Could Nick Clegg be the cure for cancer

Posted in Uncategorized on July 2, 2013 by drgscancercorner

Liberal Democrat leader Nick Clegg’s ability to maintain an upright posture, despite the complete absence of any spine, has long puzzled doctors.

Scientists are now examining the politician’s DNA for clues to this gravity defying ability. It is highly likely, according to a spokesman for the Wolfson Medical Research Institute in London, that significant advances could arise from this work in the biology of aging and possibly even in the discovery of new cures for cancer.

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It’s good to be back, now the court

Posted in Uncategorized on July 2, 2013 by drgscancercorner

It’s good to be back, now the court restrictions have been lifted at long last.

Where to start though…

“Can you catch cancer from foreigners,” is a question I’m often asked in my professional capacity and the answer of course is that you can’t. However, that doesn’t mean we should be letting them into our country willy nilly.

I can’t see anythiong wrong with the current proposal that doctors should act like border officials and police availability of the NHS for people clearly not entitled to it. You try getting access to private medicine without them checking out in advance that you’ve got the wonga to pay for it.- they don’t have any reservations about being the gatekeeper then. Same should apply to the NHS.

 

Talk about bad timing

Posted in Uncategorized on February 12, 2010 by drgscancercorner

Greak Bleak

Posted in Uncategorized on February 12, 2010 by drgscancercorner

Ever bought a greek fridge or a greek tellie?

Exactly….just how sustainable is an economy based on only olives and retsina (and donkey bumming)?

Which one of these would they rather spend the night with now?

Is it always wrong to provide futile CPR?

Posted in Uncategorized on February 12, 2010 by drgscancercorner

….the title of a piece in this week’s New England Journal of Medicine (362;6,2010,p477) from  a pediatric ICU specialist at Harvard.

He describes a case of (ultimately unsuccessful) CPR on a two year old boy with devastating neurological disability which was instituted largely as a consequence of the parents’ insistence on aggressive management of this particular patient, in the face of consistent recommedations from the hospital staff for palliative treatment only.

This particular physician asks himself  “given the already heavy workloads of physicians and nurses, is it reasonable to pull some of the hopsital’s most senior and experienced clincians away from their duties to engage in a “sham” procedure, potentially compromising the care of other patients?”

After much deliberation, he concludes that at the point of an approaching, and ultimately inevitable, death, “there are times when the interests of the patient begin to wane, whilst those of the family intensify” Surving family members must live forever afterwards with the psychological trauma of death and decisions they made, considering that “actions surrounding the moment of death are highly symbolic and often of great significance to the survivng family”.

In this situation, sometimes “the interests of the surving family members may take priority”.

Unsurprisingly, given the diverse moral and medical dimensions at play here, there is no consensus on the ethics of performing futile CPR. As the author points out, even hospitals under the same (Harvard Medical School) aegis, have disparate policies,  with some permitting clinicians to refuse non-beneficial CPR whereas others insist in universal agreement of all parties before CPR can be withheld.

The article concludes that whilst “decision making in medicine is likely to become even more complex as clinical practice becomes increasingly directed by guidelines, outcomes research and comparative-effectiveness analysis………………….in a small number of cases providing nonbeneficial CPR can be an act of sincere caring and compassion”

Futile CPR thus has a limited, but legitimate, place in the practice of medicine??

Where has the bit on Mrs PK gone?

Posted in Uncategorized on February 9, 2010 by drgscancercorner

That was my favourite section

Message from Missouri?

Posted in Cancer, Drugs on February 9, 2010 by drgscancercorner

The Missouri Divison of Tourism slogan is “Close to home. Far from ordinary”

Well…if Missouri is your home, then your sperm at least may turn out to be  far from ordinary.

Why…?….well….sperm counts, both qualitatively and quantitatively, have shown progressive annual declines over the past few decades, not just in Missouri, obviously, but in North America generally (and Europe too, come to that):

Causative concern has centred around the enormous numbers of both pesticide and importantly non-pesticide synthetic chemicals present in the environment these days. These latter ones (phthalates, for example) can leach out of plastics, carpets, and fabrics into air, rainwater, and food. Nowhere, seemingly, is safe from these noxious nasties. They are even present in many of the lotions, potions, and perfumes with which we cover ourselves and, as if that weren’t enough,  they can also emanate from exhaust, cigarette, and car fumes.

 Fertile men in an agricultural area of Missouri for example have been shown to have sperm counts about 40% lower than men in three urban US areas, and to have higher urinary concentrations of three currently used pesticides. The study didn’t however mention whether they wore a lot more perfume than their city counterparts. Similarly, direct measurement of certain phthalate metabolites is significantly related to reduced semen quality in men, endometriosis in women,and shorter gestation periods in pregnant women.

One way of attempting to counteract all of this potential damage, apart from the avoidance of agricultural openings in Missouri, has been the copious consumption of anti-oxidants, such as vitamins C&E, selenium, zinc, CoQ10 and so on. These free radical scavangers mop up the dangerous damaging agents, thus limiting the havoc they can otherwise reek.

But even this is not as straight forwards as it seems.

 A study published a few years ago – the Supplementation in Vitamins and Mineral Antioxidants (SUVIMAX) study, which involved about 13,000 people, found a 4-fold higher melanoma risk in women — but not in men — who used nutritionally appropriate doses of antioxidant supplements (J Nutr. 2007;137:2098-2105).

But additional data, published last year, from the Vitamins and Lifestyle (VITAL) study, which involved more than 70,000 people, suggest that there is no association between the use of antioxidant supplements and an increased risk for melanoma. Individuals who used multivitamins and supplemental antioxidants, including selenium, zinc, and beta carotene, did not have a higher risk for the disease.

VITAL was conducted in direct response to SUVIMAX, the latter finding that a combination of commonly used antioxidant supplements (120 mg of vitamin C, 30 mg of vitamin E, 6 mg of beta carotene, 100 μg of selenium, and 20 mg of zinc), taken for a median of 7.5 years, increased the incidence of melanoma, but only in women.

The VITAL study involved 37,382 men and 40,337 women, aged 50 to 76 years, between October 1, 2000 and December 31, 2002.

Although two-thirds of participants were either current or past users of multivitamins there was no association between melanoma risk and any multivitamin exposure variables, including overall use, duration of use in the previous 10 years, dose in pill-years, or years of use since the age of 21.

The study found that even in the highest dose category of multivitamins, which was comparable to the doses of vitamin E, vitamin C, and zinc in the SUVIMAX study, there was no increased risk for melanoma. No differences between sexes were observed; in men, relative risk (RR) was 1.09 (95% CI, 0.83 – 1.43) and in women, RR was 1.14 (95% CI, 0.78 – 1.66; P = .93 for interaction).

In a separate examination, the authors observed no increased melanoma risk with the use of supplemental beta carotene (RR, 0.87; 95% CI, 0.48 – 1.56) or selenium (RR, 0.98; 95% CI, 0.69 – 1.41) at doses comparable to those in SUVIMAX.

The VITAL studydid however have some limitations, including the absence of detailed information about several of the known melanoma risk factors and the fact that antioxidant use was based on self-reporting, and not biological measurement.

So which is the better bet  then- VITAL or SUVIMAX ?

Data in patients already diagnosed with cancer is mixed, but on balance seems to suggest that anti-oxidant may be more detrimental than advantageous.

Research into the relationship  between antioxidant consumption  and cancer risk has produced conflicting conclusions. However, data suggest that the use of antioxidants by individuals who already have cancer might negatively affect outcomes. The use of selenium supplements for example might adversely affect the prognosis of patients with prostate cancer.

Some studies have shown that antioxidant supplementation during radiotherapy decreases local tumor control and negatively affects survival of cancer patients, whereas others suggest that some antioxidants enhance the effect of some chemotherapy regimens and/or decrease their toxicity without reducing efficacy (J Natl Cancer Inst. 2008;100:773-783).

Recent experimental data ( Nature , August 2009)  give some insight into how antioxidants promote the survival and proliferation of cancer cells. According to the syudy from  the Department of Cell Biology at Harvard Medical School, normal epithelial cells will die if they are detached from the structurally supportive extracellular matrix. However, in breast cancer, oncogenes such as ERBB2 can provide survival signals to detached tumorigenic cells. Metabolic defects caused by cell detachment can also be rescued by ERBB2 and critically also by antioxidants.

These findings suggest that antioxidant activity may promote the survival of preinitiated tumor cells in unnatural matrix environments and thus enhance malignancy. The antioxidants appear to work by boosting cellular energy levels through fatty acid oxidation.

So….as with all things in life, it is a balance.

Maybe judicious usage of vitamin supplements and the avoidance at all cost of large tracts of agricultural land is the way to go?