The Nose Can Diagnose the Skin Cancer

The skin releases over 100 volatile chemical compounds, according to research from the Monell Chemical Senses Center, and published in the British Journal of Dermatology. The next stage in developing this information has been described by Dr Gallagher at the August American Chemical Society meeting. Basal cell carcinoma, the most common skin cancer, releases a pattern of volatile compounds that can be recognized by appropriate equipment, and can be used in diagnosis.

The pattern of volatile compounds released at a tumor site differs from that found near healthy skin, and this difference can be detected using solid-phase extraction and gas chromatography/mass spectrometry. Studying 11 patients with basal cell carcinoma and 11 healthy subjects, Dr Gallagher was able to differentiate the cancer subjects from the healthy. The tumors did not differ in the compounds that were present, but rather in the amounts of specific compounds present. The tumors had a specific pattern of volatile compound amounts that could be readily identified. The team is now working on the patterns presented by squamous cell carcinoma and melanoma.

This appears to be an interesting non-invasive way of detecting different skin cancers at an early stage. The apparatus used is bulky, but it’s hoped that hand-held devices using nano-sensors may be developed. My hope is that one could make use of that exquisitely sensitive aroma sensor, the dog’s nose. Two years ago I posted a note about dogs detecting melanoma tumors. The study reported then didn’t make much news; maybe this new one will encourage dermatologists to ‘get a dog’. Of course, patients may prefer to have an instrument passed over them than a dog sniffing them out . . .

How Likely Are You to Die, or Win the Lottery?

Many of us buy a lottery ticket (or two or hundreds) in the hope that one day our number will ‘come up’. It’s easier, somehow, when part of the purchase price goes to a good cause, such as college scholarships. But how likely are we to win, compared with how likely we are to die during the period of waiting?

The Bandolier Group in UK have made a simple calculation which is illuminating. They compared the chances of dying between Friday and Monday with that of dying over the same period. The odds of dying were as follows:

Total deaths in UK per year = 571,911 = per day 1,567.

Population of UK = 60,587,000

Odds of dying in UK per day = 1 in (60,587,000/1,567) = 1 in 38,667.

Odds of dying in UK over Friday/Saturday/Sunday = 1 in 38,667 x 3 = 1 in 12,889

Odds of winning the UK National Lottery = 1 in 13,983,816

So, one’s chances of dying over the weekend are over 1,000 times greater than winning the lottery (actually, 1,084 times). And that’s without factoring in things like age, chronic disease, and living standards, which can all influence mortality rates. How well do these calculations apply to the USA ? I’ve no idea, but I bet they aren’t all that far off. Maybe someone who reads this post will make the US calculations.

Relax, and Lower Your Blood Pressure

There’s no doubt that raised blood pressure requires appropriate medications, in most cases. Of course, lifestyle (more exercise, less calories) can play a big part in the treatment program, but taking one drug is usually necessary, with addition of one or even two more, some time later. That’s why there’s renewed interest in a study from the Massachusetts General Hospital and the Benson-Hendry Institute for Mind Body Medicine, published in the Journal of Alternative and Complementary Medicine.

Patients in the study had high blood pressure being treated with standard medications, and who agreed to try training in a relaxation technique; the method, called the relaxation response, was first described by Herbert Benson 30 years ago. It involves sitting with eyes closed for 10 to 20 minutes and repeating silently a word or phrase, while breathing slowly and naturally. (If you don’t know what else to say, try “Om”.)

The participants were randomly assigned to 8 weeks of the relaxation technique or 8 weeks of lifestyle modification; there were 61 patients in each group. Patients who achieved a systolic blood pressure below 140 mm Hg or more than 5 mm Hg reduction in systolic pressure over the 8 weeks were then eligible for an 8-week trial of supervised medication elimination.

During the first 8 weeks, systolic pressure decreased on average by 9.4 mm Hg in the relaxation group and 8.8 mm Hg in the lifestyle group; the difference between groups was not significant. Forty-four of the relaxation group and 36 of the lifestyle group were eligible for the second part of the study. Significantly more of the relaxation patients in this part of the study were able to eliminate an anti-hypertensive medication without loss of blood pressure control – in fact, more than 4 times as many as among the lifestyle participants.

Maybe you don’t have high blood pressure. But practicing relaxation is likely to be helpful in combating stress, and thereby a whole raft of stress-related conditions.

Start Lifestyle Changes Immediately on Diabetes Diagnosis

When told that they’ve got type 2 diabetes, many people may wonder if there’s any need to change their lifestyle. They’ve heard all about people with diabetes who’ve lived as before for years and years, without seeming to do anything but take a medication or two. Unfortunately, however, if they delay getting their blood sugar level under control, they will find it much harder to control their condition. This has now been demonstrated in a study reported in the journal Diabetes Care.

Kaiser Permanente records in Oregon from over 2,500 newly-diagnosed type 2 diabetes patients were analyzed. Attention was focused on weight change, glucose control, and blood pressure control. The HbA1c level was used to measure glucose control, the ultimate target of treatment. Changes in weight over 3 years were used to project the likelihood of a patient achieving good glucose control.

Those patients who had significant weight loss in the first 18 months after being diagnosed were 52% and 77% more likely to have good glucose control at 4 years, compared with those who had stable weight or who gained, respectively. Early weight loss was also associated with a 47% to 83% lower likelihood of raised blood pressure after 4 years, compared with those with stable weight or a weight increase, respectively, in the first 18 months.

This study shows that early weight loss (due to appropriate dietary changes and increased physical activity) after a diagnosis of type 2 diabetes predicts improved glucose control and blood pressure control. A further finding in the study was that weight regain after an initial weight loss does not necessarily mean loss of the established gain in glucose and blood pressure control.

Bottom line: Don’t let the grass grow under your feet if you’re diagnosed with diabetes – get started immediately on the necessary steps to lose weight. It will pay dividends!

MSG (Monosodium Glutamate) Linked to Obesity

Monosodium gluconate (MSG) is a flavor-enhancer used in different foods – especially in China and other Asian countries. It doesn’t have a distinct taste of its own, and it’s not fully understood how it adds flavor to other foods. It may possibly stimulate glutamate receptors in the tongue to boost meat-like flavors. The FDA and other health regulatory organizations around the world have concluded that MSG is safe, but they qualify this by adding that some rare individuals may experience what’s called the “Chinese Restaurant Syndrome” – headache, flushing, sweating, and so on – after eating quantities of the chemical.

Now a study has been done to determine if an effect seen in rats – weight gain on a diet containing MSG – can be confirmed in humans. The results are reported in the journal Obesity. In a joint project, Chapel Hill, North Carolina, scientists studied the relationship between MSG intake and overweight but healthy volunteers living in 3 villages in China. Most of the 750-plus participants prepared their meals at home; about 82% used MSG in their food. They were classified into three groups, depending on the amount of MSG they used.

Total calorie intake and the amount of physical exercise taken were equal across the groups. However, the members of the group who used the most MSG were nearly three times more likely to be overweight than non-users.

It’s not likely that MSG consumption is an important factor for the development of overweight in the vast majority of US citizens. But it may be important for Asians, and the finding itself may provide an interesting clue in science’s search for the cause of obesity.

Saturday Quack – What Doesn’t Help When Quitting Smoking

It’s extremely difficult to quit smoking, as those who’ve tried can tell you. A new report in the journal Bandolier has looked at all the ways people use to help them quit, and the findings are rather disappointing. There’s only a single intervention that works in more than 1 in 10 people trying to quit: varenicline medication. See how the other methods fared, below.

Bandolier is a monthly UK journal that publishes reviews of evidence-based medicine. In its attempt to put the results of clinical studies into perspective, it likes to use the measurement “Numbers Needed to Treat” (NNT) wherever possible. Clinical studies concentrate on whether a treatment works, or not. But more important is the question, how well does the treatment work? The NNT is a useful way of looking at results of studies because it expresses the therapeutic effort that is needed to get a therapeutic result – i.e. how many people need to be treated to get the desired result.

Here are the various methods derived from 12 reviews of clinical studies in smoking cessation, covering over 127,000 subjects studied in appropriately-controlled trials, along with their NNTs. A ‘positive’ result means not smoking at 6 months after starting the intervention.

Nicotine replacement 16

Buproprion 11

Varenecline 7

Nortriptyline 9

Clonidine 9

Physician intervention 30

Self help 65

Counseling 26

Group therapy 22

Exercise 24

I hate to tell you, but this shows that prescription medications are the only effective aids to quitting smoking. Varenecline, with a NNT of 7, nortryptiline (9), clonidine (also 9), and bupropion (11) are clearly more effective than the non-medicinal interventions. Trying to go it alone (self help) is only effective in 1 in 65 people.

Note that the above NNT quoted include the comparison with the placebo used, which may explain why acupuncture and hypnosis don’t feature on the list. Placebo responses with both these treatments can be considerable.

Buying Viagra Online Is Not Always Risky

Many men are nervous about discussing erectile dysfunction (ED) with their doctors, especially if the doctor is a woman. If they go online, they find the Internet awash with ‘pharmacies’ that are more than willing to supply answers to their problem. But recently it’s become possible to buy a prescription drug by a regulated process called e-medicine prescribing. Utah was one of the first states to contract with an Internet service for providing Viagra and other PDE-5 (phospodiesterase-5) inhibitors for the treatment of ED. Salt Lake City scientists have evaluated this service, and compare it with the traditional doctor visit-prescription-pharmacy route.

The study, reported in the Mayo Clinic Proceedings, used data from 1,000 randomly selected medical records from patients seeking ED treatment. Half of them used the online prescriber, and the others consulted a physician. They compared the appropriateness of prescription (correct diagnosis, absence of risky drug interactions), correct use of a validated questionnaire, and adequacy of patient education.

The Internet patients were somewhat younger, weighed less, and had fewer accompanying illnesses. Prescriptions should not have been issued in 2.2% of the Internet patients and 9.4% of the traditional-route patients. All the Internet patients completed the full diagnostic questionnaire, compared with less than 1 in 4 of the traditional-route patients. Disease educational material was supplied to 100% of the Internet patients, but to only a third of the regular patients.

Although the two groups of patients were not similar, the analysis shows that safety aspects were not different between the state-regulated online prescription service and traditional face-to-face prescribing; however, there was clear superiority of the Internet prescribing service in a number of respects. And apart from those documented in this study, there’s the added convenience, lower costs, and privacy of online supply. It must be emphasized, however, that this was a carefully regulated service, totally different from those offered by Internet advertising sites or unsolicited e-mails. In particular one should avoid any consideration of medications offered from overseas – the quality may be suspect.

Is Arsenic in the Drinking Water Linked to Diabetes?

The amount of arsenic in drinking water varies from place to place, but levels are monitored for safety by water authorities throughout the USA. Some organizations, such as the National Resources Defense Council list alarming risks and suggest people should install filters specifically to block arsenic. And, they say, bottled water is no solution. Other sources – e.g. the Environmental Protection Agency, or EPA – give the concentrations regarded as safe, and how to find out whether individual water supplies have a problem in this respect.

Most people, quite rightly, give little thought to the arsenic levels in their drinking water. But a new report in the Journal of the American Medical Association may give them pause. A study of 788 people over 20 drawn from the NHANES survey had their urine arsenic levels determined. The overall frequency of type 2 diabetes was 7.7%. The subjects with type 2 diabetes had a 26% higher level of arsenic in their urine than the non-diabetic subjects. This was after adjustments were made for possible interference from diabetic risk factors and seafood intake (a source of consumed arsenic). Could it be true that type 2 diabetes is more likely in people who consume more arsenic? Maybe it’s time to get more proactive about water quality in your neighborhood.