This past Friday, the Evening News staff got a potentially life-saving surprise: Katie and I brought out our inanimate friend, Annie (a first-aid mannequin), and demonstrated how to use a defibrillator. For those of you who don't know, that's the little electronic device you may have seen in airports or offices, also known as AEDs. We have them here at CBS News, but we realized that few of us would be comfortable using them if somebody collapsed. The main reason for our demo was to show that these defibrillators are incredibly simple to use. In fact, research has shown that - literally - a child can use them.
We demonstrated again later in the day for everyone to watch – and you can check out the video right here, below. Just click the monitor.
The New York Post's well-known history of clever headlines ("Headless Body in Topless Bar") has earned it a daily glance from many New Yorkers looking for the latest news – if not an occasional smile. But yesterday's headline, "TED IS DYING," provided neither. As a physician, I was deeply offended.
Even if the paper's editors turn out to be right, who are they to offer a medical prognosis? Do they know all the details of the case? Are they taking care of the senator? Even if they don't care about the feelings of the senator, his family, his friends, or any of the rest of us, there's no reporting in the article to justify the headline.
Yes, malignant glioma is a tough disease, and Sen. Ted Kennedy is in for the fight of his life. But there are patients with the disease who beat the odds and survive for more than ten years. No doctor has the right to take hope away from a patient. Who knows how Kennedy's cancer will respond to chemotherapy and radiation? We live in a time of new, exciting cancer treatments including targeted therapies that act in novel ways – for example, by depriving a cancer of nourishment by choking off its blood supply. Gene therapy, vaccines that stimulate a patient's own immune system to fight a cancer, and new forms of chemotherapy and radiation are all in active development.
How many adults do you know who've gotten whooping cough? The number might be low, but what most people don't realize is that the illness is on the rise. It's thought of as a kids' sickness, mostly because symptoms are often less severe in adults – and often go undiagnosed.
But it's very contagious, and adults can spread it to infants, in whom it can be really deadly. One study showed that in infants younger than 12 months who had contacted whooping cough, or pertussis, in 24 percent of the cases, the infant had had contact with a parent or grandparent who had a cough.
Here's where adult vaccinations come into play. An adult pertussis vaccine has been available for a couple of years, and is recommended for adults age 60 and older. Same goes for a shingles vaccine: Shingles affects 1 million people each year, but only 2 percent of adults are vaccinated.
Yesterday's breakthrough in stem cell research was nothing short of spectacular. There are different types of stem cells and the most powerful ones, the ones that can develop into any of the approximately 220 cell types in the body have — until now — only been available by taking them from embryos left over from fertility clinics. Because the embryos are destroyed, the process has been the focus of intense ethical and political debate. Right now there is a government ban on creating any new embryonic stem cell collections. The few that already exist are old and not that useful.
Last year scientists figured out a way to take skin cells from mice and turn them into stem cells that are similar to the ones found in embryos.
How did they do this? It turns out that — by fiddling with their DNA — cells can be re-programmed to turn from a skin cell into a stem cell.
The scientists figured out they can give four genes (pieces of DNA) that tell a grown up skin cell to stop being a skin cell and turn into a stem cell. They splice those genes into the DNA of the skin cell with the use of a type of virus called a "retrovirus." Those genes turn the skin cells into stem cells in just 3-4 weeks!
We thought it was going to be a long time until they did this in humans but — amazingly — two different labs, one in Kyoto and one in Wisconsin, just announced they've done it. What's so surprising is that the recipe is relatively easy to follow. I expect there will be an explosion of stem cell research all over the world.
Why are stem cells important? When most people think about stem cells, they think about giving them to patients with diseases to help cure them. For example, in diabetes, stem cells might be able to turn into cells that make insulin — exactly the kind of cells that are missing in diabetic patients. This kind of therapy is a ways off. One reason is that the process by which the four genes are inserted into the DNA of skin cells causes those cells to be at increased risk to develop into cancer. Scientists are already working on ways around this problem.
But as soon as today, scientists can start using stem cells to learn more about diseases and to figure out new treatments. Take Alzheimer's disease.
Tonight's story focuses on a report from the Framingham Heart Study that suggests that obesity – and thinness – can spread through social ties. And it's not just that obese people tend to hang out together. If one of a pair of mutual friends BECOMES obese (defined as Body Mass Index, or BMI>= 30) then the risk of the other becoming obese increases by 171%! And social closeness is much more important than geographic closeness. There was no effect for next door neighbors who weren't friends. But a friend 1,000 miles away influences you as much as a friend next door.
One of the most surprising findings was that the effect extends out three levels of friendship. Not only are you affected by your friend, but by your friend's friend and your friend's friend's friend. If everybody is connected by six degrees of separation, think how many people might be influenced by three degrees of separation!
I spoke to James Fowler, Ph.D., an author of the study appearing in July 26th's edition of the The New England Journal of Medicine. He is excited about the public health implications of this study. Think how many people might be helped by one person's healthy lifestyle. The same effect that can cause an obese friend to increase a friend's risk of obesity by 171% works the other way too. As Dr. Fowler told me, "When your obese friend loses weight and becomes either overweight or a normal weight, it reduces your risk of obesity by 63%."
Harnessing the power of friendships may well be the new new thing in medicine.
Growing up, my three sisters and I occasionally did hear about a cow that he had sewn up after it was hit by German shrapnel in the tiny French town of Batilly in the fall of 1944. This was not something he had learned in dental school. He left town about a week later and didn't return until 1957, when he was greeted as a hero by the residents of the town. The cow had lived five years but she had never given milk again.
For my dad, Tom Brokaw's book, "The Greatest Generation," unleashed a flood of World War II memories. My father suddenly started to open up. He told me that it somehow gave him "permission" to discuss details that he had kept inside. I asked him why he had never talked about the war with me or my sisters. It was hard for him to put into words. He said he had not wanted to upset us, and he didn't want to appear to be bragging. Whatever the reason, we welcomed all the new information.
PRP therapy is already being used in Europe. In the United States, it is starting to take off. Dr. Allan Mishra, an orthopedist at Stanford University Medical Center, has been a pioneer in its use in the United States. He first started using PRP in 2001. I spoke to Dr. Mishra tonight and he pointed out that healing in the tendons and cartilages tends to be poor because of limited blood supply. With PRP, "you're taking a component of your own blood, concentrating the wound-healing components and injecting those back into your body into an area where you are not able to heal very well." In brief, he adds, "you're trying to take advantage of your own body's ability to heal itself."
Traditional treatment of tendonitis has concentrated on reducing inflammation with non-steroidal anti-inflammatory medications (NSAID's), steroid injections, or rest. But the goal of PRP therapy is to promote healing rather than just decrease inflammation. Dr. Mishra estimates that he's treated between 100 and 200 patients, and that across the United States several thousand patients have been treated for orthopedic injuries. Over the past 12 months he's treated about 60 patients – mostly with elbow tendonitis (tennis elbow), knee tendonitis, and Achilles tendon repairs. With tennis elbow, for example, "you see improvement within two to four months." Dr. Mishra says that so far side-effects have mostly been limited to pain and swelling at the injection site. The cost is about $1,500 per treatment.
Study: Higher Autism Rates
Teachers like these are true heroes.
We all welcome the good news, but we have to guard against easing up in the fight against cancer. Over 500,000 Americans still die each year from cancer. And African Americans have significantly higher death rates than Whites: 38 percent higher for men and 18 percent higher for women.
We must get our priorities straight. Personally, my top three priorities are research, research, and research. Basic research is crucial to developing new strategies for detecting and fighting cancer. The budget for the National Institutes of Health doubled from 1998 to 2003, but has not kept pace with inflation since 2003. In addition to maximizing government support, we need to remember that U.S. business has contributed mightily to cancer therapy over the past decade, especially in the area of "targeted therapies" that have, for example, led to effective treatment of some forms of leukemia and breast cancer. Let's be creative in exploring new ways to increase effective partnership between government, corporations, non-profits, and philanthropic organizations.
Aside from understanding the causes and treatments of cancer, we need to improve our understanding of why patients don't get cancer screening, why they don't get regular checkups. One obvious explanation is lack of access to medical care. The odds of early cancer detection are stacked against the almost 50 million uninsured Americans and who knows how many "underinsured" Americans. But in addition, there are patients who avoid screening because of fear. When I was a third year medical student, a woman came into the hospital with a breast cancer that was literally the size of a softball. She told me that she had first noticed the growth many months earlier, but was too afraid to go to a doctor. It still breaks my heart to think about her. She did not do well. Despite all our progress in treatment and prevention, the word "cancer" still means "death sentence" to many people, especially to older people who developed their understanding of cancer way before the recent advances.
In my book, fear of the known is right up there with fear of the unknown. I have well-educated, intelligent patients who do not follow through on standard cancer screening measures such as colonoscopy, mammography, and gynecologic and skin exams. It's hard to tease out the real reasons, but a frequent explanation is along the lines of "I would rather not know if I have cancer." This is not a logical response and all the beautiful charts in the world showing the effectiveness of screening colonoscopy will likely make no difference to this person. What does make a difference is reducing the person's fear.
Just as I will never forget the woman with the large breast mass, I will also never forget the man with rectal bleeding who admitted that he only came in for colonoscopy because he saw Katie Couric's colonoscopy on television. "If she can do it I can do it," he explained. His early colon cancer was cured. We need more public awareness campaigns to educate people and to help decrease fear of the known.
Laura Bush's squamous cell carcinoma of the leg has put skin cancer back on the front page. ?Skin cancer affects about 1-1.2 million Americans a year. ?Fortunately, the majority of skin cancers found each year are basal cell (800-900, 000) or squamous cell (200-300,000) - the types that have a very high chance of being cured.? About 1-2,000 Americans die each year from these two most common forms of the disease.? Death rate has dropped about 30 percent in the past 30 years, perhaps from earlier detection and treatment than in the past.
Melanoma is another story, affecting about 62,000 Americans a year and causing about 8,000 deaths.? The vast majority - about 99% - of melanomas occur in patients 20 or older, but even children can occasionally develop this disease.? Since I was in medical school in the mid-70's, the number of yearly cases in the United States has more than doubled.? Early detection is likely one reason for the increase but nobody is exactly sure what has been causing the dramatic rise.? What is clear, however, is that early detection is the name of the game when it comes to curing melanoma.? The earlier a lesion is found the better the chance of cure.? Which brings us to the main point of this blog.
Everybody should be getting routine head to toe skin exams.? This means looking from head to toe at every millimeter of your body, including where the sun doesn't shine.? Skin cancers can occur in any location of the body, including the armpits, scalp, between the toes, in the groin or anogenital area - anywhere!? Routine self-exam should be part of your screening regimen.? If a partner is available who can examine hard to see areas such as the small of the back - all the better.
In addition, I feel that routine screening should include a well-trained health professional who is interested in performing a careful skin exam.? This is where it can get tricky.? We live in a time when subspecialists abound - even among dermatologists.? A patient may see a cosmetic dermatologist several times a year for botox injections.? The dermatologist may glance at areas of exposed skin but the patient should not feel that a full screening skin exam is being routinely performed.? I've encountered some magical thinking in this area - patients who think that that they've received skin cancer screening just because they've seen a dermatologist, even though they haven't taken their clothes off!? Trust me, no doctor is good enough to detect skin cancer without examining the skin.
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