Coffee may come with a cancer warning in California

(CNN)California coffee shops may soon be forced to warn customers about a possible cancer risk linked to their morning jolt of java.

The state keeps a list of chemicals it considers possible causes of cancer, and one of them, acrylamide, is created when coffee beans are roasted.
A lawsuit first filed in Los Angeles County Superior Court in 2010 by the nonprofit Council for Education and Research on Toxics targets several companies that make or sell coffee, including Starbucks, 7-Eleven and BP. The suit alleges that the defendants “failed to provide clear and reasonable warning” that drinking coffee could expose people to acrylamide.
    The court documents state that, under the California Safe Drinking Water and Toxic Enforcement Act of 1986, also known as Proposition 65, businesses must give customers a “clear and reasonable warning” about the presence of agents that affect health– and that these stores failed to do so.
    In addition to paying fines, the lawsuit wants companies to post warnings about acrylamide with an explanation about the potential risks of drinking coffee. If the suit is successful, the signs would need to be clearly posted at store counters or on walls where someone could easily see them when making a purchase.
    Raphael Metzger, the attorney representing the nonprofit, said it really wants the coffee companies to reduce the amount of the chemical to the point where there would be no significant cancer risk.
    Coffee has been much studied over the years, and research has shown that itprovides several health benefits, including lowering your risk of early death. It may reduce your risk of heart disease, multiple sclerosis, type 2 diabetes, Alzheimer’s and even some cancers like melanoma and prostate cancer. However, a review by the International Agency for Research on Cancer, a branch of the World Health Organization, found that drinking very hot beverages was “probably carcinogenic to humans” due to burns to the esophagus; there was no relation to the chemical acrylamide.
    The science on human exposure to acrylamide still needs “future studies,” according to a 2014 review of scientific research on the chemical’s relationship to a wide variety of cancers in the Journal of Nutrition and Cancer.
    In addition to coffee, acrylamide can be found in potatoes and baked goods like crackers, bread and cookies, breakfast cereal, canned black olives and prune juice, although its presence is not always labeled. It’s in some food packaging and is a component of tobacco smoke. According to the National Cancer Institute, people are exposed to “substantially more acrylamide from tobacco smoke than from food.”
    In 2002, the International Agency for Research on Cancer classified acrylamide as a group 2A carcinogen for humans based on studies done in animals. Studies done on humans have found “no statistically significant association between dietary acrylamide intake and various cancers,” according to the 2014 research review.
    A few additionalstudies have seen an increased risk for renal, ovarian and endometrial cancers; however, “the exposure assessment has been inadequate leading to potential misclassification or underestimation of exposure,” according to the 2014 research review.
    Even the studies showing cancer links between acrylamide in rats and mice used doses “1,000 to 100,000 times higher than the usual amounts, on a weight basis, that humans are exposed to through dietary sources,” the research review said.
    Humans are also thought to absorb acrylamide at different rates and to metabolize it differently than rodents, earlier research showed.
    The National Toxicology Program’s Report on Carcinogens considers acrylamide to be “reasonably anticipated to be a human carcinogen.”
    The Food and Drug Administration website says it “is still in the information gathering stage” on the chemical, but the FDA gave consumers suggested ways to cut it out of their diet. The FDA also provided guidance to the industry intended to suggest a range of approaches companies could use to reduce acrylamide levels. The recommendations are only a guide and are “not required,” according to the website.

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    California added acrylamide to its carcinogen list in January 1990, and the state has successfully taken companies to court over it.
    In 2008, the California attorney general settled lawsuits against Heinz, Frito-Lay, Kettle Foods and Lance Inc. when the companies agreed to reduce the levels of acrylamide found in potato chips and French fries.
    In 2007, fast food restaurants in California posted acrylamide warnings about fries and paid court penalties and costs for not posting the warnings in prior years.
    “We have a huge cancer epidemic in this country, and about a third of cancers are linked to diet,” Metzger said. “To the extent that we can get carcinogens out of the food supply, logically, we can reduce the cancer burden in this country. That’s what this is all about.”

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    Here’s the Drug Trump Uses to Treat Male Pattern Baldness

    Two weeks ago, White House physician Ronny Jackson issued a highly anticipated statement on President Donald Trumps health following a complete physical exam. Trump, Jackson claimed, is in excellent health with no concern of physical or cognitive decline.

    Jackson also revealed that, in addition to cholesterol medication and a multivitamin, the president pops the oral supplement finasteride (often sold as the brands Propecia, Propecia Pro-Pak, and Proscar) to treat male-pattern baldness. While the use of finasteride to help prevent male-pattern baldness is not newit was first approved for treating prostate enlargement in 1992 before being rebranded and sold in 1997 as a hair-loss drugit has come under fire in recent years for its supposed extreme side effects. In 2015, Merck, the drugs manufacturer, was hit with multiple class-action lawsuits alleging the drug caused severe sexual and emotional side effects.

    According to Dr. Nikki Hill, a board-certified dermatologist and hair-loss specialist based in Tucker, Georgia, using finasteride in FDA-approved doses (1 milligram) is not harmful for the vast majority of her patients.

    About 2 percent of men in their twenties have sexual side effects, Hill told The Daily Beast. Occasionally, Hills patients will report decreased sperm volume after taking the drug and sometimes even bouts of depressionbut that side effect is thankfully rare, Hill says. Ive had maybe three people in six years tell me that they feel a little more depressed, but they dont know if its circumstantial or due to taking the medicine. I end up taking them off it [if they report depression] just to make sure. The FDA lists depression as a possible side effect of finasteride on its website (PDF).

    Finasteride works by blocking an enzyme that converts testosterone to dihydrotestosterone, or DHT. Paradoxically, DHT is the hormone responsible for sexual function and hair growth earlier in life. But as men age and their testosterone decreases, an imbalance of testosterone and DHT can actually cause hair follicles to shrink, inhibiting new hair growth.

    In the past few years, however, a growing number of patients are reporting severe neurological side effects after taking finasteride so many that the National Institutes of Health (NIH) recognizes Post-Finasteride Syndrome on their list of genetic and rare diseases. Patients suffering from so-called Post-Finasteride Syndrome have reported mental and neurological side effects, like depression, suicidal ideation, anxiety, and impaired memory, and have reported such symptoms even after several months of discontinuing the drug. But these claims make little sense to most dermatologists.

    Finasteride has a very short half-life, said Dr. Nicole Rogers, a board-certified dermatologist and assistant clinical professor of dermatology at Tulane University. The drug is fully metabolized within a week, so for people with Post-Finasteride Syndrome to be reporting decreased libido and brain fog, and having it continue despite stopping the drugfrom a neurological perspective, we dont really understand why that would be.

    According to Rogers, finasteride is one of the most potent drugs on the market, and only one of two FDA-approved methods for hair loss (minoxidil, or Rogaine, being the other). While Rogaine needs to be applied to the hairline topically, finasteride is generally taken as an oral medication, which patients prefer since Rogaine can leave them looking greasy. Whats more, finasteride is typically much more effective. It can be a miracle medicine for people who take it, said Rogers, though she cautions that if patients are already prone to anxiety, depression, or have a family history of erectile dysfunction, this may not be the treatment for them.

    In addition to possible sexual and neurological side effects, increasing the risk of high-grade prostate cancer may also be a concern.

    Nobody who has a strong family history of prostate cancer should go on this medicine, Hill said. And if they do, they need to be closely monitored. According to Hill, doctors are able to screen patients for prostate cancer by checking the level of a chemical called PSA, or prostate-specific antigen, in the bloodstream. Finasteride, however, has been shown to artificially lower the numbereven when prostate cancer is present.

    If youre taking finasteride, let your doctor know, and have digital rectal exams to assess prostate cancer, rather than a blood test, Hill suggested. If theres a family history of prostate cancer in my patients, I find other alternatives [to finasteride] because theyll be tested at a younger age, and their PSA levels are very important.

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    Aid-in-dying advocates target next battleground states

    (CNN)When the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way.

    Kligler, who lives in Falmouth, Massachusetts, serves as one of the public faces for the national movement supporting medical aid in dying, which allows terminally ill people who are expected to die within six months to request a doctor’s prescription for medication to end their lives.
    Efforts to expand the practice, which is legal in six states and Washington, D.C., have met with powerful resistance from religious groups, disability advocates and the medical establishment.
      But in Massachusetts and other states, doctors groups are dropping their opposition — a move that advocates and opponents agree helps pave the way to legalization of physician-assisted death.
      The American Medical Association, the dominant voice for doctors nationwide, opposes allowing doctors to prescribe life-ending medications at a patient’s request, calling it “fundamentally incompatible with the physician’s role as healer.”
      But in December, the Massachusetts Medical Society became the 10th chapter of the AMA to drop its opposition and take a neutral stance on medical aid in dying.
      Most of those changes occurred in the past two years. They proved a pivotal precursor to getting laws passed in California, Colorado and Washington, D.C., said Kim Callinan, chief program officer for Compassion & Choices, an advocacy group that supports legalization efforts around the country. The practice is also legal in Washington, Oregon, Vermont and Montana.
      The shifts come as doctors’ views evolve: Fifty-seven percent of U.S. doctors supported medical aid in dying in a 2016 Medscape survey, up from 46 percent in 2010.
      Because of the medical society’s vote, Massachusetts is the state most likely to legalize medical aid in dying this year, predicted David Stevens, CEO of the Christian Medical & Dental Associations, a national group of 19,000 health professionals that has opposed such laws in every state.
      “I think a neutral stance is probably what’s going to push it over,” he said.
      Doctors’ opinions are also playing a role in New York, where the New York State Academy of Family Physicians endorsed an aid-in-dying bill, and the state medical society is surveying its members on the subject.
      Efforts to legalize the practice have faced pushback nationally: Last year, lawmakers in 27 states introduced aid-in-dying bills, and none passed. And in Congress, Republican lawmakers have launched several attempts to block the District of Columbia from implementing its law.
      This year, Compassion & Choices’ Callinan identified New Jersey, New York and Massachusetts as its top three target states.
      Peg Sandeen, executive director of Death With Dignity National Center, an aid-in-dying advocacy group based in Oregon, cited Hawaii as another top target. Advocates there are “trying to break the logjam in the legislature,” where the state Senate passed a bill in March, she said. Hawaii came close to legalizing the practice in 2000.
      Massachusetts has been a fraught battleground for the right-to-die movement: In 2012, opponents narrowly defeated a referendum that would have legalized the practice. Home to a robust medical hub and Harvard Medical School, the state is a stronghold for academic medicine.
      Kligler, who’s 66, has publicly described his intent to use lethal drugs to die on his own terms rather than endure what he expects to be several months of significant pain, fatigue and declining quality of life.
      Kligler said he wants other dying people to have the same option: When he used to serve as a hospice physician to cancer patients, he said, patients used to “ask me to help them to die,” but he had no legal way to do so. Kligler is also suing Massachusetts, arguing that terminally ill patients have a constitutional right to medical aid in dying.
      “It’s a question of justice,” Kligler said.
      When the Massachusetts Medical Society surveyed members last year, 60 percent said they supported medical aid in dying, and 30 percent said they opposed it.
      Dr. Barbara Rockett, a surgeon and past president of the medical society, urged fellow doctors to uphold the group’s long-standing opposition to the practice. Doctors should focus on helping dying patients through hospice and palliative medicine, she said.

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      “To intentionally help them commit suicide is wrong,” Rockett said. Proponents, meanwhile, say the practice is not “suicide” because the patient is already being killed by a terminal disease.
      Rockett said she was disappointed that her fellow delegates in the society voted to adopt a neutral stance.
      Even with the doctors group stepping out of the way, the latest aid-in-dying bill, dubbed the Massachusetts End of Life Options Act, faces formidable opposition. Catholic groups, a significant force opposing aid in dying nationally, have a robust base in Massachusetts: Over a third of residents are Catholic, second only to Rhode Island.
      Catholic groups provided much of the $5.5 million that opponents spent to defeat Massachusetts’ ballot referendum in 2012, outspending proponents by nearly 5-to-1.
      The Boston Archdiocese did not respond to repeated requests for comment for this story. But at the time the referendum failed, a spokesman said the church could not afford to lose on this issue in a Catholic stronghold: “If it passes in Massachusetts,” the spokesman said, “it’s a gateway to the rest of the country.”

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      Cancer Diagnosis from a Blood Draw? Liquid Biopsies Are Still a Dream

      Nick Papadopoulos tracks down tumors for a living. Not with X-rays or CT scans, but with DNA. The oncologist and director of translational genetics at the Johns Hopkins Kimmel Cancer Center has spent decades uncovering the unique sets of mutations that define cancers—the kind of genetic signals that not only drive tumor formation and metastasis, but distinguish one cancer from another. And now, he’s working to develop a test that could sniff out those signals before a patient starts to get sick.

      It’s the kind of test that Papadopoulos thinks could have saved his uncle’s life, had it been around a few years ago. “He had no symptoms until a cough showed up,” he says. But when it didn’t go away he went in for an X-ray, and there on the radiograph were the lesions. Dozens of them, filling his entire chest cavity. The doctors sequenced the tumors, and got him signed up for a clinical trial for a new, targeted drug. It worked for a few of them, shrinking them back to almost nothing. But the rest developed resistance.

      “He was supposed to only live two months, and the drugs prolonged his life by a year. But that year wasn’t good.” says Papadopoulos. “I think it’s time to start thinking more about detecting cancers early and less about treating them when they are late.”

      On Thursday, Papadopoulos’ research group at Hopkins revealed a novel blood test based on the combined analysis of DNA and proteins that correctly detected eight kinds of the most common cancers with a range of accuracies—from 98 percent for ovarian cancers to less than 40 percent for breast cancers. Published in Science, the test is just one among many so-called “liquid biopsies” in development; noninvasive tests that classify cancers by identifying the tiny bits of DNA that tumors shed into the bloodstream.

      Most published studies, including this one, focus on measuring and monitoring advanced tumor stages. A few liquid biopsies have even been approved to help match tumors to targeted drugs. But the dream is to develop a simple blood test to actually diagnose solid tumors in healthy-looking people. The scarcity of circulating cancer biomarkers (both in quality and quantity; tumor DNA makes up less than 0.1 percent of blood) has held those aspirations back for decades. But now, sensitive assays and computational platforms are driving the discovery of biomarkers and better ways to measure them, luring a pack of well-financed startups into the field.

      In 2016, for example, the world’s largest sequencing company, San Diego-based Illumina, spun out a new company called Grail. Its mission is described as “detecting cancer early, when it can be cured.” This ambitious aim is supported by $1.2 billion of venture capital Grail raised last year, which it intends to put toward financing massive, population-based clinical studies and optimizing its sensitive sequencing technologies.

      Grail has yet to publish any actual data (its website does advertise a commentary published in Cell last year). And neither has its chief rival in the Valley, a machine learning startup called Freenome. That three-year old company snagged a $65 million Series A last March, led by Andreessen Horowitz. Freenome isn’t limiting itself to the genetic breadcrumbs left by tumor cells—it looks to capture other disease signatures in the blood, like how the immune system changes in response to tumor microenvironments.

      Of course, Freenome has offered scant details on how exactly that kind of test would work. “You show your cards at the end, not while you’re playing poker,” says Andreessen partner Vijay Pande, who heads the investment firm’s biofunds. “Publications indicate that you’re not interested in building a company.” That said, he does expect Freenome to publish in a peer-reviewed journal ahead of its first foray into the market.

      When that could be, though, is anyone’s guess. To evaluate any of these blood screens, thousands of patients will have to get tested—and then researchers will have to wait for some of them to actually get cancer. That’s the only way to determine not only their predictive power, but also whether they lead to improved patient outcomes. The noninvasive screening tests available today—mammography for breast cancer, a protein-measuring test for prostate cancer—are rife with their own issues. Incorrect diagnoses waste time and money on treatments and burden patients with unnecessary anxiety.

      Liquid biopsy is likely to be beset by the same kinds of controversy, says Geoff Oxnard, a thoracic oncologist at the Dana-Farber Cancer Institute and a professor at Harvard Medical School. He routinely uses a single-gene liquid biopsy developed at Dana Farber to figure out which drugs represent the best options for his lung cancer patients. But will early detection versions one day be part of routine doctor’s visits? “No. I think these tests will help us better understand the risks for patients who already have a history of cancer in their family or who’ve already had something show up on a scan,” he says. “But I don’t think we have the kind of data we need to support liquid biopsy as a panacea for diagnosing cancer. At the end of the day, it’s still just a shortcut.”

      Still, Oxnard pointed out that Papadopoulos’s test represents an important step forward. One, it starts to identify where a tumor might be located. That’s been a big limitation of liquid biopsies; OK, you’ve found cancer, but what do you do next? Where do you look for the tumor? Most mutations don’t tell you anything about location. But by layering in measurements for 31 additional proteins to their machine learning model, the Hopkins team was able, on the first try, to correctly identify the tissue of origin around 80 percent of the time colorectal cancers, pancreatic, and ovarian cancers.

      The other advance is cost. Papadopoulos estimates the test could be commercialized for around $500, and cancer-spotting approaches that rely on ultra-deep sequencing could stretch costs for existing screening tests, which only look for a single gene. “This is great for the field and provides promise that these analyses will become a reality in the clinic,” says Victor Velculescu, an oncologist and colleague of Papadopoulos’ at Johns Hopkins, who has also developed liquid biopsy technologies, though he was not involved in the Science study.

      The two have developed a sort of friendly turf war as they’ve turned Baltimore into its own little liquid biopsy hub. Both researchers have recently spun off diagnostics companies to further develop their own early detection technology platforms. Earlier this month, Velculescu’s venture, Personal Genome Diagnostics, hauled in a $75 million Series B led by pharma giant Bristol-Myers Squibb. That brings its total financing to $99 million, putting it on par with some of its better-known counterparts in the Valley, adding some bicoastal intrigue to the race to the market. Whatever the outcome, it’s patients who will ultimately be the winners.

      “If it can even catch 50 percent of cancers that right now we have no way of screening for, that’s still 50 percent of patients who can now be treated in Stage 1, when they still have a chance,” says Papadopoulos. “It doesn’t have to be perfect to still save a lot of lives.”

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      Past presidents’ physicals: What we learned

      (CNN)President Donald Trump had a physical examination Friday at Walter Reed National Military Medical Center in Bethesda, Maryland. The exam was conducted by US Navy Rear Adm. Dr. Ronny Jackson, the same physician who performed President Barack Obama’s last two physicals while in office.

      CNN gathered past reports from former presidents’ physical exams — documents that typically share basic information such as height, weight and blood pressure, but also detail skin tag removal for Obama, a cyst drained on George H. W. Bush’s finger, and how Gerald Ford’s doctor advocated for a White House swimming pool.
      President aren’t obligated to release any results from their examination, but the White House said it would provide a “detailed readout” of Trump’s exam on Tuesday.
        Here’s a look at the health of past presidents, based on their physical examinations.

        President Barack Obama, 2009-2017

        Obama had four known physicals while he was in office: 2016, 2014, 2011 and 2010. The memo for each exam, written by the president’s physician, was addressed to the acting White House press secretary at the time of each report.
        Obama’s letters outline the president’s vitals — all within a healthy range — and offer brief summaries of all his major body systems and some parts such as head/ears/nose/throat. All lab results came back normal, including a PSA test for prostate cancer, which is recommended by the American Cancer Society for African-American men beginning at age 45, because they are considered at high risk for the disease.

        All four of Obama’s reports listed his current medications. In 2016, the president was advised to take vitamin D daily, Nexium “as needed for occasional acid reflux symptoms,” Nicotine gum (as needed for ongoing smoking cessation efforts), as well as Malarone “as indicated during global travel to malaria endemic areas.”

        President George W. Bush, 2001-2009

        The letter summarizing the results of George W. Bush’s 2001 physical lists 12 doctors who examined the president. His exam was supervised and reviewed by two additional doctors, including Dr. Richard J. Tubb, one of the longest-serving White House doctors.
        The report notes Bush has “a history of activity and sports-related injuries,” had benign polyps removed from his colon in 1998 and 1999 and had “mild high frequency hearing loss,” but that his speech frequency hearing was “excellent.”
        We also learned the president smoked “an occasional cigar,” didn’t drink alcohol, but did drink diet soda and coffee. That year, he also reported running “(on average) 3.0 miles, 4 times weekly” and cross-training that included swimming, free weights and the elliptical.
        The report states: “The President is in the top 2% of men his age in cardiovascular fitness. This fitness level would place him in the Excellent category for men 40-44 and Superior range for men 45 and older. He is stratified to a very low coronary risk profile.”

        President Bill Clinton, 1993-2001

        At a 1997 physical,Clinton complained he’d been having some trouble understanding people talking in crowded rooms. And following a hearing test, the 42nd president was fitted for hearing aids. He also had a benign cyst removed from the left side of his chest, which doctors said was similar to another one removed from his nose the previous year. Clinton weighed 20 pounds less than he did the year before, which he attributed to eating a healthier diet and working out more regularly.
        Following a 2001 physical, a statement by presidential physician Dr. Connie Mariano revealed “a lesion on his back suspicious for skin cancer was excised. The pathology results … confirmed that the lesion was a superficial basal cell skin cancer. Pathologists noted that the margins of the legion appeared ‘clean’ indicating that the lesion had been totally removed.”
        In 2011, CNN Chief Medical Correspondent Dr. Sanjay Gupta reported in the CNN documentary “The Last Heart Attack,” the possibilities of preventing — and perhaps even reversing — heart disease. Gupta interviewed Clinton, who spoke candidly about his personal wake-up call: a quadruple bypass operation in 2004. Clinton also had heart surgery in 2010.
        “I was lucky I did not die of a heart attack,” he told Gupta.
        In 2010, Clinton embraced a vegan diet: no meat, dairy or eggs.

        President George H. W. Bush, 1989-1993

        A 1989 physical found Bush to be in “extremely sound physical condition.” Test results showed normal X-rays, EKG, urinalysis, blood test, allergy test and dermatological exam. The president’s hips did exhibit signs of “mild degenerative osteoarthritis, which has been present for several years.”

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        A statement released by Bush’s press secretary revealed that a “sebaceous cyst on the third finger of his left hand was drained. The President is wearing a Band-Aid on the finger, which he can remove within the next few hours. This cyst has been present for many years and does not present a medical problem.”

        President Ronald Reagan, 1981-1989

        In October 1981, Reagan was examined by 14 specialists and was found to be “in excellent health,” according to a statement issued by the White House physician. Notably, he said the president had “fully recovered” from the gunshot wounds he sustained during an assassination attempt in March 1981.
        Reagan underwent another exam in May 1984, during which his doctor concluded he was in “very exceptional physical condition.” However, doctors did discover a small polyp in his colon, which they removed and determined to be benign (similar polyps were found and removed during the president’s 1985 and 1988 exams). The rest of Reagan’s tests results this year were deemed “entirely normal.”
        Following a March 1985 physical, the White House doctor said that “President Reagan continues to enjoy good health. His overall physical and mental condition is excellent. I am especially impressed with the fact that his blood pressure is lower than a year ago — this is quite remarkable.”
        Reagan received his last known exam while in office in December 1988. The president’s physician found him to be in “remarkable physical condition.”

        President Gerald Ford, 1974-1977

        In January 1975, Ford’s physician said he was “happy to report he is in excellent health. The results of all medical tests were normal in every way.”
        Ford underwent another physical in July 1976, during which his doctor said, “He has had no complaints … other than mild discomfort in his knee following periods of prolonged standing. The President has maintained his physical capacity for long working hours. He sleeps very well and continues to follow his diet and weighs between 195 and 198 pounds.”
        In 1975, Ford’s doctor noted “the completion of the new White House swimming pool will provide him with short intervals for relaxation that can easily be fitted into his busy schedule.”
        “I would like to take the time to acknowledge those citizens who, by their contributions, make a swimming pool available for the President in the White House,” Dr. William Lukash said at a January 1976 press conference. “I might add that the President was reluctant to use the pool during the winter months because of his concern about energy conservation. I spoke to him about this and felt it was to his advantage to have the use of this pool because I thought it would be an improvement in his sense of well-being and make him more conducive to his feeling better the next day. … The President swims approximately 24 lengths of the pool, which adds up to about a quarter of a mile, and he does this in about 14 minutes.”

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        Tobacco mea culpa: companies to run ‘corrective’ ads in US on smoking’s harm

        Tobacco companies have delayed correcting false statements for eleven years since a federal court ordered them to do so

        Eleven years after a federal court found tobacco companies conspired to deceive the American public, the companies will air television and newspaper ads to correct lies they told over the course of the 20th century.

        The corrective statements to be aired beginning 26 November are part of a 2006 judgment against tobacco companies, which found companies such as RJ Reynolds and Philip Morris broke anti-racketeering laws, lied about how cigarettes harmed health and denied their efforts to market cigarettes to children.

        After the judgment, tobacco companies appealed over details of the statements for more than a decade, and delayed correcting false statements into a new media era.

        Four in 10 Americans now regularly get news online, where tobacco companies will not have to publish any corrective statements.

        The tobacco companies basic strategy for everything, whether its science or regulation or litigation, is delay, said Stan Glantz, an expert on tobacco company strategy at the University of California San Francisco. The school is also home to one of the worlds largest libraries of tobacco company documents, a cache collected from lawsuits like the one decided in federal court in 2006.

        They have used a lot of arguing about what in terms of the real world are trivial issues, to delay having to make these statements for 11 years but it is what the tobacco companies do, said Glantz.

        The problem is the technology has moved on, and the statements are not in social media because it didnt really exist back then. But better late than never.

        Tobacco companies were first ordered to make the statements by US district judge Gladys Kessler, who wrote in a 1,683-page opinion in 2006 that the companies caused, a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system.

        About 480,000 Americans still die each year from tobacco-related disease, and lung cancer is the leading cause of cancer death for both American men and women. Each year, more people die of lung cancer than die of breast, colon and prostate cancer combined.

        In appealing against publication of corrective statements, tobacco companies argued against specific words in statements, fonts and even the phrase here is the truth.

        The ads will run in more than 50 newspapers across the country and on major broadcasting networks, including ABC, CBS and NBC. Companies will have to buy full-page ads in the first section of each Sunday newspaper, and a total of 260 television ads will be run for one year.

        To promote their products, tobacco companies still spend roughly $1m per hour in America, or $8.2bn per year, on advertisements in convenience stores, discounts, coupons, at adult entertainment venues and through wholesalers.

        Additionally, unlike in much of Europe, American cigarettes do not display graphic warnings on packs following appeals by tobacco companies and delays from the US Food and Drug Administration.

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        Balding, premature graying tied to higher heart disease risk

        Male-pattern baldness and premature greying are associated with a greater risk of heart disease before the age of 40 than obesity, according to a new study from India. Does this mean that doctors should be screening our hairline alongside traditional risk factors such as our weight and blood pressure?

        Over the years, scientists have developed many cardiovascular disease “risk tools”, with varying levels of usefulness. The tools normally involve measuring “classical” risk factors for cardiovascular disease, including high blood pressure, elevated blood cholesterol levels, obesity and diabetes. Included in most of these risk tools is age, because risk of cardiovascular disease in later life is higher if you have risk factors in your forties.
        Beyond these classical risk factors, several slightly odd risk factors have been identified. These include weak grip strength, skipping breakfast and being divorced. Previous research has also suggested that premature hair greying is linked to vascular (blood vessel) disease. Male-pattern baldness may also be an early sign of cardiovascular risk.

          Fivefold greater risk

          The new study, presented at the 69th Annual Conference of the Cardiological Society of India, looked at coronary artery disease, a major form of cardiovascular disease. They specifically studied men under the age of 40. This is important as the classical risk factors are not as good at predicting cardiovascular disease in younger people. This study investigated the links between premature hair greying, hair loss and coronary artery disease in young Indian men.
          The researchers, from the UN Mehta Institute of Cardiology and Research Centre in Ahmedabad, compared men under 40 with coronary artery disease with age-matched healthy men. All participants had their degree of coronary artery disease measured using a variety of clinical tests. Participants also had their baldness and hair whiteness rated.
          When the researchers compared results between the two groups, they found that men with coronary artery disease had significantly higher rates of premature greying (50% versus 30%) and male-pattern baldness (49% versus 27%). After adjusting for other factors, they found that male-pattern baldness carried a 5.6 times greater risk of coronary artery disease. Premature greying was associated with a 5.3 times greater risk.
          These hair-related factors were apparently better predictors of coronary artery disease risk than obesity, which was only associated with a 4.1 times greater risk. All of the classical risk factors were worse at predicting coronary artery disease than male-pattern baldness and premature greying.

          Focus on what you can change

          While the study is very interesting, it must be noted that the numbers recruited were relatively small (780 men with coronary artery disease and 1,270 healthy males). Also, the study only recruited Indian men. Before we reconsider how we screen for cardiovascular disease in people under 40, this type of study needs to be repeated in a larger, more diverse group of people.
          If these findings are true, the next step is to understand why it is so. Obesity is a modifiable risk factor, so weight loss can be an important tool in reducing the risk of future cardiovascular disease. As of yet there is little we can do to reverse or prevent male-pattern baldness or premature greying, beyond cosmetic changes.

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          It is possible that these factors may be markers of biological age, which may influence cardiovascular risk. This might mean that there is little we can currently do to reduce this risk. There may also be genetic factors that link premature baldness or greyness with cardiovascular disease risk, but these have yet to be discovered.
          It remains to be seen if male-pattern baldness or premature greying really are risk factors for cardiovascular disease across the general population. Until there is more evidence, it is best to be reminded that eating a healthy diet rich in fibre and getting regular exercise are excellent ways to reduce the risk of having heart problems in the future.

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          Bodybuilding drugs sold online often contain unapproved substances, study says

          (CNN)Selective androgen receptor modulators, known as SARMs, are pharmaceutical drugs that mimic the effects of testosterone. Not yet approved by the US Food and Drug Administration, these compounds are often marketed to bodybuilders online as “legal steroids” that can help them look leaner and more muscular.

          Most of the products sold online as SARMs contain either these unapproved substances alone — sometimes in amounts different from what is specified on the label — or other unapproved hormones and steroids, according to a study published Tuesday in the medical journal JAMA.
          “There are serious potential side effects, and there’s this wide-held misperception that these compounds are safe,” said Dr. Shalender Bhasin, co-author of the new study and director of the research program in men’s health at Brigham and Women’s Hospital.
            About a dozen pharmaceutical companies have been developing SARMs since the mid-1990s, Bhasin explained. Designed to help people with diseases such as muscle wasting, they are intended to have beneficial effects similar to those of testosterone, which can increase muscle and energy, without negative side effects such as blood clots and enlarged prostate.
            Some SARMs have undergone limited human testing, but others have not, so their overall safety and efficacy remains unknown, Bhasin said. Still, early research has shown that in large doses, they can suppress natural production of testosterone and induce infertility. They also might have psychiatric side effects, including mania and suicidality.
            Life-threatening reactions, including liver toxicity, have occurred in people taking SARMs, which also have the potential to increase the risk of heart attack and stroke, according to the FDA.
            “Young men, almost exclusively young men, they’re using these compounds to improve their appearance,” Bhasin said.
            He collaborated with researchers from the US Anti-Doping Agency and the Uniformed Services University of the Health Sciences to conduct the new study, which began with a simple Google search.

            Testing the products

            Common names for SARMs include ostarine, andarine, RA140, ibutamoren, GW501516 and SR9009. Searching for these terms online, Bhasin and his colleagues found more than 210 products, most of which were either out of stock or unavailable. However, the research team was able to purchase 44 drugs that they evaluated using the World Anti-Doping Agency’s approved chemical analysis procedures.
            About half — 23 products — contained SARMs. An additional 17 products (39%) contained one or another unapproved drug, such as growth hormones or steroids, that have been banned by the anti-doping agency.
            Meanwhile, only 18 of the 44 had an active compound that matched what was listed on the label, and a quarter of the products had detectable amounts of the listed compound at a different amount than stated on the label. In eight products, label ingredients remained undetectable.
            When he first heard the “unsubstantiated reports of SARMs and other appearance- and performance-enhancing drugs” being sold online, he was “incredulous,” Bhasin said.

            Regulation and enforcement

            “The whole basis of commerce is that you buy something either on the internet or in a store, and it has a label that shows what is in the container, and it tells you what the product is and how much is being sold,” Bhasin said. “Just imagine, you go to the grocery store and you want to buy baby food for your children” — but the contents are not what the label says, or “worse, it contains something else whose safety is unknown.”
            Drs. Richard J. Auchus and Kirk J. Brower of the University of Michigan wrote in an editorial that accompanies the new study, “How can these pharmaceutical agents be widely available to the public without FDA approval, prescription, or manufacturing oversight?”
            “Rapid developments in information technology, consumerism, medicine, and public policy” all play a role in the availability of these substances, explained Auchus and Brower, who were not involved in the new study.
            Noting that the 1994 Dietary Supplement Health and Education Act exempted products classified as “dietary supplements” from rigorous studies prior to marketing, the “result was a flood of unregulated” products. Androgens (male hormones) were “aggressively marketed as supplements, even though these compounds are drugs and not food,” Auchus and Brower wrote. Many “so-called dietary supplements still contain hormones, drugs, and known toxins often not listed on the label,” they wrote.
            Who is responsible for clamping down on these products?
            Although the FDA is duty-bound to take action against adulterated or misbranded dietary supplements after they reach market, the agency “does not have the resources to address all of these cases,” Auchus and Brower noted.
            The FDA recently issued warning letters to three companies for distributing products that contain SARMs. Marketed and labeled as dietary supplements, the products are actually unapproved drugs no evaluated for safety, according to the FDA.
            Lindsay Meyer, a spokeswoman for the FDA, said these letters are warning shots for every company in the industry, not just the companies that receive them.
            It’s been difficult to police this activity because “most of these are being sold in dietary supplements so they don’t require any kind of premarket review,” said Meyer. “The internet is far more vast than the FDA is. As soon as we go after one of these websites or sellers or something, another one just crops back up in their place.”
            The US Drug Enforcement Administration shares responsibility for enforcement of laws regarding the sale of SARMs. “However, the DEA is overwhelmed with the opioid epidemic, and industry-sponsored legislation last year seriously impaired efforts of the DEA to thwart complicit narcotic distributors,” the editorial authors wrote.
            The DEA did not respond to a request for comment.
            “There’s no way that the authorities can intercept them, because there’s such a huge flood across our borders from so many sources, it would just be prohibitively expensive to intercept them,” said Dr. Harrison Pope, a professor of psychiatry at Harvard Medical School-affiliated McLean Hospital who was not involved in the new study.
            He said “thousands upon thousands” of websites offer these drugs, which pour into the United States from numerous sources around the world.
            “It is an important study that I hope will further awaken the population especially people who are would be purchasers to the hazards and the unpredictability of this mushrooming internet scene,” said Pope, author of another study that looked at performance-enhancing drugs sold on the Web. “With high probability you either will not be getting what you thought you were getting, or you will be getting other drugs of unknown toxicity that were not advertised in what you were getting.
            “It’s a problem that is not gonna go away, and if anything, it’s going to increase as the years go by.”

            Letter of the law

            When asked about the misrepresentative labels found in the new study, Sam Steger, a spokeswoman for MedFit Rx Inc., a company that sells SARMs, said, “it is imperative that our labels reflect the contents of our products accurately. We are of course familiar with the ‘buzz’ in the industry, but cannot speak to the internal workings of other companies.”
            Steger said her company’s products fall within FDA regulation as sports supplements.
            “We do not market as a dietary supplement and do not sell banned substances,” she wrote in an email. “To start they are not illegal or banned substances.”
            She noted a 2014 law that includes designer drugs and “hormonal substances” under the definition of anabolic steroids, which are banned under the Controlled Substances Act. The same law states that “an herb or other botanical, a concentrate, metabolite, or extract of, or a constituent isolated directly from, an herb or other botanical” is not “a drug or hormonal substance” and would not be considered illegal.
            The new study, though, found that 91% of the 44 tested products had an unapproved drug — so just 9% were made of botanicals and not drugs.
            Bhasin admits his study was not “exhaustive” and says that with “the rapidly changing nature of such internet sites, the results of similar searches will vary.” Still, he bemoans the increasing use of SARMs.
            “We don’t have very good information, but investigators have estimated in the US alone there may be 2 to 4 million young men who have used performance-enhancing drugs sometime in their life,” he said.
            “Widespread perception amongst policy makers and the public is the problem of performance enhancing is really a problem of cheating in sports.

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            “The vast majority of people who use these appearance and performance-enhancing drugs are not elite athletes. In fact, they’re not athletes at all,” Bhasin said. Rather, they’re teens and young men, often members of the armed forces, who want to improve their appeal.
            “So we are seeing these dual epidemics of body image disorder in young men, which is also referred to as muscle dysmorphia, and the associated growing abuse of appearance- and performance-enhancing drugs,” Bhasin said. “Easy availability of these compounds over the internet without a prescription is concerning because it will fuel these epidemics.”

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            Animal agriculture is choking the Earth and making us sick. We must act now | James Cameron and Suzy Amis Cameron

            Film-maker James Cameron and environmentalist Suzy Amis Cameron writes that to preserve Americas majestic national parks, clean air and water for future generations leaders must be pressed to address foods environmental impact

            Our collective minds are stuck on this idea that talking about foods environmental impact risks taking something very intimate away from us. In fact its just the opposite. Reconsidering how we eat offers us hope, and empowers us with choice over what our future planet will look like. And we can ask our local leaders from city mayors to school district boards to hospital management to help, by widening our food options.

            On Monday and Tuesday, the city of Chicago is hosting a summit for the Global Covenant of Mayors for Climate and Energy to discuss climate solutions cities can undertake. Strategies to address and lower foods impact should be front and center.

            Animal agriculture is choking the Earth, and the longer we turn a blind eye, the more we limit our ability to nourish ourselves, protect waterways and habitats, and pursue other uses of our precious natural resources. Raising livestock for meat, eggs and milk generates 14.5% of global greenhouse gas emissions, the second highest source of emissions and greater than all transportation combined. It also uses about 70% of agricultural land, and is one of theleading causes of deforestation, biodiversity loss, and water pollution.

            On top of this, eating too much meat and dairy is making us sick, greatlyincreasing our risk of heart disease, type 2 diabetes, several major cancers (including breast, liver and prostate) and obesity. Diets optimal for human health vary, according to David Katz, of the Yale University Prevention Research Center, but all of them are made up mostly of whole, wholesome plant foods.

            So what gives? Why cant we see the forest for the bacon? The truth can be hard to swallow: that we simply need less meat and dairy and more plant-based options in our food system if were to reach our climate goals.

            The Avatar movie set had plant-based menus. Photograph: 20th Century Fox/Everett/Rex Features

            This can start with individual action. Five years ago, our family felt hopeless about climate change, and helpless to make meaningful change. But when we connected the dots on animal agricultures impact on the environment, coupled with the truth about nutrition, we took heart because it gave us something we could actually do.

            To create change at the scale needed, this will take more than individual choice we need to get climate leaders on board about the impact of food. Cities and counties have used their buying power to transition fleets from diesel to electric, and we need to do the same with how we purchase food. We have done this in our own community, moving the lunch program of Muse School, in Calabasas, California, and the Avatar movie set to plant-based menus. Scaling up initiatives like these can make a big difference: if the US reduced meat consumption by 50%, its the equivalent of taking 26 million cars off the road. We think thats damn hopeful.

            Decision-makers on all levels can make it easier for us to eat better, by expanding access to food options that are good for our health, affordable, and climate-friendly. Nationwide, cities and school districts have adopted food purchasing policies that include environment, health and fair labor standards. The city of Chicago is a recent adopter of this Good Food Purchasing Program, and so the solutions-focus of the summit is the perfect place to discuss how food can move us toward climate goals. In the same breath that we discuss fossil fuels, we should be talking animal ag, or were missing a big part of the problem and a big part of the solution.

            Yes, food is inherently personal. Its the cornerstone of holidays, it fuels high school athletes and long workdays, and it nourishes nursing mothers and growing children. And yes, Americans love meat and cheese. But more than that, we love our majestic national parks, family beach vacations and clean air and water for our children and grandchildren.

            As individuals, we can make choices on how to better nourish our families, and as citizens, we can encourage local leaders to make choices that will allow us to enjoy our land and natural resources now and in the future.

            James Cameron is a film-maker and deep-sea explorer. Suzy Amis Cameron is a founder of Muse School and Plant Power Task Force.

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            Data, cancer treatment and patient personalisation

            Image: pixabay

            In recent years, the scientific community has come to think about cancer — and cancer treatment — differently.

            Whereas in past decades, cancer was diagnosed, classified and treated according to the specific types of tissues it affected — breast cancer, for example, has traditionally been treated with drugs developed specifically for tumours in the breast — modern medicine takes a decidedly more personalised approach.

            Today, explains Dr Warren Kaplan, the Chief of Informatics at the Garvan Institute of Medical Research, cancer is thought of as a disease of DNA, rather than something that easily fits into “buckets” based on where in the tissue it originates.

            Different treatments for different genetic profiles

            “The three billion base pairs that make up our DNA — our genome — make each and every person in the world unique,” says Kaplan. “But this is also what makes each person’s cancer unique.”

            By understanding a patient’s genome, doctors can determine the specific combination of drugs that will best suit their patient.

            Researchers and scientists at Garvan and all over the globe are working to decode and sequence genomes in order to investigate the genetic makeup of cancers. The end goal, Kaplan explains, is to deviate from a “one size fits all” approach to treatment options. Once genomes are sequenced, it becomes easier for doctors and scientists to construct tailored treatment programs based on patients’ individual genetic profiles.

            The benefit of this approach to treatment is twofold, says Kaplan.

            “First, tumours with certain genetic profiles may respond to certain anti-cancer drugs better than others,” he says, citing an example of a pancreatic tumour that responds better to a drug traditionally prescribed for breast cancer. “Secondly, this information can also help tailor a patient’s treatment plan. By understanding a patient’s genome, doctors can determine the specific combination of drugs that will best suit their patient and avoid any harmful side effects.”

            The role of data 

            One of the obstacles to this approach, however, is the sheer amount of data it takes to sequence a single person’s genome: about 500 gigabytes. That’s equivalent to streaming about 100 HD movies.   

            In order to lend a hand – and a byte – Vodafone Foundation has released a mobile app, DreamLab, that crowd-sources data from willing donors. All users have to do is download the app (which is now available on iOS and Android), select a project they want to contribute to, and then charge their phone as they do normally. The app then goes to work downloading small bits of information from the cloud, which helps fuel cancer research such as the work being done by Garvan.

            To date, users around the world have taken up the night shift as a ‘cancer researcher,’ and “crunched” about 70% of the first research project, which focuses on comparing genetic profiles of patients with four types of cancer (breast, ovarian, prostate and pancreatic). DreamLab now has 165,000 active users – the more people that use the app, the faster researchers can complete projects which lead to discoveries.

            Kaplan has high hopes that this data holds at least a few of the answers for solving cancer.

            “We hope that in the future, those diagnosed with cancer will have their genomes sequenced and compared to this library, so that they can benefit from much more effective and accurate assessments of their illness,” he explains. “This way, doctors will be able to develop customised treatment plans that are known to be effective for a patient’s specific genetic profile.”

            Download the DreamLab app now on iOS from the App Store or on Android from Google Play to help fight cancer.

            Disclaimer: Downloading DreamLab uses data. DreamLab can be used when your device is charging and has mobile network or WiFi connectivity. Mobile data to use DreamLab is free for Vodafone Australia customers on the Vodafone Australia network. Roaming incurs international rates. 

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