Bow-wow or squeak-squeak?

When it comes to “sniffing” out cancer, it looks like you may have a choice.

New medical research suggests that dogs and mice may just give us the clue to finding cancer early.

An article in the current issue of the online medical journal PLoS One describes the research of a group of scientists in Philadelphia that trained mice to smell the urine of other mice to determine which mice had lung cancer.

And the experiment was a success: the “smeller” mice were able to tell which of the other mice had lung cancer with a fairly high degree of success.  Unfortunately, their success was limited to later stage cancers and the very early stage lung cancers were missed.

In the next step of the experiment, the researchers did laboratory studies to look at what are called “volatile compounds” in the urine by analyzing the urine samples on a specialized machine that can identify small quantities of chemicals.

(Volatile compounds are substances that can exist in a liquid and gas phase.  So, while they may be contained in urine, once passed out of the body they move into a “gaseous” phase which accounts for their smell.  Humans can smell these compounds if the concentration is sufficiently high.  However, the amount of these compounds in the body in humans or mice with cancer is probably microscopic, and therefore you need a more sensitive sniffer—like a trained dog or mouse, whose sense of smell is much more delicate than a human’s—to pick up the characteristic odors that may be associated with a cancer.)

The investigators then looked at the results of their chemical analysis, and identified a number of compounds that could have explained the results of the mouse experiment.  To their surprise, many of these compounds were found in lower quantities in the urine of mice with lung cancer compared to the mice without lung cancer.

They go on to point out that smell is based on a combination of a number of different compounds, and that lower amounts of a compound may change the smell of the urine just the same as a larger amount of a compound.

Further analysis showed that the researchers could actually plot the differences in the chemical structures of the urine from the mice with and without lung cancer, once again with a reasonably high degree of accuracy.

Their conclusion?

“The data in this paper are consistent with the hypothesis that diagnostically useful volatile compounds are produced in patients with lung cancer and secreted into the urine, thus providing support for this diagnostic approach in the context of lung cancer.”

They also noted that using urine samples for this process is probably a better bet than using breath samples, which has been the approach utilized by some other investigators.  And they are moving forward with studies in human patients to determine if these interesting results are in fact applicable in the real world and will help us detect cancer at an earlier stage than currently possible.

This isn’t the first time I have written or commented on this type of research.

I can recall a paper that appeared a number of years ago in a British medical journal that reported—as best I recall—using dogs to sniff urine samples of cancer patients to detect bladder cancer.  That experiment was a modest success, and it did get a lot of media attention.

More recently, in another such report dog trainers were able to get neighborhood dogs to sniff breath samples from cancer patients and identify them accurately when compared to breath samples from people without cancer.

When I heard about article #1, I laughed and went on with other business.  When I heard about article #2, I actually thought maybe this thing was real after all.

At the time, my comments were generally along the lines of the currently reported research.  Namely, is it so far out to believe that a cancer could produce a compound in such small amounts that we humans can’t smell it or identify it, but dogs—with their great sense of smell--may in fact be able to discriminate the minute quantities of volatile compounds present in urine, breath, or other bodily fluids of cancer patients? (If you don’t think dogs have a great sense of smell, you ought to see my “untrained” golden retriever find his tennis ball on a two acre piece of land late at night.)

When I wrote my blog on the topic, I thought I was done with the subject only to have it become one of the most enduring posts on this site.  After four years, people are still posting comments on that blog.  Obviously, there is a lot of interest in this subject.

So before you start laughing about mice smelling urine samples or dogs smelling breath samples to detect cancer, I would suggest you take a step back and give the idea some serious thought and consideration.

I learned a long time ago never to say never.  And when it comes to detecting cancer early by a smell test, well….stranger things have happened.

Gotta go, now.  Kobi (my dog) wants me to throw his tennis ball…

Now that the tanning industry has had its nosed bloodied by the Federal Trade Commission, maybe it’s time for the Food and Drug Administration to step up to the plate.

That’s the question that is looming large for many interested in the issue of tanning bed risk, and the upcoming FDA meeting on March 25 where further restrictions on tanning beds are going to be considered.

From my point of view, and based on my personal/family experience, action can't come soon enough.

This is clearly not a new topic.

Several years ago, the World Health Organization published a detailed, comprehensive report on the risks of tanning beds.  They concluded they were bad for your health, and recommended that youth under the age of 18 should be banned from using them.

Fast forward to this past July, and you have the International Agency for Research in Cancer—better known as IARC—issuing a statement that tanning beds are in fact a Class I carcinogen, on the same page and same line as tobacco.

In other words, just like tobacco, here is a product that when used as intended has a considerable chance of causing you harm.  And, at the same time, it is unclear except in the most limited of circumstances how tanning beds can possibly offer any benefit that can’t be achieved using approaches that are much less risky at substantially less cost.

In very condensed terms, what happened this past Tuesday was that the FTC charged the Indoor Tanning Association (ITA)—a trade industry that is supported by the tanning industry—of “making false health and safety claims about indoor tanning.”  According to the FTC press release, the association simultaneously “agreed to a settlement that bars it from any further deception.”

So what did they “decept” you might ask?

In a March 2008 advertising campaign—one that raised great concern among those aware of the risks of indoor tanning—the Association claimed:

·        Indoor tanning is approved by the government

·        Indoor tanning is safer than tanning outdoors because the amount of ultraviolet light received when tanning indoors is monitored and controlled

·        Research shows that vitamin D supplements may harm the body’s ability to fight disease, and

·        A national Academy of Sciences study determined that “the risks of not getting enough ultraviolet light far outweigh the hypothetical risk of skin cancer.”

As part of the settlement, the industry has to let people know that they don’t have to become tan to get vitamin D and that doing so “may increase the likelihood of developing skin cancer and can cause serious eye injury.”

When you look at a more detailed report of the FTC investigation, you find that the industry actually claimed—according to the FTC—that indoor tanning does not increase the risk of skin cancer.  The FTC countered that “tanning, including indoor tanning, increases the risk of skin cancer, including squamous cell and melanoma skin cancers.”

I distinctly remember the advertisements in question. 

Some of us were so concerned that—through the National Council on Skin Cancer Prevention—we actually wrote a letter to the ombudsman of a major national newspaper that ran the ads, taking them to task for running an advertisement that was clearly full of dangerous misinformation.  To the best of my knowledge, we never received a response.

And then there was the article that appeared in the New England Journal of Medicine that provided an excellent review of vitamin D but also included tanning beds as a means of supplementing vitamin D.  We complained about that as well, but the editor declined to run our letter.

Shortly thereafter, there were published reports  and an article on this blog discussing the fact that the researcher who wrote the article indicated that his research was supported by the Ultraviolet Foundation, which is a “foundation” wholly supported by the ITA.

So the battle goes on an on.

This past November, I had the privilege of testifying on behalf of the American Cancer Society at a hearing in Howard County MD that resulted in a county-wide ban on the use of tanning beds by minors under the age of 18.  This was an outright ban, not one of those “if your parents give you permission it’s OK” types of restrictions.

The room was filled with people in favor and opposed to the ban, and to be certain there were a number of tanning salon owners there who said they don’t want to harm children, and feel that tanning is safe (there were also a number of people there who had a strange looking tan, but that’s not a topic for this blog.  They just looked really out of place.)

There were also experts there who testified on behalf of the tanning salon owners.  One of those was a recently retired FDA official who just happened to be intimately involved with tanning bed regulation at the FDA prior to his retirement.

We are going to have a replay of that hearing on March 25^th at an FDA advisory committee meeting just outside of Washington DC, when the FDA is going to consider whether they should reclassify tanning lamps from their “essentially safe” list to one that has a bit more teeth. 

That, at least, would reflect current thinking on the question that these lamps are not safe when used as intended, and in fact can cause serious harm.

Like many things in life, this all comes down to one’s personal experiences.  And my family has had one of those experiences.

When my daughter was in high school, she succumbed to the lure of the tanning industry and wanted to get tan for her prom.

As you might imagine, she never told me or consulted with me about this.  After all, dear old Dad may have some knowledge about these things, but what does he really know?

Well, Dad may not know anything but my daughter soon discovered the problem with tanning beds.

You see, she has what is called “type I” skin.  That means she is very fair, and can’t tan.  She burns.

And that’s how I found out that my daughter was going to the “tanning” salon.  She returned home one Saturday, red as a lobster from head to toe, burned by one of those salons that allegedly always follows the rules.  And now she is at a lifetime increased risk of skin cancer and melanoma as a direct result of her sessions under the “safe” UV light in a local tanning salon.

I guess I shouldn’t be surprised.

Researchers have documented the dangers of tanning devices.  They have also documented the lack of controls on the tanning industry.

So I ask you, why?  Why continue this charade?  Why let this go on? 

Tanning isn’t something we need.  It’s something we want—for all the wrong reasons. It can even be addicting like cigarettes.  And, like cigarettes, when used as intended it does bad things—even causing cancer that can result in death—and doesn’t do anything good that can’t be done otherwise more safely, more effectively and less expensively.

I say it’s time for the FDA to follow the lead of the FTC and get on with the job that has to be done.

And, as reflected in a number of bills and proposed regulations currently pending in state and local legislative and regulatory bodies around the country, it’s time to ban the tan—especially for those under the age of 18.

Ah, yes…Happy New Year (even if we are already half way into this new month.  My, how time flies)!!!

And with the New Year come new or repurposed resolutions, many of which are years old.  Among those resolutions—you guessed it—are losing weight, getting (more) exercise, and trying to once again try to stay healthy.

This New Year brings with it a new twist on the old resolution gambit, and that is how health care reform may—read that “may”—impact your focus on losing those long neglected pounds by penalizing you if you don't succeed. 

But maybe we should put aside the politics, and concentrate on innovative ways to “get into the game,” as is now happening in my hometown of Thomasville in southwest Georgia.

First, the thing about weight loss:

Every year we try to lose it, and every year we usually gain it back, maybe even with a few “bonus” pounds.  I’m not going to go into that discussion again, having done it many times in the past.

However, I will say that I am just like a lot of you.  Every year I make the pledge, usually get off to a good start, and inevitably falter.  This past year has been no different, and as I have mentioned in prior blogs, my travel schedule doesn’t help matters. 

That will not deter me from trying again, and hoping that maybe this year will be the year. So far, so good, with 6 pounds gone this past week and my resolve intact.  Come back in another couple of weeks and maybe I will tell you about my further hoped-for success. 

The sad part of this story is that I gained much of this weight over two or three months prior to the holidays, only to pump it up another couple of pounds during Christmas and New Years, in no small part due to my wife’s excellent cooking (and maybe a bit of my own barbecue).  It was no mean feat to gain all of those pounds, and I promise you I feel it.  (I call this phenomenon the “Groundhog diet,” after the Bill Murray film where he keeps reliving the same Groundhog Day, over and over and over again.)

Now I am back on the wagon, doing what I need to do.  We will see what happens.  Only time will tell.

However, there is some help here in my hometown.  And I think it is actually an interesting story, one that could possibly be duplicated in your community as well.

The program/concept is called “Team Lean”, and it is a community-wide weight loss program now just getting started for the third year here in Thomasville, Georgia.

Sponsored by the local YMCA, Archbold Hospital and Flowers Foods among others, Team Lean reaches out to over 18,000 people in the Thomasville community. Last year, over 1400 people participated, which to me is an astounding commitment.

The plan is fairly simple: form a team of four or five people, pay $50 a member for the ten week “competition”, and see which team loses the most weight.  Weigh-ins are done weekly, and the results are published in the local newspaper.  There are a large number of exercise classes for all ranges of fitness, held at the local Y as well as other training programs in the city.  Even the restaurants get into the game, advertising and promoting their “healthy choices” menus.

This really is a community-based effort.  The concept started at another YMCA in the area, and has been taken up here in Thomasville with enthusiasm.  I have to admit that I am impressed with the way the program is run, including the booklets, graphics and T-shirts that are all part of the program.  And when Team Lean starts, it truly becomes the talk of the town.

I especially like the fact that my wife has joined, because as you may have found out as well, losing weight on your own is a tough road to hoe.  Having company and companionship on the journey makes it just a bit easier. 

I also appreciate the fact that when my wife gets on her team and commits to her diet and exercise program, those same cooking skills that helped me gain the weight are terrific at helping me lose the weight as she changes from the “Southern cooking load ‘em up with fat, butter and salt cookbooks” to the “get-lean/healthy eating” varieties.  (By the way, her team is called “Five Flabby Fannies.”  Go figure…)

At the end of this ten week journey, there are cash awards given to the most successful teams.  In fact, since Team Lean started in 2008, over 30,000 pounds have been lost, and almost $100,000 in cash prizes have been paid out.

So that is how one town deep in the Southern farm belt is dealing with obesity on the community level.

Which brings me to the question of why all of this is so important politically in this era of health care reform. 

That’s because there is a movement afoot to charge you more for your health insurance if you happen to be one of the unfortunate millions in this country who are overweight and obese.

Last week, the American Cancer Society Cancer Action Network, the American Diabetes Association, and the American Heart Association joined over 100 other organizations to express their concern about language in the Senate-passed bill health reform bill that would allow employers to charge employees thousands of dollars more in health insurance premiums (up to 30% or even 50% of a plan’s premium) if you don’t meet your employer’s pre-set “health targets.”

The practical implication would be that your employer could require you to lose weight or pay up.  If they were “nice,” that might mean 5 or 10 pounds.  But it could also mean getting into lean, mean fighting shape—which is unrealistic for almost all of us including yours truly.

Incentives such as workplace wellness programs would be OK according to the organizations that signed on to the letter.  But tying behaviors to health insurance premiums should not part of a reform program.

The sad reality is that losing weight—as an example—is hard to do.  There are few strategies that are successful in the long term.  Yes, there are those beautiful people on TV shows who work hard every day (all day in fact) at losing weight, and keep it off for long periods of time.  But that is not the medical reality that we physicians are familiar with.

Like Jessica Rabbit said in the movie, “I'm not bad. I'm just drawn that way.”  Weight loss has a lot to do with genes and environment.  Choice plays a role, but it is not choice alone that dictates our body types.  And if you live in a community where it is dangerous to go outside to take a walk, or where there are no grocery stores that offer attractive, affordable fresh meats and vegetables, you are just plain out of luck.

And now, with the Senate-passed bill in hand, you may not just be out of luck, you may be out of cash—and lots of it.

The short version: incentives, yes; punishment, no.  That’s the position of the American Cancer Society and many other respected health-related/focused organizations.

So that is where I am starting my New Year: trying once again to pursue the elusive goal of getting at least close to a medically-desirable weight along with my dear wife and partner. 

To help us along, we have a strong community program which provides the support and the social environment to make it happen (even our friends who had us over for dinner last night substituted skinless chicken breasts for ground hamburger in their delicious chili).

We want to be successful, but we want to do it on our terms.  Speaking as someone who has tried to “get it right” when it comes to diet and exercise, I know from personal experience how hard it is to do.

Being penalized as part of a government program for trying and failing to get there just doesn’t make sense, when there are so many other proven ways to get to where we want to go. 

We need to build on success--not punishment--when it comes to improving the public’s health.