Cancer survival rates for abdominal cancers

April 24, 2024April 23, 2024

Princess Kate Middleton, born in 1982, is unlucky to have a cancer diagnosis at such a young age. Many Royal well-wishers are upset and sad about Kate Middleton’s cancer diagnosis and they all wish for an excellent outcome. Since Kate Middleton has announced her cancer diagnosis, there has been understandably a huge interest on survival rates for various abdominal cancers.

Due to privacy concerns the Palace has not revealed the type of cancer but the chemotherapy she is undergoing has termed “preventative” implying that she had a localised cancer which has been successfully removed surgery. It is also implied by many newspapers that the cancer has been found “incidentally” after surgery.

With these caveats, these are the survival rates for various abdominal cancers. This is only a guide, as the cancer can behave vastly differently in various people.

The survival figures quoted are from the publicly available cancer research U.K. (CRUK ) website

Pancreatic cancer: Almost 55 out of 100 people with localised pancreatic cancer er survive their cancer for 1 year or more after diagnosis. Pancreatic cancer is one of the nastiest cancer and only 25% survive their cancer for 3 years or more after diagnosis.

Stomach cancer: England Survival statistics show that 65 out of 100 people (65%) with stage 1 stomach cancer will survive their cancer for 5 years or more after they’re diagnosed.

Gallbladder cancer: American Survival statistics show that More than 65 out of 100 people with localised cancer survive their cancer for 5 years or more after diagnosis.

Small Intestine cancer: More than half (53.0%) of people diagnosed with small intestine cancer in England are predicted to survive their disease for five years or more.

Large Bowel cancer: The survival statistics for early bowel cancer is very optimistic. Around 90 out of 100 people (around 90%) with stage 1 bowel cancer will survive their cancer for 5 years or more after they’re diagnosed and treated.

Ovarian cancer: The survival statistics for early ovarian cancer is also excellent. Almost 95 out of 100 women (almost 95%) will survive their cancer for 5 years or more after they are diagnosed.

Obviously no two people are the same and there are no guarantees with any cancer. Cancer does not spare the well-off in the society.

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in any way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Is there too much care at the end of life in cancer patients?

April 23, 2024

Cancer is a dreadful disease. Advanced cancers are often incurable, even though lot of cancer patients do survive for years with treatment.

With the benefit of hind sight, it is obvious that in some patients, treatment has been futile and toxic chemo treatment could have been stopped early .

It is very difficult to predict who will respond to a particular treatment and who will be harmed by futile chemotherapy , even when someone is very fit.

There is a criticism from some people in medical profession that there is too much futile care towards the end of life in cancer patients.

But cancer patients do often want to fight the cancer and not give up. It is a delicate balance. Read the BMJ piece and contribute your views via rapid response.

References

BMJ: Is there too much care in advanced cancer? BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q784 (Published 05 April 2024)

BMJ : Illness trajectories of incurable solid cancers. BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-076625 (Published 01 March 2024)

New cancer drug combination that is active in advanced bowel cancer after other drugs have failed.

October 24, 2023October 24, 2023

Advanced bowel cancer that has become resistant to prior chemotherapy drugs is always difficult to treat.

A drug combination shows significant activity in this setting.

Sotorasib and Panitumumab are already in use in other settings and hence they will be used very soon in clinics.

New Drug for Lung cancer

October 24, 2023October 24, 2023

This year’s ESMO 2023 Conference had breaking news for lot of new drugs in various cancers.

One such drug called Amivantamab is very promising in 1st line as well as 2nd line setting, both in combination with chemotherapy as well as in combination with a new oral drug called lazertinib.

Amivantamab combination therapies emerge as new options for EGFR-mutated advanced NSCLC

Exciting New Drug for Breast cancer and Lung cancer !

October 24, 2023October 24, 2023

Datopotamab Deruxtecan is a new drug which is known in shorter version as Dato Dxd.

Dato Dxd is very promising in breast cancer and Lung cancers that have failed to respond to prior treatments

Dato Dxd belongs a existing new group of cancer drugs known ADCs ( Antibody drug Conjugate).

ADCs involve a combination of carrier molecule and a payload. ADCs go and stick to surface of cancer cells and off load the chemotherapy drug which in turn damages the cancer cell.

Data presented at the an European Cancer congress in Madrid demonstrates high degree of cancer activity. Hopefully the drug will be available for clinical use very shortly after it has been properly licensed by regulatory authorities.

References

Datopotamab deruxtecan met the PFS endpoint in previously treated NSCLC

Antibody–drug conjugates improve outcomes for patients with inoperable or metastatic breast cancer

A major breakthrough in advanced bladder cancer

October 22, 2023October 22, 2023

Advanced bladder cancer is a difficult disease to treat in many patients.

For a long time, there was no major advance in first line treatment

Today, at an European Cancer conference in Madrid, there was a breakthrough announcement about a new combination for bladder cancer.

The combination of EV ( enfortumab vedotin) and Pembro ( Pembrolizumab) has shown dramatically better results in a clinical trial reported today.

The combination of EV+ Pembro will become first choice of treatment for Advanced bladder cancer now.

References

LBA6 EV-302/KEYNOTE-A39: Open-label, randomized phase III study of enfortumab vedotin in combination with pembrolizumab (EV+P) vs chemotherapy (Chemo) in previously untreated locally advanced metastatic urothelial carcinoma (la/mUC)

Is over thinking and over sharing negative events – bad for mental health ?

September 21, 2023September 21, 2023

Yes, a recent study suggests that contrary to popular opinion, trying to forget bad news is better than openly talking about it.

More than 50 years back, many people particularly, British people were advised to keep a stiff upper lip and carry on with their life and not dwell or over share their negative experiences. Then came the American way of Psychotherapy which encouraged everyone to talk about bad things that happened to them.

Men, in particular, were also encouraged to openly talk about their emotions. This was widely accepted as the right thing to do by almost all psychologists and psychiatrists.

Contrary to this widely accepted view, now a new study has shown that the old British stiff upper lip of keeping your emotions in check and carrying on with life is probably better.

The British Royal family, particularly, the Late queen was often accused of not showing enough emotions in Public. This study proves that she is probably right and is having the last laugh !!

So it may be perfectly reasonable not to talk and dwell on bad news and getting on with life.

Mentally suppressing bad news may be not be harmful. Pushing away bad memories can fade them and improve your mental health.

Obviously, one cannot read too much into one study and we have to hope that other studies would confirm or refute this study.

References

Telegraph: A stiff upper lip could make you happier. 21 Sept 2023.

Scientific American. Suppressing an Onrush of Toxic Thoughts Might Improve Your Mental Health.

Science Daily. Suppressing negative thoughts may be good for mental health after all, study suggests.

Can Therapy Be Harmful? 2021.

NHS PTSD treatment

Journal Reference:

2023: Zulkayda Mamat, Michael C. Anderson. Improving mental health by training the suppression of unwanted thoughts. Science Advances, 2023; 9 (38) DOI: 10.1126/sciadv.adh5292

2015: Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials. JAMA. 2015 Aug 4;314(5):489-500. doi: 10.1001/jama.2015.8370. PMID: 26241600.

2009: Berk, M., & Parker, G. (2009). The Elephant on the Couch: Side-Effects of Psychotherapy. Australian & New Zealand Journal of Psychiatry, 43(9), 787–794. https://doi.org/10.1080/00048670903107559

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s personal views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is NOT previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice.

New treatment option for myeloma

June 5, 2023June 29, 2023

CAR-T cell treatments are now routinely used in some blood cancers.

A recent study presented at the American Society of Clinical Oncology, shows that CAR-T cell treatment is a valuable option for those patients who have already tried conventional treatments .

References

1. Daily Mail. Breakthrough in treating one of the deadliest blood cancers: ‘Remarkably effective’ new immunotherapy can slow disease’s progress by 74%

2. ASCO 2023: Long-term remission and survival in patients with relapsed or refractory multiple myeloma after treatment of LCAR-B38M CAR-T: At least 5-year follow-up in LEGEND-2.

3. ASCO 2023: First phase 3 results from CARTITUDE-4: Cilta-cel versus standard of care (PVd or DPd) in lenalidomide-refractory multiple myeloma.

New radiotherpy alternative treatment for low grade brain tumours

June 5, 2023June 29, 2023

Brain Radiation therapy has long term side effects particularly in young people

People with low grade cancer of brain have a prognosis of many years.

Hence, it is important from a quality of life point of view that alternative treatments are used to minimise or avoid the risk of brain damage from radiation

Vorasidenib is a new type of medical treatment . It is a tablet developed specifically to target a specific vulnerable part of low grade brain cancers. The Vorasidenib tablets target abnormal proteins in cancer and hence spares a lot of normal tissues.

A study presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago on June 4 is very promising.

Preliminary results show that the tablet significantly delays the growth of the tumour.

References

1. National Cancer Institute. Vorasidenib Treatment Shows Promise for Some Low-Grade Gliomas.

2. NEJM. Vorasidenib in IDH1- or IDH2-Mutant Low-Grade Glioma

3. Vorasidenib ASCO2023 news. INDIGO: Vorasidenib Offers Patients With IDH-Mutant Low-Grade Glioma a Means to Delay Chemotherapy and Radiotherapy

Cervical cancer- less radical surgery is enough for low risk cancers

June 5, 2023April 10, 2024

How long hormone therapy is needed for breast cancer?

June 4, 2023June 4, 2023

Some breast cancers are very much dependent on the female hormones for growth.

Even after an successful operation for breast cancer, cancer can come back in some people. It’s estimated that “about 1% come back on average each and every year for at least 20 years”

It is a well known fact the taking anti-female (anti-oestrogen) hormone therapy can prevent the cancer from coming back.

But these hormonal therapies do have side effects and there is an ongoing debate about how long patients should take these treatments.

A breast cancer specialists consensus meeting took place recently in Europe. There is emerging consensus that 7-8 years is sufficient on average for lot of low to medium risk patients. The high risk patients do need it for 10 years. ( slides courtesy of ASCO 2023 meeting presentation)

It is important that breast cancer patients talk to their oncologist about these data before they take any action !

References

ASCO Daily news. 2023. ER-Positive Breast Cancer: Assessing Late Relapse and Moving Treatment Forward.

New drug combo for ovarian cancer

June 3, 2023June 4, 2023

Low grade ovarian is a difficult cancer to treat with chemotherapy.

So it is quite reassuring to note that a new drug combination is very promising in this setting .

Interim Results were revealed at the American Society of Clinical oncology conference in Chicago.

The study is continuing and the drugs are not available outside the study setting.

Hopefully, in the near future, the final study results of study would lead to this combination becoming standard of care in routine practice. Nothing guaranteed though !

References

Telegraph. New drug cocktail could double treatments for rare form of ovarian cancer

ASCO Chicago 2023: Initial efficacy and safety results from ENGOT-ov60/GOG-3052/RAMP 201: A phase 2 study of avutometinib (VS-6766) ± defactinib in recurrent low-grade serous ovarian cancer (LGSOC).

Can diet reverse memory loss ?

May 30, 2023May 30, 2023

Yes, diet may help memory loss.

Flavanols are natural chemicals present in tea, cocoa, apples, and berries.

A group from Columbia university and Brigham and Women’s Hospital assessed the effects of flavanols and multivitamins on memory.

The authors indicate the in people with poor intake of flavanol, benefitted from flavanol supplements.

Flavanols are naturally found in in certain fruits and vegetables. ( green leafy vegetables, blackcurrants, onions, apples, berries, cherries, peaches, soybeans, citrus foods, tea, chocolate, lettuce, peppers, grapes and even wine).

Even though more confirmatory studies are needed, a good intake of these fruits and vegetables would be beneficial to overall physical health.

References

1. Daily Telegraph. Memory loss ‘can be reversed by simple diet changes’.

2. PNAS 2006. Flavonoid fisetin promotes ERK-dependent long-term potentiation and enhances memory.

3. Harvard 2021 news letter. Harvard finds flavonoids linked to sharper thinking and memory.

4. Low-Flavanol Diet Drives Age-Related Memory Loss, Large Study Finds

5. ORIGINAL paper. (COcoa Supplements and Multivitamin Outcomes Study – COSMOS-Web): “Dietary flavanols restore hippocampal-dependent memory in older adults with lower diet quality and habitual flavanol consumption” according to authors published in Proceedings of the National Academy of Sciences. ( doi : not live at time of publication of blog).

Can party drugs cause Parkinsonism?

May 11, 2023May 7, 2023

Yes, some recreational drugs have the potential to cause long term brain damage and cause Parkinsonism like symptoms.

The famous Hollywood actor of 1990s , Michael J. Fox has suggested drugs and alcohol could have caused his Parkinson’s.

Watch Michael J Fox on CNN video.

People with Parkinsonism have tremors, stiff and inflexible muscles along with slow movements and shuffling gait.

Be careful !

References

Can recreational drugs cause PARKINSON’S? As Michael J Fox, 61, says he fears partying too hard in the ’80s may have done permanent damage… research suggests cocaine, MDMA and meth can trigger disease. By Emily Joshu Health Reporter For Dailymail.Com
Updated 13:34, 07 May 2023

Movement disorders and MDMA abuse.

Parkinsonism and dystonia caused by the illicit use of ephedrone–a longitudinal study.

The methamphetamine experience: a NIDA partnership.

Is skipping breakfast harmful?

May 7, 2023May 7, 2023

Yes, many studies do suggest that skipping breakfast is bad for health.

Skipping breakfast increases risk of obesity, high blood pressure, diabetes and heart diseases.

A recent Guardian article provides a different view point and suggests that it may not be harmful to skip breakfast if you do not overindulge during lunch or later in the day with unhealthy food. There is some evidence to suggest that people who skip breakfast as part of planned dieting may benefit from it. The evidence is still evolving though.

People often skip breakfast because they are rushing from home to work; These people who are under lot of stress and juggling too many things in life, tend to eat unhealthily later in the day.

Many people do not have enough energy to continue fasting until Lunch. So skipping breakfast is not a good option for many.

The best thing would be to eat a healthy but light breakfast that keeps one going at work until lunch break.

References

1. Skipping breakfast is associated with overweight and obesity: A systematic review and meta-analysis.

2. Breakfast Skipping, Body Composition, and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Randomized Trials.

3. Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality.

4. Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk.

5. Skipping Breakfast Is Associated with Hypertension in Adults: A Meta-Analysis.

6. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies.

7. Associations of Skipping Breakfast, Lunch, and Dinner with Weight Gain and Overweight/Obesity in University Students: A Retrospective Cohort Study.

8. Association between Breakfast Skipping and Body Weight-A Systematic Review and Meta-Analysis of Observational Longitudinal Studies.

Should NHS in U.K. introduce charges for appointments ?

March 23, 2023March 23, 2023

NHS – National Health Service in UK – is a free universal health care system and has been publicly funded since its introduction in 1948. Since it is free at point of delivery, all sections of population are able to access it regardless of their ability to pay.

Unfortunately, due to underfunding and increasing demand, NHS is struggling to cope and there are long waiting times for most services.

One of the potential ways to control demand in NHS is introduction of a nominal access charge for appointments.

Nominal charges can affect people’s behaviour. For example, nominal charges for single plastic bags in supermarket led to dramatic reductions in use of single use plastic bags.

Similarly, there is a potential for charges for appointments to reduce demand in NHS. The charges might stop patients making GP appointments for simple pain killers, Skin creams, anti-allergy tablets and indigestion medicines as these medicines are available to buy over the counter from pharmacies and supermarkets.

Charges might also reduce unnecessary attendances at Emergency departments.

Would they really work in practice?

No one knows for sure; a trial in an area of country might be the only way to find out whether it works in UK.

What about other countries experience regarding charges?

Germany introduced a quarterly charge (Praxisgebuehr) but scrapped it. There is some evidence that people from lower socioeconomic status were more affected by charges. There has also been some evidence that since removing the charges, there has been incoordination of care and possibly higher healthcare costs.

There is some evidence from other countries that user fees may have some impact on Demand.

There are some drawbacks to access charges and the vulnerable sections of the population would be at high risk of being harmed.

Read my letter in BMJ and do contribute your views through rapid response section.

Article: Supermarket plastic bags and NHS demand management
Free to access link: http://bmj.com/cgi/content/full/bmj.p630?ijkey=HPXCInDzw6eWEXz&keytype=ref

Does exercise help the brain ?

February 15, 2023February 15, 2023

Yes, moderate and vigorous physical activity helps the brain to stay sharp.

A large study looked at people born across England, Scotland and Wales in 1970 and followed-up throughout childhood and adulthood

A report of the study with 4481participants (52% female) found that moderate and vigorous physical activity helps cognition compared to light intensity physical activity.

But a word of caution though !

People with sedentary behaviour in this study had better brain sharpness than doing light intensity physical activity !

It seems bizarre to suggest Sedentary activities are good for brain !

We don’t know why this study showed this particularly unexpected finding. It could be that the study missed to collect some important information that influences brain.

This fact about sedentary behaviour is counterintuitive but science does sometimes show unexpected results. Sometimes unexpected findings are true and Sometimes they are false due to data collection issues or convoluted statistical tests.

That’s why it is important that information from multiple studies is taken together rather than relying on one study to make any scientific conclusion on any topic !

References

Exploring the associations of daily movement behaviours and mid-life cognition: a compositional analysis of the 1970 British Cohort Study.

Minerva. BMJ. Physical activity and cognition in middle age.

Are artificial sweeteners safe?

December 5, 2022September 9, 2022

No !

Many people try to have a healthy diet without compromising taste.

Hence lot of low calorie foods have artificial sweeteners.

But artificial sweeteners are not a risk free option.

A French study looked at safety of various artificial sweeteners as (aspartame, acesulfame potassium, and sucralose) in a variety of foods and drinks (beverages, table top sweeteners, dairy products, etc).

They found that artificial sweeteners increased the risk of heart problems and risk of strokes.

References

Artificial sweeteners and risk of cardiovascular diseases: results from the prospective NutriNet-Santé cohort
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj-2022-071204 (Published 07 September 2022)
Cite this as: BMJ 2022;378:e071204

Can Calcium supplements harm the heart ?

November 7, 2022July 29, 2022

Yes, calcium supplements can cause harm.

Calcium is an essential mineral and an average average adult body contains more than 2 pounds of calcium.

Calcium is very essential not only for bone health but also for good functioning of many organs.

Too little calcium is bad but too much of calcium is also harmful.

Because calcium supplements are freely sold in Supermarkets and Pharmacies, many people assume they are absolutely safe.

A study published in Heart journal suggests that calcium supplements has the potential to damage heart valves.

The study also found that “Oral calcium supplementation with or without vitamin D is associated with lower survival”.

The results obviously need to be confirmed by other studies.

In the meantime, anyone with good amount of calcium in their routine diet need to think carefully about risk versus benefits of calcium supplements before taking them.

References

Daily Mail. Could bone boosting calcium pills be causing major damage to the hearts of millions of Britons?
By Erin Dean For The Mail On Sunday
22:01, 21 May 2022

Supplemental calcium and vitamin D and long-term mortality in aortic stenosis | Heart

Calcium, vitamin D and aortic valve calcification: to the bone or to the heart? | Heart https://heart.bmj.com/content/early/2022/03/23/heartjnl-2021-320672

Should NHS bribe people to adopt a healthy life style?

October 27, 2022October 27, 2022

A recent study conducted in U.K. later looked at the problem of smoking in pregnant women.

The study gave money to pregnant women if women stopped smoking.

The study found that giving money up to 400 pounds made some women stop smoking but sadly, the women stopped smoking only for a short period. After six months, there was NO significant difference between women given money and women given only usual advice about smoking.

The first issue with this study is the principle of “inducing / bribing” people with money to give up unhealthy habits. Shouldn’t the healthcare staff educate women rather than giving money for bad behaviour?

The second issue is no one knows whether the money was used wisely. Pregnant women who smoke are likely to have other vices such as unhealthy diet, physical inactivity, alcohol misuse, use of recreational drugs etc. Unhealthy behaviours cluster.

Giving money may have encouraged the women to stop smoking temporarily but the money could have used by women to replace smoking with other unhealthy behaviours. Unfortunately, the study doesn’t seem to looked at this problem.

In the study, two thirds of adverse events occurred in women given money vouchers. The authors have naively dismissed them as unrelated. The increase in adverse events suggests that women, who were given money, may have used the money unwisely. Perversely this well intentioned attempt to encourage good behaviour seem to have caused harm !

First, do no harm should be motto of healthcare staff .

Finally, most women who smoke during pregnancy are likely to be from lower socioeconomic group. Poverty is the underlying reason for most of their problems in life including unhealthy habits.

The Healthcare staff in UK are dealing with multiple crisis at present. It is beyond the ability of NHS staff to deal with poverty. The government through social services and public-health team should deal with poverty.

Read my reply at BMJ rapid response and contribute your thoughts through BMJ rapid response

References

Sundar S. Clustering of unhealthy behaviours and medicalisation of unhealthy lifestyles.

Effect of financial voucher incentives provided with UK stop smoking services on the cessation of smoking in pregnant women (CPIT III): pragmatic, multicentre, single blinded, phase 3, randomised controlled trial. BMJ 2022; 379 doi: https://doi.org/10.1136/bmj-2022-071522 (Published 19 October 2022)

Jefferies D. The steady crisis across the NHS. BMJ 2022;377:o1566. doi:10.1136/bmj.o1566

Sokol D K. “First do no harm” revisited BMJ 2013; 347 :f6426

Does Vitamin D reduce the risk of death in old people ?

October 3, 2022July 27, 2022

Unfortunately, No !

At least according to an Australian study published earlier this year.

Previously some studies suggested a benefit for Vitamin D supplements in older people.

In 2014, a Cochrane review suggested
that vitamin D, supplements might
reduce risk of death in older people. The esteemed Cochrane review recommended further studies.

A randomised controlled trial of oral vitamin D, supplementation for five years in Australians aged 60 or older reports no benefits. Among 20 000 participants followed for five years, the
primary outcome–death from any cause.
occurred as frequently in those taking
the active supplement as it did in those
taking placebo.

References

Vitamin D supplements . . . and other stories
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o452 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o452

Cochrane review Vitamin D supplementation for prevention of mortality in adults. (Cochrane Database Syst Rev doi:10.1002/14651858. CD007470.pub3).

The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality.
Rachel E Neale et al. Lancet Diabetes Endocrinol. 2022 Feb. Lancet Diabetes Endocrinol
doi:10.1016/S2213-8587(21)00345-4

Is 10 minute exercise every day any good?

September 5, 2022May 7, 2022

Yes, even a 10 minute exercise everyday is good.

‘Something is better than nothing’ principle applies.

Even Simple walking, Gardening or House work helps a lot.

Any exercise benefits the obese as well as those whose weight is in the normal range.

The normal recommendation is to do “at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity “

But, in the American study, even people who exercised less than the recommended benefitted from exercise.

Sit Less, Move More !

References

Telegraph: Why ‘exercise snacking’ could extend your life by two years.
Just 10 minutes’ walking, gardening or simply moving about pays health dividends
By Jessica Salter
7 May 2022 • 5:00am

NIH News in Health

A Little Exercise Might Lengthen Life

Original research paper link: Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis
Steven C Moore et al. PLoS Med. 2012.

Should one-off errors by honest doctors need to be punished harshly?

August 1, 2022July 27, 2022

Patients trust their doctors to do their job competently with due diligence each and every time, without any exception.

In an ideal world, doctors should do their utmost to justify their patients trust and confidence.

Doctors who persistently underperform need to be punished. Doctors who willfully and knowingly harm their patients should be punished harshly.

But doctors are human beings. Human beings are never perfect in whatever work they do.

Furthermore, the “Practice of Medicine” is more of an art balancing probabilities rather than an exact science with discrete answers all the time to every problem.

So unintentional medical errors happen all the time.

There are extremely few doctors who haven’t done an honest mistake or error in their entire career. So if all doctors are punished harshly each and every-time an honest error occurs , there will be few doctors left who won’t practice defensively.

Defensive medicine has a cost. Defensive Medicine would push up the cost of medical care further. And fewer and fewer people would be able to afford medical care.

Read my personal views on BMJ website and submit your views on the BMJ rapid response section

Article: GMC: harsh punishment is a sword of Damocles
Free to access link: http://bmj.com/cgi/content/full/bmj.o1828?ijkey=1NzgQpzG45Vgi7U&keytype=ref

GP suspension for failure to refer fast track. GMC: harsh punishment is a sword of Damocles. BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1828 (Published 26 July 2022)Cite this as: BMJ 2022;378:o1828

Why advanced cancer patients choose to have chemotherapy!

July 25, 2022July 25, 2022

Many people would be surprised to learn that cancer patients with advanced incurable cancer actively choose chemotherapy for relatively small benefits.

Chemotherapy has the potential to relieve cancer related symptoms but in many advanced cancers, Chemotherapy prolongs survival ( on average ) only by a few months . Yet, lot of patients do opt to try chemotherapy which can be sometimes quite toxic.

Even in countries such as U.K. where oncologists are NOT on a fee for service contract (such as NHS), lot of patients do opt for Chemotherapy.

Perhaps, Chemotherapy gives hope for people not ready to face death.

Read my views in BMJ and contribute your thoughts on this topic through the rapid response section of online BMJ.

BMJ Article: Death, futility, and oncology

Free to access link: http://bmj.com/cgi/content/full/bmj.o1785?ijkey=Du1yaSA5KhkGz23&keytype=ref

Is watching the daily “Step count” helpful?

July 14, 2022July 3, 2022

Yes, certainly!

Although it is obvious exercise helps, it is good to have definitive evidence from good studies.

A large Australian study involving 5000 elderly women (average age 79) looked at the physical activity of these women for over a week.

After that, the women were followed up for the next seven years, and 400 of them developed
diabetes. Not surprisingly, women
with higher step count were found to be at lower risk of developing diabetes. Each extra 2000 steps per day was found to reduce the diabetes risk by 12% fall.

Another study from Sweden also showed that high daily step count reduces the risk of diabetes in elderly people.

The widely used daily target of 10,000 steps/day is good but even step counts lower than 10,000 steps , say 4500 to 6000 steps/day, are very beneficial.

Probably something is better than nothing!

References

Associations of Daily Steps and Step Intensity With Incident Diabetes in a Prospective Cohort Study of Older Women: The OPACH Study
Alexis C Garduno et al. Diabetes Care. 2022. (Diabetes Care doi:10.2337/dc21-1202).

Vitamin D supplements . . . and other stories
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o452 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o452

Daily step count and incident diabetes in community-dwelling 70-year-olds: a prospective cohort study
Marcel Ballin et al. BMC Public Health. 2020. FULL TEXT.

Can bowel cancer be diagnosed without a camera test?

July 4, 2022July 3, 2022

Yes, previously a camera test (colonoscopy) was the only reliable way of looking at the inside of the bowels.

Now, there is an alternative. Advances in scan technology has enabled radiologists to look at the inside surface of bowels without a direct camera .

A special type of scan called Virtual Colonoscopy is helping doctors diagnose bowel cancer in appropriate patients.

There is increased awareness of bowel cancer following the death of 40 yr old Dame Deborah James.

Hopefully, Virtual colonoscopy will play an important complementary role in early diagnosis of bowel ( colon) cancer.

Does frequent sipping of water help?

June 6, 2022March 6, 2022

Yes, according to an article in Telegraph.

It is known that drinking water before eating helps overweight people to lose weight.

Also frequent sipping of water would help to meet the daily recommended intake of water. A significant proportion of population do not drink enough water.

References:

Water Intake, Water Balance, and the Elusive Daily Water Requirement. Lawrence E. Armstrong and Evan C. Johnson. Nutrients. 2018 Dec; 10(12): 1928.
Published online 2018 Dec 5. doi: 10.3390/nu10121928
PMCID: PMC6315424 (daily total water intake (TWI, L/24h) ˂1.8 L” may influence the risk of dysfunctional metabolism and chronic diseases.

Daily Telegraph. Why sipping water could help you lose weight.
Robert Pattinson did it for his role as Batman and bodybuilders do it before an event, but doctors advise a measured approach
By
Sharon Walker
6 March 2022 • 12:00pm

USA. About 80 percent of people’s total water comes from drinking water and beverages — including caffeinated beverages — and the other 20 percent is derived from food. women who appear to be adequately hydrated consume an average of approximately 2.7 liters (91 ounces) of total water — from all beverages and foods — each day, and men average approximately 3.7 liters (125 ounces) daily.

Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants. doi: 10.4103/0976-9668.136180
PMCID: PMC4121911
PMID: 25097411

Increased Hydration Can Be Associated with Weight Loss
Simon N. Thornton
Front Nutr. 2016; 3: 18. Published online 2016 Jun 10. doi: 10.3389/fnut.2016.00018
PMCID: PMC4901052

A word of caution applies to all ‘food/ drink and disease’ association reports. Almost every week there are newspaper reports of studies exploring associations between “various food/drink” with “various diseases” and “health”. Some of them are conflicting and confusing with a positive study followed by a negative study ! This news report is no different in that respect.

Does calcium in diet prevent fractures in elderly people ?

May 9, 2022February 6, 2022

Yes.

A study published in British Medical Journal (BMJ) looked at 7195 permanent residents living in 60 residential aged-care facilities in Australia.

Over a two year period, they provided residents in half the facilities (30 facilities) with additional milk, yoghurt, and cheese. The residents in the remaining 30 facilities who served as controls had their usual menus.

The study found that the additional calcium in diet is beneficial.

Improving calcium and protein intakes reduced the risk of falls and fractures that commonly occur in aged care residents.

References: Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2364 (Published 21 October 2021)
Cite this as: BMJ 2021;375:n2364

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Can cancer “finger prints” help to destroy them?

April 22, 2022April 22, 2022

Potentially yes !

We still don’t know a lot about cancers, how they start, when they start and what keeps them going.

We already know that some of the changes seen more often in cancerous tissues than in normal tissues can help to devise anti-cancer treatments. Examples include Herceptin for Breast cancer, Olaparib for Ovarian cancer.

But there is a lot a do if we were to cure or control cancers.

A recently published study by the Cambridge team is quite exciting. It probably would lead to more similar studies and ultimately better and more effective cancer treatments.

The study analysed all the genetic material from cancers (“whole genome”) and found “genetic finger prints” in various cancers . Targeting these changes could help to diagnose and treat cancers more effectively.

A word of caution: it usually makes many years for the new discoveries to lead to better treatments. Clinical trials often take years to start, recruit and analyse results.

References

BBC. Cancer: Huge DNA analysis uncovers new clues. By Smitha Mundasad
Health reporter

Daily Telegraph. Mindblowing’ gene discovery brings tailor-made cancer treatment a step closer. Cambridge research reveals 58 new mutational signatures, raising hopes of a cancer care revolution based around personalised treatment By Laura Donnelly, HEALTH EDITOR 21 April 2022 • 7:00pm

Science Magazine AAAS. Andrea Degasperi et al. ‘Substitution mutational signatures in whole-genome–sequenced cancers in the UK population.’ SCIENCE • 22 Apr 2022 • Vol 376, Issue 6591 • DOI: 10.1126/science.abl9283

Wearable Technology: are Physical activity and Fitness monitors useful ?

April 11, 2022February 6, 2022

Once we come out of this COVID pandemic, everyone’s attention needs to be focused on the obesity pandemic.

During the COVID pandemic, lot of people started to focus on their physical fitness. People invested in Home Exercise equipment and in wearable technology such as Fitness monitors.

Even before this pandemic, lot of people have started using Fitness monitors.

Are they any good?

A recent study published in British Medical Journal (BMJ) looked the effectiveness of physical activity monitors.

The study authors looked at more than 120 trials involving more than 16 700 participants.

Most of studies they looked at were either European (31%) or North American (40%). Most of these studies included healthy participants (47%), although some included overweight participants (17%).

They found Fitness monitors are generally safe and help to increase physical activity.

Whether the Fitness monitors will help overweight people to lose weight permanently over long term needs further investigation.

References:

Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068047 (Published 26 January 2022)Cite this as: BMJ 2022;376:e068047

Gov.UK. Physical activity: applying All Our Health
Office for Health Improvement & Disparities
Guidance. Physical activity: applying All Our Health. Updated 16 October 2019

Bravata DM, Smith-Spangler C, Sundaram V, et al. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298:2296-304. doi:10.1001/jama.298.19.2296 pmid:18029834.

Activity monitors for increasing physical activity in adult stroke survivors
Elizabeth A Lynch et al. Cochrane Database Syst Rev. 2018.

Another drug to fight severe COVID

March 21, 2022March 9, 2022

More good news !

The new drug for COVID is called baricitinib.

The drug Baricitinib is not a brand new drug. It is normally used to treat a type of joint problem called rheumatoid arthritis. Now, this drug has been found to be very beneficial in patients suffering from severe COVID.

The drug was evaluated as part of the renowned RECOVERY trial.

RECOVERY ( Randomised Evaluation of Covid-19 Therapy) trial is led by investigators in U.K.

The trial found that Baricitinib reduces the risk of death by around one fifth in patients with severe covid-19.

On the other hand, Some bad news about a drug who was thought to be promising before. Questions have been raised about the actual benefit , if any, from a previously approved drug called Molnupiravir.

Overall, at present, we have lot more drugs to tackle COVID in addition to the Vaccines.

References

BMJ. Covid-19: Anti-inflammatory treatment baricitinib reduces deaths in patients admitted to hospital, finds trial
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o573 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o573

BBC news. Another life-saving Covid drug identified
By Michelle Roberts
Digital health editor

Guardian. Arthritis drug could help save Covid patients – study
Rheumatoid arthritis drug baricitinib can reduce risk of death from severe Covid by about a fifth
Nicola Davis Science correspondent
@NicolaKSDavis
Thu 3 Mar 2022 18.07 GMT

Daily Mail. Arthritis drug cuts risk of severely-ill Covid patients dying by up to a fifth, major trial reveals. By Luke Andrews Health Reporter For Mailonline
15:00, 03 Mar 2022 , updated 16:42, 03 Mar 2022

BMJ. Molnupiravir’s authorisation was premature
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o443 (Published 03 March 2022)
Cite this as: BMJ 2022;376:o443

Can mild Covid affect the brain ?

March 11, 2022March 9, 2022

Yes, according to an Oxford study.

The team investigated brain changes in 785 UK Biobank participants (aged 51–81).

The team compared Brain scans before COVID infection and Brain scans after infection.

They found that people with COVID subsequently had “brain shrinkage” and reduced “brain function” particularly relating to parts of brain dealing with emotions smell and long-term memory

It is not known whether these brain changes are temporary and reversible after a while or whether these changes are permanent.

References

Original paper in Nature for COVID brain. Douaud, G., Lee, S., Alfaro-Almagro, F. et al. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature (2022). https://doi.org/10.1038/s41586-022-04569-5

Daily Telegraph. Covid may cause the brain to degenerate three times faster than normal
Study finds ‘significantly greater cognitive decline’ among people who have been infected with coronavirus
By Sarah Knapton, SCIENCE EDITOR
7 March 2022 • 4:46pm

BBC. Scans reveal how Covid may change the brain By Rebecca Morelle
Science Editor, BBC News

Bloomberg. Covid Can Shrink the Brain as Much as a Decade of Aging, Study Finds. By Jason Gale+Follow7 March 2022, 16:00 GMT

Daily Mail. ‘Covid brain’ IS real: Illness can cause regions of the brain to SHRINK and lead to cognitive decline, new study finds. By Bhvishya Patel For Mailonline
02:16, 08 Mar 2022 , updated 07:18, 08 Mar 2022

Why did so many vaccinated people catch the omicron variant recently ?

March 9, 2022March 9, 2022

Many people report that they have seen many of their friends and family and work colleagues have caught the COVID virus during the recent wave.

Why did so many vaccinated people catch the infection?

It’s because of two reasons. (1) the vaccines are not 100% effective and (2) there is substantial reduction in vaccines effectiveness over time.

A large U.K. study looked at vaccine effectiveness against symptomatic disease caused by the omicron and delta variants in England.

Frighteningly, No effect against the omicron variant was noted from 20 weeks after two Astra Zeneca vaccine doses, and the effectiveness of two Pfizer vaccine was only marginally better with 8.8% protection at 25 or more weeks after two Vaccine doses.

Vaccine effectiveness improved to about 65% protection at 2 to 4 weeks after a third Pfizer booster but this was not long lasting and the effectiveness decreased to about before decreasing to 44% at 10 or more weeks after Vaccination.

In summary, Vaccination with two doses of AstraZeneca or Pfizer vaccine provided limited protection against symptomatic disease caused by the omicron variant.

A third booster with Pfizer or Moderna vaccine substantially increased the protection, but even that protection gradually decreased over time.

This study, published in the Prestigious NEJM journal, was Funded by the U.K. Health Security Agency and hence highly reliable.

One has to hope that any new variants do not bypass the vaccine protection and cause much more severe disease than omicron!

References

Daily Mail. US Omicron surge is close to reaching its peak with infections ‘coming down as fast as they went up as variant runs out of people to infect’: Deaths remain low, rising just 10% in two weeks as daily cases rise 184%. By Mansur Shaheen U.S. Deputy Health Editor For Dailymail.Com
14:53, 12 Jan 2022 , updated 22:18, 12 Jan 2022

NEJM. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant.

Nature magazine. Iketani, S., Liu, L., Guo, Y. et al. Antibody evasion properties of SARS-CoV-2 Omicron sublineages. Nature (2022). https://doi.org/10.1038/s41586-022-04594-4 ( substantial loss in neutralizing activity against omicron variant)

Are COVID vaccines less effective in people with low-immunity?

March 6, 2022March 5, 2022

Yes, the COVID vaccines struggle to boost the immunity against COVID in people who have a defective or suppressed immune system.

A recent study published in BMJ looked at all relevant publications and confirms this. Cancer patients and patients who have received organ transplants are at risk of inadequate protection from the vaccines.

It is important that people who have low immunity get boosters as recommended by the guidelines ( third or fourth dose).

References

BMJ. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068632 (Published 02 March 2022)
Cite this as: BMJ 2022;376:e068632

U.K. govt. COVID-19 vaccination: a guide to booster vaccination for individuals aged 18 years and over and those aged 16 years and over who are at risk. Updated 2 February 2022.

NHS. Coronavirus (COVID-19) vaccine for people with a severely weakened immune system. Page last reviewed: 24 February 2022

Is Diclofenac better than opioid drugs such as morphine, oxycontin, codeine, tramadol for knee arthritis pain ?

March 1, 2022February 6, 2022

Yes.

Diclofenac is sometimes overlooked as a pain killer before people go on to stronger morphine-like prescription pain killers.

A study published in BMJ suggests that Diclofenac tablets take by mouth is effective for pain due to arthritis.

Overall, Diclofenac, taken by mouth, seem to be effective and generally safer than Opiod drugs. But caution is needed particularly in elderly people with multiple other medical problems.

Interestingly, Diclofenac Cream applied over the skin and Joints seem to be particularly effective for Knee arthritis pain.

Applying the cream also overcomes the problem of Diclofenac side effects, since very little of Diclofenac reaches other parts of the body.

The authors recommend Diclofenac Skin Cream as first line pharmacological treatment for knee osteoarthritis.

References

BMJ. Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2321 (Published 12 October 2021)
Cite this as: BMJ 2021;375:n2321

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Are the brain surgeons more brainy than others ?

February 28, 2022February 6, 2022

It is a common perception that brain surgeons are more brainy than the rest of general public.

It is also often quipped that rocket scientists are more smarter than general public

How true is it ?

A study published in British Medical Journal (BMJ) looked at the “smartness” of the rocket scientists and brain surgeons.

They assessed the “smartness” by using an online test. The study involved 600 aerospace engineers ( rocket scientists) and 148 neurosurgeons ( brain surgeons).

This online test known as “Cognitron’s Great British Intelligence Test” measured distinct aspects of cognition, spanning planning and reasoning, working memory, attention, and emotion processing abilities.

The brain surgeons had higher scores than the rocket scientists in semantic problem solving. The rocket scientists got higher scores in mental manipulation and attention.

With many other sections of the tests, the brain surgeons and rocket scientists did not do a lot better than the general population !

The study concludes that both neurosurgeons and aerospace engineers are unnecessarily placed on a pedestal with common phrases such as “It’s not rocket science” and “It’s not brain surgery”.

This study does NOT prove the experts do not know much more than general public.

The study does NOT mean that “social media rants” and “conspiracy theories” are somehow right !

Would you let a lay person operate on your brain ?

Technical and Scientific Expertise is still valuable !

References

“It’s not rocket science” and “It’s not brain surgery”—“It’s a walk in the park”: prospective comparative study
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-067883 (Published 13 December 2021)
Cite this as: BMJ 2021;375:e067883

Guardian. Brain surgeons and rocket scientists no brighter than the rest of us, study finds
Data from 329 aerospace engineers and 72 neurosurgeons suggests they are not necessarily cleverer than general population.
Nicola Davis
@NicolaKSDavis
Mon 13 Dec 2021 23.30 GMT

BBC. Rocket scientists and brain surgeons aren’t necessarily more clever – study

Can “depression” cause heart problems and diabetes?

February 15, 2022February 16, 2022

Sadly Yes !

A UK Biobank study analysed more than 325,000 individuals of European ancestry. The study found that people with low mood are at higher risk of developing heart and blood sugar problems. [ medical terms- coronary artery disease (CAD), type 2 diabetes (T2D) and atrial fibrillation].

Individuals with depression in this study were more likely to be current smokers; reported less vegetable and fresh fruit intake, less exercise and sleep; and had higher body weight (body mass index – BMI).

Even though the study adjusted the statistics for various baseline factors, one cannot help wonder whether there are yet unidentified factors at play.

References: Low depression frequency is associated with decreased risk of cardiometabolic disease. Michael C. Honigberg, Yixuan Ye, Lillian Dattilo, Amy A. Sarma, Nandita S. Scott, Jordan W. Smoller, Hongyu Zhao, Malissa J. Wood & Pradeep Natarajan.
Nature Cardiovascular Research (2022). Published: 14 February 2022

Daily Mail. Depression may increase the risk of heart disease and type 2 diabetes, major study warns. By Emily Craig Health Reporter For Mailonline16:00, 14 Feb 2022 , updated 16:34, 14 Feb 2022

Does the use of Cosmetic and Deodorant Powder in Genital areas increase risk of Ovarian cancer ?

February 14, 2022February 5, 2022

Some women apply powder to their private area, either through direct application or on underwear, sanitary napkins, diaphragms or tampons.

Some studies have previously raised the concern that this deodorant powder, particularly talc powder, can increase the risk of ovarian cancer.

A high quality study looked at the “Association of Powder Use in the Genital Area With Risk of Ovarian Cancer“.

The study findings are reassuring.

The study found no major significant association between use of powder in the genital area and ovarian cancer.

References

Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. Katie M. O’Brien, PhD; Shelley S. Tworoger, PhD; Holly R. Harris, ScD; et al. JAMA. 2020;323(1):49-59. doi:10.1001/jama.2019.20079

Penninkilampi R, Eslick GD. Perineal talc use and ovarian cancer: a systematic review and meta-analysis. Epidemiology. 2018;29(1):41-49. doi:10.1097/EDE.0000000000000745

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

How quickly do COVID vaccines lose their effectiveness?

February 11, 2022December 25, 2022

The rapid development and deployment of COVID vaccines has played a critical role in bringing the Pandemic under control (at least in early 2022).

But there is a disappointing factor with the current vaccines. The disappointing factor is NOT the side effects !

The disappointing factor is the loss of efficacy (protection) within a matter of months, particularly against new variants.

How quickly do the vaccines lose their effectiveness?

An Italian study published in BMJ provides some insight.

In this study involving more than 33 million people, the long term protection of Pfizer-BioNTech and Moderna vaccines was assessed.

Vaccine effectiveness against any SARS-CoV-2 infection significantly decreased from 82% to 33% at about 7 months after the second dose.

Vaccine effectiveness against severe covid-19 (admission to hospital or death) was much better though. The effectiveness decreased but to a much lesser extent, from 96% to 80%.

This Italian study confirms that a booster dose of vaccine six months after the primary vaccination cycle is the best way forward.

Reference: Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: retrospective cohort study
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-069052 (Published 10 February 2022)
Cite this as: BMJ 2022;376:e069052

Benefits of Vitamin D supplements and Omega 3 supplements

February 6, 2022February 5, 2022

Most people assume that nutritional supplements are always beneficial. But it is not always the case.

Paradoxically, the people, who may need the supplements because they don’t have a healthy diet, are the often ones who do not take the supplements !

But people, who usually do not need various supplements, because they are health conscious and have a good healthy diet, are often the ones who take the supplements unnecessarily !

Sometimes Supplements can be harmful. Hence, the need for clinical trials to assess the benefits and risks of various supplements.

So it is interesting to read a trial in the British Medical Journal (BMJ) which looked at Vitamin D and marine derived omega 3 fatty acids supplements. The study looked the effect of these two supplements in preventing Autoimmune diseases.

Autoimmune disease is a type of disease where body’s own immune system misfires and causes inflammation in self-tissues.

Autoimmune diseases, are often chronic conditions and cause considerable misery.

The study published in BMJ looked at Autoimmune diseases, such as rheumatoid arthritis, polymyalgia rheumatica, autoimmune thyroid disease, psoriasis, and inflammatory bowel disease, and all other new onset autoimmune diseases.

This well conducted study used a dummy pill and hence the results are usually expected to be quite reliable.

About 25 800 participants were enrolled in the study and were followed up for an average of about 5 years.

This large study from United States found that vitamin D and omega 3 fatty acid supplementation taken for five years reduces the risk of developing autoimmune diseases.

References: Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-066452 (Published 26 January 2022)
Cite this as: BMJ 2022;376:e066452. https://www.bmj.com/content/376/bmj-2021-066452

Medical Negligence Jackpot

January 22, 2022January 22, 2022

Modern Medicine is not without risks.

Practically all interventions or even non-interventions can cause harm. For example, a doctor simply encouraging a patient to drink more water or recommending bed rest can be harmful in certain medical circumstances.

Many medical harms ( side effects and complications) are certainly not due to significant clinical negligence.

But in the small minority where harm is due to clinical negligence ( albeit un-intentional ), getting compensation is not straightforward.

It is a shame that not everyone who suffers medical harm is able to seek compensation.

Patients usually have to prove medical negligence to get compensation and only a small fraction of people do have the time, money and drive to pursue a negligence claim through legal process. It seems like a jack-pot where a few win big amounts while others receive nothing.

A recent hotly debated case about a doctor who did not strongly recommend folic acid to a mother, has re-opened the discussion on no-fault compensation.

Read the articles in the BMJ and respond if you can.

References

S Sundar. “Wrongful conception” case: “Wrongful conception”: the case for no-fault compensation. BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o153 (Published 21 January 2022) Cite this as: BMJ 2022;376:o153. Free to access link: http://bmj.com/cgi/content/full/bmj.o153?ijkey=tVbj8XpptPFTQES&keytype=ref

Folic acid supplementation and the complexities of blame. BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o144 (Published 20 January 2022)Cite this as: BMJ 2022;376:o144

Papanikitas A, Spicer J, Hayhoe B. “Wrongful conception” ruling against UK general practitioner. BMJ2022;376:o79. doi:10.1136/bmj.o79 pmid:35031556. FREE Full TextGoogle Scholar

Dyer C. Show jumper wins case against mother’s GP for “wrongful conception” that resulted in her disability. BMJ2021;375:n2999. doi:10.1136/bmj.n2999. pmid:34862168. FREE Full TextGoogle Scholar

Toombes v Mitchell T. [2021] EWHC 3234. https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2021/12/Toombes-v-Mitchell-Approved-Judgment.pdf.

BMJ. What implications does the Toombes vs Mitchell case have for other healthcare professionals?
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o162 (Published 20 January 2022)
Cite this as: BMJ 2022;376:o162

Dollimore L. Spina bifida showjumper wins landmark legal case over her “wrongful conception”: Evie Toombes, 20, who sued her mother’s GP claiming she “should never have been born” could win millions in damages. Daily Mail 2021 Dec 1. https://www.dailymail.co.uk/news/article-10262911/Para-showjumper-sued-mothers-GP-claiming-never-born-wins-landmark-case.html

Do statins cause muscle aches and pain ?

January 3, 2022July 23, 2021

Yes, Statins can cause muscle aches and pains.

But the number of people getting it is very small and in vast majority of people, the symptoms are not serious.

Most importantly, the benefits of statins outweighs the risk of side effects.

That is the conclusion of a study published in BMJ medical journal.

References

BMJ. Associations between statins and adverse events in primary prevention of cardiovascular disease: systematic review with pairwise, network, and dose-response meta-analyses
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1537 (Published 15 July 2021)
Cite this as: BMJ 2021;374:n1537

Low mood: Anti-depressants should not be the first choice for everyone

December 22, 2021December 21, 2021

We live in a society where we look for quick fixes for everything.

For example, Fast-foods are immensely popular because we are all busy and we want quick fixes.

So it is not surprising that some people look at prescription medications as a quick fix for their low mood.

For some people, anti-depressants can be very helpful.

But a recent article suggests that anti-depressants should not be the first choice for everyone

Telegraph. Antidepressants might be largely ineffective, study suggests
By
Telegraph Reporters
21 December 2021 • 8:27am

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Poor Sleep and Heart attacks

December 15, 2021November 13, 2021

A study reports that going to sleep 10pm is linked to lower risk of heart disease.

The study suggests that “Early or late bedtimes may result in individuals missing cues that help reset body clock each day”

The association with increased heart problems was stronger in females.

Even though going to bed early is very hard with globally interconnected mobile devices, it is important we all sleep well !

References

Guardian newspaper. Sleep at 10pm linked to lower risk of heart disease, study finds.
Nicola Davis Science correspondent
@NicolaKSDavis
Tue 9 Nov 2021 00.05 GMT

Accelerometer-derived sleep onset timing and cardiovascular disease incidence: a UK Biobank cohort study
Shahram Nikbakhtian, Angus B Reed, Bernard Dillon Obika, Davide Morelli, Adam C Cunningham, Mert Aral, David Plans
European Heart Journal – Digital Health, ztab088, https://doi.org/10.1093/ehjdh/ztab088
Published: 09 November 2021

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Can vitamins increase risk of cancer ?

December 6, 2021July 23, 2021

Yes

Vitamins are absolutely essential nutrients and vitamin deficiency causes various illness.

But a high dose of vitamin, far too much than needed by the body, is also bad.

Everything in moderation is good. Even an abundance of a good thing is bad.

It is similar to food. Lack of food would cause starvation and even death in the extreme. But too much of food causes obesity and other health problems. Same principle applies to vitamins.

A Cochrane review looked at the ability of vitamins to prevent lung cancer. The review concluded that there is “no beneficial effect of supplements for the prevention of lung cancer and lung cancer mortality in healthy people”

Worryingly, the review also found that the following:

– Vitamin A supplements increase lung cancer incidence and mortality in smokers or persons exposed to asbestos”.

– Vitamin C increases lung cancer incidence in women.

– Vitamin E increases the risk of haemorrhagic strokes.

So if you are having a healthy balanced diet, be careful with vitamin supplements.

Drugs for preventing lung cancer in healthy people
Marcela Cortés-Jofré et al. Cochrane Database Syst Rev. 2020.
Free PMC article

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Why is the COVID booster needed ?

November 27, 2021November 27, 2021

Two reasons

One, immunity levels decrease after about six months . The extra shot boosts the immune system.

Two, the end of pandemic once again is pushed away as a new omicron variant has now come on the scene

References

Will Britain need a £1billion Covid booster vaccine roll-out for EVERYONE every winter? Two doses of Pfizer’s vaccine wane after six months no matter what age you are, major Israeli study finds. By Joe Davies For Mailonline
13:32, 17 Nov 2021 , updated 15:55, 17 Nov 2021.

Daily UK Covid cases breach 50,000 for first time in a month after rising 13% in a week and deaths creep up 2% to 160 but hospital admissions fall for 10th day in a row. By Luke Andrews Health Reporter and Rory Tingle, Home Affairs Correspondent For Mailonline
16:37, 26 Nov 2021 , updated 18:39, 26 Nov 2021

Boris ‘plans travel bans on MORE countries over Christmas’ amid fears of new Covid super-variant Omicron as health chiefs call for calm and say there is ‘no plausible scenario’ strain will take UK back to ‘square one’. By Shaun Wooller and Eleanor Hayward and Claire Ellicot For The Daily Mail and Tom Pyman For Mailonline
22:00, 26 Nov 2021 , updated 01:58, 27 Nov 2021

BBC Covid: Face masks re-introduced as UK Omicron cases found

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light

A new COVID variant !

November 25, 2021November 25, 2021

A new variant of Coronavirus has emerged in Africa and it is causing significant concern.

The variant seems to have “changed its coat”. The scientists worry that these changes ( mutations) can make it more transmissible and potentially evade vaccines.

U.K government has put six African countries on the Red List. All flights from South Africa, Namibia, Zimbabwe, Botswana, Lesotho and Eswatini are being suspended now.

References

BBC news. Covid: New heavily mutated variant B.1.1.529 in South Africa raises concern. James Gallagher
Health and science correspondent.

BBC News. Covid: Africa travel restrictions over variant fear.

Guardian. South Africa to be put on England’s travel red list over new Covid variant.
Hannah Devlin, Ian Sample and Jessica Elgot
Thu 25 Nov 2021 21.22 GMT

Daily Mail. Scientists sound alarm over new ‘worst-ever’ super-mutant Covid variant that will make vaccines at least 40 per cent less effective as flights are BANNED from South Africa and five other African countries. By Tom Pyman and Connor Boyd Deputy Health Editor For Mail online
20:32, 25 Nov 2021 , updated 22:07, 25 Nov 2

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Chocolate, Coffee and Wine: Good or Bad for Heart?

November 21, 2021November 19, 2021

Are Chocolate, Coffee and Wine good for heart ?

Depends…

Dark Chocolate: good

Coffee: possibly good

Wine: probably not good

Read the interesting article in Guardian .

Good or bad? Top cardiologist gives verdict on chocolate, coffee and wine
Exclusive: Prof Thomas Lüscher assesses the heart healthiness of some of our favourite treats

Andrew Gregory Health editor
Fri 19 Nov 2021 12.29 GMT

A word of caution applies to all ‘food and disease’ association reports. Almost every week there are newspaper reports of studies exploring associations between “various food/drink” with “various diseases”. Some of them are conflicting and confusing with a positive study followed by a negative study !

So don’t be surprised if there is a completely different news report next week !

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Anxiety and Irritable Bowel Syndrome (IBS)

November 20, 2021November 13, 2021

IBS or Irritable bowel syndrome is a common condition. Lot of people with IBS also have Anxiety problems.

So it was not known whether anxiety by itself causes the IBS.

A recent study suggests Anxiety and IBS coexist due to genetic abnormalities. Anxiety by itself does not seem to lead to someone developing IBS.

This large U.K. study involving 53,400 cases and 433,201 controls suggests that genes that alter brain–gut interactions may be responsible for IBS.

On the other hand, the overall likelihood of an individual developing IBS due to genes passed down the family seems low.

So with IBS, lot of things about it continue to remain a mystery. How IBS starts and how it progresses is still mostly unknown. Hopefully, future research will clarify things.

BBC News. Anxiety link to irritable bowel syndrome seen in DNA – research
By Michelle Roberts
Health editor, BBC News online

University of Cambridge. Large-scale genetic study reveals new clues for the shared origins of irritable bowel syndrome and mental health disorders

Eijsbouts, C et al. Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders. Nature Genetics; 5 Nov 2021; DOI: 10.1038/s41588-021-00950-8

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.

Can modified Infant formulas (breast milk substitutes) do harm ?

November 13, 2021November 13, 2021

Yes.

Breastfeeding is best for mother and baby. But for various reasons, it is not possible to breast feed. So Infant formulas (breast milk substitutes) are widely used.

These infant formulas are often modified in the hope of making them equivalent to breast milk.

A recent study analysing data from multiple studies reports that modified infant formulas are not better.

The study worryingly suggests potential harm from infant formulas supplemented with long chain polyunsaturated fatty acids (LCPUFAs).

Mimicking nature doesn’t always work !

Reference

BMJ. Effect of nutritionally modified infant formula on academic performance: linkage of seven dormant randomised controlled trials to national education data
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-065805 (Published 11 November 2021)
Cite this as: BMJ 2021;375:e065805

BMJ. Enriched formula milks and academic performance in later childhood
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2661 (Published 11 November 2021)
Cite this as: BMJ 2021;375:n2661

Disclaimer: Please note – This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog are NOT, in way whatsoever, intended to be a substitute for professional advice. The blog is NOT previewed, commissioned or otherwise endorsed, in any way, by any organisation that the author is associated with. The views expressed in this blog likely represents some of the author’s personal views held at the time of drafting the blog and MAY CHANGE overtime, particularly when new evidence comes to light.