Four Charts On How Health Care Has Changed Since 'Mad Men' - Forbes

“Mad Men” returns for its seventh season on AMC on Sunday night, with Don Draper, Joan Holloway, and the rest of the extended Sterling Cooper family back for an extended final go.

As a health care wonk, one joy of watching “Mad Men” has been how the show’s creators have used the characters’ behaviors—and their interactions with the nation’s health system—to consistently tweak our nostalgic view of the 1960s. (When the show debuted, the plot was set in March 1960; by the time the sixth season wrapped up, “Mad Men” had advanced all the way to November 1968.)

Writing at the Advisory Board Daily Briefing in 2012, I took a deep dive into how health care’s changed since the days of Don Draper, interviewing doctors and nurses who began practicing 50 years ago and highlighting five examples from the show.

The macro-level transformation in health care is also captured in the charts below, which are excerpted from a massive infographic we created for the Daily Briefing. (For the full infographic, click here or scroll to the bottom of this post.)

Here are four of the biggest health care shifts from 1960 to 2014.

1. Health care has become big business.

The show doesn’t focus on one of the most significant changes to the nation’s health care system—the long political battle over Medicare and Medicaid that culminated in 1965—although Season 4 does devote a throwaway line to the debate at the time. ”If they pass Medicare, they won’t stop until they ban personal property,” an older man grumbles at a Christmas party.

That obviously hasn’t happened, although it’s striking to think how public programs have come to dominate the nation’s health spending. More than half of all hospital discharges are from patients covered by Medicare or Medicaid, and that trend is only going to increase—about 10,000 Baby Boomers enroll in Medicare every day, and Obamacare’s Medicaid expansion could further grow that program by more than 21 million in the next decade. By 2030, more than 150 million Americans may be covered by Medicare and Medicaid.

The advent of Medicare also launched a new era: Health care as big business.

Rosemary Gibson of The Hastings Center recently pointed out a striking statistic that sums up the transformation.

• In 1965, there were zero health care companies on the Fortune 100 list.
• In 2013? There were 15.

2. We’re much more mindful of being healthful.

The idea of personal healthfulness is basically non-existent when “Mad Men” opens. Everyone drinks, no one exercises, and even characters who suffer from various medical maladies can’t make the connection between their behaviors and outcomes.

Take Roger Sterling, the suave fellow ad man who’s a mentor to Don. Roger’s a frequent smoker…and in mid-puff when he suffers his second heart attack of Season 1. (“Not again,” he grimaces, cigarette in hand. Although don’t fear for Roger; his character’s back to smoking, drinking, and eating steaks in no time.)

Today, we’re much more conscious of the importance of exercise and a balanced diet, and smoking rates have plummeted among adults. But one surprise: For all of the martinis seen quaffed on the show, we actually drink more today.

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3. Health care itself is much, much better.

This is practically a given, but better prevention, detection, interventions, and management have all contributed to massive improvements in treatment and outcomes. Writing at Forbes, Matthew Herper took a closer look at some of those innovations, like how the catheter revolutionized heart care and the introduction of randomized control trials to better test for medicines that work.

The numbers bear out the transformation. Life expectancy has gone up nearly a full decade since 1960, and if you survive to age 65, you’re expected to live an extra five years. Heart disease remains a serious concern, but a heart attack has gone from a lethal event to a chronic disease that can be managed with medications and other therapies.

And even though the cancer incidence rate has skyrocketed—in part because of improved detection—the mortality rate has plummeted.

4. We’ve come far on gender equality—although we still have a ways to go.

As depicted by the show, the U.S. health care system of the 1960s is openly paternalistic.

Doctor-patient confidentiality apparently doesn’t apply to women: Don Draper regularly gets a rundown of his wife Betty’s therapy sessions—from Betty’s doctor.

And another female character’s manic depression is treated in a barbaric way: She’s forced to undergo electroshock therapy by her husband, ultimately losing some of her memory.

Much of that changed, certainly, as the broad push for equal rights trickled down to medicine. But don’t discount the shifting gender and power roles within health care, as more women became doctors or advanced nurse practitioners. Even nurses’ attire changed in an important way, from skirts in the 1960s to scrubs today.

And yet, gender equality in health care still isn’t fully realized in the year 2014. Male doctors today still are much better compensated than female doctors, partly because of the specialties they choose. And even though female nurses outnumber male nurses by 10 to 1, men still get paid 10% more.

See for yourself how health care’s changed; the full graphic’s below. 

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For the working poor, new health premiums can be a burden - Los Angeles Times

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For nearly two decades, Barbara Garnaus maintained a modest, delicate life balance: keeping her part-time Orange County school district job and juggling her bills and credit card debt.

Now 63, living alone, she counts every dollar, has no cellphone and commutes an hour in traffic so she can keep an affordable apartment in Laguna Woods.

Having good health helped. Garnaus got by without medical insurance, relying on yearly exams at a free clinic. But that changed last year: Garnaus now needs treatment for cancer, and she bought insurance under Obamacare.

Thousands of Californians like Garnaus are poised to reap significant benefits from the nation's healthcare overhaul: access to levels of service and treatment previously out of their reach, and government subsidies that bring down payments dramatically. Still, Garnaus is anxious about taking on even modest additional monthly costs.

At the margins of poverty, even committing to premiums, co-payments and other new medical expenses of hundreds or a few thousand dollars a year can be difficult to manage, according to researchers and groups working with the low-income patients now required by federal law to buy insurance.

"When you talk about paying for something on a monthly basis like that, it's something very real that people have to consider," said Kandis Driscoll, a manager with the Santa Monica-based Insure the Uninsured Project. "It could be a survival decision."

Price was Garnaus' overriding consideration in choosing a policy.

"I got the cheapest one, the very cheapest one," she said. "And for me it's still not cheap."

::

As she reviews invoices at her desk, the tail of a blue scarf wrapped around Garnaus' head brushes her shoulder. Tacked to the wall behind her are photos of her with former colleagues and an old yearbook portrait showing off the wavy blond hair she lost to chemotherapy last year.

She works 20 hours a week ordering pencils and testing materials, earning $22,480 annually before taxes, and isn't eligible for the district's health insurance coverage. She's tried unsuccessfully to get full-time work at the district and elsewhere, she said, but felt it was best to hold on to what she had when the recession hit.

Her monthly take-home paycheck is about $1,750. With her $1,180 rent, about $150 on gasoline and $100 on utilities, she's left with less than $320 each month for food and any other expenses, including medical bills.

In March of last year, Garnaus was diagnosed with a rare but aggressive uterine cancer. She initially received treatment through Orange County's taxpayer-supported healthcare program. She qualified for the low-income program because her earnings fell below the $22,980 annual ceiling the county had set for a single-person household, roughly 200% of the federal poverty level.

When that county program expired Dec. 31, most of the patients transitioned to Medi-Cal, the state's program for the elderly and poor. But Medi-Cal covers people only up to 138% of the poverty level — $15,800 for a single person — which disqualified Garnaus.

Garnaus acknowledges that insurance will be good for her health and finances in the long run but says she's barely able to cover the increased monthly costs. With government subsidies, her monthly insurance premiums are $13.50, and co-pays to see her oncologist are $20. When lab work or a CT scan is required, it can cost up to $100 more.

"I'm continuously getting into debt," she said. Under her plan, she says, she can have up to $2,250 in annual out-of-pocket payments.

During a workday lunch break last month, Garnaus said she was contemplating skipping CT scans recommended by her doctors because of the added cost. "It's a very scary situation," she said.

Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, a healthcare research group, said that previously uninsured patients living on the cusp of poverty and now required to buy insurance may struggle with the new financial obligations but should focus on the upside.

"These individuals will pay more," she said, "but they will get better benefits."

In February, Garnaus saw her oncologist for the first time with her new insurance. She cringed at the $20 co-payment and $15 for lab tests.

But she was thrilled days later when the results came back. "I'm crystal clear, just clean as a whistle, thank God," she said.

Recently, a friend who also has uterine cancer told Garnaus that a CT scan was the only thing that caught a resurgence of her disease.

Now, Garnaus feels increased pressure to get a scan. She says she's just not sure where she'll get the co-payment.

"That's the $100 I don't have," she said.

soumya.karlamangla@latimes.com

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Chrissy Amphlett's 'I Touch Myself' Reworked for Breast Cancer Campaign: Watch - Billboard

The late Chrissy Amphlett’s iconic song “I Touch Myself” is enjoying an all-star makeover for an Australian breast cancer awareness campaign.

The song, originally a hit in the early '90s for the rocker's band the Divinyls, has been covered by a cast of home-grown stars including breast cancer survivor Olivia Newton-John, ARIA female artist of the year winners Sarah Blasko and Megan Washington, Baby Animals singer Suze DeMarchi, and ARIA Hall of Fame inductee Little Pattie, who is Amphlett’s cousin.

Each of the 10 singers appear in a powerful black and white video which was commissioned by Cancer Council NSW and launched over the weekend. The charity has declared the song as the anthem for its #itouchmyselfproject, which has a dedicated Website at http://itouchmyself.org. 

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The song “celebrates female sexuality like no other,” the charity notes in a statement. “Like Chrissy, it is bold, brave, and brassy. It rocked our world. And when Chrissy developed breast cancer, it was a song she wanted to become an anthem for spreading awareness about the importance of touching ourselves for early detection of the disease.” 

Amphlett died on April 21, 2013 at the age of 53. A mammogram and ultrasound failed to initially detect her cancer. It was only when she self-examined that she returned to the doctor to insist on a biopsy, which in 2010 revealed the cancer. 

Amphlett’s widower Charley Drayton spoke to the Sunday Telegraph ahead of the one-year anniversary of her passing. "She would have wanted us to be more in touch with ourselves and to listen to what's going on inside physically, and to be more in charge of our destiny and not wait for doctors or advisers to be in charge of us,” he said. 

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“I Touch Myself” became an international hit in 1991 when it reached No. 4 on the Billboard Hot 100, No. 10 in the U.K. and No. 1 in Australia, and had radio programmers around the world pondering whether the song was too naughty to spin (Amphlett wrote the work with Mark McEntee, Billy Steinberg and Tom Kelly).

The singers who came together for the new campaign, notes Cancer Council NSW, have done so “to make Chrissy's final wish a reality.”

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Device that prevents hair loss for cancer patients may become available in U.S. - New York Daily News

Bill Denver for New York Daily News Carolyn Dempsey assumed going bald would be part of the physical and psychological assault of chemotherapy, until she found DigniCap.

When the dreaded diagnosis of breast cancer came in May, several thoughts raced through Carolyn Dempsey’s panicked mind.

“First was, ‘Will I live? Will I get to see my children grow up?’ ” recalled the New Jersey music teacher and mother of three. “Next was, ‘Am I going to lose my hair?’ ”

Dempsey, 44, said she assumed losing her signature blond ponytail and going bald would be part of the physical and psychological assault of chemotherapy, along with the nausea and fatigue. But she was prepared to face it all.

Courtesy Dempsey Family

Carolyn Dempsey undergoing chemotherapy for early stage breast cancer at Weill-Cornell Breast Center.

Enlarge Courtesy Dempsey Family

Dempsey is part of the hospital's research trials testing the DigniCap.

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Courtesy Dempsey Family Carolyn Dempsey prior to her fourth and final chemo treatment showing full head of hair.

Bill Denver for New York Daily News Dempsey outside her home in Chatham, N.J.

Until a friend told her about a little-known scalp-cooling technique which has been shown to prevent chemo-induced hair loss for patients with early-stage breast cancer.

Dempsey eventually found her way to the Weill Cornell Breast Center at New York-Presbyterian Hospital, where Dr. Tessa Cigler is heading up a research trial on DigniCap, a Swedish device that has been successfully used in Europe since 1999, but not available in the United States.

That may change in 2015, when New York researchers along with doctors in California and North Carolina, present their promising findings to the FDA.

“Cold-cap therapy is empowering,” said Cigler, the lead researcher for Weill Cornell’s ongoing clinical trial. “It allows women to maintain their self-esteem and sense of well-being, as well as to protect their privacy.

“Without these caps, 100% of the women lose their hair by the second treatment,” she added.

Marta Vallee-Cobham, the clinical research nurse for the trial, said that DigniCap would be a game changer for thousands of American women and men, as it has been overseas.

“For those of us who have been giving chemo for so long, to see that finally there is something to provide confidence to patients is exciting,” said Vallee-Cobham. “When you can offer this, the world changes. You see it in our patients’ whole outlook as they deal with cancer.”

Courtesy Dempsey Family Carolyn Dempsey with husband Brian and staff from DigniCap and Weill-Cornell Breast Center.

Barry Williams for New York Daily News Dr. Tessa Cigler is heading up a research trial on DigniCap.

While sitting in a reclining chair receiving chemo infusion, a snug-fitting silicone cap is fitted onto the patient’s head. The cap is hooked up to a refrigeration unit which cools the scalp to 37 degrees.

The cold constricts the scalp’s blood vessels, which limits the chemo from reaching and killing off hair follicle cells.

“We are very encouraged by the number of patients who have been able to keep their hair,” Cigler said.

Courtesy Dempsey Family Breast cancer survivor Carolyn Dempsey sits with her with her children Calder, 9, (l.) and Austen, 6, (r.), two of her three children, before chemotherapy. Bill Denver For for New York Daily News Breast cancer survivor Carolyn Dempsey (C) says keeping her hair during her treatment helped her family cope with her cancer.  Bill Denver for New York Daily News Carolyn Dempsey, seen with her children and dog, is championing the Swedish technology in the U.S.

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Dempsey said she felt so fortunate to find out about the trial in time. She also worried that being bald would frighten her children — ages 12, 9 and 6.

“Not having that reminder every time you look in the mirror that you are sick, and you look normal to your family made the chemo much more bearable,” said Dempsey, who lost some hair on top of her head. “Instead of illness, I saw myself. Many people had no idea I had cancer.”

She and her husband, Brian, also felt strongly about getting the word out about DigniCap as well as the Penguin cap which has been in use, but much more difficult to use as friends or family have to bring dry ice to the oncology center and change the cap every 30 minutes for a set amount of time — before, during and after chemo.

Barry Williams for New York Daily News The cooling and control unit, DigniC3, of the DigniCap scalp cooling system.

“When Carolyn was diagnosed, we were given Xeroxes with a list of wig makers, but there was no mention of cold caps or DigniCaps,” said Brian Dempsey, a Manhattan graphic designer.

During her final chemo treatment last week at Weill Cornell, breast cancer patient Lauren Desharnais was ecstatic.

As Vallee-Cobham lifted off the cap, Desharnais, who traveled three hours from Albany for her treatments, was amazed when she put her fingers through her scalp.

“It’s startling that my hair is still here!” she said, beaming. She got up from the chair, threw on her trench coat and some pink lipstick, and walked out of the hospital onto the streets of Manhattan. No one would ever know she had been sick.

“It’s no one’s business if you have cancer,” Desharnais said. “This way, you tell who you wish to tell. I’m outraged that in Europe they’ve had this technique for years and not here.”

Barry Williams for New York Daily News Lauren Desharnais has kept most of her hair after receiving scalp-cooling therapy. Barry Williams for New York Daily News Lauren Desharnais, right, receives a hug from clinical research nurse Marta Vallee-Cobham during her last chemotherapy visit at Cornell Weill Breast Center. Barry Williams for New York Daily News Lauren Desharnais, right, shares a laugh with her son Andrew Desharnais after scalp-cooling therapy, which is undergoing clinical trials in New York.  Barry Williams for New York Daily News Lauren and Andrew leave Cornell Weill Breast Center on Tuesday, following her treatment. 

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***

HOW IT WORKS

The DigniCap sits at room temperature when placed snugly on the patient's moistened head 30 minutes before the chemotherapy infusion begins.

The cap, with its internal coils, is hooked up to a refrigeration unit which gradually cools the cap down to 37 degrees. The cooling cap is kept on during the chemo infusion, and then for another 1-2 hours after the infusion.

To minimize any hair loss, patients are advised to put little stress on the hair and scalp, limit washing hair to two times a week, avoid using heat from blow-dryers, curling irons or rollers. Limit brushing or combing hair or coloring hair.

The Weill Cornell Breast Center has an active cold-cap program. For more information, call (212) 821-0644 or go to http://ift.tt/1iJhLLu.

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Blood type influences prostate cancer relapse, study shows - Telegraph.co.uk

A man in consultation following a prostate examination Photo: Alamy

A man's blood group has been shown to significantly influence the chance that prostate cancer will return after successful surgery.

Men with group O blood are far less likely to suffer a recurrence of the disease following surgical intervention.

By contrast, men with blood group A were shown by new research to be 35% more likely to fall victim to the disease again, even after surgery.

Prostate cancer is the most common form of cancer in European men and 40,000 cases are diagnosed in Britain annually.

Study author Dr Yoshio Ohno, of Tokyo Medical University, said: "This is the first time that anyone has shown that prostate cancer recurrence can vary with blood group.

"As yet, we don't know why the risks vary with blood group, but this work may guide us towards new avenues of molecular research on prostate cancer progression.

"Should we be counselling people with certain blood groups that they have a greater or lesser chance of recurrence, and should these risk factors be built into decisions on treatment?"

The new research, presented at the European Association of Urology's (EAU) annual congress in Stockholm this week, tracked 555 patients with prostate cancer between 2004 and 2010.

An individual's blood group is determined by the presence of different antigens and antibodies. Antigens and antibodies serve as the blood's defences against foreign substances.

Group O blood is the most common in the UK with 44% of the population estimated to have the type. Roughly 42% of Britons have group A blood.

Previously, different blood groups have been associated with different risk levels for developing certain cancers, such as gastric and pancreatic cancers.

EAU general secretary Professor Per-Anders Abrahamsson said: "This is an interesting first finding. There is great geographical variation in the incidence of prostate cancer, so there are obviously strong genetic factors at play.

"Blood groups have already been shown to be associated with prostate cancer incidence, now it looks like they might be associated with treatment outcomes as well."

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Odd-Hour Workers Face Loss of Employer Health Plans - Wall Street Journal

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Wall Street Journal

Odd-Hour Workers Face Loss of Employer Health Plans Wall Street Journal Susan Caspersen was in a hospital in Akron, Ohio, last November recovering from an emergency appendectomy when she got some unwelcome news: as of Jan. 1, 2014, she would no longer be eligible for the health-insurance plan offered by her employer, ... and more »

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In New York, Hard Choices on Health Exchange Spell Success - New York Times

In contrast with the early stumbles in most of the country, New York State, almost from the start, has provided a textbook lesson in how to make the Affordable Care Act work. But it has done so by making some tough decisions.

New York has signed up more than 900,000 people for commercial or government plans, lured 16 insurance companies onto its exchange, provided subsidies for most customers and reduced premiums across the board.

“I have to say that on the whole this is a very savvy bunch of people they have operating the exchange,” Mark P. Scherzer, a lawyer and consumer advocate , said. “It really is a story of something that government could actually do right.”

The state’s success was no accident. It began with a receptive customer base and the benefit of experience, since New York already had some of the country’s most generous insurance coverage for the poor and sick. Resistance to the health exchange among Republicans in the state may, oddly enough, have helped make it more successful.

But New York also took some aggressive and unpopular steps that few other states have taken, by creating a highly centralized system limiting consumer choice, essentially giving insurance seekers little incentive to shop off the exchange.

As a result, most New Yorkers who are not insured through an employer are effectively barred from choosing any doctors or hospitals they want.

At least 100,000 people have lost their old health plans because they did not conform to new federal requirements. Thousands more freelancers and other “sole proprietors” were barred from banding together for group insurance rates, a change in longstanding practice that almost certainly pushed more consumers to buy insurance on the exchange.

Donna Frescatore, executive director of New York State of Health, as the exchange is called, said the state’s decisions had been vindicated by the fact that premium rates had dropped more than 50 percent from previous years.

Individual premiums for Manhattan residents, for instance, dropped from $1,534 for a standard health maintenance organization, or H.M.O., in 2013 to $621 for a comparable exchange plan now. “I think it has in part ensured that customers have affordable options,” Ms. Frescatore said.

Long before President Obama was elected, New York was a pioneer in requiring insurance companies to provide individual or small-group coverage to people regardless of existing illness, and to price it without regard to health, age, gender or occupation, core provisions of the Affordable Care Act.

And while the federal law allows children to be covered under their parents’ policies until they turn 26, New York already required offering coverage up to 30, and still does.

“So in those other states, you have health plans trying to figure it out,” said Peter Newell, an analyst for the United Hospital Fund, a nonprofit research organization. “In New York, you could sidestep a lot of problems.”

Still, the exchange had a rough start. Republicans in the State Senate tried to block it by refusing to support the creation of an independent authority to run it. New York could have followed 36 other states in simply joining the exchange set up by the federal government, whose numerous problems were not yet evident. Instead Gov. Andrew M. Cuomo established the state ’s exchange by executive order, deeding it to “seasoned stagehands,” as Mr. Newell put it, in the Health Department.

About 508,000 of those who enrolled qualified for Medicaid and 63,000 for Child Health Plus, another government-subsidized plan; 363,000 bought private plans. The number who purchased private plans by March 31, the enrollment deadline for 2014 coverage, exceeded federal government predictions for New York by more than 60 percent. Nationwide, thanks to a last-minute surge, 7.1 million people signed up for private plans by the end of March, allowing the Obama administration to hit its goal of 7 million.

The Kaiser Family Foundation, a health policy research institution, has ranked New York’s exchange as the most competitive of seven states studied, based in part on the large number of companies participating and their relatively balanced market share.

In an unusual decision that had a strong impact on consumer choices, New York required insurers to offer the same type of coverage on the exchange as off.

The result was that none of New York’s insurers offered out-of-network coverage for individuals, except in a small part of western New York, because they wanted to hold down costs and avoid being swamped by sick people. So regardless of whether individuals buy their plans on the exchange or off, they cannot get coverage outside a fixed network of doctors and hospitals, even if they are willing to pay more for it.

With no out-of-network coverage, “New York is a real outlier,” said Mr. Scherzer, who advocates more options. “But they did it in part because they thought it would keep premiums down, which of course it does,” he said.

State officials say the decision served to level the playing field for insurance companies and consumers. But it has led to complaints from consumers who cannot go to the doctors or hospitals they want.

The sickest customers tend to be the most upset, like Abigail List, a 53-year-old therapist in Manhattan, who said she had to choose one of the most expensive plans, costing $300 more a month than others, so she could have coverage for her longtime cancer doctors at NYU-Langone Medical Center. “I’m being railroaded, that’s why I’m so furious,” Ms. List said.

The most prestigious and specialized hospitals tend to take the fewest plans on the exchange. Memorial Sloan-Kettering Cancer Center, the renowned cancer hospital, takes only two exchange plans for individuals, Health Republic and Oscar.

“It’s fairly difficult to take the pricing that some of the other insurers on the exchanges are proposing,” said John Gunn, the chief operating officer for Sloan-Kettering. “It was way below our cost of providing the service.”

He said Sloan-Kettering was working with about 100 patients to make sure they had access to the hospital if they needed it, either by being in network or by special arrangement.

Benjamin Lawsky, the state’s financial services superintendent, said that not requiring out-of-network coverage was strategic in the first year but was being reconsidered. “As we think about setting rates for Year Two, has the exchange matured enough that we think it’s wise to mandate an out-of-network benefit?” Mr. Lawsky said. “We’ll make that decision probably in the next few weeks.”

The exchange also benefited from the state’s refusal to reinstate canceled plans when President Obama said it could; state officials said restoring the plans would have caused chaos by upsetting insurance pricing.

The state’s rollout was not without snags. Its website was swamped on the first day but capacity was quadrupled over the next four days.

Some doctors have complained that they are mistakenly listed in plans they do not accept, or have been cut from plans they would like to be on. Empire BlueCross BlueShield, overwhelmed by early sign-ups, agreed to pay cash penalties to about 20,000 customers who did not receive their insurance cards in time for coverage in January.

But others were surprisingly willing to forgive the exchange its shortcomings.

Marilyn Miller, a retired ballet dancer who now runs Pilates on Hudson in Peekskill, N.Y., had her old plan canceled. But she is happy that her new one covers regular doctor visits, and she is putting money into a health savings account in case she ever needs to see a specialist outside of her network.

“It was well worth it to be able to get insurance and not have it tied to my business,” Ms. Miller said.

Malka Percal, 63, a copy editor who lives in downtown Manhattan, lost her freelancer’s plan and her “really wonderful” doctor. But she likes the promise of universal health care. “Is it Pollyannaish of me?” she said. “I have a really hopeful feeling.”

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Is organic better for your health? A look at milk, meat, eggs, produce and fish. - Washington Post

By Tamar Haspel,

Organic or conventional? It’s a choice many grocery shoppers are faced with, over and over. The price difference is easy to see; it’s right there on the product. The quality difference is much harder. Is the organic milk better for your kids? Is the conventional lettuce more likely to carry pathogens?

Leave aside for the moment whether organic agriculture is better for the planet and whether organic livestock have better lives, although there’s a strong case for both of those arguments. Leave aside flavor, too, because it’s subjective and variable. What motivates many organic buyers, particularly the parents of small children, is health benefits, and there are two questions: Do organics do us more good (in the form of better nutrition), and do they do us less harm (in the form of fewer contaminants and pathogens)?

Because the risks and the benefits vary by product — meat is different from produce — it’s important to look at each category separately. While every category has the potential to harbor pathogens (such as E. coli in produce and salmonella in chicken), there are some product-specific concerns, including pesticide residue in produce and hormones in milk.

Here’s a rundown of the evidence on nutrition and contamination levels for organic and conventional products in five categories — milk, produce, meat, eggs and fish — to help you decide whether to buy organic or stick with conventional.

Milk

Nutrition: Compared with conventional milk, organic milk has higher levels of omega-3 fats, which protect against heart disease and may decrease the risk of depression, stroke, cancer and other diseases, but the quantities are too small to be very meaningful. (It takes 11 quarts of organic milk to equal the omega-3s in four ounces of salmon.) Milk’s omega-3 content is a function of the cow’s diet, and higher levels reflect more grass. (A few other nutritional differences between organic and conventional milk have been studied, but there isn’t enough research to draw conclusions.)

Contamination: Neither organic nor conventional milk contains antibiotics. By law, every truckload of milk, organic and conventional, is tested for veterinary drugs, including antibiotics, by trained dairy workers. Any load that tests positive is pulled out of the food supply. In 2012, that was one in 6,000 loads. Organic cows aren’t given antibiotics, and conventional ones are given them only for illness, and their milk isn’t used until after a withdrawal period.

The U.S. Department of Agriculture tests for pesticide levels and has found them to be “very low.” The main culprit is DDE, a remnant of the agricultural pesticide DDT.

DDT was banned years ago, but the USDA said it “is very persisten[t] and remains in many cropland soils. It is also in the body fat of all Americans and most farm animals and wildlife. Conventional and organic farmers can do little to avoid the DDE residues in milk. Over the next thirty to fifty years these residues will gradually decline below limits of detection.”

Pasteurization fails some of the time, allowing milk contaminated with bacteria to get into the food supply, but there are no reports comparing illnesses caused by organic vs. conventional milk.

Hormones: The issue with milk is that many conventionally raised dairy cows, unlike organic ones, are injected with bovine growth hormone (BGH, the synthetic version of which is called either recombinant bovine growth hormone, rBGH, or recombinant bovine somatotropin, rBST) to increase their milk production. The problem isn’t the hormone itself — it’s unlikely to survive pasteurization or human digestion and, even if it did, its mechanism doesn’t work in humans — but rather a compound called insulin-like growth factor (IGF-I).

Both organic and conventional cows have IGF-I in their milk, but cows that get hormone treatment may have more of it. Humans also produce IGF-I, and a recent review of many studies concluded that milk drinkers generally have higher IGF-I levels. But it may not be because of IGF-I in milk. Eating animal and soy protein can also increase IGF-I levels in our bodies. It’s not the IGF-I in foods, but how the body responds to other compounds, that increases human levels.

Some research has linked IGF-I to cancer. The American Cancer Society found that “some early studies found a relationship between blood levels of IGF-I and the development of prostate, breast, colorectal and other cancers, but later studies have failed to confirm these reports or have found weaker relationships.” The organization concluded in 2011 that “the evidence for potential harm to humans is inconclusive.” A 2009 FDA report says that IGF-I levels in rBGH milk are safe

The use of rBGH has fueled concerns among some parents about giving milk to children, but the FDA report concluded that “consumption by infants and children of milk and edible products from rBGH-treated cows is safe.”

Bottom line: Organic milk has higher omega-3 fat levels, but probably not enough to make a difference. Exposure to pesticides, contaminants or hormones is not a significant risk in either organic or conventional milk.

Produce

Nutrition: Many studies have compared the vitamins, minerals, macronutrients and other compounds in organic and conventional produce, and a 2012 review concluded that the results were all over the map. The one exception was that the phosphorus content of organic produce is higher, although the review, done by Stanford University scientists, calls that finding “not clinically significant.” Along with calcium, phosphorus helps build strong bones and teeth.

Contamination: There are two issues for foods that grow in the ground: pesticides and pathogens. There is widespread agreement that organic produce, while not pesticide-free, has lower residue levels and fewer pesticides. A study using USDA data found that 73 percent of conventional produce sampled had residue from at least one pesticide, compared with 23 percent of organic, though that study is more than 10 years old. There also isn’t agreement about whether that’s meaningful for human consumption.

Carl Winter, a toxicologist at the University of California at Davis, says that the Environmental Protection Agency, working from animal research and factoring in the special sensitivities of human subgroups such as babies and children, has found that lifetime risk of adverse health effects due to low-level exposure to pesticide residue through consumption of produce is “far below even minimal health concerns, even over a lifetime.”

Dana Barr, a research professor at Emory University’s Rollins School of Public Health, has less faith in the EPA standards. She points to one particular pesticide class, organophosphates, and notes evidence — including a 2013 review she co-authored — correlating exposure to possible neurological problems such as ADHD and lower IQ in children, which she says the EPA standards don’t adequately consider.

But another review last year by a different group of scientists found “the epidemiologic studies did not strongly implicate any particular pesticide as being causally related to adverse neurodevelopmental outcomes in infants and children.” As of December 2013, the position of the Centers for Disease Control and Prevention was that high levels of organophosphate exposure were associated with some neurobehavioral problems in farm communities with exposure higher than that in the general population.

An American Academy of Pediatrics 2012 report noted the correlation between organophosphate exposure and neurological issues that had been found in some studies but concluded that it was still “unclear” that reducing exposure by eating organic would be “clinically relevant.”

The EPA expects to have a new assessment of organophosphates in 2016. In the meantime, the agency has determined that certain foods —snap beans, watermelon, tomatoes and potatoes — are likely to have higher residues of the pesticide than other produce. If you’re pregnant or feeding small children, you may want to consider organic versions of those foods.

As for pathogens, the 2012 Stanford review found that E. coli contamination is slightly more likely in organic than conventional produce.

The best strategy to reduce risk from produce isn’t to buy either organic or conventional. Rather, it’s to cook your food. A CDC review notes that leafy vegetables, led by lettuce and spinach, are the No. 1 cause of food-borne illnesses, responsible for 22 percent of food-borne illnesses.

Bottom line: While there may be no significant nutritional difference between organic and conventional produce, organic does have lower levels of pesticide residue. However, there isn’t universal agreement on the risk those residues pose.

Meat

Nutrition: As with milk, the main issue here is omega-3 fats. Some organic meat and poultry have more of them than conventional products do. The reason is diet: Animals that eat more grass have lower fat levels overall and higher omega-3 levels than animals fed more grain.

Although measurements of omega-3 fats in beef vary, the numbers are low and substantially below what can be found in a serving of salmon.

Contaminants: The USDA randomly tests carcasses for residues of pesticides, contaminants and veterinary drugs including antibiotics. In 2011, it screened for 128 chemicals, and 99 percent of the tested carcasses were free of all of them.

It found a few with residue violations and a similar small number with residue within legal limits (mostly of arsenic and antibiotics). Although the USDA doesn’t report organic and conventional separately, contaminant risk overall is extremely low.

The bigger concern is pathogens. Studies of bacterial contamination levels of organic and conventional meat show widely varying results. These findings suggest that organic meat may be slightly more likely to be contaminated, possibly because no antibiotics are used. But conventional meat is more likely to be contaminated with antibiotic-resistant bacteria. The 2012 Stanford review found that slightly more organic chicken samples were contaminated with Campylobacter than conventional samples and that organic pork was more likely than conventional to harbor E. coli. But the risk in meat overall was essentially the same. And whether meat is conventional or organic, the solution is adequate cooking.

Bottom line: There doesn’t seem to be much difference, health-wise, between organic or conventional meats. Grass-fed beef has a slight edge over grain-fed because of higher omega-3 levels, but the amounts are probably too small to affect human health.

Eggs

Nutrition: As with milk and meat, the omega-3 levels of eggs are affected by the hens’ diet and can be increased by pasturing or diet supplementation for either organic or conventional hens. Eggs high in omega-3s are generally labeled.

Contaminants: There’s very little research on contaminants in eggs. The USDA’s 2011 National Residue Program tested 497 egg samples and found no residues of pesticides, contaminants or veterinary drugs, including antibiotics. This isn’t surprising because, according to Pat Curtis, a poultry scientist at Auburn University, laying hens aren’t routinely given antibiotics, and there is a mandated withdrawal period after they do get the drugs (to treat illness) before their eggs can be sold. The 2012 Stanford review concluded that there is “no difference” in contamination risk between conventional and organic eggs.

Bottom line: There are no significant differences affecting health between organic and conventional eggs.

Fish

The USDA has not issued any organic standards for farmed fish or shellfish, but several overseas organizations have. (Because there’s no way to control the diet of wild fish, “organic” doesn’t apply.) Canadian standards prohibit antibiotics and hormones, restrict pesticides and set criteria for acceptable feed. There’s not enough research comparing organic and conventional fish to draw any conclusions about their health benefits.

Haspel writes regularly for The Post’s health and food sections. Follow her on Twitter: @TamarHaspel.

More from The Washington Post: 10 nutrients that can lift your spirits Benefits of organic milk may be an oversell Hydroponic is not the same as organic Access to unpasteurized milk is increasing. So are illnesses.

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One way to pay for health-care costs in retirement - Washington Post

A couple of weeks ago, I posted on the vast gap between the savings we’ll actually need for health-care in retirement and the amount most people think they’ll need. Here’s a bit of good news on health savings accounts, an under-utilized way to  accumulate those funds for people enrolled in high-deductible health-care plans. –Lenny Bernstein

There is quite a bit of research that highlights the danger of financial shortfalls in retirement faced  by many Americans. Although some people accrue enough savings to meet their basic needs, health costs – which tend to rise after retirement – remain a major concern. A recent MarketWatch analysis found that most retirees will spend an average of $250,000 on out-of-pocket health costs during their retirement years, an amount that can quickly cut into their savings.

Health savings accounts (HSAs) offer consumers a way to save for these costs now and into retirement years. But many consumers view them only as spending accounts for managing in-year expenses.  Employers and HSA providers who help workers understand the full potential of  HSAs will give them a valuable option and will benefit themselves..

Health savings accounts were introduced just over 10 years ago, many years after flexible spending accounts (FSAs), which you use to pay medical bills each year. Many consumers confuse their features. FSAs were designed as a way to manage predictable health-care expenses within a given year. HSAs are designed to be a powerful short and long term savings vehicle.

Employee Benefit Research Institute estimate of out-of-pocket health care costs in retirement.

HSAs are individual accounts, owned by the consumer, just like personal checking and savings accounts.  As such, they are portable – the account and the contributions in it remain the property of the account holder, even if he or she changes jobs or   enrolls in a different health insurance plan.  Consumers can continue to contribute up to the allowable IRS limit, as long as they are enrolled in qualifying high deductible health plans. The funds roll over from year to year with no expiration.

Best of all, HSA contributions are triple-tax-advantaged.  Contributions are tax free. Once HSA account balances reach a minimum threshold, funds can be invested, with interest and earnings on investments tax free.  And HSA account holders do not pay income tax on funds when they withdraw the money for qualified health-care expenses, as they do with the money in their 401Ks.

All of these features make HSAs an attractive way of managing near term health-care spending and saving for health-care costs through retirement.

Employers also benefit when their employees understand the full value of HSAs.  Employers realize an immediate tax benefit when more workers adopt HSAs and contribute to them. HSAs augment benefit programs, which are typically designed with the intent of attracting and retaining talent. Forward-thinking employers may want to offer integrated retirement planning strategies that take into account potential future health needs by offering to match contributions to HSAs, as they do for 401Ks.

HSAs are growing as more people come to understand them. According to a recent report, assets in HSAs exceeded $20 billion  as of January 2014.  Growth is stable. And HSA investment assets have now reached $2.3 billion, meaning that more than 10 percent of HSA deposits are currently invested in mutual funds or other long-term growth vehicles.  These trends are expected to continue as the popularity of HSAs grows and consumers increasingly look to HSAs as a complement to their retirement savings.

Tom Torre is chief executive  of Alegeus Technologies, which provides benefit and payment solutions for employers.

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Girl with cancer who befriended Michigan State basketball star dies - CBS News

Adreian Payne, No. 5 of the Michigan State Spartans, walks on the floor for Senior Night with Lacey Holsworth, a 8-year-old who is battling cancer, after defeating the Iowa Hawkeyes 86-76 at the Jack T. Breslin Student Events Center on Feb. 6, 2014, in East Lansing, Mich.

EAST LANSING , Mich. - Lacey Holsworth, the 8-year-old who battled cancer and became friends with Michigan State University basketball star Adreian Payne, has died, CBS Detroit reported.

Lacey's dad, Matt Holsworth, said the girl died at their St. Johns, Mich., home late Tuesday "with her mommy and daddy holding her in their arms."

Princess Lacey has achieved the ultimate victory. She now dances among angels.... The world is a... http://t.co/SAXeJ4D4zH

— Princess Lacey (@adorablelacey) April 9, 2014

The cancer-stricken girl became friends with Payne when she met him during one of her hospital stays two years ago.

"They communicate and hang out like a brother and sister," Holsworth told The Associated Press last month. "It's a unique and special bond."

When it was Payne's turn to be honored during the Spartans' Senior Night ceremony last month, the 6-foot-10 center scooped up Lacey and carried her around the court.

"She was tired that day," Payne recalled in an interview with the AP. "I just figured I'd pick her up instead of having her walk."

He scooped her up again, taking her toward the top of a ladder as Michigan State celebrated winning the Big Ten tournament by cutting down the nets in Indianapolis. He even included her in his recent shot at the college dunk contest.

Lacey watched Michigan State's NCAA tournament run from the stands. After Payne scored a career-high 41 points to help Michigan State beat Delaware in one tournament game, Payne talked as much about what his performance meant to Lacey as it did to the Spartans.

"It's like having a family member who's really sick," he said. "The only thing you can do is play basketball. You can't be there with them. Just knowing that when I play well, it makes her happy. It feels like I'm doing something, in a way, to make her feel better."

The little girl affectionately known as "Princess Lacey," had neuroblastoma, a fetal-nerve cell cancer. She wore a long, blond wig because chemotherapy took her hair.

Back pain while dancing in 2011 led to the discovery of a football-sized tumor that had engulfed her kidney. After another tumor wrapped around her spine, her father had to carry her into a hospital on Dec. 28, 2011. She lost feeling below her belly button and couldn't walk on her own for several months, a long stretch that included the first of many visits from Payne.

While Lacey had some victories in her battle, the cancer kept coming back and eventually spread to her neck, head and pelvic region.

"She loved unconditionally and without hesitation," Holsworth said. "Spreading her smile and love throughout the world."

© 2014 CBS Interactive Inc. All Rights Reserved.

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Cancer quests - The Economist (blog)

HOW can playing on an app generate scientific meaning? It’s a question that Cancer Research UK may have just answered at a favourable time: the use of mobile games increased by 66% last year. The charity enlisted the help of gaming experts at tech startup Guerilla Tea, as well as the Dundee agency, Amazon Web Services and many others in the creation of “Genes in Space”.  

Released two months ago, the spaceship exploration game is centred on the hunt to harvest the fanciful element alpha by charting a course and steering a ship accordingly through outer space. Its premise is nothing revolutionary in the gaming world, but its true purpose is. Everyone who plays “Genes in Space” aids in a quest—not to find element alpha, but instead the gene mutations that cause breast cancer. Hannah Keartland, citizen science programme manager at Cancer Research UK, believes the mobile game is the first of its kind.

The game was created from the DNA microarray data found in a breast cancer trial by Carlos Calda for Cancer Research UK’s Cambridge Institute. They appear to the player by way of clusters of dots on the route mapping graph and purple clouds of element alpha in space.

By taking part in both game elements, the player locates genetic data that veer from the standard pattern—which could indicate genetic faults that cause cancer. The results are then sent as data files to scientists, which direct them to the areas that need further investigation.“The human eye is very good at spotting patterns and anomalies—much better than computers,” explains Ms Keartland.

The app was created after Cancer Research UK’s resounding success two years ago with their first attempt to crowd-source data: “Cell Slider”. This interactive website taught players basic pathology before guiding them through an investigation of real tumour samples. It helped to analyse data six-times faster than scientists could working alone.

“Genes in Space” has had encouraging results too. Since its release, it has been played for more than 53,000 hours—equivalent to more than six months of cancer research. Four weeks after it appeared, the charity reported that its players had made 1.5m classifications—the analysis of a length of DNA that spans the English Channel twice. (By contrast, it took scientists working alone more than a decade for faulty BRAF genes to be declared responsible for many Melanoma skin cancers.)

Entertaining elements suffered as a result of the game’s role in aiding cancer research according to CEO of Guerilla Tea, Mark Hastings. But with countless game apps available today, having this hook will likely mean that “Genes in Space” maintains a following for longer than apps without helpful outcomes.  

But when using untrained and unknown individuals to do scientific work, there is always the possibility of error, which is why each sample in the game is analysed by many players—slowing down the process a bit. This also suggests why there is a limit to the types of research projects that people can help with through a game format.

According to Mr Hastings, there are likely other types of data analysis within research that could benefit from games that crowd-source real-life data. “But until scientists come forward to tell us that, I’m afraid there’s not a huge amount we can do about it,” he admits. Fortunately though, "Genes in Space" has already allowed breast cancer research to be taken light-years ahead.

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Prostate cancer screening may be improved with new test - Fox News

Men who have elevated levels of prostate specific antigen (PSA) during prostate cancer screening often turn out not to have cancer, but a new set of markers in the blood may improve the ability of the test to distinguish men who have cancer from those who don't, a new study suggests.

In the study, a blood test that looked for three markers in the blood, in addition to PSA, was much better than PSA alone at distinguishing men with prostate cancer from those with high PSA levels who did not have cancer.

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Moreover, the percentage of men who were misdiagnosed as a result of their PSA test (i.e., they were suspected to have cancer when they did not, or they were not suspected to have cancer and did) was reduced from about 32 percent to 9 percent when their blood was tested for just one of the markers in addition to the PSA test. [10 Dos and Donts to Reduce Your Risk of Cancer]

PSA is a protein in the blood that is sometimes increased in men with prostate cancer. Although the PSA test has been used for nearly 25 years as a way to screen for prostate cancer, it has come under scrutiny in recent years, because it is not very selective for men who have prostate cancer, said Kailash Chadha, of the Roswell Park Cancer Institute in Buffalo, N.Y, who presented the findings April 6 at the meeting of the American Association for Cancer Research.

Some studies show that 70 percent of men who have high PSA levels do not have cancer.

This is a drawback, Chadha said, because men with high PSA levels may have a biopsy they do not need, leading to patient discomfort and extra health care costs.

Another criticism of PSA testing is that it finds cancers that would never go on to cause health problems, leading patients to undergo unnecessary treatments.

The new study also found that the same three blood markers were better than PSA alone at distinguishing localized prostate cancer (which remains in the prostate gland) from high-risk cancer that is likely to spread to other parts of the body.

While the findings need to be confirmed in future studies, "it's very encouraging at this point" that this set of blood markers seems to address the two main drawbacks of PSA testing, Chadha said.

"What we really needis something that will reduce the number of men getting unnecessary biopsies, and also better distinguish those who should get treated compared to those who don't need to be treated," said study researcher Dr. Willie Underwood III, a urologist and associate professor of surgical oncology at the Roswell Park Cancer Institute. "Right now, with our current tools, we can't adequately do that."

The three markers are proteins in the blood called cytokines, specifically IL-8, TNF-alpha and sTNFR1.

The new study was small; it included 46 men, and nearly all of them were white. Future studies looking at these markers will need to be larger and more racially diverse, Underwood said.

Copyright 2014 LiveScience, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Health Goal Met, White House Reviews Missteps - New York Times

WASHINGTON — Days after hitting their target of signing up more than seven million people for health insurance, Denis R. McDonough, the White House chief of staff, and other top aides to President Obama gathered last week on the patio just outside Mr. McDonough’s West Wing office.

In an hourlong interview they requested, the officials said one of their biggest mistakes in the disastrous health care rollout last fall was worrying about the wrong thing. They said they focused too much on their ultimately unfounded fear that not enough insurance companies would participate in the health marketplaces and that premium prices would be too high. In turn, they said, they ignored what became the real problem, a website that was virtually inaccessible in its opening days.

“It wasn’t for lack of time; it was for lack of time on the right variables,” Mr. McDonough said.

Like all White House aides who have endured withering criticism and survived a political crisis, Mr. McDonough and the others sought to cast their actions in the best possible light. Not surprisingly, their conversation was filled with high praise for Mr. Obama and satisfaction that they had at last fixed the website and met their enrollment goals.

They also offered a new look into the high levels of anxiety inside the West Wing last fall, their nightmare scenarios and the future, as they see it, of the Affordable Care Act.

Mr. McDonough was joined in the discussion by Phil Schiliro, a former congressional liaison who rejoined the White House team in December to help manage the health care program; Jeffrey D. Zients, director of the National Economic Council, who helped salvage the website; Kristie Canegallo, a top aide to Mr. McDonough on health care; Jennifer Palmieri, the White House communications director; Tara McGuinness, an outreach leader for the health care effort; and Marlon Marshall, the deputy director of the Office of Public Engagement.

Here are excerpts from that conversation:

Q: Is there something you can say about what wasn’t working at the White House that caused the struggles on health care?

MR. MCDONOUGH: The work in setting up the individual marketplaces actually was sound and good. One of the lessons learned, I’ll be candid with you, is we spent a lot of time on the issues in setting up and insufficient time, in retrospect, in the tools that will allow the transaction to then be completed.

Q: Did you focus on getting the competition and pricing right because you anticipated the opposition would jump on that issue?

MS. PALMIERI: We thought that was the hard part. The big questions at the time, among policy people and the press, was: Were you going to be able to put these marketplaces together? Were they going to have competition? Were the premiums going to be affordable?

Q: [To Mr. McDonough] There was a moment in early February where you freaked out and said: We’re not on track to meet our enrollment targets, and I’m not going to be the one to walk into the Oval Office on March 31 and tell the president we didn’t get there.

MR. MCDONOUGH: Yeah, I was quite hot.

Q: Because at that point, you felt like your staff was preparing to take it easy?

MR. MCDONOUGH: I feared that may be the case.

MS. CANEGALLO: I remember you saying something to the effect of like, which is a very McDonough-ism thing to say: Leave everything on the field. At the end of this, we don’t want it to be April 1st and feel like we didn’t throw everything that we could against the wall.

Q: Give me an example of what you were doing to prepare for contingencies when the law went into effect on Jan. 1.MR. SCHILIRO: Kristie put together a comprehensive book that anticipated everything that could go wrong.

MS. CANEGALLO: A “break glass” book. [A three-ring binder, named for the boxes that read “In Case of Emergency, Break Glass,” provided White House officials a resource for responding to a variety of potential crises.]

MR. SCHILIRO: It was pretty scary. Think of it this way... it’s preparing for Y2K in health care. You just don’t know what could go wrong. Every hospital in the country had our 800 number because we set up a special 800 number for anybody who had a problem. So you know when you go to a hospital and you get to that little admitting desk, that 800 number was right there. The hospitals helped. The pharmacies helped. The insurers helped. MS. PALMIERI: We followed Twitter to see if anyone was tweeting that they had a problem.

Q: Who was doing that? Denis wasn’t watching Twitter?

MR. MCDONOUGH: I don’t know how to get it.

Q: So, lessons learned?

MR. ZIENTS: We need to expand bringing in the best I.T. folks in the country into the government, and then procurement and contracting and making sure the very best companies, with the very best people, are bidding on government contracting.

Q: Be realistic. Isn’t that a 10-year project?

MR. ZIENTS: I think you can make a lot of progress fast. Particularly when the president of the United States is holding you accountable.

Q: Think at the 60,000-foot level about the way history books talk about presidential administrations and how they have problems and confront them. Are there lessons about the mistakes made?

MR. MCDONOUGH: Look, I’m a person with a very active conscience. But I’m not going to bare that to you today. I’ve done a lot of thinking about that.

The first thing is you’ve got to keep the team together and keep them focused on the right target. And that’s true no matter what you’re going through. We’re all in this together, and all you’ve got is each other, basically. The second is to hear your early warning. Congress was a good early warning for us. They are back in their districts every week. They come back with very actionable intelligence.

The third is something I’ve been saying ever since October 1, which is the strength is in the planning, not in the plan. There’s never a plan that you run in the government, and I don’t know, maybe the private sector, that survives first contact.

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Simple Blood Test To Spot Early Lung Cancer Getting Closer - NPR (blog)

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hide captionAn artist's illustration shows lung cancer cells lurking among healthy air sacs.

David Mack/Science Source

One of these days there could well be a simple blood test that can help diagnose and track cancers. We aren't there yet, but a burst of research in this area shows we are getting a lot closer.

In the latest of these studies, scientists have used blood samples to identify people with lung cancer.

At the Stanford School of Medicine, Dr. Maximilian Diehn spends some of his time as a radiation oncologist treating patients with cancer, and some of his time delving into the world of DNA. In particular, he's been working on ways to detect DNA that has been shed from a tumor and ends up in a patient's blood.

"The problem has been that there's a very small amount of the DNA there, usually, so it's very hard to detect," Diehn says.

" If there is cancer DNA in the body left, that suggests there are still cancer cells left, so that patient is probably not cured.

- Maximillian Diehn

But new technologies allow him to find tiny amounts of DNA and scan large parts of it to look for mutations that come from tumors. And that opens up all sorts of possibilities.

"The initial impetus was having something I could use in my own patients ... as a blood test that would let us both detect the presence of cancer as well as monitor how a patient's cancer responds to various treatments," he says.

Right now, doctors often just wait and hope. And it can take months or even years to see whether a cancer treatment has worked.

But Diehn and his colleagues say they've developed an exquisitely sensitive DNA test that can tell them right away whether there is tumor left in a patient.

"If there is cancer DNA in the body left, that suggests there are still cancer cells left, so that patient is probably not cured," he says, "whereas if the cancer DNA is gone, that suggests the patient is likely to be cured."

And if the cancer is still there, they can try other treatments.

Their new experimental test is specific for lung cancers – non-small-cell lung cancers, to be precise. They report in Nature Medicine that they were able to detect tumor DNA in every patient they studied who had a more advanced cancers (Stage 2 or higher). And, more remarkably, they have been able to detect very early, Stage 1 lung cancer, about half the time (with a test they're still working to perfect).

"Now, since we can already detect half of them with the current assay, we're very hopeful that the majority of cases will have detectable DNA," Diehn says.

Researchers at Stanford are not only working to improve the lung-cancer test, they're developing tests for other cancers — including lymphomas, cancers of the breast, esophagus and pancreas.

"But the ultimate holy grail would be to move this to the early detection of cancer," says Dr. Ash Alizadeh at Stanford. "The early detection of cancer could save many lives by being amenable to being treated."

They aren't the only lab on that quest. Dr. Luis Diaz and colleagues at the Johns Hopkins School of Medicine recently reported a blood DNA test targeting 14 different tumor types. The team at the Hopkins Kimmel Cancer Center also found about half the early-stage cancers in their volunteers. Diaz says even a test that only finds early stage cancer half the time is still a big step forward.

"When you have a Stage 1 tumor, the patients feel healthy," Diaz says. "They're still going to the gym, they're still performing all their activities of daily living without any sort of feeling that something's wrong. This blood test will detect the cancer at a very early stage — albeit only in 50 percent of cases."

The researchers are optimistic they can improve the test so it will catch many more cases, but they don't yet know whether that's a matter of better technology or if some tumor DNA will simply always remain hidden. And it's not entirely clear yet how many false alarms might turn up. But even now, this emerging DNA technology has many uses.

"For me this is very exciting because there is momentum building in this field," Diaz says. Many skilled and capable research groups are diving into this field, so "what we're going to see is really cool questions answered that we couldn't have answered in any other way."

And while new medical technologies often drive up the cost of care, these researchers hope that a few years from now, a cancer blood test will be available for a few hundred dollars. Using it could help patients avoid costly scans – and avoid late-stage diagnoses, when cancer is often more difficult and more expensive to treat.

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Guarded Optimism After Breast Cancer Drug Shows Promising Results - New York Times

SAN DIEGO — Researchers say that a new type of drug can help prevent advanced breast cancer from worsening, potentially providing an important new treatment option for women and a blockbuster product for Pfizer.

In a clinical trial, the drug cut in half the risk that cancer would worsen, or progress, researchers said here on Sunday. The median time before the disease progressed or the women died was 20.2 months for those who received the drug, compared with 10.2 months for the control group.

“The magnitude of benefit we are seeing is not something commonly seen in cancer medicine studies,” Dr. Richard S. Finn, a principal investigator in the study, said in an interview. Dr. Finn, an oncologist at the University of California, Los Angeles, called the results “quite groundbreaking.”

The drug, known as palbociclib, also appeared to prolong survival but not by a statistically significant amount. Those who received the drug lived a median of 37.5 months compared with 33.3 months for those in the control group.

The results from the Phase 2, or midstage, study were presented here at the annual meeting of the American Association for Cancer Research. They are being closely watched on Wall Street, because palbociclib is considered a jewel in Pfizer’s product pipeline, with analysts predicting annual sales of billions of dollars. Amgen is entitled to an 8 percent royalty on sales of the drug.

As strong as the results were, it is possible they will be a bit of a letdown to some investors.

That is partly because they were not quite as good as interim results presented about halfway through the trial. At that point, the difference in median progression-free survival was 26.1 months for palbociclib versus 7.5 months for the control group.

The lack of a statistically significant survival benefit could also give investors pause.

Dr. Finn said, however, that a statistically significant survival benefit should not have been expected at this point because only 61 of the 165 patients in the trial had died. Also, patients can use other drugs after leaving the trial, which can dilute any effect of palbociclib.

Palbociclib slows the runaway proliferation of cancer cells by inhibiting the activity of two related enzymes involved in cell division — cyclin-dependent kinases 4 and 6.

While Pfizer is in the lead to bring this new class of drugs to market, Novartis has begun late-stage testing of its own CDK 4/6 inhibitor. Eli Lilly is at an earlier stage, with some results for its drug presented here. While breast cancer is the initial focus, the drugs are being tested for other cancers.

Breast cancer specialists not involved in the study were encouraged but somewhat cautious. “These results are strikingly positive and with a large potential impact to patients,” Dr. José Baselga said in a speech at the conference discussing the results.

But Dr. Baselga, the physician in chief at the Memorial Sloan-Kettering Cancer Center, said the results might have been biased because the study investigators, who determined whether tumors had progressed, knew which patients were getting palbociclib.

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said larger studies were still needed.

“This is a small Phase 2 trial — not tiny, but not the kind of study that would typically lead to a change in practice,” he said.

The study, sponsored by Pfizer, involved 165 post-menopausal women receiving their initial treatment for recurring or metastatic breast cancer. The cancers were estrogen receptor-positive, meaning their growth was fueled by that hormone, but negative for Her2, a different protein.

About 60 to 65 percent of breast cancers fit that description, according to Dr. Dennis J. Slamon of U.C.L.A., another investigator in the study. Analysts at the ISI Group, an investment research firm, estimate that about 50,000 American women a year would be eligible for palbociclib.

All the women in the trial took letrozole, a drug that blocks the synthesis of estrogen. Such drugs are standard initial therapy for this type of breast cancer. About half the women also received palbociclib, which was taken orally once a day for three out of every four weeks.

The biggest side effect, experienced by about three quarters of patients, was a decreased white blood cell count. But that did not lead to infections as it usually does, according to Dr. Finn, who said that the drug was generally well tolerated.

Still, many patients had their doses reduced because of side effects, and 13 percent of patients who received palbociclib dropped out of the study because of side effects, compared with 2 percent in the control group.

A big question is whether Pfizer will be able to win approval of the drug based on this study. The Food and Drug Administration normally requires larger Phase 3 studies, but sometimes makes exceptions for drugs for cancers and other life-threatening illnesses.

If Pfizer can get early approval, the drug could probably reach the market next year. If the company must complete a Phase 3 study, which is already underway, approval might be delayed a couple of years, according to the ISI Group.

Garry Nicholson, president of Pfizer’s oncology division, told analysts on Sunday that the company “can envision the possibility” that the data from the Phase 2 trial would be sufficient for approval. He said the company had not gotten far enough in its discussions with the F.D.A. to be able to decide whether to seek approval now, however.

In 2008, the F.D.A. granted accelerated approval to Genentech’s Avastin as a treatment for breast cancer based on a single trial in which the drug delayed disease progression by about five and a half months.

But the women who got Avastin did not live significantly longer, and subsequent studies showed a smaller effect in delaying progression. In 2011, the F.D.A. revoked approval of Avastin for breast cancer treatment.

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People across the US take a dive for young cancer patient - New York Daily News

Orlin Wagner/AP Kansas City Chiefs fan Ty Rowton, known as XFactor, participates in the “Plunge for Landon” fundraiser Friday. Orlin Wagner/AP The event raised money for 5-month-old Landon Shaw who was diagnosed with cancer. Orlin Wagner/AP Hundreds of people across the country joined in by jumping into various bodies of water.

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KANSAS CITY, Mo. — Being told to “go jump in a lake” is usually a snarky kiss-off. But it’s become a heartwarming call-to-action for a Missouri community whose effort to help the family of a 5-month-old boy with cancer has inspired thousands across the country to submerge themselves in cold bodies of water.

Organizers of the Facebook-based Plunge for Landon fundraiser said they have lost count of how many people have posted videos of themselves taking a dive for Landon Shaw, a Tarkio infant who was diagnosed in late February with a rare form of cancer. People are jumping in, from chilly farm ponds north of Kansas City to the Gulf of Mexico and the Potomac River in Washington, D.C.

“I can’t believe how viral this is going,” said Alyssa Shaw, Landon’s mom. “My son has been such an inspiration to everybody and opened up people’s eyes that you can’t take life for granted.”

Before they jump into the water, participants record themselves challenging three other people to do the same, with monetary pledges for each person who completes the challenge. The effort had raised more than $30,000 by Friday evening, only five days after notice of the fundraiser was first posted on the popular social networking site.

Entire schools, police departments and businesses around the region have posted videos of participants taking the plunge.

Landon was 4 months old on Feb. 23 when his parents took him to Children’s Mercy Hospital in Kansas City to find out why he was vomiting and losing weight. Doctors found a tumor on his left kidney, which they removed, and later discovered a large mass on his brain.

Landon’s heart stopped during an operation to remove the brain tumor, his mother said, and he lost so much blood that doctors gave the family little hope their baby would survive.

My son has been such an inspiration to everybody and opened up people’s eyes that you can’t take life for granted.

“The surgeons came into the room and said they would be surprised if he made it through the night,” Shaw said.

Landon did make it through, and his condition improved enough that on April 1, Shaw and her husband, Brandon, were able to bring their baby home.

But the child still has a long road ahead, with chemotherapy sessions, MRIs and CT scans. And the family is on Medicaid, Shaw said, which isn’t nearly enough to cover medical bills that are just starting to arrive.

The plunge group’s Facebook page had more than 11,700 members Friday, seven times the number of people who live in the small farming community of Tarkio, two hours north of Kansas City.

Lydia Hurst, who helps maintain the group’s page, said participants include a soldier in Afghanistan, and people in Germany, South Korea, Spain and Ireland.

Ty Rowton, also known as the red tight-wearing Kansas City Chiefs super fan “X-Factor,” dove into a pond near Bonner Springs, Kan., on Friday after being challenged by several people he didn’t know. In turn, he challenged the Royals, Chiefs and all their fans to also chip in to help baby Landon.

My legs got numb faster than I thought they would. It was shocking. I went home and showered and didn’t get warm until about noon that day.

Hurst took her own plunge Tuesday morning in sub-freezing temperatures. Like most people she knows who did their own plunges, she said she never would have jumped into a frigid farm pond had it not been for the thought of the little boy.

“My legs got numb faster than I thought they would,” she said. “It was shocking. I went home and showered and didn’t get warm until about noon that day.”

Residents of the former college town of roughly 1,600 also have been holding bake sales and fundraising suppers — popular affairs in rural Bible Belt communities — to help the family pay for travel and other expenses. But the plunge drive has brought in the bulk of donations.

A YouTube video shows U.S. Rep. Sam Graves, a lifelong Tarkio resident, in a suit and tie as he dove head-first into the Potomac in Washington on Wednesday. He challenged several Republican leaders, both nationally and in Missouri, to take the plunge.

Lora Cummins, a former Tarkio resident who is an ordained minister and beach body coach in Port Aransas, Texas, accepted the challenge of some of her ex-classmates in the town and jumped into the Gulf of Mexico on Wednesday.

“All of us are so fortunate to have grown up there and forged lifelong bonds,” she said. “Facebook has brought us all back together.”

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