NO JOB, NO INSURANCE -- NOW WHAT?
Friday, February 27, 2009
- Story Highlights
- For many Americans, job loss equals loss of health insurance
- In the last three months alone, more than 1.7 million jobs have evaporated
- Under the president's new plan, the government will cover part of COBRA costs
- Many Americans will have to wait for more complete health care reform
By Jennifer Pifer-Bixler
CNN Medical Producer
SARASOTA, Florida (CNN) -- On a recent afternoon, Pamela Rinchich quietly recalled how her cancer doctor abruptly canceled an appointment. Rinchich owed $268 from a previous visit: She didn't have the money and the doctor refused to see her until she paid.
"I offered to do whatever I could, even work in the office to cover it," said Rinchich, with tears in her eyes.
Just a few months earlier, life was going great for Rinchich. She was planning a wedding with her fiancé, Jim, and she had a good job as a supervisor at the Honeywell plant in Sarasota, Florida.
In February 2008, she said, management called all the employees into the break room. "We were told that our plant was closing," she said.
The jobs were moving to Mexico. One hundred twenty-five people were laid off. Rinchich, who had worked at the plant for more than 20 years, picked up her last paycheck just days before her wedding in March.
She was upset but optimistic. She had a plan. She had been taking classes to be a dental assistant. She didn't think she was going to have a problem finding a job. "The economy wasn't as bad then."
Then, in late May, Rinchich found a lump in her breast. A mammogram confirmed the bad news: She had Stage 2 breast cancer. In early June, she underwent a full mastectomy and began chemotherapy.
At first, Rinchich still was covered under Honeywell's health insurance plan. But by September, she had to pay for her own health insurance.
Rinchich is far from alone. She is one of the millions of people President Obama said he wants to help with his ambitious plan to reform health care. Meet another family caught in the squeeze
On Thursday, Obama unveiled details of the federal budget for the next 10 years. Among other things, the budget calls for the creation of a $634 billion health care reserve fund. Among the fund's goals are universal health care coverage and reducing growth in insurance premiums.
The president's budget was unveiled just as the number of Americans who have lost their jobs -- and their employer-paid health insurance -- is growing.
According to the U.S. Department of Labor, payroll employment has declined by 3.6 million since the start of the recession in December 2007. In the last three months alone, more than 1.7 million jobs have evaporated.
Experts say it's hard to tell exactly how many people have no health insurance, but they have a rough idea. "We are expecting about half the people who lost their jobs also lost their health insurance," said John Shield, senior vice president of the Lewin Group, a health-care policy research and management consulting firm.
"Our nation is facing a serious problem," said Christy Schmidt, senior director of policy at the American Cancer Society Cancer Action Network.
She said her organization saw between an increase of between 6 and 10 percent in the number of calls in December 2008 compared with December 2007. Many of the calls, she said, come from people who have lost their health insurance because they also lost their job.
Rinchich did have a bit of a safety net. She was eligible for COBRA, which allows employees who leave a company to be covered under the company's health care plan for a year and a half. But the $368 she has to pay each month cuts deeply into her $900 monthly unemployment check.
Rinchich's story is not unique. A study released earlier this month by Families USA found the average national premium costs for family COBRA coverage consume 84 percent of average unemployment benefits. For individuals it's about 30 percent.
"We need to get a grip on the issue," said Kathleen Stoll, deputy executive director of Families USA. She is optimistic that the provision in Obama's stimulus plan will help ease some of the strain.
Under the new plan, she said, the federal government will pick up 65 percent of the cost of COBRA premiums. "It's great. It's going to help a lot of folks," said Stoll, but she also said it has some limitations. Among other things, to be eligible, you must have lost your job after August 31, 2008.
Unfortunately, the Obama COBRA plan won't help Rinchich since she lost her job at the beginning of 2008. She's not sure how much longer she will be able to pay for COBRA and is working with a cancer nonprofit to see if she can get help.
So far, she owes close to $20,000. She cashed out her pension to pay her car note, mortgage and utility bills. "But that's all gone now," she said.
When she is feeling up to it, Rinchich looks for work as a dental assistant. She's now cancer free, but has more surgeries ahead. "I just try to keep a positive attitude," she said, as she tries to figure out the next step
UNITED CANCER FOUNDATION PRESENTS:
"HEALTH & HOPE"
THE DOCTOR IS FREE!
(updated) Friday, September 04, 2009
The following is a brief explanation of our Project: "Health & Hope" along with our goals and our progress up to this point. The latest statistics concerning cancer are that estimates for 2009 suggest a staggering 500,000 people will be diagnosed with Breast or Prostate Cancer (resulting in approximately 75,000 deaths). The general consensus and belief of all Oncologists is that: Early detection truly saves lives. "When cancer is found early, most patients will live much longer than other patients whose detection occurred in a later stage. Early detection and treatment greatly increases survival rates to the extent that these patients usually will pass from natural causes other than cancer." Unfortunately, many Americans not only fail to receive regular screenings, they also lack the insurance coverage and the funds to access proper medical care.
The United Cancer Foundation will be offering "Health & Hope" to those in need! We will be saving lives by offering FREE Health care! We will be providing the following medical assistance for 2000-3000 patients per weekend event for FREE: Cancer Screenings, Dental: (cleanings, fillings and extractions), Vision: (complete eye exams, prescription glasses made on site) Medical: (specialist exams and consults, podiatry, diabetes screening and education, skin care, skin rashes and screening for skin cancer) Women's health: (mammograms, pap smears and breast exams) Men's health: PSA testing. Follow-up care will be a major component of this event. This will all done by volunteer Doctors. This event will benefit, Children, Women, Men, Minorities and the Disabled.
We will be offering "Hope" by making follow-up care and "Health" education a major component of this event!
Initially, the "HEALTH & HOPE" healthcare project started with 8 groups such as American Cancer Society, Susan G. Komen for the Cure South Florida, Palm Beach County Health Department and Remote Area Medical of Knoxville TN. Now an additional 12 more organizations and foundations have indicated they want to be a part of this event. We will have 20+ community based organizations helping to make this event successful by offering their support services for our project: "Health & Hope". There has never been an event in Florida where this many community based organizations have come together to help 2,000- 3,000 families in one weekend event. This will be the biggest healthcare event Florida has ever seen! Everyone loves the idea of Volunteer Doctors donating their services. These events are so popular that people line up a day in advance to be seen. This will not be an ordinary health fair event; there will be over 400 volunteers to help thousands of those in need in just one weekend! There is no other event like this being held in Florida! Our main focus is getting FREE Cancer Screenings and health care to individuals who are in need of immediate medical assistance. The event date will be announced shortly!
At the end of the day, all those involved will be proud to have been a part of this event that helped so many people in need of immediate healthcare!
The United Cancer Foundation is seeking Foundations, Corporations and individuals who are willing to become one of our sponsors, to be part of this noble cause, while helping to save American lives! In 2010 we plan to start offering these weekends across the State utilizing an all volunteer group consisting of, cancer survivors, churches and local volunteers. Our project’s initial financial goal is $1,000,000 to purchase the necessary medical equipment to run these events.
At this time, early detection is the best way to beat cancer! See our article from Wired Magazine issue: 17.01: WHY EARLY DETECTION IS THE BEST WAY TO BEAT CANCER
How bad is our local health care crisis? Just in Palm Beach County, population estimates for 2006 were 1,274,013. According to The Economic Council of Palm Beach County’s latest statistics; 27.5% of residents under 65 are uninsured. That would be over 350,000 people. Where do they go for medical care? These are disturbingly large numbers. Offering these free medical weekends will save the County money and help the many individuals who need medical care now!
On a national level it only gets worse. According to a report from U.S. Department of Commerce census bureau news dated Tuesday August 28, 2007: The number of people without health insurance coverage rose from 44.8 million (15.3 percent) in 2005 to 47 million (15.8 percent) in 2006. The uninsured of The United States need your help, NOW!
The Foundation web site is: (www.unitedcancerfoundation.org)
UCF is a 501(c) (3) charitable organization and is eligible to receive tax-deductible contributions.
Steven H. Kaplan - Founder/UCF
WHY FREE SCREENINGS? IT’S THE 90/10 RULE!
When the first cell in one of Brenda Rosenthal's ovaries mutated and turned cancerous, she felt no symptoms. The telltale pains or lumps that signal cancer were still months, if not years, away. But there were signs, sparks thrown off by the tumor that had begun to smolder in her belly. As more cells were conscripted from the original task coded in their DNA and assigned a new, malignant mission, they produced proteins that leaked into Rosenthal's bloodstream. Had an effort been made to see these molecules, had there been a strategy for detecting them, the 69-year-old wouldn't face such long odds today.
Certainly, there were statistical red flags, if only Rosenthal had known to look for them. Twenty years before, she had survived a bout of breast cancer, increasing her risk for ovarian cancer in the future. That risk was exacerbated by a mutation in her BRCA2 gene that's been associated with much higher rates of breast and ovarian cancers.
Going purely by the numbers, Rosenthal, a New York City native now living in Delray Beach, Florida, was a prime candidate for ovarian cancer. But even after the link between the BRCA2 gene and breast and ovarian cancer was discovered in 1995, Rosenthal didn't think to get tested. "It didn't even register," she says. "I went on with my life, and I didn't think about cancer." It wasn't until 2005, when she first noticed a physical symptom—"this huge lump in my stomach area"—that Rosenthal learned she was once again a cancer patient.
Ovarian cancer, like most cancers, is measured in four stages. Stage I is early, when the disease is contained in the ovaries. In stage II, it may be present in the fallopian tubes or elsewhere in the pelvis. By stage III, it has migrated into the abdomen or lymph nodes. And by stage IV, the malignancy has spread, or metastasized, into major organs like the liver or uterus. (The first three stages are further subdivided into A, B, and C levels.) For ovarian tumors discovered in stage I or II, the survival rate 10 years after diagnosis is reassuringly high—almost 90 percent—because treatment is straightforward: surgery, perhaps followed by low doses of radiation. But survival rates drop precipitously as the diagnosis shifts to stage III or IV, when the cancer is well established and spreading. Here, the survival rate falls to 20 percent and then to 10 percent. Unfortunately, more than two-thirds of ovarian cancers aren't found until these later stages. That was true in Rosenthal's case: By the time she noticed her lump, the disease had spread and progressed to stage IIIC.
The survival rate for many cancers is similar to the cliff-like curve that defines ovarian malignancies. Find the disease early, thanks to a stray blob on an x-ray or an early symptom, and the odds of survival approach 90 percent. Treatment—surgery—is typically low risk. But find it late, after the tumor has metastasized, and treatment requires infusions of toxic chemicals and blasts of brutal radiation. And here the prognosis is as miserable as the experience.
This reality would seem to make a plain case for shifting research and resources toward patients with a 90 percent, rather than a 10 or 20 percent, chance of survival. But these are largely hypothetical patients. Cancer may be present, but since it hasn't been detected, as a practical matter these cases don't yet exist. People with full-blown cancer, however, are very real. They are our fathers and mothers, our children and friends. They're right in front of us. These are the 566,000 Americans who will die of cancer this year.
The US spends billions of dollars to save these late-stage patients, trying to devise better drugs and chemotherapies that might kill a cancer at its strongest. This cure-driven approach has dominated the research since Richard Nixon declared war on the disease in 1971. But it has yielded meager results: The overall cancer mortality rate in the US has fallen by a scant 8 percent since 1975. (Heart disease deaths, by comparison, have dropped by nearly 60 percent in that period.) We are so consumed by the quest to save the 566,000 that we overlook the far more staggering statistic at the other side of the survival curve: More than a third of all Americans—some 120 million people—will be diagnosed with cancer sometime in their lives. Their illness may be invisible now, but it's out there. And that presents a great, and largely unexamined, opportunity: Find and treat their cancers early and that 566,000 figure will shrink.
By Thomas Goetz 12.22.08 WIRED MAGAZINE: 17.01 + More
DON LISTWIN LEARNED ABOUT THE 90/10 SURVIVAL CURVE AFTER HIS MOTHER, GRACE WAS DIAGNOSED WITH OVARIAN CANCER IN 2000.
Don Listwin learned about the 90/10 survival curve after his mother, Grace, was diagnosed with ovarian cancer in 2000. Doctors had diagnosed her—twice—with a bladder infection and prescribed antibiotics. Not surprisingly, that treatment didn't work. By the time her doctor established that she had ovarian cancer, she was stage IV and 12 months from her death.
Listwin, a onetime heir apparent to CEO John Chambers at Cisco Systems, says his impulse was to sue the doctor, the hospital, and anyone else who looked culpable. "I thought their incompetence had killed my mother," he says now. "But then I started staring at this 90 percent and this 10 percent, and I realized that if she had just been over here at 90, she'd be alive today." An electrical engineer by training, Listwin started to ask questions. Why does survival drop off so steeply? What happens in later stage cancers that make them so lethal? And most obviously, why can't we find the killer cancers early? "This looked like an emergent systems engineering problem, a systems biology problem," he says. "And it looked like an opportunity to engineer solutions."
Listwin, who says he was at Cisco during "the right 10 years," left the company in 2000 at age 41 with $100 million in the bank. Typically, people like Listwin—wealthy, philanthropic, and touched by cancer's ruthlessness—get on the cure bandwagon. But after looking at the numbers, Listwin was drawn to the problem of early detection. In 2004, he created the Canary Foundation, a research group with the single goal of bringing a battery of screening tests to patients and their doctors by 2015, starting with ovarian cancer and moving on to pancreatic, lung, and prostate. Listwin likes to explain the Canary approach with PowerPoint, and every presentation starts with a slide of the survival curve for cancer. Pointing to the 90 percent, he makes this simple observation: When we see cancer early, we have a chance to fight it.
In fact, much of the meager increase in cancer survival rates over the past 30 years can be attributed not to new chemotherapies or treatments but to early detection. Deaths from skin cancer, which is the most obvious to diagnose and treat, have fallen 10 percent. Since the Pap smear—a simple swab of the cervix for precancerous and cancerous cells—became part of routine care in the US in the 1950s, cancer incidence and mortality rates due to cervical cancer have fallen by 67 percent. Five-year survival rates for breast cancer have likewise improved as mammography and MRI screening have increased. There are tests for these diseases not because they are biologically different from other cancers but because they occur in accessible parts of the body. It's neither difficult nor prohibitively expensive nor dangerous to swab a cervix or perform a mammogram. Other areas of the body, though—the lungs, the pancreas—are less accessible and harder to monitor. Consequently, their malignancies are far more deadly.
Despite this proven model, early detection is an afterthought in cancer research. The pharmaceutical industry spends nearly $8 billion annually on cancer research, according to the International Union Against Cancer, most of it steered toward drug development and late-stage treatments. The major cancer foundations spend lavishly on cure-based research: The Susan G. Komen Breast Cancer Foundation spent $180 million on cures in 2007; the Michael Millken Prostate Cancer Foundation spends about $14 million annually pursuing a cure for prostate cancer; the National Cancer Institute spent just 8 percent of its 2007 budget, less than $400 million, on detection and diagnosis research. Compared to these sums, Canary's $5 million annual budget scarcely registers. Yet Canary stands out in the cancer research community because its focus is on early detection rather than treatment.
By Thomas Goetz 12.22.08 WIRED MAGAZINE: 17.01 + More
THE RIDDLE OF EARLY DETECTION!
More than 140 million Americans will get cancer at some point in their lives. Find the disease early and survival rates are high. Catch it late and it's much more likely to be fatal. There are three main hurdles to clear before widespread early detection becomes possible.
|Some cancers can be too easy to find.||Other cancers are inherently elusive.||The money goes where the cancer is.|
|About 80 percent of prostate cancers are detected early. Yet most patients survive at least five years even if untreated. The problem: deciding whether medical intervention is necessary.||Pancreatic cancer, for one, betrays almost no symptoms, making diagnosis a matter of pure luck. Only 3 percent of cases are found in the first, most curable stage.||Some malignancies, notably lung cancer, are mostly detected only in late stages. As a result, that's where most research is directed. Shifting those priorities won't be easy.|
A creature of Silicon Valley, Listwin based his foundation in San Jose and has structured it like a tech startup. Canary has recruited some of the nation's foremost oncologists, molecular scientists, and biostatisticians—researchers from the Fred Hutchinson Cancer Research Center in Seattle, New York's Memorial Sloan-Kettering Cancer Center, and Stanford School of Medicine—and assigned them to one of four teams, each of which concentrates on a specific cancer. The foundation uses its grants as seed capital. Research is closely tracked so that years aren't lost in the lab. Failure is allowed, so long as it happens fast. And in contrast to many big-ticket medical technologies, there's a priority on making costs for a test low enough that innovations can be widely deployed. The objective is to draw in research money from the NCI and other cancer foundations as well as venture capital, jump-starting an industry. Once that happens, Listwin's exit strategy will be easy: "I'll be on the beach in Belize," he says.
In case the allusion isn't obvious, the Canary Foundation takes its name from the avian early detection system used by coal miners. Listwin, whose year-round tan, golf-pro good looks, and cheerful swagger make him seem younger than his 49 years, adopts the plumage of the namesake bird at every opportunity, wearing a canary yellow blazer at most foundation functions. (At outside meetings, he goes with a buttercup oxford shirt, tucking a matching pocket square in a blue coat.) Given his manner, though, the yellow jacket brings to mind less a songbird than a hornet, buzzing around and ever-ready to engage.
Last May, at the foundation's annual science meeting at Stanford, Listwin was in typically high spirits. The Canary Symposium pulls together the 125 scientists who work on Canary research in the US and Canada. For them, the symposium is an opportunity to share progress, swap strategies, and meet such luminaries as NCI director John Niederhuber and Lee Hartwell, director of the Hutchinson Center and chair of Canary's science team. It's also a chance to get a taste of Silicon Valley swank. Listwin makes a point of serving the best food and drink during the three-day event; a friend who is an avid wine collector generously uncorks several cases of remarkable wines, from 30-year-old Bordeaux to $300 California zinfandels. It makes for a blithe mood, and this year, Listwin had extra reason to be jazzed. He'd just announced an agreement with Stanford to build a new research center focused on early detection. Scheduled to open this year, the Canary Center at Stanford will be a headquarters for Sam Gambhir, director of the university's molecular-imaging program and the developer of a promising new ultrasound technology that's central to Canary's efforts.
Listwin is much more engaged than the average philanthropist. Rather than dole out research money and send the scientists back to their labs, he's involved in each step of the scientific process, from generating hypotheses to analyzing the data. Ever the engineer, he has schooled himself in the minutiae of biomarkers and cancer genetics and readily interrupts a presentation to correct a scientific point. (At a recent meeting of the NCI's Early Detection Research Network, he was mistakenly introduced as "Dr. Don Listwin.") And drawing from his corporate days, Listwin applies classic group management theories to the effort. "It's basic team-building," he says. "Forming, storming, norming, and performing."
Each member of the team is responsible for a different link in the chain leading to a workable screening test—or more accurately, toward two tests: a biomarker blood test to identify a cancer, followed by an imaging test to isolate it in the body. Some group members are engaged in proteomics—running tissue samples through mass spectrometers to uncover the proteins that may be biomarkers for a particular type of cancer and then handing off promising proteins to other specialists who use statistical methods to confirm the correlation. Others are developing new imaging tools that can pinpoint a tumor as small as 2 millimeters across. Still others design cost-benefit models to determine whether a test has commercial potential. And in contrast to the five-year duration of a standard NCI grant, Canary reviews its grants annually. "Most scientists aren't used to doing things this way," says Martin McIntosh, a bioinformatics guru at the Hutchinson Center and member of Canary's ovarian team. "If something's not working, Don's not afraid to pull the plug. So that takes some getting used to. But there's definitely a sense that we're getting somewhere, that we're working on this problem in a new and smart way."
By Thomas Goetz 12.22.08 WIRED MAGAZINE: 17.01 + More
As Founder of the United Cancer Foundation and a recent cancer survivor myself, I can speak from experience in making you aware of the thousands of new cancer patients diagnosed every day. No one is a stranger to infirmity, and we all know of the formidable physical and emotional challenges any illness brings, but the diagnosis and treatment of cancer knows no economic boundaries. With poverty and unemployment rates rising steadily and the number of uninsured citizen’s sky-rocketing, less and less Americans each year can contend with the cost of this disease. We are aware that our great nation currently faces economic uncertainty, but it is during these times especially that we need your support the most.
The United Cancer Foundation will be offering "Health & Hope" to those in need! We will be saving lives by offering FREE Health care! We will be providing the following medical assistance for 2000-3000 patients per weekend event for FREE: Cancer Screenings, Dental: (cleanings, fillings and extractions), Vision: (complete eye exams and prescription glasses) Medical: (specialist exams and consults, podiatry, diabetes screening and education, skin care, skin rashes and screening for skin cancer) Women's health: (mammograms, pap smears and breast exams) Men's health: PSA testing. Follow-up care will be a major component of this event. This will all be done by volunteer Doctors. This event will benefit, Children, Women, Men, Minorities and the Disabled.
We will be offering "Hope" by making follow-up care and "Health" education a major component of this event!
Initially, the "HEALTH & HOPE" healthcare project started with 8 groups such as American Cancer Society, Susan G. Komen for the Cure South Florida, Palm Beach County Health Department and Remote Area Medical of Knoxville TN. Now an additional 12 organizations and foundations have indicated they want to be a part of this event. We will have 20+ community based organizations helping to make this event successful by offering their support services for our project: "Health & Hope". There has never been an event in Florida where this many community based organizations have come together to help 2,000- 3,000 families in one weekend event. This will be the biggest healthcare event Florida has ever seen! Everyone loves the idea of Volunteer Doctors donating their services. These events are so popular that people line up a day in advance to be seen. This will not be an ordinary health fair event; there will be over 400+ volunteers to help thousands of those in need in just one weekend! There is no other event like this being held in Florida! Our main focus is getting FREE Cancer Screenings and health care to individuals who are in need of immediate medical assistance. The event date will be announced shortly!
At the end of the day, all those involved will be proud to have been a part of this event that helped so many people in need of immediate healthcare!
Follow-up care will be a major component of this event!
These events are so popular that people sometimes line up a day in advance to be seen.
Why free screenings? It’s the 90/10 rule.
Fact: If we find Cancer early, 90% survive. If we find Cancer late, 10% survive.
Breast Cancer statistics for 2008 indicate that an estimated 182,460 new invasive Breast Cancer cases will be diagnosed among women, as well as an estimated 62,030 additional cases of non-invasive Breast Cancer. Along with these startling numbers, it is estimated that in 2008 approximately 40,480 women are expected to die from Breast Cancer.
Prostate Cancer statistics for 2008 indicate that an estimated 186,320 men will be diagnosed with Prostate Cancer and an estimated 28,680 deaths will occur.
The latest Cancer statistics are that estimates for 2009 suggest a staggering 500,000 people will be diagnosed with Breast or Prostate Cancer (resulting in about 75,000 deaths). These are only a fraction of the 556,000 Americans who will die of other Cancer related diseases.
The United Cancer Foundation is seeking help from other Foundations, Corporations and individuals who have the finances to help us take this project to a National level. Americans need help and they need it now!
UCF is a 501(c)(3) charitable organization and is eligible to receive tax-deductible contributions.
The Foundation web site is: (www.unitedcancerfoundation.org)
MESSAGE FROM THE FOUNDER
Friday, September 10, 2010
As Founder of the United Cancer Foundation, I would like to apologize and take a moment to update all of our friends that offered to help bring our FREE healthcare event for Palm Beach County families. There have been 100’s of calls asking when Remote Area Medical® (RAM) will be coming back to Palm Beach County, Florida to offer FREE Medical, Dental and Vision Care, for the uninsured, underinsured unemployed, and those who cannot afford to pay that was to be held at:
Americraft Expo Center - South Florida Fairgrounds
9067 Southern Blvd, West Palm Beach, Florida.
After the cancellation of the event in April, Remote Area Medical® had requested that more committees be set up to ensure we would have enough medical and non- medical volunteers. I was doing most of the work myself with a few part time volunteers after recovering from an emergency triple by-pass operation. That was a bad idea! In May, 2010, I started to work towards obtaining help. I was in the planning stage to sit down with Christ Fellowship® who had expressed an interest in helping us bring Remote Area Medical® back to Palm Beach County. Again, I was physically not ready to take this event on by myself without at least hiring one full time and one part time employee to get started.
Unfortunately without the funding to hire employees, we will be unable to bring Remote Area Medical® back to Palm Beach County to offer FREE HEALTHCARE!
I will try to keep everyone posted on my web site every few months as to where we are at. We are looking for an individual or a company that would want to sponsor free healthcare events for the Families of Palm Beach County, Florida. Our long term plan was that with enough employees we would be able to hold this event though-out Florida.
I felt the need to apologize to the many volunteers numbering over 500, that worked very hard helping in our effort to bring Remote Area Medical® to Palm Beach County
Provenge makes use of the patient's own white blood cells to attack cancer.
(CNN) -- A vaccine treatment for prostate cancer has become the first therapy of its kind to win approval for use in U.S. patients.
The U.S. Food and Drug Administration approved Provenge, a novel technique for fighting prostate cancer, on Thursday. The treatment involves taking a patient's own white blood cells and using a drug that trains them to more actively attack cancer cells.
"It's a landmark in the sense that it would be the first approved cell-based immune therapy," said Dr. Nina Bhardwaj, director of the tumor vaccine program at New York University Langone Medical Center, who is not involved with Provenge or its maker, Dendreon Corp.
The treatment is intended only for men with so-called "metastatic castration-resistant" prostate cancer, for whom hormone suppressant therapy has not worked. Studies have shown that Provenge prolongs survival by about four to 4.5 months.
But the real breakthrough is the approval of this new way of treating disease, which could be used for other cancers and conditions, such as HIV, Bhardwaj said.
"It's a major conceptual advance; it's a modest therapeutic advance," said Dr. Christopher Logothetis, prostate cancer researcher at the University of Texas M. D. Anderson Cancer Center. Logothetis testified to an FDA panel in 2007 about the drug, but has no financial ties to Dendreon.
It is unclear whether insurance companies will cover the cost of Provenge and it may be prohibitively expensive for some, Bhardwaj said. Dendreon says it will be priced similarly to other new biologics that prolong survival.
Investment firm J.P. Morgan estimates a full course of Provenge will cost $65,000; estimates by other investors put it between $50,000 and $100,000, according to J.P. Morgan. Cancer drugs Avastin and Erbitux, also based on new concepts in treating different kinds of cancer, cost up to $100,000 per year.
"In this whole scheme of things, [Provenge is] costly, but not unheard of," Bhardwaj said.
Provenge is the first cancer treatment vaccine that the FDA has approved.
Although Provenge is considered a vaccine, it is a treatment for patients who already have prostate cancer, rather than a preventive measure, said Dr. David Penson, assistant professor of urologic surgery at Vanderbilt University, who was an investigator in a Provenge clinical study and has presented the research, but has no financial ties to the company.
The Provenge process involves taking out some of the patient's white blood cells and sending them to a facility where they are activated with Provenge. The infusion is sent back, and a physician delivers it to the patient intravenously. A complete course of therapy takes three cycles in one month.
A phase 3 clinical trial called IMPACT, involving 512 men with castration-resistant prostate cancer, found that Provenge reduced the risk of death by 22.5 percent compared with a placebo.
The IMPACT study also found that the treatment extended the lives of patients by an average of 4.1 months; a separate trial with 225 men found an average life extension of 4.5 months. Clinical trials also found that 33 percent of patients with advanced disease remained alive three years after treatment with Provenge.
"This is a significant improvement in survival, and is more significant in that it is a new way of treating prostate cancer," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, in an e-mail.
Brawley and Logothetis said they will prescribe the therapy for patients who fit the criteria.
Because the treatment makes use of the patient's own cells, it does not cause the severe side effects seen in chemotherapy, Penson said. The main side effects seen for Provenge were flu-like symptoms, such as chills and fever, lasting one to two days. Docetaxel, a chemotherapy drug that is the only available alternative for these patients, is toxic to the body, and can lead to infection, muscle and bone pain, and hair loss, he said.
Potentially, Provenge could one day be used in combination with chemotherapy, Penson said. Right now it is prostate-cancer specific, but the principle behind it may be applicable to other cancers, he said.
The treatment has had an long journey on the way to approval. An FDA advisory panel reviewed Provenge in 2007 and voted in favor of it, but the agency declined to approve it, requesting more data. Logothetis also recommended additional research at that time.
Concerns surrounded the drug because although the initial studies showed a survival benefit, they did not demonstrate a delayed progression of cancer, Logothetis said. Usually, both of these benefits are seen in proven cancer therapies.
"Since the traditional measures of efficacy are not seen in these studies, it has created initial skepticism," Logothetis said.
But given the survival benefit found in the later results, there is now little doubt that the treatment works, he said. The question is why it works without delaying tumor progression.
The results could mean that the drug resists negative effects of cancer rather than cancer growth, he said. Alternatively, the slowing of the tumor's growth may be too small to measure with available tools. It is also possible that the mechanism is entirely different, changing the tumor in some way that scientists do not yet understand.
Other promising research may have been stifled for similar reasons, Logothetis said.
"You can assume that many trials that would have been beneficial were stopped early because there was no effect on progression on the tumor," Logothetis said.
One concern now is capacity, because Dendreon's facilities initially won't be able to handle the demand, Logothetis said.
The company intends to make Provenge available through about 50 centers, all of which were approved clinical trial sites, and plans to expand its existing manufacturing facility in New Jersey, said Dendreon spokeswoman Katherine Stueland. The expansion should be done by early 2011, and the company is also building facilities in Los Angeles, California, and Atlanta, Georgia, which should be complete in mid-2011, she said.
While giving to a charity can help you feel good about yourself, giving has other benefits as well.
Donations to qualified charities can be claimed on your federal tax return as an itemized deduction. Keep official receipts stating the donor's name, charity, date and donated amount to verify for IRS. Donations to foreign, civic or political organizations do not qualify.
Make a Difference
Some see donating as a way of paying forward help they have been given, while others just want to improve the world and their community. Donations help groups, such as the United Cancer Foundation, provide funding for free breast and prostate screenings, while also funding medical care to the uninsured fund research to find cures or new treatments for illnesses.
Some donors pay homage to the memory of a loved one by making a donation in that person's name. Choose a charity that supports a cause your loved one believed in or one for which he volunteered.
Donations are showcased in a positive light at charity events. Extra publicity is received through advertisements on radio, television, print publications or programs. This marketing strategy can attract customers, while supporting a cause.
It's extra special to donate to a cause close to your heart. Perhaps you know someone who has been diagnosed with Cancer or cannot afford to see a Doctor. Or you may have been homeless at one point in your life and want to help others.
Donations can show support or give thanks to a particular group for their service. Give to a local charity that strengthens your community by providing FREE healthcare to those in need
The United Cancer Foundation qualifies as an exempt organizations under section 501 (c) (3) of the Internal Revenue Code, organized for health education, including providing funding for free breast and prostate cancer screenings The primary activity of UCF will be to provide funding for free breast and prostate screenings, while also funding medical care to the uninsured
The United Cancer Foundation was founded by a recent Cancer and Heart By-Pass Surgery survivor. Who is committed to making a positive difference in the lives of those that cannot afford healthcare.
Other ways to donate
You can include the UNITED CANCER FOUNDATION in your will.
Donate your car (Great tax write off) Call for details.
Each and every gift counts to help us fulfill our mission. We are counting on your support and appreciate your gift. Please send your donation to:
United Cancer Foundation
1200 North Federal Hwy.
Boca Raton, Florida 33432
Want to feel better, have more energy and perhaps even live longer? Look no further than old-fashioned exercise.
The merits of regular physical activity — from preventing chronic health conditions to promoting weight loss and better sleep — are hard to ignore. And the benefits are yours for the taking, regardless of age, sex or physical ability. Need more convincing? Check out seven specific ways exercise can improve your life.
1. Exercise improves your mood.
Need to blow off some steam after a stressful day? A workout at the gym or a brisk 30-minute walk can help you calm down.
Physical activity stimulates various brain chemicals that may leave you feeling happier and more relaxed than you were before you worked out. You'll also look better and feel better when you exercise regularly, which can boost your confidence and improve your self-esteem. Regular physical activity can even help prevent depression.
2. Exercise combats chronic diseases.
Worried about heart disease? Hoping to prevent osteoporosis? Physical activity might be the ticket.
Regular physical activity can help you prevent — or manage — high blood pressure. Your cholesterol will benefit, too. Regular physical activity boosts high-density lipoprotein (HDL), or "good," cholesterol while decreasing triglycerides. This one-two punch keeps your blood flowing smoothly by lowering the buildup of plaques in your arteries.
And there's more. Regular physical activity can help you prevent type 2 diabetes, osteoporosis and certain types of cancer.
3. Exercise helps you manage your weight.
Want to drop those excess pounds? Trade some couch time for walking or other physical activities.
This one's a no-brainer. When you engage in physical activity, you burn calories. The more intense the activity, the more calories you burn — and the easier it is to keep your weight under control. You don't even need to set aside major chunks of time for working out. Take the stairs instead of the elevator. Walk during your lunch break. Do jumping jacks during commercials. Better yet, turn off the TV and take a brisk walk. Dedicated workouts are great, but physical activity you accumulate throughout the day helps you burn calories, too.
4. Exercise boosts your energy level.
Winded by grocery shopping or household chores? Don't throw in the towel. Regular physical activity can leave you breathing easier.
Physical activity delivers oxygen and nutrients to your tissues. In fact, regular physical activity helps your entire cardiovascular system — the circulation of blood through your heart and blood vessels — work more efficiently. Big deal? You bet! When your heart and lungs work more efficiently, you'll have more energy to do the things you enjoy.
5. Exercise promotes better sleep.
Struggling to fall asleep? Or stay asleep? It might help to boost your physical activity during the day.
A good night's sleep can improve your concentration, productivity and mood. And you guessed it — physical activity is sometimes the key to better sleep. Regular physical activity can help you fall asleep faster and deepen your sleep. There's a caveat, however. If you exercise too close to bedtime, you may be too energized to fall asleep. If you're having trouble sleeping, you might want to exercise earlier in the day.
6. Exercise can put the spark back into your sex life.
Are you too tired to have sex? Or feeling too out of shape to enjoy physical intimacy? Physical activity to the rescue.
Regular physical activity can leave you feeling energized and looking better, which may have a positive effect on your sex life. But there's more to it than that. Regular physical activity can lead to enhanced arousal for women, and men who exercise regularly are less likely to have problems with erectile dysfunction than are men who don't exercise — especially as they get older.
7. Exercise can be — gasp — fun!
Wondering what to do on a Saturday afternoon? Looking for an activity that suits the entire family? Get physical!
Physical activity doesn't have to be drudgery. Take a ballroom dancing class. Check out a local climbing wall or hiking trail. Push your kids on the swings or climb with them on the jungle gym. Plan a neighborhood kickball or touch football game. Find a physical activity you enjoy, and go for it. If you get bored, try something new. If you're moving, it counts!
Are you convinced? Good. Start reaping the benefits of regular physical activity today!
WebMD Health News
Reviewed by Laura J. Martin, MD
(Feb. 7, 2011) New Orleans -- The number of nonmelanoma skin cancers continues to rise, with an estimated 3.7 million cases in the U.S. in 2009.
That's the latest figure from researchers who last year reported that more than 2 million Americans were treated for 3.5 million nonmelanoma skin cancers -- mainly basal cell and squamous cell carcinomas -- in 2006.
Although these skin cancers can be easily treated if detected early, "the long-established culture of tanning is creating a huge public health problem," says Brett M. Coldiron, MD, clinical associate professor of dermatology at the University of Cincinnati.
"We need to admit there's an epidemic," he tells WebMD.
Nonmelanoma Skin Cancers Rose 1.6% in 2009
For both studies, Coldiron and colleagues used Medicare claims data to count the number of skin cancer removal procedures among Medicare recipients and extrapolated figures to the rest of the population.
Their earlier report, published last year in the Archives of Dermatology, showed skin cancer removals among Medicare patients increased on average 4% a year from 1992 to 2006.
The new findings, presented at the annual meeting of the American Academy of Dermatology (AAD), showed that procedures among Medicare patients increased an additional 2.4% from 2006 to 2007, 2.6% from 2007-2008, and an additional 1.6% in 2009.
For Many, Damage Is Done
What's worse, the numbers may continue to rise, says AAD President Ronald L. Moy, MD, professor of dermatology at the University of California Los Angeles David Geffen School of Medicine.
That's because there is often a lag time of 20 years or more between sun damage and manifestations of skin cancer, he tells WebMD.
"For many baby boomers, the damage has already been done," Coldiron says. "Think back to the days when people used to lather baby oil all over their skin."
"If we keep going like this, there will be a doubling of [nonmelanoma] skin cancers in the next 15 to 20 years," Coldiron says.
Most Accurate Figures to Date
"The cost of all these cases is tremendous," Coldiron says. Diagnosis and treatment of each cancer tops $2,000, bringing the total cost of the 3.7 million cases in 2009 to more than $8.6 billion.
The researchers say their work provides the most accurate figures on skin cancers to date.
"You can't treat a nonmelanoma skin cancer without a positive biopsy, and the number of procedures for nonmelanoma skin cancers is available. So the number of procedures is an excellent proxy for the actual number of cancers," Coldiron says.
Still, some cancers fully removed during biopsies may have been missed, and some cancers that required multiple treatments may have been counted more than once, he says.
Coldiron notes that nonmelanoma skin cancer is a non-reported disease, and there are no available databases from national private insurers.
Tips for Minimizing Skin Cancer Risk
Studies show that "even though people know that overexposure to ultraviolet light can lead to skin cancer, they still tan. We need young people to realize that tanning for cosmetic reasons now will ultimately increase their risk for skin cancer," Coldiron says.
The AAD offers these tips to minimize your risk of skin cancer:
- Always apply a broad-spectrum water-resistant sunscreen with a sun protection factor (SPF) of at least 30 to exposed skin when going outdoors.
- Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses when possible.
- Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. Rule of thumb: If your shadow is shorter than you are, seek shade.
- Use extra caution near water, snow, and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
- Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a UV-free self-tanning product, but continue to use sunscreen with it.
- If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
Some of these findings were presented at a medical conference and should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.
SOURCES: 69th Annual Meeting of the American Academy of Dermatology, New Orleans, Feb 4-8, 2011.Brett M. Coldiron, MD, clinical associate professor of dermatology, University of Cincinnati.Ronald L. Moy, MD, professor of dermatology, University of California Los Angeles David Geffen School of Medicine.Coldiron, B. Archives of Dermatology, March 2010; vol 146: pp 283-287.
©2011 WebMD, LLC. All Rights Reserved
WEDNESDAY, Nov. 17 (Health Day News) -- Resistance exercise such as weight training affects blood vessels differently than aerobic exercise and offers other cardiovascular benefits, finds a new study.
Researchers at the Appalachian State University in Boone, N.C., compared blood vessel (vascular) responses to two types of moderate-intensity workouts: three sets of 10 repetitions of eight resistance exercises and 30 minutes of aerobic cycling.
There were significant differences in the vascular responses to the two types of exercises. Resistance exercise produced greater increases in blood flow to the limbs, while aerobic exercise reduced arterial stiffness, but without an increase in blood flow.
Resistance exercise also led to a longer-lasting decrease in blood pressure after exercise, compared to aerobic exercise.
"Resistance exercise may offer greater benefits from the increases in blood flow to active muscles and could be implemented as a companion to an aerobic training program," wrote study leader Scott R. Collier, of Appalachian State University, and colleagues in a press release.
They said their findings support previous research showing that resistance exercise has unique effects on blood pressure and limb blood flow.
"The present study indicates that an acute bout of resistance exercise shows many favorable cardiovascular benefits and should therefore be considered as part of a daily exercise training program," the researchers concluded.
The study appears in the November issue of Journal of Strength and Conditioning Research.-- Robert Preidt
UCF is a 501(c)(3) charitable organization and is eligible to receive tax-deductible contributions.
Steven H. Kaplan - Founder/UCF
When Stan Brock started Remote Area Medical (RAM) in 1985, never in his wildest dreams did he think his services would be needed in the United States, the wealthiest country in the world.
RAM began as an all-volunteer mobile medical clinic that provided free and immediate health care to people living in remote areas of the Amazon rainforest. In 1992, he was asked to bring the clinic to Knoxville, Tennessee. He was shocked by what he saw.
"People were in desperate need of the most basic care," he said at RAM's most recent expedition in Oakland, California last month. "It didn't occur to me when I first came to this country, but it wasn't long before I could see there were similarities between people who don't have access to healthcare in a place like the Amazon and people who have access but can't afford it in America - and they're all in the same boat."
An estimated 50 million Americans are uninsured and another 25 million are underinsured, meaning they can't pay the difference between what their insurance will cover and the total cost of their medical bills. Someone files for bankruptcy every 30 seconds in the US because of a serious health problem, according to a Harvard University study.
Since 1992, RAM has conducted 640 expeditions in the US. When the travelling medical clinic comes to town, the lines begin forming at around midnight. An average of 3,000 people are treated at a typical four-day event. Over 90 per cent of the patients are in desperate need of basic dental and vision care. Each clinic costs roughly $100,000 to run, requires over 1,000 volunteers, and takes an entire year to organise.
When patients entered the clinic at the Oakland Coliseum, they were greeted by smiling volunteers, rows upon rows of dental chairs, optometric stations, and tables covered with medical tools, gloves, and equipment.
When Milka Guiterrez heard that free healthcare was being offered, she moved her schedule around to get a good place in line. On Sunday night, long after her three kids were sound asleep, she left her house at 1am. She was number 474 in line.
Shortly before patients began entering the makeshift clinic five hours later, Guiterrez ran home, grabbed her kids, and returned with her fingers crossed. She got lucky.
She and her kids had eye exams and dental work. Her eight-year-old daughter Paloma was in pain from the drilling, but managed to crack a smile. "When I used to smile, there was yellow stuff everywhere," she said wiping away tears. "I was so embarrassed. I stopped smiling when I was six. It hurts, but now I'm happy."
After 12 years with the US Postal Service, Anita Moore was hurt on the job and lost her health insurance. She got in line at 3:30am. By 6pm, she had her eyes checked, her teeth cleaned, two fillings, and four extractions.
Six months ago, she had an injury and hasn't been able to lift her arms above her shoulders. The pain went away after 15 minutes of acupuncture at the clinic. "I was so happy because I couldn't lift. I was just shocked. Now I can move them around," she said. "It's a blessing."
Les Kuller, an unemployed construction worker who got in line at 5:30am, lost his health insurance when his wife passed away two years ago. He got a molar fixed, had his blood pressure checked, was given a pair of eyeglasses, and had chiropractic and physical therapy work. He was so touched by the care he received and the volunteers he met, he came back the next day to join them.
"The least I could do is give back," he said. "On one hand, this is so incredibly amazing that all these volunteers can pull this together. On the other hand, it's a sad commentary about what the hell is going on in Washington and why the hell these knuckleheads can't walk across the aisle and shake hands and figure this thing out."
Kuller says he hopes people standing in overnight lines for basic medical care "embarrasses the hell" out of politicians. I heard similar sentiments from several people receiving care at the clinic.
When profit comes before care
Democratic politicians proudly point to the Patient Protection and Affordable Care Act, the bill that was signed by President Obama in March 2010, as real progress, but Physicians for a National Health Program (PNHP), an organisation of doctors who support healthcare for all, say the bill is nothing more than a false promise of reform.
Instead of eliminating the real problem, the new legislation will enrich and further entrench the profit-driven, private health insurance industry, and leave 23 million people still uninsured in 2019, according to PNHP.
If Republicans have their way, the 45 million seniors and people with disabilities who rely on Medicare will see their out-of-pocket costs double - or do without treatment altogether.
RAM founder Stan Brock doesn't like to talk about politics. He's too busy making sure people get treated. RAM's next stop is in Pikeville, Kentucky. From there, he and his team will head to Cocke County, Tennessee, Wise County, Virginia, and Chicago, Illinois. Because he's has had so many requests from all over the country, he sees no end in sight.
This is what happens when profit comes before care.
UnitedHealth's first quarter profits this year rose 13 per cent to $1.35 billion from $1.19 billion last year. UnitedHealth CEO Stephen Hemsley's total compensation of $101.96 million last year made him the highest paid executive in the country.
The United States is the only major country in the industrialized world that doesn't guarantee healthcare to all of its citizens. It's unconscionable that 45,000 people in the US die every year because they can't afford healthcare.
Senator Bernie Sanders, an independent from Vermont who believes that the US should put patients over profits, recently re-introduced the American Health Security Act, which would provide every citizen with healthcare coverage through a state-administered, single payer program.
Here's a fact from the PNHP that never made its way through the noise machine during the so-called healthcare debate - which was shaped by the insurance industry from the beginning. It should be repeated over and over again. the bureaucracy and paperwork of the profit-making health insurance industry consume one-third of every healthcare dollar.
Streamlining payment through a single-payer system would save more than $400 billion per year - which is enough to provide comprehensive, high-quality coverage for all.
RAM's Stan Brock says a single-payer system, as long as it covers dental and vision, would put him out of business in the US. "That would allow us to go back to the Amazon, Central America, Haiti - and other places where we belong."
The views expressed in this article are the author's own and do not necessarily represent the UNITED CANCER FOUNDATION'S editorial policy.
Reduce Stress to Help Your Diabetes
How Stress Affects People with Diabetes
Written by Bonnie Sanders Polin, PhD
Stress affects people diabetes, both those type 1 diabetes and type 2 diabetes (well, of course, it affects people without diabetes, too, but we'll just stick to the people with diabetes). And managing stress isn't as easy as just telling yourself to relax and get through your to-do list. When you have diabetes, stress can affect your blood glucose level, so managing stress when you have diabetes is just another way to work on managing your blood glucose level.
This article addresses how stress affects people with diabetes and has some suggestions for way to manage the stress in your life (because let's face it, you'll probably never be able to entirely get rid of stress!).
How Stress Affects People with Diabetes
In people with diabetes, stress can alter the blood glucose levels in two ways.
First, people under stress may not take care of themselves. They may eat more and exercise less. They may forget or feel they do not have time to check blood glucose levels or plan for healthy meals.
Second, stress can change blood glucose levels directly. Scientists have studied the effects of stress on glucose levels in both animals and people. Diabetic mice have elevated glucose levels when under physical or mental stress.
The effects in people with type 1 diabetes indicate that glucose levels may go up as they do in the majority of people, but they can also go down in some. In type 2 diabetes, stress often raises blood glucose levels.
Stress Management Tips: Relaxation to Handle Stress
Relaxation is not a substitute for exercise; it is an adjunct which will allow you to feel better all day long.
In fact, relaxation includes brief or quick relaxation, a stress walk, and then the longer relaxation techniques. It also includes deep breathing. Try the ones that appeal to you. You won't be unhappy.
The best thing about learning to relax is that you can take these techniques with you wherever you go. Some are quick and some take a bit more time. Let's look at some of these.
The Stress Walk is just what it says. If things are getting to you at work, get up and walk around the office a few times, walk the steps or walk around to another part of the workplace and back a few times.
At home, walk your living room or home. Even a short walk can give you a needed time out, releasing muscle tension and allowing more oxygen to enter your body and brain. This is amazingly effective.
You have no idea how often I get up and walk to other rooms or pick up clothes, make a bed, etc. just to relieve the tension of sitting at the computer.
- Loosen your clothing to get more comfortable. Remove that extra sweater and take off the glasses.
- Tighten the muscles in your toes. Holds for a count of 10. Relax and enjoy the sense of release of tension.
- Flex the muscles in your feet. Hold for a count of 10. Relax.
- Move slowly up through your body-legs, abs, back, face...contracting and relaxing muscles as you go.
- Breathe slowly and deeply.
In the 1920s, Dr. Edmund Jacobson developed a system of relaxation he called Progressive Muscle Relaxation. It involves tensing and totally relaxing specific muscle groups. It is a structured relaxation somewhat like what we described above, but it has rules you will want to learn.
You may need a teacher to help you get this. It takes some training. Here we share the first lesson of three with you. To do this, you will need to sit in a chair with your feet flat on the floor. It is preferable to do this with your eyes closed. When you tense a muscle, hold the tension for 5 seconds and then relax for 30 seconds before you go on to the next tensing movement. After you are done, breathe in deeply and stretch. Open your eyes and feel great.
- Right hand and forearm. Make a fist and then release
- Right upper arm. Bend the arm and make a muscle, then release.
- Left hand and forearm. Make a fist and then release.
- Left upper arm. Bend to make a muscle and then release.
- Forehead. Raise your eyebrows and then relax your face.
- Eye and cheeks. Squeeze the eyes and then relax.
- Mouth and jaw. Clench your teeth and pull the corners of mouth down and relax.
- Shoulder and neck. Lock your hands behind your neck and push the back of the head against this resistance (don't move the head). Pull
- Chest and back. Breathe in deeply and hold your breath, pressing the shoulders together at the back at the same time, then let your shoulders hang, and breathe normally.
- Belly. Tighten the abs and then release
- Right thigh. Shovel the right foot forward against resistance and then release.
- Right calf. Lift up right heel and then relax.
- Right foot. Crook the toes and then release.
- Left thigh. Shovel left foot forward and relax.
- Left calf. Lift up left heel and then relax.
- Left foot. Crook toes and then relax.
In the 1930s, Johannes Schultz and Wolfgang Luthe developed Autogenic Training. It uses the healing powers of the brain and the power of suggestion. It involves repeating certain mental directives and concentrating on them until the body responds. An example of this might be "My arms are heavy and warm."
This is a technique that teaches your body to respond to certain commands. Using these commands you can tell you body to lower blood pressure, control breathing and even body temperature.
It consists of 6 standard exercises that make the body feel warm, heavy, and relaxed. For each exercise you get into a simple posture (sitting in a chair or reclining), concentrate without any goals, and then use visual imagination and verbal clues to relax your body in some specific way.
The goal is to achieve deep relaxation and reduce stress.
After you learn the process you can use it whenever you need it. This is not a quick teach. It takes 4 to 6 months to master all 6 exercises.
You learn each exercise by reading about it or watching a teacher and then practicing it for a few minutes several times a day. It does, however, take training and practice to gain the benefits of the program.
Experts believe that this is a process that is similar to self-hypnosis and biofeedback, both of which we used in our practices at times.
Many people continue to use all 3 techniques. It is safe for most people, but you do need a complete physical before your begin this process.
People with diabetes and heart disease should practice it only under the care of a physician. It needs to be stopped if you have any adverse effects from doing the exercises.
For some people, for example, there is drop or increase in blood pressure that may cause problems so, as we said only with a medical person in charge. Also children under 5 years of age and people with severe mental illness are advised not to use this technique.
Manage Stress to Help Manage Diabetes
These relaxation techniques are ways to limit stress and the effects of stress in your life. Since stress affects blood glucose levels, people with diabetes should learn how to manage stress in easy, effective ways.
August 11th, 2011
Serial killer' cells can target leukemia, study says
A step toward a new possible treatment for leukemia, one that uses patients’ own immune cells to target and destroy cancer is getting a lot of media attention.
It should be noted, however, that the therapy, however promising, has been tested in only three patients, who had varying side effects such as fevers as high as 104 degrees, heart dysfunction and breathlessness. Most of the side effects resolved themselves within a matter of weeks.
A year after the therapy, two of the patients had complete remission of leukemia and one had a partial response to the therapy (meaning the patient still has cancer, but a less severe case). All three were suffering from chronic lymphocytic leukemia, one of the most common types of the disease that affects blood and bone marrow.
Published Wednesday in both the New England Journal of Medicine and Science Translational Medicine, researchers reported that they had been able to engineer the patients’ own white blood cells into “serial killers” to destroy the cancer cells.
The research team from the University of Pennsylvania's Abramson Cancer Center and Perelman School of Medicine extracted white blood cells from the patients and genetically reprogrammed them to attack tumor cells.
They programmed the T cells, which are a blood cell type that protects the body from infection, to bind to a protein that is expressed in chronic lymphocytic leukemia tumor cells. Doctors infused the modified T cells back into the patients’ bodies.
"Within three weeks, the tumors had been blown away, in a way that was much more violent than we ever expected," said Dr. Carl June, senior author of the study, in a university press release. "It worked much better than we thought it would."
One of the trial participants wrote in a first-person essay, "I'm healthy and still in remission. I know that this may not be a permanent condition, but I decided months ago to declare victory and assume that I had won."
The study could have implications for leukemia, which develops in about 43,000 people every year, according to the Leukemia & Lymphoma Society. Treatment for leukemia is difficult because bone marrow transplants are the best bet for survival. But transplants come with high risk of complications and difficulty matching donors.
In the New England Journal of Medicine, researchers described a 64-year-old man whose tumor cells had spread all over his blood and bone marrow.
Two weeks after the T-cell transfusion, nothing seemed to change. But then, the man started having high fever, chills and nausea. Tests showed a dramatic increase in T cells in his blood and massive cancer cell death. This was life-threatening, because his body became clogged with so many dead cells, according to CNN affiliate, Philly.com.
A month after the transfusion, his blood and bone marrow showed no evidence of leukemia.
For leukemia patients, this cell trial is on hold and not enrolling additional patients at this time, according to the University of Pennsylvania's website. The trial will reopen in the next one or two months, but very few patients will be able to be treated.
Despite promising results, an accompanying editorial in NEJM urged caution because of side effects such as the depletion of B-cells, which are a type of white blood cells that produce antibodies to fight off infections.
“Only with the more widespread clinical use,” wrote the editorialists, Dr. Walter Urba and Dr. Dan L. Longo, “will we learn whether the results reported… reflect an authentic advance toward a clinically applicable and effective therapy or yet another promising lead that runs into a barrier that cannot be easily overcome.”
- Coronary calcium scan looks at plaque in the arteries
- Another recommended imaging test is an ultrasound of the carotid artery
- These new tests give patients a chance to make major changes in their diet and lifestyle
Most heart attacks strike with no warning, but doctors now have a clearer picture than ever before of who is most likely to have one, says Dr. Arthur Agatston, a Miami cardiologist and author of the best-selling South Beach diet books. Agatston says relatively new imaging tests give real-time pictures showing whether plaque is building up in key blood vessels, alerting doctor and patient to an increased risk of a potentially deadly heart attack. "Unless you do the imaging, you are really playing Russian roulette with your life," he said. Agatston invented one of the imaging tests, the coronary calcium scan, which looks at plaque in the arteries leading to the heart. Plaque in these arteries is a red flag for a potential heart attack. (Agatston does not make any money from the coronary calcium scan.) The other imaging test Agatston recommends is an ultrasound of the carotid artery, looking at plaque in the main blood vessel leading to the brain. Plaque in the carotid artery is a sign of increased risk for a heart attack and stroke. Both tests are non-invasive and outpatient, although the calcium scan does expose the patient to the equivalent of several months of normal background radiation.
One large federally funded study found the coronary calcium score a better predictor of coronary events like a heart attack than the traditional Framingham Risk Score, which considers age, cigarette smoking, blood pressure, total cholesterol and HDL, the "good" cholesterol. Agatston thinks the coronary calcium scan should be routinely scheduled at age 50, like a colonoscopy, or earlier for people with family histories of heart disease. Most hospitals now offer the imaging tests, some at less than $100 for both, and they are often covered by insurance. Cardiologists now generally use the calcium scan only for patients considered at intermediate risk for heart disease, determined by traditional measures such as cholesterol, blood pressure, lifestyle and family history.
High-risk patients already receive such aggressive treatment as cholesterol-lowering statin medication, but many doctors don't think low-risk patients need to incur the expense or small dose of radiation that comes with a coronary calcium scan. "There is a large group in the middle called intermediate risk, which may be as much as 50% of the population," said Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University A good candidate for a coronary calcium scan, she says, would be a 50-year-old man with slightly elevated cholesterol and a father who had a heart attack. "Do you put this 50-year-old who has this family history on a statin medication with potential expense (and) side effects for the next four decades of his life, or do you further refine how far at risk he is?" she asked. A calcium score would answer that question, she says. There's a third test Agatston likes: a $65 blood test that looks at a patient's LDL, or bad cholesterol. LDL particles come in different sizes, and patients with a lot of small-particle LDL are more likely to build up plaque in their blood vessels, Agatston says. Alternately, patients with large LDL particles do not tend to accumulate plaque. "There are a lot of little old ladies in their 80s with very high cholesterol who have squeaky clean vessels. They have very large particles, and they don't get into the vessel wall," Agatston says. These new tests give patients a chance to make major changes in their diet and lifestyle, and give doctors an opportunity to treat them with medication. "One of the best-kept secrets in the country in medicine is the doctors who are practicing aggressive prevention are really seeing heart attacks and strokes disappear from their practices. It's doable," Agatston says.
Prevent and Reverse Heart Disease
Caldwell B. Esselstyn, Jr., M.D.
A groundbreaking program backed by the irrefutable results from Dr. Esselstyn’s 20-year study proving changes in diet and nutrition can actually cure heart disease
Heart disease remains the leading cause of death in the United States for men and women. But, as Dr. Caldwell B. Esselstyn, Jr., a former internationally known surgeon, researcher and clinician at the Cleveland Clinic, explains in this book it can be prevented, reversed, and even abolished. Dr. Esselstyn argues that conventional cardiology has failed patients by developing treatments that focus only on the symptoms of heart disease, not the cause.
Based on the groundbreaking results of his 20-year nutritional study—the longest study of its kind ever conducted—this book explains, with irrefutable scientific evidence, how we can end the heart disease epidemic in this country forever by changing what we eat. Here, Dr. Esselstyn convincingly argues that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease, but also reverse its effects.
The proof is in the results. The patients in Dr. Esselstyn’s initial study came to him with advanced coronary artery disease. Despite the aggressive treatment they received, among them bypasses and angioplasties, 5 of the original group were told by their cardiologists they had less than a year to live. Within months on Dr. Esselstyn’s program, their cholesterol levels, angina symptoms, and blood flow improved dramatically. Twelve years later 17 compliant patients had no further cardiac events. Adherent patients survived beyond twenty years free of symptoms.
Drop in cholesterol levels: After 5 years on Dr. Esselstyn’s plant-based diet, the average total cholesterol levels of his research group dropped from 246 milligrams per deciliter to 137 mg/dL (Above 240 mg/dL is considered “high risk,” below 150 mg/dL is the total cholesterol level seen in cultures where heart disease is essentially nonexistent.) This is the most profound drop in cholesterol ever documented in the medical literature in a study of this type.
Cardiac events: The 17 patients in the study had 49 cardiac events in the years leading up to the study, and had undergone aggressive treatment procedures. Several had multiple bypass operations. After beginning the eating plan, there were no more cardiac events in the group within a 12-year period. Angiogram evidence: Angiograms taken of the participants in the study show a widening of the coronary arteries, and thus a reversal of the disease.
PREVENT AND REVERSE HEART DISEASE offers readers the same simple, nutrition-based plan that dramatically changed the lives of his patients forever. With this eating plan, sufferers of heart disease will maintain cholesterol levels low enough to ensure that they will never have a heart attack. Best of all, the book offers more than 150 delicious recipes that Dr. Esselstyn and his wife, Ann Crile Esselstyn, have developed over the years showing readers how easy it is to enjoy their new way of eating.
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Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out
Allan S. Brett, M.D., and Richard J. Ablin, Ph.D.
Forty years after prostate-specific antigen (PSA) was identified and nearly 20 years after it became available for prostate-cancer screening, the U.S. Preventive Services Task Force (USPSTF) recently recommended against PSA-based screening. In the interim, untold millions of men have been tested. Because PSA is not cancer-specific and because prostate cancer's aggressiveness varies widely, controversy and debate about PSA screening were predictable from the outset.
Although we agree fully with the task force's analysis, there are three issues that the panel did not address but that are relevant to primary care clinicians, who initiate most PSA screening. (One of us is a general internist who has discussed the pros and cons of PSA screening with hundreds of patients over two decades; the other discovered PSA in 1970.)
The first issue pertains to office-based decisions about whether to initiate PSA screening. Virtually all guidelines call on clinicians to discuss the benefits and harms of screening and to individualize screening decisions according to patients' values and preferences. For example, the American Urological Association states that decisions "should be individualized, and benefits and consequences should be discussed . . . before PSA testing occurs". The American Cancer Society advises clinicians to provide "information about the uncertainties, risks, and potential benefits" to help men "reach a screening decision based on their personal values".
At first glance, these guidelines appear exemplary, because they embrace the idea of patient-centered informed decision making. However, before 2009 — when results from two large screening trials were finally published — an evidence-based discussion of benefits was impossible because no convincing data existed to support screening. To be sure, clinicians could speculate loosely about potential benefit ("We might catch prostate cancer early enough to save your life") and potential harm ("Screening might result in burdensome interventions with serious complications"). But the idea that physicians could initiate truly informed discussion was wishful thinking, because clinicians and patients had to consider an enormous list of probability estimates and uncertainties: What PSA cutoff is best? What level should trigger repeat PSA testing or biopsy? How often should we repeat either one? What is the patient's pretest probability of cancer? What is the chance that a PSA test plus a biopsy will find cancer, if it's present? If cancer is found, will it be clinically important? Will this patient prefer surgery, radiation therapy, or watchful waiting? What are the probabilities of serious side effects from each treatment, and how will this patient weigh them? Most important, will screening reduce this patient's risk of death from prostate cancer?
All these factors are relevant to discussions of benefits and harms, harmonized with patients' values or preferences. But it was impossible to address so many probabilities and uncertainties coherently during routine office visits. Thus, patients were not really making informed decisions, and office-based discussion of the pros and cons of PSA testing was essentially a charade. Instead, most patients' decisions reflected their general concerns about cancer or their general inclination to accept (or resist) medical interventions.
In March 2009, initial results of the two major screening trials were finally available. Unfortunately, they created more confusion than clarity. A U.S. trial showed no mortality benefit from screening; a European trial showed a small reduction in prostate-cancer–related mortality, but large numbers of men received aggressive treatment to benefit few. Both trials had important methodologic limitations (which are addressed by the USPSTF). Discussions with patients about the benefits and harms of screening have therefore become even more difficult since 2009, since clinicians must now add another layer of uncertainty: explaining why two huge randomized trials were less than definitive and why experts disagree about their interpretation.
The second issue is the variable and often idiosyncratic management of PSA levels in primary care and urology practices. Many PSA levels fall near the commonly used action thresholds in the range of 2.5 to 4.0 ng per milliliter. Men are tested and retested — sometimes several times per year — hoping to hear that their PSA levels "went down" or at least "didn't go up". Patients undergo repeated biopsies, often at arbitrary intervals, after small spikes in PSA levels. PSA screening has even contributed to overuse of quinolone antibiotics, which many clinicians prescribe for lowering mildly elevated PSA levels in asymptomatic men with presumed prostatitis, even though a recent trial showed no difference between the PSA response to antibiotics and placebo.
These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA's limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter and triggers a biopsy that reveals cancer, clinicians refer to ―PSA-detected cancer.‖ But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.
The substantial variability in how clinicians manage serial PSA levels is understandable, since published guidelines are vague and offer little guidance. But the guidelines are vague precisely because the limitations of PSA screening preclude the kind of rational, standardized, evidence-based algorithm that should inform any routine preventive intervention.
The third issue lies at the interface of clinical practice, public health, and responsible stewardship of health care resources. Although the USPSTF explicitly does not consider costs, policymakers cannot ignore economic aspects of screening. Using data from the European screening trial, researchers have estimated that $5.2 million would have to be spent on screening (and the interventions that follow it) to prevent one death from prostate cancer. That estimate does not appear to include the costs of excessive serial PSA testing and repeated office-based encounters devoted to discussions about screening or interpretation of fluctuating PSA results. The extraordinary time, effort, and costs associated with the PSA-screening enterprise must be evaluated against other claims on health care spending and physicians' time and energy. We believe that the current PSA-based screening paradigm does not compare favorably with competing health care priorities.
Some people have argued that PSA screening should at least be available for black men, because the incidence and aggressiveness of prostate cancer are greater in black than in white Americans. This proposal, however well intentioned, is misguided. In 2007, the proportion of deaths among U.S. men that were attributed to prostate cancer was 3.3% among blacks and 2.3% among whites; these rates are close enough that race-specific distinctions for screening are unwarranted. Furthermore, there is no evidence that the balance of benefits and harms from PSA screening differs for blacks and whites. If PSA screening is worthwhile, it should be applied universally; if it is not, selective screening would be a disservice to black men. Eliminating the unconscionable racial gap in overall access to essential health care services would be a far better way to address disparities than promoting a questionably effective cancer-screening program: the percentage of blacks without medical insurance is nearly twice that of whites.
For two decades, primary care physicians have been expected to present a flawed screening test to patients, cloaking the flaws in an elaborate ritual of informed decision making. In turn, men have been expected to make sense of a confusing mix of hypothetical outcomes. Although the USPSTF recommendation is unlikely to end the PSA controversy, a document finally exists that should provide guidance to clinicians and policymakers.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
As your parents get older, how can you be sure they're successfully taking care of themselves and staying healthy? When you visit your aging parents, ask yourself the following questions. Then, if necessary, take steps to help your aging parents maintain their independence.
1. Are you’re aging parents taking care of themselves?
Pay attention to your parents' appearance. Are their clothes clean? Do they appear to be taking good care of themselves? Failure to keep up with daily routines — such as bathing, tooth brushing and other basic grooming — could indicate dementia, depression or physical impairments.
Also pay attention to your parents' home. Are the lights working? Is the heat on? Are the bathrooms clean? Is the yard overgrown? Any big changes in the way your parents do things around the house could provide clues to their health. For example, scorched pots could mean your parents are forgetting about food cooking on the stove. Neglected housework could be a sign of depression, dementia or other concerns.
2. Are you’re aging parents experiencing memory loss?
Everyone forgets things from time to time. Modest memory problems are a fairly common part of aging, and sometimes medication side effects or underlying conditions contribute to memory loss. There's a difference, though, between normal changes in memory and the type of memory loss associated with Alzheimer's disease and other types of dementia. Consider your aging parents. Are memory changes limited to misplaced glasses or an occasionally forgotten appointment? Or are memory changes more concerning, such as forgetting common words when speaking, getting lost in familiar neighborhoods or being unable to follow directions? If you're concerned about memory loss for either of your aging parents, schedule an evaluation with the doctor.
3. Are your aging parents safe in their home?
Take a look around your parents' home, keeping an eye out for any red flags. Do your parents have difficulty navigating a narrow stairway? Has either parent fallen recently? Are they able to read directions on medication containers?
4. Are your aging parents safe on the road?
Driving can sometimes be challenging for older adults. If your aging parents become confused while driving or you're concerned about their ability to drive safely, it might be time to stop driving. To help your aging parents maintain their independence, suggest other transportation options — such as taking the bus, using a van service, hiring a driver or taking advantage of other local transportation options.
5. Have your aging parents lost weight?
Losing weight without trying could be a sign that something's wrong. For aging parents, weight loss could be related to many factors, including:
- Difficulty cooking. Your parents could be having difficulty finding the energy to cook, grasping the tools necessary to cook, or reading labels or directions on food products.
- Loss of taste or smell. Your parents might not be interested in eating if food doesn't taste or smell as good as it used to.
- Underlying conditions. Sometimes weight loss indicates a serious underlying condition, such as malnutrition, dementia, depression or cancer.
If you're concerned about unexplained weight loss for either of your aging parents, schedule an evaluation with the doctor.
6. Are your aging parents in good spirits?
Note your parents' moods and ask how they're feeling. A drastically different mood or outlook could be a sign of depression or other health concerns. Also talk to your parents about their activities. Are they connecting with friends? Have they maintained interest in hobbies and other daily activities? Are they involved in organizations or clubs?
If you're concerned about your parents' moods, schedule an evaluation. Depression can be treated at any age.
7. Are your aging parents able to get around?
Pay attention to how your parents are walking. Are they reluctant or unable to walk usual distances? Is knee or hip arthritis making it difficult to get around the house? Would either parent benefit from a cane or walker? Issues such as muscle weakness and joint pain can make it difficult to move around as well. If your parents are unsteady on their feet, they might be at risk of falling — a major cause of disability among older adults.
There are many steps you can take to ensure your aging parents' health and well-being, even if you live far away. For example:
- Share your concerns with your parents. Talk to your parents openly and honestly. Knowing that you're concerned about their health might give your parents the motivation they need to see a doctor or make other changes. Consider including other people who care about your parents in the conversation, such as other loved ones, close friends or clergy.
- Encourage regular medical checkups. If you're worried about a parent's weight loss, depressed mood, or other signs and symptoms, encourage your parent to schedule a doctor's visit. You might offer to schedule the visit yourself or to accompany your parent to the doctor — or to find someone else to attend the visit. Ask about follow-up visits as well.
- Address safety issues. Point out any potential safety issues to your parents — then make a plan to address the problems. For example, perhaps your parents could use assistive devices to help them reach items on high shelves or to help them stay steady on their feet. A higher toilet seat or handrails in the bathroom might help prevent falls.
- Consider home care services. If you’re aging parents are having trouble taking care of themselves, perhaps you could hire someone to clean the house and run errands. A home health care aide could help your parents with daily activities such as bathing and dressing. You might also consider Meals on Wheels or other community services. If remaining at home is too challenging, you might suggest moving to an assisted living facility.
- Contact the doctor for guidance. If your parents dismiss your concerns, consider contacting the doctor directly. Your insights can help the doctor understand what to look for during upcoming visits. Keep in mind that the doctor might need to verify that he or she has permission to speak with you about your parents' care, which might include a signed form or waiver from your parents.
- Seek help from local agencies. Your local agency on aging — which you can find using the Eldercare Locator, a public service of the Administration on Aging — can connect you with services in your parents' area. For example, the county in which your parents live might have social workers who can evaluate your parents' needs and put them in touch with pertinent services, such as home care workers and help with meals and transportation.
Sometimes aging parents won't admit they need help around the house, and others don't realize they need help. That's where you come in. Remind your parents that you care about them and that you want to do what's best to promote their health and well-being, both today and in the months and years to come.