Articles of Interest this Week

quadruple DNA helix

Here are some of the articles I found interesting this week.

Cancer

What kind of patient are we? Does it make any difference? Susan Gubar on the advantages or not of being a good, polite and cooperative patient in Living With Cancer: The Good Patient Syndrome. She is more cynical than me; my experience is that being polite, courteous and expressing thanks builds the relationship that allows one to flag, professionally, when things do not appear to be going right or potential mistakes are being made.

The ongoing discussion of Lance and Livestrong continues, with some interesting takes on celebrity cancer struggles, starting with Ilana Horn’s Lance Armstrong, Susan Komen, cancer and me, a great piece that reminds us that life provides plenty of adversity to remind us what counts, without cancer, and celebrity tales of success just place more pressure on us ordinary folk. Sunrise Rounds reminds us that cancer ‘heroes’ are all around us, no need to resort to the celebrities in Replacing Lance; Cancer heroes.

We tend to focus on certain aspects of our cancer treatment and recovery. While on one level, this is an example of  a superficial concern (First came my cancer diagnosis, then came my bad hair year), we all find different ways of dealing with our cancer and its after effects, and whether this is anchored more deeply or a more superficial ‘proxy’, matters less than whether it provides a helpful coping mechanism.

Australia is often at the leading edge on sun protection, given their hot and sunny summers, and this piece provides a good overview of good sunscreen and other sun protection techniques (Sunscreen, skin cancer and the Australian summer). Bit strange to be referring to this article during the extreme cold snap this week!

Encouraging news from the front line of cancer research on using synthetic HDL (high density lipoprotein) nanoparticles, by starving B-cell lymphoma cells of one of their key nutrients, natural HDL in New way to kill lymphoma without chemotherapy: Golden nanoparticle starves cancer cell to death. A number of years away, to say the least.

More on the research front as curiouser and curiouser, cancer genetics become more complicated in Quadruple DNA helix discovered in human cells, leading to possible treatment that would only target quadruple DNA helix cancer cells, with less toxicity to normal cells. But also a long way off and much more research required.

And on the more practical level, for those of you with peripheral neuropathy (numbness in feet or hands), this short 5 minute video from Memorial Sloan-Kettering may be of interest (Diagnosing Chemotherapy-Induced Peripheral Neuropathy).

Health and Wellness

Contributing to the ongoing debate on cancer screening, Overdiagnosis: An epidemic or minor concern? takes an interesting approach, comparing screening to preventing snipers, arguing for better and more informed discussion with patients on the potential risks and benefits.

Building on this, another good piece on how patients and doctors need to understand each other, how probabilities work (and don’t work), and what the risks and tradeoffs are with any proposed treatment, always taking into account the patient’s priorities and wishes in When the Patient Knows Best. Part of the challenge that most of us have, particularly at the beginning, is that we are still too much in shock and starting the learning curve to be very effective. I was more effective the second time round than the first, given I was more knowledgeable, more confident in my discussions with my medical team, who were by then well-known to me.

On the general health policy front, while I agree with the assumption that patients need financial incentives to improve lifestyle choices in Patients need pay for performance too, this is not terribly well articulated and without examples. A better example of an integrated approach is an earlier post on the approach of the Cleveland Clinic (Smokers Penalized With Health Insurance Premiums).

We are what we eat and reflect our environment. The links between endocrine disruptors in household chemicals and obesity are explored in Warnings From a Flabby Mouse, yet another possible factor contributing to obesity in addition to poor lifestyle choices (lack of exercise, nutrition). See also earlier article How Chemicals Change Us.

Mark Bittman on the cleverness and cynicism of the Coke obesity ad Coke Blinks – I don’t recall Coke supporting the Bloomberg Big Gulp ban. The parody video is quite well done in calling Coke (and the soft drink industry) out on this. And this shameful position, given the obesity epidemic among their communities – money talks in Minority rights groups NAACP and Hispanic Federation join lawsuit against NYC big soda ban.

Good summary on recent findings on smoking death rates and the importance of stopping smoking early to avoid early death in New Report On Smoking In Women Confirms That “Women Who Smoke Like Men Die Like Men”.  While no hard evidence, and no link to some of the more graphic anti-smoking images on cigarette packages in countries like Canada,  Experts believe plain packaging of tobacco products would cut smoking. My own take is that is has been the range of anti-smoking initiatives, including labelling, that have contributed to declining rates.

Other

A somewhat tongue-in-cheek piece on courtesy and politeness in The Courtesy Control Malfunctions, a bit similar to Susan Gubar’s piece but in a more general context. As always, context matters, sometimes being more direct is appropriate, sometimes not, although better to err on the politeness side.

On the more serious side, a discussion of how we are able to hold contradictory beliefs, and some of the biases that are reinforced by our worldview in The Mind’s Compartments Create Conflicting Beliefs. At the individual level, being aware of this phenomenon, and consciously reading and exposing oneself to different viewpoints, is one tactic; when trying to convince others, being aware of their worldview can be helpful in how one approaches a discussion. Useful in any number of personal and professional situations.

Lucy Kellaway on the importance and challenge of plain language. The test examples are funny but pointed in Bosses fail the 10-year-old test, and a reminder to us all.

If you apply the 10-year-old test to business in general, it quickly becomes clear which practices should be kept and which eliminated. Why do the bosses of big US companies earn almost 400 times more than the average worker? Try answering that in a way that a child would accept. It can’t be done.

Many of the things that most of us spend our days at work doing fail the test, too. Sifting through the emails that have arrived in my inbox in the past hour or so, I’ve found one from a management consultant telling me that “the next evolutionary change in business requires a paradigm shift in thinking, involving a grassroots revamp”.

A 10-year-old could never see the sense in that, so it deserves to be eradicated. As, perhaps, does the entire management consultancy industry.

My Dream Food Label – NYTimes.com

A provocative proposal by Mark Bittman on food labelling, moving to a red, yellow, green light system covering nutrition, ‘foodness’ (or degree to which made with real ingredients), and ‘Welfare’, or how food is produced (e.g., treatment of animals, environmental damage).

I am a great fan of informative labelling. In an earlier life, I worked on ecolabelling issues and am aware of some of the challenges in designing neutral, informative and helpful labels, not to mention avoiding these being captured by trade or other interests.

Worth a read. Quote:

Even the simplest information — a red, yellow or green “traffic light,” for example — would encourage consumers to make healthier choices. That might help counter obesity, a problem all but the most cynical agree is closely related to the consumption of junk food.

Of course, labeling changes like this would bring cries of hysteria from the food producers who argue that all foods are fine, although some should be eaten in moderation. To them, a red traffic-light symbol on chips and soda might as well be a skull and crossbones. But traffic lights could work: indeed, in one study, sales of red-lighted soda fell by 16.5 percent in three months.

My Dream Food Label – NYTimes.com.

What Is Food? – NYTimes.com

Some good opinion pieces on the controversy around NYC’s Mayor Bloomberg’s proposed ban on super-sized soft drinks.

The first by Mark Bitman, noting that soft drinks (and equivalents) don’t meet the definition of food ‘provides those substances necessary for growth, health, and good condition.’ Quote:

The arguments against this ban mostly come from the “right.” (There actually is no right and left here, only right and wrong.) We’re told, as we almost always are when a progressive public health measure is passed, that this is “nanny-statism.” (The American Beverage Association also argues that the move is counterproductive, but the cigarette companies used to market their product as healthful, so as long as you remember that, you know what to do with the A.B.A.’s statements.) On a more personal level, we hear things like, “if people want to be obese, that’s their prerogative.”

The second by Daniel Lieberman reminds us of the evolutionary roots of our sweet tooth, and who argues for even more government intervention to compensate for our evolutionary instincts and the widespread availability of sugar. Quote:

Adults need help, too, and we should do more to regulate companies that exploit our deeply rooted appetites for sugar and other unhealthy foods. The mayor was right to ban trans fats, but we should also make the food industry honest about portion sizes. Like cigarettes, mass-marketed junk food should come with prominent health warning labels. It should be illegal to advertise highly fattening food as “fat free.” People have the right to be unhealthy, but we should make that choice more onerous and expensive by imposing taxes on soda and junk food.

We humans did not evolve to eat healthily and go to the gym; until recently, we didn’t have to make such choices. But we did evolve to cooperate to help one another survive and thrive. Circumstances have changed, but we still need one another’s help as much as we ever did. For this reason, we need government on our side, not on the side of those who wish to make money by stoking our cravings and profiting from them. We have evolved to need coercion.

And on the good news side, Disney’s plan to impose standards on food advertising aimed at young children on Disney owned television channels, radio stations and web sites (but nothing about their various resorts).

Disney Takes on Obesity

And lastly, Jeffrey Simpson’s lambasting of yet another government study on obesity, rather than any concrete action. Simpson is weak on the concrete action part as well, citing only the OECD as the authoritative source on what to do (the OECD recommends focus on at-risk individuals while obesity now affects such a large number of people). While income equality is one key factor (as it is on so many issues), bit simplistic that improving that (which we should in any case) will solve obesity, given that the factors involved apply to all social strata. There are lessons from the anti-smoking campaigns here. Quote:

In Canada, the largest number of people live in suburbs where the car rules. The average television set is on in the average Canadian household more than 20 hours a week, and kids who leave television gravitate to other kinds of screens: video games on iPads or the computer. Fast-food advertisers drown the airwaves. And so on.

 Fighting Obesity by Fighting Poverty

Regulating Our Sugar Habit – NYTimes.com

In an ideal world, such regulation would not be needed, as education and the like would mean there was a reduced market for sugar products. However, as Daniel Lieberman points out in his Harvard lecture, we are wired through evolution to eat and absorb too much fat and sugar, so regulation may be needed.

Regulating Our Sugar Habit – NYTimes.com.