LBN *agenda* Blog

*LBN-*EXTRA* BLOG COMMENTARY

By David W. Streets

Today marks two months since my Stage 4 Cancer diagnosis… Things I have learned:

• See your Doctor on a regular basis….make the time and do it!
• Trust and thankfulness for my wonderful team of Doctors.
• The survival rate of people with my diagnosis is 8%…
• Death is not so frightening when it is so close.
• Life is short….live it to the fullest.
• Your real friends rise to the top like cream.
• Many friends don’t know what to do, so they do nothing.
• Cancer is isolating to a social person.
• Music sounds more beautiful.
• Flowers smell more fragrant.
• Small things make all the difference.
• I have learned patience and to be more practical.
• Memories are the greatest gift others leave us and that we can leave.
• Forgiveness starts with our self and then can radiate outwards.
• The prayers of our parents sustain us all through our lives.
• True friends cannot be separated by time nor distance.
• Prayers and positive energy make a huge difference.
• The fight is harder than you think, but worth the cost.
• Every day is a gift.

If You Feel O.K., Maybe You Are O.K.

By H. Gilbert Welch

Early diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one) heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.

It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.

Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.

The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer … is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly — into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms).

This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system.

It wasn’t always like this. In the past, doctors made diagnoses and initiated therapy only in patients who were experiencing problems. Of course, we still do that today. But increasingly we also operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s a huge change in approach, from one that focused on the sick to one that focuses on the well.

Think about it this way: in the past, you went to the doctor because you had a problem and you wanted to learn what to do about it. Now you go to the doctor because you want to stay well and you learn instead that you have a problem.

How did we get here? Or perhaps, more to the point: Who is to blame? One answer is the health care industry: By turning people into patients, screening makes a lot of money for pharmaceutical companies, hospitals and doctors. The chief medical officer of the American Cancer Society once pointed out that his hospital could make around $5,000 from each free prostate cancer screening, thanks to the ensuing biopsies, treatments and follow-up care.

A more glib response to the question of blame is: Richard Nixon. It was Nixon who said, “we need to work out a system that includes a greater emphasis on preventive care.” Preventive care was central to his administration’s promotion of health maintenance organizations and the war on cancer. But because the promotion of genuine health — largely dependent upon a healthy diet, exercise and not smoking — did not fit well in the biomedical culture, preventive care was transformed into a high-tech search for early disease.

Some doctors have long recognized that the approach is a distraction for the medical community. It’s easier to transform people into new patients than it is to treat the truly sick. It’s easier to develop new ways of testing than it is to develop better treatments. And it’s a lot easier to measure how many healthy people get tested than it is to determine how well doctors manage the chronically ill.

But the precept of early diagnosis was too intuitive, too appealing, too hard to challenge and too easy to support. The rumblings show that that’s beginning to change.

Let me be clear: early diagnosis is not always wrong. Doctors would rather see patients early in the course of their heart attack than wait until they develop low blood pressure and an irregular heartbeat. And we’d rather see women with small breast lumps than wait until they develop large breast masses. The question is how often and how far we should get ahead of symptoms.

For years now, people have been encouraged to look to medical care as the way to make them healthy. But that’s your job — you can’t contract that out. Doctors might be able to help, but so might an author of a good cookbook, a personal trainer, a cleric or a good friend. We would all be better off if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be.

(H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, is an author of “Overdiagnosed: Making People Sick in the Pursuit of Health.”)

Regulating Our Sugar Habit

By Mark Bittman

When Ronda Storms, a Republican state senator in Florida, is accused of nanny-state-ism for her efforts on behalf of a sane diet, it’s worth noting. When she introduced a bill to prevent people in Florida from spending food stamps on unhealthy items like candy, chips and soda, she broke ranks: few of her party have taken on Big Food. And as someone who has called for the defunding of an educational Planned Parenthood program and banning library book displays supporting Gay and Lesbian Pride Month, she is hardly in her party’s left wing. Not surprisingly, she’s faced criticism from every corner: Democrats think she’s attacking poor people, and Republicans see Michelle Obama. Soon after Storms proposed the bill, she told me, “Coca-Cola and Kraft were in my office” hating it.

Yet she makes sense. “It’s just bad public policy to allow unfettered access to all kinds of food,” she told me over the phone. “Why should we cut all of these programs and continue to pay for people to use food stamps to buy potato chips, Oreos and Mountain Dew? The goal is to feed good food to hungry people.”

To some, dictating what recipients of benefits through the Supplemental Nutrition Assistance Program can eat seems unfair. But when the program began in 1939 it aimed both to feed the unemployed and to aid farm recovery. Participants received $1.50 in stamps for every cash dollar spent, 50 cents of which was designated for purchase of agricultural surplus. That’s already a directive on spending, but perhaps more important is that nearly three-quarters of a century ago almost the only thing you could buy — with or without regulation — was real food. Since then Big Food has moved our diet in the wrong direction, and now we have a surplus of empty calories.

The argument for limiting the use of food stamps to actual food is consistent with established policy. They’re already disallowed for tobacco, alcohol,vitamins, pet foods, household supplies and (with some exceptions) food meant to be eaten on premises. Payments have been based on the cost of a “nutritionally adequate diet.”

Let me state the obvious: there is no nutritional need for foods with added sugar.

All of this is part of the bigger question: How do we regulate the consumption of dangerous foods? As a nation, we’ve accepted the need to limit the marketing and availability of tobacco and alcohol. The first is dangerous in any quantity, and the second becomes dangerous when overconsumed.

And added sweeteners, experts increasingly argue, have more in common with these substances than with fruit. In a recent paper in Nature, Robert H. Lustig, Laura A. Schmidt and Claire D. Brindis remind us that for the first time, chronic diseases pose a greater health threat than infectious ones, and of the three main risk factors for chronic diseases — alcohol, tobacco and diet — two are regulated and one is not.

The authors specifically target “any sweetener containing the molecule fructose (which makes sugar sweet) that is added to food in processing” as the key problem in our current diet, and correlate the rise in consumption of sugar with a rise in disease, listing the many ways in which sugar’s effects on the body are similar to those of alcohol. Their contention is that sugar is hardly “an empty calorie,” but rather an actively harmful one: “Fructose can trigger processes that lead to liver toxicity and a host of other chronic metabolic diseases.”

Added sugar is not the only dangerous food. But unlike animal products, for example, which we also overconsume, it has no benefits. Yet we down it at the rate of 150 pounds per person per year, and while scientists argue whether it is addictive in humans (it meets the criteria for addiction in animals), it is most certainly habit-forming. Lustig and his co-authors suggest that actions like imposing taxes on added sugar or establishing a minimum age for purchase of sodas (they mention 17 in their paper) would reduce consumption.

The question “Is this necessary?” is unavoidable. But as obesity and its consequences ravage our health care system, we struggle not only with our own diets but also with preventing our children from falling into the same traps. Last year a brigade of parents stood watch outside a corner store in North Philadelphia in an attempt to prevent their kids from buying junk food.

They’ve been called foot soldiers, but you might call them vigilantes. Vigilantism occurs when people believe the government isn’t doing its job. We need the government on our side. It must acknowledge the dangers caused by the most unhealthy aspects of our diet and figure out how to help us cope with them, because this is the biggest public health challenge facing the developed world.

U.S. Census Bureau: American Fact Finder

“American FactFinder is your source for population, housing, economic and geographic information.”

“Life shrinks or expands in proportion to one’s courage.” – Anais Nin

LBN-HAPPY BIRTHDAY:

Jack Lousma (76)
Ja Rule (36)
Antonio Sabato Jr. (40)
Anthony Robbins (52)
Dennis Farina (68)
Gretchen Christopher (72)
Lena Gercke (24)
Alex Rocco (76)
Joss Ackland (84)

LBN-QUESTION

How serious of a problem is the curse of distraction?

Nancy Deville, author of Healthy, Sexy, Happy

The word “curse,” makes me think of my great grandfather, Lukasz Syroka, born in Poland in 1880. In a violent fit of rage, Lukasz murdered his neighbor. The farmer’s son put a curse on Lukasz’s family which was apparently enough of an incentive to heed the call from America where the streets were paved with gold. Lukasz made enough money in the New World to send his peasant wife and children the money for the first class berth on a boat. The waited for the next one but could only afford steerage, which was filthy and crowded with bare boards to sleep on and rats scuttling around, baring fangs, eyes glowing in the dark. That was just the beginning and a lot of bad stuff happened to family after that. Since I was raised Catholic I took the curse of a grieving son seriously when my grandma told me about it and vociferously rejected it, which may have resulted in me escaping the tragedies that continued to befall my family and ultimately leading to me to live on the beach in Santa Monica with OMG all the curses of distraction. Dying young, genocide, rape, living under a regime, that allows ten year olds to hack your arms off with machetes, addictions, pedophile priests, politicians who want to outlaw birth control, AIDS and other intractable diseases are examples of “curses.” Iphones, Ipads, Mad Men, Facebook, Twitter, CNN, NPR, and the LBN E-lert are not “curses,” but luxuries to be managed.

LBN-Commentary

By Nicholas Bakalar

The standard treatment for latent tuberculosis infection-that is, infection without symptoms-is nine months of daily doses of Isoniazid, and antibiotic. The treatment is effective, but only about 60 percent of patients carry it out completely.

Now the Centers for Disease Control and Prevention has found that a regimen of 12 weekly doses of Isoniazid along with another antibiotic, Rifapentine, is just as effective, provided a health care worker supervises the administration of the medicine.

The recommendation, based on results of three randomized clinical trials, appears in the Dec. 9 issue of the agency’s Morbidity and Mortality Weekly Report. The regimen is for patients 12 and older who are otherwise healthy.

Children under 12 can be put on the three-month program in situations where the danger of tuberculosis division of the C.D.C. “Within that 11 million, we target those at highest risk,” he said, including those who come from countries where TB is more common, people with diabetes and those on drugs that suppress the immune system.

“If you have any of these underlying conditions,” he added, “you should get tested, and if positive, consider taking treatment under the advice of a physician.”

Why Do Innocent People Confess?

By David Shipler

Several  months after Antonio Ramirez was shot seven times in Oakland, Calif., the police picked up a frightened 16-year-old named Felix, isolated him in an interrogation room late at night without a lawyer, rejected his pleas to see his mother, and harangued him until he began to tell them what he thought they wanted to hear.

They wanted a diagram of the crime scene, he later told his court-appointed lawyer, Richard Foxall, but whatever he drew was so inaccurate that the police never produced it. When he described escaping in one direction after the killing, they corrected him, because they knew from witnesses that the shooter had gone the opposite way. When he didn’t mention an alley nearby, they told him about it, and he incorporated it into his statement. “Now we’re getting somewhere,” said one officer, as Felix recalled to his lawyer.

So, they demanded, where was the gun? Felix denied having a gun. “That’s when they really got out of control and started yelling at him,” Mr. Foxall said. “He started to feel personally threatened.” Slyly, he made up something demonstrably untrue: that he had left the gun with his grandfather. “I thought this was brilliant,” his lawyer said, because it discredited the tale. “He doesn’t have a grandfather. Both grandfathers are dead.”

Once the police had badgered a rough murder confession from Felix, they taped it. Yet the confession lacked a critical detail — one that officers neglected to feed to him. Felix learned it three days later in court when he was handed the charge sheet and saw the date of the crime. He stared at the document and realized that he had the perfect alibi: On the day that Antonio Ramirez was gunned down, Felix had been locked up in a juvenile detention facility for violating probation in a case of theft.

The murder charge was dropped, of course, and Mr. Foxall was greatly relieved. “I would have hated to have had to try the case,” he said. “It would have been very scary. Juries don’t want to believe that somebody will confess to a crime he didn’t commit.” Judges don’t want to believe this either. In fact, according to Mr. Foxall, the juvenile commissioner in Felix’s case said, “Well, I don’t understand — why would he confess?”

If you have never been tortured, or locked up and verbally threatened, you may find it hard to believe that anyone would confess to something he had not done. Intuition holds that the innocent do not make false confessions. What on earth could be the motive? To stop the abuse? To curry favor with the interrogator? To follow some fragile thread of imaginary hope that cooperation will bring freedom?

Yes, all of the above. Psychological studies of confessions that have proved false show an overrepresentation of children, the mentally ill and mentally retarded, and suspects who are drunk or high. They are susceptible to suggestion, eager to please authority figures, disconnected from reality or unable to defer gratification. Children often think, as Felix did, that they will be jailed if they keep up their denials and will get to go home if they go along with interrogators. Mature adults of normal intelligence have also confessed falsely after being manipulated.

False confessions have figured in 24 percent of the approximately 289 convictions reversed by DNA evidence, according to the Innocence Project. Considering that DNA is available in just a fraction of all crimes, a much larger universe of erroneous convictions — and false confessions — surely exists.

Officers are taught to use all the tricks and lies that courts permit within the scope of the Fifth Amendment’s shield against self-incrimination. John E. Reid & Associates, which has trained thousands of interrogators, suggests that a suspect be induced to waive his constitutional rights to silence and counsel by giving him the famous Miranda warning “casually” and not immediately after arrest, when he is “defensive and guarded” and “more likely to invoke his rights.” When a skilled questioner splices it nonchalantly into conversation, the warning’s empowering message of choice can be lost on a suspect. Many false confessors have been routinely Mirandized in this perfunctory manner.

To get people talking, the Reid training also recommends questions that imply leniency without making explicit promises, and that reduce moral responsibility by blaming peer pressure: “Was this your idea or did your buddies talk you into it?” Interrogators are advised to pretend to have evidence but not to fabricate it. A suspect can be shown a card bearing a latent fingerprint and be told: “This is your fingerprint. We found it inside that stolen car.” That’s been allowed by courts if the police officer puts his or her own print on the card but not if the officer fakes it with the suspect’s print. Admissions produced by these tactics may be true or untrue.

A cunning lie generated a false confession from Martin Tankleff, 17, who found his parents one morning in their Long Island home slashed and stabbed, his mother dead, his father barely alive. The boy called 911 and was taken for questioning. Getting nowhere, Detective K. James McCready decided on a trick. He walked to an adjacent room within hearing distance, dialed an extension on the next desk, picked up the phone and faked a conversation with an imaginary officer at the hospital. He went back to the son and told him that his father had come out of his coma and said, “Marty, you did it.” In fact, Seymour Tankleff never regained consciousness and died a month later.

In experiments and in interrogation rooms, adults who are told convincing fictions have become susceptible to memories of things that never happened. Rejecting their own recollections through what psychologists call “memory distrust syndrome,” they are tricked by phony evidence into accepting their own fabrications of guilt — an “internalized false confession.”

That is what happened to a shaken Martin Tankleff, and although he quickly recanted, as if coming out of a spell, he was convicted and drew 50 years to life. He spent 17 years in prison before winning an appeal based on new evidence that pointed to three ex-convicts. But they have never been tried. Whoever killed the Tankleffs remains at large.

There are possible remedies. After Felix’s false confession, the Oakland Police Department began video recording “as soon as a homicide suspect enters the interview room, as opposed to only taping a portion of the interview,” said Sgt. Chris Bolton, the police chief of staff. Some lawyers worry nonetheless that judges won’t watch hours of subtle coercion, and that jurors will still find the taped confession decisive.

The police could be prohibited from lying about nonexistent evidence; from inducing a suspect to imagine leniency; from questioning minors without a parent or a lawyer present. They could be required to corroborate a confession with stringent evidence.

Finally, post-conviction challenges of confessions could be assigned to judges and prosecutors other than those who tried the original cases. The natural unwillingness to admit a grave error should not have to be overcome for justice to be done.

(David K. Shipler is the author of the forthcoming “Rights at Risk: The Limits of Liberty in Modern America,” from which this article is adapted.)

LBN-Commentary

By Nicholas Bakalar

Statins, among the most commonly prescribed drugs for the prevention of cardiovascular disease, also appear to reduce the risk for death in patients hospitalized with the flu.

A study published last week in The Journal of Infectious Diseases analyzed data on 3,043 men and women who were hospitalized with influenza in 10 states; their average age was 70. About a third of them were taking statins, and more than half had been vaccinated against the flu.

Among those hospitalized, 151 died within 30 days of the test that confirmed they had the flu. After controlling for race, sex, underlying disease, flue vaccination status and other factors, the researchers found those on statins had a 41 percent reduced risk of death compared with those who were not taking the medicine.

How a statin might protect against flu is still unclear. “The basic mechanism is that it is down-regulating the body’s overactive immune response to flu,” and Dr. Ann R. Thomas, an author of the study and a physician with the Oregon Public Health Division.

Dr. Thomas added that this observational study is not the last word. “It may be that people on statins are healthier at the outset,” she said. “The next step is to do a randomized clinical trial.”