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消基會董事長程仁宏表示，有20個產品在網頁引述「衛署食字公文字號」，讓消費者誤以為該產品通過衛生署的檢定，但這字號是業者通知衛生署即將販賣該產品，而衛生署回覆的公文字號，不具任何檢定效力；以公文字號當廣告，程仁宏說，已違反食品衛生管理法。 消基會打電話詢問業者，業者聲稱該產品有美國太空總署(NASA)的聲明，可讓太空人使用，還可以治療愛滋，除了內服能改善酸性體質，不管是異位性皮膚炎、黴菌感染、尿布疹等各種皮膚問題，甚至建議牙周病患拿來刷牙，打著「內服外用兩相宜」的療效。 --- 刷牙 「你去刷牙。」 「我漱過口了。」 「你不刷牙，你給我出去。」 「為什麼是我出去，不是妳出去？」 他就這樣把老婆給氣跑了。 現在他每天刷牙。 老婆仍無音訊。 |
State health officials notified 628 patients this week that they should be tested for hepatitis and H.I.V. infection because they were treated years ago by an anesthesiologist in Nassau County who used improper procedures for preventing the spread of blood-borne diseases.
The latest news and reader discussions from around the five boroughs and the region.
The anesthesiologist, Dr. Harvey Finkelstein, of Plainview, first became the focus of a state health investigation in 2005 after two of his patients contracted hepatitis C. His name was reported by Newsday.
Yesterday, county and state officials traded blame over the 34-month delay in notifying the patients. At the same time, the incident led state health officials to seek a meeting with the Centers for Disease Control and Prevention to address an issue of drug packaging that was apparently at the heart of the problem.
In 2005, investigators found that, in violation of widely accepted practices recommended by the C.D.C., Dr. Finkelstein, 52, who specializes in pain management, was reusing syringes when drawing doses of medicine from vials that hold more than one dose.
He would use a new syringe for each patient. But when giving one patient more than one type of drug by injection, his practice of using the same syringe to draw medicine from more than one vial led to the potential contamination of the vials. The blood of a patient who was infected with hepatitis C could, by backing up through the syringe and entering the vials, infect another patient when the same vial of medicine was used again. This is what happened in at least one case, health officials said.
State health officials said yesterday they hoped to get the C.D.C.’s support in seeking the elimination of such multidose vials.
Any fix would come too late for Raymond Bookstaver, 49, a Hicksville mechanic who was one of two patients initially identified as having been infected by Dr. Finkelstein’s improper use of syringes.
“I feel like I went to a doctor for help, and what I got instead was a death sentence,” Mr. Bookstaver said. His hepatitis is being treated, but erupts unpredictably, causing him to suffer flulike symptoms including nausea, vomiting and aching that leaves him bedridden, he said.
At least one and possibly more doctors in the state, including a New York City anesthesiologist, have been reported to state health officials in the last several years for reusing syringes. State officials said they would cite those reports in their meetings with C.D.C. officials.
In 2005, Dr. Finkelstein was instructed in the proper use of syringes in administering pain medications by state health investigators and he has since been monitored to make sure he complied, a State Health Department spokesman said.
For reasons that were unclear yesterday, his case was not referred to the State Board for Professional Medical Conduct of the State Education Department until nine months after his unsafe practices were known.
That agency, charged with taking disciplinary actions against doctors, found no evidence of wrongdoing, and recommended no disciplinary action.
In January 2005, the Health Department began an epidemiological investigation to determine how many of Dr. Finkelstein’s patients were infected by the vials of medicine that he had used more than once.
Investigators notified 98 patients who had received epidural injections for pain management in the three weeks before, during and after Dr. Finkelstein’s two patients were infected, telling them to get tests for blood-borne infections including hepatitis and H.I.V.. Of the 84 who were tested, no other cases of infection were traced to Dr. Finkelstein.
The state then expanded its investigation to cover the years from 2000 to 2005. It was in 2000, Dr. Finkelstein told the investigators, that he began using one syringe to draw doses from numerous vials. In a statement released this week, the state health commissioner, Richard Daines, said “the department identified all 628 patients who had received injections between Jan. 1, 2000, and Jan. 15, 2005, after a thorough review of medical records at all sites where this physician practiced.”
The Nassau County executive, Thomas R. Suozzi, called the long delay in making the notifications “outrageous,” and blamed Dr. Finkelstein and state health officials who he said were overly deferential in their negotiations with the physician’s lawyers.
Claudia Hutton, a spokesman for Commissioner Daines, said that it was routine for the department’s staff to negotiate with a doctor’s lawyers in its investigations, and added: “We worked with Nassau County hand in hand. They were with us all the way. It’s nice that our partners are now playing 20-20 hindsight, but that’s life.”
State health officials acknowledged that the process, begun under the previous health commissioner, could have been more efficient. But they also said that before informing large numbers of patients, they wanted to make sure they only informed those who were at risk of being exposed, to avoid public panic.
“The commissioner wishes it were faster,” said Ms. Hutton, the department spokesman, “and it’s something he’s going to look at and sit down to figure out why the things happened the way they did and how we could have done it more efficiently.”
But, she added, “epidemiological investigations do take a while, and what we had here — it’s not like we found 25 cases within a two-week time frame — we thought we should be cautious.”
But patients and consumer advocates said the delay from January 2005 to November 2007 was a disservice to the public.
Though Mr. Bookstaver’s illness was diagnosed almost immediately by his family doctor, he said that other patients — the 628 notified this week, for example — might not have been as lucky. “What if they have been living with these diseases all this time untreated? And thinking they had the flu?” he said.
Joanne Doroshow, director of the New York-based Center for Justice and Democracy and a member of a state task force on medical malpractice, said the case illustrated “a too-cozy relationship between the medical profession and the people who supposedly regulate them.”
Michael Duffy, a lawyer who specializes in medical malpractice cases and vice president of the New York State Academy of Trial Lawyers, said that the long delay in notifying the 628 potential victims of Dr. Finkelstein’s practice was especially troubling because none would be able to seek damages in court.
與蔡醫師的一席話（1998年元月26日午；澄清醫院咖啡屋）
蔡醫師仍然很風趣，他帶領我們看看中港路澄清醫院的設計（日本人設計）。他把病房的門打開再關上，閉上時都會慢慢地閉合，不會夾到手，也不會發出聲音。
我們試用一下兒童病房內的洗手間，我注意到尺度考慮過兒童的身材大小，只是，天呀！連衛浴器材都用TOTO牌的，未免太…。其它如大廳、鐘面、椅子等等之色彩的講究，結帳的等待室，在在有日本人的細心。
蔡醫師說，醫院管理受到建築設計影響極大，例如他們高階主管在高樓，無法與主治醫師們一起，他認為不好。
醫院很大的問題是各專科設備投資愈來愈大（近視手術設備就要二千多萬元，耳鼻喉科五百多萬元…）所以究竟專門或綜合，對人才（近來有八位主治醫師會加入，他面談醫師極重視背景的了解…）及資源（有限）都有很大的影響。
醫院就專職管理者而言，發展其實很有限，而且這行要先有專業知識，才能與人講專業語言。
現在很大的問題是要使現場人員能對人微笑，知道他們所面對的是人，而不要只自顧忙 他的工作，做完後就下一號。標準作業程序（SOP）沒用，這些應對進退SOP都有，可是尚未能做到。〝May I Help You ?〞的主動協助心態仍待建立，現場的人要對排隊等待的人的心理了解。
現在醫院很競爭，所以無法像一般工廠或單位安排放長假，這點員工很不諒解。蔡醫師問杜邦怎麼做，我向他解釋杜邦全球所有的員工，不分等級，大家有相同的200股認購權。
蔡醫師提一個例子，某組助理二人中有一人要請長假，所以工作要由一人擔，他認為那做事的可以多拿點錢，上級不同意，說為何別人不會來幫忙。問題之一是大家都很專，不願意走出自己的領域，沒有「多能工」的概念。
主治醫師如果肯用心，五十餘位，很容易吸引百位病人，那麼病床使用率就會大大提高（每間平均設施百萬元）。他們現在把主治醫師的開會改成Club的方式，每月請人來講一些修養的東西，例如「如何欣賞抽象畫…」等等，有機會請鍾老師談談「顧客之聲」。
蔡醫師談日本的管理特色是Follow (up)、做；美國是存疑，要將一套理論改改再用；我們則是莫不關心（Indifference）。
我向他說日本的成功之道有三套半，一是頂級負責人承諾要做好；二是大規模的教育訓練，品質教育要從頭來、自己來，要能找出如何貫徹團隊一體的心，上級的願景方式；三是要有持續改善，一件接一件不斷合作改善的習慣（合作團隊學習）。
蔡醫師的碩士論文是《主治醫師的滿意度調查》，彰化基督教醫院的百位中有七十多人與他談過，我認為這是很符合「新人才資源管理」的主題，希望他可以為我們發表摘要。
在亞洲，不少女士們都儘量避免曬太陽，主要是怕臉上會出現雀斑以及皮膚可能提早老化。如果專家告訴你，曬太陽可以延緩衰老達五年之多，女士們會不會重新考慮？
科學家發現，不常曬太陽，以及透過進食時吸收的維生素D不足夠的人，他們體內的基因就會受損，導致老化以及與年齡有關疾病的出現。
人體內有90%的維生素D是經過暴露在太陽光下自行產生的，因此這類維生素D被稱為“陽光維生素”（sunshine vitamin）。
缺乏維生素D所造成的損害影響是巨大的。從生理上來說，“陽光維生素”低的人比高的人，要早老五年。
陽光的保護作用
倫敦大學國王學院（King's College）的首席研究員布蘭特•理查茲（Brent Richards）醫生說：“研究的結果是令人興奮的，因為這是首次有研究顯示體內維生素D高的人可能較體內維生素D低的人老化得較慢。”
他說：“這也解釋了維生素D如何保護人體，避免與年齡有關的疾病，例如心臟病等。”
協助撰寫這份報告的國王學院的蒂姆•斯佩克特（Tim Spector）教授說，研究顯示人們應該花多一點時間曬太陽，以及進食含維生素D高的食物，例如魚、雞蛋、強化奶、早餐麥片或補充劑（supplement）。
皮膚癌的恐懼
斯佩克特教授說，在英國人口當中，相信有大約三分一人缺乏維生素D，因此，數以十萬計的人有可以致命的疾病。
此外，也有人擔心，在陽光下暴曬過多，會導致皮膚癌出現。英國每年有1,800人死於皮膚癌。
不過，英國癌病研究基金會（Cancer Research UK）的亨利•斯考克羅夫特（Henry Scowcroft）說，要得到“陽光維生素”並不需要在陽光下長期暴曬，只要暴露在陽光下一點點時間便足夠。
文／馮超傑
常有一些攝護腺肥大患者因排尿問題，在不同醫院看了不同的泌尿科醫師，結果得到不一樣的答覆。有的醫師認為，需要手術治療；有的醫師認為藥物治療即可；有些患者接受了手術治療後，排尿不適的症狀不但沒有改善，甚至有時症狀反而加劇，術後仍需服用藥物治療。
攝護腺肥大是50歲以上男性常見疾病，位於攝護腺尿道周圍的腺體不正常的增生所造成，攝護腺肥大雖然不會要人命，卻會造成生活上很大的不便。
常 見攝護腺肥大的外徵表現有頻尿、尿流遲緩、急尿及夜尿等。臨床上，有些患者攝護腺僅有輕度肥大的現象，但是他的頻尿及夜尿的現象卻已很明顯，代表患者可能 伴隨有膀胱過動症等其他非攝護腺因素；有些患者在肛門指診、經直腸超音波檢查，發現攝護腺有明顯的肥大，但是排尿不適的症狀並不明顯，顯示攝護腺的整體肥 大並不必然會壓迫到尿道。
因此如果僅憑患病症狀、肛門指診、超音波或是尿流速檢查，就認為是攝護腺肥大所造成是不夠的，因為有時會誤判。如 果對前述患者貿然施行攝護腺切除手術，尤其是攝護腺僅有輕度肥大患者，在攝護腺組織不多的情況下，特別容易將沒有肥大的正常攝護腺組織也切除，或是手術 時，傷到膀胱頸附近的逼尿肌，造成逼尿肌反射亢進，膀胱頸也可能由於疤痕組織收縮，造成狹窄，使得病人在術後排尿不順的情況無法改善。
對於排尿不適症狀為輕度或中度患者，正確的治療是以觀察或是服用藥物為主，不建議以手術治療。
對於因攝護腺肥大造成反覆尿瀦留、復發性尿路感染、復發性肉眼可見的血尿、膀胱結石、大的膀胱憩室等，則建議以手術切除增生的攝護腺組織。
膀 胱鏡檢查對於排尿不適症狀為輕度或中度，且以藥物治療的患者並不需要；但是對於藥物治療無效，有可能進行手術治療患者，除非術前已可明確將排尿不適原因歸 咎於攝護腺肥大，否則最好先在門診施行膀胱尿道鏡檢查，以確定攝護腺肥大，並且壓迫到尿道者，再入院手術，如此可避免患者在進了手術室施行麻醉後，才發現 攝護腺僅有輕度肥大，並沒有阻塞尿道，但又因為箭已在弦上，而接受了不必要的攝護腺切除，使患者未蒙其利反受其害。
臨床經驗顯示，年齡在 60歲以下需要以攝護腺切除手術來治療排尿不適的比率較低，因此患者年齡在60歲以下，或是排尿症狀不嚴重（例如夜裡需起床解尿1至2次），在接受攝護腺 切除手術的建議前，最好再詢問其他專業醫師的第二意見，做審慎的評估，以免術後排尿問題無法獲得應有的改善。
攝護腺肥大的發生率會隨著年齡的增高而增加，對於藥物治療無效，且臨床評估確實是由於攝護腺肥大所造成的排尿不適患者，手術切除增生的攝護腺組織，對於改善患者排尿不適、維持生活品質，是有立竿見影的效果。
高齡患者並非不適合手術治療，而是需要視病人的身體狀況而定。臨床上，就有一名高齡93歲患者術後恢復情形和常人一樣迅速。
總之，攝護腺肥大症狀的嚴重度，或是攝護腺肥大的程度，絕非決定手術的唯一因素，而需將兩者一併考慮。
至於術前的膀胱鏡檢查，雖然不能單獨做為施行手術的依據，但是卻可以將不需要手術的患者篩選出來，免除了不當的手術。
（本文作者為台中光田綜合醫院泌尿科主治醫師）
About two years ago, a group of federal researchers reported that overweight people have a lower death rate than people who are normal weight, underweight or obese. Now, investigating further, they found out which diseases are more likely to lead to death in each weight group.
Share your thoughts on this article.
Linking, for the first time, causes of death to specific weights, they report that overweight people have a lower death rate because they are much less likely to die from a grab bag of diseases that includes Alzheimer’s and Parkinson’s, infections and lung disease. And that lower risk is not counteracted by increased risks of dying from any other disease, including cancer, diabetes or heart disease.
As a consequence, the group from the Centers for Disease Control and Prevention and the National Cancer Institute reports, there were more than 100,000 fewer deaths among the overweight in 2004, the most recent year for which data were available, than would have expected if those people had been of normal weight.
Their paper is published today in the Journal of the American Medical Association.
The researchers also confirmed that obese people and people whose weights are below normal have higher death rates than people of normal weight. But, when they asked why, they found that the reasons were different for the different weight categories.
Some who studied the relation between weight and health said the nation might want to reconsider what are ideal weights.
“If we use the criteria of mortality, then the term ‘overweight’ is a misnomer,” said Daniel McGee, professor of statistics at Florida State University.
“I believe the data,” said Dr. Elizabeth Barrett-Connor, a professor of family and preventive medicine at the University of California, San Diego. A body mass index of 25 to 30, the so-called overweight range, “may be optimal,” she said.
Others said there were plenty of reasons that being overweight was not desirable.
“Health extends far beyond mortality rates,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston.
Dr. Manson added that other studies, including ones at Harvard, found that being obese or overweight increased a person’s risk for any of a number of diseases, including diabetes, heart disease and several forms of cancer. And, she added, excess weight makes it more difficult to move about and impairs the quality of life.
“That’s the big picture in terms of health outcomes,” Dr. Manson said. “That’s what the public needs to look at.”
Researchers generally divide weight into four categories — normal, underweight, overweight and obese — based on the body mass index, which is a measure of body fat based on height and weight. A woman who is 5 foot 4, for instance, would be considered at normal weight at 130, underweight at 107 pounds, overweight at 150 pounds and obese at 180.
In this study, those with normal weight were considered the baseline and others were compared to them.
The federal researchers, led by Katherine Flegal, of the Centers for Disease Control and Prevention, said the big picture they found was surprisingly complex. The higher death rate in obese people, as might be expected, was almost entirely driven by a higher death rate from heart disease.
But, contrary to expectations, the obese did not have an increased risk of dying from cancer. They were slightly more likely than people of normal weights to die of a handful of cancers that are thought to be related to excess weight — cancers of the colon, breast, esophagus, uterus, ovary, kidney and pancreas. Yet they had a lower risk of dying from other cancers, including lung cancer. In the end, the increases and decreases in cancer risks balanced out.
As for diabetes, it showed up in the death rates only when the researchers grouped diabetes and kidney disease as one category. Diabetes can cause kidney disease, they note. But, the researchers point out, the number of diabetes deaths may be too low because many people with diabetes die from heart disease, and often the cause of death is listed as a heart attack.
The diverse collection of diseases other than cancer, heart disease and diabetes, which show up in the analyses of the underweight and the overweight, have gone relatively unscrutinized among epidemiologists, noted Dr. Mitchell Gail, a cancer institute scientist and an author of the paper. But, Dr. Gail added, “these are not a negligible source of mortality.”
The new study began several years ago when the investigators used national data to look at death risks according to body weight. They concluded that, compared with people of normal weight, the overweight had a decreased death risk and the underweight and obese had increased risk.
That led them to ask if being fat or thin affects a person’s life span, what diseases, exactly, are those individuals at risk for, or protected from?
The research involved analyzing data from three large national surveys, the National Health and Nutrition surveys, which are administered by the National Center for Health Statistics. Their participants are a nationally representative group of Americans who are weighed and measured, assuring that heights and weights are accurate, and followed until death. The investigators determined the causes of death by asking what was recorded on death certificates.
The researchers caution that a study like theirs cannot speak to cause and effect. They do not yet know, precisely, what it is about being underweight, for instance, that increases the death rate from everything except heart disease and cancer. Researchers tried to rule out those who were thin, because they might have been already sick. They also ruled out smokers, and the results did not change.
Dr. Gail, though, had some advice, which, he said, is his personal opinion as a physician and researcher: “If you are in the pink and feeling well and getting a good amount of exercise and if your doctor is very happy with your lab values and other test results, then I am not sure there is any urgency to change your weight.”
大概在17年前 我當時任職的Du Pont公司申請一隻基因鼠的專利
過數年公司將21世紀的口號訂為
The Miracles of Science.......
2007.11.02 • 14:38 EST
In news sure to shiver exterminators everywhere, scientists at Case Western Reserve University have created a super mouse. A mighty mouse! And not just one -- 500 of them! As a result of genetic engineering that boosts the level of an important skeletal muscle enzyme, these little buggers are markedly more active, more aggressive, fitter, and can breed and live longer than ordinary mice.
Whereas a regular rodent can't last an hour on a treadmill -- a cute little mousey treadmill, naturally, not one you find at Gold's -- the super mice can run five or even six hours at 20 meters per minute. An ordinary female mouse can't have any baby mice after she's about a year old, but the mighty mice can reproduce well past age 2.
Richard Hanson, a biochemistry professor who developed the mice with the help of his mousey grad students, offers this quotable quote in a press release: "They are metabolically similar to Lance Armstrong biking up the Pyrenees; they utilize mainly fatty acids for energy and produce very little lactic acid."
The engineered mice have very high levels of an enzyme called phosphoenolpyruvate carboxykinase, or PEPCK-C. Ordinary mice have only 0.08 units of PEPCK-C per gram of skeletal muscle -- super mice have an amazing 9 units per gram.
As a result, their metabolisms are through the roof. And when exercising, super mice rely on fatty acids for their fuel, while ordinary mice use carbohydrates, which raises the level of lactic acid in their blood.
Alas, the researchers say they're not going to do the same thing in humans. "The ethical implications are such that this approach should not be used in humans, or is it technically possible at this time to efficiently introduce genes into human skeletal muscle, in order to mimic the effect seen in our mice," Hanson says. One wonders if the Defense Department feels the same way. (Or maybe the DoD will just use super mice to go after Iran?)
The mouse study is published in the Journal of Biological Chemistry.
Here's a video of the super mouse in action. The mouse in the back is an ordinary rodent -- watch how quickly he conks out, while the enzymey mouse in front keeps going.
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老鼠也能跑馬拉松。美國學者透過基因工程成功繁殖出能連續跑六個小時不用休息的「威力鼠」（mighty mouse）。學者表示，這種威力鼠的相關研究，可以促進新藥研發，甚至藉此強化運動員的體能。 參與研究的俄亥俄州凱斯西儲大學生物化學教授韓森說，威力鼠能以每分鐘廿公尺的速度連續跑六個鐘頭，一天能跑六公里。 威力鼠體內新陳代謝機制極佳，以消耗脂肪酸的方式產生能量。由於體內產生的乳酸極少，這種老鼠的肌肉不容易有疲累感，好比在環法自由車賽七連霸的阿姆斯壯在庇里牛斯山區騎車，一馬當先。 學者說，「威力鼠」計畫在探索一種名為PEPCK-C的酵素在肌肉與細胞組織中的代謝功能。 學者修改了老鼠的基因，使基改鼠體內產生大量的PEPCK-C，這種酵素的增加，顯然提高了老鼠體內脂肪轉換成能量的效率。韓森說：「就算不吃不喝，它們還是能連續跑四或五個小時。」 英國每日郵報指出，四年前研究人員就成功創造出第一隻威力鼠，但是直到最近才在「生物化學期刊」公布成果。研究人員至今總共繁殖了五百隻。 新型基改鼠的食量比實驗控制組中的野生老鼠多百分之六十，體重是一般老鼠的一半，吃再多仍能保持苗條，活動力是一般家鼠的十倍。 一般老鼠平均壽命是兩年，這種基改鼠能活三年。基改母鼠的生育期也比其他老鼠長，普通老鼠一歲之後就不再生育，但母的基改鼠到兩歲半仍能生小鼠。 更大的驚奇是威力鼠的誕生，來自研究團隊運用標準基改技術處理老鼠體內單一的新陳代謝基因，人類也有相同的基因。 |
Public health
Nov 1st 2007
From The Economist print edition
EVERY day there are new stories in the tabloids about the latest link, sometimes tenuous, sometimes contradictory, between cancer and some aspect of lifestyle. If this is a recipe for confusion, then the antidote is probably a weighty new tome from the World Cancer Research Fund (WCRF). It is the most rigorous study so far on the links between food, physical activity and cancer—and sets out the important sources of risk.
Individually (except for smoking) these risks are quite small. However, many a mickle makes a muckle, and in total they add up to something significant. Roughly speaking, smoking is responsible for a third of cancers (smoking 20 cigarettes a day increases your risk of lung cancer 20-fold), poor food and lack of exercise result in another third, and other causes account for the rest. Some of this last third are known: genetic predisposition, ultraviolet sunlight, pollutants such as pesticides, and other factors including cosmic radiation and a naturally occurring radioactive gas called radon. But the picture is undoubtedly incomplete.
The research has taken six years, involved nine research institutes, and examined more than half a million publications—which were whittled down to 7,000 relevant ones. From these, the new guidelines spring. Few come as news (see table), but the most surprising is the degree to which even being a bit overweight is a risk. One of the most important things a person can do to avoid cancer is to maintain a body mass index (BMI) of between 21 and 23. According to the WCRF's medical and scientific adviser, Martin Wiseman, each five BMI points above this range doubles the risk of post-menopausal breast cancer and colorectal cancer.
For those unfamiliar with BMI, it is calculated by dividing a person's weight in kilograms by the square of his height in metres. Until now, a healthy BMI has been thought of as being between 18.5 and 24.9. The report implies that this range should be narrowed. It is not enough to avoid being clinically obese, or even just a bit overweight. To minimise your risk of cancer, you have to avoid getting fat at all.
Indeed, paying attention to what you eat and drink seems to be the report's watchword. The list is depressingly familiar from injunctions relating to what is coming to be known as metabolic syndrome (obesity, late-onset diabetes, high blood pressure, heart disease and kidney failure, which are starting to look like symptoms of a single, underlying problem). Why cancer and metabolic syndrome might be connected is not yet clear. Cancer is caused by mutational damage to genes that otherwise hold a cell's reproductive cycle in check, and thus stop that cell proliferating. Metabolic syndrome, as its name suggests, seems to be related to the way cells process fats and sugars. There may be no direct link. But it may be that metabolic syndrome involves the production of growth-stimulating molecules that help cancers along.
On the matter of the miscellaneous final third, Devra Davis, an epidemiologist at the University of Pittsburgh and the author of a new book* on cancer, argues that more attention needs to be paid to pollutants and chemical hazards. Few Americans, she says, are aware that the roofs of 35m homes may be insulated with material containing asbestos (which is linked to a cancer called mesothelioma). She observes that a forthcoming report from America's Government Accountability Office will criticise the government for its lack of public warnings about such risks.
There is also concern in America about the overuse of medical X-rays, especially in emergency rooms. Not many people, for example, are aware that computerised tomography (CT) scanning uses large doses of X-rays. A scan of a baby's head is equivalent to between 200 and 600 chest X-rays. However, Dr Wiseman says these risks account for a trivial number of cancers and guesses the remainder are also something to do with nutrition.
With hazards everywhere, plus the complications of genetic predisposition and age, it is hard for someone to work out his actual risk of developing either cancer or metabolic syndrome. If that is a recipe for inaction—as it often is—there may be a solution in the form of a personalised health check-up called the PreventionCompass.
This system has been developed by the Institute for Prevention and Early Diagnostics (NIPED), a firm based in Amsterdam. It requires the customer to answer a detailed questionnaire about his way of life and to undergo a series of tests. It draws its conclusions by running the results through a “knowledge system”—a database that pools expertise from many sources.
Coenraad van Kalken, NIPED's founder, says his scientists have programmed in risk factors for cancer, cardiovascular disease, diabetes, kidney disease, lung disease, “burn-out”, depression and other psychological disturbances. The system can, for example, use family history and elevated levels of a particular protein in the blood to work out who should undergo a biopsy to look for prostate cancer. And because it looks at lifestyle as well as biochemistry, it could similarly suggest lower alcohol consumption and a colonoscopy to someone at risk of colorectal cancer.
In the case of this disease, and also breast cancer, such early diagnosis prevents a serious and incurable condition. Bob Pinedo, the director of the Free University medical centre in Amsterdam, told a symposium held by the European School of Oncology in Rome on October 26th that it costs €250,000 ($360,000) to treat (not cure) a patient with late-stage colorectal cancer for 20 months. In the Netherlands, that would pay for 1,000 colonoscopies.
Given the rising costs of dealing with cancer alone—in America this is more than $100 billion a year—prevention and early detection look set to take off. In trials of the PreventionCompass that NIPED conducted last year, more than 75% of the staff of four Dutch companies volunteered to join the scheme. Moreover, occupational-health officers in these companies claim that more than half their staff actually made changes to their way of life as a result. Not bad for a system that costs about €100 a year for each employee.
This year two large insurance companies, which provide corporate health-care, income and disability insurance to employees, are offering to lower the premiums of customers who sign up to the PreventionCompass. Next year, the plan is to extend the scheme more widely, by recruiting Dutch GPs to offer it to people from lower-income groups who do not have such private health insurance.
The message, then, is prevention, not cure. And it is a message that needs to be heeded across the world as poor countries grow wealthier and adopt the eating habits and sedentary lives of the rich. It is an irony that evolution has shaped people to enjoy fat, sugar and indolence—things in short supply to man's hunter-gatherer ancestors, and desirable in the quantities then available. Wealth allows them to be indulged in abundance. Unfortunately, human bodies have evolved neither to cope nor, easily, to resist.
bbc
少喝酒、少吃紅肉
英國多份報章今天都在頭版報道了與健康有關的消息，取材重點雖然不一，但主題是一致的，就是如何才能保持健康。
《泰晤士報》的標題是“擊敗癌病的新手則(sic)”。文章列舉了多項該做與不該做的事情。該做的事情包括每天運動、吃青菜穀物、母乳餵養嬰兒與保持苗條。
文章列舉不該做的事情比較多一點，這包括不要吃加工食品、不要吃太多紅肉、不要吃快餐、不要吃太多鹽、不要喝甜的飲料與不要喝太多酒。
《每日電訊報》報道說，專家提出警告，除非減少喝酒的分量以及減少吃紅肉，不然，數以百萬計的人可能會患上癌病。
報道說，這份全面的檢討報告顯示，一個人是否肥胖，他的飲食習慣和有否運動，關係著他患上癌病的機率。 
腌肉、火腿被勸籲不要吃
《每日郵報》報道說，21位國際專家代表世界癌病研究基金會花了450萬英鎊所做的研究報告受到食品界的質疑。此外公眾也納悶，如果腌肉、火腿與香腸這類加工製品都不能夠吃，那麼什麼才是安全食品？
The recommendations include avoiding processed meats such as ham, bacon, salami or any other meat preserved by smoking, curing or salting
Being even slightly overweight can increase the risk of a range of common cancers including breast, bowel and pancreatic cancer, a landmark study has found.
The largest review of links between diet and cancer, incorporating more than 7,000 studies, concludes that there is convincing evidence that excess body fat can cause at least six different types of the disease. The researchers give warning that everyone should be at the lower end of the healthy weight range.
Their recommendations include avoiding processed meats such as ham, bacon, salami or any other meat preserved by smoking, curing or salting; only consuming small amounts of red meat; moderate consumption of alcohol; and avoiding junk food and sweet drinks.
Professor Sir Michael Marmot, who chaired the expert panel assembled by the World Cancer Research Fund (WCRF) to review evidence on the dietary causes of cancer, said he had been shocked to find that weight was so important.
A report by the fund published ten years ago linked only one cancer to being overweight. Professor Marmot said the evidence now showed that at least six – cancers of the oesophagus, pancreas, bowel, breast postmenopause, kidney and endometrium (womb lining) – were linked and that the risks were increased by even quite modest weight gains.
The finding is particularly alarming, given the expanding girth of the British population. An official report last month gave warning that by 2050, 60 per cent of men, 50 per cent of women and a quarter of all children could be clinically obese.
A healthy weight is defined as having a body mass index (BMI) below 25; BMI is calculated by dividing an individual’s body weight in kilograms by the square of the height in metres.
Sir Michael said: “A BMI of 25 is fine, but it would be a bit finer if it was lower. The healthiest thing is to be as low as possible within the normal range.” The report suggests moderation in the consumption of red meat, suggesting a limit of 500g (18oz) per person per week. A total avoidance of processed meats is recommended because of convincing evidence that eating meat increases the risk of colon cancer.
The WCRF report emphasises the benefits of exercise, for its direct effects on some cancers, and because it helps to prevent becoming overweight or obese. It made ten recommendations which do not, save in one case, conflict with advice given for the avoidance of other common causes of death, such as heart disease.
The exception is alcohol, which Professor Marmot said had been shown to cut the risk of heart disease. For cancer prevention the optimum level is zero, but for heart disease it is two units a day for men and one for women, he said. The panel agreed that the levels set for minimum heart risk should be accepted.
The report is based on an analysis of cancer studies from around the world dating back to the 1960s. The initial trawl produced half a million studies, which was pared down to the best 7,000. The results were analysed by nine teams and then presented to a panel of twenty-one leading scientists for their recommendations. They looked at cancers at 17 different sites in the body and at a wide range of factors, mostly dietary, that can affect risk of developing the disease.
Professor Marmot said: “We are recommending that people aim to be as lean as possible within the healthy range, and that they avoid weight gain throughout adulthood. This might sound difficult but this is what the science is telling us more clearly than ever. The fact is that putting on weight can increase your cancer risk, even if you are within the healthy range.”
Dairy foods, cheese, butter, coffee and fish get a clean bill of health. But sugary drinks – including fruit juices – can increase weight and are therefore not recommended. Nor are fast foods because they are energy-dense and lead to excess weight or obesity, which in turn increase cancer risks.
Professor Martin Wiseman, the project director, said: “This report’s recommendations represent the most definitive advice on preventing cancer that has ever been available anywhere in the world.”
Breast-feeding has a double benefit, the report says, protecting mothers against breast cancer and their babies against obesity. Mothers were advised to breastfeed exclusively for six months and to continue with complementary breastfeeding after that.
Dietary supplements for cancer prevention were not recommended, since there was evidence that at high doses they could have adverse effects. But selenium, in the diet or as a supplement, did appear to have benefits against lung, colon and prostate cancer.
Professor Mike Richards, the Government’s clinical director of cancer, said: “The WCRF report is the most authoritative and exhaustive review done thus far on the prevention of cancer through food, nutrition and physical activity. For those of us wanting to lower our risk of developing cancer, it provides practical lifestyle recommendations.”
Karol Sikora, Professor of Cancer Medicine at Imperial College School of Medicine, said: “The educational message for the public should be that there are healthy diets and unhealthy diets, but we should keep everything in perspective and not suggest rigid avoidance. Alcohol, red meat and bacon in moderation will do us no harm, and to suggest it will is wrong.”
Chris Lamb, consumer marketing manager at the British Pig Executive, said that people should continue to eat bacon “in a responsible way as part of a balanced diet”. Cancer was a “complicated subject” and could not be prevented simply by reducing intake of meat.
“Two thirds of all cancers are not caused by diet. Just by addressing the meat issues, you are not necessarily going to prevent cancer,” he said.
Mr Lamb said that the average consumption of red meats was less than 500 grams per week in any case, so many people did not need to change their eating habits at all.
He added that there were concerns amongst farmers that sales of processed meats could fall as a result of the report. “That is obviously a potential at the end of the day, but we’re hoping that consumers will think about being responsible in overall terms.”
The ten WCRF recommendations:
Be as lean as possible within the normal range of body weight
Be physically active as part of everyday life
Limit consumption of energy-dense foods, and avoid sugary drinks
Eat mostly foods of plant origin
Limit intake of red meat and avoid processed meat
Limit alcoholic drinks
Limit consumption of salt, and avoid mouldy cereals or pulses
Aim to meet nutritional needs through diet alone
If a new mother, breastfeed your baby
Cancer survivors should follow the recommendations for cancer prevention
some healthcare quality links醫療品質網站(部分)
