Monthly Archives: November 2018

Women’s Awareness and Perceived Importance of the Harms and Benefits of Mammography Screening

Those of you who have been following this blog for many years know that I have been discussing this issue many times. Women are given only the benefits of mammograms, without discussing the potential harms. As this effects all women, and is a very important issue, women need to be aware of both sides of the debate. This study helps to redress the imbalance in information re mammograms.

Women’s Awareness and Perceived Importance of the Harms and Benefits of Mammography Screening

Results From a 2016 National SurveyJiani Yu, BA,

JAMA Intern Med. 2017 Sep; 177(9): 1381–1382. Published online 2017 Jun 26. doi:  [10.1001/jamainternmed.2017.2247]PMCID: PMC5818835PMID: 28654987

corresponding author

1Rebekah H. Nagler, PhD,2Erika Franklin Fowler, PhD,3Karla Kerlikowske, MD,4,5 and Sarah E. Gollust, PhD6Author informationArticle notesCopyright and License informationDisclaimerThis article has been cited by other articles in PMC.

There is growing scientific consensus that mammography has a modest impact on averting deaths from breast cancer, while exposing women to a number of harms. Yet it is not well known how women in the general US public perceive the benefits and harms of mammography screening. Previous research has been published on public enthusiasm for screening and underestimates of harms, but these findings may be outdated. In this study, we present 2016 data on women’s awareness and perceptions of the benefits and harms of mammography, drawn from a larger survey of US adults on exposure to cancer-related information in the media.Go to:

Methods

Study participants were recruited by GfK, a survey research firm that maintains a probability-based panel of approximately 55 000 adults. GfK recruits panel participants through address-based probability sampling and provides small financial incentives to panel members for completing surveys. Among eligible panelists randomly selected to participate, 1519 (51%) completed the online survey between May 24 and June 6, 2016. Data reported herein are restricted to US women aged 40 to 59 years (n = 407) who received a stand-alone module about (1) awareness of the benefits/harms of mammograms, and (2) evaluations of the importance of these benefits/harms (Table 1 and Table 2). Both the question blocks, and the items within these blocks, were randomized. Prior to these items, respondents answered questions about their general and mammogram-related news and health media consumption. They also answered 2 items (“have you ever had a mammogram” and “when did you have your most recent mammogram to check for breast cancer”), which we used to construct 3 categories of mammogram history: (1) never had a mammogram, (2) had over a year ago, and (3) had less than a year ago. We tested for differences in importance evaluations by mammogram history using ordered logit regression. Analyses applied the GfK survey weights to adjust for nonresponse bias and panel nonresponse to produce nationally-representative estimates. The study was determined to be exempt from review by the University of Minnesota institutional review board.

Table 1.

Awareness and Perceived Importance of Mammogram Benefits, Nationally Representative Sample of 407 Women Ages 40 to 59 Years

BenefitsFrequency, % (95% CI)
AwarenessaImportanceb
I Have Heard of This BeforeNot At AllSlightly Important or ImportantVery Important
Mammograms can save lives.97.1 (94.8-98.4)1.9 (0.9-3.8)31.2 (26.7-36.1)66.9 (61.9-71.6)
Mammograms can lead to earlier treatment of breast cancer.96.2 (93.6-97.8)2.1 (1.1-4.0)31.3 (27.0-35.9)66.6 (61.7-71.2)
Mammograms can provide peace of mind by finding that you do not have breast cancer.92.2 (89.3-94.3)3.2 (1.8-5.7)40.3 (35.1-45.7)56.5 (51.1-61.7)
Mammograms can find cancer early, sometimes before cancer symptoms begin.91.2 (88.0-93.6)2.3 (1.2-4.0)31.9 (27.3-36.8)65.9 (60.9-70.5)

aFor each benefit, respondents indicated “I have heard of this before” or “this is new information to me today.”bRespondents were asked “If you were to consider getting a mammogram in the future, how important would the following potential benefits of mammograms be to you personally?” Responses were measured on a 5-category Likert scale ranging from “not important” to “very important”; middle categories (“slightly important,” “moderately important,” and “important”) are collapsed.

Table 2.

Awareness and Perceived Importance of Mammogram Harms, Nationally Representative Sample of 407 Women Ages 40 to 59 Years

HarmsFrequency, % (95% CI)
AwarenessaImportanceb
I Have Heard of This BeforeNot at AllSlightly Important or ImportantVery Important
Women who receive positive mammogram results, even if eventually it turns out they do not have cancer, may feel anxious and stressed.77.6 (73.2-81.3)14.2 (10.8-18.3)62.4 (56.9-67.6)23.5 (19.2-28.3)
Mammograms can find something that looks like cancer but eventually turns out not to be cancer. This is called a “false-positive” or “false alarm.”75.4 (70.7-79.5)11.8 (8.7-15.9)64.8 (59.1-70.1)23.4 (18.7-28.8)
Mammograms, like all x-rays, expose women to very small doses of radiation, which could increase risk for cancer.67.4 (62.5-71.9)13.2 (10.2-17.1)67.1 (62.3-71.7)19.6 (16.0-23.8)
Mammograms can lead to increased costs to women because of follow-up tests and procedures.50.1 (44.0-56.2)19.8 (16.0-24.3)61.5 (55.7-66.9)18.8 (14.7-23.7)
Mammograms can lead to increased costs to the health care system because of follow-up tests and procedures.42.7 (36.8-48.8)23.0 (18.9-27.7)61.9 (56.8-66.7)15.1 (11.5-19.6)
Some breast cancers found by mammograms are treated with potentially-risky surgeries or medications that would not have needed such treatment after all.39.7 (34.8-44.8)9.0 (5.9-13.5)62.3 (57.0-67.3)28.7 (24.3-33.5)
Some breast cancers that are found by mammograms are so slow-growing that they would not have caused any health problems for women in their lifetime.26.5 (21.7-31.8)13.4 (9.8-18.1)65.1 (58.7-70.9)21.5 (16.2-28.0)

aFor each harm, respondents indicated “I have heard of this before” or “this is new information to me today.”bRespondents were asked “If you were to consider getting a mammogram in the future, how important would the following potential harms of mammograms be to you personally?” Responses were measured on a 5-category Likert scale ranging from “not important” to “very important”; middle categories (“slightly important,” “moderately important,” and “important”) are collapsed.Go to:

Results

Fifty-eight (14.2%) participants reported never having a mammogram, 197 (56.4%) reported having a mammogram within the past year, and 103 (29.4%) reported having a mammogram less recently. Nearly all respondents (366, >90% for each) were aware of 4 statements describing mammography benefits (Table 1). When asked to rate their importance, most (223 [54.8]) concluded that each benefit was “very important.” Respondents’ awareness of harms, however, was much more variable (Table 2). Although only 108 (26.5%) reported prior awareness of overdiagnosis and 161 (39.7%) of overtreatment, 305 (74.9%) were aware of false-positive results and the potential of psychological distress. In contrast to their evaluations of benefits, fewer women rated harms as very important, ranging from 61 (15.1%) (health care system costs) to 117 (28.7%) (overtreatment). There were no statistically significant differences in awareness or ratings of importance by age group (40-49 years vs 50-59 years).

Women who reported having a mammogram within the past year were significantly more likely to rate all 4 benefits as very important, compared with those who who never had a mammogram (62.4%-74.9% vs 44.9%-58.0%; differences significant at P<.05). Women who reported having a mammogram within the past year were significantly less likely to rate health care system costs and radiation harms as very important compared with those who never had a mammogram (11.5% and 15.1% vs 22.9% and 25.7%; differences significant at P<.05). Go to:

Discussion

Women are more aware of the benefits of mammography screening than the harms, and women who have recently undergone mammography are more likely to judge these benefits as important. This may be owing to a lack of balanced information from physicians, public health officials, news media, and disease advocacy groups that have long emphasized screening’s benefits. Our findings suggest that there are opportunities for targeted education and communication at both the general public and individual levels, with a focus on educating women on the harms of screening, which they are much more likely to experience than benefits. However, the fact that women are predisposed to consider benefits as more important than harms poses a challenge to informed decision making about screening, suggesting the need for new paradigms in communicating the cumulative risks of the benefits and harms.

Apocalypse now: wifi and radiation sickness sweeping the world

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Apocalypse now: wifi and radiation sickness sweeping the world

March 21, 2017 8.53am AEDT

The researchers extrapolated figures from 17 reports published in 1985-2004 from nine countries to estimate how many people by 2017 would be sensitive to electromagnetic radiation from common household appliances, including mobile phones, and environmental exposures like power lines, and TV, phone and radio transmission masts.

According to their calculations, by now, half the world’s population would be suffering from electrosensitivity. That’s around 3.75 billion people, surely the biggest plague ever to affect the world.

And if we continue their extrapolation for a few more years, the researchers will have answered their own original question.

What is electrosensitivity?

Electrosensitivity is not a disease recognised by any authoritative disease classification system. It is a self-diagnosed label adopted and promoted by people who believe they are sensitive to exposure to electromagnetic radiation from sources like power lines, electrical appliances, computers, cordless and mobile phones, wifi, smart electricity meters, dimmer switches, radio, television and mobile phone transmission towers.

Unless you live in the wilderness, you are surrounded by electromagnetic radiation. My suburban wifi network icon shows 10 networks near my house. And that’s just one source. For all this electromagnetic radiation, hypothesised increases in brain cancer have not occurred across Australia more than 29 years after the first mobile phone was switched on.

This news clip shows a tragic case of a woman who wears a cloth head cover she thinks will protect her from radio frequency radiation emitted from mobile phone transmission towers.

How fear takes hold: one woman believes a cloth head cover will protect her from mobile phone tower emissions.

And here’s an electromagnetic fearmonger frightening an audience for over an hour about many sources of electromagnetic radiation while holding a wireless microphone next to his head.

Creating fear about electromagnetic radiation while carrying a wireless microphone.

A legitimate line of research

Those who study the phenomenon call it idiopathic environmental intolerance attributed to electromagnetic fields or IEI-EMF.

The acid test for those who claim these sensitivities is a provocation study. People who say they are harmed by exposure to electromagnetic or radio frequency radiation volunteer to be randomly exposed to actual, sham or zero doses of the agents, like wifi, they say are making them sick.

Two systematic reviews of all the published evidence from such studies have both found no evidence people saying they are “electrosensitive” really are.

A 2009 review looked at 46 provocation studies involving 1,175 people. Some of the studies were blind, when the people in the studies were not told if the exposures they were about to receive were active or sham; some studies were double-blind, where the experimental staff also did not know which was which until after the exposures occurred and the reactions recorded.

However, the study participants could not correctly identify when they were being exposed to active electromagnetic fields. The authors concluded:

Despite the conviction of … sufferers that their symptoms are triggered by exposure to electromagnetic fields, repeated experiments have been unable to replicate this phenomenon under controlled conditions.

The second review from 2011 looked at whether exposure to electromagnetic fields triggers physiological or cognitive changes in people who say they are electrosensitive. It looked at 29 single or double-blind experiments where participants were exposed to different electromagnetic frequency levels, and their outcomes objectively assessed.

Most differences in symptoms between the groups could not be replicated or did not differ significantly between control and test groups. The researchers concluded:

At present, there is no reliable evidence to suggest that people … experience unusual physiological reactions as a result of exposure to electromagnetic fields.

In South Africa in 2010, a group of people who believed they were electrosensitive planned to sue a radio tower operator over symptoms over a six week period. But they didn’t know the tower had been switched off at the time.

How widespread?

Among the 17 “studies” on electrosensitivity Hallberg and Oberfeld listed were an estimate of 5% of the Irish population, published in something called “This is London”, and a Swedish estimate of 50,000 sufferers in 1994 attributed to “anonymous”, with no reference supplied.

More serious studies involving sample surveys of populations find around 4% of people at any one time say they are electrosensitive.

‘Communicated’ diseases

Evidence therefore points strongly to electrosensitivity and idiopathic environmental intolerance generally being “communicated diseases”, which spread by people hearing about the alleged dangers, and sometimes then worrying themselves sick.

This is the nocebo effect, where worrying about something causes the problems that may have been described or found on the internet.

Many people do indeed present with objectively measurable and observable symptoms, in what medicine has long understood as somatisation, where anxiety and distress manifest as symptoms that drive those experiencing them to seek help and reassurance they suffer from the effects of some noxious external agent.

When Oberfeld spoke about his forecasts to a meeting, even before he could begin, reportedly:

… Several people had to leave the Carmelite Centre in Dublin’s Aungier Street, claiming discomfort from the toxic atmosphere generated by the concentration of cell phones and electromagnetic frequencies just a short distance from the capital’s premier shopping street and St Stephen’s Green”.

Opportunists regular cash in on such anxiety and promote sometimes expensive, quasi-scientific sounding protection devices said to shield or minimise exposure from nasty radiation.

One of these operating in Australia is Geovital Academy which stands ready to extract cash for paint, mats, mesh and matresses supposed to shield. Tin foil hats are not in their catalogue.

From at least May 8, 2012 until May 31, 2013 the Wayback Machine shows Geovital had a supportive statement from Noble (sic) Prize winner Ivan Engler talking about the dangers of “geopathic stress”.

With almost all of my (roughly 300 patients) with a cancerous disease, their bed was placed for years on an energetically unfavorable place in a Geopathic Zone”.

No one called Ivan Engler has won a Nobel Prize in any category. But he may have won a Noble prize, whatever that might be.

A Doctor in the Neighborhood

I live in the area, and often bump into my patients in the local shopping centre, or else in the strangest places when traveling. This piece resonates with me as it shows up some of the ethical dilemmas GP’s can face. This is not my usual blog but I put it in for a general interest perspective.

A Doctor in the Neighborhood
By Danielle Ofri, M.D.
February 11, 2016 5:45 am February 11, 2016 5:45 am 51 Comments

One of the main premises of health care reform is that everybody needs to have a primary care doctor, ideally in the community. I happen to live right near my clinic, so I often see many of my patients on the street. This can be good or bad. There have been innumerable times when a meeting on the street has added an important element to medical care — reminders of missed visits, lost prescriptions, continuing issues that would not have otherwise made it to my office.
There have been other moments when it has been less sanguine, such as when I’m out walking the dog in old sweatpants and a ratty T-shirt.

But when my children started at the local elementary school, things began to feel awkward. Several of my patients had children in the same school. We’d see one another in the schoolyard, and I felt a discomfort that was different from what I had experienced when meeting them on the street.

I sensed that my patients felt equally awkward — we simply flashed one another quick smiles and kept to ourselves. It was as if we had an unspoken agreement that we’d keep our “other” relationship quiet. Here, we were all just parents picking up our children.

My sense of discomfort was tested further when, some years back, I was called to evaluate a young woman with pneumonia who had been in a psychiatric ward for several months. She had been hospitalized on and off for severe depression over the last decade, I learned, and hadn’t been able to hold a job. Her husband worked long hours, so the grandmother had moved in to help take care of their three young children. It broke my heart to hear this, imagining how difficult it must be for her children.

When she sat up to allow me to listen to her lungs, I parted the edges of her gown to place the bell of my stethoscope. There, across her back, was an elaborate tattoo that spelled out a name – a one-of-a-kind name. I did a double take when I saw it, and endeavored to be sure that my team of medical students and interns did not see the shock on my face. I knew that name!

It was the name of one of my children’s classmates from several years earlier. I knew immediately that it had to be the same person.

Looking at the mother now, the familial resemblance was obvious. And what sadly solidified the connection was knowing the behavioral difficulties and social disconnects this child had exhibited. Now I had the context for this — the painful effects of a parent with mental illness.

As I listened to the reedy murmurings of my patient’s breath, I tried to sort through my own feelings. Part of me felt guilty that I was in possession of “insider information” from the nonmedical part of my life. On the other hand, this knowledge offered me a broader and more empathetic understanding of the implications of my patient’s illness. It wasn’t as if I’d obtained this information in any sort of unethical manner. Yet it made me uncomfortable.

I closed my patient’s gown and sat down to discuss the treatment of her pneumonia. Then I asked her how her children were doing.

“O.K, I guess,” she said, her eyes wandering past me to the window. “But it’s been hard on them, me being in the hospital so much.”

I wanted to say, I know, I really do. I wanted to offer her some solidarity and empathy as a parent, and also the acknowledgment of her child as a real person, scrambling on the school’s jungle gym. But I decided that it would be best to keep this local connection quiet. I thought that it might embarrass her, and once revealed, that recognition could not be undone.

Her pneumonia improved within a week, and she returned to the psychiatric ward. We did not see each other again. I occasionally saw her child in the schoolyard, always dropped off by the father or grandmother. Each time I experienced a wince of pain, knowing the extra layer of suffering that this family faced. Then our children — mine and hers — graduated and moved on to different schools.

There aren’t any ethical guidelines about where a doctor should live or how she should behave when she and her patient are in line at the grocery store. My rule of thumb is that I keep quiet and allow my patients to decide how much interaction they want, if any at all.

Being local, though, has some advantages. During one of the big snowstorms, when the city ground to a halt and many of my suburban colleagues were digging out their driveways, I was one of the physicians who could make it to the hospital early. My patients who live in the neighborhood also arrived on time and were happy that their appointments would not have to be rescheduled.

We stamped the snow off our boots and settled into the medical routine. “Neither sleet nor snow…,” one patient said to me as I took his blood pressure. That isn’t the half of it, I thought.

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Danielle Ofri’s newest book is What Doctors Feel: How Emotions Affect the Practice of Medicine. She is a physician at Bellevue Hospital and an associate professor of medicine at the New York University School of Medicine, as well as editor in chief of the Bellevue Literary Review. She spoke on Deconstructing Our Perception of Perfection at TEDMED.

a probiotic in emotional symptoms of chronic fatigue syndrome

A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome

  • A Venket Rao1,
  • Alison C Bested2, 3,
  • Tracey M Beaulne3,
  • Martin A Katzman4, 5,
  • Christina Iorio5,
  • John M Berardi6 and
  • Alan C Logan1Email author
Gut Pathogens20091:6

DOI: 10.1186/1757-4749-1-6

Received: 03 October 2008

Accepted: 19 March 2009

Published: 19 March 2009

Abstract

Chronic fatigue syndrome (CFS) is complex illness of unknown etiology. Among the broad range of symptoms, many patients report disturbances in the emotional realm, the most frequent of which is anxiety. Research shows that patients with CFS and other so-called functional somatic disorders have alterations in the intestinal microbial flora. Emerging studies have suggested that pathogenic and non-pathogenic gut bacteria might influence mood-related symptoms and even behavior in animals and humans. In this pilot study, 39 CFS patients were randomized to receive either 24 billion colony forming units of Lactobacillus casei strain Shirota (LcS) or a placebo daily for two months. Patients provided stool samples and completed the Beck Depression and Beck Anxiety Inventories before and after the intervention. We found a significant rise in both Lactobacillus and Bifidobacteria in those taking the LcS, and there was also a significant decrease in anxiety symptoms among those taking the probiotic vs controls (p = 0.01). These results lend further support to the presence of a gut-brain interface, one that may be mediated by microbes that reside or pass through the intestinal tract.

Discussion

The idea that implanting the intestines with Lactobacillus strains may improve quality of life and mental health is not a new one. Dr. George Porter Phillips first reported in 1910 that although Lactobacillus tablets and powder were ineffective, a gelatin-whey formula with live lactic acid bacteria improved depressive symptoms in adults with melancholia [15]. In a series of case reports, separate researchers concluded in 1923 that ‘the administration of acidophilus milk is recommended in the treatment of psychoses as a means to physical betterment’ [16]. In this pilot study we found that the oral administration of Lactobacillus casei strain Shirota (LcS, Yakult Honsha, Tokyo, Japan) caused a significant rise in fecal Bifidobacteria spp. and Lactobacillus spp. The rise in Lactobacilli was an expected finding, although the concomitant rise in Bifidobacteria suggests that there may be far reaching effects of oral probiotics on other microbial residents of the gastrointestinal tract. This finding supports previous research showing that the oral administration of Lactobacillus plantarum 299 V caused a significant rise in fecal Bifidobacteria levels [17]. In this case the elevation of Bifidobacteria levels should be considered a positive finding, particularly when considering that Bifidobacteria levels may be low in CFS. Also of relevance is a recent experimental study which has shown that a specific strain of Bifidobacteria can boost plasma tryptophan levels and alter serotonin and dopamine turnover in areas of the brain associated with depression and anxiety [12]. We also found a significant reduction in anxiety scores among those CFS patients consuming the LcS bacteria. The group differences in anxiety are noteworthy since anxiety is a frequent mental health symptom reported by CFS patients.

In recent years the interface between neuropsychiatry and gastroenterology has converged into a new discipline referred to as enteric neuroscience. Emerging studies have shown that intestinal bacteria may directly communicate with the central nervous system by way of the vagal sensory nerve fibers and the peripheral immune system. Indeed, experimental studies have shown that even minute doses of microbes within the gastrointestinal tract, levels that do not trigger an immune response, are capable of influencing neurotransmission in the paraventricular hypothalamus, the central nucleus of the amygdala, and the bed nucleus of the stria terminalis [8]. All three of these regions are involved in the processing of emotions related to anxiety and mood. It is also true that quantitative alterations in the make-up of gastrointestinal microbes are a consequence of states of stress and fear, and alterations in the gut microflora have recently been associated with impaired glucose control and obesity [18, 19].

More hints of a connection between intestinal microflora and brain function come from studies in the autistic spectrum. Research has shown marked alterations of the gastrointestinal microflora in autism, with specific elevations in various Clostridium spp. [20]. Some researchers speculate that low-grade chronic intestinal inflammation induced by elevations in bacteria such as potentially pathogenic Clostridium spp may be directly influencing brain centers. Experimental studies show that indeed chronic gut inflammation leads to activation of areas of the brain associated with mental health and behavioral disorders, including the hypothalamus, amygdala and cortical centers [21]. While we did not look specifically at Clostridium spp. in this pilot investigation, it has been noted that Lactobacillus can competitively displace Clostridium and other potentially pathogenic gut bacteria [22]. Propionic acid is a short chain fatty acid produced primarily by Clostridium and Bacteroides spp.; emerging research suggests that this acid may be involved in anxiety. Elevated production of propionic acid in the gut has been shown to increase behaviors associated with anxiety and aggression in animals [23]. It has also been shown recently that when propionic acid gains access to the brain it can impair the social behavior of animals. Changes to the animal behavior include decreased playful behavior, increasing social isolation, and an increase in repetitive behaviors that may indicate anxiety [24]. While human data is lacking, a study in animals did show that the LcS as used in our study can lower cecal propionate levels [25].

Some researchers have stated that the so-called ‘hygiene hypothesis’ extends into the realm of mental health disorders as well. The hygiene hypothesis is the proposition that the documented rise in chronic inflammatory disorders (allergies, autoimmunity, and inflammatory bowel disease) within developed countries is driven by a changing microbial environment, an absence of beneficial bacteria that has in turn altered the immuno-regulatory circuits which normally keep inflammatory responses in check [26]. Many mental health conditions, and so-called functional somatic disorders such as CFS, have been well-documented to have elevations in inflammatory cytokines, and these inflammatory cytokines at even low levels can produce symptoms of anxiety and depression in otherwise healthy adults [26]. Therefore, since orally administered probiotics can decrease inflammatory cytokines in humans, it has been postulated that bacteria may be used to positively influence mood in patient populations where both emotional symptoms and inflammatory immune chemicals are elevated [10]. It is becoming increasingly clear that anxiety and stress itself may lower levels of fecal lactic acid bacteria, and this, in turn, may compromise various aspects of health [27].

Overall the results suggest that specific strains of probiotic bacteria may have a role to play in mediating some of the emotional symptoms of CFS and other related conditions. However, it is important to note that this is a small pilot study and broad conclusions cannot be drawn at this time. Since we did not evaluate bowel function during the study, it is entirely possible that the decreased anxiety was a consequence of improved bowel function. In an unexplained medical condition such as CFS, where over 70% of patients meet the criteria for IBS, it is possible that regulation of bowel movements made a difference in mental state. Indeed LcS has been shown to regulate bowel function and decrease constipation in a controlled trial [28]. It is also true that LcS has been shown to reduce small intestinal bacterial overgrowth and the subjective reporting of the passage of gas in patients with IBS [29]. This is of significance because SIBO and intestinal permeability often overlap, and patients with chronic fatigue syndrome are known to have both increased intestinal permeability and SIBO. Indeed, correction of SIBO and intestinal permeability has been shown to improve symptoms in CFS and depressive disorders [30, 31]. Therefore, it is entirely possible that our results are an artifact of improved gut structure and function via the LcS restoration of a healthy intestinal biofilm. However, a recent study using the same LcS strain in healthy adults suggests that there may be a more direct microbial influence on emotional state. In healthy adults who were reported to be more depressed/less elated in daily functioning at baseline, there was significant improvement in mood scores after taking the probiotic. In that controlled trial the improvements in mood were not related to changes in bowel function [11].

This preliminary research raises many questions regarding possible mechanisms whereby probiotics might influence anxiety and depression. The results of the present study should be viewed simply as a stimulus for further research. Follow-up studies with probiotics should further examine specific gut microbes, intestinal structure and function as well as physiological markers associated with anxiety and depression. These may include inflammatory cytokines and other immune chemicals, blood tryptophan levels and urinary metabolites of neurotransmitters.

Science or snake oil: is Garcinia cambogia the magic weight-loss pill it’s hyped up to be?

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Science or snake oil: is Garcinia cambogia the magic weight-loss pill it’s hyped up to be?

June 20, 2016 6.09am AEST

Disclosure statement

Dr Nicholas Fuller has received research grants for other clinical trials funded by Australian Egg Corporation, Weight Watchers International, SOHO Flordis International, Arnotts Biscuits, Sanofi-Aventis, Novo Nordisk, Allergan, Roche products, MSD, and GlaxoSmithKline.

Partners

University of Sydney provides funding as a member of The Conversation AU.

The burgeoning field of complementary medicines, including weight-loss products, is now a billion-dollar industry. Every year, more people are spending disposable income on complementary and alternative medicines that may prove to have no benefit for our health.

Garcinia Cambogia is one such example. Marketed as a weight-loss pill, it has had an exponential rise in sales since it was featured on the Doctor Oz show.

Garcinia cambogia is the former scientific name of a native Southeast Asian plant, belonging to the family Clusiaceae, that bears a pumpkin-shaped fruit. The skin of the fruit contains the active ingredient, hydroxycitric acid (HCA). HCA inhibits an enzyme that produces fatty acid, thus suppressing fatty acid and the processing of cholesterol.

But does this mode of action translate to the weight-loss claims associated with it? Or is it just clever marketing convincing us this product helps us lose weight?

An Australian advertisement for the weight-loss supplement Garcinia Cambogia. Screenshot, http://www.garciniacambogiasave.com/, CC BY

Double-blinded, randomised controlled trials are the gold standard of clinical study and whenever possible should be conducted to test the effectiveness of a treatment compared to a placebo. Weight-loss products should be assessed for a minimum of six months, with a further six-month follow-up period (12 months total).

There has never been a long-term study investigating the efficacy of Garcinia Cambogia. Most of the studies have been conducted in animals.

In fact, the majority of well-designed trials investigating the effect of this product on weight loss have found no effect that is of clinical relevance. In a 12-week double-blind, placebo-controlled trial conducted in humans, people receiving 3000mg of Garcinia Cambogia extract (1500mg of the active component HCA) per day lost the same amount of weight as the control group.

Another 12-week study with a four-week follow-up (16 weeks total) also found no greater weight-loss effect than for a placebo control group. For those studies where a statistically significant effect was reported, the weight loss was around one kilogram more than for those receiving a placebo pill.

Positive and greater weight losses were found in some studies, but this effect is suppressed when looking at all of the studies combined.

The Garcinia Cambogia plant Livia Lacolare/Flickr, CC BY

With respect to other health benefits from taking this supplement, the evidence to suggest it can improve blood cholesterol levels is lacking.

Most importantly, the product safety profile of Garcinia Cambogia has been adequately tested and there appear to be no issues.

Some complementary medicines have been found to contribute to improved health outcomes, through increased efficacy and cost-effectiveness. However, if there is to be a role for such complementary and alternative weight-loss products and medicines, we must build upon the evidence to investigate whether these increasingly popular products are a viable treatment option.

A recent Obesity Australia and Price Waterhouse Coopers report found obesity cost Australia A$8.6 billion in 2011-2012, with the indirect costs far higher. We must establish whether complementary medicines have a role to play in preventing and treating obesity. If we take no action to reduce obesity rates, an additional 2.4 million people will become obese at a cost of $87.7 billion over 10 years.

Trust Me, I’m An Expert: Food fraud, the centuries-old problem that won’t go away

Trust Me, I’m An Expert: Food fraud, the centuries-old problem that won’t go away

What is in these products? And if additives don’t affect your health, would you care? Shutterstock
Listen Food fraud, the centuries-old problem that won’t go away

What have you eaten today? And how much do you know about how it was produced, what was added to it along the way, and how it made its way to your plate?

Even as most of us grow increasingly removed from actual food production, many consumers still take food fraud and perceptions of food purity incredibly seriously.

Scandals around “meat glue” or milk and honey contamination, and the skyrocketing global interest in organic foods, underscore the fact that many of us still care quite deeply about the foods we eat and how they’re produced – and that’s affecting food labelling, regulation and consumer behaviour.

One person who’s studied that terrain closely is Dr Andrew Ventimiglia, a Research Fellow at The University of Queensland, who researches food fraud and how it relates to science, culture, trademark law and food regulation.


Read more: Trust Me, I’m An Expert: Cyclone season approacheth, but this year there’s a twist


He sat down with The Conversation’s deputy politics and society editor Justin Bergman to talk about the weird history of food adulteration and certification – everything from 19th century dairy farmers adding sheep brains to skim milk to make it look frothier, to centuries-old oil and wine adulteration scandals.

Dr Ventimiglia said types of food fraud laws have been recorded as early as the 13th century, but the issue really came into focus in the 1800s.

Adulterated milk was one of the first issues that got national attention, and this was roughly in the mid 1800s to late 1800s, both particularly in the UK and the US. And the earliest form of adulterated milk that was really concerning to regulators was actually simply skim milk.

Producers who were making skim milk were adding flour or starch, sometimes carrots for sweetness, but they were also adding things that did pose a public health risk.

So, for instance, chalk was added to increase the whiteness of milk, as well as often sheep or calf brains to froth the milk […] those posed really legitimate health risks that were recognised by early analytic chemists and that really initiated some early food regulations.

And while food scandals persist today, food standards are increasingly more concerned with fraudulent claims on packaging and innovations in food production. For instance, is yoghurt made with coconut milk still considered yoghurt? What to do about foods that claim to be “all natural?”

Special thanks to our multimedia intern, Dilpreet Kaur Taggar, for editing this segment together.


Read more: Trust Me, I’m An Expert: How augmented reality may one day make music a visual, interactive experience


From food adulteration to food poisoning

We also hear from Associate Professor Shauna Murray from the UTS Plant Functional Biology and Climate Change Cluster, about her research into ciguatera fish poisoning. It’s a non-bacterial illness associated with fish consumption and symptoms in humans may include gastrointestinal, neurological and even sometimes cardiovascular problems.

Editorial intern Jordan Fermanis spoke to Dr Murray about why this tropical disease is showing up further south, and how recreational fishermen are helping researchers unlock the mysteries of ciguatera.


Trust Me, I’m An Expert is a podcast where we ask academics to surprise, delight and inform us with their research. You can download previous episodes here.

And please, do check out other podcasts from The Conversation – including The Conversation US’ Heat and Light, about 1968 in the US, and The Anthill from The Conversation UK, as well as Media Files, a brand new podcast all about the media. You can find all our podcasts over here.

Additional audio and credits

Additional editing by Dilpreet Kaur Taggar

Kindergarten by Unkle Ho, from Elefant Traks

Free Music Archive: Podington Bear, Clouds, Rain, Sun

Demand increases for organic produce, 23 ABC News.

Is your honey real honey or just “sugar syrup”? ABC News Australia.

Fake honey: Study finds disturbing results, ABC News Australia.

Meat glue secret, Today Tonight.

Chinese milk report, CNN.

Missouri Wine History, MissouriWine.

Pure. Fresh. Milk. 1991 Promo.

Australian milk ad.

Sad Marimba Planet by Lee Rosevere from Free Music Archive

Melatonin: An Anti-Tumor Agent in Hormone-Dependent Cancers.

I have discussed the benefits of melatonin many times. One of its major benefits is its anti cancer properties. It is also very safe and natural to the body.

Int J Endocrinol. 2018 Oct 2;2018:3271948. doi: 10.1155/2018/3271948. eCollection 2018.

Melatonin: An Anti-Tumor Agent in Hormone-Dependent Cancers.

Menéndez-Menéndez J1, Martínez-Campa C1.

Author information

Abstract

Melatonin (N-acetyl-5-methoxytryptamine) is a hormone synthesized and secreted by the pineal gland mainly during the night, since light exposure suppresses its production. Initially, an implication of this indoleamine in malignant disease was described in endocrine-responsive breast cancer. Data from several clinical trials and multiple experimental studies performed both in vivo and in vitro have documented that the pineal hormone inhibits endocrine-dependent mammary tumors by interfering with the estrogen signaling-mediated transcription, therefore behaving as a selective estrogen receptor modulator (SERM). Additionally, melatonin regulates the production of estradiol through the control of the enzymes involved in its synthesis, acting as a selective estrogen enzyme modulator (SEEM). Many more mechanisms have been proposed during the past few years, including signaling triggered after activation of the membrane melatonin receptors MT-1 and MT-2, or else intracellular actions targeting molecules such as calmodulin, or binding intranuclear receptors. Similar results have been obtained in prostate (regulation of enzymes involved in androgen synthesis and modulation of androgen receptor levels and activity) and ovary cancer. Thus, tumor metabolism, gene expression, or epigenetic modifications are modulated, cell growth is impaired and angiogenesis and metastasis are inhibited. In the last decade, many more reports have demonstrated that melatonin is a promising adjuvant molecule with many potential beneficial consequences when included in chemotherapy or radiotherapy protocols designed to treat endocrine-responsive tumors. Therefore, in this state-of-the-art review, we aim to compile the knowledge about the oncostatic actions of the indoleamine in hormone-dependent tumors, and the latest findings concerning melatonin actions when administered in combination with radio- or chemotherapy in breast, prostate, and ovary cancers. As melatonin has no toxicity, it may be well deserve to be considered as an endogenously generated agent helpful in cancer prevention and treatment.

Five commonly over-diagnosed conditions and what we can do about them

Five commonly over-diagnosed conditions and what we can do about them

August 17, 2017 8.50am AEST

Some conditions should be classified as normal in some people and don’t need treatment. from http://www.shutterstock.com.au

Over-diagnosis occurs when someone is diagnosed with a disease that wouldn’t harm them, or when treatment does more harm than good. It happens because healthy people are often tested or screened to find the early signs of disease, and because diagnostic technology can see ever-smaller abnormalities.

The problem is that early detection of disease is a double-edged sword. While it can be life-saving, for some people the “abnormalities” that are diagnosed and treated would never have caused harm if left alone.

Researchers are currently investigating the size of this problem, and how many people are over-diagnosed. But existing evidence from Australia and elsewhere suggests it’s a problem across a lot of conditions.

Thyroid cancer

Researchers documented in The New England Journal of Medicine last year that Australia, like other nations including the United States, has experienced a recent tripling of the numbers of people diagnosed with thyroid cancer – many of them with very small tumours.

The problem is, as the researchers explain, many of those small tumours are in fact benign, and many of the people being diagnosed, and then treated with potentially risky operations and drugs, are over-diagnosed.

The NEJM piece estimated over 500,000 people may have been over-diagnosed in the past two decades, across 12 countries, including 10,000 people in Australia.

Some thyroid cancers which are operated on don’t need to be, as they’re benign. from http://www.shutterstock.com

ADHD

There are on-going debates about whether too many children are being diagnosed with and medicated for attention deficit hyperactivity disorder.

A study of almost one million Canadian children found those born in December were much more likely than those born in January to receive an ADHD diagnosis and medication, which could mean immaturity is being pathologised. Researchers concluded:

These findings raise concerns about the potential harms of over-diagnosis and over-prescribing.

Prostate cancer

Concerns about over-diagnosing prostate cancer date back at least 30 years. Many men will die with prostate cancer, rather than of it. Despite evidence of unnecessary diagnoses and over-treatment, the push to test healthy men, with no symptoms, for prostate cancer continues.

While it’s hard to know exactly how many Australian men are over-diagnosed with prostate cancer, recently reported estimates from the US suggest between 20-50% of prostate cancers diagnosed via screening (during the period of screening) may be over-diagnosed – in other words they would not have caused harm if left undetected.


Read more: Most people want to know risk of overdiagnosis, but aren’t told

Costly and harmful: we need to tame the tsunami of too much medicine

Resisting expanding disease empires: why we shouldn’t label healthy people as sick


Polycystic ovary syndrome

Polycystic ovary syndrome is an example of a condition where changes in the definition have greatly expanded the number of people potentially labelled. In a piece published today in the British medical journal, the BMJ, Tessa Copp and colleagues from the University of Sydney show how the proportion of women of reproductive age who could potentially be labelled has jumped dramatically from around 5% using the 1990 definition, to up to 21% when using the 2003 definition.

As the authors suggest, there are concerns many healthy women may be labelled unnecessarily, causing anxiety about their fertility or long-term health. The authors therefore recommended a cautious approach to diagnosing the condition.

Breast cancer

Reflecting uncertainty around exactly how to measure over-diagnosis, there are sometimes wide variations in estimates of the size of the problem. A major independent review of the global evidence suggested 19% of the breast cancers diagnosed during active mammography screening may be over-diagnosed. This means they would not have caused harm to the women because they may be benign.

Previous estimates in Australia suggest the rate could be around 30%.

What can we do about over-diagnosis?

Together with colleagues Thanya Pathirana and Justin Clark, we’ve today published a comprehensive analysis in the BMJ of possible drivers of over-diagnosis and potential solutions. Causes range from cultural beliefs that “more is better” in medicine, to financial incentives driving unnecessary tests and treatments.

The good news is doctors’ groups across the globe – including in Norway, Britain, Canada and now Australia – are now publicly acknowledging the problem of overdiagnosis.

As our BMJ analysis highlights, there are many potential solutions. There’s an urgent need for public information and awareness campaigns. New educational curricula for health professionals are a priority. And screening programs need to be reformed to make sure we’re only targeting those at high risk.

Saffron for the menopause

Archives of Gynecology and Obstetrics

, Volume 297, Issue 3, pp 717–724 | Cite as

Efficacy of Crocus sativus (saffron) in treatment of major depressive disorder associated with post-menopausal hot flashes: a double-blind, randomized, placebo-controlled trial

  • Ladan Kashani
  • Sophia Esalatmanesh
  • Farzaneh Eftekhari
  • Samrand Salimi
  • Tahereh Foroughifar
  • Farnaz Etesam
  • Hamideh Safiaghdam
  • Ehsan Moazen-Zadeh
  • Shahin Akhondzadeh

Abstract

Purpose

Due to concerns regarding the side effects of hormone therapy, many studies have focused on the development of non-hormonal agents for treatment of hot flashes. The aim of this study was to evaluate the efficacy and safety of saffron (stigma of Crocus sativus) in treatment of major depressive disorder associated with post-menopausal hot flashes.

Methods

Sixty women with post-menopausal hot flashes participated in this study. The patients randomly received either saffron (30 mg/day, 15 mg twice per day) or placebo for 6 weeks. The patients were assessed using the Hot Flash-Related Daily Interference Scale (HFRDIS), Hamilton Depression Rating Scale (HDRS) and the adverse event checklist at baseline and also at the second, fourth, and sixth weeks of the study.

Results

Fifty-six patients completed the trial. Baseline characteristics of the participants did not differ significantly between the two groups. General linear model repeated measures demonstrated significant effect for time × treatment interaction on the HFRDIS score [F (3, 162) = 10.41, p = 0.0001] and HDRS score [F (3, 162) = 5.48, p = 0.001]. Frequency of adverse events was not significantly different between the two groups.

Conclusions

Results from this study revealed that saffron is a safe and effective treatment in improving hot flashes and depressive symptoms in post-menopausal healthy women. On the other hand, saffron, with fewer side effects, may provide a non-hormonal and alternative herbal medicine option in treatment of women with hot flashes.

Successful Low Dose Naltrexone Fibromyalgia Trial Points to Safe, Low Cost Therapy; Implications for Chronic Fatigue Syndrome

+100%-In this second of two studies by Stanford researchers on  low dose naltrexone’s effectiveness in Fibromyalgia (FM), LDN was found to  significantly reduce pain and improve mood and quality of life.  About 60% of study participants reported pain reductions of at least 30%. Sleep and fatigue were not affected. The second study, a small placebo-controlled, blinded cross-over study, was a followup to a smaller less rigorous but successful first study three years ago.

Pointing to the three drugs already approved for FM, the researchers suggested  LDN as a possible fourth.

No LDN studies have been done in chronic fatigue syndrome (ME/CFS) and none are underway, but it’s the  first drug Dr. Klimas, a prominent ME/CFS physician, turns to for pain in ME/CFS and fibromyalgia.

Low Dose Naltrexone

Low dose naltrexone is cheap, readily available and safe...but does it work in FM and ME/CFS?

Usually used in high doses to combat alcoholism and narcotics withdrawal, low dose naltrexone is being examined in a variety of  disorders including fibromyalgia, multiple sclerosis and schizophrenia. LDN  blocks the opioid/endorphin receptors in the brain and has the advantage of being cheap (@ $40/month),  readily  available and safe.

LDN been used in fibromyalgia and chronic fatigue syndrome and other disorders for years but only lately have studies begun to examine its effectiveness.  Cheap,  unpatentable and  readily available at compounding pharmacies, LDN is no gold mine for drug companies but could be a boon for patients on a budget.

Despite the lack of interest from drug companies,  23 LDN  drug trials are underway on disorders ranging from fibromyalgia to multiple sclerosis to alcoholism to Crohn’s disease to Schizophrenia.  The American Fibromyalgia Association funded the two Stanford low dose naltrexone fibromyalgia trials.

Why Low Dose Naltrexone Might be Effective in Fibromyalgia  or Chronic Fatigue Syndrome

LDN could be reducing pain and improving mood in several ways.

Endorphin Release – By blocking the receptors for endorphins, one of the ‘feel good’ substances in the brain,  low doses of naltrexone appear to trick the brain in producing more  endorphins. Given that endorphins are known as ‘natural pain relievers’ some of LDN’s effects in FM could be from endorphin related pain relief.  Several studies suggest altered endorphin levels are present in the brains of people with fibromyalgia.

Endorphins are produced by the HPA axis, which is impaired in both ME/CFS and FM, and during such activities as exercise, meditation, sex etc. all of which are probably fairly rare in people with these disorders.

Natural Killer Cell Stimulation  – LDN enhances the responses of natural killer cells, an area of much interest in ME/CFS.

B-cell Inhibition – LDN inhibition of  B-cell activity is intriguing in light of the Rituximab findings and the LDN studies underway in autoimmune disorders such as multiple sclerosis.

Mouse studies found  LDN provided a ‘remarkable neuroprotective effect’ on mice engineered to have autoimmune encephalitis. One third of the mice, for instance, injected with LDN did not show any signs of neurological disturbance (compared to 100% of non-injected mice),   and disease severity was greatly reduced overall.

Glial cells in the central nervous system. Microglial cell activation could be contributing to the pain and fatigue in fibromyalgia and to the neuroinflammation found in other neurological disorders.

Microglial Cell Inhibition – The Stanford researchers believe  fibromyalgia is a neuro-inflammatory disorder characterized by ‘hyper-sensitive’ microglial cells; the main immune cells in the central nervous system.

Structurally similar to the macrophages found in the body, resting microglial cells display little activity but transform themselves, after being activated by inflammation, infection or cell death, into ‘hairy monsters’ that spew out pro-inflammatory cytokines, excitatory amino acids such as glutamate and nitric oxide with glutamate being a primary agent of damage. (Interestingly,  glutamate production appears to be associated with reduced glutathione levels that occur during microglial activation. )

Microglial cells are  responsible for producing neuropathic pain and flu-like symptoms such as pain, fatigue, etc.  (eg sickness behavior). Rodent studies suggest LDN blocks the activity of toll-like receptors (TLR4) found  on the  microglial cells .

 New Drug Target

Microglia produced neuroinflammation could  be contributing  to a wide variety of neurological conditions including multiple sclerosis, Alzheimer’s, traumatic brain injury, Parkinson’s disease and others and researchers are beginning to explore ways to keep microglial cells from becoming over-activated. The authors of this study stated they  expected that new compounds aimed at keeping microglial cells quiet are under development and being tested.

Unfortunately it’s impossible to directly assess microglial functioning in humans but recent advances in positron emission tomography may be peeling away some of the fog currently veiling microglial activity in humans.

A New Class of Neuroprotective  Drugs?

LDN is not the only possible microglial inhibitor that might work in FM or ME/CFS.  Other possibilities include naltrexone’s close relative naloxone, dextromethorphan, 3-hydroxymorphinan and ibudilast. Each of these drugs was developed for other purposes and later found to have microglial inhibiting properties and the optimal doses for each, interestingly enough, is likely to be much lower than suggested for their original purposes.

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In fact the authors  propose that finding the correct dose will play a key role in how effective these drugs are.  The authors expected that testing was probably underway to determine that.

Conclusions

LDN’s availability has kept drug companies from pursuing it but it’s an intriguing option in Fibromyalgia and ME/CFS. It’s no panacea and the latest study suggested it may not be effective against fatigue but chronic fatigue syndrome is also a pain disorder and LDN’s  ability to improve mood and quality of life would be welcome indeed