Currently browsing posts about: Cancer

According to a new study in JAMA, multivitamins might reduce the risk of some cancers, although not by much.

But even a tiny benefit, restricted to skin cancers in healthy male doctors—but not prostate cancers, alas—is good news for the supplement industry.  Supplement sellers are eager to make sure you don’t miss this research.

The study results came out on October 18.  Pfizer, the maker of the Centrum Silver pills used in the study, placed this ad in the New York Times on October 19:

But that’s not all.  CVS pharmacy sent me this personal e-mail message:

Pfizer, of course, could not be happier.

Why do I think this is about marketing, not public health?

I have a soft spot in my nutritionist’s heart for broccoli. It’s a lovely vegetable when fresh and lightly cooked, and is loaded with vitamins, minerals, antioxidants, fiber, and all those other good things that nutritionists like me encourage everyone to eat and enjoy.

I expressed some of this fondness for broccoli in a 1997 Commentary in the Proceedings of the National Academy of Sciences with this prescient title: “Broccoli sprouts as inducers of carcinogen-detoxifying enzyme systems: Clinical, dietary, and policy implications.”

In it, I quoted President (#41) Bush’s now famous statement:

I do not like broccoli…And I haven’t liked it since I was a little kid and my mother made me eat it. And I’m President of the United States, and I’m not going to eat any more broccoli!’

Even in the 1990s, broccoli had policy implications.

And now the New York Times has come up with a lengthy front-page investigative report on how broccoli came to be used by conservatives as a metaphor for the role of government in health care reform.

The story begins with a question asked by Supreme Court Justice Antonin Scalia.  If the government can require people to buy health insurance, maybe it could force people to buy broccoli: “Everybody has to buy food sooner or later,” he said. “Therefore, you can make people buy broccoli.”

It turns out that broccoli did not spring from the mind of Justice Scalia. The vegetable trail leads backward through conservative media and pundits. Before reaching the Supreme Court, vegetables were cited by a federal judge in Florida with a libertarian streak; in an Internet video financed by libertarian and ultraconservative backers; at a Congressional hearing by a Republican senator; and an op-ed column by David B. Rivkin Jr., a libertarian lawyer whose family emigrated from the former Soviet Union when he was 10.

The Times report is well worth reading, not least as a case study in how conservatives frame issues.  My favorite part is the sidebar on “the broccoli trail.”  Here’s the example from April 2012:

Rush Limbaugh, on his radio program:

“You’re telling me that you want the Supreme Court to decide that the government can tell you that you have to buy health insurance and broccoli?”

In late March, New York Times columnist (and Nobel-prize winning economist) Paul Krugman wrote of “Broccoli and Bad Faith.”

Let’s start with the already famous exchange in which Justice Antonin Scalia compared the purchase of health insurance to the purchase of broccoli, with the implication that if the government can compel you to do the former, it can also compel you to do the latter. That comparison horrified health care experts all across America because health insurance is nothing like broccoli.

Why? When people choose not to buy broccoli, they don’t make broccoli unavailable to those who want it. But when people don’t buy health insurance until they get sick — which is what happens in the absence of a mandate — the resulting worsening of the risk pool makes insurance more expensive, and often unaffordable, for those who remain. As a result, unregulated health insurance basically doesn’t work, and never has.

Maybe the best we can do with all this is to eat our broccoli and hope that it keeps us out of the health care system.

As I mentioned in a previous post, the United Nations General Assembly met this month to consider resolutions about doing something to address rising rates of “non-communicable” diseases (i.e., chronic as opposed to infectious diseases such as obesity-related coronary heart disease, type 2 diabetes, and cancers).

The Declaration adopted by the Assembly disappointed a consortium of 140 non-profit public health advocacy groups who issued a statement noting the conflicts of interest that occur when international agencies “partner” with companies that make products that contribute to an increase in disease risks.”

The consortium suggested actions that they hoped the U.N. would recommend, such as:

• Realign food policies for food and agricultural subsidies with sound nutrition science
• Mandate easy-to-understand front-of-pack nutrition labeling
• Ban the promotion of breast-milk substitutes and high-fat, -sugar and -salt foods to children and young people
• Prohibit advertising and brand sponsorship for alcohol beverages
• Increase taxes on alcohol beverages
• Expand nutritious school meal programs

The group also said that the U.N. should still work on:

• Developing tools to navigate the trade law barriers to health policy innovation,
•  Establishing disease-reduction targets and policy implementation schedules
• Instituting mechanisms to keep commercially self-interested parties at arms-length and public-interest groups constructively involved

Food companies and trade associations are actively involved in lobbying the U.N. not to do any of these things.  This consortium has much work to do.

I’ve just received the latest cancer statistics from CA–A Cancer Journal for Clinicians. The good news is that overall cancer death rates are down from their peak in the 1990s and rates of specific cancers are stable or decreasing.  None seems to be increasing.

Look at what is happening with heart disease (page 15).   Its rates have fallen by half since the mid-1970s for people under age 85.  Even for people over 85, heart disease death rates are falling rapidly.

Obesity is a risk factor for both cancer and heart disease.  So ideas about its effects on health need to take these statistics into consideration.  But before dismissing obesity as a risk factor, note that both heart disease and cancer remain leading causes of death, and both disproportionately affect low-income groups.   Groups with low income and education tend to have many risk factors for these diseases, among them high rates of obesity.

Public health still has plenty of work to do.

The World Cancer Research Fund and the American Institute for Cancer Research has just come out with an update on their 1997 report on diet and cancer risk and prevention. After five years of research, the groups have produced ten recommendations. These, no surprise, look not all that different from most other sets of dietary recommendations issued for the last 50 years or so for prevention of chronic disease risk.  The recommendations emphasize staying lean and being active (“eat less, move more”). The report will be loaded with data, charts, and references and I’m looking forward to getting my copy. Enjoy!

• Be as lean as possible within the normal range of body weight.
• Be physically active as part of everyday life.
• Limit consumption of energy-dense foods. Avoid sugary drinks.
• Eat mostly foods of plant origin.
• Limit intake of red meat and avoid processed meat.
• Limit alcoholic drinks.
• Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes).
• Aim to meet nutritional needs through diet alone.
• Mothers to breastfeed; children to be breastfed.
• Cancer survivors: Follow the recommendations for cancer prevention.

A most unusual presidential panel on cancer prevention, sponsored by the National Cancer Institute, has just weighed in with a report asking for better policies to make it easier for people to eat more healthfully. The Washington Post views the report as taking on the food industry (also tobacco). It quotes the chair of the panel as saying that the country has a moral obligation to protect the health of Americans. Indeed it has, but it is surprising that a panel reporting to this president puts so much of the responsibility for healthful eating on the food industry. The report itself is worth reading for its strikingly candid comments–“Ineffective policies, in conjunction with limited regulation of sales and marketing in the food and beverage industry, have spawned a culture that struggles to make healthy choices – a culture in dire need of change”–and its emphasis on the need to eat less and move more (my philosophy, precisely). The committee had only three members: it’s chair, Dr. LaSalle Leffall of Howard University, Margaret Kripke (M.D. Anderson Cancer Center, University of Texas), and none other than Lance Armstrong.

Oh that nutrition and health were that simple. The The WHEL trial results appeared yesterday in JAMA. The sadly disappointing results of that trial showed no difference in rates of breast cancer recurrence among women who typically ate 5 servings of fruits and vegetables every day as compared to those who ate nearly twice that amount. I served on the data management committee for this trial and was involved with it for more than 10 years–a fascinating experience and a long saga.  I thought the trial was exceptionally well done. The investigators monitored fruit and vegetable intake by measuring the amounts of carotenes and other nutrients in the blood of the participants. Although there was some convergence of dietary patterns over the 8 years of study, the patterns were distinct enough to show benefits from eating more fruits and vegetables if that had been the case. An accompanying editorial explains why sorting out diet and cancer risk is so complicated. In the meantime, what to do? We know that people who habitually eat fruits and vegetables are healthier than those who don’t. The old “five-a-day” is a reasonable goal and it’s too bad that the promoters of that message messed it up by turning it into “fruits & vegetables: more matters.” As with most things in nutrition, enough is enough and more is not necessarily better.