Monthly Archives: June 2004

Is smokeless safer?

  • 6/14/2004
  • Los Angeles, CA
  • Valerie Reitman, Times Staff Writer
  • The Los Angeles Times

A growing number of anti-smoking researchers and public health advocates are adopting a tack that not long ago would have been considered heresy: suggesting that hard-core smokers who can’t kick the habit would be better off switching to new smokeless tobacco products. With slogans such as “Spit-free” and “For when you can’t smoke,” these products differ markedly from the messy snuff and chewing tobacco stereotypes associated with your granddaddy’s spittoon or certain pro baseball players’ stuffed cheeks. They are clean, discreet, last about 30 minutes and come in mint, wintergreen and other flavors. Some go down easily, dissolving much like a breath mint, while others look like tiny tobacco-filled teabags, tucked into the side of the mouth and discarded like chewing gum.

Though no one is calling the products “safe” — any tobacco that has been cured contains some carcinogens — numerous epidemiological studies have shown that smokeless tobacco is far less likely to cause any type of cancer, including oral cancer, than cigarettes. “If someone can’t quit smoking, there is no question that smokeless is much safer. It doesn’t cause heart or lung disease, and if it does cause cancer, it does so at a much lower rate,” said Dr. Neal Benowitz, a professor of medicine at UC San Francisco and director of its cancer center’s Tobacco Control Program.

Gary Giovino, director of the Tobacco Control Research Program at the Roswell Park Cancer Institute in Buffalo, N.Y., agreed. “If everybody who smoked used these instead, there would be less disease. “Many Americans may be unaware that most scientists and researchers say that smokeless tobacco is less hazardous than cigarettes in causing deadly disease. That’s not surprising. For years, some private and government medical organizations have disseminated outdated information on the subject. For instance, the Mayo Clinic in Rochester, Minn., recently acknowledged that information on its website was incorrect and would be revised.

Though some information on the Centers for Disease Control and Prevention’s website was modified after one prominent researcher protested it, the agency, part of the U.S. Surgeon General’s Office, takes the position that “there is no safe form of tobacco” and that there “is no significant evidence that suggests that smokeless is a safer alternative to smoking,” spokeswoman Karen Hunter said. Some tobacco researchers contend the misinformation hinders individuals from making educated decisions about whether to switch to smokeless products. “I think it’s not scientific and is a deception,” said Lynn Kozlowski, who heads Pennsylvania State University’s biobehavioral health department. “What the studies show is that in the U.S., smokeless causes oral cancer but that cigarettes are even more likely to cause oral cancer.”

With names that include Ariva and Stonewall, both made by Star Scientific Inc., and Revel, made by the U.S. Smokeless Tobacco Co., which also makes the Copenhagen and Skoal brands, the new products have been rolled out in a few U.S. cities and are also available from their manufacturers’ websites. They promise to deliver the nicotine fix smokers crave and take the edge off the physiological urge to light up.

Although the nicotine in cigarettes is powerfully addictive, it is the cigarette smoke — not the nicotine — that delivers the killer punch, possibly producing as many as 60 known carcinogens and about 5,000 other chemicals. Studies show that many people still believe that it is the nicotine that is the harmful element. Brad Rodu, an oral pathologist at the University of Alabama, said nicotine should be treated more like caffeine: as an addictive drug that can be used safely. (His “tobacco harm-reduction” research is funded by a five-year grant from U.S. Smokeless.) “We would have smokers understand the nicotine addiction can be separated from the smoking.”

Sweden’s experience with smokeless tobacco is one of the forces giving momentum to this harm-reduction campaign in the U.S. Over the last 40 years, a large percentage of Swedish smokers — primarily men — have switched from smoking cigarettes to using a moist snuff product called “snus.” Sweden’s cancer rates for men, including oral cancer, have declined and now are the lowest in Europe.

In contrast, cancer rates for Swedish women — few of whom have made the switch from cigarettes to snus — remain as high as rates for most other European women. Nevertheless, snus is outlawed by the rest of the European Union countries, while cigarettes are widely sold and remain quite popular, an irony not lost on some European healthcare providers. In a December 2002 report titled “Protecting Smokers, Saving Lives,” Britain’s Royal College of Physicians concluded that “the consumption of noncombustible tobacco is on the order of 10 to 1,000 times less hazardous than smoking, depending on the product.”

Many public health advocates fear that providing smokers with alternative products will keep them from quitting altogether, the healthiest option. They also fear that some nonsmokers, including teenagers, might start using them and, if they do, that the nicotine will encourage them to start smoking. Some of this concern stems from the difficulty in knowing the long-term hazards of substitute products as well as the distrust of the tobacco companies based on past claims.

For example, in 1981, the U.S. Surgeon General recommended that smokers who couldn’t quit would be better off switching to “low-tar” or “light” cigarettes because they were less likely to develop smoking-related illnesses. Instead, smokers were found to puff harder and inhale more deeply to compensate, thus taking in an equal amount of tar or more. Internal documents revealed that the cigarette makers knew that to be the case all along. Kenneth Warner, director of the University of Michigan Tobacco Research Network, said he was convinced that the promise of reduced risk kept tens of thousands smoking rather than quitting — undoubtedly hastening many deaths. Nearly three years ago, the National Cancer Institute charged that light cigarettes did nothing to lower smokers’ health risks. Among the largest fears is that teenagers will get hooked on smokeless products, then switch to smoking when they realize that cigarettes deliver a faster and more powerful hit of nicotine. Greg Connolly, former director of the Massachusetts Tobacco Control Program, said kids who start on smokeless tobacco were three times more likely to go on to smoking cigarettes — and that some smokeless companies had deliberately targeted teenagers. He agreed that the newer products are less carcinogenic and probably safer to use but said the new products were not being aggressively pushed by their makers. Instead, the more carcinogenic, dirtier discount brands of smokeless products are growing in popularity. “I’d be the first to say [the new products] are safer,” Connolly said. “But I don’t want them to be hurting our kids. This is an industry you can’t trust.”

A lethal habit

The push for safer alternatives comes amid mounting gloom about smoking. Although cigarette smoking has declined dramatically from its peak in the 1960s, it has leveled off in the last decade. About 46 million Americans — 22% of adults, according to the CDC — still light up each day despite aggressive public education campaigns, heavy cigarette taxes to make them less affordable, significant social stigma and widespread smoking bans in public places. An estimated 10 million Americans use smokeless tobacco.

It’s a very tough habit to break — tobacco researcher and former smoker Giovino calls quitting “a toothache in the soul.” Although 70% of smokers say they want to quit and 34% of them attempt to do so each year, only 10% manage to stay smoke-free for a year, according to the Institute of Medicine. “We are not promoting tobacco use,” the University of Alabama’s Rodu said. “But we have a reality of 46 million smokers, and they now have only one option: to quit. It’s quit or die.”

Several tobacco researchers maintain that smokers would be better off switching to “medicinal” nicotine products such as patches, nicotine gums and lozenges. The “pure” liquid nicotine in these has been extracted directly from the stem of the tobacco plants. But because the plant has not been cured or burned, it doesn’t present the carcinogens that other tobacco products do. Prices of these “pure” products — designed for limited rather than long-term use — are out of reach for many. At $50 and up, they can cost several times the price of a pack of cigarettes or smokeless tobacco. About 33% of those living below U.S. poverty levels smoke, compared with 22% of the general population, according to the CDC. The patches have not proven to be very effective, Giovino said, with fewer than 10% of users successfully quitting. This is at least in part, many researchers say, because it does not deliver enough nicotine.

Tobacco products are exempt from Food and Drug Administration regulation, while safer, pure medicinal products are subject to FDA scrutiny because they are considered to be drug (nicotine) delivery systems. Getting FDA approval requires time and expense, driving up prices. Products that tout themselves as smoking-cessation aids also require FDA clearance. Hence, the new smokeless products do not market themselves as quitting aids but rather, as substitutes for situations when someone can’t smoke, such as on a plane.

“A growing number of people recognize the disparity, that the conventional cigarettes are most harmful and that cleaner alternatives face a lot of hurdles and uncertainties,” said Jed Rose, director of the nicotine research program at Duke University Medical Center.

Moreover, the smokeless-tobacco makers face a difficult balance in marketing the products, for if they tout them as being safer, they face scrutiny from the Federal Trade Commission and state attorneys general and would have to prove their claims based on clinical trials they now are not required to conduct.

Some anti-smoking program directors also fear that although there may be less carcinogenic risk in the new smokeless products, no one can be sure they won’t pose other potential dangers because they have not been independently tested. “It’s likely they are less hazardous, though we don’t know much about them because nobody has done any analyses,” said Dr. Richard Hurt, professor of medicine and director of Mayo’s nicotine dependency program. “What if they’re found to have strychnine in them? They can put anything they want in them because they’re not regulated by the FDA.”

Of course, that’s true with cigarettes too. And making a less hazardous cigarette has proven nearly impossible, because igniting any plant material — from wood and charcoal to tobacco — produces carcinogens. Directly inhaling the smoke into the lungs elevates the risk even more.

Not as pleasurable

Even if a switch to smokeless varieties were encouraged, few people would expect that smokers would give up their cigarettes entirely. First, it isn’t nearly as pleasurable an experience for the smoker, Duke University’s Rose said. Plus, there are all sorts of behavioral and psychological cues involved, such as craving cigarettes when one has a drink or lighting up outside the office simply to get away for a few minutes. But many potential users of the new products may have an outdated view of their dangers. It was only after Penn State’s Kozlowski said he challenged claims about smokeless tobacco on the websites of the CDC and the Substance Abuse and Mental Health Services Administration that the agencies modified the information.

Yet, the Institute of Medicine has concluded that there would be at least 60% fewer deaths from the use of smokeless tobacco products than from cigarettes. Although there is a risk of oral cancer with smokeless alternatives, cigarettes are believed to cause 2.28 times more oral cancer than smokeless tobacco, pathologist Rodu concludes. As recently as last week, Mayo Clinic’s website said, “Spit tobacco has health risks just as severe or even more severe as those associated with cigarette smoking.” Asked about the statement, Mayo’s Hurt said the information was incorrect and would be revised.

Sweden’s experience indicates that substituting smokeless tobacco can help reduce cigarette smoking. Starting in the 1960s, the popularity of loose, fine-grained smokeless tobacco started to spread beyond its largely farmhand constituency to academics and eventually the general public, as the hazards of smoking and passive smoke became known, Swedish tobacco researcher Dr. Karl Fagerstrom said. In the 1980s, tobacco maker Swedish Match started marketing tobacco in tiny teabag-like pouches that made it far more aesthetically pleasing to use and increased its popularity. Over the years about 30% to 50% of male smokers switched from cigarettes to snus, and smoking rates dropped by about 0.7% each year, Fagerstrom said. About 15% of Swedish men now smoke, down from 36% in 1980.

Cancer rates have also declined, with no increases in other diseases or oral cancer rates. (It has been associated with increased irritation of the gums, Fagerstrom said, though it isn’t clear that isn’t a problem with cigarettes as well.) One reason that carcinogens are believed to be particularly low with snus: For the last 15 years, the product has been kept refrigerated from the time it leaves the factory till the time the customer gets it. That lengthens shelf life and discourages fermentation, during which the harmful nitrosamines grow. (Once purchased, it isn’t necessary to keep it refrigerated; it’s generally used within a week.)

Tobacco researchers in the U.S., including some who oppose encouraging smokers to shift, have cited the refrigeration as a key difference for the lower cancer rates in Sweden, because smokeless products in the U.S. are not refrigerated and can be kept on store shelves for months. As in the U.S., the product is sold behind the counter (to prevent theft in Sweden’s case) and purchasing isn’t allowed by those younger than 18.

Some Swedish men were able to give up smoking entirely with no problem when they switched to snus, Fagerstrom said. Others had more trouble, missing the drag and act of smoking itself. And many seem able to have an occasional cigarette, such as when they have a drink, without getting hooked on smoking again. Hence, he said, total abstinence may not be necessary for everyone to break the habit.

OCF Note #1 (6/14/04): While OCF acknowledges the findings, and the results in Sweden, we want it made clear that this article discusses products like snus which are not available in the US. Oral Cancer as a result of conventional spit tobacco use is still a real risk. And while we understand that a reduction in inhaled carcinogens from burning plant materials, and tobacco in particular, will reduce the incidence of lung cancer and possibly heart disease which is smoking related, in our area of concern we find that a conversion of one poison to another will only lead to different locations for the cancer to occur, increasing the rate of oral cancers. The tobacco industry has paid for these studies and Dr. Rodu’s work, and while we will not conclusively state that the findings are suspect, nothing that the tobacco industry has told the American public in the past, and their consistent and overt attempts to discourage the revelation of data that would be harmful to their sales, makes them suspect sources of information. OCF would like to see these products required to go through FDA testing and recommendations.

OCF Note #2 posted 11/16/04: Anyone who was starting to think that snus type spit tobaccos were a safe alternative to smoking, should rethink their arguments. This recent study published in Sweden regarding the long term experience in users of these products shows a 67% increase in cancers in people who use them….. This link will take you to the swedish article directly and you may find the article posted in OCF’s news section dated November 16, 2004. Study in Sweden

June, 2004|Archive|

Good news: 10 million cancer survivors; bad news: system not aimed at helping them

  • 7/12/2004
  • New Orleans, LA
  • By Marie Rosenthal
  • Hem/Onc News

Presidential advisory panel releases report aimed at improving outcomes for survivors.

Although there are nearly 10 million Americans who are cancer survivors, a threefold increase over the number of survivors in 1971, many enter a world that is ill equipped to handle their special needs, ranging from psychological to medical, says a new report from the President’s Cancer Panel.

“In 1971, there were 3 million cancer survivors in the United States; in 1986, there were 6 million. In 2004, there are close to 10 million cancer survivors,” said LaSalle D. Leffall, Jr., MD, who is chair of the panel, which just issued a report that looks at the late effects of cancer treatment across a survivor’s life. The panel made recommendations about issues concerning four age groups: children, adolescents and young adults, adults and the elderly.

After holding town meetings in four cities — Austin, Texas, Birmingham, Ala., Denver and Philadelphia — to talk with cancer survivors, their caregivers and health care givers, the panel found that patients reported problems during and after cancer treatment.

Late effects

Years after treatment, cancer survivors reported late effects, such as learning disabilities among children; infertility or complications with pregnancies; premature aging and heart disease; psychosocial effects and prejudicial treatment, including being denied life or health insurance. Survivors reported depression and anxiety rooted in their fight against cancer that later affects their quality of life and ability to work, panelists said.

“There were overarching issues that we found,” Leffall said at the 40th Annual Meeting of the American Society of Clinical Oncology here. “Issues affecting survival across the lifespan.” Speaking for the panel, Leffall said that the best way the government could handle these problems was to “implement comprehensive health care reform so that patients who have no evidence of cancer, but are still having problems could still get proper access to care. We believe that was extremely important.”

The provisions of this reform should include coverage for psychosocial services during and after treatment; and reimbursement for follow-up care, including that provided by non-physician personnel, he explained.

Medical records
In addition, he suggested that each patient receive an electronic medical record that spells out the individual care given to that patient, as well as a follow-up care plan. This way, patients could provide important medical histories to future doctors if the patient has a recurrence, residual effects or other illness related to cancer treatment. The follow-up care plan should include a schedule of periodic cancer screenings and examinations for the known late effects of therapy. “Every individual patient should be given an electronic record of all the health care they have received and important disease information,” said Leffall, who is the Charles R. Drew professor of Surgery at Howard University College of Medicine in Washington, D.C. “We think that every patient should have this record that would let the patient know and anyone seeing that patient for follow-up care just what was going on. This came out most clearly with pediatric cases, but there were many adults who did not know what chemotherapy they had or what were the doses they received.”

In addition, the Institute of Medicine (IOM) should evaluate the impact on HIPAA to health care. “In an effort to ensure privacy, we found sometimes that it could be an impediment to getting information out of patients because of privacy,” he said. “Of course it is important not to invade someone’s privacy, but we don’t want that to interfere with his or her health care.”

He said the government must evaluate the impact of care and give specific referrals whether they are to a cardiologist, a psychologist or a support group.

The recommendations for specific age groups included the following:

The panel suggested that the NCI and the Department of Education collaborate on ways to improve classroom re-entry and reintegration of young people with cancer or other chronic or catastrophic illnesses. These could include remote learning and teacher training. The panel found that children, parents and teachers were not ready to treat the psychological issues that occur when a child goes back to school after a bout of serious illness. Often, teachers did not know about disabilities, such as memory lapses, that can result from cancer treatment. “We believe that it is important that there is proper school re-entry to deal with the issues. The Department of Education working with the NCI could do something to help these children,” Leffall said.

The panel said that surveillance and research of adolescents and young adults, a “vastly understudied population” could be improved and would enhance treatment design. Prevention and quality-of-life interventions should be developed to benefit young people as they approach adulthood. Leffall called them the lost cohort because these patients become adults, go off to college or move to find better jobs and are frequently lost to follow-up. Leffall said that what is needed is “behavior data, surveillance and medical data that will help follow these patients in a better manner.”

An overwhelming problem for young adults is fertility, and some patients reported that preserving fertility was not always discussed before cancer treatment.

For adults, the panel said that more complete recommendations are needed to guide the post-treatment care. These should be updated regularly and published to ensure that survivors, patient educators, providers and insurers have access to them. There is a lack of research in this population that limits reimbursement for follow-up care. Leffall called this “the sandwich generation,” a generation that is trying to receive or give cancer care to a loved one while being sandwiched between responsibilities for children and older parents. Leffall said this was a group that might need support groups and referrals that can help with the problems they face.

The panel said that the IOM or other independent body should undertake a periodic assessment of the effect of legislative changes to Medicare to make sure older adults have proper access to diagnostic and therapeutic care, so they are not denied the care that they deserve. “Very often older patients have co-morbidities that can interfere with care, they should have information and referrals to take care of both problems,” he said. The number of cancer survivors is expected to increase and the need for posttreatment care and ancillary services will grow, too, making these issues even more important, according to the panel.

Source: LaSalle D. Leffall, Jr., MD
For more information:
* President’s Cancer Panel. “Living Beyond Cancer: Finding a New Balance.” 2003-2004 Annual Report. May 2004. NIH. Bethesda, Md.
* Leffall LD. Presidents Panel on Cancer: Report on Cancer Survivorship. Presented at 40th Annual Meeting of ASCO. New Orleans. June 5-8, 2004.

June, 2004|Archive|

Taking Aim at the Professional Rodeo Circuit’s Drug of Choice

  • 6/11/2004
  • CODY, WY
  • By TIMOTHY EGAN
  • The New York Times

That Copenhagen Cowboy, as they called Kent Cooper, was a saddle bronc rider on the rodeo circuit, one of the best in the world at trying to keep his spurs high on a horse that wanted no part of him. When he died two years ago at 47, the throat cancer was so bad it wrapped around his jugular vein and got into his brain. His name lives on, here in the place that calls itself the rodeo capital of the world, and in every town where cowboys wrestle animals under starry skies. But Mr. Cooper’s legacy may be something more unsettling than his many winning rides.

The Cooper family has sued the nation’s leading maker of chewing tobacco, which is also the oldest sponsor of rodeo, charging that the company addicted Mr. Cooper to a cancer-causing product without adequate warning about its hazards. Smokeless tobacco, known as chew or spit, is the drug of choice on the bull and bronc circuit, given away at sampling tents, promoted through banners and college scholarships and by charismatic champions who tell people it is part of Western culture. Mr. Cooper’s ex-wife, Susan Smith, and a small but growing number of cowboys say smokeless tobacco has made tooth-stained addicts out of too many rodeo riders and has no place in a fast-growing sport that appeals to families.

“Kent was a billboard for tobacco,” Ms. Smith said. “They all are. But I wish people knew about the other side of it. He was so addicted to it he couldn’t get out of bed in the morning without putting a wad in his mouth.”

At a time when cigarette use has fallen and tobacco’s ties have been severed with most major sports – including, this year, the former Winston Cup of Nascar – rodeo is one of tobacco’s last entertainment refuges. And smokeless tobacco, which delivers nicotine when placed between a user’s lip and gum, is the only growing segment of the industry, gaining new users in rural America. Rodeo, watched by about 23 million people in North America last year, is the rare sport where many, if not most, athletes are regular users of tobacco, which is as routine as rawhide.

“I’ll chew till my lip falls off,” said Matt Burch, a 27-year-old Wyoming cowboy who owns a rodeo company and took up tobacco as a young boy. “It’s part of the code of the West – let a guy do what he damn well wants to do.”

Ms. Smith and her 9-year-year-old son, Will Cooper, are suing the U.S. Smokeless Tobacco Company, which makes Copenhagen and Skoal, the leading brands, each accounting for more than $1 billion in sales annually in the United States. The company is owned by UST Inc. of Greenwich, Conn. The suit was filed in April in federal court in southern Idaho, where Mr. Cooper lived. Copenhagen sponsored Mr. Cooper and gave him free tobacco for much of his professional life. With prize money low until recently, and a can of tobacco costing nearly $5, sponsorship can make a big difference.

When his rodeo days were over in the mid-1990’s and he was broke, Mr. Cooper sometimes bought tobacco instead of diapers, Ms. Smith said. She is seeking an unspecified amount of money from the tobacco company, but says she does not expect to win any. What she wants is to see chew driven out of rodeo. In the suit, the family says that Copenhagen, with its high nicotine content, “is far more addictive than almost any other brand” and “has a high concentration of those components of spit tobacco that carry the greatest risk of causing cancer.”

Company officials refused to comment on the lawsuit, but said the company had been a responsible sponsor of rodeo and had worked hard to keep the product away from young people. Copenhagen was introduced in 1822 and is one of the oldest trademarks in the United States. “We are proud of our long history of supporting the sport,” said Jon Schwartz, a spokesman for UST. “Our product is a legal product for adults only, and it’s part of the Western way of life.” The company reached an agreement with 45 states in 1998, offering a range of advertising restrictions, foremost of which is that it no longer displays brand names at rodeos but instead has banners for U.S. Smokeless. Samples are still given away.

It would be hard to find a more iconic symbol of one kind of Western man than Kent Cooper. Raised as a Mormon in Idaho ranch country (the Mormon Church urges its members to refrain from tobacco, caffeine and alcohol), he took up smokeless tobacco at the age of 13, his friends said, because it was all around him. Handsome, rough-hewn and charismatic, Mr. Cooper became one of rodeo’s best-known riders in the saddle bronc competition, the signature event of the sport, where a cowboy gets points for staying on a kicking, wildly bucking horse. He qualified 13 times for the national rodeo finals. “He would have won it all one year except he decided to go off and go hunting,” said Tony Martoglio, a former rodeo cowboy in Cody. Mr. Martoglio suffered from throat cancer himself, but he still chews tobacco. “It’s the American way,” he said of his decision not to give it up. “You’ve got the right to make your own choice.”

Ms. Smith and Mr. Cooper were married for 11 years and had one child. Tobacco was always a part of Mr. Cooper’s life. “He tried to quit,” Ms. Smith said. “But he needed it at all hours – first thing in the morning, all day, late at night. He was one of those who never spit. He swallowed it.”

She said he was never sick until he developed throat cancer a few years ago. On the rodeo circuit, smokeless tobacco is part of a festive tableau, beginning at the college level. U.S. Smokeless has given out nearly $5 million in scholarships over the last 30 years to college rodeo participants, and it sponsors luncheons and other events. The commissioner of the National Intercollegiate Rodeo Association, John Smith, said the college rodeo circuit valued the boost it got from smokeless tobacco. “We all need the money,” he said. “We’re not hypocritical. We’d take beer money if we could get it.” He said only a handful of the colleges with rodeo programs did not allow tobacco sponsorship or banners.

The sponsorship money is bigger on the pro circuit. Standings are sponsored by Jack Daniel’s, the whiskey maker. The sport’s best-known athlete, Ty Murray, identified as a seven-time World Champion All Around Cowboy, appears in print advertisements saying, “My three priorities in life are my horse, my rope and my Copenhagen, but not necessarily in that order.”

But there are new voices among the horses and bulls these days. A man who calls himself Cowboy Ted Hallisey has been setting up booths at rodeo grounds where he warns children of the dangers of smokeless tobacco. Mr. Hallisey says he is a former user of smokeless tobacco, a habit he says he picked up at age 15 at the rodeo. He exudes the passion of a reformed addict. “The Kent Cooper case is going to blow the doors open on the relationship between this drug and this sport,” said Mr. Hallisey, who lives in Kanab, Utah.

Officials at the Professional Rodeo Cowboy Association said they would re-examine their relationship with smokeless tobacco before signing any new deal when their 10-year contract ends next year. “I don’t know if today’s rodeo is the same as it was 10 years ago,” said Leslie King, a spokeswoman for the association. The riders have attracted other sponsors, including jeans companies and salsa makers.

People in the tobacco industry and many rodeo cowboys say chewing tobacco is safer than smoking it. But last year the surgeon general, Dr. Richard H. Carmona, said in Congressional testimony that it was a myth that smokeless was a safe alternative to cigarettes. Cans and pouches carry warning labels about gum disease and cancer.

Each year, 30,000 American are found to have oral cancer, and about 8,000 die of it. But cowboys can feel immortal, particularly on summer nights in Cody, where there is a rodeo every night through the end of August. “Cowboys are going to chew tobacco no matter what you tell them,” said John Costello, a former rodeo athlete who announces events here. He chews as well.

OCF Note: You really have to wonder about people who make statements that making your own choice is the American way as a justification for remaining addicted to a product. I wonder if they will be equally as enthusiastic about saying that they made the free choice to have cancer when the disease strikes them. As a long time western horse owner and enthusiast who grew up in a rural environment, I find this particularly sad. Rodeo has become increasingly a family event. I think that these great cowboys could do a better job of being a role model to the young people that look up to them. The sport has come a long way from it’s roots as a demonstration of real working cowboy skills. These individuals are athletes as much as cowboys. Rodeo has the potential to make the break into the arena of a real national past time, as NASCAR racing has done in the last ten years. That leap will be partially effected by the public’s view of the participants, and how they impact the youth that watches them from the stands. Rodeo promoters who speak of the dollars should realize that like it’s gradual removal from the world of baseball, spit tobacco in sport is leaving the arena. Like the real working cowboys of the 1880’s, spit tobacco’s time is passing. Take a look at the sponsorship changes in the world of stock cars. Any smart rider, or rodeo promoter should see the potential and logical evolution of sponsorships. While this article mentions the obvious potential sponsors, who would have thought we’d see a Tide detergent sponsored race car? There’s a product about as far removed form the sport as you can get. The fact is that any promoter that works the companies will find sponsors, and whether they come from the traditional world of companies that have sponsored rodeo in the past or not, who cares? Companies are always looking for new marketing venues….. why not rodeo? Brian Hill

June, 2004|Archive|

Current Cancer Mortality: What the Numbers Mean

  • 7/10/2004
  • Bethesda, MD
  • Karen Antman, MD
  • National Cancer Institute

Since about 1990, cancer mortality per 100,000 population in the United States has been falling. This trend has been driven by decreasing mortality in the four most common malignancies: prostate, breast, lung, and colon cancers.1 Although many debate the impact of either cancer screening or treatment, the decrease in mortality for breast, colon, and prostate cancers is attributable to better treatment, to screening, or, probably, to both. The fall in lung cancer deaths almost certainly results from the fact that significant numbers of Americans quit smoking 15 to 20 years ago. Most of those who quit were men; consequently, lung cancer mortality in men peaked in about 1990 and is now falling, whereas mortality in women has only leveled off. Women have particular difficulty quitting smoking, perhaps because our society places great value on thinness, and women who quit tend to gain weight. Depression, which also decreases the success rate of quitting, is approximately twice as common in women as in men.

Mortality per 100,000 is a clean statistical end point. Although 5-year survival rates have also improved, from about 40% in the 1950s to 62% today, these rates are subject to early detection bias; they can be inflated by the implementation of screening programs, which increase the detection of small lesions with a better prognosis or of premalignant lesions of uncertain clinical significance.1 Nevertheless, because large numbers of baby boomers are now entering their 50s—an age when the risk of cancer increases substantially—the absolute numbers of Americans with cancer will almost certainly rise over the next decade.

Although mortality from the most common cancers is falling, a number of malignancies are increasing in incidence and mortality, among them pancreatic cancer, esophageal cancer, non-Hodgkin lymphoma, and melanoma. Melanoma may be related to sun exposure, and pancreatic cancer is partly associated with smoking. The rise in distal adenocarcinomas is associated with Barrett esophagus, gastric reflux, and obesity; the risk of more proximal squamous esophageal cancers has remained stable.

In terms of mortality from cancer, not all Americans are created equal. Mortality for breast and colon cancers is significantly higher in the Northeast. Mortality from prostate cancers is higher in the Southeast. Despite Medicare, some patients older than 65 years do not receive adjuvant chemotherapy for colon cancer2,3 or the current standard treatments for ovarian cancer,4 even though randomized trials have documented significant survival benefit.

Furthermore, different racial and ethnic groups have substantially different mortalities from various cancers. In children with acute lymphoblastic leukemia, survival is better in whites than in African Americans, Hispanics, or Native Americans.5 Mortality from prostate cancer is twice as high in African-American men as in white men.1 Breast cancer incidence is lower in African-American women (96 per 100,000) than in white women (113 per 100,000), but breast cancer mortality for African-American women is higher. Although breast cancer mortalities were similar for African Americans and whites in the United States in the 1970s, the rates diverged as better treatments were developed, falling in whites but not in African Americans.6,7

African-American women often have more advanced breast cancer at diagnosis, with lower percentages of well-differentiated and estrogen receptor-positive disease.8 In addition, breast cancer survival is higher in African-American women treated in military facilities than in African-American women as a whole, as reported in the Surveillance, Epidemiology, and End Results (SEER) Program. Those statistics suggest that differences in access to quality care, insurance, and social support account for much of the racial disparity.9,10 Nevertheless, among military beneficiaries, whites still survived significantly longer than African Americans, so some component may be biologic.11

Biologic differences between ethnic groups are inadequately studied, but differences in drug metabolism and transport are well described and could affect sensitivity to carcinogens, as well as responses to chemotherapy.12,13 A smaller percentage of breast tumors from African Americans express estrogen and progesterone receptors; higher receptor levels are associated with a better prognosis.10,14 In at least one study, however, other molecular indices associated with breast cancer prognosis did not differ significantly among whites, African Americans, and Hispanics.15

To have the greatest impact on the burden of cancer, we must not only discover and develop new effective therapies but also ensure equal access to established prevention, diagnostic, and treatment services.

June, 2004|Archive|

Face surgery research unit opens

  • 6/10/2004
  • London, UK
  • BBC News, (UK)

The world’s first clinical research centre devoted to facial surgery is opening in London on Thursday. The centre, set up by the Facial Surgery Research Foundation, will coordinate studies into oral cancers and facial injuries and deformities. It will bring together 40 UK surgeons, plus researchers and statisticians.

Surgeon Iain Hutchison, who is leading the centre, says he hopes its research will mean better treatments can be developed for patients more quickly.

Oral cancer is the sixth most common cancer in the world and a source of facial disfigurement for some after treatment. It is almost as common in the UK as leukemia and melanoma and its incidence is twice that of cervical cancer. Another significant part of the surgeons’ work involves caring for patients injured after binge drinking, either by falling or by fighting. All these types of causative factors will be treated by the facility.

We hope to eliminate the inconsistencies in treatment

Around 125,000 teenagers in the UK are affected by severe facial injuries after drinking every year and surgery is needed to correct the facial disfigurement of over 4,000 young people. Specialists also plan to carry out research into the psychological effects of having a facial injury. Although the centre will start by focusing research studies in the UK, it is hoped it can take part in international research projects within two or three years.

Dr. Hutchison, a consultant in oral and maxillofacial surgery at St Bartholomew’s Hospital in London, said: “The face is central to how we are judged and how we feel about ourselves. “People with facial disorders not only have to cope with the fear generated by their illness, but also the dramatic effect that treatment will have on their appearance, speech and ability to eat.”

Two preventative studies aimed at demonstrating the risk of mouth cancers from smoking and drinking to young people are already planned. Initial work has found that showing teenagers images of mouth cancers deters them from smoking. Each of the 40 surgeons would go into a school and give an illustrated talk on mouth cancers. Children in another 40 schools in the same areas would be shown a video. A third group would be given no information. The children would then be followed for over two years to see if the talks or video had any effect on smoking rates. A similar study, where surgeons would look at the most effective way of warning teenagers of the dangers of facial injuries while drinking, would also be under taken.

Dr. Hutchison said that, currently, individual surgeons may have to spend many years recruiting enough patients to carry out studies into how best to treat conditions. He says number of surgeons involved in the centre will enable more patients to be recruited more quickly. This means studies will be completed sooner, and therefore the results can influence treatment more quickly.

He told BBC News Online: “This centre will be a unique research source. It is the first of its kind in the world. We hope to eliminate the inconsistencies in treatment. These inconsistencies affect patient’s lives.” He also said the mouth cancer cure rate among the surgeons involved in the centre was significantly higher than the national average, suggesting improvements could be made.

Barbara Alves, a patient treated by Dr. Hutchison, told the BBC it was important others looked beyond someone’s facial injury. “We’re all people. Other people need to look at us for who we are, not just how we look.”

June, 2004|Archive|

Reducing Oral Cancer Risk

  • 6/9/2004
  • NEW ORLEANS , LA
  • By Stacie Overton
  • Ivanhoe Newswire

Those anti-inflammatory drugs you’re taking may be doing more good than you thought, according to researchers presenting at this year’s annual meeting of the American Society of Clinical Oncology in New Orleans. They could provide protection against a deadly cancer.

Oral cancer is often related to tobacco and has a high mortality rate. Available data suggest aspirin, a type of non-steroidal anti-inflammatory drug, has a protective effect on esophageal cancer, but only scattered data exist on whether or not it is useful in protecting against oral cancer.

Jon Sudbø, from the Norwegian Radium Hospital in Oslo, presented results of a study to determine how protective NSAIDs were against oral cancer. More than 450 people with oral cancer were included in the study. They were compared to a closely matched set of people without oral cancer, but who were at high risk of the disease.

Among those with oral cancer, less than 20 percent had a history of NSAID use. Comparatively, more than 40 percent of those who were at high risk — but did not have cancer — had a history of NSAID use. Overall, there was a 65-percent reduction in oral cancer risk with extended use of NSAIDs, and all types of NSAIDs had a protective effect.

The NSAIDs used were one of the following: aspirin, ibuprofen, naproxen, indomethacin, piroxicam or ketoprofen.

Sudbø says, “Clearly, there is a protective effect of NSAIDs against oral cancer.” Sudbø collaborated on the study with colleagues from the Norwegian Radium Hospital, the University of Texas in Austin, M.D. Anderson Cancer Center in Houston, and Cornell University in New York.

SOURCE: Stacie Overton at the 40th Annual Meeting of the American Society of Clinical Oncology in New Orleans, June 5-8, 2004

June, 2004|Archive|

Cancer patient slashes op time for cancer sufferers

  • 6/9/2004
  • Rebecca Camber
  • Manchester News (UK)

A cancer patient who endured a 12-hour operation to remove a tumour has made sure her fellow patients do not have to go through the same ordeal. Sue Slater, 54, raised thousands of pounds to supply Christie Hospital with one of the most advanced laser surgery instruments available on the market. The transoral laser surgery equipment allows surgeons to remove throat and mouth tumours in under four hours. Sue had the surgery three years ago to remove a tumour on her tongue. Along with her husband Stuart, she formed a local group, the Wilmslow Fundraisers for Christies, selling toys, jams and chutneys all year to raise the £10,500 needed to buy the life-saving equipment.
The sophisticated piece of kit is the only one in the North to allow surgeons to remove mouth and throat tumours without having to cut the skin or resort to rebuilding the face.

The gadget is equipped with a microscope to give surgeons the best view when they look for the tumour through the mouth. The equipment also gives patients a much higher chance of making a full recovery and they won’t have to bear the same scars as Sue has across her neck. Stuart, who is chairman of the group, said: “Sue went through major surgery. It was very tough. Having had personal experience of this kind of cancer, we are delighted to see this new equipment in use and hope it will provide benefits for many years to come.”

The hospital has about 600 new cases of neck and throat cancer a year, but doctors say their new equipment will slash their waiting lists. Consultant head and neck surgeon Jarrod Homer said: “We are extremely grateful to the Wilmslow Group for raising the funds to purchase this equipment which has revolutionised the treatment for this type of cancer and totally changed the outlook for patients. “We are now able to offer a gold standard service, reducing the length of time patients have to stay in hospital, reducing suffering and complications and boosting their chances of survival.

June, 2004|Archive|

Cancer’s Cost Crisis

  • 6/8/2004
  • NEW ORLEANS, LA
  • Matthew Herper
  • Forbes

After helping to develop some of the hottest new biotech drugs, Memorial Sloan-Kettering cancer doctor Leonard Saltz has come down with a bad case of sticker shock. The price tag for treating patients has increased 500-fold in the last decade.

Ten years ago, doctors could extend the life of a patient who had failed to respond to chemotherapy several times by an average 11.5 months using a combination of drugs that cost $500 in today’s dollars. Now, new medicines such as Genentech’s (nyse: DNA ) Avastin and Sanofi-Synthelabo’s (nyse: SNY ) Eloxatin can extend survival to 22.5 months, but at a total cost of $250,000. And that doesn’t include pharmacy markups, salaries for doctors and nurses, and the cost of infusing the drugs into patients in the hospital. That kind of cost is unsustainable. “Sooner or later the bubble is going to pop,” Saltz says.

Fears about the high cost of new drugs and the changing financial environment for treating cancer are major concerns among doctors gathered here at the annual meeting of the American Society for Clinical Oncology. Doctors are beginning to discuss treating cancer as a chronic disease that could be kept in check with a cocktail of pills. But that puts cancer drug firms on a collision course with both the private sector’s crackdown on high healthcare costs in the United States and the new Medicare law, which will go into effect in less than two years. As the government pays for senior citizens’ drug costs, it is likely to wind up footing the bill for a large fraction of cancer drugs. The question is simple: How many $20,000 cancer drugs can society really afford to stack on top of one another? “Absent a thoughtful national discussion, the answer is none,” says Michael A. Friedman, chief executive of City of Hope, a cancer center in Los Angeles. “We will quickly run out of resources, leading to de facto rationing.” The rising costs, he says, are “utterly insupportable.”

One hope has been that genetic diagnostic tests could predict which patients won’t be helped by an expensive drug–saving the system money. For instance, mutations in a particular gene seem to determine whether lung tumors are shrunk by pills such as Tarceva, from Genentech, OSI Pharmaceuticals (nasdaq: OSIP ) and Roche, and Iressa, from AstraZeneca (nyse: AZN ). But scientists revealed yesterday that there are many such mutations, and that patients without them benefit. That means doctors will probably try to give the drugs to everyone. And because Tarceva, which is not yet approved, has been shown to extend survival in last-ditch patients, doctors may favor it. That could make the cost problem worse. Bernstein analyst Geoffrey Porges thinks Genentech will price Tarceva at 20% more than Iressa, which already costs $1,700 a month.

Doctors are also talking about combining drugs, but the cost there is astronomical. Saltz says ImClone Systems’ (nasdaq: IMCL) Erbitux, which he helped develop, is one of the worst offenders on price. “I think they made a real mistake in their pricing,” he says. The drug costs more than even Avastin, Saltz notes; it could add another $100,000 to the cost of treating a single patient. Pills such as Tarceva are at least cheaper for the system than drugs such as Avastin, Eloxatin, and Erbitux, all of which must be infused directly into the patient’s vein in the doctor’s office. It’s possible that new drugs which themselves target cancer in several ways at once may provide some cost advantages. Pfizer (nyse: PFE), GlaxoSmithKline (nyse: GSK) and others are all testing such drugs.

Whatever solutions emerge, it’s likely that drug costs will have to come down and that some patients will be denied medicine because their chances are too slim. Says Saltz: “We’re going to have to stop taking the stance that every patient has to get every last shot at survival. The days of developing drugs and not worrying what they cost are over.”

June, 2004|Archive|

ASCO: Four Winning Cancer Drugs

  • 6/7/2004
  • New Oleans, LA
  • Matthew Herper
  • Forbes.com

The annual meeting of the American Society for Clinical Oncology is a much-watched arena for biotech concerns, which get their first chance to present new data to investors. Here are four companies that have doctors talking about their drugs.

ImClone Systems
Erbitux
Colon Cancer, Head-And-Neck Cancer

For the first time, ImClone Systems’ (nasdaq: IMCL ) Erbitux has been proven to extend patients’ lives. (In previous studies, it shrank tumors.) The new results for the drug are in head-and-neck cancer, a kind of tumor in the throat and mouth that is difficult to treat. The results are seen as proof of the drug’s efficacy. “It takes a monkey off the back of a drug that’s taken some hits,” says Leonard Saltz, an oncologist from Memorial Sloan-Kettering who played a role in Erbitux’s development. For ImClone and partner Bristol-Myers Squibb (nyse: BMY), that’s good news indeed.

Millennium Pharmaceuticals
Velcade
Myeloma, Lung Cancer

Some analysts are disappointed with the sales of Millennium’s (nasdaq: MLNM) Velcade as a treatment for multiple myeloma, a cancer of the blood. Yet many are watching to see whether the drug can work in other cancers, particularly those that form big, solid tumors. Early evidence came from a presentation using Velcade in non-small-cell lung cancer in a mere 53 patients. Bruce Johnson, an oncologist at the Dana-Farber Cancer Institute, says the results look good, but very preliminary. Roman Perez-Soles, chairman of the department of oncology at the Albert Einstein College of Medicine, picked Velcade as one of the more promising new drugs presented at the meeting.

Telik
Telcyta
Ovarian Cancer, Lung Cancer

Another drug Perez-Soles is watching is Telcyta, a drug being developed by tiny Palo Alto, Calif.-based Telik (nasdaq: TELK). The drug showed some activity in lung cancer, and continues to show positive results in ovarian cancer–the disease for which Telik expects to file for approval. In an analysis of eight patients who took the drug with chemotherapy, presented by John Kavanagh of the M.D. Anderson Cancer Center, all of the subjects at least saw their disease stabilize; one actually had a complete response, meaning the cancer disappeared. The results are preliminary but promising. “The preliminary data about activity are really, really nice,” says Lee Rosen, director of developmental therapeutics at St. John’s Medical Center in Santa Monica, Calif. “I’ve seen a number of patients receive benefit from that drug.”

Pfizer
SU11248
Kidney Cancer

With the news of efficacy of its SU11248 pill in kidney cancer, Pfizer (nyse: PFE ) is making its entry into the world of targeted cancer drugs. Another drug from Bayer (nyse: BAY ) and Onyx Pharmaceuticals (nasdaq: ONXX) presented comparable results. Pfizer’s oncology division now has a full pipeline. One piece of news that may get lost: An antibody drug the company tested in a 39-person trial caused the disease to vanish, at least temporarily, in two skin cancer patients given only a single dose. Luis Camacho, the oncologist at M.D. Anderson who conducted the trial, says that these patients have not seen their cancer return after more than a year. A surprise bonus: An observational study showed that cholesterol-lowering drugs, such as Pfizer’s Lipitor, may cut the risk of cancer, though the results were extremely preliminary

June, 2004|Archive|

Picking the best hospitals

  • 6/6/2004
  • By Avery Comarow

No matter how friendly the ads and cheery the redecorated rooms, hospitals are not hotels. Patients aren’t pampered, especially with nurses and other key hospital workers in short supply. Besides, would you go to a hotel if told you had a 1 in 30 or so chance of not emerging? That’s true for many surgical procedures. Even great hospitals have their tragedies. A year ago, in June, a healthy 24-year-old woman died after volunteering for a study at Johns Hopkins Hospital in Baltimore. Last January, a healthy man who had donated part of his liver to his ailing brother died at Mount Sinai Medical Center in New York; his surgeon is tops at live-donor liver transplants.

Face it: People who check into hospitals are there because they are too ill, or need treatment that is too ambitious or difficult, to be outpatients. Elite in a grim way, they are a class in decline. In 1980, about 1 hospital patient in 7 stayed overnight. By 1990 that had dwindled to 1 in 10 and by 2000 to a scant 1 in 16.

The sicker the patient, the more pressing the need for the best care–which is why U.S. News is publishing its 13th annual edition of “America’s Best Hospitals.” They rank 205 top medical centers, winnowed from 6,045, in 17 specialties.

These hospitals excel partly because their doctors perform large numbers of tricky and risky procedures. Study piled upon study has shown the critical role of volume. In April, for example, a paper in the New England Journal of Medicine found that elderly patients had a death rate of 4 percent at hospitals that did many pancreatic cancer surgeries compared with 16 percent at hospitals that did relatively few. Ranked hospitals tend to adhere more closely to advanced treatment guidelines, to incorporate new findings into patient care, and to conduct research that gives desperately ill patients more options.

In 13 of the 17 specialties, a hospital first must meet one of three standards to be considered: membership in the Council of Teaching Hospitals, affiliation with a medical school, or availability of at least nine of 17 specified items of medical technology. That whittled the 6,045 hospitals down to 1,958. In each specialty, a hospital must perform a given number of procedures or had to be cited by at least one physician in the past three years of U.S. News surveys. These hospitals received a score (the U.S. News Index) that equally weighs reputation, mortality, and a group of care-related factors such as nursing. Each specialty’s 50 highest-scoring hospitals are listed. For cancer the list of these hospitals is located on the resources page of the Oral Cancer Foundation’s web site.

Hospitals in the four remaining specialties (eyes, pediatrics, psychiatry, and rehabilitation) are ranked solely on reputation and did not have to meet an eligibility requirement. That is because mortality data are unavailable in pediatrics and are largely irrelevant in the three other specialties.

The “America’s Best Hospitals” methodology was devised in 1993 by the National Opinion Research Center at the University of Chicago, which carries it out and refines it. This year’s rankings were produced by Colm O’Muircheartaigh, Joseph Murphy, and Whitney Moore. The U.S. News Index accounts for:

Reputation. In each specialty, 180 board-certified physicians were selected at random and asked to list up to five hospitals they consider tops in their specialty regardless of cost or location. The score shows the percentage of responding doctors in 2000, 2001, and 2002 who picked the hospital. The number of doctors surveyed was raised by 30 per specialty this year; a total of 8,160 physicians were surveyed for the three-year period.

Mortality. This ratio compares the number of deaths of Medicare patients with specified conditions in 1998, 1999, and 2000 with the number expected. A ratio below 1.00 is better than expected; above 1.00 is worse. Adjustments for severity were derived from 3M Health Information Systems software (All Patient Refined Diagnosis Related Group).

Other factors.Most remaining data came from the 2000 annual survey of hospitals by the American Hospital Association. This year hospice and palliative care were added to certain specialties because of the increasingly recognized importance of end-of-life issues and pain management. How a particular hospital fares in these rankings should not be taken as the final word–but it is a good place to start the search for the level of care you or a loved one deserve when it is most needed.

OCF link to list Click Here

June, 2004|Archive|