December 20, 2006
Big Tobacco's anti-smoking ads may cause kids to smoke
This is not about genomics or family history directly, but I found this report so fascinatingly disturbing that I wanted to put it out there in this forum. If any of you have any insight into this, please comment. I found it to be amazing.
Link to PubMed abstract: Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. Wakefield M, Terry-McElrath Y, Emery S, Saffer H, Chaloupka FJ, Szczypka G, Flay B, O'Malley PM, Johnston LD. Am J Public Health. 2006 Dec;96(12):2154-60. Epub 2006 Oct 31
Excerpt from the Press release from Oregon State University:
More than 100,000 students from all areas of the country in 8th, 10th and 12th grades were surveyed to assess the relationship between exposure to tobacco company prevention advertising and youth smoking-related beliefs, intentions and behaviors. Researchers linked these data with Nielsen Media Research data on the exposure of youth to smoking-related ads that appeared on network and cable stations in the 75 largest United States media markets from 1999 to 2002.
Some of the findings include:
1. Each additional youth-targeted prevention ad viewed by a student resulted in a 3 percent stronger intention among all students to smoke in the future.
2. There was a 12 percent increase in the likelihood that 10th- and 12th-grade students would become smokers if they watched prevention ads targeted at their parents.
3. On average, the students were exposed to more than four youth-targeted ads per month.
December 19, 2006
Family health history in health promotion for children with special heath needs
I had a chat over coffee the other day with my friend and colleague, Nancy, who works with children with special health care needs (CSHCN). She had initiated the meeting to talk about a workshop I periodically give on recognizing kids and families who might benefit from a genetics evaluation. This, however, was not the real purpose for her wanting to connect with me. Finally, after this preliminary discussion, she got to her real purpose:
"But what about their other health needs; the health needs besides the "special" ones? What about the health needs that are more like what other kids have?"
She went on to recount a story of how, as a school nurse, she had discovered that a majority of kids in a special education classroom were found to have either a visual or hearing impairment that had gone undiagnosed because no one had thought to screen them for these common conditions. Parents and teachers both were amazed in the improvement that many of the children made once they could see or hear better after intervention. The moral of the story: Kids have other things that need checking and maintenance other than just their most obvious health needs.
She is right about this. Sometimes we treat kids with disabilities as if all that matters for their health is the one, unusual feature that gains them entry into the CSHCN club. She had recognized that sometimes the routine screening and care that are included in well child care visits and child and teen checkup screenings are not done well enough for these kids. Things like routine tetanus shots, hearing and vision screening, and so forth. It gave me pause, I have to say. These kids are always going to see the doctor, but much of the time they are going to a specialist who is treating the part that defines their"special needs" or for some other acute issue, not the more routine maintenance or preventive care that most "normal" kids receive as a matter of course.
Our discussion moved from well child care and screening to transition to adult care and prevention across the lifespan. These kids are living longer and longer. Many are growing into adulthood, passing through the stages of young adults, middle age and even old age. The need to consider strategies to assure the best overall health by preventing or ameliorating chronic diseases is gaining relevance for this population.
So, this is where family history comes in. We need to broaden our thinking of how we use it. With children who have special needs, we regularly use family history as a tool for diagnosing the underlying etiology of their functional disabilities. Might the same family health history process be used to screen for preventable conditions such as cardiovascular disease, cancer, asthma, or mental illness or familial behaviors such as alcohol use, exercise habits, and diet, that should also be considered for providing the best possible care for this child and his/her family? It seems like this should be doable.
Maybe it is being done. If you are a practitioner who cares for these kids or if you are a parent with a child with special needs, please tell us of your experiences with well child care, especially as it relates to using family health history to screen for familial risk factors (both disease or behavioral) for common, chronic diseases, and what you suggest for health promotion and disease prevention across the lifespan.
December 18, 2006
When your best isn't good enough
The Centers for Disease Control and Prevention and Nevada State Health Division have just published a mini-monograph in the January 2007 issue of Environmental Health Perpsectives entitiled "Investigating Childhood Leukemia in Churchill County Nevada (Environ Health Perspec (2007) 115:151-157).
In this summary report, the scientists involved in the investigation review all the steps taken, the myriad data collected and the exhaustive analyses done to elucidate the underlying cause(s) of acute leukemia that affected sixteen children in this community who were diagnosed between 1997 and 2002. This investigation used many tools and integrated information from multiple sources--including epidemiology, medical and exposure history, toxicology, medical chemistry, infectious agents, and genetic markers--to result in the most comprehensive investigation of a pediatric leukemia cluster ever undertaken.
The scientists, the care providers, the families of affected children and the other residents of Churchill County gave it all that they had to find the answer to this perplexing problem. Even with their very best effort and employing all that modern science has to offer, the conclusions as to what caused these cancers in some of the children in this community remain frustratingly elusive. When all was said and done, the authors conclude that they are officially stumped and offer this not very satisfying denouement to their study:
Although the cases in this cancer cluster may in fact have a common etiology, their
small number and the length of time between diagnosis and our exposure assessment lessen the
ability to find an association between leukemia and environmental exposures. Given the limitations
of individual cancer cluster investigations, it may prove more efficient to pool laboratory and questionnaire
data from similar leukemia clusters.
December 17, 2006
Significant reduction in rate of breast cancer observed
The New York Times reported on December 15, 2006 that researchers at the MD Anderson Cancer Research Center in Houston, TX have observed that the incidence rates of estrogen-positive breast cancer dropped 15% between August 2002 and December 2003. Estrogen-positive tumors are the most common form of breast cancer and account for 70% of cases of this disease. This observed drop resulted in a 7% drop in breast cancer cases overall, which reverses a general upward trend for breast cancer rates that has been observed since the mid 1940's.
The leading hypothesis to explain the observation is the reduced use of hormones by menopausal women after a large national study associated their use with increased rates of breast cancer. This hypothesis is supported by the observation that most of the observed drop in incidence was observed in women between the ages of 50 and 69. However, although the observed drop in cases is very encouraging and the association between less hormone use is both coincidental and biologically plausible, caution is still urged in interpreting these results because it is based on speculation, not on data:
â€œEpidemiology can never prove causality,â€? said Dr. Peter Ravdin, a medical oncologist at the M.D. Anderson center and one of the authors of the analysis.
But, he said, the hormone hypothesis seemed to perfectly explain the data and he and his colleagues could find no other explanation.
Everyone who is interested in cancer at both the personal and population levels will be watching to see if this initial observation is the beginning of a trend downward in the incidence of breast cancer. It will also be very useful to see if this observation is made in other populations and if biological causation can be proven.
December 15, 2006
Whole Wheat in Diet of Pregnant Rats Reduces Breast Cancer Risk in Offspring
There is a growing body of evidence that a mother's metabolic status during gestation affects her offspring's risk for chronic diseases such as diabetes and cardiovascular disease later in life. This observation is often referred to as "The Barker Hypothesis" after David Barker, a researcher and physician who has done considerable work in this area. Obviously, the metabolism of the mother is greatly influenced by her diet and a growing literature is documenting the associations between maternal diet during gestation and disease risk in offsrping.
As more and more evidence accummulates to support the notion that subtle variations in gestational development that are modulated by maternal diet significantly affect the future health of offspring, our attitudes (and possibly policy and practice) toward these first months of existence may need to be re-examined. This is clearly an area of research to watch, especially in the context of an aging population and growing concern about chronic disease risk at the personal, community and population levels. This is a public health issue.
The subject of this entry describes a recent report that links maternal diet to the future risk of breast cancer in offspring and begins to describe the molecular mechanisms that may be responsible.
A new report (Yu B, Khan G, Foxworth A, Huang K, Hilakivi-Clarke L. Int J Cancer. 2006 Nov 15;119(10):2279-86) presents data to support the authors' observation that a diet of whole wheat during pregnancy significantly lowers the risk of breast cancer in the offspring later in life. The expression of several genes seem to be affected by the inclusion of whole wheat in the mother rats' diet, including several genes that are known to be associated with breast cancer risk in humans. This observation is being interpreted to suggest that these offspring may be better able to deal with carcinogenic environmental insults than those whose mothers did not have a diet in whole wheat during their gestation. Interestingly, the observation seems to be confined only to whole wheat since ingesting other grains during pregnancy did not affect breast cancer risk for offspring.
The full report can be found in the International Journal of Cancer
The Pub Med entry is here.
December 13, 2006
Personalizing the treatment of multiple myeloma
Multiple myeloma is an aggressive form of plasma cell cancer that is often difficult to treat. Scientists at the Mayo Clinic have identified several mutations that may help doctors predict which patients will or will not respond to the therapeutic drug bortezomib (Velcade). This is very good news because having to determine the best treatment by trial and error can cost the patient time and health before the best treatment for that patient is determined.
In a recent interview, Leif Bergsagel, MD stated:
"Bortezomib seems to work in about one-third of patients who use it, but we have not been able to predict which ones," says the study's lead author, Leif Bergsagel, M.D., a hematologist at Mayo Clinic Arizona. "We now have identified a group that will likely respond because these nine mutations seem to be present in at least 25 percent of newly diagnosed patients.
"Now that we know the pathway the drug targets, and genetic mutations within this pathway that make patients respond better, we are working on a simple way to select those patients who are the best candidates for use of bortezomib," says Dr. Bergsagel.
These findings were presented at the American Society of Hematology Annual Meeting in Orlando on December 10, 2006. Dr. Leif Bergsagel from the Mayo Clinic in Arizona is the lead author on the study.
December 11, 2006
The Genographic Project: What are the concerns and expectations of native peoples?
The Genographic Project is sponsored by the Natonal Geographic Society and its goal is to use DNA methods to reconstruct the migrations of humankind from its origins in Africa to the rest of the earth. The Project is especially interested in sampling the DNA of indigenous peoples because they have stayed in their ancestral homelands longer than most other peoples and will provide more useful information to track humankind's movements over the millenia. It is likely that this information will help to shed light on the migrations of many other populations who have tended to move greater distances over time.
However, indigenous peoples tend to be distrustful of these efforts, partly because of their past experience with government and scientific researchers. They have learned to look for the benefits and risks from their own perspectives and to consider the types of unintended consequences--both good and bad-- that might not be obvious from the perspectives of others. Some people do not see that participating will benefit them directly and might hurt them, so they are disinclined to participate. Others see this as an opportunity to "prove" their ancient ties and claims to the lands they inhabit. Others feel that this information might threaten their claims to their lands. Still others hope that they will learn more about their relationship between peoples with similar cultural practices and that this would be a positive outcome. In any case, it is clear that the issues, expectations and concerns of the participants need to be addressed.
To learn more about this, Amy Harmon reports on many of these issues in the December 10, 2006 New York Times in a piece titled "DNA Gatherers Hit Snag: Tribes Don't Trust Them"