medical concerns, according to a letter published in BMJ by a group of longtime opponents to breast screening. But not everyone agrees, and the controversy looks set to continue. In a strongly worded letter published (BMJ) on 16 September, a group led by Dr. Susan Bewley raised concerns about the U.K. age-extension trial, which is examining whether the age range for screening should be extended to both younger and older women. They challenge the design of the trial as well as the qualifications of its chief investigator, calling the study an “out of control trial with ineffective oversight.”“Our concerns relate to the science and ethics of this trial. Women should always be told the full facts — here they are unwittingly participating in a research trial without fully realizing that the harm/benefit ratio is uncertain,” Bewley said. “There is no overall mortality benefit from breast screening at any age if you look at the Nordic Cochrane review — only a reduction in breast cancer mortality.”
|Age, y||No. of Breast Cancer Deaths Averted With Mammography Screening Over Next 15 y||No. (95% CI) With ≥1 False-Positive Result During the 10 yc||No. (95% CI) With ≥1 False Positive Resulting in a Biopsy During the 10 yc||No. of Breast Cancers or DCIS Diagnosed During the 10 y That Would Never Become Clinically Important (Overdiagnosis)d|
|40||1–16||6,130 (5,940–6,310)||700 (610–780)||?–104e|
|50||3–32||6,130 (5,800–6,470)||940 (740–1,150)||30–137|
|60||5–49||4,970 (4,780–5,150)||980 (840–1,130)||64–194|
Invisible Risks, Emotional Choices — Mammography and Medical Decision Making Lisa Rosenbaum, M.D. cardiologist & journalist N Engl J Med October 16, 2014: in 1993, frightened New York City parents agitated for asbestos removal from schools. As often occurs, public fear trumped expert risk assessment; the parents’ demands were met, the victory was celebrated, but then the celebration crashed. It turned out that removing the asbestos would mean closing the schools for weeks, disrupting parents’ lives. “As the costs of the removal came on-screen,” writes behavioral economist Cass Sunstein, “parents thought much more like experts, and the risks of asbestos seemed tolerable: Statistically small, and on balance worth incurring.”1
It is partly because our perceptions of risk are so influenced by our changeable emotions that we turn to experts to perform cost–benefit analyses. From environmental regulations to nuclear energy, such expert assessments inform policies meant to improve public health and welfare. We would not ask airline passengers to create standards for aviation safety or car owners to optimize fuel-emission standards, and in medicine, too, we still depend on expert-generated guidelines. Increasingly, however, in this era of patient-centered care and shared decision making, those guidelines emphasize the role that patient preference should play in the weighing of risk and benefit for any given evidence-based recommendation. This approach, with virtue on its side, is driven by the aspiration that we can, with the proper tools, empower patients to think like experts. But can we?
Many medical decisions involve considerable uncertainty and complex tradeoffs, but none seem to highlight the tension between emotions and risk assessment more than mammography screening. Although the U.S. Preventive Services Task Force (USPSTF) recommended in 2009 that women under 50 years of age not undergo routine mammography screening, and that those between 50 and 75 years of age be screened less frequently, screening rates have apparently held steady or perhaps even increased. There are many possible reasons for this trend: physicians’ habits, conflicting guidelines, medicolegal concerns, radiologists’ preference for the status quo, and the mandating of screening coverage for women of all ages in the Affordable Care Act. But I suspect that the trends also reflect the powerful role that emotions play in both reinforcing women’s commitment to screening and the challenge of communicating the potential harms of mammography.
Consider a discussion with a 45-year-old woman with no family history of breast cancer about the most likely harm of screening: a false positive result. Maybe you say, “For someone like you, there is around a 50% chance that if you have regular screening over the next 10 years, you will have a false positive result. That could lead to repeat testing, potentially including a biopsy, and lots of worry and anxiety.”2 But though doctors striving to reduce unnecessary testing tend to emphasize the psychological stress involved, this possibility does not seem to loom large for women facing this decision.
Perhaps these results reflect the likelihood that, when facing tough tradeoffs, we anticipate and try to avoid regret, rather than anxiety. Despite the demonstrable harms on the population level, cancer screening rarely begets regret for the individual. As Ransohoff and colleagues have written about the persistence of prostate-cancer screening, “the screening process is one without negative feedback. A negative test provides reassurance. A positive one is accompanied by gratitude that disease was caught early. And a false positive test, regardless of the distress it may cause, is nevertheless followed by relief that no cancer was ultimately found.”5 So women who have had false positive mammograms may spend the rest of their lives worrying that they are at heightened risk for breast cancer. But they are not left with regret about having had the test in the first place.
What about the risk of overdiagnosis — being diagnosed with and treated for a tumor that would never have become clinically significant? The potential toxic effects of treatments, ranging from chemotherapy and radiation to lumpectomy and mastectomy, make overdiagnosis the greatest potential harm of mammography screening. Though overdiagnosis has been notoriously difficult to quantify, a recent analysis of data on mammography screening over the past 30 years suggests that of all breast cancers diagnosed, 22 to 31% are overdiagnosed.6 Nevertheless, there are few risks of this magnitude that are more “off-screen” than overdiagnosis.
The first challenge in conveying this risk to women is that many are simply unaware that overdiagnosis occurs. One survey showed that only 7% of women believed that there could be tumors that grow so slowly that an affected woman would need no treatment; another study showed that women found the concept confusing even after a brief educational intervention. After being educated, women thought the information should be considered in decision making, but most believed it would not affect their own intent to be screened.3,7
This disconnect between awareness and intent speaks to the fundamental challenge of conveying the potential harms of mammography screening. That is: we do not think risk; we feel it. As research on risk perception has shown, we are often guided by intuition and affect.8 For example, when our general impressions of a technology are positive, we tend to assume that its benefits are high and its risks are low. We estimate our personal risks of disease not on the basis of algorithms and risk calculators, but rather according to how similar we are, in ways we can observe, to people we know who have the disease. And when we fear something, we are far more sensitive to the mere possibility of its occurrence than its actual probability.
That may be why overdiagnosis does not resonate emotionally. We do not see women walking around with “an overdiagnosis.” Instead, we see breast-cancer survivors. We do not hear people complaining about having endured radiation, chemotherapy, and a lumpectomy. What we hear instead is, “Thank goodness I had a mammogram and caught it early.” Our relatives do not eye us critically when we get a mammogram that reveals a nascent tumor. But people shake their heads and say, “I wish she had taken better care of herself,” when we are diagnosed after not having been screened. Thus, we can be educated about overdiagnosis. We can refine our estimates about its likelihood and incorporate them into our recommendations, as the USPSTF did in 2009. But it is hard to summon fear of a risk that remains invisible.
So how do we balance the goal of engaging women in decision making with the reality that emotions play a powerful role in shaping our understanding of benefit and risk? Some experts emphasize the need to address sources of misperception that inform beliefs far outside clinical encounters. Researchers at Dartmouth, for example, have described the misleading nature of various screening-advocacy campaigns. One advertisement by the Komen Foundation, for instance, features a photo of a beautiful young woman, with a caption reading, “The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”9 Though 5-year survival rates, because of lead-time bias and overdiagnosis, do not actually tell you whether the test saves lives, the visceral appeal of “catching something early” easily eclipses the difficult mental calculations one must undertake to figure out why early detection does not necessarily mean living longer.
The problem is that once impressions have formed, whatever their source, educational efforts to address misperceptions often fail and can even backfire. In a recent randomized trial evaluating approaches to vaccine education, for example, researchers found that, among parents least likely to vaccinate their children, exposure to information emphasizing that there is no link between vaccines and autism mitigated misperceptions but nevertheless further reduced their intention to vaccinate.10 Indeed, the fact that sound scientific information that challenges beliefs can simply intensify those beliefs has been recognized by cognitive psychologists for decades. What was more disappointing in this study was that more creative attempts to engage parents emotionally, such as using images or narratives of children dying of measles, not only failed to increase vaccination intent but also cemented some parents’ conviction that there is a link between vaccines and autism.
If there is tension between belief and sound medical information regarding vaccines, for which the benefits so clearly outweigh the risks, the tension is only heightened for decisions with more complex tradeoffs. The vaccine study thus raises two key challenges for the profession.
The first is empirical. As the locus of decision making shifts toward the patient, this study reminds us how little we know about how beliefs inform interpretation of medical evidence — or about how to negotiate those beliefs in pursuit of better health. Closing this empirical gap is daunting. Not only does each person have his or her own belief system, but the particular beliefs that are relevant for a decision regarding, say, elective percutaneous coronary intervention or palliative chemotherapy may be quite different from those relevant to childhood vaccination or mammography screening. Moreover, even though it is more practical and financially feasible to conduct a study that looks at how interventions affect knowledge and intent, what we really need are long-term studies of how new approaches to sharing information affect downstream behaviors and outcomes.
Which brings us to the second challenge, more ethical than empirical: How do we balance the need to honor preferences and values with the imperative to translate our evidence base into better population health? Our current default, particularly since medical recommendations are increasingly debated publicly, is to emphasize that decisions are “personal.” After the 2009 guidelines were published, the Obama administration and many physician leaders were all over the news reminding us of the importance of personal preferences. But even as more data accrue, including a recent review suggesting that the harms of mammography are greater than we once thought and the benefits fewer,11 the message we hear is not “Let’s do fewer mammograms.” Rather, it is “Let’s honor patients’ preferences.”
Though we certainly need to be sensitive to patients’ values, it is often hard to distinguish values from an emotional understanding of risk. Consider the decision to initiate statin therapy for primary prevention of cardiovascular disease. One patient, an avid tennis player, may recognize the potential for improved cardiovascular health but feel that the prospect of myalgias simply outweighs any potential benefit. That is a preference. Another patient hates drug companies and therefore believes that statins must lack cardiovascular benefit and be highly likely to cause myalgias and liver disease. That is an emotional understanding of risk. Both patients arrive at the same choice, but should we really celebrate them as equally informed decisions?
The tangled nature of emotions and values is particularly relevant to mammography screening, as evidenced in qualitative research done since the 2009 guidelines were released. One study explored the beliefs and attitudes of an ethnically diverse sample of women in their 40s. Though many were unaware of the guidelines, the researchers found that educating them about the new recommendations strengthened rather than diminished their commitment to screening. Women also expressed fears that the guidelines were an attempt by insurers to save money and keep them from getting the care they needed. Many women, expressing their abiding conviction that mammograms save lives, said they would have “no use” for a decision aid and viewed the weighing of benefits and harms as “irrelevant.” In fact, many said they wanted to be screened more than once a year and beginning before the age of 40 years. Finally, many believed that it was unjust that laywomen had been left out of the guideline-development process and the weighing of potential benefits and harms that it entailed.12
Such responses echo a broader debate among leading scholars of risk perception about whom we should rely on to evaluate risk. Some, such as Sunstein,1 recognizing our general difficulties in thinking about probabilities, argue that this task ought to be left to experts who can create policies to maximize public welfare. But the psychologist Paul Slovic has argued that the very concept of risk is subjective. Whereas experts tend to conceive of risk as “synonymous with expected annual mortality,” Slovic reminds us that riskiness means more to people than mortality rates.13
Undoubtedly, the recognition of the affective nature of risk perception is critical to the physician’s role in helping patients live longer, higher-quality lives. But even if we can, in some general way, address misleading statistics that drive inflated perceptions of the benefits of mammography, what do we do about the 38-year-old woman who insists on annual screening because she just lost her best friend to breast cancer? Or the 43-year-old with fibrocystic breasts who last year had a false positive mammogram and is now convinced her risk is even higher? Is there some hierarchy of emotional reasoning dictating that certain causes of heightened fears are more acceptable than others? Or because we know it is often impossible to tease out sources of belief, much less rank them, is a better approach the more paternalistic one: definitive guidelines on which physicians base their recommendations, with less emphasis on the role that patient preference ought to play?
One of the hallmarks of heuristic reasoning, as emphasized by Daniel Kahneman,14 is that faced with a hard question, we answer an easier one instead. In some sense, then, as a profession, we have fallen into a collective heuristic trap. Rather than confront these thorny ethical questions head on, we have answered an easier question: Should we respect patients’ values and preferences? The right answer will always be yes. The much harder question is how to balance that respect with our professional responsibility to use our expertise to translate clinical science into better population health.
Defaulting to patient preference in the face of uncertainty has become the moral high ground. But it is as much our job to figure out how to best help our patients lead healthier lives as it is to honor their preferences. No matter how well we can define the tradeoffs of a medical decision, the threshold at which we decide that benefits outweigh harms is as subjective as individual patients’ perceptions of those tradeoffs. But this recognition does not stop us from making rigorous attempts to quantify the tradeoffs, any more than it should stop us from trying to better understand how our patients’ feelings and beliefs inform their understanding of those numbers, consequent behaviors, and health outcomes. As Slovic has emphasized, experts’ efforts to communicate risk will fail in the absence of a structured two-way process. “Each side, expert and public, has something valid to contribute,” he notes. “Each side must respect the insights and intelligence of the other.”13
“Hello , What are you doing to detox your patients on a daily basis? We live in a crazy world where nutritional supplements with little or no clear risks to consumers are seized/ restricted, but Authorities drag feet on stopping the use of a proven toxin like BP-A found as a coating inside of most canned goods. Please understand that Randy Jirtle at Duke has shown that BP-A made healthy brown Agouti mice become obese, yellow and diabetic! That effect led to an epigenetic change, which will persist for generations and was shown to be an epigenetic change in methylation.Plan to protect yourself with lots of methylation support. I take my Beyond B12 sublingual product that provides Methyl Folate and Methyl B12. Please know virtually everyone tests positive for BP-A in urine much of the time, as we have great difficulty in avoiding this poison in our daily living. Yet authorities ignores the dangers although they finally are doing something to protect babies a little.How can anyone practice effective medicine today and ignore the toxin burden we all carry. Remember when I got out of training in 1958 normal sperm count was 140 million; today few have 40 million. I detox daily with my “Power Drink” and PEMF and I definitely show real benefits even at age 79.“BPA has been linked to possible health problems of the brain, breast and prostate. In 2008, the environmental group Natural Resources Defense Council asked the FDA to ban use of the chemical because of what it termed “serious adverse health effects.”In 2011, the American Medical Association deemed BPA an “endocrine-disrupting agent” and urged that “BPA-containing products with the potential for human exposure be clearly identified.” The FDA said it continues to evaluate the safety of BPA-containing products.”http://online.wsj.com/article/SB10001424127887323740804578600113164806902.html?mod=djemHL_t
Tying up Garry Gordon’s two themes above is obviously the fact that , as in eg the USA ARED (Centrum) trial, the Lemon-Rollo McMaster supermouse trials and the Scottish Highlands, and China supplement trials, multisupplements are longterm (especially with vigorous levels of vitamins C and D and magnesium) both antioxidant, insulin sensitizing, methylating, Nitric-oxide promoting and (heavy metal) detoxicants- ie promote healthspan and suppress degenerative diseases and infection. . .
UPDATE 18 OCT 2014: more arguments against screening mammography from UK and Canada:Curr Oncol. Oct 2014; 21(5): 210–214. Reflections on screening mammography and the early detection of breast cancer. A Countercurrents Seriesa S.A. Narod, MD *Women’s College Research Institute, Women’s College Hospital, Toronto, ON.A little learning is a dangerous thing.— Alexander Pope, An Essay on CriticismIn the stormy aftermath of the recent publication of results from the 25-year Canadian National Breast Screening Study (nbss)1, various opinions questioning the validity of the study’s results have been expressed2–7. I was a latecomer to the study. In 2005, I was charged with oversight of the final record linkage and the statistical analysis and interpretation of the final data set. Dr. Anthony Miller has been my mentor since 1987. Our first joint paper, on screening for cervical cancer, was published in 19918. I chose not to respond to individual criticisms, but instead to collect my thoughts and to try to explain why the study authors saw no benefit from screening.Most of the criticism from the radiology community focuses on issues of study design (which they claim was inadequate) and on the quality of the mammography (which they also claim was inadequate). Cancer survivors bolster those criticisms with testimonials and appeals to common sense. Supporters of the study are drawn from the public health community, and they tend to focus on overdiagnosis and health economics.The report at issue is not the first emerging from the nbss. Earlier reports9,10 were criticized for not having allowed adequate follow-up time. But the 25-year results resemble the early results, and the authors are no longer criticized for premature disclosure. None of the first-generation critics have acknowledged the consistency; instead, they look elsewhere and point out other weaknesses. They claim that high-risk women were assigned to the mammography arm in violation of the principle of randomization. In his bestseller The Emperor of All Maladies, Siddhartha Mukherjee says, as a matter of fact, that high-risk women were assigned surreptitiously to the mammography arm, which explains the lack of observed benefit11.The most recent nbss report1 tallied the breast cancers that occurred in each of the two study arms after the screening period ended (that is, between years 6 and 25), counting 2584 cancers in the screening arm and 2609 cancers in the control arm. If the screening arm had been enriched for women at “high risk,” that enrichment must have been performed in a peculiar fashion, using only risk factors that have a transient effect. Perhaps Dr. Mukherjee would care to explain what those factors were. It follows that the excess of cancers seen in the screening period (years 1–5: 666 vs. 524) was a result of early diagnosis and not from stacking the deck.In any case, compelling evidence against the criticism of assignment of high-risk women to the screening arm is provided in the most recent analysis1, and that criticism is no longer raised (although no one has retracted or apologized). Instead, critics now insist that many women with palpable lesions were sent directly to the screening arm by duplicitous research assistants. There is no reason to believe that such actions (which would involve a national conspiracy of dozens of coordinators who spoke two official languages) were taken, but even if they had been, the study and its conclusions would not necessarily be invalidated. Even if all the women with prevalent cancers had been shunted to the screening arm, the situation could still be remedied by ignoring all cancers found at the first screening round (prevalent cancers) and focusing instead on the incident cancers. Such a strategy is not uncommon in screening studies. In the nbss, no woman had the opportunity to “cross the floor” from one study arm to the other after initial assignment. Therefore, if we exclude all prevalent cases from the analysis and focus on women with no cancer at study entry, we can re-evaluate the benefit of mammography thereafter. The hazard ratio for death from breast cancers detected in screening rounds 2–5 was 0.90 (95% confidence interval: 0.69 to 1.16;p = 0.40).But what about crossover? It is claimed that a certain proportion of the women in the control arm—perhaps as high as 20%—opted for screening off-study, in particular after the screening period was over. That crossover will, some say, eclipse a benefit of screening that might otherwise have ensued. That is, the benefit of mammography (which might well have been substantial) was nullified by a subcohort of independently-minded women who went for mammography at the end of the 5 years. That speculation is fanciful, but if true, should be welcomed, because it can now be said to a patient who, at age 40, requests a mammogram, that there is no hurry; she can come back in 5 years for a mammogram and achieve the same net benefit. And when she comes back at age 45, she can be reprieved again until age 50.Crossover is a form of contamination that results in misclassification of the exposed and unexposed groups. In a trial, it will tend to bias the result toward the null. The best way to avoid misclassification is to randomize the patients after they agree to participate—as the nbss did. In contrast, in the Swedish two-county trial (discussed in more detail a little later in this article), the subjects were randomized by intention-to-treat—that is, by whether they received or did not receive an invitation to mammography12–15. Of the 78,085 women in Sweden who were offered screening, 69,645 accepted and 8440 declined. In effect, then, 8440 women in the Swedish study were de facto misclassified (versus an undisclosed number of hypothetical crossers-over in the Canadian study). The proponents of the Swedish study do not see that misclassification as a shortcoming, but instead use it to buoy their argument in favour of screening. They say that if everybody invited for screening came for screening, then the protective effect would have been more profound. In the Swedish study, all women in the control group were offered a screening test after the screening period ended (a reasonable thing to do); but those authors were not criticized for “contaminating” their study.
The second issue raised concerns the quality of the mammography. After all, the nbss tests were completed 30 years ago using 30-year-old technology. I still wonder how things might have been done differently. Mammography screening identified 212 women with breast cancer who would otherwise have been missed. They had cancers that were, on average, 1.4 cm in size, with 67% being node-negative. The survival of those women was very good. At the end of the study period, 170 women with a nonpalpable mammography-detected breast cancer were alive or had died of other causes. How many of those lives did screening save? Fifty? Twenty-five? Ten? Unfortunately, all we can say is that the number was too few to be noticed. If a significant number of those 170 lives had, in fact, been saved, surely the difference between study arms would have been noticeable. Breast cancer deaths numbered 180 in the mammography group and 171 in the control group. Perhaps some of the survivors believe that their lives were saved. They might perhaps have written a letter to the editor of their local newspaper extolling the virtues of mammography. But 42 women with a nonpalpable mammography-detected cancer died (none of whom has written a letter to the editor).
I am also among the authors of several publications on the benefits of screening by magnetic resonance imaging (mri) in high-risk women16–18. Those studies were greeted as successes, given that they demonstrated how, with the use of mri, breast cancers could be downstaged. Those studies were accepted by the radiology community as being supportive of screening. Whether mri reduces mortality has not yet been shown. I cannot predict whether mri screening will be effective in reducing mortality 10 years down the line, but I fully expect that if a mortality benefit fails to materialize, the studies will be criticized for using 30-year-old equipment and a poor study design.
Much of the criticism of the nbss has come from Drs. Daniel Kopans and László Tabár, and fellow travellers such as Siddhartha Mukherjee and Patrick Borgen2–7,11. They use the Swedish two-county trial as evidence of a good study that supports the use of mammography and quote a 30% reduction in mortality. Naturally, they do not criticize their canonical study, but it is time to take a closer look.
In the nbss, women were randomized on an individual basis after they had attended the study centre. The result was two groups of equal size and 100% compliance with the first screen. In Sweden, the two counties were divided into 19 geographic strata that were then divided into either 2 blocks (Östergötland) or 3 blocks (Kopparberg). The resulting 45 blocks were randomized, and women in more than half the blocks were sent a letter of invitation to screening. Of the 59% of women who received an invitation, 89% came for the first screen and 83% came for the second screen14.
The Canadian women were offered 5 mammograms 1 year apart. The Swedish women were offered mammograms every 2 years (ages 40–49) or every 3 years (ages 50–74) for up to 8 years. They underwent fewer screens (Table i). The cancers detected by mammography in Canada were similar in size to those detected in Sweden (Table i), but the size of the cancers occurring in the control group were very different. Those comparisons suggest that physical examinations or breast cancer awareness (or both) were important contributors to the size of cancers detected in Canada. A diminution of cancer mortality would not be expected to be associated with a 0.2 cm mean difference in tumour size, but might be expected with a net reduction of 0.7 cm in size19. Of the cancers detected in the screening arm of the Canadian trial, 68% were palpable. That fact has been a source of criticism. But a physical examination was not conducted as part of the screening protocol in Sweden, and the comparable number of palpable tumours was not given. Therefore, given the much longer mean time between screening visits in Sweden, and the high proportion of women in the screening arm that were never screened, I estimate that between 70% and 80% of the cancers in the mammography arm in Sweden would have been palpable and could have been detected by physical examination—had it been done. The fact that the relevant number is not given is a critical lapse. Suppose, for the sake of argument, that 100% of the cancers detected in the screening arm in Sweden were in fact palpable (not a gross exaggeration). What then would be the point of mammographic screening? And if that number (the palpable fraction) is not available, how can the results be judged? Neither the Swedish nor the Canadian trial can exclude the possibility that the benefit from invitation to mammography might have been restricted to women with palpable cancers.
A comparison of key parameters in the Canadian National Breast Screening Study (nbss) and the Swedish two-county trial
The Canadian study reports the number of cancers detected in the follow-up period after the end of the screening period and the number of subsequent deaths from breast cancer. From year 6 to year 25, 2584 incident cancers occurred in the screening group, resulting in 298 deaths (11.5%), and 2609 incident cancers occurred in the control group, resulting in 321 deaths (12.3%). Those data are important because they confirm that, in the absence of screening, the cancer incidence and mortality are equal in the study groups. Where are the comparable numbers for the Swedish study? Again, they are not given. But in looking at the extraordinary Figure 1 from the most recent report of the Swedish study12, the mortality curves are seen to continue to separate at 25 to 29 years after the initiation of screening, and long since screening had stopped.
Tabár and colleagues ask readers to believe that the benefits of mammography are everlasting (or at least for 20 years beyond the end of screening). They make that claim despite having no surety about whether the deaths from breast cancer in years 25–29 were the result of cancers diagnosed during the screening period or diagnosed after screening had stopped. They claim that most of the deaths from breast cancers diagnosed in the control arm occurred more than 10 years after diagnosis. Thus, the reader is asked to accept that a mean of 2.3 mammograms obtained in year 1–7 are more likely than a baseline imbalance in breast cancer risk to lead to a reduction in breast cancer mortality of 30% in years 25–29!
The incidence and mortality rates corresponding to cancers that were diagnosed after the screening trial was stopped are unavailable. Seeing the survival curves corresponding to cases detected in the screened and unscreened cohorts would be interesting. In the nbss, most cancer deaths occurred, as expected, within 10 years from diagnosis1. When the nbss was challenged as to having achieved an even balance in the study groups, the authors provided the relevant data. The Swedish authors should do the same. Patrick Borgen has stated that the nbss is the “worst clinical trial ever done”5—an extraordinary statement. Either he has devoted his life to poring over medical tracts with the zeal of a Talmudic scholar, or he is speaking nonsense. But refuting his claim is easy: it takes merely the time required to read the Swedish papers.
Once the facts are accepted (that screening mammography fails to do what it was intended to do, and that overdiagnosis is real and substantial), then the most interesting questions can begin to be addressed. Did the nbss fail because mammography is not a sufficiently sensitive imaging technique? Or has the screening community been working under false premises?
Consider sensitivity. Proponents of mammography say that the technique is currently better than it was in the 1980s, largely because it is more sensitive. (Specificity is also important, but is not at issue here.) They argue that “the more sensitive, the better.” The earlier a cancer can be identified and managed, the better. The smaller, the better. But those contentions generate an interesting paradox. Consider a woman with a small early-stage breast cancer. The recommendation is that this woman be followed with annual bilateral mammography for 5 or more years to identify recurrences and contralateral cancers20. That recommendation is based on the knowledge that the risk of contralateral cancer is between 0.5% and 0.8% annually21 and that a diagnosis of contralateral cancer is associated with an increase in mortality from breast cancer22. (It has not been shown that screening for contralateral cancer reduces mortality.) But mri is a much more sensitive screening tool than mammography, and by using mri in that setting, a small contralateral breast cancer can be identified in 4% of women with newly-diagnosed breast cancer23. And yet routine mri of the contralateral breast is not recommended, because it has not been shown to improve survival. Instead, the recommendation for follow-up with annual mammography continues. The paradox is this: If 8 years’ worth of incident breast cancers can be identified in one shot, why bother to pick them up in dribs and drabs? The mri-detected occult lesions are understood not to be clinically meaningful because they do not adversely affect mortality (overdiagnosis); however, if a similar lesion were to be found as a primary cancer in the ipsilateral breast, the radiologists insist that it is clinically meaningful. Once the paradigm that an increase in sensitivity increases overdiagnosis is accepted (that is, not all lesions are clinically meaningful), then it is the responsibility of clinicians to try to determine the ideal level of sensitivity.
The nbss has been berated for working with 30-year-old machinery, but I think that the greater problem is that clinicians are still working under 30-year-old assumptions. How much is really known about the relationship between size and survival? How confident is our community about early detection? It is universally accepted that tumour size and survival are inversely related for women diagnosed with palpable breast cancer24. That understanding is the rationale for early detection by mammography or other means. But it does not logically follow that a decrease in tumour size will necessarily lead to a decrease in mortality.
Consider two analogous situations. First, among women with breast cancer who experience a local recurrence, the strongest predictor of death is a short time from diagnosis to local recurrence25. However, that finding does not imply that a further shortening of the time from diagnosis to recurrence through intensive imaging would worsen survival. Second, studies of children with neuroblastoma noted that the children diagnosed in the first year of life experienced much better survival than those diagnosed thereafter26. That observation encouraged physicians to consider that screening for neuroblastoma by measuring urinary metabolites would increase the proportion of children diagnosed in the first year and thereby reduce mortality. The resulting clinical trial unfortunately found no benefit27. Neuroblastoma with a favorable prognosis is detectable by screening, but those cases are associated with a very high rate of spontaneous regression or maturation of the neuroblastoma into benign ganglioneuroma. Very few cases of neuroblastoma detected by screening have unfavourable biologic features such as N-Myc amplification28.
The relationship between breast cancer size and survival is not fixed, and the slope of the curve that defines the relationship varies according to the stage and pathologic features of the breast cancer24. The strongest relationship is seen with large cancers and node-positive cancers29. The relationship is attenuated among women with triple-negative cancers, with her2 (human epidermal growth factor receptor 2)–positive cancers, and with BRCA1-positive cancers19,30. Size does not predict mortality well for women with nonpalpable cancers29. Is it possible that there are additional categories wherein the size–survival relationship does not hold, and that eventually every woman with breast cancer will be able to be assigned to one of those categories? If more specific categorization were to be possible, then there would be no expectation of benefit from early detection—through mammography or any other means. In statistical terms, the question is “Are there variables n1, n2, n3, … nx, such that, after adjusting for n1, n2, n3, … nx in a follow-up study, size is no longer predictive of survival?” For example, in a study of 5423 women with cancers of less than 2.0 cm, tumour size was not predictive of survival after adjustment for grade, hormone receptor status, and her2 expression30. Those data suggest that, as the mean size of breast cancers in a population diminishes, further reductions in size can achieve only marginally less benefit. The lesson of mammography should be used to rethink the fundamentals of breast cancer and its natural history so that planning can commence for the experiments and clinical studies that will lead to better outcomes in the future.
Curr Oncol. Oct 2014; 21(5): 215–216. re: Reflections on screening mammography and the early detection of breast cancer Baum, MD ChM* *Professor Emeritus of Surgery & Medical Humanities, University College, London, U.K.
I welcome this opportunity to comment on the piece by Dr. Steven Narod in this issue of Current Oncology. His commentary systematically responds to, and rebuts, the near-hysterical reactions to the recent publication of the 25-year follow-up results of the Canadian National Breast Cancer Screening Study1. I admire his restraint in the face of criticisms that go way beyond the boundaries of polite scientific disputation.
Much of the criticism the authors of the trial have faced goes so far as to accuse them of being guilty of scientific misconduct and fraud. Those charges are libellous, but I’m sure that Narod et al. are wise enough not to resolve their differences in a court of law, but simply to open their books to scientific scrutiny, in a way that fair-minded clinicians can judge who are the real culprits. Narod has achieved precisely that end in his timely and measured response. My only criticism is minor … in that he doesn’t go far enough. For example, it could easily be pointed out that the results of the National Breast Cancer Screening Study sit comfortably within the confidence intervals of a Cochrane Collaboration overview of the screening trials, with no hint of heterogeneity2. If anything, the trial in that overview that is closest to being an outlier is the Swedish two-county trial, whose authors are the shrillest of all the critics3.
The debate is so polarized that, leaving aside possible conflicts of interest, the only assumption that can be made is that the clash is one of ideology rather than scientific discourse. In other words, the true believers in the screening dogma will never be persuaded of the error of their ways by data alone, and so when facts don’t fit their prejudice, they resort to ad hominem attacks.
I was one of those who established the first screening centre in London and South East England in 1988, but as an open-minded clinical scientist, I allowed the emerging new data to change my mind. With all due modesty, that is what is called an expression of scientific integrity. Of course, as Narod points out, the prolonged and futile debate merely inhibits real progress on the subject. The importance of breast screening programs lies not in their success, but in their failure. As Huxley put it, “The tragedy of science is the slaying of a beautiful hypothesis by an ugly fact.”
The national breast screening programs around the world have provided us with a natural experiment of the greatest historical importance, not because of their success in reducing breast cancer mortality, but because of the observations that have emerged concerning overdiagnosis of the disease4,5. About two hundred years ago, cancer was defined by its microscopic appearance. With the discovery and use of the modern microscope, the nineteenth century saw the birth of scientific oncology. Rudolf Virchow, often called the founder of cellular pathology, provided the scientific basis for the modern pathologic study of cancer6. As earlier generations had correlated autopsy findings observed with the unaided eye with the clinical course of cancer one hundred years earlier7, so Virchow correlated the microscopic pathology of the disease. However, the material he was studying came from the autopsies of patients dying from cancer. In the mid-nineteenth century, pathology correlations were performed either on cadavers or on living subjects presenting with locally advanced or metastatic disease who were almost always predetermined to die in the absence of effective therapy. Since then, and without pause for thought, the microscopic identification of cancer according to those classical criteria has been associated with the assumed prognosis of fatal disease in the absence of treatment.
A syllogism at the heart of the diagnosis of cancer therefore runs like this: People frequently die from malignant disease. Under the microscope, this malignant disease has many histologic features that we will call “cancer.” Ergo, anything that looks like “cancer” under the microscope will kill you. The screening debacle therefore suggests that some of the earliest stages of “cancer,” if left unperturbed, will not progress to a disease with lethal potential. Those pathologic entities might have microscopic similarity to true cancers, but their appearances alone are insufficient to predict a life-threatening disease.
Conventional mathematical models of cancer growth are linear or logarithmic—in other words, completely predictable at the outset. They predict transition from in situ phases to early invasive, and from early invasive to late invasive over time. Most natural biologic mechanisms are nonlinear or are better described by chaos theory8. Prolonged latency followed by catastrophe should not be all that surprising. We accept the case for prostate cancer, because we know that most elderly men will die with prostate cancer in situ and not of prostate cancer. In fact, the United Kingdom’s national prostate-specific antigen screening trial (protect) is predicated on that fact, with two a priori outcome measures defined: deaths from prostate cancer, and the number of cancers over-detected and treated unnecessarily9.
Next, it is worth noting that, contrary to all common-sense predictions, the increased detection rate of ductal carcinoma in situ has led to an increase in the mastectomy rate for the screened population4,5. Up to 45% of women with a screen-detected case of ductal carcinoma in situ end up undergoing mastectomy because of the multicentricity of the disease10. And yet the paradox is that clinically detected multicentric invasive breast cancer is relatively uncommon11. Surely that is proof enough that at least half the foci of ductal carcinoma in situ will regress if left alone; of course, determining which half remains the problem.
In conclusion, then, it can be stated with a great deal of conviction that a large proportion (on the order of 50%) of screen-detected (preclinical) foci of breast cancer are not programmed to progress if left unperturbed. That observation is of seismic importance and could set the agenda for breast cancer research into the next decade. The choice to ignore those observations, either because they do not support personal prejudice or because of some sleazy political agenda, will result in our community missing an opportunity of a life-time—and that would be unforgivable.
Narod is to be congratulated for his systematic and robust rebuttal of the unjustified attempts to destroy the credibility of the Canadian trial by a small group of vociferous critics who provide a background noise so loud that it nearly drowns out the true signal of the 25-year experiment of population screening for breast cancer.
“There’s non so blind as those that will not see.”— Jonathan Swift, Polite Conversation
Curr Oncol. Oct 2014; 21: 205–207. Screening mammography: the turning of the tide? W.D. Foulkes, MBBS PhD McGill University, Montreal, Quebec This issue of Current Oncology features a Counter-currents article by Dr. Steven Narod, “Reflections on screening mammography and the early detection of breast cancer”1, that is accompanied by a commentary from Professor Michael Baum2 supporting Narod’s thesis. Indeed, in Baum’s view, Narod’s only error was not to push home the point that the Canadian National Breast Cancer Screening Study (nbss) is not an outlier among mammography screening studies. He commends Narod for a measured response to the widespread criticism that followed publication of the 25-year follow-up results of the by now notorious nbss.
It seems as if almost everyone has an opinion on screening mammography. Everyone is entitled to an opinion, of course; but discussions about mammographic screening tend to take on a special, almost unique, quality—which perhaps speaks to the investments (financial, psychological, and career) made by many of the protagonists, which Professor Baum fleetingly mentions as potential conflicts of interest in his editorial. Baum prefers to see the ongoing debate—if that is what it is—as a clash of ideologies. But what are these ideologies that are so opposed?
Essentially, Baum’s argument is that the proponents of screening are not really scientists, in the sense that they do not accept refutation of data by data. He could be right, but I think the more parsimonious and psychologically more plausible explanation is that the aforementioned investments are simply too great: the stakes are too high. That the stakes are high is, in my view, very clear. Breast cancer is a common disease, and if population-based screening mammography is shown to have failed and is therefore no longer offered, billions of dollars would be saved every year in the United States alone3.
Narod contrasts the results of two large trials of mammography (one carried out in Sweden, the two-county study) with the nbss data. Having read these carefully laid out arguments, I think that most disinterested, but informed, readers will accept that many of the legion of criticisms that have been placed at the door of the nbss simply do not hold up to scrutiny. But mud sticks, and so many observers who do not like the results of the nbss point again and again to the same “flaws.”
One of Narod’s most telling points is that the survival curves for the two arms of the Swedish trial continue to remain separate up to 29 years after the trial was started. That observation is not consistent with any known effect of mammographic screening. It is much more likely that the populations were simply different to start with.
Further discussion of the pros and cons of these two trials is now fairly pointless. There are not much new data to be had, and I can’t see Drs. Kopans and Tabár, on reading Narod’s article, deciding that perhaps the benefits of mammography have, after all, been overestimated. Without new data, we can’t resolve this critical issue. So perhaps we need to stop the current process and actually do some new research to gather the required data.
A recent Perspective article in the New England Journal of Medicine4 noted the presence of a deep chasm separating women’s views of the likely benefit of mammographic screening and the actual data available. The nongovernmental Swiss Medical Board subsequently determined that women could not make informed decisions about screening without access to more nuanced information. Moreover, the Board felt that the benefits of mammographic screening were likely to be so small that no new screening programs should be introduced and existing programs should be allowed to run down. Their decision caused the expected uproar, but it is interesting to note that the results of a reader poll after a Clinical Decisions article 2 years earlier in the New England Journal of Medicine5 showed that a clear majority did not think that screening mammography should be started at age 40. Those results are contrary to the recommendation of many breast cancer organizations. But on the basis of these newer findings, it seems to me that the tide has turned, insofar as there are now enough interested parties prepared to question the benefits of mammography.
One of the points that Narod makes bears some discussion: He sees the problem not in terms of 30-year-old mammography machines in nbss study, but in 30-year-old thinking about the biology of breast cancer on the part of those who support screening. Logically, it can be seen that, as breast cancers enlarge, the number of cancer cells within them increases, which can provide opportunities for more malignant clones to emerge. Earlier detection will thus prevent those emerging clones from worsening outcomes. This quasi-Halstedian view, that a breast cancer makes a stately progression through biologically distinct and distinguishable stages and that the grade worsens as the tumour enlarges (assumptions that are at the heart of the original explanation of how mammography “works”6), are no longer part of mainstream thinking about breast cancer biology. Even ductal carcinoma in situ seems to possess many of the molecular changes found in invasive breast cancers, albeit at lower frequencies7,8. It seems as if the “die is cast” fairly early in the life of a breast cancer9. Intrinsic subtypes hold true as cancers grow and metastasize10, and the sojourn time varies from subtype to subtype11. Some breast cancers regress12. Others grow very rapidly13. These are not ideal biologic circumstances for the success of an “across the board” screening program. That conclusion is even borne out by a careful examination of the two-county study data14. The one group for whom screening mammography would be hoped to work—women between 40 and 49 years of age with a grade iii breast cancer (a group likely to contribute disproportionately to the observed mortality from breast cancer)—does not seem to achieve any mortality savings (see Figure 20 in Tabár et al.14). Survival at 16 years from randomization was identical in the invited and screened groups (relative risk: 0.95; 95% confidence interval: 0.55 to 1.64). One wonders if, in fact, the shoe is on the other foot. What has been learned about interpreting screening data from the current understanding of the natural history of breast cancer?
On the other side of the ledger, overdiagnosis has emerged in the past several years as a major issue in breast cancer screening. Quantifying the benefits and harms of mammography make for sobering reading by disinterested parties. If one starts with a sample of 1000 U.S. women 50 years of age, and if those women are screened annually for a decade, fewer than 4 women will avoid a breast cancer death; 3–14 women will suffer the consequences of over-diagnosis; and many hundreds will have at least 1 false alarm15. Work by Welch and Frankel suggests that women would think differently about mammographic screening for breast cancer if they were made aware of those figures at time of invitation for screening. Using best estimates, only 1 woman in 4 who develop a screen-detected breast cancer will avoid a breast cancer death16. The other 3 will do just as well, or just as poorly, without screening—or, of more concern, will have been diagnosed with a cancer that was not destined to ever present clinically. In the observational Norwegian study, only one third of the reduction in deaths from breast cancer could be attributed to mammographic screening per se17. Most women with a screen-detected breast cancer are therefore either diagnosed early (but with no effect on outcome) or are overdiagnosed.
We have been here before. Maureen Roberts, director of the Edinburgh breast screening project, died of breast cancer in 1989. While hopeful that mammographic screening would benefit women, she concluded from an analysis of the Edinburgh trial results that it did not. Before she died, she wrote “Breast screening: time for a rethink?” for the British Medical Journal18, concluding, “I feel sad to be writing this; sad because naturally after so many years I am sorry that breast screening may not be of benefit. I am also sad to seem to be critical of the many dear and valued colleagues I’ve worked with over the years, particularly those who have made such a magnificent contribution to the care and welfare of women with breast cancer. But they will recognise that I am telling the truth.”
It is time to work toward a trial of screening mammography that will incorporate variable thresholds, molecular markers, genetic testing, and psychological and physical measures of the effect of overdiagnosis. One of the two authors of the New England Journal of Medicine Perspective article discussed earlier, an ethics representative on the Swiss Medical Board, has argued that there is a moral requirement for a randomized controlled trial of mammography19 based on Welch’s idea of differing detection thresholds. I believe that women will be interested in such a study. But because almost every major U.S. medical organization focusing on breast cancer prevention, diagnosis, or treatment has stated that women should begin undergoing mammography annually from the age of 40 years, will any agency have the courage to fund it?
1. Mammograms May Offer Less Benefit Than You Think:
In one survey, most women said they believed mammography reduced the risk of breast cancer deaths by at least half and prevented at least 80 deaths per 1,000 women screened.5 In reality, mammography may, at best, offer a relative risk reduction of 20 percent and prevent in absolute terms only onebreast-cancer death per 10,000 women.
2. Mammography May Increase the Risk of Breast Cancer in Women with a BRCA 1/2 Mutation:
Results published in the British Medical Journal (BMJ) show that women carrying a specific gene mutation called BRCA1/2 (which is linked to breast cancer) are particularly vulnerable to radiation-induced cancer.6
Women carrying this mutation who were exposed to diagnostic radiation (which includes mammograms) before the age of 30 were twice as likely to develop breast cancer, compared to those who did not have the mutated gene. They also found that the radiation-induced cancer was dose-responsive, meaning the greater the dose, the higher the risk of cancer developing.
3. False Positives are Common (and Dangerous)
In the US, the risk of having a false-positive test over 10 mammograms is a concerning 58 percent to 77 percent!7, 8 When a woman is told she may have breast cancer, it causes considerable anxiety and psychological distress. Meanwhile, you will be subjected to more testing, such as biopsy or surgery, which carry their own set of risks, unnecessarily.
4. Mammograms May Not Work if You Have Dense Breasts
Up to 50 percent of women have dense breast tissue, which makes mammograms very difficult to decipher. Dense breast tissue and cancer both appear white on an X-ray, making it nearly impossible for a radiologist to detect cancer in these women. It’s like trying to find a snowflake in a blizzard.
Breast density laws have been passed in California, Connecticut, New York, Virginia, and Texas, making it mandatory for radiologists to inform their patients who have dense breast tissue that mammograms are basically useless for them. A law is now being considered at a federal level as well.
5. There are Other Screening Options
There are other screening options, each with their own strengths and weaknesses, and you have a right to utilize those options. Remember, only a biopsy can confirm cancer. Screening tools only aid in the process of showing concern.
Your Waist Size Is Linked to Your Breast Cancer Risk It’s important to remember that getting a mammogram, if you choose to, is not the same as prevention. In order to truly avoid breast cancer, you need to focus your attention on actual prevention and not just early detection, and one way to do this is by maintaining a healthy weight, and, particularly, a healthy waist size.
Researchers analyzed data from 93,000 mostly overweight post-menopausal women. This included data such as their general health, cancer status, and skirt size (which was used as a gauge of waist size). The latter – skirt size – was strongly linked to breast cancer risk.9 As TIME reported:10
“An increase in skirt size was the single most predictive measure of breast cancer risk, the study concluded. When women went up a single skirt size over a 10-year span between their mid-20s and mid-60s, they were shown to have a 33% greater risk of developing breast cancer after menopause. Buying two skirt sizes up during that same period was linked to a 77% increased risk.”
Clothing sizes can be quite ambiguous, of course, with a size 8 in one brand equal to another’s size 10. Yet, the premise that increasing waist size might increase cancer risk is sound. Breast cancer is the most common cancer in women, and obese women are thought to be up to 60 percent more likely to develop cancer than those of normal weight.
The reason for this increased risk is because many breast cancers are fueled by estrogen, a hormone produced in your fat tissue. So the more body fat you have, the more estrogen you’re likely to produce. However, excess fat around your mid-section may be particularly dangerous.
Why Your Waist-to-Hip Ratio Matters If you have a high waist-to-hip ratio, i.e. you carry more fat around your waist than on your hips, you may be at an increased risk for certain chronic conditions. Certain body compositions do tend to increase your risk of chronic disease, and carrying extra inches around your midsection has been repeatedly shown to increase cardiovascular health risks. Your waist size is also a powerful indicator of insulin sensitivity, as studies clearly show that measuring your waist size is one of the most powerful ways to predict your risk for diabetes, and this could also play a role in cancer as well.
To calculate your waist-to-hip ratio, measure the circumference of your hips at the widest part, across your buttocks, and your waist at the smallest circumference of your natural waist, just above your belly button. Then divide your waist measurement by your hip measurement to get the ratio. (The University of Maryland offers an online waist-to-hip ratio calculator11 you can use.) To determine your waist-to-hip ratio, get a tape measure and record your waist and hip circumference. Then divide your waist circumference by your hip circumference. For a more thorough demonstration, please review the video below.
|Waist to Hip Ratio||Men||Women|
|Moderate Risk||0.96-0.99||>0.81 – 0.84|
The Sugar Connection Obesity, including abdominal obesity, is driving up rates of breast cancer in many developed countries. And what is driving up rates of obesity? Many factors, actually, but sugar certainly plays a primary role. There is no shortage of research linking excessive sugar consumption with obesity, and the intake of sugar-sweetened beverages appears to have a particularly strong link. It was more than five years ago when UCLA researchers found that adults who drank at least one sugar-sweetened beverage a day are 27 percent more likely to be overweight or obese.12 Even those who only drank soda occasionally had a 15 percent greater risk.
This is far more than simply an issue of consuming “empty calories,” as sugary drinks, soda, and even fresh-squeezed fruit juice contain fructose, which has been identified as one of the primary culprits in the meteoric rise of obesity and related health problems—in large part due to its ability to turn on your “fat switch.” Alarmingly, research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions suggested sugary beverages are to blame for about 183,000 deaths worldwide each year, including 133,000 diabetes deaths, 44,000 heart disease deaths, and 6,000 cancer deaths.
About 77 percent of food items in US grocery stores contain added sugar. So it’s no wonder that, while the American Heart Association recommends a daily sugar limit of six teaspoons for women and nine for men, the average American consumes more like 22. If health agencies really wanted to make a dent in breast cancer, they would focus on sharing the truth about sugar (and grains), and their role in obesity and cancer. Unfortunately, breast cancer is big business, and mammography is one of its primary profit centers. This is why the industry is fighting tooth and nail to keep it, even if it means ignoring (or downplaying) the truth.
Avoiding Sugar and Other Top Breast Cancer Prevention Tips I believe the vast majority of all cancers, including breast cancer, could be prevented by strictly applying basic, commonsense healthy lifestyle strategies, such as the ones below. No available screening method, whether mammography or otherwise, is going to lower your risk of breast cancer… but the tips that follow will:
In addition to exercise, try to limit your sitting time to three hours a day while taking 10,000 daily steps during your non-exercise hours.
Breast screening: an obsessive compulsive disorder. in Cancer Causes Control. 2014 Jul 11. Prof Yunus Luqmani a British oncology biochemist, Kuwait University writes “Mammographic screening was founded on the premises that “it saves lives”, ‘early is better than late,’ which prevails in several countries but controversial since its inception. Findings and interpretation of clinical trials data vary considerably, with disagreement on the outcome and value of such procedure, not just about the benefits but about the potential harms of mass screening. Many are being screened for the benefit of the few. Even this might be acceptable but for concern for many women with screen detected cancers that will potentially not cause them harm, and who are very likely receiving unnecessary treatment. Many call for complete cessation of indiscriminate screening if not re-assessment of age and periodicity . Of great concern is that screening is being vigorously advocated by many healthcare workers, the media, and lay persons alike without proper awareness or appreciation of the consequences. Although some National leaflets now present a truer picture, there is distinct lack of transparency to allow women to distinguish perception from reality and to make informed choices. How many would elect to be screened if they knew that for every one woman who is notionally saved by early detection, anywhere from 2 to 10 otherwise healthy women are being turned into breast cancer patients?
Benefits of mammography
|“the benefits of screening mammography are modest at best” (Elmore & Harris BMJ 2014;348:g3824). This is the conclusion after the latest research to come out of Norway where the introduction of screening has been gradually introduced over the last 2 decades (Weedon-Fekjaer et al BMJ 2014;348:g3701).The Norwegian authorities invited women between 50 and 70 years old to attend for screening every second year and looked at before and after death rates from breast cancer. They found RELATIVE risk reduction of 28% in those invited compared with those not invited to be screened. Without knowing the ACTUAL risk reduction or the harms of screening this sounds like a “good deal”. However it is an observational study not a randomised trial and therefore susceptible to various biases.For women to make up their own minds about screening, actual figures of benefits and harms need to be given because without accuracy perceived dangers and benefits are very far from reality. For example in the US or UK asking women about their estimates of breast cancer deaths – taking 1000 women aged 50 and following them for 20 years – gave the following results:
Women believe that breast cancer is a far greater threat than it really is. They also believe that screening halves such risk.
If actual death reductions from breast cancer are taken into account, screening benefits are modest at best and if all cause deaths are taken into account the benefits all but disappear.
Commentary The mammography debate is one of the facets of the Miami Breast Cancer Conference this year. It seems as though the field of breast cancer has always been controversial, going back half a century, and breast cancer is a disease that, more than most others, is very polarizing. This disease engenders great passion—and great debate, which has been ongoing about the role of screening mammography.
A few weeks ago, The New York Times covered an article that was published in the British Medical Journal 1 about the Canadian National Breast Screening Study. On the surface, this study failed to show any benefit from mammography. That was the story that the writer, Gina Kolata, picked up and ran with. Ms. Kolata had written about her own experience with breast cancer a number of years ago; her breast cancer had not been picked up on a mammogram, and so she is somewhat biased.
In short, the Canadian study evaluated mammograms from more than 90,000 women who had very primitive mammograms between 1980 and 1984, and that is really the first problem with this study: the technology and the equipment then was incredibly limited, such that the mammograms only showed 30% of breast cancers; whereas, today, mammography detects 70% to 80% of breast cancers. Thus, taking results generated by technology from 34 years ago and making a conclusion about them in today’s world is a stretch.
One of the fundamental flaws of the Canadian study, besides the dated technology on which the conclusions were based, was that it was not randomized. Nurses, and, in some provinces in Canada, doctors, did a clinical breast exam, and, if they felt a mass or a lump, they preferentially put the patient into the mammography arm. That is what I would have done in their place; if I felt a lump, I would not be willing to send someone home.
By the end of the study, there were more than 100 extra breast cancers in the mammography arm and more breast cancers that had spread to lymph nodes in the mammography arm. And, in fact, the chance of dying of breast cancer was higher in the mammography arm.
All of the authorities with whom I have ever spoken or read who have reviewed this study dismiss it as very flawed. A number of the doctors who were involved with the study resigned their positions in protest. Despite all of that, The New York Times ran an article headlined, “Vast Study Casts Doubts on Value of Mammograms” (February 11, 2014).
Well, it is a vastly flawed study, and, in fact, there are six other, much larger and much better controlled studies, all of which showed a reduction in breast cancer mortality from 20% up to 40% in women who have mammograms—and that is certainly what we observe clinically.
We felt that it was important to really highlight this at the Miami Breast Cancer Conference this year. My guess is that our audience already knows this; but, what we would like to give them is the science about why the Canadian study was flawed so that they can talk to their patients and talk to their colleagues who may not be in the breast cancer field. That is really what I think our mission is for part of this year’s conference.
We think that this is dangerous information. We think that women will unnecessarily lose their lives to breast cancer if they forego mammography, which this study frankly says one should. I have a busy practice in Brooklyn, New York, and, at least once or twice a week, I see someone, without any question, whose life was saved by a mammogram.
I think that we all agree we need something better than mammography. We all agree that mammography can lead to over-diagnosis of breast cancers, and over-diagnosis happens, of course, when we screen for diseases in other areas of the body. We all accept this limitation.
But, for a major media outlet to take a single study that was deeply flawed and not even mention the existence of other studies, even as a point–counterpoint, I think was a bit outrageous!
12 March 2014 this publication on the Huffington Post website today under screening mammography is as appropriate as when it was published in 2010:
The NBCAM has assured women that “early (mammography) detection results in a cure nearly 100 percent of the time.” More specifically, the NBCAM is directed to claims for reducing the incidence and mortality of breast cancer through early detection by annual mammography starting at age 40. Moreover, mammograms can miss cancers in premenopausal women due to the density of their breasts, and also fail to detect cancers smaller than half an inch.
Still denied by the ACS is clear evidence that premenopausal mammography poses significant risks of breast cancer. The routine practice of taking two films annually for each breast results in approximately 0.5 rad (radiation absorbed dose) exposure. This is about 500 times the dose from a single chest X-ray and is broadly focused on the entire chest rather than narrowly on the breast. This is also 25 times higher than is allowed by the Environmental Protection Agency for whole-body radiation from local nuclear industries (0.02 rad). Moreover, the breast is the most sensitive organ to ionizing radiation.
As warned by the prestigious National Academy of Sciences in 1972 but still ignored by the ACS, the premenopausal breast is highly sensitive to the risks of cancer from mammography, as each rad exposure increases the risks of breast cancer by 1 percent. This results in a cumulative 10 percent increased risk for each breast following a decade of routine screening. This can also accounts for the 19-percent increased incidence of breast cancer since 1975. Not surprisingly, the prestigious U.S. Preventive Task Force, supported by the National Breast Cancer Coalition, warned last year against routine premenopausal mammography. Also, not surprisingly, routine premenopausal mammography is practiced by no nation other than the U.S.
Risks of premenopausal mammography are some four-fold greater for the 2 percent of women who are carriers of the A-T gene (ataxia telangiectasia) and are highly sensitive to the carcinogenic effects of radiation. By some estimates, this accounts for up to 20 percent of all breast cancers diagnosed annually. Compounding these problems, missed cancers are common in premenopausal women due to the density of their breasts.
That most breast cancers are first recognized by women was admitted by the ACS in 1985. “We must keep in mind that at least 90 percent of the women who develop breast cancer discover the tumors themselves.” Furthermore, an analysis of several 1993 studies showed that women who regularly performed breast self-examination (BSE) detected their cancers much earlier than women failing to examine themselves. The effectiveness of BSE, however, depends on training by skilled professionals, enhanced by an annual clinical breast examination. Nevertheless, in spite of such evidence, the ACS dismisses BSE, and claims that “no studies have clearly shown [its] benefit.”
As reported in our 1999 publication in the International Journal of Health Services, an article in a leading Massachusetts newspaper featured a photograph of two women in their twenties. The article promised that early detection by mammography results in a cure “nearly 100 percent of the time.” Questioned by journalist Kate Dempsey, an ACS communications director responded: “The ad isn’t based on a study. When you make an advertisement, you just say what you can to get women in the door. You exaggerate a point — Mammography today is a lucrative [and] highly competitive business.”
If all 20 million U.S. premenopausal women submitted to annual mammograms, the minimal annual costs would be $2.5 billion. Such costs would be increased some fourfold if the industry, supported by radiologists, succeeds in its efforts to replace film machines, costing about $100,000, with high-tech digital machines, costing over $400,000, even in the absence of any evidence for their improved effectiveness.
With this background, it is hardly surprising that the National Breast Cancer Awareness Month neglects to inform women how they can reduce their risks of breast cancer. In fact, we know a great deal about its avoidable causes which remain ignored by the ACS. These include:
The enthusiastic and continuing support of premenopausal mammography by the ACS is hardly surprising in view of its major conflicts of interest that still remain unrecognized. Five radiologists have served as ACS presidents. In its every move, the ACS promotes the interests of the major manufacturers of mammogram machines and films, including Siemens, DuPont, General Electric, Eastman Kodak and Piker. The mammography industry also conducts research for the ACS, serves on its advisory boards, and donates considerable funds. DuPont is also a substantial backer of the ACS Breast Health Awareness Program. It sponsors television shows touting mammography; produces advertising, promotional materials and literature for hospitals and doctor; and lobbies Congress for legislation promoting the availability of mammography. The ACS has been and remains strongly linked with the mammography industry, while ignoring or criticizing the value of breast self-examination, even following training by a qualified nurse or clinician.
The ACS conflicts of interest extend well beyond the mammography industry. The ACS has received contributions in excess of $100,000 from a wide range of “Excalibur (industry) Donors,” who manufacture carcinogenic products. These include petrochemical companies (DuPont, BP and Pennzoil), Big Pharma (AstraZenceca, Bristol Myers Squibb, GlaxoSmithKline, Merck & Company and Novartis), and cosmetic companies (Christian Dior, Avon, Revlon and Elizabeth Arden).
Samuel S. Epstein, M.D. is professor emeritus of Environmental and Occupational Medicine at the University of Illinois at Chicago School of Public Health; Chairman of the Cancer Prevention Coalition; and a former President of the Rachel Carson Trust. His awards include the 1998 Right Livelihood Award and the 2005 Albert Schweitzer Golden Grand Medal for International Contributions to Cancer Prevention. Dr. Epstein has authored 270 scientific articles and 20 books on cancer prevention, including the groundbreaking “The Politics of Cancer” (1979), and most recently “Toxic Beauty” (2009, Benbella Books: http://www.benbellabooks.com) about carcinogens, besides other toxic ingredients, in cosmetics and personal care products. Email: email@example.com. Web: http://www.preventcancer.com.
update 6 March 2014 Switzerland debates dismantling its breast cancer screening programme BMJ 2014;348:g1625 “A row has erupted in Switzerland after the Swiss Medical Board recommended that the country’s mammography screening programme for breast cancer be suspended because it leads to too many unnecessary interventions.
In a report made public on 2 February, the board said that while systematic mammography screening for breast cancer saved 1-2 women’s lives for every 1000 screened, it led to unnecessary investigations and treatment for around 100 women in every 1000.1 “The desirable effect is offset by the undesirable effects,” said the report, which was based on study data from 1963 to 1991 comparing 1000 women who were screened with 1000 women who were not. The report also concluded that screening was not cost effective.…”
update 1 Mar 2014 Supporting informed decision making when clinical evidence and conventional wisdom, clash. The nub of the screening mammography war – and all hard-sell marketing hype- is elegantly analyzed by a USA multiUniversity Communications team in Against conventional wisdom: when the public, the media, and medical practice collide. Jakob Jensen ea argue that “the screening mammography controversy was driven by the systematic removal of uncertainty from science communication. To increase comprehension and adherence, health information communicators remove caveats, limitations, and hedging so science appears simple and more certain. This streamlining process is, in many instances, initiated by researchers as they engage in dissemination of their findings, and is facilitated by public relations professionals, journalists, public health practitioners, and others whose tasks involve using the results from research for specific purposes. Uncertainty is removed from public communication because many communicators believe that it is difficult for people to process and/or that it is something the audience wants to avoid. Uncertainty management theory posits that people can find meaning and value in uncertainty. CONCLUSIONS: Science is routinely simplified as it is prepared for public consumption. In line with the model of information overload, this practice may increase short-term adherence to recommendations at the expense of long-term message consistency and trust in science”.
We see the same collusion between corporate marketeers and government regulators in so many high-profit industries:
* on Pubmed, screening mammography features for 50 years, and continued to expand exponentially without hindrance until enough epidemiologists – led by the Cochrane Group- collectively rang enough alarm bells the past decade. The zealous huge-profit USA radiology-oncology industry simply shouted down the negative result of the massive Canadian Screening Mammography trial outcome 30 years ago in 90 000 women, and continue to do so with the 25year results now reported. The huge Breast Industry retaliates by threatening whistle blowers.
*and as a result, the past 30years,- against all rational food science and biology – Montsanto’s Government- approved rape of healthy food agriculture by genetically modified crops laced with toxic environmentally persistent glyphosate C3H8NO5P- Roundup.
It is no irony that one of the leading medical scientists of the 20th century Dr John Gofman took part in the Manhattan nuclear Project, was a pioneer of VLDL lipidology, and then an activist for protecting women against the accumulating harm of mammography – “there is no safe dose of radiation”.
|at Exam.||Resulting Risk of Mammogram-Induced Breast Cancer. 1998|
|Any age in||1 exam:||1 chance in about 1,100.|
|30-34 range.||5 exams:||5 chances/1100, or 1 chance in 220.|
|Any age in||1 exam:||1 chance in about 1,900.|
|35-49 range.||10 exams:||10 chances/1900, or 1 chance in 190.|
|Any age in||1 exam:||1 chance in about 2,000.|
|50-64 range.||15 exams:||15 chances/2,000, or 1 chance in 133.|
Dr Emily Transue MD eloquently describes her personal disillusionment with screening mammography.
They fail to list other adverse effects: 7. Pain and bruising of crush mammography- sometimes prolonged; 8. spreading early and likely dormant cancer. 9. Increased incidence of breast cancer and thus more irradiation, mastectomy and all-cause mortality, and 10. complications of surgery, radiotherapy and chemotherapy. ………………………..
The Canadian study, launched in 1980, is the only trial to enroll participants in the modern era of routine adjuvant systemic treatment for breast cancer, and the women were educated in physical breast examination as advocated today.4 These important features may make this study more informative for a modern setting, compared with other randomised trials. The results of the study are strikingly similar—for both lack of efficacy and extent of overdiagnosis—to recent studies evaluating today’s screening programmes.5 6 7 The real amount of overdiagnosis in current screening programmes might be even higher than that reported in the Canadian study,4 because ductal carcinoma in situ, which accounts for one in four breast cancers detected in screening programmes,8 was not included in the analyses.
Other studies also indicate that improved treatment rather than screening is the reason for the decline in breast cancer mortality during the past four or five years.5 7 Even though different studies arrive at different reductions in breast cancer mortality (from 10% to 25%), these benefits translate to only marginal differences in absolute effects. Much larger variation is seen in the estimates of overdiagnosis.6 In studies based on statistical modelling, overdiagnosis was less than 5%.6 By contrast, most observational studies report higher estimates of overdiagnosis, ranging from 22% to 54%,6 depending on denominator used.9 When the number of breast cancers detected at screening is used as the denominator (as in the Canadian study), the amount of overdiagnosis observed in the previous randomised controlled trials is strikingly similar (22-24%).4 10
How do the data on mammography screening compare with data on prostate cancer screening by prostate specific antigen, which is currently not encouraged in the United Kingdom and other countries owing to its small effect on mortality and large risk of overdiagnosis (www.screening.nhs.uk/prostatecancer)? The figure on bmj.com shows that the absolute harms (overdiagnosis) and benefits (mortality reduction) are not very different between the screening types. The 20 year risk of breast cancer for a 50 year old woman is 6.1% with screening (including 22% overdiagnosis 4),11 and 5.0% without screening; and the corresponding numbers for prostate cancer in a 50 year old man are 3.9% with screening (including 45% overdiagnosis 12) and 2.7% without screening.11 The 20 year risk of death from cancer for a 55 year old woman is 1.5% with screening (assuming a 20% reduction in mortality2)11 and 1.9% without screening; and the corresponding numbers for prostate cancer in a 55 year old man are 1.0% with (assuming a 20% reduction in mortality12) and 1.3% without screening.11
Nevertheless, the UK National Screening Committee does recommend mammography screening for breast cancer but not prostate specific antigen screening for prostate cancer, stating that the “aim is to only implement programs that do more good than harm and that the informed choice is a guided principle of screening” (www.screening.nhs.uk/screening). Because the scientific rationale to recommend screening or not does not differ noticeably between breast and prostate cancer, political pressure and beliefs might have a role.
We agree with Miller and colleagues that “the rationale for screening by mammography be urgently reassessed by policy makers.” As time goes by we do indeed need more efficient mechanisms to reconsider priorities and recommendations for mammography screening and other medical interventions. This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established.
RESPONSES: 12 February 2014 BMJ 2014;348:g366 : 1. rebuttal by USA radiologists : Daniel B. Kopans, Professor of Radiology Harvard Medical School. Having been one of the experts called on in 1990 to review the quality of their mammograms I can personally attest to the fact that the quality was poor (1). To save money they used second hand mammography machines. The images were compromised by scatter since they did not employ grids for much of the trial. They failed to fully position the breasts in the machines so that cancers were missed because the technologists were not taught proper positioning, and their radiologists had no specific training in mammographic interpretation.
The CNBSS’s own reference physicist wrote:“..in my work as reference physicist to the NBSS, [I] identified many concerns regarding the quality of mammography carried out in some of the NBSS screening centers. That quality [in the NBSS] was far below state of the art, even for that time (early 1980’s). ” (2)
In this latest paper (3) the authors gloss over the fact that only 32% of the cancers were detected by mammography alone. This extremely low number is consistent with the poor quality of the mammography. At least two thirds of the cancers should be detected by mammography alone (4). In their accompanying editorial (5) Kalager and Adami admit that ” The lack of mortality benefit is also biologically plausible because the mean tumour size was 19 mm in the screening group and 21 mm in the control group….a 2 mm difference.” Poor quality mammography does not find breast cancers at a smaller size and earlier stage and would not be expected to reduce deaths.
The documented poor quality of the CNBSS mammography is sufficient to explain their results and all of the above disqualifies the CNBSS as a scientific study of mammography screening, but it was even worse than that. In order to be valid, randomized, controlled trials (RCT) require that assignment of the women to the screening group or the unscreened control group is totally random. A fundamental rule for an RCT is that nothing can be known about the participants until they have been randomly assigned so that there is no risk of compromising the random allocation. Furthermore, a system needs to be employed so that the assignment is truly random and cannot be compromised. The CNBSS violated these fundamental rules (6). Every woman first had a clinical breast examination by a trained nurse (or doctor) so that they knew the women who had breast lumps, many of which were cancers, and they knew the women who had large lymph nodes in their axillae indicating advanced cancer. Before assigning the women to be in the group offered screening or the control women they knew who had large incurable cancers. This was a major violation, but it went beyond that. Instead of a random system of assigning the women they used open lists. The study coordinators who were supposed to randomly assign the volunteers, probably with good, but misguided, intentions, could simply skip a line to be certain that the women with lumps and even advanced cancers got assigned to the screening arm to be sure they would get a mammogram. It is indisputable that this happened since there was a statistically significant excess of women with advanced breast cancers who were assigned to the screening arm compared to those assigned to the control arm (7). This guaranteed that there would be more early deaths among the screened women than the control women and this is what occurred in the NBSS. Shifting women from the control arm to the screening arm would increase the cancers in the screening arm and reduce the cancers in the control arm which would also account for what they claim is “overdiagnosis”. The analysis of the results from the CNBSS have been suspect from the beginning. The principle investigator ignored the allocation failure in his trial and blamed the early excess of cancer deaths among screened women on his, completely unsupportable, theory that cancer cells were being squeezed into the blood leading to early deaths. This had no scientific basis and was just another example of irresponsibility in the analysis of the data from this compromised trial and he finally retracted the nonsense after making front page headlines (6).
The compromise of the CNBSS trial is indisputable. The 5 year survival from breast cancer among women ages 40-49 in Canada in the 1980’s was only 75%, yet the control women in the CNBSS, who were supposed to represent the Canadian population at the time, had a greater than 90% five year survival. This could only happen if cancers were shifted from the control arm to the screening arm. The CNBSS is an excellent example of how to corrupt a randomized, controlled trial. Coupling the fundamental compromise of the allocation process with the documented poor quality of the mammography should, long ago, have disqualified the CNBSS as a legitimate trial of screening mammography. Anyone who suggests that it was properly done and its results are valid and should be used to reduce access to screening either does not understand the fundamentals, or has other motives for using its corrupted results.
2. confirmation: http://www.bmj.com/content/348/bmj.g366?tab=responses Per-Henrik Zahl, MD & statistician Norwegian Institute of Public Health. In this 30-year old study, the authors report no mortality reduction when screening with mammography and 22% overdiagnosis (1). The sensitivity of the mammography technique has improved tremendously in the last three decades. Ten years ago we got digital mammography and recently we have got tomosynthesis (2). The detection rate at mammography in the Canadian study was about 3 per 1000 in the second and later screening rounds (3). In digital mammography, the corresponding detection rate is 6 per 1000 screened woman and in tomosynthesis, the detection rate is 8 per 1000 (2). It could even have been higher if the pathologists had time to perform more biopsies (personal communications). In tomosynthesis a large number of stellate lesions appear, many more than in traditional mammography, and they are probably representing a reservoir of overdiagnosed breast cancers. In the last 15 years, the rate of interval cancer has been constant and is at the same level as in Canada 30 years ago (4). Thus, the level of overdiagnosis is far much bigger today than in Canada 30 years ago.
Hence Regulators in most countries have reduced recommendations for routine screening mammography to starting at age >50yrs and stopping by 70-75years (ie 10-12 times on average through midlife); whereas Radiology Associations ignore the risks and still advise screening annually from age 40 years, for life – ie at least THREE times as many times from age 40years. So women are doubly exposed to harmful pressure both in being bullied that they need screening xray mammography – the lie that ” screening mammography saves lives” when the benefit of this is unproven, and in being forced to undergo breast crushing repeatedly. A woman who recently attended for Sure Touch in Port Elizabeth objected to having her breasts snackwiched again by compression mammography. The flippant analogy is eerie when one considers how such women are expected to attend annually to have their breasts both flattened and irradiated – and more so with cumulative frying after therapeutic radiotherapy. No wonder some end up with a hard breast. . So while the young at heart may love nudging breasts-, and massage heals, (and Bissell and Fletcher at the Berkley lab show that gentle nudging with about 50 gm pressure knocks errant breast ductal cells back into healthy behaviour) – crushing force and coersion do women harm, not good; in contrast to men where forceful digital massage may (also with putative risk) relieve the infected painful prostate.. .
update 26 May 2013 Apart from the strident promotion of preventative mastectomy by a film star, reports the past week prompt review of : why and whether aggressive breast cancer may have doubled in young women 25-39years old; and it’s prevention by natural steps.
Lisa Willis, Karen Page, Trevor Graham, Tomás Alarcón, Malcolm Alison & Ian Tomlinson from Universities of London, Oxford, Cambridge, and Barcelona this month dissect “What Can Be Learnt about Disease Progression in Breast Cancer Dormancy from Relapse Data? why Breast cancer patients have an anomalously high rate of relapse up to 25 years after apparently curative surgery removed the primary tumour. Disease progression during the intervening years between resection and relapse is poorly understood. There is evidence that the disease persists as dangerous, tiny metastases that remain at a growth restricted, clinically undetectable size until a transforming event restarts growth. This suggests a natural question and a surprising answer: why are interesting trends in long-term relapse data not more commonly observed?” But they are observed: another recent 15 year followup study, from Denmark (Grantzau ea), furthermore shows that DXRT after early breast cancer almost doubles the risk of radiotherapy-associated second cancer to 1:200 of women so treated..
These reports raise yet further doubts about the wisdom of regular mass xrayscreening of well breasts from age 50 years let alone 40years, and worse- zealous major surgery and DXRT for preclinical disease, and then even worse, ongoing xray mammographic surveillance into old age.
They point in the opposite direction: that xray screening of well breasts should be avoided; DXRT avoided in localized early breast cancer; and surveillance for breast cancer limited to the many available non-xray methods;
and that women must be encouraged instead to maintain prevention with combination of safe natural (and multisystem-protecting) means as discussed repeatedly in this column – lifestyle, diet, exercise, and massage and oral use of safe natural preventative supplements. Anticancer antiangiogenesis factors from our diet are legion, include cannabis, mushrooms, resveratrol, green tea, black rasberry and Royal jelly. One would not recommend soya against breast cancr because of its phytoestrogen potential.
Xradiation has been known for decades eg 1978 1990 to be both an angiogenic and an antiangiogenic factor in tumour growth angiogenesis (Judah Folkman 1971) . so it is obviously a double-edged sword that should certainly not be used in the witchhunt for silent and usually irrelevant precancer in well breasts.
So we have the ludicrous situation reported today in JAMA that despite all the evidence for 20 years now to stop or at least halve mass xray screening and thus (over)treatment of silent early breast cancer, “Physicians, Patients Not Following Advice From USPSTF on Mammography Screening: In 2009, the US Preventive Services Task Force (USPSTF) recommended against routine screening mammography for women under 50 years and advised biennial rather than annual screening for women aged over 49yrs. But women and physicians ignored these recommendations. A new study from Harvard found that in 2005 to 2011, the percentage of women aged 40 to 49 years reporting that they had undergone mammography screening in the previous year was the same, about 47%. As for women aged 50 to 74 years, the percentage reporting mammography screening in the previous 12 months for each year analyzed also remained essentially the same, in the upper 50% range.”
Update 21 April 2013: FIFTEEN YEAR FOLLOWUP STUDIES OF BREAST CANCER AND ALLCAUSE MORTALITY FROM MENOPAUSE ONWARDS: Overall, long-term studies do not favour invasive breast screening or adjuvant therapy of early breast cancer, but actually argue against early diagnosis and treatment of both silent breast and prostate cancer. Rather, the focus must be on safe natural prevention to reduce the occurrence of all common degenerative diseases of aging.
Erbas ea at Univ Melbourne studied all sources for the prevalence of ductal carcinoma in situ. “The reported prevalence of undiagnosed DCIS in autopsy studies, of approximately 9%, has been used to suggest a larger reservoir of DCIS may exist in the population”.
Update 18 April 2013: a new study from Italy graphically illustrates the lower sensitivity of xray screening – U/S ie ultrasound picked up ‘significantly’ more tiny asymptomatic breast cancers missed in 22,131 women with negative mammography. “The overall U/S detection was 0.185%, but 0.55% with previous cancer vs 0.145% in women without cancer history (p = 0.0004), 0.22% in dense breasts (p = 0.17) vs .156% in fatty breasts. The U/S- generated invasive assessment was 0.19% The benign to malignant open surgical biopsy ratio was thus 0.17.” This is likely more overdiagnosis unless the women simply apply the preventative measures recommended below.
But while no screening method can diagnose cancer (only invasive biopsy can), and none can guarantee there arnt cancer cells busy germinating especially if stirred up by severe anxiety, radiation, crushing, biopsy etc, Sure Touch mapping is more accurate than even U/S for reassuring while reducing referral rate for U/S.
UPDATE 14 APRIL 2013: Because of the evidence the past score years set out below that xray screening actually does more harm than good, integrative medical clinics world wide do not promote xray screening mammography. But such clinics including in Cape Town generally offer regular safe and lower-cost anatomical eg Sure Touch mechanical tactile if not ultrasound or MRI, and physiological no-touch eg thermography ie bloodflow studies, – for those who need peace of mind. Some women choose to alternate Sure Touch and thermomammography.
While only 1 in 200 women have the familial gene risk, the majority of older women have the common multiple risk factors eg longevity, estrogenic and heavy metal pollution, stress, overweight density, smoking, alcohol; and there are many simple remedies described in these columns that can reverse most of the risk factors – not just of even genetic breast cancer and increasing overweight, but of all the major diseases of aging.
The problem remains the stubbornness of third party payers including governments to listen to both the evidence and to womens’ wishes, and pay for such safe, cheaper and arguably more accurate prscreening than crush xray mammography, if any is desired or desirable .
Dr Johnnie Ham MD MSc MBA Californian ObGyn discusses why xray screening mammography and aggressive medical assault on well breasts- the witchhunt for the pot of hidden gold, silent preclinical breast cancer – is a giant con by the for-profit high-tech medical goliath industry terrorizing and mutilating naive women.
Governments -WHO silence on harms of screening mammography : What is tragicomedy is that worldwide, government Regulators seem to be standing silently firm, not saying a word about the harm likely exceeding the medical benefit- the screening and cancer industry is far too profitable in jobs, taxes and votes. Search on the internet for Government warnings on harms of screening mammography does not yield a word of warning. Regulators and Medical Schemes piously promote quality screening, but say nothing about the harms versus benefits. The FDA still promotes annual screening mammography on line without a word about the risks and harms of mammography; others like the UK NHS promote it every 2 to 3 years. Yet the US Senate is actually considering a Republican Act to promote more xray breast imaging.
UPDATE 12 April 2013 The Wiki entry on breast cancer prognosis says now: “One result of media hype- breast cancer’s high visibility -(compared to other cancers in eg men, and other common major diseases) is that statistics may be misinterpreted, such as the claim that breast cancer will be diagnosed in one in eight women during their lives—a claim that depends on the unrealistic assumption that no woman will die of any other disease before the age of 95. This obscures reality that about ten more women will die from heart disease or stroke than from breast cancer.The emphasis on breast cancer screening may be harming women by subjecting them to unnecessary radiation, biopsies, and surgery. One-third of diagnosed breast cancers might recede on their own. Screening mammography efficiently finds non-life-threatening, asymptomatic breast cancers and pre-cancers, even while overlooking serious cancers. According to Prof Gilbert Welch of Dartmouth Institute, research on screening mammography has taken the “brain-dead approach that says the best test is the one that finds the most cancers” rather than the one that finds dangerous cancers.
The latest report Lancet 2011) on the Relevance of breast cancer hormone receptors and other factors to efficacy of Tamoxifen protection after breast cancer looked at 20 trials (n=21,457) in early breast cancer . In oestrogen receptor (ER)-positive disease, about 5 years of tamoxifen halved recurrence rates throughout the first 10 years but no further gain or loss after year 10; risk was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years. Overall non-breast-cancer mortality was little affected, despite small absolute increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality.
This is not surprising as tamoxifen like all synthetic sex hormones /blockers has a long list of adverse effects on bone, brain, cardiovascular, bladder, mood, immunity, body weight and metabolism, womb etc.
But the Oxford UK-led (Davies ea) landmark monumental ATLAS trial (2012) from 1996 -2010 in 36 countries and 180 000 women-years (mean presentation age mid 50s, ER+ breast cancer about 1 cm size, 2/3 had mastectomy – which is now known to increase mortality) showed that after 6846 women taking tamoxifen for up to 10 years, at about 15 years from diagnosis, tamoxifen in absolute terms was only marginal benefit- marginally reduced the risk for breast cancer recurrence, compared with stopping tamoxifen (617 vs 711; P = .002), reduced breast cancer mortality relatively by 8% (331 vs 397 deaths; P = .01) but that’s only about 1% in absolute terms, and reduced overall mortality by 10% (639 vs 722 deaths; P = .01). Over all, approximately 1/5 clinically relapsed, 1/7 deaths were from breast cancer; but of those who died, webfigures 4a and 4b of the supplementary appendix of the main ATLAS report showed that at autopsy almost half (43%) indeed had recurrent breast cancer. This gives the lie to early screening and treatment- 15 years later, even with tamoxifen for 10 years, early xray mammography detection and conventional surgical-radio-chemotherapy treatment does not cure much more than half of women with preclinical ER+ breast cancer that screening detects.The risk for recurrence by year 15 was 21.4% in the continuers group and 25.1% in the control group. ie only 3.7% absolute reduction. In addition, breast cancer mortality by year 15 was significantly reduced by nearly 3%; it was 12.2% in the continuers group and 15.0% in the control group. ie only 2.8% absolute reduction. Thus even in these women with early breast cancer, the cure rate even with tamoxifen was poor- slight reduction in the 25% recurrence and 15% breast cancer mortality rates. But almost half of the women who died had recurrence. Once again, the actual results published 4 months ago in the final Lancet report were much less impressive than the media release published 5 days later. Of these >6000 women allocated after initial surgery/ radio/chemotherapy to the tamoxifen or placebo trial, 85% did not die of breast cancer. But the cure rate was at best still only about 75%, and only half of those who died -by a mean of age 70 years – of any causes were free of breast cancer.
9 April 2013 Robert Stern at University of Arizona writes that “xray mammography alone is not a very good screening modality and has strikingly variable false positive, false negative, specificity, and efficacy rates, depending on what you read and who you believe.
8 April 2013: UPDATE: see vitamin D3 and Breast Cancer.
JAMA publishes on line from University Basel Switzerland, Shaw and Elger’s viewpoint on Evidence-Based Persuasion, often an ethical imperative to forcefully guide a hesitant patient into what seems to be the best decision, using arguments from Removal of Bias to Recommending Options and occasionally even Creating New Biases. The eternal problem remains, what is truly right? Is mass flu vaccine right? Is screening xray mammography truly lifesaving? especially if one quotes impressive but misleading relative risk reduction rather than in fact the crucial trivial absolute reduction? Is Directive Counselling however well-meant exercising undue influence? They conclude that it is an essential part of modern medical practice, without which it may be impossible to respect patients’ autonomy. Such necessary persuasion needs to meet 6 criteria.
updating the risks and futility of screening xray mammography.
There are certainly many safe natural ways we reviewed recently of reversing the risks of breast proliferation and cancer, thus justifying periodic safe low cost breast screening – mammo-imaging – by independent eg digital, mechanical tactile ” Sure Touch ” , ultrasound and/ or thermo- means.26 Feb 2013. There is a flood of new progress against breast disease , breast cancer and xray screening mammography: Contrary to the for-profit Breast industry, like all independent authorities including the Cancer Association of South Africa CANSA , the National Cancer Institute of America in 2013 no longer recommends routine xray mammography screening- it rates the EVIDENCE on X-ray screening mammography as FAIR evidence for its sole and arguable benefit – Decrease in total and breast cancer mortality – -*Consistency of studies is only Fair. External Validity: Good. Internal Validity: Variable,. But as GOOD evidence for the FIVE major HARMS of xray screening -* both consistency, internal & external validity -are good –
Winifred Cutler’s Athena Institute team warns again that screening X-ray mammography on well women is dangerous , inflicts terror, it does not reduce but may worsen the occurrence of invasive breast cancer. The Berkeley Institute’s Dr Venugopalan under profs Mina Bissell and Daniel Fletcher show that simply gentle massage helps – Compressing Breast Cancer Cells Can Stop Out-of-Control Growth Shelley Hwang ea show that in California simple lumpectomy for early breast cancer reduced deaths (up to 2009) by 28% compared to mastectomy. Belinski & Boyages at the Westmead Centre in Australia show again that common very low vitamin D levels more than double the risk of breast cancer let alone colon and all other cancers. A Harvard team (Liu ea) has just shown that the carnage of legalized poisoning (smoking – lungcancer, vascular; alcohol -liver disease, violence; adulteration with refined sugar/fructose – diabetes, vascular disease, cancer) aside, breast cancer far outstrips the other common cancers (colon, prostate cancer) in preventible life years lost. Willaims ea show again the major benefit of metformin against lethal breast cancer. Amadou ea in France confirm again the strong link between abdominal obesity and breast cancer from childhood throughout life. This again highlights the criminal stupidity of delaying metformin use till obesity let alone infertility or diabetes are established. Metformin can safely be introduced at any stage of life provided it is started at very low dose eg below 250mg/day and cautiously titrated to the maximum well-tolerated dose to avoid nausea and diarrhoea- and temporarily halved or stopped in case of intercurrent gastrointestinal upset. . Grani et al from Rome, Italy and many others remind us that both thyroid and breast malfunction are common by middle age and need to be sought and managed together. We know that in most aging populations, deleterious deficiency of especially magnesium, iodine, selenium, sulphur, and vits B, C, D and K , and melatonin and sex hormones is very common along with crippling multitoxic carcinogenic overload. So it is logical to use multisupplements, and massage anti- inflammatory anti-cancer antioxidant chelating antiestrogenic deep – penetrating iodine, coconut oil and DMSO – into the breasts as multidisease prevention and part of treatment. Oz ea in Turkey show that DMSO is more effective against breast cancer than thalidomide. But more importantly, DMSO enhances transport of any anticancer agents into cancer cells. Already in 2008 Frederick ea showed that Lugol’s Iodine is an important antiestrogen adjuvant against breast cancer. Hence we advise the harmless combination of natural multisystem micronutrients- especially fish oil, coconut oil, DMSO, vitamin C, D, K, melatonin, metformin, selenium, Lugol’s iodine and appropriate progesterone/ testosterone/ DHEA – as nutrient supplements against all chronic aging diseases especially in women at risk of breast cancer. . At Univ Newcastle on Tyne, Dr Dorota Overbeck-Zubrzycka’s landmark PhD thesis just published on FOXP3 regulates metastatic spread of breast cancer via control of expression of CXCR4 chemokine receptor promises new gene therapy in future. and her parallel study with Harvey, A. Griffiths & C. Griffith, Randomised control trial of Breast Tactile Imaging as an assessment tool for diagnosis of breast lumps in 2009/10 is now being published in full in a leading UK journal, validating this ( Sure Touch) bedside and outpatient clinic procedure as an established no-risk screening procedure, objective breast mapping record for anxious women as shown in USA, Indian and Chinese studies. Thus increasingly Authorities are accepting that screening X-ray mammography harms far outweigh trivial if any improvement in survival. But screening – by eg regular clinical exam and mechanical tactile mapping – for early signs of breast degeneration allows gentle safe self – treatment of all multisystem diseases that reverses both the breast degeneration and multisystem risk factors.
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f385 (Published 23 January 2013) Cite this as: BMJ 2013;346:f385
Thus they advise against screening people with an expected lifespan of below about 10 years. But who would undergo such bothersome risky screening even over 10 years for a proposed benefit (in death risk reduction) of 0.1% a decade ? They found the reasons against routine screening of those not at high risk ( ie no suspicious personal symptoms or familial history) are as usual those of the ensuing anxiety, the procedures – radiation and colonoscopy and biopsies – and overdiagnosis. The worst is of course the cumulative risk of breast irradiation, and perforation death from colonoscopy: “For cancer screening, about one in 10 patients who are screened (with xray mammography , or with fecal occult blood testing) will have a false positive result, leading to recall worry and likely biopsy/ colonoscopy. Serious complications (such as perforation, major bleeding, and death) occur in 3.1 colonoscopies per 1000 screened. One in 100 routinely mammography-screened women will be biopsied, and one in 1000 will be subject to overdiagnosis (that is, diagnosed with a breast cancer that was unlikely to have been clinically evident during their lifetime) and possibly unnecessary treatment.”
The same arguments apply strongly against routine screening of men for prostate cancer, or smokers for lung cancer, in the absence of symptoms. . It should be noted that even the Wikipedia Mammography review now strongly highlights the arguments against mass screening mammography. The introduction sums it up bluntly: “task force reports point out that in addition to unnecessary surgery and anxiety, the risks of more frequent mammograms include a small but significant increase in breast cancer induced by radiation. The Cochrane Collaboration (2011) concluded that mammograms reduce mortality from breast cancer by an absolute amount of 0.05% or a relative amount of 15%, but also result in unnecessary surgery and anxiety, resulting in their view that it is not clear whether mammography screening does more good or harm. They thus state that universal screening may not be reasonable. Mammography has a false-negative (missed cancer) rate of at least 10 percent. This is partly due to dense tissues obscuring the cancer and the fact that the appearance of cancer on mammograms has a large overlap with the appearance of normal tissues. A meta-analysis review of programs in countries with organized screening found 52% over-diagnosis.“
It can be argued that noninvasive screeing that finds suspicious premalignant signs can then motivate prevention by natural means- lifestyle diet and appropriate supplements. But since these preventative steps (including blood-pressure and waist/breast girth measurements and monthly self-exam for breast changes) hugely reduce the risks of all serious acute and chronic diseases, accidents and premature disability and death, routine mass screening for common ‘silent’ internal cancers eg breast, prostate colon lung womb and ovary , is irrelevant, risky and huge waste of resources for no benefit. Not applying sensible diet, lifestyle, blood-pressure checks and supplements is like failing to maintain your car, house, computers and electrical appliances etc , until these crucial assets break down. The evidence against hightech screening of the well of course does not stop the anxious well from worrying. As a heavy cigarette-smoking prof of lung medicine said 30 years ago, if an anxious patient demands a scope despite reassurance that the risk:benefit doesnt justify it, it is wise to do it. Or someone else will. At least in the context of the younger adult who will thereby be more motivated to apply prevention, non-xray non-invasive screening by eg Sure Touch breast mapping- from onset of menopause, or younger in eg diabetics and others more prone to cancer eg in AIDS, – and ultrasound quantitative bone-density risk measurement from toddlers upwards , in exercising ie sportspeople, and in any serious chronic disease especially with hormone overtones eg thyroid, diabetes, COPD/ asthma, cancer, arthritis, paralysis, AIDS,TB, cardiacs, renal, liver disease – are relatively low cost and safe compared to the traditional xray screening procedures. The brilliant new French movie The Intouchables is all about choices of lifestyle and the risks entailed. Thats what screening, and voluntary prevention, are about. No adult should be pressurized – by vested interests – into having hightech eg xray (breast, bone) or more invasive (eg scope, biopsy) screening without understandable explanation of the possible although infrequent immediate and distant risks, and remote if any benefits. Only the frequent incidental unexpected screening discovery of hypertension, increased breast lumpiness/density, and low bone density, and initiation of simple lifestyle diet changes and safe supplement therapy- the below- listed scores of supplements against all common degenerative diseases (and if needed the best primary antihypertensive – lowdose reserpine and co-amilozide – costs perhaps $1 a month to control most; and simple (breasts, arthritis, wound or elsewhere) antiinflammatory self massage if indicated with Lugol’s iodine, and analgesic antioxidant coconut oil and DMSO), gives huge early and permanent preventative pain and inflammatory benefits without risks. There are also promising studies on Pubmed between 1989 and 2011 of the benefits of DMSO in management of prostate problems in rats, and humans for transrectal procedures and intravenously as cancer adjuvant palliation. DMSO-MSM is cheaply and safely available . It comes back to basics that are anathema to politicians, Government, profiteers, Big Business Pharma and the Disease Industry. Motivating and enforcing better lifestyle and natural diet (minimizing sugar , aspartame, alcohol, processed food especially cornstarch) , and healthgiving realistic doses of supplements – vits (all – especially B, C, D3 and K), minerals (especially Mg, Zn, I2, Se, P, Bo,) and biological (plant and sealife – not land animal) extracts, (including fish oil, metformin, bioidentical human hormones, tryptophan, MSM, DMSO, chondroglucosamine, coconut oil, cinnamon, pepper, curcumin, arginine, carnitine, carnosine, ribose, coQ10, proline, rauwolfia) – reduces the occurrence of serious disease drastically with decades of health extension. This vastly reduces profit to the Disease Hospital-Drug and processed food- alcohol – tobacco industry in delayed disease till very old age, and thus loss of skilled workers’ jobs – that need to be taken up elsewhere. That’s called reinvention, recycling…
for appointments for consultations, or non-xray procedures by registered practitioners : Sure Touch breast prescreening on Saturday mornings next on 7 February 2015 by Sister Zeneath Ismail – cash R650 (then R450 if followup scan desired within 3 months); -QUS ultrasound quantitative bone density cash R450 -tariff item 3612- anytime; Unlike radiologists’ and thermography reports (which describe only the imaging finding), the rates quoted include relevant breast or bone consultation and management planning by specialist nurse & physician.
IF BOOKED TOGETHER, (not necessarily the same morning) then combined breast and bone screening is R1000.
OTHER SERIOUS health problems ARE DEALT WITH BY CONSULTATION DURING THE WEEK (OR ON A DIFFERENT SATURDAY MORN) : heart- ECG, fatigue, HRT, sexual health, hypertension, depression, memory/dementia, lung & lungfunction, anaemia-haematology; kidney/bladder/pelvic, hormone-endocrine, depression, osteoporosis, sleep, diabetes, thyroid, adrenal; cramp; skin, infection including STDs & HIV/AIDs, stroke, epilepsy-neurology, dizziness, heartburn/digestive/liver, neuropathy, sexual health, menopause, HRT, genitourinary; immune problems, or arthritis relief;
Thermography no-touch infrared screening for suspicious cancer /inflammatory changes: by Radiographer Melinda-next 23 March 2015. R900 breasts; R1100 head and upper; or lower body & pelvis; R1300 whole body.
Bookings/queries contact Evelyn/ Reyhana / Val at the Natural Medicine Clinic, 1st Floor no 15, Grove Medical Bldg, opp ABSA (parking ABSA Parkade ) near Warwick/Cavendish Square Claremont Cape Town RSA, ph +27216831465 or a/h +2783 4385248 or firstname.lastname@example.org .
For the disabled – by arrangement drive up the ramp to the Clinic door on the Grove Bldg 1st floor parking deck.
Under CMS Council for Med Schemes Reg 10(6), open Medical schemes eg hospital plans have to pay from their own funds (not members’ savings) for appropriate outpatient consultation (tariff item 0191) for PMBs ie major conditions eg cancer, depression, neck/spinal problems, serious heart, lung, other disease., etc. Breast and osteoporosis concerns are generally part of menopause consultations N95.9 (if not already eg breast cancer code C50) and thus are often billable med scheme benefits. The menopause billable item only applies if you are 45yrs upwards, unless you have had total hysterectomy.
On patients’ requests, appropriate invoice can be prepared and submitted to your scheme for refund of your due benefits. Some schemes eg hospital plans falsely deny due benefits until reported to their regulator CMS. For medical plans where the billable tariff benefit rate is higher than the breast screening fee paid, the med plan rate 0191 will be charged eg R790 by the contracted specialist, and refundable by Discovery to the member. some basic schemes eg Keycare, Bonitas require preauthorization, or referral by their contracted GP .
CAPE PENINSULA HYPERTENSION & HEADACHE CENTRE (50 years of experience) at The Natural Medicine Clinic NMC , 1st Floor, 15 Grove Bldg, Grove Claremont, Cape Town- between ABSA Parkade on Grove Ave, and Warwick Sq opp Cavendish. ph 0216831465/ 071202574 or email email@example.com.
As the commonest silent killer of aging people in the world, pain, obesity and often-resultant systemic hypertension HBP deserve the best and cheapest treatment. Headache is rarely caused by hypertension, but unlike hypertension, is usually easily controlled if not cured.
But precisely because HBP is so common- in half of us by old age, especially at night- it is a huge moneyspinner for Big Pharma and the Disease Industry.
so the last thing the HBP Industry wants is too successful too cheap treatment. Hence they (eg the WHO, the SA Hypertension Society and medical schools- state clinics)- blacklist the best baseline treatment- lowdose amilozide and lowdose reserpine, to promote sales of ever-newer unproven drugs with multiple risks. .
But 60 years of experience (5 centuries in India) confirms that Rauwolfia and its extract reserpine remain the best and sufficient treatment for most patients provided it is combined with a mild diuretic eg magnesium-potassium; or natural herbs eg Green tea, cranberry juice, Apple cider vinegar , Dandelion, Nettle, Fennel, buchu, horsetail;
or a magnesium-potassium conserving equivalent- the recent proven designer ie synthetic lowdose safe diuretic amilozide eg Amiloretic 55mg 1/4 to 1/2 tab, combined with natural lowdose reserpine 0.25mg tab 1/4 to 1/2 tab, both initially daily, eventually perhaps only 3 days a week. . These lower HBP and associated anxiety/depression gently but surely to avoid complications.
The NMC is open office hours from 9 am 6 days a week, and offers objective electronic arm and leg bloodpressure measurement and if required urine and heart testing for causes and effects of hypertension etc. If desired, appointment can be made with a hypertension-metabolic specialist physician.
see https://healthspanlife.wordpress.com/category/reserpine/ for further details to fight dementia, stroke, heart/kidney failure, heartattack, blindness, diabetes, gangrene, etc. The last thing the Disease Industry and hospitals, medical schools want us to do is wipe out these common diseases with safe lowcost treatment..
The Nonscience Witch Hunt Against Hormone Replacement Therapies for Deficiency Syndromes Must End
An A4M Position Paper on Physician-Prescribed HRT
Introduction “Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of Men and deny equal privileges to others; the Constitution of the Republic should make a Special privilege for medical freedoms as well as religious freedom.”~Benjamin Rush (1745–1813), physician, writer, educator,
Since the inception of the anti-aging medical movement in 1991, various establishment parties have ruthlessly leveraged their positions of power in academic, political, and regulatory arenas for the purpose of attempting to limit the use of hormone replacement therapies (HRT) in adults with documented clinical deficiencies. For over 15 years, a prolonged and calculated campaign of deceit, fraud, and suppression has threatened physician licensures and liberties to treat and prescribe life-improving therapies, leading potentially to the direct compromise of patients’ health and longevity. Dozens of physicians have been sanctioned and punished with loss of license and academic standing. This pernicious abuse of position and power is particularly prevalent with regard to recent challenges made against human growth hormone (HGH), testosterone (TRT), and DHEA replacement therapies that are trumpeted by the mainstream media. Biased reporters frequently – and inappropriately – demonize legitimate physicians and clinical compounding pharmacies that are reluctantly positioned on the frontline of a decades-old agenda to limit freedom of choice and information, and the physicians’ most essential responsibility to select the best course of therapy and medication for their patients.
This conflict is being played out of late in the arena of anti-aging medicine, a clinical specialty that has flourished in its 22 year long history, garnering the support of more than 100,000 physicians and scientists worldwide who practice or research life-enhancing, life-extending interventions today. Prof. Dr. Imre Zs.-Nagy, of the University of Debrecen Medical and Health Science Center (Hungary), and founder of the Archives of Gerontology and Geriatrics (published by Elsevier), observes: “In my role as a basic and clinical scientist, I have had an opportunity to witness more than four decades of advances and declines in the arena of preventive medical care … there has been little else as dramatic, important, beneficial, and significant as the anti-aging medical movement.”1
The Anti-Aging Medical Movement
The Official Definition of Anti-Aging Medicine
Anti-aging medicine utilizes diagnostic protocols that are supported by scientific evidence to arrive at an objective assessment upon which effective treatment is assigned. Physicians who dispense anti-aging medical care are concerned with the restoration of optimal functioning of the human body’s systems, organs, tissues, and cells. Attempting to rebrand what they cannot deny, those in positions of power in academic, political, and regulatory arenas are inventing new catchphrases including longevity medicine, successful aging, healthy aging, and the like, in an effort to dilute and absorb the A4M’s original definition of anti-aging medicine. To implement this campaign, we suspect that these individuals have pejoratively solicited major media outlets to denigrate the A4M, its officers, and its members.
Critics with A Dark Agenda (Political Elites)
There are TWO main “skeptic” organizations – the James Randi Educational Foundation (JREF) and the Center For Inquiry (CFI). Both are well funded from secret sources.
JREF reported, in 2010, a total income of $999,971.00 and a Total Asset claim of $1,736,101.
The Center For Inquiry, Inc (CFI), based in Amherst, New York shows on their Form 990 that they took in $5,242,304 in Total 2009 Income, and they had, that year, Total Assets of $3,017,144. Their Schedule B ANONYMOUS contributions totaled $2,318,652.
More, CFI claimed that they received, in 2009, in addition to their anonymous contributions, a so-called “Management Fee Income” of $2,458,156. What do you suppose they managed? And who paid them to manage it? Maybe they manage Wikipedia health care articles? How about Search Engine Optimization (SEO) bringing skeptic, including Stephen Barrett’s (Quackwatch), articles to the first page of Google?
Much more – This cabal minimizes and delays innovative medical advancements by lodging anonymous complaints to state licensing boards against cutting-edge practitioners. Their insidious campaign also controls grant monies and research funding, somewhat silencing the voices of innovative medicine in favor of mainstream views. By leveraging control of the media in direct jeopardy of journalistic integrity, this control group seeks to suppress all in medicine that is not fully controlled by the establishment. To permit this level of manipulation and disinformation is wrong and ethically corrupt. The fate of a valuable avenue of medical innovation for the public interest – anti-aging medicine – stands at-risk.3
A JAMA commentary purported to address the legality of human growth hormone (HGH, GH) treatment by physicians for growth–hormone deficient (GHD) patients.4 It is the view of A4M that the commentary contained a number of incorrect, misplaced references and studies, and multiple basic scientific errors, in an apparent attempt to damage the anti-aging medical profession and the physicians practicing solid, evidence-based medical health care focused on improving and maintaining patients’ quality of life. It is A4M’s further opinion that the authors selected self-serving studies, in which they failed to qualify the conclusions in an effort to bolster what A4M believes is a disinformation campaign. It is A4M’s opinion, for example, that they incorrectly intermingled Internet sales of homeopathic pseudo-“GH” sprays, amino acids, and sports nutritional over-the-counter products in order to inflate their incorrect claims suggesting an illegal diversion of HGH by physicians and pharmacies, implying a black market in FDA-approved prescription injectable HGH for hormone replacement treatments by anti-aging physicians where none exists.
Misrepresentation in Competitive Sports
20 July 2014 HIGH CARBS OR LOW CARBS? THE BIG FAT SURPRISE – which is best for weight loss? a collaborative literature metanalysis study July 2014 by Naude ea the universities of Stellenbosch, Cape Town and Liverpool (UK) claimed to compare the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults, stratified by outcomes at 3-6 months and 1-2 years. Of nineteen trials (n = 3209), 3 had adequate allocation concealment. In non-diabetic participants, analysis showed little or no difference in mean weight loss in the two groups at 3-6 months (MD 0.74 kg) or for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose. In diabetic participants, findings showed a similar pattern. CONCLUSIONS: Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
‘But Noakes points out, Low-fat, high-carb, high-sugar diet a likely cause of obesity/diabetes “I refer to the report in the Cape Times of July 10, “Noakes’s popular low-carb diet is not healthier, better for weight loss – study “. Since the authors of that study (Naude ea) do not understand either what constitutes a low-carbohydrate diet or the unique biological effects of such diets, they were predisposed to produce a biased report that comes to exactly the wrong conclusion.
‘First, the conclusion of their study was predictable since the authors chose to review only studies in which subjects ate the same number of calories on both diets. It is not clear how the authors conceived that diets that provided exactly the same number of calories would produce different outcomes. Indeed, a core teaching of these nutritional scientists is that the degree of weight loss is determined by the reduction in calorie consumption. Thus the authors knew the outcome of their study even before they undertook it. This is not good science.
‘Second, the studies included in their meta-analysis are not of the low-carbohydrate diet described by either Dr Robert Atkins or ourselves in Real Meal Revolution. Dr Atkins realised in the 1970s that the majority of overweight/obese persons can only reduce their weights successfully, and keep that weight off in the long term, if they eat less than 60g carbohydrate/day for the rest of their lives. Higher intakes are increasingly less effective. In Real Meal Revolution we stress that those with insulin resistance/ type 2 diabetes need to keep their carbohydrate intakes even lower, ideally to about 25g/day. The “low-carbohydrate ” diets included in the meta-analysis provided a minimum of 200g carbohydrate/day (or 4-8 times higher than the carbohydrate content that is known to be effective). As a result this is a meta-analysis of studies providing a high, not a low-carbohydrate load for those with obesity/insulin resistance/type 2 diabetes.
‘Third, the extent of weight loss in the studies included in he meta-analysis is small, the greatest values being about 10kg. For most people with significant weight problems, such small weight losses are probably relatively meaningless and should be classified a diet failure, not a success. But freeliving persons who follow individually prescribed carbohydrate diets providing about 25g carbohydrate/day report quite remarkable degrees of weight loss, not infrequently up to 40-80kg, usually achieved effortlessly if the low-carbohydrate rules are followed.
‘Fourth, the unique biological effects of the properly-defined low-carbohydrate is that (i) It reduces hunger, allowing subjects to eat fewer calories without experiencing continual hunger. The point, as stressed by Dr Atkins, is that the low-carbohydrate diet is a low-calorie, no-hunger diet. (ii) The diet lowers blood insulin concentrations. In those with obesity/insulin resistance/metabolic syndrome, it is continually elevated blood insulin concentrations that cause ill-health (as clearly established by the work of Dr Gerald Reaven of Stanford University over the past 50 years).
‘The authors found that health benefits were no different on either diet. A number of properly designed, peer-reviewed meta-analyses of the real low-carbohydrate diets show that weight loss and health benefits are superior compared with higher-carbohydrate diets. Unfortunately, the authors appear to be ignorant of those studies since neither they nor your reporter refers to them. This implies the presence of bias, questioning the true intent of the report.
‘The report also includes the statement of the Heart Foundation of South Africa (HFSA) to the effect that a diet high in saturated fat causes heart disease. Unfortunately, the HFSA spokesperson appears unaware of Nina Teicholz’s recentbook, The Big Fat Surprise: Why Butter, Meat, Cheese Belong in Healthy Diet, and the June 23 Time Magazine Ending the War on Fat, which show that this dogma is false and is not based on any credible science. It is time the HFSA updated its understanding of what actually causes heart disease. They might also want to consider whether their promotion of their unproven low-fat, high-carbohydrate, high sugar diet for the past 37 years is the most likely direct cause of the obesity/diabetes epidemic that has since engulfed South Africans.
‘Indeed on a practical side, I wonder if the authors have ever considered studying the dietary intakes of the obese diabetic patients they treat at Tygerberg and Groote Schuur hospitals. Do patients with these diseases eat either high- or low-carbohydrate diets? Why is is that these twin diseases, which are crippling the health services of the Western Cape, began to increase exponentially only after the 1977 Dietary Guidelines that institutionalised the low-fat, high-carbohydrate diets? Surely these are the critical questions that should really be exercising the minds of the Western Cape’s nutritional scientists? The best conclusion that can be drawn from this study is that diets providing more than 10 percent of daily calories in the form of carbohydrate are equally ineffective in producing meaningful degrees of weight loss in those with obesity/insulin resistance/type 2 diabetes.”
15 June 2014 DIET RISKS FOR BREAST CANCER, INFECTION & ALL ELSE: Sugar? Fats? Vitamins?
IT IS COMMON CAUSE THAT ONE DOESNT, CANNOT PREVENT OR TREAT INFECTION BY POOR NUTRITION OR LOWDOSE ANTI- MICROBIALS- such policy is futile if not dangerous for breeding resistance as well as disease extension. The studies below confirm the obvious, (as Klenner, Pauling, Cameron ea showed the past 50 years with highdose vit C injection), that vitamin D3 orally also works as a multiantimicrobial agent if given as early as possible in safe very high dose and bloodlevel eg 600 000iu monthly (in the first month, – in Salhuddin’s Pakistan PTB patients (presumably also Sunni muslim) initially mean wt 45kg, thats vit D3 ~440iu/kg/d) for two doses ie a mean of 300iu/kg/day over 90days; not the current preventative recommendation of 80iu/kg /day to a safe blood level of around 50-60ng/ml. As Holick has said, with adequate water intake even 50 000iu vit D3 a day ie 1.5million iu/month for months causes no toxicity. Given the 40% mortality rate in the frail Saudi MERS patients, and in acute severe influenza and other serious viral infections, it can be expected that such highdose immediate vitamin D3 therapy orally with eg 600 000iu, combined with highdose vitamin C, zinc and some multivite, (never mind appropriate antibiotics in acute bacterial infection) will similarly virtually eliminate mortality.
But no KSA Govt website mentions this- except the Saudi Gazette a year ago which strongly urged vitamin D supplement in the KSA as even daily sun exposure does not bring most Saudi women above the vitamin D deficiency threshold. It says Since Muslim women can only reveal the hands and face, they may need to be out in the sun for longer than 30 minutes. But the review conspicuously fails to mention that in public outdoors in KSA, women must have even the head and face covered. It also propagates surprising dangerous nonsense that “severe deficiency needs monthly vitamin D injection – “Mom, have you taken your vitamin D injection this month?, when all it requires is an oral daily, weekly or fortnightly dose vitamin D3 at trivial cost.” It does stress “One of the main reasons why vitamin D deficiency is so common in the Kingdom is because there are very few food sources of vitamin D. Foods which have fairly good amounts of vitamin D are fish liver oil, sweet potatoes, egg yolks, vegetable oils, butter, and fatty fish such as salmon, sardines, and tuna,” said Dr. Rasha Jameel, a consultant in family medicine at a local hospital. In the United States, all milk and dairy products are fortified with vitamins A and D, but no such measures are in place in the Kingdom“.
This correlates with a new metaanalysis (in the BMJ this month) of observational studies from Europe and USA, that all-mortality hazard ratio over a mean of 10 years increases by 57% as vit D level falls from the highest to the lowest level. The KSA apparently chooses to ignore that, as this column reported recently from WHO data, despite apparently being the wealthiest country per capita of bigger populations in the world, KSA’s population life expectation is about 5 years lower than eg far less sunny Britain’s; ie KSA all-cause mortality rate is avoidably materially higher. Despite KSA medical professors having reported in studies that most of the KSA population is deficient in vits D and C, the KSA Govt website chooses to ignore this on official websites; unlike other even Middle-Eastern governments promoting vit D fortification or meaningful safe supplements costing trivial amounts.
Even a new study last year from KSA universities confirmed that ” Most commonly consumed food products by Saudi population which are supposed to be fortified by vitamin D are either not fortified or contain an amount less than (apparently from their table 2 ~ half of) recommended by guidelines set for US marketplace”. Even a UAE authority recently stressed “Can fortified milk fight Vitamin D deficiency? Shockingly low levels of D3 among UAE population cannot be rectified by milk alone.” As Holick ea, including a Turkish University 2010 trial report, oral vitamin D3 is far more effective , and safer than, either vitamin D2, or vitamin D injection -never mind much cheaper. This current ostrich-head-in-the-sand denialism by the KSA government is like that of the RSA govt under Presidents Mbeki and Zuma 10-15 years ago about preventing and treating HIV-AIDS – considering that the safe and beneficial daily intake of vitamin D3 is now universally recognized as 4000 if not 10 000iu/day (ie about 80iu/kg/day or pro rata up to perhaps fortnightly) , to a mean blood vit D level of about 60 to 80ng/ml. .
As Prof Mike Holick pointed out a few years ago, “Even in Saudi Arabia, Qatar and South Africa, more than 50% of the population is deficient in vitamin D, all because of their avoidance of sun. Based on some of the literature, it seems that we could probably decrease health care costs across the board by 25% if everybody had optimal vitamin D status.” As Al Faraj ea reported in Riyadh in 2003, Prof Zahid Naeem from a KSA university wrote in 2010, “Vitamin D deficiency is an ignored epidemic in KSA and globally“; confirmed by a KSA study by Ali ea in 2012: “Even in a sunny country like Saudi Arabia the prevalence of vitamin D deficiency in young female is high“.. One does not need to speculate why the KSA and all governments globally choose to ignore this inconvenient truth, downplay effective vigorous vitamin C and D3 (sunshine) supplements- such widespread vitamin D and C deficiencies, like cigarette smoking and alcohol abuse, suit governments and Big Pharma- the Disease Industry- in reducing populations growths and creating jobs for the highly profitable Disease Industry and it’s shareholders- for whom Only Disease Pays. Cheap safe natural Prevention Does not Pay since it at least halves sickness never mind disease industry jobs, taxes and profiteering in the global $multitrillion Disease and Diet and Vaccine and Invasive Screening Industry scams.
And Karen Hansen ea at Univ Wisconsin 2014 have just shown that giving vitamin D2 (not D3) 50 000iu fortnightly for a year is actually adverse – as Holick and others have show – IT DEPRESSES – perhaps halves – THE BIOLOGICALLY ACTIVE blood 25OHVIT D3 while boosting perhaps 5 fold the far less active blood 25OHvit D2 levels , and actually worsens rheumatoid arthritis clinically and serologically . One can speculate whether vit D2 actually blocks optimal function of VDRs vitamin D receptors. Trials published 2012 from Japan and Netherlands showed that vitamin D3 – blood 1,25(OH)2D3 (but not TNFalpha blockers) blocked inflammation (ie TNF tumour necrosis factor alpha activation of vascular calcification).
Salahudfin ea’s new randomized controlled trial from Pakistan Vitamin D3 injection accelerates clinical recovery from tuberculosis shows “impressive clinical (weight gain, chest xray and sputum clearing) improvement over 3 months on outpatient TB therapy (Directly Observed Therapy (DOTS) with 2months of 4 antituberculous drugs [Isoniazid, Rifampicin, Ethambutol and Pyrazinamide] followed by 6months Isoniazid and Ethambutol) with two doses 600 000iu vit D3 imi (vs placebo inj) a month apart- ie equivalent to about 7 000iu/day over the 3 months treatment period . This dose of vitamin D is as recommended for vitamin D supplement by the Pakistan Endocrine Society. Trough 25OH vit D levels increased from about 20 to 90ng/ml. After 12weeks, the vitamin D supplemented pts (mean 28 yrs, BMI 17.2kg, 85% moderate to far advanced lung disease) had significantly greater mean weight gain (kg)+3.75, (3.16 – 4.34) versus+2.61, p 0.009; lesser residual disease by chest xxray- 30% fewer zones involved 1.35 v/s 1.82 p 0.004, and 50% or greater reduction in cavity size 106 (89.8%) v/s 111 (94.8%), p 0.035. Vitamin D supplementation led to significant increase in MTBs-induced IFN-g secretion in patients with baseline ‘Deficient’ vitamin D serum levels (p 0.021). Patients in the vitamin D arm and serum < 30 ng/mL (‘Insufficient’ and ‘Deficient’ groups) at enrollment had significantly greater improvements in TB severity scores compared to patients with normal baseline vitamin D levels; p 0.014. This corresponds with the earliest reports of the benefits of vitamin D in TB patients published in 1848  that describes disease arrest, weight gain and reduction in mortality in patients with TB treated with cod liver oil compared to standard therapy alone. More recently, Martineau et al  demonstrated that a single oral dose of 2.5mg (100,000IU) of vit D2 significantly reduced growth of mycobacteria . A randomized, placebo controlled study on 67 Indonesian patients, by Nursyam et al , Jakarta  reported that pulmonary TB patients given 420,000IU of vitamin D over 6weeks ie 10 000iu/day had significantly higher sputum conversion rates as compared to placebo (p 0.002). Martineau et al.  showed that 100,000 IUs of 25-hydroxyvitamin D3 supplementation significantly improved sputum conversion rates in patients with the Taq1 25-hydroxyvitamin D receptor polymorphism of the tt genotype. .
As Salahuddin ea note, the good results in Pakistan in only 3 months with vigorous INITIAL dose vit D3 contrasts with Two recently published large randomised, controlled trials of conservative vitamin D3 over months that achieved far lower blood vitamin D levels found no difference in clinical outcomes or mortality after 400,000IU of 25-hydroxyvitamin D3 or placebo were given by Martineau ea in London, UK to 146 pulmonary TB patients – where mean (trough or midpoint) vit D level (after 100 000iu vitamin D(3) or placebo at baseline and 14, 28, and 42 days after starting standard tuberculosis treatment) – was surprisingly only 40ng/ml at 56days – ie after a mean of 7000iu/d by 56 days, vs 10ng/ml on placebo)- less than half of the bloodlevel achieved on vit D3 in the Pakistan trial ;
and by Wejse et al 2009 in Guinea-Bissau to 365TB patients – who received 300,000 IUs of vit D3 ie only 100,000 IU or placebo at inclusion and again 5 and 8 months after the start of treatment, ie below 1000iu vit D3 per day over the 12 month trial period “. The Guinea-Bisseau pts thus might have achieved a mean blood vit D level boost of only 10ng/ml.. and now Havers ea (Baltimore) show Low 25(OH)D is common in diverse HIV-infected populations and is an independent risk factor for clinical and virologic failure; Low 25(OH)D was associated with high body mass index (BMI), winter/spring season, country-race group, and lower viral load. Baseline low 25(OH)D was associated with increased risk of human immunodeficiency virus (HIV) progression and death (adjusted hazard ratio (aHR) 2.13; 95% confidence interval [CI], 1.09–4.18) and virologic failure (aHR 2.42; 95% CI, 1.33–4.41). and Shepherd ea (Eurocoord) Low Vitamin D predicts short term mortality in HIV-positive persons Odds of death decreased by 46.0%( P = .04) for a 2-fold increase in latest 25(OH)D level.. In patients with current 25(OH)D <10 ng/mL, hsIL-6 concentration increased by 4.7%(95% CI, .2,9.4, P = .04) annually after adjustment for immunological/inflammatory markers, and no change in hsCRP rate was observed (P = .76)
UPDATE: 2 Mar 2014: PARACETAMOL ACETAMINOPHEN, DIGOXIN AND SPIRACTIN are ESTROGENIC: even the most popular and perhaps safest synthetic designer painkiller paracetamol acetaminophen (Tylenol, Panado) discovered in 1877 has again been shown (Harvard University 2014- the Nurses’ Health Study from 20 years ago) to be ( like the 250year old biological human hormone digitalis/digoxin, and the 50year old synthetic antihormone spironolactone), a weak estrogenic ie they proliferate the breasts and thus cancer potential. Acetaminophen use was positively associated with total Estrogen Metabolites (2+ days/week vs. non-use: 236 vs. 198 pmol/mg creatinine; p difference = 0.02, p trend = 0.11), Thus like its cousin phenacetin (never mind alcohol and smoking) after decades of fraudulent promotion as safe, paracetamol’s harms outweigh its utility
Thus while it is fairly safe in adults in moderation, like all designer synthetic drugs eg NSAIDs and synthetic/xenohormones, like even lowdose aspirin, paracetamol has many risks (even for the eyes) and doesnt cure anything- whereas digoxin and spiractin may have lifesaving benefits in serious heart/ hypertensive disease. .
As always, for pain best stick to physical cure by eg manipulation, massage, rest and exercise, heat or cold, acupuncture; or some natural safe biological analgesic/antipyretic combination– massage with arnica/menthol/coconut oil/ DMSO/cayenne/Lugol’s iodine/magnesium oil; or these orally with eg fish oil; vitamins C (eg citrus), D3 (sunshine) and B esp B5 (meat, whole grain, avocado, brassica); magnesium, manganese, copper, iodine, selenium; GABA (but not gabapentin and pregabalin – Bad Medicine); plant extracts eg boswelia, bromelain, buchu, catsclaw, curcumin, dandelion, MSM, nettle, ginger, caffeine, ecchinacea, sage, cherries, Oregano, rosemary, thyme, mint, cannabis, angelica, valerian; and cartilage eg glucosamine-chondroitin .
Oct 2013: BREAST PAIN, CHEST PAIN AND HORMONE CONTRACEPTION.
CHEST/BREAST PAIN: In men and women, nontraumatic pain in the front , back and sides of the chest (and abdomen) is mostly neuromusculoskeletal, and easily diagnosed by the history (absence of cough, central deep pain radiating especially to the jaw , back or left shoulder, breathlessness, fever, heartburn), and physical examination –absence of systemic signs or significant changes in pulse and bloodpressure);
and appropriate assessment of the neck and thoracic spine since these are so often where root pain (around the shoulder girdle, trunk and limbs) originates and can be simply relieved ie cured and thus diagnosed.
This is crucial in daily busy primary care ie general practice where patients –especially the younger fitter ones without the common high risks – want a quick opinion and fix so they can move on, not have to undergo xrays, heart- and blood-tests that specialists and hospitals, medical schemes, politicians and civil servants thrive on..
Older women of course usually have the major extra anterior chest organs – pendulous breasts – to consider. But the same history and physical exam as in men quickly mostly sorts out the source and thus the cause of the pain: a mammary cause eg hormonal congestion diffuse tenderness, discharge, or tender lump or gland, or root cause, is quickly apparent.
CASE REPORTS: at yesterday’s breast clinic we saw the usual spread of middle-age issues in the eight (mean age 45yrs, 32 to 65yrs) who booked for breast prescreening imaging :
HORMONE CONTRACEPTION vs NECESSARY (PRO)HORMONE SUPPLEMENTS:
TWO IN THEIR FORTIES ON DEPOT PROGESTINS:
CHEST PAIN: clerk Ms booked herself for screening with almost constant discomfort in her left breast for about 10weeks.. Like her and her doctors’ examinations, mammography a month earlier found nothing abnormal.. She had no history of trauma or pain elsewhere, just slight neck discomfort. Her last period was years earlier, still on contraception progestin injections. Examination and mechanical tactile breast imaging confirmed tender full breasts; with maximal palpation tenderness midthorax laterally at the site of her complaint. Pressure and rotation elicited no discomfort elsewhere. Gentle traction manipulation of her neck halved the ‘breast’ discomfort, which disappeared with a final satisfying click with gentle prone rotational pressure on her appropriate upper thoracic vertebra – confirming the root source of her pain had been cured; and obviated further concern , tests and analgesia.
Manageress also on longterm depot hormone contraception (Mirena), with growing breasts, rising weight despite careful diet, and concern about hip osteoporosis on DXA screening that was not improving but worsening the past 3 years on some routine vitamins C, D3 2000iu/day. K2 and calcium supplements. Her husband (not she) observed that she had severe night sweats.
Both of the ladies on synthetic progestin contraception were reminded that such depot synthetics suppress the ovaries ie cause artificial menopause with all its longterm subtle adverse effects, and that such hormones are known to slightly increase the risk of breast cancer, fattening and osteoporosis. Both were recommended progesterone cream, vitamin D and metformin as well as the other almost 20 bone supplements, for (pro)hormone balance and to assist with body fat and thus all-risk reduction
Ms mid-60s with no complaints except stress vertebral fracture from osteoporosis now on opioid patch! mother died of breast cancer at 78yrs; she has had 10 mammograms; just dense lumpy breasts;; advised vigorous vit D, Super C, K2; Triple Bone-Pain – antiarthritic blend; metformin; DHEA and melatonin 20mg/d;
Ms early 50s with menopausal symptoms, hypertension ( on perindopril) and lumpy breasts, now off Nuristerate, , was advised to take appropriate supplements including progesterone cream. There is a new report from Holmes ea Canada http://www.ncbi.nlm.nih.gov/pubmed/24075077 that ACEi/ARBs use eg perindopril was associated with significant 22% increased deaths from breast cancer (95% CI: 1.04-1.44), let alone the risk with such drugs of recurrent persistent cough and insidious nephropathy; so is advised to swop over to the safest best and cheapest 1st-line antihypertensive regime of lowdose reserpine with low dose amilozide,
Ms mid-30s with a child despite endometriosis and PCOS , 4 years after removal of Mirena (7 years) , had lumpy breasts. Advised metformin, vits D and Supervit C, minerals and vitamins.
Ms early 30s with PCOS , two aunts in their 50s with breast cancer, her granny from the other parent having died of breast cancer at 76years.. with lumpy breasts; she was advised the supplements including progesterone cream, melatonin, and metformin.
TWO IN THEIR 30S HAD KNOWN BREAST CANCER:
Ms mastectomy and DXRT 2011, now off Nuristerate , given weeks to live 18 mo ago with brain metastases that have shrunk with chemoradiotherapy and her zealous work as a cancer counselor; lumpy other breast; now advised metformin, sutherlandia, melatonin 20mg/d, vigorous vit K2, D and Supervit C, DIM, mushroom, astragulus, selenium, minerals and vitamins within her means.
Ms had lumpectomy and 3 positive glands/12 removed in 2011, refused further oncology/ radiochemotherapy. Lumpy breasts confirmed . Advised metformin, sutherlandia, melatonin 20mg/d, vigorous vits K2, D and Supervit C, DIM- I3C, mushroom, astragulus , selenium, minerals and vitamins; if not Iscador, cesium, TCM, and pancreas/gene therapy within her means.
BREAST PREVENTION REGIME: apart from optimizing diet and lifestyle with appropriate obesity-reducing diet and avoidance of estrogenic foods and drugs,
Based on published evidence and our experience from patients of analgesics and anticancer benefit, all were advised to try triple breast massage daily with coconut oil, Lugols iodine then DMSO for a few weeks, and if they want reassurance, return in a month or two for followup breast imaging to show the shrinkage in all lumps that most show. Those with higher risks are advised to take the oils by mouth as well, and if iodine depleted, oral iodine , for their global benefits.
However, short of avoiding sex, or use condoms and barrier creams, or ill-advised sterilization or dependence on coitus interruptus, their contraceptive method is hard to improve, short of relying on the oldfashioned intrauterine device without any contraceptive hormone. The oldest naturally occurring pregnancy we have seen was at 55 years, so women have to take care past this age…Natural human contraception with depot human progesterone and estrogen was developed decades ago, but naturally not made available commercially because only synthetics are patentable and thus commercially viable raincheck drugs that profit Big Pharma, health professionals and politicians. .
Instead, women are advised simply to protect the breasts, womb, brain, heart, skeleton, face etc, and stop menopause symptoms, by adding just enough human progesterone cream daily to their face makeup (+- vaginally); (testosterone cream sparingly if indicated for frailty, depression and poor sex) , and take a sensible daily blend of the twenty other natural bone and multisystem antioxidant anabolics (as this website www.healthspanlife.wordpress.com details under osteoporosis) including vitamin D about 2500iu/kg/month ie about 150 000 to 200 000 iu/month for an average size adult.
In people rapidly fattening due to lifestyle, stress and the bad marketed adverse food chain, wiser choices have to be promoted-which does not suit most politicians, Big Business or the Disease Industry for whom Only Disease Pays- Prevention Doesn’t Pay.. So to protect against fattening and insulin resistance perils, metformin to sensible tolerance is also an inevitable recommended natural albeit prescription supplement until healthy robust lean weight can be maintained without it.
The supplements listed above – (fish oil, appropriate parenteral human sexhormone replacement and the other antioxidants/anabolic vitamins, minerals and natural biologicals including the prohormones metformin and vitamin D) also mostly obviate the deplorable high-risk use (for commercial profiteering) of risky synthetics eg statins, bisphosphonates, psychotropes, analgesics, NSAIDS, patented xenohormones and chemotherapy etc – none of which address the underlying stress, deficiency and pollution ie primary causes of disease.
UPDATE: FIGHTING THE TIDE OF BREAST CANCER, DISEASE in YOUNGER WOMEN:
16 June 2013 A new review by Carolanne Wright reviews how to combat estrogen overload – How environment and lifestyle contribute to hormonal imbalance while devastating the health of both men and women.
27 May 2013 Wikipedia reports that in 2008, about half a million women died from breast cancers (out of some billion older women worldwide ie 0.5 per 1000 women, an annual deathrate of 0.05% pa), 23% of cancer deaths in women; with cancer overall accounting for about 13% of deaths -the commonest being stomach-colon-liver 2.8%; lung cancer 1.4%, then breast 0.46% of deaths. So breast cancer – mostly undetected globally by the luxury of mammography till it presents clinically- kills only perhaps 1:2000 older women per year, ie perhaps <25% of the perhaps 1:500 older women who develop clinical breast cancer- 995/1000 of older women’s deaths being from other causes than breast cancer.
These figures dispel the dangerously fraudulent fearmongering lie of the USA Radiological and Breast Cancer Associations and Curves International that “(screening) mammography saves lives”. Its good to see in the current Curves South Africa website that in this Celebrating Mothers’ Week at Curves, they have dropped the Mammography saving lives myth of 3 years ago that started this particular theme column. That hasnt stopped USA doctors from continuing to propogate the lie.
But some there eg Dr Lissa Rankin MD – daughter of a mammography radiologist- are still brave enough to refute the lie. And even the American Cancer Society chief medical officer doesnt make such ludicrous claims but points out how complex the issue of prescreening detection is. .
Johnson and Bleyer reported Feb 2013 from the SEER study that advanced breast cancer in young USA women 25-39yrs has doubled between 1976 and 2010.
South Africa (religion mostly African Christian) has the distinction of being one of Earth’s most corrupt and illiterate countries, with strange bedfellows – Latin America (mostly Catholic), Egypt Lebanon & Pakistan(Islamic), and South Korea(mixed religions)- that follow the USA in defying evidence – in this case of danger to cows and humans – and allow the use of rBGH recombinant Bovine Growth Hormone ; and sex hormones in dairy and meat production. The evidence of harm, eg carcinogenicity and feminization is so strong that such use has been banned in many countries for decades .
MORTALITY TREND AND CANCER IN RSA AND GLOBALLY: Breast cancer is usually a disease of postmenopausal women-who till a centry ago on average barely lived to that age. In South Africa at the peak of the untreated AIDS epidemic around 2000, with average lifespan drastically fallen, of all deaths, overall infections (HIV TB, pneumonias etc) caused about 39%, external causes 12%, cardio/vascular disease 11%, cervix cancer 1.4% and breast cancer 1.3%. But Statistics SA report last month that by 2010, with antiretrovirals, life expectancy had risen about 5years, and that of all deaths, HIV+TB deaths had at least halved to 15% (17% in Africans, 9% in coloureds, 2.4% in Indians), cardio/vascular deaths were 12% in blacks but 27.8% in whites; external causes down to 9%, cancers 9% (mostly digestive and respiratory); with only 20 breast cancer deaths ie 0.00% reported in RSA.
Breast cancer is still rare in a mostly young population with mean age of survival of women still half of that of the first world, with virtually a generation gap due to the carnage of the untreated AIDS era and institutionalized male violence especially against women, children and minorities- xenophobia.
But meat and dairy milk (in South Africa widely containing added rBGH and sex hormones) are among widely used foodstuffs likely contributing, as Joe Mercola notes, to the increasing occurrence of breast cancer in younger women. Never mind deadly sugars, smoking and alcohol consumption on the rise here in RSA.
AVOIDING CANCER AND MASTECTOMY:
To improve immunity, insulin receptor sensitivity, lessen obesity and excessive estrogenization (from both outside your body, and your own fat production):
Just this month, a major trial from UCLA (Smith, Kurzer ea) confirmed that in healthy sedentary young women, moderate exercise 2.5 hour a week significantly beneficially lowered the risky estrone level and raised the 2OH:16OH estrone ratio.
These preventative steps may remove justification for therapeutic mastectomy (which is known to reduce survival) for localized breast cancer , let alone preventative bilateral mastectomy even in women with high penetration BRCA genes, as publicized this month by filmstar Angela Jolie .
update 22/3/2014: the March equinox:Vaccines and antivirals for preventing and treating influenza in healthy adults have very modest benefit. as the seasonal flu epidemic wanes in the northern hemisphere and approaches in the south, Authorities eg the US CDC continue relentlessly to promote mass flu vaccination. The South African Authority NICD recommends vaccination for anyone at high risk ie the elderly, infants or the sick, and carers. It also recommends antivirals eg Tamiflu for infection- but the BMJ recently publishes Study claiming Tamiflu saved lives was based on “flawed” analysis. a 2012 BMJ report by the samemedical journalist Zosia Kmietowicz notes Cochrane group rejects Roche’s offer of “advisory board” to discuss analysis of oseltamivir data. The 2011 Cochrane question remains unresolved: Does Oseltamivir Tamiflu Really Reduce Complications of Influenza?
But current Cochrane review of controlled trial publications to 2013 confirms “Vaccination of pregnant women is recommended internationally, while healthy adults are targeted in North America. The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 (95% CI 64 to 80). . Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 (95% CI 29 to 115). Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms. CONCLUSIONS: Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women. This review includes 90 studies, 24 of which (26.7%) were funded totally or partially by industry. Out of the 48 RCTs, 17 were industry-funded (35.4%).
A current German review Methodological quality of systematic reviews on influenza vaccination. Fourty-six systematic reviews fulfilled the inclusion criteria. Average methodological quality was high but variability was large (AMSTAR range: 0-11). Quality did not differ significantly according to vaccination target group. Cochrane reviews had higher methodological quality than non-Cochrane reviews (p=0.001). this was due to better study selection and data extraction, inclusion of unpublished studies, and better reporting of study characteristics (all p<0.05).
Abstract: The Semmelweis Reflex is about rejecting, deriding important new scientific discoveries or any serious sincere statement/action. I didnt fully appreciate the importance of that age-old human (mostly male) evil – mocking, martyrdom and murder by denialism- until I started this review of the current flu season threat and the role of supplements, and researched pioneer medical martyrs Drs Ignaz Semmelweis, Jack Drummond and Linus Pauling as paradigms of the scourge of modern vested-interest denialism and falsehoods, in medicine as much as politics, religion etc..
In fact, just as it is negligence to deny (as Semmelweis’s persecutors did) gloving up or properly washing hands between examining patients , or ensure that every adult has bloodpressure checked occasionally, it is clearly bad practice not to ensure that everyone – especially the young and old, takes a multinutrient plus extra vigorous dose vitamins D3 and C, plus some protective herbs- garlic, cinnamon, ginger, origanum; and fish oil and/or coconut oil if not both; and drastically cut down sweetness intake- especially fructose, sucrose and aspartame that now pervade all mass- produced food and drinks..
update 21 January 2014 : URGENT: THE 2014 FLU EPIDEMIC: “High H1N1 prevalence and mortality rates a concern: Type A (H1N1) influenza, the commonest flu virus in Canada this year, has a higher than anticipated mortality rate causing some to wonder if it’s virulence has increased. The worrisome factor “is the reported mortality rate,” says McGill University. As of Jan. 13, there were twenty confirmed deaths in Canada attributed to H1N1. “There are more deaths than what we expect for the regular H1N1 influenza, The strain this year could be more virulent . 96% of this year’s lab -confirmed influenza is H1N1. The virus is unusual in that it appears to affect younger people more than other strains of seasonal influenza. People 20 to 65 are being hit harder than usual, comprising 52% of flu cases. However, if you look at Europe, it’s still H3N2. Its an example of how you never know what the flu is going to do.” Alberta confirmed a death on Jan. 8, due to the virus H5N1, an avian virus. The deceased woman had recently returned from China. The mortality rate is higher with H5N1 than H1N1, “but fortunately, it’s not an easy virus to transmit”. So far, it seems that there are no cases of H5N1 transmission from human-to-human. It seems like the cases of H5N1 are few and far between and related to contact with birds in China. Patrick Janukavicius, Montréal, Quebec. In the same period, at least 20 children have reportedly died of the same strain in USA.
update 12 Jan 2014 THE ANTIFLU VACCINE DECEPTION: this review by Doc Joe Mercola stresses the disease-mongering myths, futility and risks in real life of flu vaccination and antiflu drugs eg Tamiflu ; and the overwhelming importance of natural immune boosters like Vit D3 & C, zinc, selenium, herbs, and hygienic prevention.
1 Jan 2014 CURRENT INFLUENZA STATUS: The 22 December solstice is the sun at its southern nadir seen from planet Earth, the onset respectively of real winter in the Northern hemisphere, and real summer in South Africa. Last year the Gregorian New Year heralded a fierce flu season in the northern hemisphere, and as usual feathered- and jet-propelled air travel brought the corresponding surge at the bottom of Africa.
And ominously, the Plagues & Pandemics (Howard Phillips 2012) of temperate climates that did so much historically to mould global demography not least the past 360 years in South Africa ( –STDS- pox, bubonic, polio, cholera, influenza, and now tuberculosis, Mad Cow disease, and HIV-AIDS). and especially antibiotic-resistant germs – are all on the increase despite (or because of) the increasingly futile $trillion armamentarium of 20th century designer vaccines and other antimicrobials..
Pneumonia is a welcome friend of the old, often rapidly relieving prolonged degenerative incapacity; such ending mostly by virus respiratory infection the gateway for the final bacterial infection.
Unlike the selflimited coronavirus common cold, breath-and hand-borne type A influenza, although usually mild in the well, is the commonest trigger in the frail. Many of us in our (grand)parents’ time lost relatives in the 1918/1919 “Spanish” H1N1 flu pandemic. But that was a unique global catastrophe because it killed mostly armies of healthy men, and then young working adults, apparently from cytokine storm, with 30 % of the workforce out for up to3 weeks if not 20% mortality. This is harrowingly described in the recently published Letters ( to his Mother) of Dr Arthur Conan Doyle, who lost – apart from his first wife to TB- more young relatives to the flu than to warfare.
The recent spring months here – apart from seasonal allergies -have seen declining viral respiratory illness in Cape Town, with the upper respiratory accent often shifted down to more gastritis-enteritis .
But New Year 2014 UK and northern North America forecast and are having a wet if not white New Year. ‘Flu rates are reported already high and rising in USA and Canada– mostly influenza A H1N1(swine-avian flu-the main 1918/19 killer); including already 6 deaths in USA and 3 in Canada.
but not in Europe, where the influenza (A > B) prevalence is still low and slightly more H3N2 than H1N1; in UK there has rather been been increase in RSV respiratory syncytial virus bronchitis in infants. . .
In fact by 28 December the exploding H1N1 deathtoll had hit 13 in Texas alone; especially in youths; with increasing Tamiflu resistance reported eg in Missisippi.. On 24 Dec the USA CDC mailed an emergency Advisory Notice to Clinicians: Early Reports of pH1N1-Associated Illnesses for the 2013-14 Influenza Season: From November through December 2013, CDC has received a number of reports of severe respiratory illness among young and middle-aged adults, many of whom were infected with influenza A pH1N1 pdm09 virus. Multiple pH1N1-associated hospitalizations, including many requiring intensive care unit (ICU) admission, and some fatalities have been reported. While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far. For the 2013-14 season, if pH1N1 virus continues to circulate widely, illness that disproportionately affects young and middle-aged adults may occur.
Our regional South African Communicable Diseases Institute says , “H1N1 was documented here from April to September. But of 2566 pts with severe respiratory illness for January to October 2013 enrolled and tested at the five sentinel sites, only 6% were positive for influenza – mostly virus -H1N1. A pneumonia case in Cape Town was found to be due to Leigionnaire’s.
Now from China 147 human cases of avian influenza H7N9 have been confirmed including 48 deaths. – especially from poultry contact. No vaccine is currently available for avian influenza (H7N9) virus.
SAPA–AFP, 10 December 2013: Resistant flu virus keeps contagiousness. A mutant form of the H7N9 flu virus that is resistant to frontline drugs is just as contagious as its non-resistant counterpart, according to a study, published inthe journal Nature Communications. The virus has claimed dozens of lives since its outbreak in February. H7N9 is believed to have spread to humans from poultry, where it circulates naturally. The World Health Organisation (WHO) said on its website that “so far”, no evidence has emerged of “sustained” transmission of H7N9 among people.
And H7N1 and H7N7 has broken out in ostriches in South Africa,
So never mind the common cold coronaviruses and many other prevalent infections, increased caution is due against all common diseases at this season- both the USA H1N1 swine flu circulating the past few years, and now the Chinese H7N9 flu. . And the MERS-Co Virus Middle-East SARS-type outbreak has not gone away… 9 new cases reported the past week or two from the KSA alone .–the-deadly-middle-east-coronavirus-outbreak/
A current NEJM has a new report of a trial of quadrivalent Vaccine for Prevention of Mild and Moderate-to-Severe Influenza in Children by vaccine manufacturers GSK. The vaccine reduced severity by perhaps 70%- but at a cost of 1.5% serious adverse events, 50% more than the control group (hepatitis A vaccine only). The question remains- why risk flu vaccine’s ~1.5% serious adverse events when a single high dose of vitamin D3 300 000iu even just annually, and regular vitamin C with a multivite including zinc and selenium (at trivial cost ) largely cover one against a multitude of infections including AIDS and TB, and all degenerative health problems?
Is it coincidence, or divine evolution, that we have had available at low cost for about 60 year (never mind zinc, selenium, iron, iodine, vitamins A and vitamin E) two safe natural major antimicrobials in vigorous safe dose – vitamins C and D3? Medico-Pharma Big Business and governments have been heavily discrediting and ruthlessly suppressing these for their own profiteering vested interest even as plagues of HIV, TB, influenza rage, and Big Business determinedly profits hugely from killer smoking and alcohol sales despite increasing marketing restriction? South Africa- a major producer of alcohol and tobacco-smoke, and fossil-fuel-burning power stations, factories and motorvehicles – continues to lead the world with the highest road and respiratory death rates despite zealous attempts to reduce their lethal use.
Apart from optimal hygiene including avoiding livestock and poultry contact, smoking, alcoholism and pollution including swimming and sick buildings- air-conditioning- what can we take to minimize avoidable influenza ie immune depletion risk? apart from enough sunshine, exercise, rest, sleep, walking barefoot, not carrying a cellphone, and good mixed fresh organic diet? The clinical benefit of influenza vaccines is anything but proven, and the adverse risks appreciable.
Big Business and thus governments and the media profit from illness, so they keep publishing articles promoting Big Business: new antibiotics, vaccines and other synthetic drugs that do not prevent or cure but if anything perpetuate chronic degenerative obesity-diabetes-vascular-respiratory,- digestive-arthritic-cancer diseases; – and GMO-genetically modified preserved food and bottled drinks stuffed with slow poisons like refined cornstarch – fructose; salt; sucrose and cereals, soya, Roundup, antibiotics, preservatives, estrogenics, aspartame, and especially boiled and baked omega6 and sugars; instead of marine omega3 and MCT- medium chain triglyceride virgin coconut oil, and unrefined cereals eg oats, wholewheat bread etc..
Big Business and it’s cash-cow Disease Industry decries the natural healthgiving lowsugar Asian/ Mediterranean diet-organically pastured and grown livestock meat and dairy products, lightly cooked if not raw (oily) fish, fruit and nuts, coloured veggies, and plenty of oils in their natural plant form. These were the norm till food processing became Big Business in our lifetime post WW2, and the developed world was bluffed by Organized Medicine, the Food Barons and Big Pharma with the masterly fiction of Ancel Keyes, into jettisoning the natural longevity “sea and farm” diet of the east eg Japan, and West eg Mediterranean (fresh produce & cholesterol-rich dairyproducts, meat and fish) for the Diet Deception (Gary Taubes, Tim Noakes) and Bad Pharma ( James le Fanu, Ben Goldacre) of Ancel Keyes‘ low-fat high-refined cereals, margarine; and the cholesterol -busting and psychotropes/ painkillers /antidementia/antivascular/ antidiabetic disease Designer Drugs-for-all myths.
It spends multimillions promoting alcohol, smoking and ever-newer designer prescription drugs and vaccine, and disinformation on old well-proven cheap drugs like reserpine, amilozide, metformin, natural physiological human hormone replacement, natural antioxidants and anti-inflammatories , and decrying ineffective but deliberately lowdose and isolated or imbalanced vitamins and minerals .
The ATBC vits A+E trial (isolated highdose vits A and E) was one such farce in very high risk smokers in an icy climate. . Others have been the recent Norwegian trial using only up to 1000iu vit D supplement a day,
*a commercial multisupplement in the TACT post-heart attack trial – but the composition of the multisupplement included only deficiency-disease prevention microdoses of micronutrients including 100iu vitamin D3/d and equally negligible vitamin K- not pharmacological doses of key vitamins eg vits B, C, D & K2 that are well proven to greatly reduce infections and chronic degenerative diseases ;
* the Physicians’ Health Study randomized elderly professional men to placebo or combinations of vitamin C (500 mg synthetic ascorbic acid), vitamin E (400 IU of synthetic alpha-tocopherol), beta-carotene (50 mg Lurotin), and a multivitamin (Centrum Silver – this included anti-deficiency disease low dose of all common vits and minerals BUT only 400iu Vit D3), .
* The third study- on lowdose (traditional anti-deficiency disease) Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer was simply a literature review of 26 best-quality published trials of microdoses – not pharmacological safe macrodoses.
ie these three trials published in this Annals Internal Medicine issue to please Big Pharma advertisors to discredit supplements shared the usual problem of now well-known futile lowdose supplement doses at least of vitamins D3 and K, if not also vitamin C in the multigram dose scientifically promoted by the Drs Stone- Klenner-Pauling followers.
Sir Jack Cecil Drummond (1891-1952) was one of the world’s pioneer 20th century biochemists and nutritionists in UK, from 1916- 1952 discovering or defining and promoting under his world-famous biochemist professors Rosenheim, Halliburton and Funk the role especially of vits A, B, C and E. Thanks to his and Churchill’s forceful vision and foresight, he oversaw food supply and diet and thus keeping Britons healthy through and after WW2. He was so successful in promoting healthy cheap and unpatentable micronutrients and natural fresh food (in the face of the mushrooming megaprofit processed food and designer drug industry) that it speculatively led to his and his family’s 1952 assassination by competing interests in France –The Vitamin Murders, Fergusson 2007. .
MURDER BY DENIALISM: It is incontrovertible common cause that irrational and often jealous medical denialism costs endless lives:
* Scurvy prevention: Dr James Lind (who did the first ever recorded clinical trial) showed by 1750 that sailors’ scurvy on long sea voyages was preventable; but despite his pioneer discovery, the British navy cost the lives of thousands more seamen from scurvy when the Admirals neglected for 50years until the Napoleonic Wars to supply the fresh produce- eg limes – that rapidly cured and prevented the lethal scourge.
This despite the fact that another UK navy surgeon Dr John Woodall had already over 130 years earlier- by 1617 – published in UK The Surgeon’s Mate stating We have in our owne country here many excellent remedies generally knowne,- Scurvy-grasse, Horse-Reddish roots, Nasturtia Aquatica, Wormwood, Sorrell, and many other good meanes… to the cure of those at home…and Sea-men returned from farre who by the only natural disposition of the fresh aire and amendment of diet, nature herselfe in effect doth the Cure (of scurvy- for which antiscorbutic citrus had been known since antiquity) without other helps. the Lemmons, Limes, Tamarinds, Oranges, and other choice of good helps in the Indies… do farre exceed any that can be carried tither from England.
* Childbed fever prevention: in 1865 Dr Ignaz Semmelweis (1818 -’65) an AustroHungarian Roman Catholic ob-gyne in Vienna, was locked up, and beaten to death within weeks, because he showed – to the outrage of his peers- that handwashing with chlorinated lime eradicated the epidmic puerperal fever (three times that in the midwives’ ward) in the doctors’ labour wards; 70years before Thir Reich terrorists took charge, his senior colleagues reacted violently to his progressive promotion of (what was already more advanced British and French) hygiene and science, and his urging them to wash their hands after examining corpses before examining women in labour.. . Tragically for Semmelweis and new mothers in the Hapsburg empire then, Pasteur (b 1822) and Lister (b 1827) ‘s germ antiseptic discoveries were already being implemented further west, but had not yet been publicized.
*metformin after centuries of use as an antidiabetic herb galega officinalis, and its extraction as an antidiabetic in 1922, came into increasing use globally from the 1950s as the best treatment for type 2 diabetes, but the USA- to protect their own new patent antidiabetic drugs – ruthlessly suppressed its use there (like that of the natural salt lithium for manic depression) for 40years till the mid-1990s.
*AIDS and ART denialism: until 5 years ago in South Africa the overwhelming-majority “people’s” government (with the country’s vast resources), and its successive “health” ministers, cost the lives of an estimated 300 000 AIDS victims through sufferers – indigent state dependents- being denied antiretroviral ART drugs, (never mind still till now denied quality education and civil security, and thus adequate basic nutrition, and meaningful housing, jobs and thus hope.) Genocidal AIDS denialism about which the still-ruling (since 1994) leadership cadre did nothing until under intense international pressure and repeated Constitutional Court orders, combined with political rival factioneering in the ruling party, they ousted the denialist president and his denialist Disease Minister in 2008.
DENIALISM TARGETS IN NUTRITION:
VIGOROUS VITAMIN C ASCORBIC ACID PHARMACOTHERAPY : Much effort and Big Pharma money has been spent to denigrate the irrefutable science-based work (between their advocacy years shown) of Drs Irvine Stone (1934-1984), Fred Klenner(1948-74) and Linus Pauling (1970-1991) of antibiotic dose >50 to 1000 mg/kg/d pure vitamin C (not the antiscurvy 10mg/d) – as a universally needed essential in primates. We primats, like guineapigs and a few birds and fish species, are among the few that do not make their own since we lost the needed gene and thus enzyme in our evolution..
It took about 150 years after Lind’s publication for the antiscorbutic factor to be named as vitamin C by Dr Jack Drummond, another 10 years for it to be assayed and its structure proven- but despite the pioneering clinical work of Dr Fred Klenner in the 1950s proving the lifesaving benefit of tens of grams a day intravenously, it took another 20 years before Dr Linus Pauling took up Dr Irvine Stone’s conviction and put highdose vitamin C on the world Nobel prize map; just on Pubmed, vitamin C has >51 000 citations since 1921, and intravenously in 763 entries since 1946, with Dr Fred Klenner reporting it intravenously asmajor antibiotic in the Southern Medical journal from 1948..
The 2009 book Injectable Vitamin C and the Treatment of Viral and Other Diseases collection of medical journal papers from the 1930s to 2006 details the exhaustive scientific evidence proving the uniform benefit of even 1gm a day vit C both as an antimicrobial antiinflammatory antioxidant and immunomodulator against major crippling / lethal diseases from polio to tuberculosis, pneumonia, hepatitis, rabies, encephalitis, neuritis, poisoning, cancer, and pancreatitis;
and the persistent resistance of the FDA and other multinational Regulators to recognize (so as to protect their domestic patent drug manufacturers- Big Pharma and their politician and civil service lobbyists )- such uniquely safe and effective natural drug therapy. The final chapters of that 2009 book pose the crucial questions of overwhelming vested interest by the organized medical – hospital –pharmaceutical mega-industry and governments in not eradicating preventable disease, the Big Pharma banning of natural effective remedies- The Origin of the 42-Year Stonewall of Vitamin C, and Medical Resistance to Innovation,
The University of Oregon, the Riordan-Gonzalez group and more recently Hemila and Chaker‘ and Ullah et al’ s 2012 reviews have published much validating what Drs Goodall, Lind, Drummond, Stone, Klenner, Pauling and Cameron started.VIGOROUS VITAMIN D3 CHOLECALCIFEROLPHARMACOTHERAPY costing wholesale ~ <US$0.5/month for ~200 000iu /month in South Africa) reduces serious infection by perhaps 90% ie 9fold: . eg 80iu/kg/d – 500iu/d (15000u/month) for an infant, 50 000iu/wk or 200 000iu/mo for an adult; who if obese, may need two to three times the average dose, to achieve the (?) optimal 25OH vit D level of around 70ng/ml for health, higher for any acute or chronic chronic illness.
The modern prophets of vitamin D3 have been the three pre-WW2 doyens :
Prof Chris E Nordin (MB ChB 1950) working in bone physiology for 60 years now; 84 papers on vitamin D on Pubmed
Prof Walter Stumpf (1927-2012; MD 1952) the recently deceased professor at North Carolina University, neuropsychiatrist and radiobiologist in his 60year medical career with over 500 publications (76 on Vit D on Pubmed) including early discovering that vitamin D targets all systems and diseases; professor-walter-e-stumpf-ahead-of-his-time/ and https://healthspanlife.wordpress.com/tag/stumpf-dr-walter/
paralled by Prof Robert Heaney (MD 1951) at Creighton University, osteoporosis and nutrition authority with 119 vitamin D papers on Pubmed since 1982, over 400 publications to date;
succeeded by Prof Mike Holick (PhD 1971, MD 1976) with 391 publications on vitamin D since 1970 on Pubmed, who has done more than most to show that the maximum daily body production of vitamin D3 with plenty of sunlight is enough to prevent rickets and reduce all disease, but nowhere near the pharmacologically therapeutic 80iu/kg/d needed to maintain a vigorous all-disease protective bloodlevel of 60-100ng/ml.
and Dr John Cannell (MD 1976, registered psychiatrist from 1993, nutritionalist), a legendary whistleblower . who successively campaigned against #cigarette smoking; and uncovered: # the cigarette-smoking (Black Lung) compensationitis fraud of miners’ pneumoconiosis; #the fictitious inflated “above national average” school results (Lake Woebegone) that all states were inventing and reporting (as is still happening – mass government deception- in South Africa) ; then the
# recovered memory therapy (RMT) scandal – a form of psychotherapy in which patients recovered memories of abuse that they had no previous memory of. Such therapy resulted in false memory syndrome (FMS) of events that never occurred as well as an epidemic of multiple personality disorder (MPD), a rare disorder historically conceived of as being a hysterical disorder. Unfortunately, many MPD patients believed the psychiatrist conducting the RMT and went home to falsely accuse their parents and others of horrendous acts that never occurred. Cannell teamed up with two Harvard professors to write a peer reviewed paper on RMT, debunking the witch-hunt; then since the 1990s researching and promoting # vitamin D deficiency as major cause of much psychopathology including autism, and vigorous vitamin D therapy to correct multiple diseases, through the Vitamin D Council. He has (co)authored some 13 papers, and published a book. .
Now a major longterm German Cancer Research screening program has just publishd the 2002-2013 ESTHER study (Perna ea) of 10 000 citizens followed with serial 25OH vit D levels; to assess the association of apparently unsupplemented vit D levels with fatal and nonfatal CVD in the same study population. Follow-up data, including survival status, up to over 9 years. Comparing subjects with 25(OH)D levels below 12ng/ml and above 20ng/ml resulted in the lower vitamin D level cohort showing a higher hazard ratio of 1.27 (95% confidence interval = 1.05-1.54) for total CVD and 1.62 (1.07-2.48) for fatal CVD in a model adjusted for important potential confounders. No significant association for nonfatal CVD was observed. In dose-response analysis, we observed an increased cardiovascular risk at 25(OH)D levels below 30ng/ml. Results for CHD and stroke were comparable to the results obtained for the composite outcome CVD. Our results support evidence that low 25(OH)D levels are associated with moderately increased risk of CVD, BUT the observed association is much stronger for fatal than for nonfatal events.
But the benefit of sunlight in healing tuberculosis has been used for well over a century; while the Google antibiotic benefit of calciferol on Pubmed goes back at least to 1950.
In a prospective 16 mo trial in press from Australia, vit D3 even just 60 000iu/month (ie 2000iu/day) halved antibiotic use in seniors. (Tran, Neale ea 2014) Effect of vitamin D supplementation on antibiotic use: a randomized controlled trial.
Since the toxic dose of vitamin D long term reportedly may be as high as 600 000iu/day or a blood level well >150ng/l , imagine how much better the antimicrobial benefit of vitamin D3 at 80 to 100iu/kg/day or pro rata – even higher eg 10 000+iu/day for obese people who sequester more vit D in fat. .
Dr Robert F Cathcart wrote 30 to 20 years ago in Med Hypotheses. 1981 Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy The amount of oral ascorbic acid tolerated by a patient without producing diarrhea increase somewhat proportionately to the stress or toxicity of his disease. Bowel tolerance doses of ascorbic acid ameliorate the acute symptoms of many diseases. Lesser doses often have little effect on acute symptoms but assist the body in handling the stress of disease and may reduce the morbidity of the disease. However, if doses of ascorbate are not provided to satisfy this potential draw on the nutrient, first local tissues involved in the disease, then the blood, and then the body in general becomes deplete of ascorbate (Anascorbinemia and Acute Induced Scurvy). The patient is thereby put at risk for complications of metabolic processes known to be dependent upon ascorbate. 1984 Vitamin C in the treatment of acquired immune deficiency syndrome (AIDS). evidence is that massive doses of ascorbate (50-200 grams per 24 hours) suppress the symptoms of the disease and can markedly reduce secondary infections. In combination with usual treatments for the secondary infections, large doses of ascorbate will often produce a clinical remission which shows every evidence of being prolonged if treatment is continued. .. despite continuing laboratory evidence of helper T-cell suppression. There may be a complete or partial destruction of the helper T-cells during an initial infection that does not necessitate a continuing toxicity from some source to maintain a permanent or prolonged helper T-cell suppression. However, it is possible ascorbate may prevent that destruction if used adequately during that prodrome period. Emphasis is put on the recognition and treatment of the frequent intestinal parasites. Food and chemical sensitivities occur frequently in the AID syndrome and may aggravate symptoms considered to be part of the AID syndrome. A topical C-paste has been found very effective in the treatment of herpes simplex and, to a lesser extent, in the treatment of some Kaposi’s lesions. Increasingly, clinical research on other methods of treating AIDS is being “contaminated” by patients taking ascorbate. 1991 A unique function for Vitamin C is as reducing substance, electron donor. When vitamin C donates its two high-energy electrons to scavenge free radicals, much of the resulting dehydroascorbate is re-reduced to vitamin C and therefore used repeatedly. Conventional wisdom is correct in that only small amounts of vitamin C are necessary for this function because of its repeated use. The point missed is that the limiting part in nonenzymatic free radical scavenging is the rate at which extra high-energy electrons are provided through NADH to re-reduce the vitamin C and other free radical scavengers. When ill, free radicals are formed at a rate faster than the high-energy electrons are made available. Doses of vitamin C as large as 1-10 g per 24 h do only limited good. However, when ascorbate is used in massive amounts, such as 30-200+ g per 24 h, these amounts directly provide the electrons necessary to quench the free radicals of almost any inflammation, and reduces NAD(P)H and therefore provide the high-energy electrons necessary to reduce the molecular oxygen used in the respiratory burst of phagocytes. In these functions, the ascorbate part is mostly wasted but the necessary high-energy electrons are provided in large amounts.
A recent review from Atlanta Kearns ea found 30 papers which aggregate to show that annual vitamin D3 dose (not D2) of optimally 300 000 to 500 000iu (wholesale cost ~R5 in South Africa) for deficient adults is best for avoiding poor patient compliance with minimal risk and major benefit.
THE INFERIORITY OF VITAMIN D2 SUPPLEMENT: It should be noted that the long-used Lennon’s Strong Calciferol datasheet (1974 updated 2004) does not indicate that this 50 000iu tablet labelled ‘calciferol’ is in fact vitamin D2 (ergocalciferol), not the fourfold more potent cholecalciferol D3 formed by sunlight in the skin. This is disclosed only on the Lennons website.. and in the South African Medicines Formulary. So ‘Strong Calciferol’ in South Africa (actually the D2 not D3 form of calciferol) is convenient but seriously deceptive mislabeling- much weaker than the ideal vitamin D3, and therefore its effect unpredictable compared to D3- in fact Dierkes ea Norway show that giving D2 may actually lower 25OH vit D level in the blood.. Sadly, despite this being reported to the local manufacturers and authorities, no correction of the clinically serious misperception created by the Strong Calciferol label and insert has been issued to health practitioners by the Medicines Control Council and the manufacturer Aspen-Lennons.
A recent 8yr study in Cape Town blacks Reciprocal seasonal variation in vitamin D status and tuberculosis notifications in South Africa Martineau, Nhamoyebonde ,Wilkinson ea confirmed that vitamin D deficiency (serum 25(OH)D <20 mg/L) is associated with susceptibility to tuberculosis (TB) in HIV-uninfected people in Cape Town as it is Europe. Vitamin D deficiency was present in 62.7% of 370 participants and was associated (OR ~5.4) with active TB in both HIV-uninfected and HIV-infected -(P < 0.001) people. Vitamin D status varied according to season: 25(OH)D concentration was double in summer-January- March compared to winter (23 vs 12ng/l; P < 0.001). Reciprocal seasonal variation in TB notifications was observed:lowest in autumn and highest in spring October through December (4,2 vs. 5; P < 0.001). Vitamin D deficiency is highly prevalent among black Africans in Cape Town and is associated with susceptibility to active TB both in the presence and absence of HIV infection.
Antimicrobial implications of vitamin D is detailed by Youssef, Peiris ea (USA Dermato-Endocrinol 2011) against all microorganisms – viruses, fungi, bacteria, protozoa (except perhaps leishmaniasis) as both profound prevention and therapy; in many cases without commercially invented marketed antimicrobials to which there is growing and deadly microbial resistance, let alone toxicity.. There is evidence that seasonal vitamin D deficiency status contributed greatly to the 1918/19 flu-pneumonia pandemic (Grant & Giovannucci 2009).
and finally, a month ago JAMA published from Effect of Micronutrient Supplementation on Disease Progression in Asymptomatic Antiretroviral-Naive HIV-Infected Adults in Botswana A Randomized Clinical Trial, that Micronutrient deficiencies occur early in human immunodeficiency virus (HIV) infection, and supplementation with micronutrients may be beneficial; however, its effectiveness has not been investigated early in HIV disease among adults who are antiretroviral therapy (ART) naive. 2 year supplementation with either daily vitamins BCo, C and E, selenium alone, or B,C,E with selenium vs placebo: study conducted in 878 patients infected with HIV subtype C with a CD4 cell count greater than 350/μL who were not receiving ART between 2005 and July 2009. Results participants receiving the combined supplement of vitamins plus selenium vs placebo had half the risk of reaching CD4 cell count 250/μL or less (adjusted hazard ratio [HR], 0.46); and secondary events of combined outcomes for disease progression or AIDS-related death, whichever occurred earlier [adjusted HR, 0.56); . There was no effect of supplementation on HIV viral load. Multivitamins alone and selenium supplementation alone were not statistically different from placebo for any end point. Reported adverse events were adjudicated unlikely related to the intervention, and there were no notable differences in incidence of HIV-related and health-related events among study groups.Conclusions and Relevance In ART-naive HIV-infected adults, 24-month supplementation with a single supplement containing vitamins BCo,C,E and selenium was safe and significantly reduced the risk of immune decline and morbidity. Micronutrient supplementation may be effective when started in the early stages of HIV disease.the universities of Miami, Harvard and Florida
THE PARADOX OF THE GLUCOSE- ASCORBIC ACID- CHOLESTEROL- STEROID CASCADE: Is it coincidence, or evolution, that the basic animal fast-energy circulating anabolic substrates are glucose, fatty acids and aminoacids? from which basic glucose C6H12O6 ( from ingested fructose C6H12O6 and sucrose C12H22O11, or fats or protein) the liver manufactures the basic cardinal steroid cholesterol C27H46O. Then from cholesterol we metabolize by adding or splitting off carbon molecules the crucial anabolic and regulating human hormones- 1. ouabain C29H44O12 the adrenal hormone made also in the hypothalamus and heart ; adrenal), 2. active calciferol C27H44O the strengthening and reproductive secosteroid; 3 the prime sex/ reproductive steroids pregnenolone C21H32o2, and thence progesterone C21H30O2, testosterone C19H28O2, DHEA C19H24O2. and thence estradiol C18H24O2. and 4 the prime adrenal mineralo/glucocorticoid steroids cortisol C21H30O5, aldosterone C21H28O5.
But we primates and a few other species lost the ability to synthetise on demand in quantities of grams a day the crucial vitamin C ascorbic acid C6H8O6 that is key to all the above. And vested interests in the Disease Industry want us to believe the biological nonsense heresy that we must ingest minimal unprocessed foods- cholesterol, fats (especially dairy, marine oil Omega3 and medium-chain triglyceride- coconut oil) and abundant vitamins C and D3, but eat abundant processed foods- refined plant Omega6, refined carbs- fructose, sucrose, fruit juice, cooldrinks, cereals, confections- which overload causes insulin resistance and thus lipidemia, obesity- metabolic syndrome -diabetes, cancer and cardiovascular disease.
The Semmelweis reflex: A current Wiki essay sums up the current genocidal problems of deliberate deceptions/denialism in Diet, Vitamins and causality – for ruthless profit and possibly cynical eugenics: “The Semmelweis effect is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms.The term originated from the saga of Dr Ignaz Semmelweis, who discovered that childbed fever mortality rates reduced ten-fold when doctors washed their hands with a chlorine solution before examining patients. His hand-washing suggestions were rejected by his contemporaries, often for non-medical reasons. For instance, some doctors refused to believe that a gentleman’s hands could transmit disease (see Contemporary reaction to Ignaz Semmelweis). In his book The Game of Life, Timothy Leary provided the following polemical definition of the Semmelweis reflex: “Mob behavior found among primates and larval hominids on undeveloped planets, in which a discovery of important scientific fact is punished”. The expression has found way into philosophy and religious studies as “unmitigated Humean skepticism concerning causality“.”
Idealism, ethics may evolve; but the problem of human bigotry, self-interest and subjective ie personal bias do not diminish, they spread. It is classic that Semmelweis (1818-1865) the observant innovative Catholic medical scientist of his time (before microbes and antiseptics were known) was fatuously condemned not just by his jealous competing Vienna colleagues, but even by his progressive and reformist Copenhagen contemporary obgyn Prof Carl Levy (1808-1865)- who outlived him by only 4 months;
ironically at the same time that their Copenhagen contemporary Dr Soren Kierkegaard (1813-1855) was increasingly isolating himself on the lonely ethical journey against the convenience lazzez- faire tide, writing for ethical life and religion against the hypocrisy of the Church and becoming the father of both reformist theology and psychology. But unlike Semmelweis who was way ahead of the bioscience and humanity of his time, Kierkegaard stuck to and isolated himself in promoting the incompatible ie blind-faith-based religion – the dilemma of Abraham’s conviction (or delusion) to sacrifice his son- and ethical morality;
and closely followed by Rudolph Steiner (1861-1925) another more profound European thinker who bridged science, spirituality, progressive education, architecture, agriculture, natural medicine, nutrition, and social reform;
contrary to the rationalists of the 19th Century “Age of Enlightenment” and since, like British historian-philosopher -ethicist Winwood Reade (1838 – 1875) who published the enduring secularist’s bible The Martyrdom of Man (1872), of which Churchill wrote 25 years later “he was right but wrong to say it” on the book’s critique of the wrongs of war and religion, of mankind’s selfishness, corruption and destructiveness (by the greedy aggressive acquisitive minority) against the weak masses and the environment) that carries on worse in the 21st century than even the 20th century; and 150 years later bioscientist and philosopher Stephen Jay Gould (1941-2002) rationalized sadly the non-overlapping Magisteria of Science and Faith, objective “provable” science – which in fact is seldom immutably constant as is mathematics- and purely faith-based “unprovable” religious belief.
It was only a year ago that Richard Conniff published his column on Strange Behaviours, The Medical Martyrs. And the medical hero martyrs in this review- Semmelweis, Margaret Sanger, Drummond and Pauling – never made it onto his list.
But then nor did the modern medical freedom fighters Steve Biko, Agostinho Neto, Che Guevera. Jonas Savimbi, Neil Aggett, and the living spouse of Steve Biko, Dr Mamphele Ramphele….
Women of the Century apart (like Margaret Sanger, Marie Curie, Eleanor Roosevelt, Golda Meir, Indira Gandhi, Helen Keller, Benazir Bhutto, Mother Theresa, Aung San Suu Kyi -many of whom have been martyred), it is a philosophical debate whether among the men the medical martyr Semmelweis (1818-1865) ranks with his 19thC contemporaries- Lincoln (1809-1865), Kierkegaard(1813-1855), Pasteur (1822-95), Lister (1827-1912) ; and his successors (and 20th C leading achievers): Koch(1843-1910), Edison(1847-1931), Steiner (1861-1925), Gandhi(1869-1948), Weizmann(1874-1952), Churchill (1874-1965), Einstein (1875-1955), Jung (1875-1961), FD Roosevelt(1882-1945), JK Galbraith(1908-2006), Martin Luther King (1929-68), Pauling and Mandela as arguably giant enduring male leaders -innovators- teachers and achievers of the past two centuries.
Unlike eg Socrates, Hippocrates and Jesus of Nazareth, one of the five greatest polymath medical and ethical sages of all time Rabbi Dr Moses Maimonides (RamBam) avoided martyrdom by burying himself in practicing selfless medical service for sultan and peasants alike, and jurisprudence for his GreekoRoman based Islamic-Sephardic times and philosophy, like his guru predecessor Avicenna and his contemporary savant Averroes. .
CONCLUSION: Today it can be argued that the denial of effective phamacotherapeutic doses of especially vitamins C and D3, let alone supportive doses of balancing vits (A, B1,3,5,6,9 & 12, E and K2); the often-crucially deficient minerals (eg magnesium, sulphur, phosphate, iodine, zinc and selenium), and biologicals like human transdermal balanced HRT, coenzyme Q10, alphalipoic acid, milk thistle, cinnamon, fish oil, chondroglucosamine, DMSO, coconut oil, is a repetition of denialism of the germ theory, and of optimal physiological human micronutrition as well as macronutrition. .
– especially when patients are poor and thus malnourished, and plagued by diarrhoea and stress, TB, lipidemic vascular disease and cancer; and when antiretroviral ART- although life-saving- is even more diabetogenic and neurotoxic than untreated AIDs.
Even transdermal administration is better than nothing, perhaps better (for the frail and noncompliant eg oldies) than oral or injection eg of vitamins D3 & C and progesterone , metformin, (in addition to the usual magnesium chloride, vits A, BCo & E) may be beneficial whether by patch or cream for both healing, infection, calming, heart, circulation, infection, arthritis, osteoporosis, and neuritis, applied under coconut oil, codliver oil and DMSO as further analgesic, anti-inflammatory, memory and absorption enhancers.
REFERENCES: New reviews bear out the major benefits of micronutrient supplements selenium, zinc, silver, vits A, B, C, D, E; and DMSO, sutherlandia and aloe against HIV-AIDs. and co-infection;
Effect of micronutrient supplementation on disease progression in asymptomatic, antiretroviral-naive, HIV-infected adults in Botswana: a randomized clinical trial.Baum MK, Marlink R ea .JAMA. 2013 Nov 27;310(20):2154-63. .
In vitro effects of Sutherlandia frutescens water extracts on cell numbers, morphology, cell cycle progression and cell death in a tumorigenic and a non-tumorigenic epithelial breast cell line.Stander A, Joubert AM. ea, J Ethnopharmacol. 2009 Jul 6;124(1):45-60
below are some of the most recent 94 studies of vitamin D and human infectionin published just in 2013:
New insights on the role of vitamin D in the progression of renal damage: Kidney Blood Press Res. 2013;37:667-78. . Lucisano S, Santoro D.ea Many studies indicate relationship between hypovitaminosis D and survival, vascular calcification, bone mineral metabolism, immune, cardiovascular and endocrine. Vitamin D analogs reduces proteinuria, in particular through suppression of the renin-angiotensin-aldosterone system (RAAS) and exerts anti-inflammatory and immunomodulatory effects. In particular vitamin D deficiency contribute to an inappropriately activated RAAS, as a mechanism for progression of chronic kidney disease (CKD) and/or cardiovascular disease. Human and experimental models of CKD showed that vitamin D may interact with B and T lymphocytes and influence the phenotype and function of the antigen presenting cells and dendritic cells, promoting properties that favor the induction of tolerogenic T regulators rather than T effectory. Interstitial fibrosis may be prevented through vitamin D supplementation. .
Should vitamin D supplementation be a regular part of asthma care? Gordon BR.Otolaryngol Clin North Am. 2014 Feb;47:97-108. .Vitamin D (vitD3) deficiency occurs frequently and has profound effects on health, especially asthma.
Vitamin D in asthma and future perspectives.Huang H, Zarogoulidis K. ea Drug Des Devel Ther. 2013 Sep 23;7:1003-13.
vitamin D deficiency associated with development of Acinetobacter baumannii infections in critically ill patients?; Türkoğlu M, Aygencel G et al.; Journal of Critical Care 28 (5), 735-40 (Oct 2013)
Association between vitamin D and hepatitis C virus infection: a meta-analysis. Villar LM, Romero-Gomez M. ea World J Gastroenterol. 2013 Sep 21;19(35):5917-24.
Association between prehospital vitamin D status and hospital-acquired bloodstream infections. Quraishi SA, Christopher KB. Ea, Am J Clin Nutr. 2013 Oct;98(4):952-9.
Human parvovirus B19 associated dilated cardiomyopathy. Jain P, Jain A, Khan DN, Kumar M. BMJ Case Rep. 2013 Aug 5;2013.
The role of vitamin D supplementation in the risk of developing pneumonia: three independent case-control studies. Remmelts HH, van de Garde EM ea .Thorax. 2013 Nov;68(11):990-6.
Correlation between serum vitamin D level and severity of community acquired pneumonia in young children Ren J, Sun B, Miao P, Feng X. Zhongguo Dang Dai Er Ke Za Zhi. 2013 Jul;15(7):519-21. Chinese. http://www.ncbi.nlm.nih.gov/pubmed/23866270
Role of vitamins D, E and C in immunity and inflammation. Shaik-Dasthagirisaheb YB, Pandolfi F. J ea Biol Regul [Correlation between serum vitamin D level and severity of community acquired pneumonia in young children].Homeost Agents. 2013 Apr-Jun;27(2):291-5.
Pre-hospital vitamin D concentration, mortality, and bloodstream infection in a hospitalized patient population.Lange N, Christopher KB ea. Am J Med. 2013 Jul;126(7):640.e19-27.
Vitamin D deficiency in HIV infection: an underestimated and undertreated epidemic. Pinzone MR, Nunnari G. eA Eur Rev Med Pharmacol Sci. 2013 May;17(9):1218-32.
Vitamin D deficiency and sudden unexpected death in infancy and childhood: a cohort study.Cohen MC, Offiah A, Sprigg A, Al-Adnani M. Pediatr Dev Pathol. 2013 Jul-Aug;16(4):292-300.
Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population.Aregbesola A, Tuomainen TP. ea J Epidemiol Community Health. 2013 ;67:533-6.
Treatment of pulmonary tuberculosis.Nunn A, Phillips PP, Abubakar I.Curr Opin Pulm Med. 2013 ;19(3):273-9.
Role of vitamin D in children with respiratory tract infection.Esposito S, Baggi E, Bianchini S, Marchisio P, Principi N. Int J Immunopathol Pharmacol. 2013 J26(1):1-13.
Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study.Koh GC, Dedicoat M. PLoS One. 2013;8:e57752.
Improving outcomes in patients with psoriasis.Tidman MJ. Practitioner. 2013 ;257:27-30, 3.
vitamin C refs & infection:
Authors’ perspective: What is the optimum intake of vitamin C in humans? Frei B, Birlouez-Aragon I, Lykkesfeldt J. Crit Rev Food Sci Nutr. 2012;52(9):815-29.
Micronutrients at the interface between inflammation and infection—ascorbic acid and calciferol. Parts 1 & 2: .Ströhle A, Wolters M, Hahn A. Inflamm Allergy Drug Targets. 2011 ;10:54-74- FULL TEXT IS ON LINE. .
Vitamin C for preventing and treating tetanus Cochrane Database Syst Rev. 2008 Apr 16;(2):
Answer: none provided it is safely and economically measured and safely and economically corrected at all ages from small children to dotage. It is so cheap and easy to halve the fracture risk and rate in all, and thus save vast suffering, costs and especially deaths.
A spinal surgeon laments as we all do the poor correlation between dual xray bone density analysis DXA and fracture risk.
The simple answer is that bone density is not the top risk factor for fractures,
The chief risk for fractures in the aging is falls and fragility ie global health balance including agility-co-ordination, balance, and strength- muscle mass.
As this column has previously detailed, DXA is valuable for looking at risk areas in the hip or a vertebra;
but just as screening X-ray mammography overdiagnoses clinically relevant breast cancer, trunkal DXA measurement increasingly overreads bone density as we age because of false densification- vascular calcification overlying hips and spine, and progressive collapse wedging of vertebrae.
That’s why, as this column has previously referenced, QUS -quantified ultrasound – done mostly at the heelbone, has become the international gold standard for monitoring global fracture risk, since that bone measured in its long axis is generally free of overlying vascular calcification and collapse wedging. It is recommended by international bodies, many leading universities from Cape Town to Cambridge to Scotland, Japan and USA. .
There is generally good correlation between true DXA measurement at hip and spine, and heel QUS measurement.
And QUS lacks the cumulative radiation risks of DXA.
That’s why QUS bone density is increasingly recommended from childhood, for monitoring and thus simple prevention of frailty – thus avoiding the mushrooming fracture and frailty risk in later life
http://www.ncbi.nlm.nih.gov/pubmed/22878531 Osteoporos Int. 2012 Aug Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria.Chan ea Garvan Institute of Medical Research,Sydney, Australia.
http://www.ncbi.nlm.nih.gov/pubmed/22037972 Osteoporos Int. 2012 Jan:143-53.Quantitative ultrasound of heel and fracture risk. Moayyeri ea .University Cambridge UK. Metanalysis: 21 studies with 55,164 women and 13,742 men were included with a total follow-up of 279,124 person-years. All QUS parameters were associated with risk of different fracture: 1 SD decrease in BMD associated with almost doubling of hip fracture risk. (RR by BUA 1.69, SOS was 1.96). There was marked heterogeneity among studies on hip and any clinical fractures but no evidence of publication bias amongst them. Different validated devices predicted fracture risks with similar performance; with similar performance in men and women. This study confirms that heel QUS, using validated devices, predicts risk of different fracture outcomes in elderly men and women.
Oct 30, 2010.
FRAILTY FRACTURES- OSTEOPOROSIS- ARE ALSO COMMON- AND EASILY PREVENTED- IN AGING MEN
The just-published Champ study of osteoporosis in men over 70yrs in Australia shows the high risk for older men as well: 25% had vertebral fractures, but only 77% of the men with fractures had even osteopenia let alone osteoporosis on DXA screening. and this does not factor in the overreading by DXA at the spine and hip owing to the high prevalence of both calcinosis and vertebral collapse. And abysmally few of the men were taking realistic preventatives.
The study bears out:
that frailty, usually from aging – is the chief risk factor for non-violent fractures;
and the low sensitivity of especially DXA screening, never mind the folly of waiting for fractures or dementia or worse before doing safe lowcost (QUS bone risk) screening as one incentive to starting multipreventative supplements.
As the GIOS Project in Spain yet again confirms, simple diagnosis and safe treatment of those at risk of non-violent fractures is scandalously neglected.
And it does not require costly risky high technology – xray screening bisphosphonates or strontium ranelate..
Like doctors, men are far more resistant than even women to heeding warning to start screening and supplements early enough.
The CHAMP study again highlights the importance of asymptomatic middleaged men never mind women having periodic no-xray ultrasound quantitative bone strength scans routinely as the gold standard so as to prompt them to take the appropriate blend of the fewscore supplements effective against both frailty fractures as well as the associated lipid- diabetes- vascular -respiratory- dementia- cancer diseases.
A: THERE IS NO PROBLEM PROVIDED THEY ARE APPROPRIATE.
update 20/12/12 Dr Giske Ursin of the Norwegian Cancer Registry has just published thoughts on collaboration – not anger for and against risky xray mammography – needed to move the field forward on avoiding breast cancer, to defend the integrity of women’s breasts. http://www.ncbi.nlm.nih.gov/pubmed/23234258
this column has previously reviewed mammography screening https://healthspanlife.wordpress.com/2011/11/06/negligent-promotion-of-screening-xray-mammography-as-saving-lives/
A new paper – from the USA National Cancer Institute no less- writes about the fraud of alarmist marketing of cancer screening/treatment. http://www.nejm.org/doi/full/10.1056/NEJMp1209407
Another new paper, from Wisconsin University, What Is the Optimal Threshold at Which to Recommend Breast Biopsy? notes that with an annual incidence of breast biopsy of 0.626% there (ie about 6 per 1000 women of the ~18 000 screened over 5 years ), 1 in 4 biopsied ie about 0.15% of those screened will be proven to have some degree of (pre)cancer.. They confirm the 2% risk threshold at which radiologists recommend biopsy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492229/
Of well women, perhaps <1 in 20 justify screening breast imaging except in those women with relevant anxieties ie the worried well.
But screening xray mammography often uncovers clinically silent ie preclinical breast cancer which otherwise might never cause problems in lifetime; and such irradiation and crushing may activate and spread dormant precancer cells.
Just as cardiograms are electrical-, echo- or angio- images of the heart, mammograms MGMs are widely different technology images of the breasts.
But unlike heart disease, no living imaging technique diagnoses with certainty cancer that is not already clinically pretty obvious.
The breast carcinogenic radiation risks from X-rays have been known for a century and yet it’s heavy usage is often inappropriate, profit-driven.
When patient’s history and physical exam suffice to exclude significant risk of breast cancer with practical certainty, it is unnecessary to crush, irradiate, needle or cut. Low risk women expose themselves to a greater risk with lower-dose screening X-ray MGMs and more invasive costly tests. For the common “silent” cancers (e.g. prostate/breast), statistics do not support that routine invasive screening of the apparently healthy saves lives.
As with all technology, many ‘grams – imaging methods – have evolved for the breasts. Like the infants they are built to nourish, breasts are extremely sensitive to irradiation. The lower the X-ray dose, the worse the subtle genetic damage that may occur – even decades later. We know this from follow-up consultations with women with initially healthy breasts >15 years earlier who had repeated xray mammograms, versus their sisters who had xray mammograms only when suspicions arose; and from controlled laboratory experiments on rodents and human breast cells.
Objective statistical analyses since the Canadian breast X-ray screening trial more than 20 years ago, show no benefit, but show instead an increasing risk of more breast cancer, more breast surgery and more premature deaths in well women repeatedly xrayed. .
ALTERNATIVE BREAST SCANS available include no-touch photographic thermo-mammography, gentle ultrasound;
and gentle mechanical tactile imaging (MTI), which may be better than xray or ultrasound MGM show early warning signs such as thickening of tissue and lumps. These signs may be reversed with diet, supplements and lifestyle changes.
From international studies and local experience, MTI (e.g. Sure Touch Mammography) has become the best at outpatients, to document the physical exam findings with three-dimensional characteristics mapped.. With this simple process, perhaps < 1 in 30 healthy women may need referral for ultrasound, and perhaps < 1 in 100 cases justify biopsy, and as the Wisconsin study shows, <1 in 1000 found to have significant breast cancer. It has been validated as at least as effective as (if not better than) other breast imaging in studies in USA, England, China and India.
MTI is recommended by CANSA, which says that from 2005 data about 1:29 women will be diagnosed in their lifetime with breast cancer. .
Studies confirm the obvious, that the more experts with vested interests (in XRMGM and breast cancer management) who draw up Guidelines, the more likely that Panel is to encourage mass XRMGM and intervention. So instead of perhaps 1 in 30 woman justifying breast imaging, the Breast Disease Industry – including the USA Breast Cancer Association the Industry funds – wants every woman X-ray screened regularly ideally from age 40years for the rest of their lives. But despite rage from the $8billion a year USA breast screening industry, Authorities have steadily cut back the age of starting mass screening XRMGM from age 40 to 50 years and to every 2nd or 3rd years.
No preclinical imaging diagnoses cancer. The only sure diagnosis is lump excision histology – if not multiple biopsies with their risk of needle spread.
Talk about unsubtle seduction. This year – despite massive financial (including stock-market) and marketing pressure- even mammography wine and food parties at USA radiology centers to persuade women to submit http://online.wsj.com/article/SB126325763413725559.html -two books never mind a flood of scientific journal papers have just been published questioning routine xray mammography of the well:
Dr Peter Gotzsche and the Danish Cochrane epidemiology team have published the evidence from all over the world – from at least 14 countries- against universal XRMGM for all, against the myth of the benefits and safety of regular xray mammography.. http://www.dailymail.co.uk/health/article-2120750/The-expert-branded-woman-hater-saying-breast-cancer-screening-ruins-lives.html and
The Big Squeeze: A Social and Political History of the Controversial (XRAY) Mammogram (Culture and Politics of Health Care Work) by radiologist Dr Handel Reynolds 2012 http://handelreynoldsmd.com/the_big_squeeze_history_mammography.html
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