News Potpourri [*].

OBESITY AND INACTIVITY FUEL GLOBAL CANCER EPIDEMIC

Source: BMJ 2001; 322:945

Obesity and lack of exercise contribute to up to a third of colon, breast, kidney, and digestive tract cancers. The World Health Organization (WHO) recently released a report prompted by concerns that obesity constitutes a growing global epidemic. The Centers for Disease Control and Prevention estimate that obesity causes 300,000 deaths annually in the United States. Half of European adults and 60% of Americans are considered to be overweight. Additionally, the proliferation of Western diets and sedentary life-styles in developing countries poses a threat to people who were previously at low risk of obesity. Obesity consumes 8% of the US health care budget and an estimated $100 billion in indirect and direct costs. Researchers say weight gain increases the risk of cancer; however, there is no evidence that weight loss would reduce the risk of the disease. The WHO panel reported that despite the lack of direct evidence, hormonal changes produced by weight loss seem likely to reduce the risks of some cancers, especially breast and uterine cancer.

SKIN CANCERS

Source: JaMA 2001; 285:2066

Children born today have a 1 in 57 risk of developing melanoma. Researchers at the University of Miami School of Medicine say the risk two generations ago was 1 in 1,500. Some studies show that in those using a broad-spectrum sunscreen, fewer nevi develop than in nonusers of sunscreen. Although reducing exposure to midday sun and wearing protective clothing remain the best preventive tactics, the American Academy of Pediatrics now endorses the use of sunscreens on exposed skin, including the face, from birth onward. Since more than 80% of a person's lifetime sun exposure occurs by the age of 18 years, researchers encourage physicians to recommend that patients use sunscreens that block both ultraviolet. A and B light with a sun protection factor of at least 15 on children.

US HEALTH CARE SPENDING TO RISE SHARPLY

Source: BMJ 2001 322:692

Health care spending in the United States is expected to grow by 8.6% this year. The National Health Statistics Group of the Health Care Financing Administration says the rise is due in large part to spending on prescription drugs. The group reports that spending on health care grew by less than 6% over the past 7 years. The US spent $1.2 trillion on health care services in 1999, up by 5.6% from 1998, and marked the seventh consecutive year of spending growth below 6%. Growth from 1997 to 1998 was reported at 4.8%. The report contributes the growth to rising provider costs, insurers' inability to negotiate increasing price discounts, and greater income growth that will drive increased consumer demand. Overall health care spending is expected to more than double, to $2.6 trillion by the year 2010, in part because spending on prescription drugs is expected to grow by 12.6% a year on average.

PREDICTING BRAIN CELL DEATH

Source: JAMA 2001; 285:2070

A new computer program can predict the chances of brain cells dying as the result of a stroke. Researchers at Harvard Medical School say the software rapidly combines several new types of images obtained by magnetic resonance imaging (MRI) into a map of the brain. This allows physicians to assess the risk of brain damage with high specificity and sensitivity. It also allows physicians to almost immediately analyze data that previously took up to 30 minutes to assess. The computer breaks the advanced MRI brain scan into distinct cubes about one tenth of an inch in diameter, and two key pieces of information are measured for each one. One cube reveals whether blood flow through vessels in the area is blocked, and the other indicates whether brain tissue is living or dying. Researchers based the program on imaging and other data from 14 patients who had a stroke in the middle cerebral artery and did not receive thrombolytic or neuroprotective therapy.

LUNG CANCER DEATH RATES RISE 600% IN US WOMEN

Source: BMJ2001; 322:752

Death rates from lung cancer among white women in the United States increased b) 600% between 1950 and 2000. The US Surgeon General recently released a report that says the death rate from lung cancer was 5 per 100,000 in 1950 and 35 per 100,000 in the year 2000. In 1950, lung cancer accounted for 3% of all cancer deaths in women, whereas it accounted for an estimated 25% of deaths in 2000. Twenty-seven thousand more women died of lung cancer in the year 2000 than of breast cancer. The 700-page report expands on the first report by the Surgeon General released in 1980 and is the work of nine senior federal health officials from the Centers for Disease Control and Prevention and the office of the secretary for health. The report emphasizes the need for prevention, starting with teenaged girls and young women. The report and executive summary are available online at www.surgeongeneral.gov/library.

NEW DIABETES GLUCOSE TEST

Source: JAMA 2001; 285:2186

The Food and Drug Administration (FDA) has approved the GlucoWatch Biographer (Cygnus Inc., Redwood City, Calif), a device that detects trends and tracks patterns in glucose levels in adults with diabetes without puncturing the skin. The device, which can b used to detect and assess episodes of hyperglycemia and hypoglycemia, is designed supplement but not replace information fron standard home glucose monitoring devices The instrument applies a very low electric cur rent to extract glucose samples through intact skin, measures them every 20 minutes, and sounds an alarm if the glucose reaches a pre selected level. The FDA approved the GlucoWatch Biographer based on four studies that included 480 patients 18 years of age o older with type 1 or type 2 diabetes requiring insulin treatment. The studies generated 19,000 glucose readings from 1,400 devices over 25,000 hours and compared them with blood glucose tests once or twice per hour The median correlation coefficient was about 0.90 in each of the studies, but up to 25% of the time the results changed by more than 30%. The device was less effective at detecting low glucose levels than very high levels and did not function if a patient's arm was damp with sweat. The FDA officials say results from the device must be interpreted in sequential readings over time and then confirmed with a blood glu cose test before changing insulin doses because of the potential for error.

PREGNANT WOMEN MAY NOT BE TESTED FOR DRUGS WITHOUT CONSENT

Source: BMJ2001; 322:753

Hospital workers are no longer allowed to test pregnant women in the United States for use of illegal drugs without their informed consent or a valid warrant. The ruling from the US Supreme Court stemmed from a 10-year-old lawsuit brought against the city of Charleston SC, by women who were arrested after a urine test for cocaine yielded positive results. The Supreme Court ruled that possible danger to a woman's fetus through use of illegal drugs did not alter basic constitutional rights. The ruling overturns a 1999 decision a lower federal court that said clandestine drug testing programs were justified in order o stop drug use by pregnant women. In the current ailing, the court says that while the goal of the previous program may have been to get women into substance abuse treatment, the immediate objective of the searches was to generate evidence for law enforcement purposes.

(*.) Originally prepared for presentation on Southern Medical Association's web site (http://www.sma.org) by Elaine McClellan-Holm.