Seeking Sickness, Medical Screening and the Misguided Hunt for Disease

Medical screening: are you ready for all the things that could go wrong?

Seeking Sickness book image
Alan Cassels says promoters of #screening overpromise on its benefits and downplay its harms, which can range from the merely annoying to the life threatening…

Why wouldn’t you want to be screened to see if you’re at risk for cancer, heart disease, or another potentially lethal condition? After all, better safe than sorry. Right?

Not so fast, says Alan Cassels. His Seeking Sickness book takes us inside the world of medical screening, where well-meaning practitioners and a profit-motivated industry offer to save our lives by exploiting our fears.
He writes that promoters of screening overpromise on its benefits and downplay its harms, which can range from the merely annoying to the life threatening. If you’re facing a screening test for breast or prostate cancer, high cholesterol, or low testosterone, someone is about to turn you into a patient. You need to ask yourself one simple question: Am I ready for all the things that could go wrong?

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Les industriels ont-ils trop de place à l’intérieur de l’agence du médicament

Dominique Maraninchi: ” Un nouveau Mediator ne doit plus être possible – L’ ANSM est convertie à la transparence “

Le Figaro Santé logo
L’association “Accidents et maladies liés aux risques des Médicaments” n’a constaté aucune réforme sérieuse de l’ANSM.

Dominique Maraninchi, démissionnaire de ses fonctions de Directeur de l’Agence nationale de sécurité du médicament et des produits de santé est interviewé par Damien Mascret du Figaro et réponds aux questions suivantes:

  • Dans quelques semaines va s’ouvrir le procès du Mediator. Comment l’Agence du médicament va-t-elle le vivre?
  • Vous reconnaissez la part de responsabilité de l’Agence dans le scandale du Mediator?
  • Comment être sûr qu’un nouveau scandale de ce type n’est plus possible?
  • Qu’est-ce qui a changé depuis cette loi?
  • L’Agence du médicament est-elle convertie à la transparence?

Lisez “Un nouveau Mediator ne doit plus être possibleLe Figaro actualite/2014/07/04/22566 ainsi que l’entiereté du commentaire de Georges Alexandre Imbert…

Mammography Screening Behaviors of Women exposed prenatally to DiEthylStilbestrol

Because of the potential elevated risk for breast cancer in women exposed prenatally to DES, continued monitoring is recommended for this group, which is predominantly over the age of 45

Abstract

image of PubMed NCBI The Endocrine Society logo
Because of the potential elevated risk for breast cancer in women exposed prenatally to DES, continued monitoring of standard mammography recommendations is recommended for this group, which is predominantly over the age of 45.

BACKGROUND:
In utero diethylstilboestrol (DES) exposure is a risk factor for rare development of vaginal and cervical cancer and may potentially be a risk factor for breast cancer.
Mammography use in this population is relatively unknown; therefore, this study aims to determine if in utero DES exposure is associated with the frequency of mammography screening examinations while considering demographic and clinical factors.

METHODS:
Using combined DES cohort questionnaire data, self-reported mammography screening over the past 5 years (2001-2006) was analyzed in women aged ≥45 years. Binary logistic regression assessed if DES exposure was associated with mammography use after adjustment for benign breast disease (BBD), previous cancer diagnosis, and whether insurance access influenced screening use.

RESULTS:
Overall, the frequency of mammography examinations was similar for both DES-exposed and unexposed women. DES-exposed (n=2986) and unexposed women (n=1397) over the age of 44 reported receiving ≥3 mammography examinations in the past 5 years (73.8% and 74.0%, respectively). After adjustment, DES exposure was not associated with ≥3 mammograms in the past 5 years compared to ≤2 examinations (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.86-1.17), p=0.99).

CONCLUSIONS:
In utero DES exposure was not associated with mammography use, nor was health insurance status or a BBD or cancer diagnosis. Because of the potential elevated risk for breast cancer in women exposed prenatally to DES, continued monitoring of standard mammography recommendations is recommended for this group, which is predominantly over the age of 45.

Sources

  • Mammography screening behaviors of women exposed prenatally to diethylstilbestrol, NCBI, PMID: pubmed 22150213, 2012 Feb;21.
  • Full text: Mary Ann Liebert, Inc. publishers, doi:10.1089/jwh.2011.2741.
More DES DiEthylStilbestrol Resources

Six Times as Many People Died of Methadone Overdoses in 2009 than a Decade Before…

Use prescription painkillers only as directed by a health care provider
Get help for substance abuse problems if needed (1-800-662-HELP)

Prescription Painkiller Overdoses in the US 2012
Use prescription painkillers only as directed by a health care provider – Get help for substance abuse problems if needed (1-800-662-HELP) – @CDC_eHealth

Prescription painkiller overdoses – opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone – were responsible for more than 15,500 deaths in 2009. While all prescription painkillers have contributed to an increase in overdose deaths over the last decade, methadone has played a central role in the epidemic. More than 30% of prescription painkiller deaths involve methadone, even though only 2% of painkiller prescriptions are for this drug. Six times as many people died of methadone overdoses in 2009 than a decade before.

Methadone has been used safely and effectively to treat drug addiction for decades. It has been prescribed increasingly as a painkiller because it is a generic drug that can provide long-lasting pain relief. But as methadone’s use for pain has increased, so has nonmedical use of the drug and the number of overdoses.

Sources
  • Prescription Painkiller Overdoses in the USCDC,methadoneoverdoses, July 2012 – PDF.
  • Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008CDCmm6043a4.htm, November 4, 2011

Health Problems for Women related to Endocrine Disruptors

This post is part of our new “ EDCs HEAL serie “

Health problems for women related to EDCs
Watch our health posters album on Flickr – image via @HealthandEnv
Sources and Related Information
Endocrine Disruptors

ASD – First Time Researchers show a Definitive Cause of Autism to a Genetic Mutation

Disruptive CHD8 Mutations Define a Subtype of Autism Early in Development

Summary:

In a collaboration involving 13 institutions around the world, researchers have broken new ground in understanding what causes autism. This is the first time researchers have shown a definitive cause of autism to a genetic mutation. Previously identified genetic events like Fragile X, which account for a greater number of autism cases, are associated with other impairments, such as intellectual disability, more than autism.

Abstract:

SCIENCE DIRECT logo
Disruptive CHD8 Mutations Define a Subtype of Autism Early in Development

Autism spectrum disorder (ASD) is a heterogeneous disease in which efforts to define subtypes behaviorally have met with limited success. Hypothesizing that genetically based subtype identification may prove more productive, we resequenced the ASD-associated gene CHD8 in 3,730 children with developmental delay or ASD. We identified a total of 15 independent mutations; no truncating events were identified in 8,792 controls, including 2,289 unaffected siblings. In addition to a high likelihood of an ASD diagnosis among patients bearing CHD8 mutations, characteristics enriched in this group included macrocephaly, distinct faces, and gastrointestinal complaints. chd8 disruption in zebrafish recapitulates features of the human phenotype, including increased head size as a result of expansion of the forebrain/midbrain and impairment of gastrointestinal motility due to a reduction in postmitotic enteric neurons. Our findings indicate that CHD8 disruptions define a distinct ASD subtype and reveal unexpected comorbidities between brain development and enteric innervation.

Sources:
  • Disruptive CHD8 Mutations Define a Subtype of Autism Early in Development, ScienceDirect, DOI: 10.1016/j.cell.2014.06.017 pii/S0092867414007491, 3 July 2014
  • Genetic link to autism found, known as CHD8 mutation, ScienceDaily, 140703125851, July 3, 2014

Overdose Deaths from Prescription PainKillers have SkyRocketed during the Past Decade in the US

Use prescription painkillers only as directed by a health care provider
Get help for substance abuse problems if needed (1-800-662-HELP)

Prescription Painkiller Overdoses in the US 2011
Use prescription painkillers only as directed by a health care provider – Get help for substance abuse problems if needed (1-800-662-HELP) – @CDC_eHealth

Deaths from prescription painkillers – opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone – have reached epidemic levels in the past decade. The number of overdose deaths is now greater than those of deaths from heroin and cocaine combined.

A big part of the problem is nonmedical use of prescription painkillers—using drugs without a prescription, or using drugs just for the “high” they cause. In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year.

Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month. Although most of these pills were prescribed for a medical purpose, many ended up in the hands of people who misused or abused them.

Improving the way prescription painkillers are prescribed can reduce the number of people who misuse, abuse or overdose from these powerful drugs, while making sure patients have access to safe, effective treatment.

Sources
  • Prescription Painkiller Overdoses in the US, CDC, painkilleroverdoses, November 2011 – PDF.
  • Vital Signs: Overdoses of Prescription Opioid Pain Relievers — United States, 1999–2008, CDC, mm6043a4.htm, November 4, 2011

Bisphenol A triggers Epigenetic Changes in Rats that may lead to Breast Cancer

Fetal BPA exposure triggers changes in the postnatal and adult mammary gland epigenome and alters gene expression patterns

Prenatal Exposure to BPA Alters the Epigenome of the Rat Mammary Gland and Increases the Propensity to Neoplastic Development

Abstract

PLoS_logo
Fetal BPA exposure triggers changes in the postnatal and adult mammary gland epigenome and alters gene expression patterns.

Exposure to environmental estrogens (xenoestrogens) may play a causal role in the increased breast cancer incidence which has been observed in Europe and the US over the last 50 years. The xenoestrogen Bisphenol-A (BPA) leaches from plastic food/beverage containers and dental materials. Fetal exposure to BPA induces preneoplastic and neoplastic lesions in the adult rat mammary gland. Previous results suggest that BPA acts through the estrogen receptors which are detected exclusively in the mesenchyme during the exposure period by directly altering gene expression, leading to alterations of the reciprocal interactions between mesenchyme and epithelium. This initiates a long sequence of altered morphogenetic events leading to neoplastic transformation. Additionally, BPA induces epigenetic changes in some tissues.

To explore this mechanism in the mammary gland, Wistar-Furth rats were exposed subcutaneously via osmotic pumps to vehicle or 250 µg BPA/kg BW/day, a dose that induced ductal carcinomas in situ. Females exposed from gestational day 9 to postnatal day (PND) 1 were sacrificed at PND4, PND21 and at first estrus after PND50. Genomic DNA (gDNA) was isolated from the mammary tissue and immuno-precipitated using anti-5-methylcytosine antibodies. Detection and quantification of gDNA methylation status using the Nimblegen ChIP array revealed 7412 differentially methylated gDNA segments (out of 58207 segments), with the majority of changes occurring at PND21. Transcriptomal analysis revealed that the majority of gene expression differences between BPA- and vehicle-treated animals were observed later (PND50). BPA exposure resulted in higher levels of pro-activation histone H3K4 trimethylation at the transcriptional initiation site of the alpha-lactalbumin gene at PND4, concomitantly enhancing mRNA expression of this gene.

These results show that fetal BPA exposure triggers changes in the postnatal and adult mammary gland epigenome and alters gene expression patterns. These events may contribute to the development of pre-neoplastic and neoplastic lesions that manifest during adulthood.

Sources
  • Prenatal Exposure to BPA Alters the Epigenome of the Rat Mammary Gland and Increases the Propensity to Neoplastic Development, PLOS one, DOI: 10.1371/journal.pone.009980, July 02, 2014 – PDF.
  • BPA triggers changes in rats that may lead to breast cancer, Environmental Health News, bpa-mammary-glands, July 2, 2014

Video Entretien avec le Professeur Philippe Even – Guide des médicaments inutiles… ou dangereux

Le professeur Philippe Even explique le pourquoi de son livre et pointe les dérives de l’industrie pharmaceutique…

Rencontre avec le professeur Philippe Even, auteur avec le professseur Bernard Debré, d’un livre de 900 pages – Guide des 4000 médicaments utiles, inutiles ou dangereux – où sont passé au crible 4 000 médicaments. Il explique le pourquoi de ce livre et pointe les dérives de l’industrie pharmaceutique.

Le Distilbène DES, en savoir plus:

EDCs – Intersex Fish Now in Three Pennsylvania River Basins

Reproductive health indicators of fishes from Pennsylvania watersheds: association with endocrine-disrupting chemicals of emerging concern

Intersex fish have been found in Pennsylvania’s Susquehanna, Delaware and Ohio river basins, indicating that the effects of endocrine-disrupting chemicals are more widespread than previously known. Previously sampling within the Chesapeake Bay drainage indicated signs of reproductive endocrine disruption in the Potomac river basin.

USGS logo
Reproductive health indicators of fishes from Pennsylvania watersheds: association with chemicals of emerging concern.

New U.S. Geological Survey-led research published in Environmental Monitoring and Assessment found two fish species, smallmouth bass and white sucker, exhibiting the effects of exposure to endocrine-disrupting chemicals. Intersex characteristics caused by hormones and hormone-mimicking compounds include immature eggs in male fish.

Male smallmouth bass from all sites sampled had immature eggs in their testes; prevalence was lowest in the Ohio drainage, intermediate in the Delaware and highest in the Susquehanna. Neither the white sucker nor the redhorse sucker had intersex characteristics in any basin, though white suckers sampled at some sites in the Delaware and Susquehanna basin did have a yolk precursor in their blood.

In aquatic environments, the presence of these intersex characteristics is widely used as a biomarker for assessing exposure to estrogenic chemicals, as well as anti-androgenic chemicals which inhibit development of male characteristics. Bass in general, appear to be sensitive to estrogenic chemical exposure, particularly in regard to development of intersex.

The prevalence and severity of the immature eggs in smallmouth bass corresponded with the percent of agricultural land use in the watershed above the collection sites,” said Vicki Blazer, a research fish biologist and lead author of the study.
Chemical compounds associated with estrogenic endocrine disruption, in particular estrone, a natural estrogen, were also associated with the extent and severity of these effects in bass.”

Sites in the Susquehanna drainage had a higher prevalence and severity of these effects than sites in the Ohio drainage. In general, the percentage of agricultural land use was highest throughout the Susquehanna drainage and the Schuylkill River, and lowest throughout the Ohio drainage.

Sites upstream and downstream of waste water treatment plant sites were also sampled, and the watersheds varied greatly in the number of waste water treatment plant and sewage discharges. There was no significant relationship between the number of waste water treatment plants and the prevalence of immature eggs in male fish, though results did indicate that the severity of intersex characteristics of male small mouth bass generally increased at downstream sites from waste water treatment plants.

The sources of estrogenic chemicals are most likely complex mixtures from both agricultural sources, such as animal wastes, pesticides and herbicides, and human sources from waste water treatment plant effluent and other sewage discharges,” said Blazer.
Further research is underway to better characterize the sources and timing of exposure to these complex mixtures in relation to fish health.

Sources
  • Intersex Fish Now in Three Pennsylvania River Basins,
    USGS Newsroom, article.asp?ID=3921, 6/27/2014
  • Full Study – Reproductive health indicators of fishes from Pennsylvania watersheds: association with chemicals of emerging concern, Springer, s10661-014-3868-5, 17 June 2014
  • Intersex Fish Showing Up in Pennsylvania Rivers,
    LiveScience, 46603, July 01, 2014