Monthly Archives: February 2008

Race will aid runner facing new challenge

  • 2/28/2008
  • Tacoma, WA
  • Craig Hill
  • theNewsTrib.com

When Rochel Cobb thinks of her dad, she thinks of running.
She thinks of the frigid jogs together through the snow when she was a girl. She remembers the family reunions her dad organized at various fun runs around the country.

And, perhaps most vividly, she remembers the day in 2004 when her dad finished the Avenue of the Giants Marathon 10 years after doctors told him he’d never run again.

So in August, when her dad, Bobby Goddard, learned he had a life-threatening form of tongue cancer, she knew the perfect way to honor him.

Cobb’s idea was the Live, Love, Run! a race through Point Defiance Park she hopes will become an annual event. She says her goal for the run on Saturday is to raise money to cover the more than $30,000 in treatment and to encourage people to “pursue things despite adversity.”

Eventually, the Goddard family hopes the run will fund a health awareness center it wants to open in Bobby Goddard’s honor.

Bobby Goddard, a 57-year-old general contractor in Tacoma, started radiation treatment in late January. Doctors say there is a 50-percent chance the treatment will work. If it doesn’t, Goddard’s wife, Jamie, says doctors may have to remove part of Bobby’s tongue.

Bobby has beaten longer odds.

In 1994, he fell 25 feet off of a roof and broke 14 bones including his hips and a leg.

“It was pretty terrible,” said Jamie Goddard. “He had pulleys over his bed so he could pull himself up with one arm. It took a lot of physical therapy just so he could walk without a limp.

“Doctors said he would need a hip replacement and that he’d never run again.”

The doctors were wrong on both accounts.

“That was the biggest challenge of my life,” Bobby Goddard said in an interview that had to be conducted by e-mail because of his treatment. “As I passed over the finish line, I felt like I was hugged by angels. I was unexpectedly overwhelmed.

“Knowing that I was able to accomplish this goal gives me the confidence that I can pull through this as well.”

As his family plans the run and an auction, which will be held Feb. 15, they seem to gain strength from Bobby.

“He’s amazing,” Cobb said. “We want to get out his message that your dreams are worth going after even if it gets difficult.”

Cobb moved to Tacoma to organize the race, leaving her husband, Kurtis, behind in Phoenix. Susan Goddard, Bobby’s sister, moved from Michigan to help.

“I am overwhelmed with the love and support of my family,” Bobby said. “… I’m looking forward to crossing the finish line on race day.”

Jamie says Bobby hopes to walk the two-mile course on race day. The race also has 10- and 5-kilometer courses.

Cobb, 27, says her dad’s struggle has made her cherish her time with him even more.

“It puts into perspective your own mortality,” Cobb said. “I don’t have kids, and – when I do – I wonder if my dad will ever get to meet them.

“It makes you want to live wholly and pursue things despite adversity.”

If runners get nothing else from Saturday’s run through Point Defiance, Bobby Goddard hopes they hear that message.

“In the future, I believe that this race will be one of the biggest and most popular races in Washington,” he said. “The goal is to raise funds for the awareness center and have a positive impact on a lot of people’s lives.”

February, 2008|Archive|

OraMoist outperforms leading mouthwash, study says

  • 2/25/2008
  • Tulsa, OK
  • staff
  • Dental Economics (www.dentaleconomics.com)

Patients suffering from dry mouth (xerostomia) preferred treatment with a new, adhesive oral disk called OraMoist rather than treatment with the leading oral rinse, according to a new study.

The study was conducted by Dr. Doron Aframian at Hadassah Medical Center in Israel. One group of patients suffering from xerostomia was treated with OraMoist, the other with the leading mouthwash.

Results included:
1) 70 percent of those treated with OraMoist reported they would use the product in the future, compared to 30 precent of those using the mouthwash.

2) Patients treated with OraMoist showed an increase of saliva production from .11 ml/2 min to .19 ml; the patients treated with mouthwash increased only from .09 ml to .10 ml.

3) Both groups reported a statistically significant reduction in xerostomic sensation, but the moisturizing effect of OraMoist lasted longer than that of the mouthwash.

OraMoist is a disk that adheres to the roof of the mouth, and releases ingredients that help moisten the mouth for up to four hours. It slowly releases tricaprin, a lipid that lubricates and moistens the mouth for up to four hours, and calcium carbonate, citric acid and natural lemon to stimulate saliva production and restore proper Ph balance to the mouth.

Dry mouth results from health conditions, aging, drugs, or lifestyle choices. Diabetes, Parkinson’s disease, and Sjogren’s syndrome cause xerostomia, as do more than 1,000 prescription drugs. Smoking or drinking alcohol or caffeine can also cause dry mouth.
According to the 2002 U.S. annual report on oral health, 17 percent of unmedicated adult Americans suffer from dry mouth. Thirty-four percent of Americans taking three prescription drugs regularly suffer; 67 percent of Americans taking seven or more medications suffer.

As the population ages, more and more Americans will suffer from dry mouth.

Note:
Statistics are from the National Institute of Dental and Craniofacial Research, 2002

February, 2008|Archive|

New tobacco products under fire

  • 2/22/2008
  • Evanston, IL
  • Lisa Watson
  • MedIll Report (news.medill.northwestern.edu)

Candy-flavored cigarettes in bright packages, dissolvable tobacco tablets, chemical additives to increase addiction, and clever marketing have helped tobacco companies counter restrictions and declining smoking rates, according to a report released Wednesday.

These innovations are garnering more support for pending legislation that would give the U.S. Food and Drug Administration power to regulate the design and marketing of tobacco products.

There is a “new generation of designer tobacco products,” that is unregulated by the government, said Mary Maryland, incoming president of the Illinois division of the American Cancer Society, at a news conference at the Chicago Children’s Museum Wednesday. “Tobacco products come in more forms, flavors, shapes and sizes, with more unproven health claims than ever before, all with the goal of getting kids to smoke and to keep smokers addicted.”

The report, “Big Tobacco’s Guinea Pigs: How an Unregulated Industry Experiments on America’s Kids and Consumers,” details trends in the tobacco industry designed to attract new users and keep old ones.

Issued by the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association and the Campaign for Tobacco-Free Kids, the report documents additions that cigarette companies make to tobacco to encourage new users and discourage current users from quitting:

– New smokeless products, such as dissolvable tobacco tablets, are promoted as a way to get a nicotine “fix” in places where smoking is prohibited. Camel Snus and Marlboro Snus are the newest examples, currently in test markets around the United States.

– Flavorings mask the harshness of smoking, making it easier for new smokers to become accustomed to the taste, but often introduce added carcinogens. Flavors such as lime, mint, strawberry, pineapple and vanilla are likely to appeal to young smokers, Maryland said.

– Added ammonia converts the nicotine in cigarette smoke into its “freebase” form. In other drugs, such as cocaine, the freebase form is recognized as more addictive because it reaches the brain more quickly. This technique may have been more important than the Marlboro Man in boosting Marlboro’s popularity in the 1970s, the report says.

– Health claims such as “less tar” or “light” lead consumers to believe they are choosing a healthier option, when this is not proven. According to a 2001 study by the U.S. National Cancer Institute, the amount of tar in these products is reduced when measured by smoking machines. However, in practice, people who use these products inhale more frequently, take more frequent puffs or increase the number of cigarettes they smoke.

– Increased nicotine levels make it more difficult to quit. In addition, non-FDA approved nicotine products like Skoal and Snus claim to help people stop smoking, when they may actually discourage people from quitting.

These additions make tobacco products more addictive and more hazardous, but unlike other legal drugs, they are not regulated by the government, according to the report.

“Tobacco products are far from tobacco rolled in paper,” said Maryland. “They are highly engineered nicotine delivery devices. Regulation would certainly be appropriate. Most Americans don’t know that many chemicals are added to cigarettes to make them more addictive because the tobacco companies are not currently required to disclose anything about their products.”

Tobacco companies are prohibited from marketing to children, but Sen. Dick Durbin (D-Ill.) said these rules are not effective enough. “You can’t stop those who are currently addicted — it’s almost like prohibition, it’s not going to happen,” Durbin said at the news conference. “But if you can cut off the new smokers, if you can stop the recruitment of children, you will see the number of smokers diminish over the years.”

These concerns lead the report to support the Family Smoking Prevention and Tobacco Control Act, pending in Congress, which would give the FDA authority to regulate ingredients in tobacco products as well as marketing.

If the bill passes, the FDA would be able to require that companies disclose ingredients in tobacco products, prohibit misleading health claims, require changes to existing products and review new products before they could be sold.

“If we don’t step up there will be another generation of death,” Durbin said. “Death created by the tobacco industry.”

February, 2008|Archive|

Why politics and public health don’t mix

  • 2/22/2008
  • Toronto, Ontario, Canada
  • Andre Picard
  • Globe and Mail (www.theglobeandmail.com)

HPV immunization is the most highly publicized, expensive and politicized vaccination campaign in Canadian history.

It is also, from a public health perspective, a monumental flop.

Ontario launched its program to vaccinate all Grade 8 girls with much fanfare last August. Yet, to date, only half of those in the target group have received one or more of the three doses of Gardasil.

That is a pathetically low level of uptake, particularly for a vaccine that has the potential to prevent cervical cancer. (The vaccine is not mandatory, but in school-based programs 80 to 90 per cent of students usually get vaccinated.)

Why are teenaged girls and their parents rejecting the vaccine in such large numbers?

Why have the greatest medical minds in our country been unable to convince the public that preventing cervical cancer with a simple vaccine is not only possible, but a wondrous thing?

Answering those questions should be a priority for public health officials and health policy makers from coast to coast.

The failure here is not with the vaccine. Gardasil is one of the most studied vaccines ever. The results from those studies were impressive: The vaccine has an almost universal ability to prevent infection with strains of the human papillomavirus that are responsible for the bulk of cases of cervical cancer (not to mention that HPV is also responsible for most causes of throat cancer and penile cancer). Logically, this should prevent cervical cancer, though only time will tell.

Still, it is a leap of faith worth taking and one we have made before – for example, in vaccinating children against hepatitis B (another sexually transmitted disease) to prevent liver disease.

No, HPV vaccination is a flop, without question, because of a failure to communicate.

The hallmark of public health communications has, for far too long, been proselytizing: “If we say everyone should have the vaccine, everyone should have the vaccine. Trust us.”

Sorry, but that way of communicating – preaching rather than educating – just doesn’t cut it any more. Not in the age of 24-hour news channels, the Internet and instant messaging.

It is not enough to be on the side of the angels: You have to make your case and make it well.

That is particularly true when you are tackling sensitive topics such as sexual mores and gynecological health – which will necessarily arise in a discussion of HPV – and when you are dealing with a volatile, headstrong population such as teenaged girls.

At some schools, girls at the front of the HPV vaccine line were texting their friends farther down the queue that the shot really hurt. And it does hurt more than most vaccines, for reasons not entirely clear. But the speed at which information – both true and false – now moves is precisely why public health officials have to be much more candid.

The concerns with the HPV vaccine are many and varied: Will vaccinating young girls somehow encourage them to become sexually active sooner? Can you get cancer from the vaccine? Are there side effects? Does the vaccine prevent cervical cancer? If you have received the vaccine do you no longer need to get a Pap test?

Public health officials and medical professionals have, in far too many instances, been dismissive of these concerns instead of patient in their explanations.

Worse yet, they have at times been downright hostile toward those who dared question the wisdom of the HPV vaccination campaign.

The day before Ontario launched its campaign, a group of researchers published an article in the Canadian Medical Association Journal that argued it was premature to have a universal HPV vaccination campaign.

The lead author, McGill University epidemiologist Abby Lippman, was vilified in Salem-witch-trial manner for failing to toe the party line. Whether you agree with the point of view or not, she did what scientists should do: ask tough questions.

Public health officials should answer them, not tuck their tails between their legs and whine.

There are those who essentially blame Dr. Lippman for the failure of the HPV vaccination campaign. There are those, too, who blame the media, in particular a cover story in Maclean’s magazine titled “Our girls are not guinea pigs” and articles in The Globe and Mail that were critical of the political machinations that led to the rapid adoption of a $300-million funding program to support HPV vaccination in Canada.

Surely we can do a little better than shooting the messenger. Beginning with getting a message.

The decision to launch a universal HPV vaccine campaign is probably justified – or at least justifiable – but the way in which it was done stinks to high heaven.

The HPV campaign was a cynical bid by politicians to woo the votes of soccer moms, and public health officials naively (at best) went along for the ride.

The lesson here is that politics and public health don’t mix. Complex public health campaigns should never be undertaken without first doing the necessary groundwork, including education and developing a 21st-century communications plan.

Haste makes waste, the old aphorism says. Haste also makes for poor public health policy.

February, 2008|Archive|

American Association for Cancer Rresearch Seventh Annual Landon Awards

  • 2/22/2008
  • Washington, D.C.
  • press release
  • EurekaAlert.org

Scientists whose discoveries have led to fundamental advances in the science and treatment of cancer are the recipients of two prestigious international prizes offered by the Kirk A. and Dorothy P. Landon Foundation and the American Association for Cancer Research (AACR).

This year’s Dorothy P. Landon-AACR Prize for Translational Cancer Research is awarded to John Mendelsohn, M.D., president and professor of cancer medicine at The University of Texas M. D. Anderson Cancer Center, for his pioneering translational research that led to the discovery of a new class of agents to treat cancer and for his landmark contributions to our growing knowledge of targeted cancer therapies.

“The translation of John Mendelsohn’s research from the laboratory into clinical practice created a new paradigm for treating cancer, providing novel treatment options and life-saving alternatives to many patients living with cancer,” Foti said. “His dedication and leadership deserve the highest recognition and we are proud to honor John for his revolutionary work.”

The Dorothy P. Landon-AACR Prize for Translational Cancer Research

Throughout his distinguished career, Mendelsohn has dedicated his research efforts to understanding how growth factors regulate the proliferation of cancer cells by activating receptors on the surface of the cells. Mendelsohn and his colleagues were the first to propose a new approach to cancer therapy by suggesting that blocking the epidermal growth factor receptor (EGFR) could prevent cancer cell growth and reproduction.

Mendelsohn and his colleagues proved their hypothesis by producing an anti-EGF receptor monoclonal antibody that blocked receptor kinase activation and inhibited cancer cell growth. Mendelsohn’s findings ignited intense and continued interest in this area of clinical cancer research. Continued research on EGF receptors, carried out by Mendelsohn and numerous collaborators for almost two decades, proved the original demonstration that both inhibition of a growth factor receptor and inhibition of a tyrosine kinase could be useful approaches to creating new categories of anti-cancer agents.

The eventual landmark development of C225, the human chimeric version of the anti-EGF receptor monoclonal antibody, has changed the way some advanced cancers, including advanced head and neck and pancreatic cancers, are treated and it led to the 2004 FDA approval of cetuximab for treatment of advanced colorectal cancer. Today, there are more than 130 active clinical trials using C225 to treat 15 cancer subtypes and two non-cancer diseases.

“Dr. John Mendelsohn had a hunch that paid off. When he identified an antibody against the EGF receptor in the early 1980s, he immediately forged ahead on the path to evaluate and develop this antibody as a treatment for tumors that expressed high levels of the receptor and relied on it for growth,” said Stanton L. Gerson, M.D., director of the Case Comprehensive Cancer Center and chair of the Dorothy P. Landon-AACR Prize for Translational Cancer Research selection committee.

“While the path was arduous, as it often is for pioneers in cancer therapy, Dr. Mendelsohn’s hypothesis turned out to be spectacular, resulting in a new and effective treatment for many patients with non-small cell lung cancer and head and neck cancer. His work, perhaps the most important new development in cancer therapeutics in the past 20 years, has helped define the field of targeted and personalized therapy for cancer. Rarely does a single discovery have such impact in the field of cancer,” Gerson added.

A distinguished AACR member, Mendelsohn served as the founding editor of Clinical Cancer Research, a bimonthly translational research journal published by the AACR, and has been a member of the editorial boards of numerous other scientific journals. He has authored more than 300 scientific papers and articles for journals and books, and serves as senior editor of the textbook, “The Molecular Basis of Cancer.” Mendelsohn has received a number of national and international honors in recognition of his career achievements, including most recently: the Dan David Prize in Cancer Therapy; the Fulbright Lifetime Achievement Medal; the Bristol-Myers Squibb Freedom to Discover Award for Distinguished Achievement in Cancer Research; the David A. Karnofsky Memorial Award from the American Society of Clinical Oncology; the AACR-Joseph H. Burchenal Clinical Research Award; and the Gold Medal of Paris. Mendelsohn earned his bachelor’s degree in biochemical sciences magna cum laude from Harvard College and received his M.D. cum laude from Harvard Medical School.

The Landon-AACR Prizes in Cancer Research were first presented in 2002 to promote and reward seminal contributions to our understanding of cancer through basic and translational cancer research. These distinguished scientific prizes are designed to bring heightened public attention to landmark achievements in the continuing effort to prevent and cure cancer through quality research.

February, 2008|Archive|

Improved Survival of Patients With Human Papillomavirus Positive Head and Neck Squamous Cell Carcinoma in a Prospective Clinical Trial

  • 2/20/2008
  • Baltimore, MD
  • Carole Fakhry et al.
  • JNCI Journal of the National Cancer Institute 2008 100(4):261-269

Background:
The improved prognosis for patients with human papillomavirus (HPV)–positive head and neck squamous cell carcinoma (HNSCC) relative to HPV-negative HNSCC observed in retrospective analyses remains to be confirmed in a prospective clinical trial.

Methods:
We prospectively evaluated the association of tumor HPV status with therapeutic response and survival among 96 patients with stage III or IV HNSCC of the oropharynx or larynx who participated in an Eastern Cooperative Oncology Group (ECOG) phase II trial and who received two cycles of induction chemotherapy with intravenous paclitaxel and carboplatin followed by concomitant weekly intravenous paclitaxel and standard fractionation radiation therapy. The presence or absence of HPV oncogenic types in tumors was determined by multiplex polymerase chain reaction (PCR) and in situ hybridization. Two-year overall and progression-free survival for HPV-positive and HPV-negative patients were estimated by Kaplan–Meier analysis. The relative hazard of mortality and progression for HPV-positive vs HPV-negative patients after adjustment for age, ECOG performance status, stage, and other covariables was estimated by use of a multivariable Cox proportional hazards model. All statistical tests were two-sided.

Results:
Genomic DNA of oncogenic HPV types 16, 33, or 35 was located within tumor cell nuclei of 40% (95% confidence interval [CI] = 30% to 50%) of patients with HNSCC of the oropharynx or larynx by in situ hybridization and PCR. Compared with patients with HPV-negative tumors, patients with HPV-positive tumors had higher response rates after induction chemotherapy (82% vs 55%, difference = 27%, 95% CI = 9.3% to 44.7%, P = .01) and after chemoradiation treatment (84% vs 57%, difference = 27%, 95% CI = 9.7% to 44.3%, P = .007). After a median follow-up of 39.1 months, patients with HPV-positive tumors had improved overall survival (2-year overall survival = 95% [95% CI = 87% to 100%] vs 62% [95% CI = 49% to 74%], difference = 33%, 95% CI = 18.6% to 47.4%, P = .005, log-rank test) and, after adjustment for age, tumor stage, and ECOG performance status, lower risks of progression (hazard ratio [HR] = 0.27, 95% CI = 0.10 to 0.75), and death from any cause (HR = 0.36, 95% CI = 0.15 to 0.85) than those with HPV-negative tumors.

Conclusion:
For patients with HNSCC of the oropharynx, tumor HPV status is strongly associated with therapeutic response and survival.

CONTEXT AND CAVEATS
Prior knowledge

Analyses of retrospective case series had demonstrated that patients with head and neck squamous cell carcinoma (HNSCC) whose tumors were human papillomavirus (HPV)-positive had a better prognosis than patients whose tumors were HPV-negative, but this remained to be confirmed in a study that adequately controlled for factors of known prognostic value.

Study design

The association of tumor HPV status with therapeutic response and survival was evaluated in patients participating in a trial of chemotherapy and radiation therapy by Kaplan–Meier analysis and a Cox proportional hazards model.

Contribution

The presence of HPV in tumors of patients with HNSCC was positively associated with response to treatment and overall survival after adjustment for a set of other factors known to be associated with clinical outcome.

Implications

The risks and benefits of current therapies may need to be assessed separately according to the HPV status of the patient’s tumor.

Limitations

Larger samples may be needed to more thoroughly evaluate the possibility of confounding by smoking and other variables.

Authors:
Carole Fakhry, William H. Westra, Sigui Li, Anthony Cmelak, John A. Ridge, Harlan Pinto, Arlene Forastiere, Maura L. Gillison

Authors’ affiliations:
Johns Hopkins Medical Institutions, Baltimore, MD (CF, WHW, AF, MGL); Dana-Farber Cancer Institute, Boston, MA (SL); Vanderbilt University, Nashville, TN (AC); Stanford University, Palo Alto, CA (HP); Fox Chase Cancer Center, Philadelphia, PA (JAR)

February, 2008|Archive|

New Generation of Tobacco Products Threatens Efforts to Reduce Tobacco Use, Save Lives in U.S., Report Warns

  • 2/20/2008
  • Washington, D.C.
  • staff
  • redOrbit.com

An insidious new generation of tobacco products is threatening efforts to reduce tobacco use in the United States, warns a new report issued today by a coalition of public health organizations.

The report describes how tobacco manufacturers take advantage of the lack of government regulation to design and market products that recruit new youth users, create and sustain addiction to nicotine, and discourage current users from quitting. Responding to declining smoking rates and growing restrictions on smoking, tobacco manufacturers are finding novel ways to entice new users, especially children, and discourage quitting.

To stop the tobacco industry’s harmful practices and protect public health, leading public health organizations urge Congress to pass pending legislation granting the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products and their marketing.

The report, “Big Tobacco’s Guinea Pigs: How an Unregulated Industry Experiments on America’s Kids and Consumers,” was issued by the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association and Campaign for Tobacco-Free Kids, with funding by the Robert Wood Johnson Foundation. The full report and a slideshow of new tobacco products can be found at http://www.tobaccofreekids.org/productsreport.

The report details key trends including:

– Flavored products: Cigarettes, smokeless tobacco and cigars have been introduced in an array of candy, fruit and alcohol flavors. R.J. Reynolds’ Camel cigarettes, for example, have come in more than a dozen flavors, including lime, coconut and pineapple, toffee, and mint. Flavorings mask the harshness of the products and make them appealing to children.

– Novel smokeless products: New smokeless tobacco products have been marketed as ways to help smokers sustain their addiction in the growing number of places where they cannot smoke. In addition to traditional chewing and spit tobacco, smokeless tobacco now comes in teabag-like pouches and even in dissolvable, candy-like tablets.

– Targeted products and marketing: New products and marketing have been aimed at women, girls and other populations. The most recent example is R.J. Reynolds’ Camel No. 9 cigarettes, a pink-hued version that one newspaper dubbed “Barbie Camel” because of marketing that appealed to girls.

– Unproven health claims: A growing list of products have been marketed with unproven and misleading claims that they are less harmful than traditional cigarettes. Claims have included “All of the taste… Less of the toxin” (Brown & Williamson’s Advance cigarettes) and “Reduced carcinogens. Premium taste” (Vector Tobacco’s Omni Cigarettes).

– Undisclosed product designs: The report also illustrates how tobacco manufacturers control nicotine delivery to maximize addiction, while using flavorings and other additives to make their products taste milder, easier to inhale and more attractive to children and first-time smokers. A few aspects of product design not disclosed to consumers include the use of:

– Ammonia to increase the speed and efficiency of nicotine absorption.

– Eugenol and menthol to numb the throat to minimize irritation from smoke.

– Glycerin and cocoa to enable deep lung exposure (cocoa produces carcinogens when burned).

– Sugars and chocolate to make smoke milder and make cigarettes more appealing, especially to children and first time smokers.

– Filter technology and ventilation holes that allows deep penetration of nicotine into the lungs of the smoker and increase the addictiveness of the product.

The report makes it clear that tobacco products are “highly engineered nicotine delivery devices, finely tuned to appeal to the taste, feel, smell and other sensations of new and addicted smokers.”

“It is mind-boggling that tobacco products are the number one cause of preventable death in the United States, yet they are virtually unregulated to protect public health,” said William V. Corr, Executive Director of the Campaign for Tobacco-Free Kids. “Until Congress grants the FDA authority over tobacco products, America’s kids and consumers will remain guinea pigs in the tobacco industry’s never-ending experiments to sell more of its deadly and addictive products.”

Tobacco companies have introduced an even broader array of products internationally that could appear on the U.S. market. New products recently launched by Philip Morris International include Marlboro Mix 9, a high-tar, high-nicotine product sold in Indonesia, and Marlboro Intense, a short but strong version of the brand that is being tested in Turkey and lets smokers get a quick nicotine hit when stepping outside smoke-free environments.

Bipartisan legislation pending before Congress (S. 625/H.R. 1108) would give the FDA authority to:

– Restrict tobacco advertising and promotions, especially to children.

– Ban candy-flavored cigarettes.

– Require tobacco companies to disclose the contents of tobacco products, changes to their products and research about the health effects of their products.

– Require changes in tobacco products, such as the removal or reduction of harmful ingredients.

– Prohibit health claims about so-called “reduced risk” products that are not scientifically proven or that would discourage current tobacco users from quitting or encourage new users to start.

– Require larger, more effective health warnings on tobacco products.

– Prohibit terms such as “low-tar,””light” and “mild” that have misled consumers into believing that certain cigarettes are safer than others.

The Senate bill, sponsored by U.S. Senators Edward Kennedy (D-MA) and John Cornyn (R-TX), has 56 sponsors and co-sponsors, while the House bill, sponsored by U.S. Reps. Henry Waxman (D-CA) and Tom Davis (R-VA), has 215 sponsors and co-sponsors. The legislation is also supported by more than 560 public health, faith and other organizations across the country. A poll conducted in 2007 found that 70 percent of American voters support Congress passing the legislation.

“The tobacco industry has repeatedly marketed its deadly, addictive products to children as part of a broad strategy to hook the next generation of customers by portraying smoking as glamorous, cool and alluring. That is the reason why every day 4,000 new kids try their first cigarette,” said Daniel E. Smith, president of the American Cancer Society Cancer Action Network (ACS CAN). “Congress must act now to reduce suffering and death from tobacco-related disease and free our youth from the firm grasp of the rogue tobacco industry.”

“The bottom line is that tobacco companies continue to put our children at greater risk for heart disease and stroke with shady marketing and product design. Wishful thinking won’t change that, but the FDA regulation of tobacco products will,” said M. Cass Wheeler, CEO of the American Heart Association.

“Congress has an unprecedented opportunity in 2008 to pass this life-saving legislation that will finally give FDA the authority to crack down on the tobacco companies and their new deadly products,” said Bernadette A. Toomey, President and CEO of the American Lung Association. “Now is the time for them to act to protect kids and prevent them from a lifetime of addiction and disease at the hands of these shameful new products.”

Tobacco use is the leading preventable cause of death in the United States, killing more than 400,000 people and costing the nation nearly $100 billion in health care bills each year. About 90 percent of adult smokers begin in their teens or earlier. Every day, another 1,000 kids become regular, daily smokers, and one-third of them will die prematurely as a result.

February, 2008|Archive|

Clueless on STDs, Throat Cancer, and Oral Sex

  • 2/20/2008
  • web-based article
  • Bernadine Healy M.D.
  • US News (www.usnews.com)

There’s an argument out there that oral sex is not sex. For some grown-ups, it’s a way to deny that they’re cheating. To some young people, oral sex preserves virginity—technically speaking—and allows for what is perceived as risk-free sexual intimacy. From a medical perspective, however, this is sex—and generally, as practiced, it’s unsafe. People seem clueless that sexually transmitted diseases such as herpes, gonorrhea, chlamydia, and human papillomavirus can take hold in parts of the oral cavity during sex with infected partners and that the oral contact can infect the genitals, too. HPV is a particularly scurrilous threat, since it incubates silently in the back of the mouth and is now linked to a dangerous form of throat cancer in both men and women similar to the one that arises in the cervix.

Head and neck cancers, which can attack the mouth, nose, sinuses, and throat, have been diseases of people over 50 with a history of heavy smoking and drinking. Thanks to the decrease in smoking and use of chewing tobacco, these disfiguring cancers are in steady decline. However, this triumph of prevention is clouded by an unexpected increase in oropharyngeal cancer, which develops in the tonsils and the base of the tongue and is apt to show up in those who don’t smoke or drink heavily, and in younger people. Earlier this month, researchers from Johns Hopkins reported in the Journal of Clinical Oncology that between 1973 and 2004 there had been a near doubling of the incidence of these HPV-related oral cancers among people in their 40s.

It doesn’t take Sherlock Holmes to figure out that this rise in oropharyngeal cancer is linked to changing sexual practices and, in particular, ones that involve bathing the throat with HPV-infected fluid. Increasingly, scientists are implicating HPV-16, and in some cases 18, the same ones that causes cervical cancer. In 2006, a Swedish study of preserved surgical specimens from excised oropharyngeal cancers going back over 30 years identified HPV-16 in less than a quarter of specimens removed in the 1970s. By the 1990s, the proportion was 57 percent. After 2000, it was 68 percent. In 2007, a study published in the New England Journal of Medicine found HPV-16 in 72 percent of oropharyngeal cancers in the United States. Not proof, but based on correlations with sexual behavior, and an abundance of similar findings both here and around the world over the past few years, there is credible if not alarming medical concern that the infection is being acquired through unprotected oral sex.

That our children might be at growing risk for this deadly cancer is particularly unnerving. Health surveys indicate that well over half of American teens now engage in oral sex, with about 10 to 20 percent claiming “technical virginity.” Pediatricians will tell you that this behavior is fueled by the adolescents’ belief that oral sex is risk-free play, making it more common and acceptable. But few practice it safely. Some of this is anecdotal. But British researchers determined that more than 80 percent of university students ages 16 to 21 failed to protect themselves with condoms during oral sex. This is an age group well known for diligently using them during vaginal sex.

Granted, the major risk for STDs comes with vaginal sex, but the relative ease and growing frequency of oral sex among those engaging in casual “hookups” is a virtual epidemic in the making. Providing our young people with graphic medical information and stern parental and medical guidance is long overdue. As with all sex education, the abstinence message should be foremost and explicit. But it’s not enough. They must also know that safe sex applies to sex by mouth, too. And, that’s a message for all ages, unless one has a single faithful partner.

Concern about the growing risk of oropharyngeal cancer also bears on the use of the new HPV vaccine, Gardasil, which protects against HPV-16 and 18. Currently it’s approved for young women only. Yet men contract, carry, and transmit HPV and develop HPV-related genital cancers, though far less commonly than do women. But, when it comes to HPV-related tonsil and tongue cancer, men are at greater risk than women. This should provide strong impetus for an HPV vaccine that works for men, too—an effort that’s taking an inexplicably long time. Before anyone thinks, however, that a cancer vaccine will deliver a free pass on risky behavior, just imagine for a moment what a rip roaring case of pharyngeal gonorrhea might look like. It’s not pretty.

February, 2008|Archive|

EU Panel Says Oral Tobacco Is Addictive, Hazardous

  • 2/20/2008
  • Geneva, Switzerland
  • Thomas Mulier
  • Bloomberg.com

Swedish-style snuff hasn’t been proven to help people quit smoking, a European Union panel said, dealing a blow to tobacco companies that lobbied for lifting a ban on the product.

Smokeless tobacco is addictive and hazardous to health, the committee said in a report on its Web site. Evidence that the snuff, known as snus, may help Swedish smokers stop isn’t sufficient to lift an EU ban because it’s “not possible to extrapolate the patterns of tobacco use” to other countries, the committee said.

Snus is a moist form of snuff that is placed between the upper lip and gums rather than sniffed. The tobacco industry, led by British American Tobacco Plc and Swedish Match AB, has been lobbying the EU to lift the ban, which applies to all members of the bloc except Sweden. Cigarette makers have been moving into smokeless tobacco products, trying to create a new market as public smoking restrictions spread through the U.S. and Europe.

“This conclusion implies that there will be no impetus for a change in policy for a lifting of the ban,” wrote David Hayes, an analyst at Lehman Brothers who has an “overweight” rating on Swedish Match.

The EU banned snus for health reasons before Sweden joined. The country negotiated an exception to the rule when it became a member, becoming the only EU nation where the product can be sold legally.

Shares Fall

Swedish Match shares fell 4 kronor, or 2.8 percent, to 138 kronor in Stockholm, where the company is based. That gives the company a market value of about 36.8 billion kronor ($5.84 billion). London-based BAT declined 19 pence to 1,825 pence in London.

Studies show that all smokeless tobacco products contain carcinogens and may cause cancer of the pancreas, the committee said. Research indicates some kinds of oral tobacco are associated with a “high” risk for mouth cancer, though it hasn’t been proven for snus, the panel added. Smokeless tobacco also may increase the risk of death after a heart attack, the committee said.

Snus is at least 50 percent less likely to lead to heart disease than cigarettes, and possibly 100 percent less likely to lead to lung cancer, the committee said.

“Politicians must now decide on whether it is reasonable to continue to deny European smokers access to a dramatically less hazardous alternative to cigarettes,” Lars Rutqvist, vice president for scientific affairs at Swedish Match, said in a statement. “This is probably only the first step in a long political process.”

Benefits, Risk

The benefits of lifting a ban would be offset by the risk that consumers who might never have smoked would start using snus, or that consumers who quit smoking for the product would continue using it indefinitely, the panel said.

Some evidence from the U.S. suggests that smokeless tobacco use may lead to cigarette smoking, while Swedish data don’t support this conclusion, the report said. Cultural differences “suggest caution in translating findings across countries” and there are no randomized trials on smokeless tobacco as a cigarette substitute.

“We will continue to engage with the European Commission — encouraging them and others to support the replacement of the current ban with a regulatory framework that allows the sale of snus,” Chris Proctor, BAT’s head of science and regulation, said in a statement. The Brussels-based commission is the EU’s executive.

February, 2008|Archive|

HPV-positive Head and Neck Cancers Have Improved Prognosis

  • 2/18/2008
  • Ketchum, ID
  • staff
  • CancerConsultants.com

Patients with head and neck cancer who test positive for the human papillomavirus (HPV) have a better prognosis compared with those who do not have HPV. These results were recently published in the Journal of the National Cancer Institute.

Head and neck cancers originate in the oral cavity (lip, mouth, tongue), salivary glands, paranasal sinuses, nasal cavity, pharynx (upper back part of the throat), larynx (voice box), and lymph nodes in the upper part of the neck. Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year. Squamous cell carcinoma of the head and neck (HNSCC) is the most common type of head and neck cancer. It originates in squamous cells, which are commonly part of the outermost layers of tissues.

Human papillomaviruses (HPV) consist of more than 100 different viruses. Some types of HPV cause warts on the hands or feet; others cause genital warts; and some have been linked with cancer, most notably cervical cancer. Recent studies have suggested that HPV may also be strongly associated with the development of head and neck cancer.

Researchers from several institutions in the United States recently evaluated data from 96 patients with advanced HNSCC who had participated in a previous clinical trial evaluating chemotherapy and radiation therapy for their disease. Patients’ cancers were tested for HPV.

– HPV types 16, 33, or 35 were present in 40% of cancer.

– Patients with HPV-positive cancer had improved anticancer responses to chemotherapy and chemotherapy plus radiation therapy.

– At two years overall survival was 95% for patients with HPV-positive cancer compared with only 62% for patients with HPV-negative cancer.

– Patients with HPV-positive cancer had a lower risk of cancer progression or death from any cause compared with patients with HPV-negative cancers.

The researchers concluded: “For patients with HNSCC…HPV status is strongly associated with therapeutic response and survival.” Patients with HNSCC may wish to speak with their healthcare provider regarding HPV testing and different therapeutic options based on HPV status.

Reference:
Fakhry C, Westra W, Li S, et al. Improved survival of patients with human papillomavirus–positive head and neck squamous cell carcinoma in a prospective clinical trial. Journal of the National Cancer Institute [early online publication]. February 13, 2008. DOI: doi:10.1093/jnci/djn011.

February, 2008|Archive|