Should a Candidate’s Weight Be Part of the Conversation?

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AppId is over the quota

New Jersey Gov. Chris Christie says jokes about his girth are par for the course. But the notion that the extra pounds he carries are a legitimate election issue is absurd, he says.

As the New York Times reports, when Christie bowed out of the 2012 presidential race yesterday, he criticized those who said his weight somehow reflects on his ability to lead a state or country. (He didn’t single out any critics, but the Washington Post’s Eugene Robinson last week wrote a column called “Chris Christie’s Big Problem.”)

“The people who pretend to be serious commentators who wrote about this are among the most ignorant I?ve ever heard in my life,” Christie said at the press conference where he announced his decision, according to the NYT. He continued: “To say that, because you?re overweight, you are therefore undisciplined — you know, I don?t think undisciplined people get to achieve great positions in our society, so that kind of stuff is just ignorant.”

The notion of weight as a matter of personal responsibility “has been central to social, legal, and political approaches to obesity,” wrote researchers at Yale University’s Rudd Center for Food Policy & Obesity and other institutions in Health Affairs last year. “It evokes language of blame, weakness and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity.”

The folks at Rudd and others would like to see more attention paid to those environmental conditions, with a greater focus on community-centered rather than individual actions to combat obesity.

In a statement posted to the Rudd website, Rebecca Puhl, director of research at the center, objected to criticism of Christie, saying “there is no reason to assume that a person can’t be an effective political candidate or leader simply because of his or her body weight.” She continued: “Discounting an individual’s credentials, training, accomplishments or abilities because of body weight is discriminatory. This communicates a harmful and unfair message that a person’s talents and contributions to society have no value if that person is obese.”

Christie doesn’t shirk personal responsibility for his weight — he says that it likely affects his health and readily acknowledges that he eats too much. But he rejects the idea that the topic of weight has any place in the political arena.

Readers, what do you think? Is a candidate’s weight a proxy for his or her self-discipline or other component of leadership?

Photo: Associated Press

How Quality Indicators Can Hurt the Elderly

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AppId is over the quota

Quality indicators are supposed to encourage better health care.

But in the case of the elderly, they may lead to “unintended harms,” according to a commentary published in the Journal of the American Medical Association.

In general, these indicators encourage physicians to provide more care deemed appropriate, not to pare back on care that is inappropriate, says Sei Lee, an author of the piece and an assistant professor of medicine in the geriatrics division at the University of California, San Francisco. (His co-author is Louise Walter, also at UCSF.)

That means a hypothetical doctor who prescribed medications to everyone who came in the door, whether they needed them or not, could look great according to the indicators, Lee — who is also staff physician and associate director of the VA Quality Scholars Fellowship at the San Francisco VA Medical Center — tells the Health Blog.

The elderly population is much more heterogeneous, health-wise, than younger folks, he says. Some 65-year-olds are very active and taking maybe an aspirin a day, while others have had numerous heart attacks and are basically debilitated. Given that variety, “it’s more important to think about targeting” people to be sure they’re getting appropriate care that won’t result in harmful side effects, Lee says.

For example, one quality measure looks at what percentage of patients have their blood sugar controlled. But there’s no routine measurement of how many people develop too-low blood sugar, necessitating emergency glucose tablets or even a trip to the E.R., says Lee. An indicator measuring how many women receive mammograms could be balanced by one reporting “the rates of inappropriate screening mammography (i.e. in patients with preexisting advanced cancer or dementia who are unlikely to benefit),” the commentary says.

(A study published last year found a significant number of people with advanced, incurable cancer were still receiving screenings for other cancers.)

To help make sure preventive care goes to those likely to benefit, quality indicators could account for how long a person is likely to live and encourage “prevention only in those patients whose predicted life expectancy exceeds the intervention’s lagtime to benefit,” the commentary says. For example, rather than rating a physician on whether he or she offers colorectal cancer screening for adults aged 50 to 75, it could encourage screening for people with a life expectancy of more than seven years.

That would help ensure an 80-year-old with no major health problems would get screened, while protecting a 70-year-old with a serious, incurable condition from an invasive test that isn?t likely to help.

A study recently published in the Archives of Internal Medicine found primary-care doctors cite the incentives created by quality indicators as a reason for treating patients more aggressively than is ideal.

Image: iStockphoto

A.M. Vitals: Cloning Technique Used to Create Human Embryos

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AppId is over the quota

Cloning Technique Success: Researchers reported in Nature that they created 13 early-stage human embryos that were partial clones of diabetic patients, albeit abnormal ones, with three sets of chromosomes instead of the usual two, the WSJ reports. That extra set would have to be eliminated if the cloning technique were ever to be used to develop stem-cell based treatments for patients with diseases, the paper says.

Tracking Operations Toward the End of Life: New research published in the Lancet shows that almost one in ten Medicare patients who died in 2008 had surgery in their last week of life, while almost one in three had surgery during their final year of life, the New York Times reports. Researchers said the number of operations towards the end of life was surprising, but an expert not involved with the study said it’s impossible to judge from these data whether or not those surgeries were valuable.

Probing the Middlemen: Rep. Elijah Cummings from Maryland, a Democrat on the House Oversight and Government Reform Committee, is investigating distributors offering drugs in short supply on the so-called “grey market” at marked-up prices, the WSJ reports. Cummings wrote to five companies about the prices at which they had offered the drugs. The Institute for Safe Medication Practices has called the recent rash of shortages “unprecedented.”

Miscarriage Tied to Tainted Cantaloupe: Adding to the toll from the outbreak of listeriosis linked to eating cantaloupes, an Iowa woman has miscarried after contracting the infection, MSNBC.com reports. The medical examiner for the Iowa Department of Public Health says the woman, who is between 18 and 40, miscarried early in her pregnancy after eating tainted cantaloupe. The cantaloupes were recalled by Jensen Farms of Colorado on Sept. 14 but infection symptoms can take two months to manifest.

Image: iStockphoto

Jobs’s Death Focuses Attention on Rare Form of Pancreatic Cancer

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AppId is over the quota

Apple CEO Steve Jobs famously kept quiet about his illness and while a rare form of pancreatic cancer was at the root of his struggles, the company’s announcement of his death yesterday didn?t include information about the precise cause.

But if you ever question what someone can accomplish after being diagnosed with cancer, consider this. In the seven years since Jobs underwent surgery to remove what doctors call a neuroendocrine pancreatic tumor and — except for one medical leave — remained at the helm of Apple, the company:

Broadened the product line of the ubiquitous iPodIntroduced the MacBook Air laptopCreated an online retail phenomenon with the opening of its app storeTransformed the personal digital technology landscape with the introduction of the both the iPhone and the iPad

The high-tech visionary clearly never embraced a role as a cancer survivor and whether he’ll ever be seen as an inspiration in that regard remains to be seen. But his illness has focused attention on a tumor with widely varying prognosis about which little is known.

“We all call these neuroendocrine tumors,? Michaela Banck, a pancreatic cancer expert at the Mayo Clinic, tells the Health Blog. But ?if you have 50 patients, you have 50 different tumors with 50 different prognoses.? As the name implies, the tumors can affect levels of insulin and other hormones produced by the pancreas, but Banck says more research is needed to better understand how the cancer’s impact on hormones affects prognosis.

The encouraging news is that while the much more common form of pancreatic cancer, affecting 95% of cases, is especially fast moving and lethal, neuroendocrine tumors are often slow-growing and can be effectively treated with surgery — even cured in some cases if caught early enough. (As the WSJ reports today, Jobs’s disease ran a fairly predictable course.)

Two drugs — Afinitor from Novartis and Sutent from Pfizer — were approved for neuroendocrine pancreatic tumors early this year. No information is available on whether Jobs was treated with the drugs.

Jobs also had a liver transplant in 2009, though its connection to the cancer wasn’t disclosed. One worry about the role of transplants for cancer patients is that drugs used to prevent rejection of the organ depress the immune system, potentially opening the door for the cancer to return.

Interestingly, Afinitor is a member of a class of drugs originally developed to prevent organ rejection.

Mayo’s Banck is hopeful that the explosion information about cancer in general from genetic analysis of tumors will soon unlock some of the mysteries of the disease that struck Jobs.

Photo: Getty Images

U.K. Pledges $31 Million to Help Wipe Out Guinea Worm Disease

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AppId is over the quota

The British government has pledged about $31 million to help eradicate guinea worm disease, a donation that public-health experts say will bring them close to finishing the job.

A quarter century ago, the?crippling parasitic infection afflicted 3.5 million people a year in more than 20 countries. This year, there are expected to be just over 1,000 cases in four African countries. More than 98% of those cases are in South Sudan, with a few dozen in Ethiopia, Mali, and Chad.

Guinea worm disease is passed along when people drink water from sources containing water fleas that harbor guinea worm larvae. Once inside a human, the larvae spawn worms that can reach three feet in length. The worms incubate for a year and then emerge slowly through painful lesions. When people soak their lesion-covered limbs in water, the worms release larvae, starting the cycle all over again.

The 25-year-long push to eradicate guinea worm is championed by former U.S. President Jimmy Carter, whose Carter Center in Atlanta has led the effort. The donation from the U.K. Department for International Development will be made over four years to the Carter Center.

According to the center, the best way to eliminate the disease is to “prevent people from entering sources of drinking water with an emerging guinea worm and to educate households to always use household or pipe filters to sieve out tiny water fleas carrying infective larvae.”

Donald Hopkins, vice president for health programs for the Carter Center, said $275 million, donated by several governments, has been spent so far wiping out the disease. The U.K. donation will go toward the $75 million the Carter Center estimates is needed to get the job done and to verify eradication.

“We?re very close,” says Hopkins, who has been working on guinea worm eradication since 1980. “This is going to happen. I can?t predict when, but it will be soon.” The Carter Center?s goal is to break the cycle of disease transmission in South Sudan next year, with no cases reported in 2013, he says. It would take three years of no cases to certify that the disease has been wiped out.

The donation comes as the U.K. is growing foreign-aid donations while implementing belt-tightening elsewhere, said Annabelle Malins, British Consul General in Atlanta. “We hope this will be a major tipping point to provide for the full funding requirement” for guinea worm eradication, she said.

Guinea worm disease would be the second human disease to be eradicated after smallpox, and the first to be wiped out without a vaccine or medical treatment. The disease hurts local agriculture in particular as it cripples workers temporarily during planting or harvests.

Image: Associated Press

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KARACHI: While fewer women in Pakistan are diagnosed with breast cancer compared to countries such as the US, Pakistan still has the highest number of women dying of the condition in the world, according to Dr Jo Anne Zujewski, a visiting expert from the US National Cancer Institute.

She was speaking at a round-table talk on breast cancer awareness, risks and prevention, treatment and survivorship arranged at the Avari Towers by the US consulate, this week. By South Asian standards, Pakistan shows an unusually high incidence of a disease that was largely seen as one of the affluent in the West. Comparing Pakistan to India, she said that while one in every 22 women in India is likely to develop breast cancer, the risks amounts to one in every nine women for Pakistan.
Local estimates show that Pakistan sees almost 90,000 cases of breast cancer, resulting in almost 40,000 deaths per year. [This rate of mortality is as high as the US, that has the highest rate of cancer patients in the world. “This means that even if you are less likely to develop breast cancer in Pakistan, your death is more likely here if you develop it” she told.]
She explained that the incidence of the disease is higher in the US than in Pakistan mainly because lifestyle differences: “We eat more and reproduce less, which is not the case in Pakistan and other developing countries”. The growing rate of the disease in Pakistan is, thus, a matter that requires proper investigation, she concluded.
She also said that as obesity is a major cause of breast cancer in the West, coming generations in Pakistan can draw a lesson to avoid poor nutrition and over-eating.
Attempting to erase misconceptions, she said that men can also develop breast cancer, although they are less likely to do so than women, and that the disease can be passed down not only through the mother but also through the father, and Pakistan is one of the countries where incidence of breast cancer is observed to be growing more due to hereditary factors rather than lifestyle, although only proper research will yield firm conclusions. She said that “being a woman and getting older is all that you basically need” to develop breast cancer, although a family history of the disease increases the risk up to 60 per cent. The disease mostly affects older women although it can also affect young women and reproductive factors that contribute to high risk are never giving birth or being older at the time of the first birth, having menses at age 11 or earlier and experiencing menopause at age 55 or later, she said.
Most breast cancer cases in Pakistan are detected at stages III and IV. After these advanced stages, the cancer can reach the bones, neck, lymph nodes, arms, liver and lungs. According to the Pink Ribbon Campaign, without treatment, 75 per cent of breast cancer patients in Pakistan may die within five years while the rest are likely to die within the next five.
With the average age of occurrence of the disease being 53 in Pakistan, she recommended that women should go for scans from age 40, and get a physical examination every year.
TREATMENT
The different stages
Stage I: Confined to the breast only
Stage II: Breast and lymph nodes – operable
Stage III: Breast and regional lymph nodes – inoperable
Stage IV: Spread to distant parts of the body
MYTHS
This is not true:
Breast cancer only affects older women.
If breast cancer does not run in your family, you will not risk it.
Only your mother’s family history of breast cancer can affect your risk
Breast cancer is a contagious disease.
Breast cancer can be a result of a curse/evil eye.
Breast feeding increases the chance of breast cancer