Monthly Archives: May 2006

Vitamin D and You: Don’t Forget Common Sense

A couple of months ago I mentioned that I attended a conference in Toronto where we discussed the topics of ultraviolet radiation, vitamin D and health.


 


Today, the Canadian Cancer Society released the first public information from the conference, which was cosponsored by the American Cancer Society, the World Health Organization and other organizations from Canada, the United States and Australia.


 


Although we did our best to craft concise messages to help explain what we know and what we don’t know about vitamin D and your health, there is concern that those messages will not be understood by many folks. 


 


And, worse, there is the risk the messages may be deliberately misinterpreted to promote behaviors that are associated with significant increased risks to one’s health, particularly with respect to skin damage.


 


For an actual copy of the statement, please go to the posting on the Canadian Cancer Society website.


 


There is no dispute among medical professionals that vitamin D is beneficial for our health, and there is no dispute that sun exposure is the major source of vitamin D for most of us.


 


But there is also no dispute that … Continue reading →

Lung Cancer and Non-smokers: Let’s Get It Right

During the extensive media coverage of the sad and untimely death of Dana Reeve from lung cancer, I was intrigued by the many experts who were interviewed on national news shows or in the newspapers and magazines proclaiming there was an epidemic of lung cancer in non-smokers. 


 


Invariably, the comment was made that lung cancer was becoming a particular problem for non-smoking women compared to men who were non-smokers.  This comment would then be followed with a series of theoretical discussions as to why this was the case, including genetic differences, hormonal susceptibility, and so on.


 


When reporters would speak to me, I told them I couldn’t substantiate these differences, and I wasn’t going to guess as to why non-smoking women were more susceptible to lung cancer than non-smoking men.


 


I can tell you I wasn’t comfortable with my apparent ignorance.  As it turns out, I may not have been so ignorant after all.


 


This week, colleagues of mine from our epidemiology department at the American Cancer Society and the University of California San Diego published an article in the Journal of the National Cancer Institute which is the most definitive analysis of Continue reading →

The “Eat Right Challenge”: A Journey for Life

During this week when we celebrate the launch of the American Cancer Society’s 2006 Great American Eat Right Challenge, it’s a good time to revisit the fact that all of us could do a better job of taking care of our diet, our weight, and our health. 


 


And, I believe that many of us understand the sense of accomplishment that comes from setting right something that has gone wrong with ourselves.


 


In that context, there are some messages I feel strongly about, and I would like to share them with you today:


 


·        Just because you are a doctor and believe in prevention doesn’t mean you necessarily follow your own good advice.


 


·        Even people like me, who are supposed to know better, can lose their way on the path to staying healthy. 


 


·        Ultimately, it’s not that you have fallen off the wagon that counts.  What counts is that you get back on.


 


Maybe what has happened to me recently will strike a chord with you or someone you know, and move them along to commit to improving their own health.


 


There is a euphemism about tall people … Continue reading →

For Smokers: A New Ray of Hope

For years I have had at least one consistent answer to the question, “What is the single most important thing I can do about my health?”


 


And the answer is, “If you are a smoker, stop.  And if you are not a smoker, don’t start.”


 


But the  major barrier for smokers who want to quit, despite all of the news and information about the incredible dangers of cigarette and cigar smoking, is the fact that cigarette and cigar smoke is so incredibly addicting.


 


Once hooked, many people simply can’t do anything about it.  That’s not their fault, given the fact that the nicotine in cigarettes and cigars is one of the most addicting substances we know of.


 


Today, a new form of targeted therapy has been approved by the Food and Drug Administration that may just be the answer for many chronic smokers who have failed quit attempts in the past.


 


The name of the drug is varenicline (trade name: Chantix) that has been developed and will be marketed by Pfizer.


 


The reason so many of us are hopeful about this new medication is because it has a different mechanism of action … Continue reading →

Hormone Therapy: Better Guidance, Less Confusion

 


 


 


It seems as though we have been bombarded with estrogen stories over the past several months.


 


It was just a couple of weeks ago that I discussed a report from the Women’s Health Initiative that estrogen-only hormone replacement therapy in post-menopausal women did not increase the risk of breast cancer.


 


Now there is a new report published in the Archives in Internal Medicine yesterday which has the potential to add to women’s confusion regarding the risks of estrogen therapy to treat menopausal symptoms.


 


The headlines may say that the study shows that estrogen increases breast cancer risk.


 


My interpretation is that in fact the study gives us information that rounds out our knowledge about the risks of estrogen and breast cancer, and confirms that if the drug is used as intended there is less cause for concern than was the case previously.


 


The study provides information on the breast cancer risk of 28,835 women in the Nurses Health Study, a long term follow-up study of nurses conducted by the Harvard Medical School and the Harvard School of Public Health.


 


These outstanding and highly regarded investigators have reported numerous studies on … Continue reading →

Who Pays Depends on Who You Are and Where You Live

 


 


 


An article in the Wall Street Journal earlier this week caught my attention.


 


It discussed the current use of the targeted therapy Herceptin as an adjuvant treatment for breast cancer, and how is faring in the marketplace both in the United States and in Europe.


 


The article highlighted for me the stark contrasts between how we approach the availability of new medicines and new indications for established medicines in this country and in the rest of the world.


 


Those differences are real, and have implications for the type of health care and health insurance “system” we are willing to accept in this country.


 


Herceptin is probably the first real targeted therapy drug.  It is a drug that, until recently, was used solely to treat women who had recurrent breast cancer, and whose breast cancer tissue contained a gene called “HER 2.”  It is a very expensive drug.


 


Women with an HER2 positive breast cancer generally have a poorer prognosis than women without this genetic marker, and tend to relapse sooner after primary treatment for their cancer even when they receive appropriate adjuvant therapy.


 


You may recall that last … Continue reading →

Medicare and The Costs of Cancer Drugs

I spent much of the past week sitting in a room participating on a committee that advises the Medicare folks on their physician fee schedule.


 


I enjoy my work on this committee, but thinking about how we as a society are going to pay for the many new procedures and technologies we discuss can be daunting.


 


During the meeting I had a chance to get an early look at a report on Medicare spending patterns for 2005.  I was particularly interested in the costs of chemotherapy drugs.


 


It was not a pretty picture. To be honest, it was somewhat depressing.


 


Medicare, in my opinion, is going to face a real challenge in getting adequate funding to pay for the newer cancer chemotherapy drugs while still providing all of the medical services that doctors order and patients and their families have come to expect.


 


There are two parts to the Medicare program.  Medicare Part A covers hospital costs, and Part B covers physician visits and chemotherapy drugs, among many other services.


 


Part A costs are covered by the Medicare program.  Part B is supported 25% by the monthly premiums that … Continue reading →