Obese Patients With Pancreatic Cancer Have Shorter Survival …

Obese Patients With Pancreatic Cancer Have Shorter Survival, Study Finds

People with non-alcoholic fatty liver disease

By Steven Reinberg

HealthDay Reporter

TUESDAY, Oct. 22 (HealthDay News) — A diagnosis of pancreatic cancer usually carries with it a poor prognosis, and the news may be even worse for those who are obese: It could mean dying two to three months sooner than pancreatic cancer patients of normal weight, new research shows.

Prior studies have tied obesity to a higher chance of getting pancreatic cancer, but the new study asked whether the disease affects the tumor’s aggressiveness and the patient’s overall survival.

“[The new research] adds to the growing body of evidence that obesity is linked to cancer,” said Dr. Smitha Krishnamurthi, an associate professor of medicine at the Case Western Reserve University School of Medicine.

The study was published Oct. 21 in the Journal of Clinical Oncology. Krishnamurthi was not involved in the new study, but did write a related journal commentary.

Because it is so often asymptomatic and is detected late, pancreatic cancer remains one of the most deadly tumor types. According to the American Cancer Society, more than 45,000 people will be diagnosed with the disease this year, and it will claim over 38,000 lives.

In the new study, a team led by Dr. Brian Wolpin, an assistant professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School, collected data on more than 900 patients with pancreatic cancer who took part in either the Nurses’ Health Study or the Health Professionals Follow-Up Study. These patients were diagnosed during a 24-year period, the researchers said.

After diagnosis, the patients lived for an average of only five months. Normal-weight patients, however, lived two to three months longer than obese patients, the researchers found.

This association remained strong even after the researchers took into account factors such as age, sex, race, ethnicity, smoking and the stage of the cancer at diagnosis. The study did not, however, prove a cause-and-effect relationship between weight and length of survival.

In addition, obese patients were more likely to have more advanced cancer at the time they were diagnosed compared with normal-weight patients. Overall, the cancer had already showed signs of spreading in 72 percent of obese patients at the time of diagnosis, compared with 59 percent of normal-weight patients.

It also seemed to matter how long the patient had been obese — the association between weight and survival was strongest for the 202 patients who were obese 18 to 20 years before being diagnosed with pancreatic cancer.

Krishnamurthi said the reasons for the link aren’t clear. She said the study can’t tell us whether shorter survival in obese patients “was due to biologic changes that can occur in obesity, such as increased inflammation in the body, or whether the obesity caused other conditions that interfered with the treatment of pancreatic cancer.”

Diabetes Could Double The Risk Of Esophageal Cancer In Patients With …

Diabetes, a component of metabolic syndrome, has previously been linked to Barrett’s esophagus — where the esophageal lining becomes similar to that of the stomach — but the prevalence of diabetes in patients with the esophageal disease has never been researched. Now, a new study has found that diabetes could double the risk of developing esophageal cancer in patients with Barrett’s esophagus.

“There has been a rising incidence of metabolic syndrome over the past decades, which seems to correlate with an increase in esophageal cancer,” lead researcher Prashanthi N. Thota, who presented the team’s findings at the annual meeting of the American College of Gastroenterology, told MedPage Today.

People develop Barrett’s esophagus when their esophageal muscles fail to close tightly enough, and allow gastric acid to enter the esophagus. When this happens, it can damage, and eventually change the lining of the esophagus. These changes can eventually cause dysplasia — an increased population of immature cells — and possibly even cancer.

Thota’s team of researchers looked at data from 1,623 patients who had Barrett’s esophagus and were seen between 2000 and 2013. Of these patients, 274 also had diabetes or were diagnosed with it during the duration of the study.  After accounting for sex, race, and length of Barrett’s esophagus segment, the researchers found adenocarcinoma — cancer of the epithelium — in 15.8 percent of those without diabetes and 25.9 percent of those with diabetes during the 16-month follow-up. They also saw high-grade dysplasia or cancer in 17.9 percent of patients with diabetes compared to only 9.7 percent of those without.

Interestingly, the researchers also found that 61.9 percent of patients who had hypertension didn’t develop dysplasia compared to 56 percent of those who had hypertension — the researchers had expected the opposite. “I suspect that this relates to the use of antihypertensive drugs rather than the condition per se,” Thota told MedPage Today.

A 2012 study also found that diabetic men could have an increased risk for developing esophageal cancer. Looking at data from 17 other studies, the researchers concluded that diabetics had a “modestly increased risk” of esophageal cancer and adenocarcinomas, and that men were significantly more at risk. 

Harvard Researchers Address Obesity and Toxic Food

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By Dr. Mercola

A staggering two-thirds of Americans are now overweight, and according to the American Heart Association,1 five percent of American children can now be considered “severely obese,” which puts their health at grave risk.

One in four Americans are either diabetic or pre-diabetic, and an estimated 110,000 Americans die as a result of obesity-related ailments each year. This includes cancer, about one-third of which are directly related to obesity.

Carb-rich processed foods, along with rarely ever fasting, are primary drivers of these statistics, and while many blame Americans’ overindulgence of processed junk foods on lack of self control, scientists are now starting to reveal the truly addictive nature of such foods.

The video above features Huffington Post’s Editorial Director Meredith Melnick and a panel of experts in nutrition, public health, and obesity. In it, they discuss the effects that our toxic food environment have on weight. The video also includes clips from the four-part HBO documentary series,2 Weight of the Nation.

As reported in the featured article:3

“Obesity is a risk factor for cardiovascular disease, atherosclerosis, high cholesterol, high blood pressure, type 2 diabetes and some cancers. People who are obese may also face social and professional discrimination, limited mobility and elevated rates of depression.

In June of this year, the American Medical Association (AMA) classified obesity as a disease for the first time — and what a complicated disease it is. At the time of the resolution, the organization wrote:

“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.”

 It is this gray area — “the suggestion of the chosen lifestyle” — that we joined together to discuss.

Obesity—A Disease, or the Outcome of Poor Lifestyle Choices?

As the article mentions, the conventional view has been that obesity is either the result of “bad genetics” or poor lifestyle choices combined with a certain amount of laziness or lack of willpower.

But as panelist Walter Willett (who chairs the department of nutrition at the Harvard school of public health) points out, the fact that obesity rates 50-60 years ago were only one-third of what they are today is a potent clue that genetics are not to blame.

Also, a number of other affluent nations do not have the same obesity problems as the US. For example, the obesity rate among Swedish and Japanese women is between five and six percent, compared to almost 40 percent for American women. Furthermore, when people from such countries move to the US, they end up gaining significant amounts of weight…

This tells us there’s something in the American diet that is different from other nations, in which people do not have the same level of difficulty with their weight.

Unfortunately, branding obesity as a disease is not going to do anything to change matters for the better. If anything, it will only deepen the problem, as drugs, surgery and even “anti-obesity vaccines”4 will quickly become the advertised answer for this new “disease.”

For example, just one month before the AMA’s reveal of obesity as a disease, a new diet drug sold under the name Belviq became available by prescription to patients with a body mass index (BMI) above 30, or a BMI of 27 with at least one weight-related condition, such as hypertension or Type 2 diabetes.

The drug works by activating serotonin receptors in your brain, which is thought to reduce feelings of hunger—although it sounds awfully similar to the action of certain antidepressants, known as selective serotonin reuptake inhibitors, which boost serotonin levels and are fraught with dangerous side effects, including suicide. CNN Health5 also reported that some patients taking the drug have reported heart valve problems.

The drug’s website6 admits that it’s still not known whether Belviq might increase your risk of heart problems or stroke. A sound health care system simply would not encourage the use of a weight loss drug that might lead to increased heart attack or stroke risk when the appropriate dietary- and lifestyle changes would REDUCE those risks right along with the lost weight…

The fact is, well-educated nutritional experts already KNOW what’s causing obesity and how to fix the problem. But this involves massive changes to the processed food industry, updating agricultural subsidies to promote healthier non-processed foods, and telling the public the truth about nutrition—without any regard for industry profitability. We also need to stop the dangerous marketing of junk food to children.

Food Addiction and Obesity Is a Profit-Driven Enterprise

At the heart of the problem is the issue of toxic food—foods that are heavily processed and purposely designed for maximum “craveability.”  None of this happened by chance. Companies spend untold amounts concocting just the right flavor formulas to keep you coming back for more. To illustrate my point, consider this: Researchers at the Boston Children’s Hospital recently demonstrated that highly processed carbohydrates stimulate brain regions involved in reward and cravings, promoting excess hunger.7 As reported by Science Daily:8

“These findings suggest that limiting these “high-glycemic index” foods could help obese individuals avoid overeating.”

While I don’t agree with the concept of high glycemic foods, the featured research shows just how foolhardy the AMA’s decision to reclassify obesity as a disease really is, because drugs and vaccines are clearly not going to do anything to address the underlying problem of addictive junk food!

“Sensory-specific satiety” is a fundamental guiding principle in the processed food industry, and this applies to everything from junky snacks to staples like pasta sauce—that’s part of the problem! Processed fructose, salt and fat are the top three substances making processed foods so addictive. Novel biotech flavor companies like Senomyx also play an important role in the development of foods that trick you into thinking it’s healthier than it really is.

Senomyx, for example, specializes in helping companies find new flavors that allow them to use less salt and sugar in their foods. But does that really make the food healthier? This is a questionable assertion at best, as these “flavor enhancers” are being created using carefully guarded patented processes. They also do not need to be listed on the food label, which leaves you completely in the dark—all you see is that the food contains far less of the dietary culprits you’re told to avoid.

Following USDA Diet Recommendations is a Recipe for Obesity

Some of you may be old enough to recall the 1992 Food Pyramid, which had grains as the largest bottom block of the pyramid, encouraging you to eat 6-11 servings of bread, cereal, rice and pasta each day. This excess of carbohydrates, most of them refined, is precisely the opposite of what most people need to stay healthy. At the very top of the pyramid was fats and sugar, and while sugar clearly belongs there, healthy fats do not. In fact, most people would benefit from getting anywhere from 50 to 70 percent of their total calories from healthy fats!

The food pyramid was replaced with “MyPlate9 in 2011, which slightly downplayed grains as the most important dietary ingredient, making vegetables the largest “slice,” but it still has a long way to go before it will offer a meal plan that will truly support your optimal health.

One of its most glaring faults is that MyPlate virtually removed all fats from the equation! In fact, except for a small portion of dairy, which is advised to be fat-free or low-fat, fats are missing entirely… There is no mention of the importance of dietary fats, even the “politically correct” ones like the monounsaturated fats in olive oil and nuts, such as pecans (canola oil is also in this category, but I advise avoiding it and using coconut oil instead).

The US government refuses to accept the ever mounting data showing that saturated fat is actually an incredibly healthy, nourishing, and all-natural fat that humans have been thriving on for generations. It provides the necessary building blocks for your cell membranes and a variety of hormones and hormone like substances that are critical to your health. Saturated fats from animal and vegetable sources (such as coconut oil, avocado, non-CAFO meat and dairy,  also provide a concentrated source of energy in your diet.

When you eat fats as part of your meal, they also slow down absorption so that you can feel satiated longer, which helps curb overeating. Additionally, they act as carriers for important fat-soluble vitamins A, D, E and K, and are needed for mineral absorption and a host of other biological processes. To get these healthy saturated fats in your diet, you need to eat animal foods like butter and other full-fat raw dairy products and eggs, yet these foods are still demonized by the establishment.

Take Control of Your Health and Embrace REAL Food

With a food system and dietary guidelines that promote obesity and actively prevents optimal health by restricting critical nutrients, is it any wonder Americans are struggling? If you’re at all concerned about your health, nutrition is paramount, and you’re simply not going to get what you need from a boxed concoction of processed ingredients.

So, first and foremost, you have to realize that a healthy diet equates to fresh whole, preferably organic foods, and foods that have been minimally processed. I advise spending 90 percent of your food budget on whole foods, and only 10 percent (or less) on processed foods. If the food meets the following criteria, it would fall under the designation of “real food,” which is the very foundation of good health:

  1. It’s grown without pesticides and chemical fertilizers (organic foods fit this description, but so do some non-organic foods)
  2. It’s not genetically engineered 
  3. It contains no added growth hormones, antibiotics, or other drugs
  4. It does not contain any artificial ingredients, including chemical preservatives
  5. It is fresh (keep in mind that if you have to choose between wilted organic produce or fresh conventional produce, the latter may be the better option)
  6. It did not come from a concentrated animal feeding operation (CAFO)
  7. It is grown with the laws of nature in mind (meaning animals are fed their native diets, not a mix of grains and animal byproducts, and have free-range access to the outdoors)
  8. It is grown in a sustainable way (using minimal amounts of water, protecting the soil from burnout, and turning animal wastes into natural fertilizers instead of environmental pollutants)

How to Combat Food Addiction and Regain Your Health

The sad fact is, if you eat a standard American diet (SAD), which primarily consists of processed foods, you’re virtually guaranteed to inadvertently pack on extra pounds, even if you think you’re eating healthy.  For the majority of people, limiting carbs to non-starchy vegetables and severely restricting or eliminating carbohydrates such as sugars, fructose, and grains in your diet will be the key to sustained weight loss.

It’s important to realize that refined carbohydrates like breakfast cereals, bagels, waffles, pretzels, and most other processed foods quickly break down to sugar, increase your insulin levels, and cause insulin resistance, which is the number one underlying factor of nearly every chronic disease and condition known to man, including weight gain.

As you cut these dietary villains from your meals, you need to replace them with healthy fats, such as the following. (Avoid the common Paleo mistake of replacing carbs with protein as that could actually convert to sugar in your diet and could be more problematic than excess carbs.)

 

I’ve detailed a step-by-step guide to this type of healthy eating program in my free comprehensive nutrition plan.

Additionally, a growing body of evidence shows that intermittent fasting is particularly effective for losing weight. One of the mechanisms that makes intermittent fasting so effective for weight loss is the fact that it provokes the natural secretion of human growth hormone (HGH), which is a fat-burning hormone. Fasting also increases catecholamines, which increases resting energy expenditure, while decreasing insulin levels, which allows stored fat to be burned for fuel. Together, these and other factors will turn you into an effective fat-burning machine. Hence, if like many tens of millions of people, your goal is to shed excess fat, fasting can be both effective and beneficial for improving many disease markers.

Best of all, once you transition to fat burning mode your cravings for sugar and carbs will virtually disappear—it’s really as close to a “magic pill”-effect as you’ll ever get. While you’re making the adjustment, you could try an energy psychology technique called Turbo Tapping, which has helped many sugar addicts kick their sweet habit.

Last but certainly not least, to boost weight loss, make sure to incorporate high-intensity, short-burst-type exercises, such as my Peak Fitness Program, two to three times per week. Several studies have confirmed that exercising in shorter bursts with rest periods in between burns more fat than exercising continuously for an entire session. High intensity exercise can also combat food cravings. It always amazes me how my appetite, especially for sweets, dramatically decreases after a good workout. I believe the mechanism is related to the dramatic reduction in insulin levels that occurs after exercise.

Diabetes Hastens Death for Older Women

Published: Sep 18, 2013 | Updated: Sep 18, 2013

Postmenopausal women with diabetes had two to three times the risk of dying over an average of 10 years of follow-up than those without diabetes, regardless of race or ethnicity, analysis of data from the Women’s Health Initiative (WHI) showed.

Among white women, the hazard ratio for all-cause mortality on an adjusted analysis for those with diabetes was 2.2 (95% CI 2-2.36), while among blacks it was 2.11 (95% CI 1.83-2.44), according to Yunsheng Ma, MD, PhD, of the University of Massachusetts in Worcester, and colleagues.

Similar risks also were seen for Hispanic women (HR 2.3, 95% CI 1.72-3.23) as well as for those of Asian ancestry (HR 2.12, 95% CI 1.43-3.15), the researchers reported online in the American Journal of Epidemiology.

“Among people with diabetes in the United States, blacks and Hispanics are 2.1 times and 1.5 times more likely than whites to die of all causes, respectively, whereas total mortality among Asians is considerably lower compared with that among whites,” they noted.

Because the potential for disparities in mortality among women with and without diabetes according to race or ethnicity has not been established, Ma and colleagues analyzed data from 158,833 participants in the ongoing WHI, which enrolled women between 1993 and 1998.

The participants’ mean age was 63. A total of 84.1% were white, 9.2% were African American, 4.1% were Hispanic, and 2.6% were Asian.

At the time of enrollment, 4.4% reported having a history of diabetes diagnosis, and during an average duration of follow-up of 10.4 years, the cumulative incidence of diabetes was 5.45%.

Those who had diabetes at the time of enrollment typically had more comorbid conditions, had higher body mass index, engaged in less activity, and had poorer quality diets than those without diabetes.

The total percentages of women with diabetes, either prevalent or incident, by the cutoff point of August 2009 were 27.1% among black women, 20.8% for Hispanics, 15.9% among Asians, and 11.7% for white women.

In addition to all-cause mortality, similar risks across racial/ethnic groups were found for cardiovascular mortality and cancer death after adjustment for multiple factors including socioeconomic status, hypertension, hormone use, and smoking.

For cardiovascular death, the HRs for whites and blacks were 2.87 (95% CI 2.57-3.20) and 2.65 (95% CI 2.10-3.35), respectively, while they were 3.05 (95% CI 1.66-5.61) for Hispanics and 2.26 (95% CI 1.14-4.46) for Asians.

For deaths from cancer, the HRs among the four groups were 1.44 (95% CI 1.27-1.62) for whites, 1.38 (95% CI 1.05-1.81) for blacks, 2.13 (95% CI 1.30-3.47) for Hispanics, and 2.06 (95% CI 1.09-3.88) for Asians.

The researchers then calculated the population attributable risk percentages, which reflects both the disease prevalence and mortality risk, with these results for all-cause mortality:

  • Whites: 11.1 (95% 10.1-12.1)
  • Asians: 12.9 (95% CI 4.7-20.9)
  • Blacks: 19.4 (95% CI 15-23.7)
  • Hispanics: 23.2 (95% CI 14.8-31.2)

For cardiovascular disease mortality, the population attributable risk percentages were highest for Hispanics at 30.6 (95% CI 8.7-49.7) and blacks at 25.9 (95% CI 17.8-33.7), and for cancer the risk percentages were highest for Hispanics and Asians, but the confidence intervals overlapped.

“Both black and Hispanic women, who are at higher-than-average risk of developing diabetes, had higher proportions of all-cause and [cardiovascular disease] mortality attributable to diabetes than did whites,” the researchers noted.

“Because of [this] ‘amplifying’ effect of diabetes prevalence, efforts to eliminate racial and ethnic disparities in deaths from diabetes should focus on prevention of type 2 diabetes mellitus,” they stated.

Strengths of the study included its large sample and prospective design, while limitations included self-report of diabetes and the lack of information on glycosylated hemoglobin or anti-diabetic medication use.

The study was supported by the NIH, the National Cancer Institute, and CDC.

The authors reported no conflicts of interest.


Primary source: American Journal of Epidemiology
Source reference: Ma Y, et al “All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, Hispanic, and Asian women with and without diabetes in the United States” Am J Epidemiol 2013; DOI: 10.1093/aje/kwt177.

Nancy Walsh

Staff Writer

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70 institutes to be set up for treating cancer, diabetes: Ghulam Nabi Azad


JAMMU: The Central government has approved a plan to set up 70 medical facilities for treating cancer, diabetes and cardiovascular diseases, Health Minister Ghulam Nabi Azad said today.

“There will be an increase in the number of patients suffering from cancer, cardiovascular diseases and diabetes in next 15 years.

“To deal with such diseases, we have formulated a policy to set up hospitals and cancer institutes,” the minister told reporters on the sidelines of a function here.

“The Cabinet has approved a plan to set up 70 medical facilities,” he said.

“There is no cancer institute in the government sector. Only the Tatas has one institute,” Azad said.

“There is a huge shortage of human resources in the country and it is the highest in the world,” he said.

“We were first to bring in changes in the MCI Act, introduced in 1965, and its rules which resulted in increase of 75 per cent doctors in speciality and super-speciality fields (MD seats),” he said.

Azad said six new super-speciality hospitals on the lines of AIIMS were being set up in the country apart from upgradation of some hospitals to super-speciality facilities.

Regarding the policy to provide medicare to new-born, he said 27 crore children would be benefited under this scheme.

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Road deaths, cancer and diabetes becoming Africa's hidden epidemics

Road traffic deaths in sub-Saharan Africa are predicted to rise by 80% by 2020, according to a World Bank report, which found the region to have the highest number of accidents, but the fewest vehicles on the road.

An estimated 24.1 people per 100,000 are killed in traffic accidents every year, according to the bank. Younger and poorer people are disproportionately vulnerable: accidents on the road are expected to become the biggest killer of children between five and 15 by 2015, outstripping malaria and Aids.

“The poorest communities often live alongside the fastest roads, their children may need to negotiate the most dangerous routes to school and they may have poorer outcomes from injuries, due to limited access to post-crash emergency healthcare,” the report says.

Aside from the obvious distress caused by accidents, sub-Saharan Africa’s high-risk roads have a significant economic impact too. Crashes are estimated to cost African countries between 1 and 3% of their GNP each year, the report finds.

Roads and disease: common ground

The report considers road safety alongside rising rates of non-communicable diseases (NCDs), such as diabetes and cancer. The authors maintain that both represent largely hidden epidemics in Africa.

While there are a “whole bundle of different drivers” behind the rise in road accidents and NCDs, some of the causes show remarkable parallels, Dr Jill Farrington, the former Europe co-ordinator for the World Health Organisation’s NCD programme and the report’s co-author, says.

The shift towards urbanisation is a case in point. City residents typically take less exercise, triggering diabetes and cardiovascular problems. Rising incomes are driving demand for processed foods that are higher in sugar, fat and salt. The same factors result in increased car use and ownership, and more traffic accidents.

Alcohol consumption links the two. Though seven in 10 adults abstain from drinking alcohol in sub-Saharan Africa, those who do have the highest prevalence of heavy episodic drinking globally, the report says.

A lack of data makes it difficult to determine the extent to which traffic accidents are caused by alcohol. However, a study of police reports in Nigeria between 1996 and 2000 found that half of all car crashes involved drink-driving.

There is growing awareness of NCDs. Between 2001 and 2008, funding for cancer, heart disease and diabetes in developing countries grew sixfold. In 2011, the UN held a major summit on the theme. Even so, programmes to combat NCDs comprise less than 3% of global development assistance.

The lion’s share of public health spending and health-related donor aid goes to infectious diseases, particularly malaria, tuberculosis, and HIV and Aids. Policies and intervention to tackle these “big three” diseases are typically managed through separate “vertical” systems. The authors of the World Bank report argue that this silo approach is often counterproductive and co-ordinated health programmes are needed.

Integrated healthcare

The logic of a more holistic healthcare system is compelling, says Farrington: “If cars get faster on the roads and it’s unsafe, it will actually reduce walking and cycling, which will then have consequences for the development of obesity.”

There are practical arguments for a more integrated approach to disease interventions too. Many African countries have agreed to continent-wide commitments to combat NCDs, but they lack the resources to tackle each individually.

With the financial downturn, additional aid is unlikely, Farrington says. “The concern would be that if these [commitments] are all implemented separately, it would need resources and capacity beyond what is available.”

The report flags up early examples of where integrated, or “horizontal”, thinking is emerging. In Botswana, for example, health facilities set up for patients with HIV and Aids are being used to carry out screening and vaccinations for the human papilloma virus.

South Africa has developed a similar approach. Eight of the top 10 diagnoses in primary care are respiratory conditions. These relate as much to NCDs such as acute bronchitis or asthma as they do to infectious diseases such as TB and HIV. As a result, nurses are being trained to adopt a people-centred, rather than a disease-focused, approach to diagnosis.

“We wouldn’t be able to run a health system in the UK or any other so-called developed country that has these vertical programmes running right through it,” Dr Kalipso Chalkidou, international director at the London-based National Institute for Health and Care Excellence, says.

The aid sector’s obsession with targets is seen as a reason for the persistence of disease-specific policies; it is easier to measure vaccinations than calculate how many people have access to healthcare, Chalkidou says.

“Those who champion this individual approach to diseases and conditions should try and think more laterally,” she says. “It [integrated health provision] is going to happen, but how it’s going to happen and whether everyone involved is keen to make it happen is another question.”

Diabetes drug: 'Maybe I erred in my judgement'

There is growing evidence that the ban the Union Health Ministry imposed on June 18 on pioglitazone — a widely used anti-diabetes oral drug — was taken with undue haste and in great secrecy.

There was no large-scale scientific study undertaken to know the risk of bladder cancer caused by the drug before imposing the ban. The drug was approved for use in India in early 2000s and many thousands are on this drug.

According to media reports, theexpeditious decision to ban the drug was taken by keeping the Drug Technical Advisory Board in the dark.

Ironically, the first ever meeting to discuss the safety profile of the drug was undertaken on July 11, after the ban. The expert committee meeting was convened when the government came under severe flak from diabetologists across the country. The expert committee wanted the ban to be revoked.

According to a Health Ministry official, the whole issue has now been referred to the Drug Technical Advisory Board, which will meet on July 19. There are indications that the government may revoke the ban within a few weeks of imposing it.

Ironically, the government acted based on a letter sent by a few doctors, including the Chennai-based diabetologist Dr. V. Mohan, chairman of Dr. Mohan’s Diabetes Specialities Centre. Dr. Mohan’s letter was based on his observation of eight bladder cancer cases in those on pioglitazone drug.

“I had written a letter to the Drug Control General of India (DCGI) in January [asking him] to consider a ban. It was my opinion,” said Dr. Mohan to The Hindu. “We saw eight cases of bladder cancer [in patients on pioglitazone] and published it in the Journal of Association of Physicians of India (JAPI). There are 1,200 lawsuits in the U.S. field by patients who are on pioglitazone. Doctors can get sued, so I felt like informing the DCGI. I sent the letter in good faith.”

Asked why he did not ask that scientific studies be undertaken instead of calling for a ban — especially since Indian data on the drug’s safety is not known — Dr. Mohan said: “I could have done it…maybe I erred in my judgement…I did it in good faith. I thought the DCGI would do it…undertake a study.” In a January 2012 paper published in JAPI he had himself noted: “we require more robust data on the risk of bladder cancer with pioglitazone and Indian studies are clearly needed.”

Even the information about the eight bladder cases published in the journal was only a letter to the editor and not a research article. Unlike research articles, letters to editor are not peer reviewed and hence have very little scientific credibility.

MSD, the Indian subsidiary of Merck, would stand to gain the most from any ban on pioglitazone. MSD’s gliptin (Januvia) costs Rs.42 for a tablet and is one of the main replacements for pioglitazone, which costs Rs.5 a tablet.

MSD has been funding a certificate course run by Dr. Mohan’s Diabetes Education Academy for the last two years. Dr. Mohan refused to divulge the amount or percentage of funding he gets from the company.

“PHFI is the implementing partner for the course supported by MSD through an educational grant,” a PHFI spokesperson noted in an email to The Hindu. “[The course] is to train and sensitise primary health care physicians for effectively preventing, diagnosing and treating diabetes in a large number of individuals, families and communities.”

France is the only other country to have banned the drug. The USFDA requires only a box warning to be carried and Germany recommends that the drug not be given to new patients. But the dosage used abroad is as high as 40-45 mg a day compared with 15 mg a day in India. “When we use 30 mg a day we would reach the cumulative dose of 28,000 mg in less than three years,” Dr. Mohan noted.

Dr. Balaji, Director of a diabetes centre in Chennai, said: “Several thousand patients are on pioglitazone and if it causes bladder cancer in a few years we should have seen hundreds of cases. That is not the case.”

It is a well known that Indians have a very different genetic makeup and hence are more vulnerable to becoming diabetic compared with Caucasians. Unlike Caucasians, diabetes strikes even slim Indians. “For the same body weight, Indians are 1.5 times more insulin resistant than Caucasians,” Dr. Balaji said. “And the ratio of visceral fat to subcutaneous fat is higher in the case of Indians. That is why doctors use waist circumference to measure abdominal obesity, a surrogate marker to know the predisposition to diabetes.”

Considering the differences in the genetic makeup of Indians and their susceptibility to diabetes, it becomes all the more important to carry out many studies here in India to understand the safety profile of the drug. Unfortunately, all available literature on bladder cancer risk is based on data from other countries.

Probably the only study to evaluate bladder cancer risk in Indians who are on pioglitazone was published in July in the Indian Journal of Endocrinology and Metabolism. The study by Dr. Balaji, which looked at the safety profile of 958 patients who are on three different pioglitazone dosages (7.5 mg, 15 mg and 30 mg a day), did not find any “increased risk of bladder-related abnormalities across all treated age groups even after two years of treatment.”

“The risk: benefit is tilted heavily in favour of pioglitazone,” notes an editorial published in May in the Indian Journal of Endocrinology and Metabolism. “The number of patients required to be exposed to pioglitazone to cause one bladder cancer is too high when compared to the number of deaths prevented by its prescription.”

DNA flaw boosts cancer risk from diabetes—study



In this Friday, March 2, 2012, file photo, DNA samples are processed at the New York State Police Forensic Investigation Center in Albany, New York. A DNA flaw may explain why people with Type 2 diabetes are more prone to blood cancers than the rest of the population, a study said Sunday, July 14, 2013. AP PHOTO/MIKE GROLL

PARIS—A DNA flaw may explain why people with Type 2 diabetes are more prone to blood cancers than the rest of the population, a study said Sunday.

Doctors have long known that Type 2 diabetes is associated with leukemia and lymphoma, but the reasons for this have been unclear.

Researchers in France and Britain, looking at blood samples from nearly 7,500 people, including 2,200 patients with Type 2 diabetes, suggest the answer lies in cellular mutations called clonal mosaic events (CMEs).

These are defects that result in some cells having extra copies—or, alternatively, missing copies—of large stretches of genetic code.

Reporting in the journal Nature Genetics, the researchers said that in the general population, CMEs are usually very rare in young people but become more common with aging.

Among people aged over 70, around two percent have these mutations, which gives them a tenfold higher risk of developing blood cancer, previous research has found.

'Ban on diabetes drug unjustified'

MUMBAI: Physicians, including diabetologists, have come out in strong defence of an commonly used anti-diabetes drug pioglitazone, banned by the Union health ministry two weeks ago.

Doctors believe the ministry’s concerns of the drug’s adverse effects like heart failure and bladder cancer are “exaggerated”.

Some from the medical community felt that the ban was too sudden and not completely justified. The drug pioglitazone, explained diabetologist Dr Vijay Panikar, was the best one to address insulin resistance, the main issue in type 2 diabetes. “We are a country of young diabetics where many a majority of the population

suffer from insulin resistance before diabetes. We need a drug that is economical, durable and efficacious,” he said. Three million Indians reportedly rely on the drug.

Pioglitazone is already banned in France and Germany but not the whole of Europe. “There is clearly no consensus about the drug being harmful, which is why the rest of Europe continues to use it,” said Dr Siddharth Shah, editor, Journal of the Association of Physicians of India (JAPI). “There is no denying that the drug has adverse effects but its judicious use can help curb the risk factors,” he added. Medical associations and experts, however, had little data to vouch for its safety. Among the adverse effects of the drug, the most debated are its role in increasing the risk of cardiovascular diseases and bladder cancer. Weight gain, too, has been associated with the prolonged use of the drug.

Diabetologist Dr Rajiv Kovil said that the correlation between the ailments and drug usage are yet to be conclusively established. But, at the same time, Kovil admitted that there was very little data to show otherwise. “The drug’s unavailability will push up insulin usage and also the use of more expensive molecules. For diabetics, the treatment cost may go up by three times,” he added. The ministry’s decision to ban pioglitazone and its combinations has hit the Rs 700-crore market, affecting six leading pharmaceutical companies. Three years ago, another drug from this family, rosiglitazone, was banned in the country, following a decision taken in Europe. In the US, pioglitazone is sold with a boxed warning. The Drug Controller General of India has also asked for detailed scientific data before thinking about revoking the ban.

Obesity-Cancer Link Explained By 'Gut Bug' Changes, New …

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Changes in the gut microbiome could help explain why obese mice are more likely to develop liver tumors (inset).
Credit: Eiji Hara/Japanese Foundation for Cancer Research

A long-standing question in medical science has been explaining the obesity-cancer link in humans; previous studies have shown that obesity increases the risk for many illnesses such as diabetes and cancer. But the exact biological mechanism that underlies this link has been elusive.

But now, a new study of mice microbiomes (the communities of trillions of microbes that live in the digestive tract) has revealed a DNA-damaging acid that seems to be the key molecule linking excess weight to cancer.

Researchers at the Cancer Institute at the Japanese Foundation for Cancer Research in Tokyo discovered that obesity in mice alters their microbiota — their intestinal “bug” population — which in turn leads to the unregulated production of an acid molecule called deoxycholic that can cause damage to a cells DNA and eventually cancer (e.g., liver cancer).

To uncover the elusive link, the team — led by Eiji Hara — studied two groups of mice: one lean group that was fed a normal diet, and a second group fed a fat-heavy diet (making them obese). To induce cancer in the mice (which normally don’t get much cancer) they exposed both groups to a cancer causing chemical shortly after birth.

Results of these experiments revealed the identical obesity-cancer link noted in humans: only 5% of the mice in the lean group developed cancer later in life, whereas all the obese mice did. But this result does not mean that diet itself is the primary trigger; when the team reproduced the experiment with mice that were genetically altered to become obese (though fed a normal diet), they found that these mice had an increased incidence of cancer. This seems a clear indication that it is obesity, rather than diet, that made the difference.

Pinning Down the Causal Mechanisms

The researchers found that the obese mice were more prone to live cancer and analysis of their tumors showed increased levels of key signaling molecules called pro-inflammatory cytokines which, as the name suggests, promote inflammation (note: Inflammation has been strongly correlated with tumorogenesis in many studies, but whether it is the cause, or effect, of cancer is still debated).

The team also observed that the obese mice had higher levels of deoxycholic acid (DCA), which is a cellular by-product that results when gut microbes break down bile acid (which is manufactured in the liver). The DCA has been shown previously to damage DNA and is associated with some human cancers.

With the confirmation of these two indicators (the elevated DCA and cytokine levels), the researchers next analyzed the mice intestinal tracts. Intriguingly, they observed that the obese mice were host to a different mixture of gut bugs. Specifically, they found that a type of bacteria known as gram-positive bacteria (which have a single, thick cell wall) were far more prevalent in the fatter mice.

When the team treated the obese mice with an antibiotic (vancomycin) that targets gram-positive bacteria, the result was reduced levels of DCA and a reduced incidence of cancer. Further, when they directly targeted the DCA — by slowing bile acid breakdown or stimulating more bile acid secretion into the gut — they again found a reduced incidence of cancer (and giving them increased doses of DCA brought the cancer risk back up).

“I was very surprised by the process,” Hara says. “We never expected that changes in the gut microbiota could cause the higher risk of cancer.” [source]

The gut microbiota has been the focus of intense research just in the past two years and researchers have noted many links between the composition and activity of our microbiomes and various diseases (such as inflammatory bowel disease, certain allergies, and heart disease).

These recent findings by Hara et al lend additional support to the once controversial ‘germ theory” of cancer causation: that bacteria can be primary contributors to the development of cancer (note: the helicobacter pylori bacterium was  shown to cause stomach cancer nearly a decade ago). These results may help doctors better predict — and even prevent — the disease.

However, more research is needed to demonstrate that the same mechanisms are at work in humans, who possess different cellular “micro-environments” than mice.

Results of the experiments were reported on-line June 26, 2013, in the journal in Nature.

Some source material for this post cam from the Science NOW article:‘Gut Bugs Could Explain Obesity-Cancer Link’ by Gisela Telis

 

 

Michael Ricciardi (362 Posts)

Michael Ricciardi is a well-published writer of science/nature/technology articles and essays, poetry and short fiction. Michael has interviewed dozen of scientists from many scientific fields, including Brain Greene, Paul Steinhardt, and Nobel Laureate Ilya Progogine (deceased).
Michael was trained as a naturalist and taught ecology and natural science on Cape Cod, Mass. from 1986-1991. His first arts grant was for production of the environmental (video) documentary ‘The Jones River – A Natural History’, 1987-88 (Kingston, Mass.).
Michael is also an award winning, internationally screened video artist. Two of his more recent short videos; ‘A Time of Water Bountiful’ and ‘My Name is HAM’ (an “imagined memoir” about the first chimp in space), and several other short videos, can be viewed on his website (http://www.chaosmosis.net).
Michael currently lives in Seattle, Washington.