Cancer and Vitamins

 

Teenagers, MySpace and Risky Behaviors

“A critical weekly review of important new research findings for health-conscious readers…”

 

By, Robert A. Wascher, MD, FACS

 

 

Last Updated:  01/18/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author.  Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

 

CANCER & VITAMINS

 

Regular readers of this column already know that the results of recent cancer prevention research studies have been very disappointing with regards to antioxidant vitamins.  Earlier, and much lower powered, laboratory and epidemiological research had suggested a role for Vitamin C, Vitamin E and beta-carotene in preventing some types of cancer.  However, recent large-scale prospective human clinical trials have not identified any protective role for these vitamins against either cancer or cardiovascular disease.  Now, yet another prospective, randomized, placebo-controlled clinical trial adds its weight to other recently published cancer prevention trials and, once again, the study’s outcomes are not favorable.

 

In this study, just published in the Journal of the National Cancer Institute, 7,627 women were randomly assigned to take daily supplements of Vitamin C, Vitamin E, or beta-carotene, or an identical placebo (sugar pill).  In addition to it prospective, randomized, placebo-controlled design, this study is also laudable for its large cohort of patient volunteers, and for its nearly 10-year duration of follow-up.

 

During the course of this decade-long study, 624 women developed cancer, and 176 died of cancer.  At nearly 10 years of average follow-up, there was no statistically significant difference in cancer risk or cancer-associated deaths among women in any vitamin group when compared with the women in the placebo group.  Vitamin C, Vitamin E and beta-carotene supplements, taken alone or in combination, did not have any significant effect on the risk of developing cancer, or of dying of cancer, when compared to placebo sugar pills.  (There was, however, a non-significant trend towards a decreased incidence of colon cancer in the Vitamin E group, and a non-significant trend towards an increase in lung cancer risk in the beta-carotene group; both of which have been observed in previous studies).

 

As someone who previously held great hope that antioxidant vitamins and other dietary supplements might reduce the risk of both cancer and cardiovascular disease, I really wish that I could report some positive findings in this area of research.  However, increasingly, when subject to the much greater power of “gold standard” prospective, randomized, placebo-controlled clinical research trials, our earlier hypotheses about antioxidant vitamins and cancer prevention simply haven’t held up to this higher level of research scrutiny.  (Which makes other scientifically validated lifestyle approaches to cancer prevention all the more important, as I discuss in much greater detail in my forthcoming book, “A Cancer Guide for the Human Race.”)

 

As the inventory of bottles in my own little plastic tray of vitamins and other supplement continues to shrink in the face of overwhelming research pointing to their lack of benefit, my wife has been able to reclaim more space in her kitchen cabinets, and I have been saving some spare change that I previously spent on Vitamin E, Vitamin C and beta-carotene supplements.

 

TEENAGERS, MYSPACE & RISKY BEHAVIORS

 

Okay, so what parent doesn’t already know what their teenager is likely thinking about much of the time?  We all know that adolescence is a turbulent, intense, hormone-fuelled period when kids begin to question almost everything that their parents have been telling them; and a time when many teens either fantasize or actually engage in risk-taking behaviors.  However, what is different about today’s teens, when compared to my own Baby Boomer generation, is that, through the twin miracles of the Internet and social online networks like MySpace, today’s adolescents can easily tap into a universe of like minds (as well as many nefarious denizens that anonymously lurk everywhere on the Web).

 

A new clinical study, just published in the journal Archives of Pediatric & Adolescent Medicine, provides some disturbing insight into how teens may be using social networking sites, like MySpace, to reveal behaviors associated with sexual content, substance abuse and violence.  In this intriguing study, the researchers analyzed the content of 500 publicly available MySpace profiles of 18 year-old teens in the United States. 

 

Of the 500 MySpace profiles, 54 percent were associated with content specific for risky behaviors.  Twenty-four percent of these 18 year-olds referenced risky sexual behaviors in their online profile, 41 percent made references to engaging in illegal substance abuse, and 14 percent alluded to having engaged in violent acts.  Not surprisingly, female teens were much less likely to make reference to violent behaviors when compared with males.  Teens reporting a non-heterosexual sexual orientation were nearly 5 times more likely to report sexual behaviors when compared to self-reported heterosexual adolescents.  Among the 18 year-olds who reported strong religious feelings or who referenced attending church, discussion of sexual behaviors was 68 percent less common when compared to other teens.  These religious teens were also 62 percent less likely to report illegal substance abuse, and were 88 percent less likely to report violent behaviors.  Likewise, reporting involvement in a sport, or other hobbies, was associated with a significantly lower involvement in risky sexual, substance abuse, and violent behaviors.

 

While this study undoubtedly suffers from “selection bias,” in that it only analyzed a cross-section of adolescent MySpace profiles that were accessible to the general public, it still provides a fascinating window into the online behavior of American adolescents.  (Indeed, one must assume that the prevalence of the self-reporting of risky behaviors by teens who have chosen to keep their profiles confidential is likely to be significantly higher than was identified in this particular study.)  Given the unregulated environment of the Internet, I urge all parents to closely monitor the activities of their children online.  Stay involved with your teens, and keep the lines of communication open, always.

 

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and the Director of Surgical Oncology for the Kaiser Permanente healthcare system in Orange County, California

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher’s Biography

 

Links to Other Health & Wellness Sites

http://doctorwascher.com

All rights reserved.

 

 

Dr. Wascher’s Archives:

1-11-2009:  Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009:  Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

12-28-2008:  Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008:  Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008:  Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer;  Postscript: A Possible Cure for Down’s Syndrome

12-7-2008:  Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008:    A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008:  Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008:  Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008:  Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008:  Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008:  Smoking & Quality of Life

10-19-2008:  Agent Orange & Prostate Cancer

10-12-2008:  Pomegranate Juice & Prostate Cancer

10-5-2008:  Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008:  Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008:  Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208:   Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008:  Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008:  Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008:   Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008:  Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008:  Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008:  Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008:  Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008:  Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008:  Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008:  Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008:  Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008:  Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008:  Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008:  Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008:  Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008:  Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008:  BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008:  Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008:  Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008:  Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008:  Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008:  Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008:  Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity 

3-2-2008:  Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008:  Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008:  Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008:  Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for  Down’s Syndrome?

2-3-2008:  Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008:  Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology’s Gastrointestinal Cancers Symposium

1-20-2008:  Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008:  Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008:  Testosterone Supplements in Elderly Men; Colorectal Cancer– Reasons for Poor Compliance with Screening Recommendations

12-31-2007:  Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007:  Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007:   Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality 

12-11-2007:  Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007:  Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer 

 

Share on digg

RADIATION TREATMENT OF PROSTATE CANCER & RISK OF SECOND CANCERS

Exposure to high doses of ionizing radiation, whether from a nuclear explosion or from radiation therapy for cancer, has long been known to increase the risk of cancer formation.  A growing body of clinical data is helping to further develop our understanding of secondary radiation-induced cancers. 

Much of our current understanding about radiation-induced cancer is based upon long-term observation of the Japanese survivors of the World War II atomic bombings in Hiroshima and Nagasaki.  In particular, an increased incidence of leukemia, myeloma, and cancers of the thyroid, breast, lung, stomach, esophagus, ovary and bladder has been identified in atomic bomb survivors who were close to ground zero.

Following the catastrophic failure of the Chernobyl nuclear reactor in Ukraine, in 1986, an excess of leukemia and thyroid cancer among workers who were involved in the clean-up of the reactor’s contaminated debris has already been documented.

More recently, several studies have reported upon the incidence of secondary cancers in adults who were treated with radiation therapy for lymphoma during childhood and adolescence.  An increased incidence of cancers of the lung and the female breast has been confirmed among patients who previously underwent extended-field chest irradiation (also known as mantle radiation therapy) for Hodgkin’s Lymphoma, and these secondary cancers typically occur 15 to 20 years following treatment.  Rare cancers of the bone and cartilage, called sarcomas, have also been associated with prior radiation therapy treatments.  Now, a new research study suggests that certain forms of prostate cancer radiation therapy may also be linked to an increased risk of subsequent radiation-induced secondary cancers.

Currently, there are several different treatment approaches available for prostate cancer therapy.  Surgery can be performed to completely remove the prostate gland (prostatectomy) when the tumor is still confined to the prostate.  Implants of radioactive seeds, placed within the prostate gland (brachytherapy), can also be used to destroy cancer within the prostate.  External beam irradiation is another form of radiation therapy, but unlike brachytherapy, external beam irradiation is delivered by a machine that concentrates radiation onto the prostate gland from a source external to the body.  Although great progress has been made in fine-tuning the delivery of radiation to the prostate gland with both brachytherapy and external beam irradiation, there is, inevitably, some “collateral damage” that occurs to the organs and tissues that surround the prostate, as it is impossible to confine 100 percent of the delivered radiation dose to the prostate gland alone.

A new study, in the Journal of Urology, evaluated the cancer treatment records of more than 240,000 men who had previously been treated for prostate cancer with prostatectomy, brachytherapy, external beam radiotherapy or a combination of brachytherapy and external beam radiotherapy between 1988 and 2003.  The data for this study was collected from the massive Surveillance, Epidemiology and End Results (SEER) national cancer database, which is maintained by the National Cancer Institute.  This study was conducted by researchers from Columbia University and the Mount Sinai Medical Center. 

In this study, the authors compared the incidence of subsequent cases of cancers of the bladder and rectum occurring in these 243,082 men.  The men who underwent prostatectomy alone, and who did not receive any radiation therapy, essentially served as the “control group” for this study.

An almost insignificant increase in the risk of bladder cancer was seen in the men who underwent brachytherapy alone.  However, there was a more pronounced and statistically significant increase in the risk of both bladder cancer and rectal cancer observed among the men who received either external beam radiotherapy alone or combined brachytherapy and external beam radiotherapy.  Compared to the men who underwent prostatectomy alone, external beam irradiation was associated with an 88 percent increase in the relative risk of developing bladder cancer, and a 26 percent increase in the relative risk of developing rectal cancer.  Among those men who received both brachytherapy and external beam radiotherapy, the relative risk of developing bladder cancer was 85 percent higher than what was observed in the men who underwent prostatectomy alone, while the relative risk of developing rectal cancer was 21 percent higher.  (It should be noted that “relative risk” is a measure of the difference in risk between two patient treatment populations, and is not the same as the “absolute risk” of developing a particular disease.)

In this retrospective study, which involves a relatively short duration of clinical follow-up, external beam irradiation for prostate cancer (either administered alone or in combination with brachytherapy) was associated with a significant increase in the risk of developing subsequent cancers of the bladder and rectum. 

Since most studies of radiation-induced secondary cancers have shown an average biological lag time of 15 to 20 years between radiation therapy and the diagnosis of secondary malignancies, the findings of this study may actually underestimate the long-term risks of secondary bladder and rectal cancers in men who have previously received external beam radiotherapy as treatment for their prostate cancers.  At the same time, however, recent and continuing improvements in the accuracy of radiation therapy delivery have significantly reduced the “innocent bystander” effect, whereby clinically significant doses of radiation are absorbed by the organs that surround the prostate gland (namely, the bladder and the rectum).  As a final note, all retrospective studies that are based upon prospectively collected data, such as this study, are subject to potential biases, including the “completeness” of the clinical data that is present within large databases such as the SEER database.  However, based upon a large body of clinical literature on this topic, the findings of this particular study are not at all surprising, or unexpected.

All patients who are planning to undergo therapy for prostate cancer should first talk with their oncologists about the unique risks and benefits associated with each potential treatment option before choosing the best and most appropriate form of therapy.

 

SEXUAL CONTENT ON TV & TEEN PREGNANCY RISK

Although the effects of violent and sexual content on television, or on video games, on adolescents and young adults is the subject of considerable debate, there are multiple recent studies that appear to substantiate the concerns of many parents who wrestle with these issues.  For example, several clinical research studies have recently found that children who frequently play video games with violent themes are more likely to engage in aggressive or antisocial behavior at school and at home. 

In view of the enormous impact of teen pregnancy on individuals, families and society, many parents and family advocates have viewed with alarm the increasingly unfiltered sexual content present in both movies and television shows.  A new Rand Corporation study, just published in the journal Pediatrics, has concluded that there may well be a significant link between exposure to television shows with sexual content or themes, on the one hand, and the likelihood of pregnancy prior to age 20.  This study was funded by the National Institute of Child Health and Human Development, which is part of the National Institute of Health (NIH).

In this study, data from prospective surveys of teens were analyzed over a 3-year period.  A total of 1,762 adolescents between the ages of 12 and 17 anonymously completed surveys regarding their sexual experiences and their television viewing habits, and the same group of teens then completed the same survey one year later.  The incidence of teen pregnancy in this group of adolescents was monitored for a period of 3 years.

Sexual content in television shows measured by the surveys included: (1) sexually-oriented behaviors such as kissing, intimate touching, and implied or depicted intercourse; and (2) discussions about sexual plans or desires, or about sexual behavior that had already occurred, or “expert advice” about sexually-related topics.

The results of this study demonstrated a linear association between heavy exposure to sexual content on television and the initiation of intercourse and other sexual behaviors during adolescence.  The teens who anonymously admitted to watching the greatest number of sexually-themed television shows were 2 times as likely to initiate sexual intercourse within the following year as were the teens who watched the least amount of sexual content on TV.  In terms of age-related sexual behavior, 12 year-olds who watched the greatest number of television shows with sexual themes engaged in sexual activities at a level comparable to 14- and 15-year-old teens who watched the least number of shows with sexual content.  An especially interesting finding of this study was that television shows that featured only discussions about sexual activities were still associated with an increased likelihood of engaging in intercourse, and in teenage pregnancies, among adolescents viewing such shows. 

Other adolescent behaviors linked with the early initiation of intercourse included: older age, hanging out with older friends, achieving lower grades at school, sensation-seeking behaviors, and rule-breaking behaviors (e.g., skipping classes). 

On the other hand, behaviors most associated with a lower likelihood of intercourse during adolescence included: having parents who monitored their teens’ behavior, having more educated parents, having parents who disapproved of teenage sexual activity, and living with both parents (please note that the greatest deterrents to adolescents engaging in intercourse, based upon the results of this prospective clinical study, involved parent-related factors…).

In this study, an early age at initiation of sexual activity (including intercourse), and the incidence of teen pregnancy, were found to strongly correlate with the extent to which television shows with sexual content (including mere discussions about sexual activities and behaviors) were viewed by teens.  Conversely, minimizing viewing exposures to such television programming, and being supervised by two parents who disapproved of adolescent sexual behavior, was associated with the lowest rates of teen sexual activity and teen pregnancy.

Many parents will respond to the findings of this research study with something along the lines of, “No, duh….”  However, this is the first prospectively conducted research study to confirm what many of us parents have long believed.  My advice is to stay connected with your teens, and stay involved with their lives, even when they demand that you do otherwise.

 

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net
 

To read more of Dr. Wascher’s Health Report columns, please visit his

website at:  http://www.doctorwascher.com

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

 

Share on digg

 

EARLY CHILDHOOD SCREENING PREDICTS LATER BEHAVIORAL PROBLEMS

Significant emotional or behavioral problems are often not detected until affected children begin school.  Moreover, even in moderately severe cases, children with emotional and behavioral problems may not receive appropriate screening and intervention until they have been in school for several years.  Researchers from the University of Connecticut and the University of Massachusetts have just published the results of an interesting study, in the journal Pediatrics, in which they screened children for behavioral and psychological problems at a very early age, and then followed them as they subsequently entered elementary school.

A total of 1,004 socio-economically and ethnically diverse children were evaluated in this study.  The children’s parents completed a standardized Brief Infant-Toddler Social and Emotional Assessment survey when their children were between 12 and 36 months of age (the average age of the children participating in this research study was 24 months).  These children were again evaluated once they entered elementary school, at an average age of 6 years.  Both parents and the children’s teachers participated in this latter evaluation of social and behavioral problems in this large group of children. 

Among those infants and toddlers with evidence of social, developmental and emotional problems detected upon their initial evaluation, 49% were reported, when these children subsequently began elementary school, to have significant behavioral and social difficulties in class, based upon their teachers’ evaluations.  The initial Brief Infant-Toddler Social and Emotional Assessment and Evaluation survey also predicted which babies and toddlers would later develop significant criteria for psychiatric disorders.  Among those infants and toddlers who had evidence of developmental or behavioral difficulties on their initial survey, more than two-thirds (68%) were found to meet the criteria listed for specific psychiatric disorders after reaching elementary school.

As a disclaimer, I will mention that the disciplines of Psychiatry and Psychology are rather unique among the clinical sciences in that it is very difficult (if not impossible) to obtain completely objective research data in clinical research studies such as this one.  Human behavior is extremely complex, variable, and unpredictable.  Thus, unlike research studies that randomize different groups of patients to receive different medical therapies, or studies that involve laboratory experiments, clinical psychiatric and psychological research studies cannot completely control all of the experimental factors that might skew either the resulting data, or, for that matter, its interpretation.  Therefore, I generally do not include such studies in my column.  In this case, however, I chose to include this particular study, because I believe that it may be helpful for some parents (and teachers) to know about its findings.

While I absolutely do not advocate performing routine psychiatric testing on children who do not have any evidence of significant behavioral or psychiatric problems, the results of this study suggest that it may be possible to pick up evidence of significant behavioral or/and psychological problems in the majority of “at risk” children long before they begin their school years.  While not every child with “abnormal” scores on the Infant-Toddler evaluation survey ultimately experienced psychiatric illnesses by the time they reached elementary school, in this study, more than two-thirds of such children were, in fact, subsequently diagnosed with a psychiatric disorder after starting elementary school. 

Perhaps, if identified during late infancy or while still a toddler, children who are at high risk of developing significant emotional or psychiatric illnesses might be able to undergo more intensive early screening and, if appropriate, begin therapy before they start attending school.  If effective therapy is available prior to beginning elementary school for any significant emotional or psychiatric illnesses that are identified early, then these children might have a much more positive and successful experience at school in their later years.

 

PSYCHIATRIC DISORDERS AMONG PARENTS OF AUTISTIC CHILDREN

The incidence of autism in the United States has been, inexplicably and dramatically, rising in recent years.  According to the Autism Society of America, autism is currently diagnosed in 1 of every 150 children born, and approximately 1.5 million people in the US are thought to have an autistic disorder.  Currently, the care of autistic patients is thought to cost around $90 billion per year, and some experts predict that this cost will rise to $200 billion dollars, or more, within the next 10 years.  There is also evidence, from the London School of Economics, that the early diagnosis and treatment of autism can reduce the lifetime cost of caring for such patients by as much as two-thirds (in most cases, the difficulties in communication and social interactions that are the hallmarks of autism can usually be detected within the first 3 years of life).

There is a great deal of debate about the potential causes of autistic disorders.  Recent studies have shown that at least some cases of autism do appear to be linked to specific gene mutations, suggesting that some cases of autism are very likely a result of inheritance.  There has also been a tremendous controversy regarding autism and its link, if any, with childhood vaccinations (and the mumps, measles and rubella, or MMR, vaccine, in particular).  However, multiple rigorous clinical research studies have, so far, failed to find any link between the development of autism and vaccinations.  In most cases, autism is diagnosed during the same age range as when children are beginning to receive their immunizations, and many public health experts have suggested that this factor is the most likely explanation for the apparent onset of the symptoms of autism following vaccinations. 

A new Swedish study, also just published in the journal Pediatrics, takes a look at the incidence of psychiatric illnesses in the parents of children who have been diagnosed with an autistic disorder.  As is the case in most of Scandinavia, and in much of Europe, essentially the entire population has access to universal healthcare provided by the federal government and its contractors.  It is for this reason that huge numbers of patients can be followed in clinical research studies in such countries, as a wide range of clinical data is routinely entered into central public health databases, even in countries with relatively small populations. 

This particular study was the result of collaboration between researchers from Sweden’s famed Karolinska Institute, the University of North Carolina at Chapel Hill, and the Mount Sinai School of Medicine here in New York.  Using the Swedish Medical Birth Register and the Swedish Multi-Generation Register, and other centralized public health databases, the researchers identified 1,227 children born between 1977 and 2003 who were subsequently treated for an autistic disorder.  For comparison purposes, more than 30,000 other children born during the same interval, but without any history of autism, were also included in this research study.  The researchers were then able to further assess this public health data to determine the incidence of treatment for psychiatric disorders among the parents of both groups of children born between 1977 and 2003 (editorializing for a moment here, and needless to say, conducting a study like this is never likely to be approved here in the United States).

In this study, the incidence of mental health disorders among the parents of autistic children was found to be significantly greater than what was observed among the parents of the much larger “control” group of parents of non-autistic children.  Specifically, schizophrenia was found to be more common in both mothers and fathers of autistic children, while depression and personality disorders were found to be more common among mothers of autistic kids, only.

While the results of this study, as with previous studies, suggests that at least some cases of autism might be inherited (and might be associated with other psychiatric disorders that are also thought to be heritable), one must be very careful in drawing conclusions from this data.  Certainly, caring for a child with autism, or other serious mental or physical illnesses, is a tremendously taxing and stressful undertaking.  I can easily imagine that parents who are faced with, potentially, the lifelong care of a severely disabled child could rather easily succumb to the stresses of such demands by developing emotional or psychiatric illnesses themselves. 

Unfortunately, this study, which was based solely on confidential public health records in Sweden, cannot tell us very much about the details of mental illness among parents of autistic children.  Also, as I have already mentioned, virtually all clinical studies involving psychiatric testing and evaluation are associated with a significant likelihood of subjectivity and bias, due to the inherent complexity of assessing human behavior and personality.  All of these disclaimers aside, this study still suggests that at least some significant percentage of autism cases may be linked to specific genetic factors which, in turn, may also be associated with other psychiatric illnesses within families.  The recent identification of specific gene mutations associated with at least some cases of autism also suggest that many (but not all) cases of autism are likely to be the result, at least in part, of specific and potentially heritable genetic factors.

 

SOCIAL & PSYCHIATRIC PROFILES OF YOUNG ADULTS BORN PREMATURELY

As neonatal intensive care units have become increasingly sophisticated in caring for extremely premature babies, more and more of these tiny infants are surviving into adulthood.  There have been numerous clinical research studies published about this group of patients, with some studies finding a significant increase in the incidence of lifelong physical and mental health difficulties among those who were very premature at birth.  As is often the case with public health research, there have also been quite a few studies published that have suggested that most people who were born prematurely do just fine if they survive into adulthood.

A new Dutch study in the Journal of Pediatrics, which was part of a larger ongoing study of children and adults born prematurely, evaluated 656 healthy adolescents who were born very prematurely, and compared them with their same-age peers with respect to general lifestyle, risk-taking behaviors, the presence of psychiatric disorders, and social interactions. 

Interestingly, both the teenage boys and teenage girls who had been born prematurely were less likely to smoke than their peers who had been born after a full-term pregnancy.  The teenage boys born prematurely were also less likely to drink alcohol than their full-term counterparts, while the adolescent girls who were born prematurely consumed alcohol as often as the girls who were born at full-term.  Lifetime illicit drug use was also significantly less common among the teens (boys and girls) who were born prematurely, when compared to their full-term birth peers.  With the notable exception of using public transportation without paying the fare… the adolescents born prematurely were far less likely to be involved in criminal activity than the kids who born at full-term.  Although the boys born prematurely appeared to experience greater difficulty in establishing relationships than their full-term peers, on the whole, the incidence of psychiatric disorders did not differ significantly between the two groups of adolescent boys and girls.

Healthy adolescents who were born “very pre-term,” or at a “very low birth-weight,” like those who were included in this study, represent a very select subgroup of young adults who have managed to grow and thrive, and to achieve excellent overall health, despite severe prematurity at birth.  In this particular subgroup of young adults born very prematurely, risk-taking behavior appeared to be less common than was observed in the general population.  At the same time, increased difficulties with initiating new relationships appeared to be more common among the teens who were born prematurely, especially among the boys.  While the explanations for these differences in social behavior between the two groups of teens is not unclear, they are nonetheless intriguing and worthy of further study.

 

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center:

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html

Send your feedback to Dr. Wascher at:  rwascher@doctorwascher.net

http://www.doctorwascher.com

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

Share on digg

  BENEFITS OF FULL DRUG COVERAGE FOR MEDICARE RECIPIENTS AFTER HEART ATTACK? 

Patient compliance with medications following a heart attack has been shown to improve survival.  However, recent studies (please see my column for 3-2-08) have pointedly confirmed that many patients stop having their heart medications refilled within a year or two of their heart attack.  With an estimated 47 million uninsured people in the United States, and many millions more with inadequate healthcare insurance, it is not surprising that many patients decide to stop taking costly medications.  A new study in the journal Circulation has examined the potential benefits (in terms of additional years of quality life added and costs associated with the treatment of cardiovascular disease) of eliminating out-of-pocket medication costs for Medicare beneficiaries.   

Using complex statistical modeling, the researchers considered the potential benefits of providing 100% drug coverage for the following types of  cardiac medications:  aspirin, beta-blockers, ACE inhibitors and blockers, and statins.  When considering the current Medicare Part D medication coverage plan, patients enrolled in this plan at the time of their heart attack were projected to live, on average, an additional 8.21 quality-adjusted life-years, while incurring an average of $114,000 in medical treatment-related costs.  However, based upon a hypothetical 100% drug coverage model, which assumes that all patients will take their medications as prescribed (i.e., because out-of-pocket costs for drugs are eliminated), additional quality-adjusted life-years following heart attack was estimated to rise to 8.56, while total costs associated with medical treatment was estimated to be $111,600 per patient.  Thus, based upon this statistical model, switching to a 100% drug coverage benefit for Medicare patients, following a heart attack, might be expected to both extend lives and decrease the cost of medical care for individual patients (although the anticipated increase in lifespan, with the addition of 100% medication coverage, would actually nullify any significant overall cost savings, according to the results of this study). 

Of course, it is one thing to try and hypothetically estimate the costs and benefits that might arise from a change in existing drug benefits coverage, but the reality would almost certainly be a bit more complicated.  First, and foremost, the high cost of medications is not the only factor that has been linked to poor patient compliance with medications.  Medication side effects and the inconvenience associated with taking multiple medications are also well-known significant impediments to patient compliance.  It is unlikely that compliance with medications will ever reach 100% in any substantial population of patients, even with a 100% drug benefit.  Additionally, the administrative costs associated with transitioning to this enhanced drug benefit plan, were it ever to be enacted, might further siphon off some of the individual patient savings projected by this study.  Finally, as a physician who treats a large volume of patients from socioeconomically depressed communities, I have to wonder if physician prescribing patterns might also change if patient co-pays were no longer required for medications.  In my own case, when presented with the option of several equally effective drugs for patients, I try to select older, generic medications for my patients, in order to reduce their out-of-pocket expenses.  If co-pays were completely eliminated, I wonder how many physicians would then adopt a “sky is the limit” approach to prescribing medications. 

Despite my reservations regarding this study’s projected benefits from implementation of a full drug coverage plan for Medicare patients, there is no doubt but that the skyrocketing costs of medications, and mandatory patient co-pays for these medications, cause many patients to stop refilling their prescriptions.  Undoubtedly, the elimination of patient co-pays would indeed significantly improve patient compliance with their prescribed medications.  On the other hand, the Medicare entitlement plan is projected to become insolvent if current and predicted expenditures are not radically reduced.  Unfortunately, there is no easy answer for the inherent conflict between limited healthcare budgetary resources and spiraling healthcare costs.  From a purely clinical perspective, however, I would strongly favor 100% medication coverage for the poor and elderly, as these are the patients who would benefit the most from such coverage.

PARENT-TEEN CONVERSATIONS ABOUT SEX 

Every parent I have ever known has dreaded having “The Talk” with their teenage son or daughter about the birds and the bees.  It is no secret that many parents find the topic embarrassing and uncomfortable to discuss with their progeny.  At the same, the pressure on teens to engage in sexual activity has never been greater than it is in our current sex- and body-obsessed culture.  Recent studies have suggested that as many as 1 in 4 teenage girls have already become infected with sexually transmitted diseases in the United States, and in certain inner city and minority populations, the incidence of sexually transmitted diseases in teenage girls may actually be as high as 50%.   

A great deal has already been written about the best approach to having this critically important discussion with your son or daughter, although most of us parents already understand that there is simply no perfect way to actually go about it.  However, a new study in the journal Pediatrics does provide some helpful clinically-based evidence about how to talk to your teenager about sexual topics. 

In this study, 312 adolescents, and their parents, participated in a randomized, controlled clinical research trial involving structured interventions in parent-teen communication about sexual topics.  The teens completed surveys at the beginning of the study, and then at additional specified intervals after the interventions were completed.  At each survey, teen respondents had to report the extent (if any) of parent-teen discussion of each of 22 specific sex-related topics.  The study’s two primary endpoints were the number of times that parents and teens engaged in discussion of sexual topics, and the number of times that each specific topic was discussed.   

Based upon the surveys completed by the teens, repeated discussions of sexual topics with their parents were associated with a closer relationship between parents and their teens, and a higher level of communication between them (both in general and in terms of discussing sexual topics).  Teens who reported that they did not have repeated discussions with their parents about sexual topics reported a much lower level of feeling close to their parents, and a lower level of openness between them and their parents in discussing sex-related themes.  Those adolescents who reported discussing the greatest number of specific sex-related topics with their parents also reported a significantly greater sense of openness of communication with their parents than did the teens who reported that fewer specific topics were discussed.   

While the results of this study appear rather intuitive, they nonetheless reinforce the importance of repetitive discussions, between teens and their parents, about sex-related topics.  In this clinical study, both repetition and increased breadth of discussion appeared to be associated with an enhanced teen-parent level and openness of communication, both with respect to discussing sex-related topics and in general communication as well.  While these sensitive but very important discussions can leave both parents and teens feeling a bit uncomfortable initially, an open, honest, and repetitive approach to such discussions appears to work the best.  

SOY (GENISTEIN) & PROSTATE CANCER 

The effects of so-called “natural products” on disease prevention is an area of great interest to me, and to millions of other health-conscious people.  An area of particular interest to me is the prevention of cancer through lifestyle modification, including dietary habits and natural supplements.  (Estimates by public health experts have suggested that up to 80% of all cases of cancer might be prevented by lifestyle changes alone.)  At the same time, the dietary and “nutritional” supplements industry, with its multi-billion dollar annual sales, continues to promote its products as having significant disease preventing properties, even though the scientific evidence for such claims is often weak, or altogether absent.  With these facts in mind, one must be very careful to maintain a healthy level of skepticism about the myriad claims made by the manufacturers of many of these supplements, or by enthusiastic supporters of such products.  With these cautionary statements in mind, an interesting new prostate cancer research study appears in the current issue of the highly respected journal Cancer Research.   

Genistein, which is found in soy-derived foods and products, has been the subject of intense cancer-related research.  A member of a class of plant-derived substances known as isoflavones, genistein has been found to have antioxidant properties, as well as weakly “estrogenic” effects, which mimic the effects of the dominant female hormone estrogen.  Additional research has also shown multiple other biological effects for genistein, as well.   

A great deal of genistein research has been directed at the two human cancers that are most closely linked with exposure to female and male sex hormones: breast cancer and prostate cancer, respectively.  Unfortunately, as is very common in clinical research, the findings of many of these studies have often provided contradictory results.  In this new study, human prostate cancer cells were implanted into immune-deficient mice, and the effects of dietary genistein supplementation in these mice was then studied. 

The mice were divided into two groups: one group received genistein supplements and the other group was fed only standard “mice chow.”  Blood levels of genistein were measured, and the mice receiving genistein were confirmed to have circulating blood levels of genistein comparable to those seen in men taking genistein supplements.   

The findings in this animal model were rather dramatic.  Although the implanted tumors in the mice receiving genistein supplementation continued to grow just as much as they did in the mice not receiving genistein, the spread of tumors to other organs in the mice receiving genistein was reduced by an astounding 96% when compare to the mice that did not receive this isoflavone supplement.   

These results are very intriguing as prostate cancer, as with most other types of cancer, causes death primarily as a consequence of tumor spreading throughout the body (also known as metastasis).  Although genistein supplementation did not appear to reduce the growth of the implanted primary prostate tumors in these mice, a nearly 100% reduction in tumor metastasis was observed.  Whether this effect is long-lasting or not cannot be determined from this clinical study.  Just as importantly, this study cannot tell us whether or not similar beneficial genistein-associated effects will also occur in humans with prostate cancer.  However, ongoing and recently completed human clinical research trials will, hopefully, provide important answers to these and other important clinical questions.  

Dr. Wascher is an oncologic surgeon, professor of surgery, a widely published author, and the Director of the Division of Surgical Oncology at Newark Beth Israel Medical Center

http://www.sbhcs.com/hospitals/newark_beth_israel/mservices/oncology/surgical.html 

Doctor Wascher’s Home Page:   http://doctorwascher.com 

Send your feedback to Dr. Wascher at rwascher@doctorwascher.net
 

Copyright 2008.  Robert A. Wascher, MD, FACS.  

All rights reserved.

Share on digg