Sleeping less than six hours a night skews activity of hundreds of genes

http://www.guardian.co.uk/science/2013/feb/25/sleeping-six-hours-night-activity-genes
Ian Sample, science correspondent

Genes affected by lack of sleep include those governing the immune system, metabolism and the body's response to stress

When people don't get enough sleep, changes to genes that control metabolism may trigger or exacerbate conditions such as diabetes or obesity. Photograph: Getty

Getting too little sleep for several nights in a row disrupts hundreds of genes that are essential for good health, including those linked to stress and fighting disease.

Tests on people who slept less than six hours a night for a week revealed substantial changes in the activity of genes that govern the immune system, metabolism, sleep and wake cycles, and the body's response to stress, suggesting that poor sleep could have a broad impact on long-term wellbeing.

The changes, which affected more than 700 genes, may shed light on the biological mechanisms that raise the risk of a host of ailments, including heart disease, diabetes, obesity, stress and depression, in people who get too little sleep.

"The surprise for us was that a relatively modest difference in sleep duration leads to these kinds of changes," said Professor Derk-Jan Dijk, director of the Surrey Sleep Research Centre at Surrey University, who led the study. "It's an indication that sleep disruption or sleep restriction is doing more than just making you tired."

Previous studies have suggested that people who sleep less than five hours a night have a 15% greater risk of death from all causes than people of the same age who get a good night's sleep. In one survey of workers in Britain more than 5% claimed to sleep no more than five hours a night. Another survey published in the US in 2010 found that nearly 30% of people claimed to sleep no more than six hours a night.

Professor Dijk's team asked 14 men and 12 women, all healthy and aged between 23 and 31 years, to live under laboratory conditions at the sleep centre for 12 days. Each volunteer visited the centre on two separate occasions. During one visit, they spent 10 hours a night in bed for a week. In the other, they were allowed only six hours in bed a night. At the end of each week, they were kept awake for a day and night, or around 39 to 41 hours.

Using EEG (electroencephalography) sensors, the scientists found that those on the 10 hours-per-night week slept around 8.5 hours a night, while those limited to six hours in bed each night got on average 5 hours and 42 minutes of sleep.

The time spent asleep had a huge effect on the activity of genes, picked up from blood tests on the volunteers, according to a report in the US journal Proceedings of the National Academy of Sciences. Among the sleep-deprived, the activity of 444 genes was suppressed, while 267 genes were more active than in those who slept for longer.

Changes to genes that control metabolism might trigger or exacerbate conditions such as diabetes or obesity, while disruption to other genes, such as those that govern the body's inflammatory response, might have an impact on heart disease. Further genes that were affected have been linked to stress and ageing.

Sleep loss also had a dramatic effect on genes that govern the body's biological clock, suggesting that poor sleep might trigger a vicious cycle of worsening sleep disruption. The tests showed that people who slept for 8.5 hours a night had around 1,855 genes whose activity rose and fell over a 24-hour cycle. But in the sleep deprived, nearly 400 of these stopped cycling completely. The remainder rose and fell in keeping with the biological clock, but over a much smaller range.

"There is a feedback between what you do to your sleep and how that affects your circadian clock, and that is going to be very important in future investigations," said Dijk.

The researchers did not check how long it took for genes to return to their normal levels of activity in the sleep-deprived volunteers, but they hope to in further studies. Though scores of genes were disrupted in the sleep-deprived, the scientists cannot say whether those changes are a harmless short-term response to poor sleep, a sign of the body adapting to sleep-deprivation, or are potentially harmful to health.

Jim Horne, professor of psychophysiology at Loughborough University's Sleep Research Centre, said: "The potential perils of 'sleep debt' in today's society and the need for 'eight hours of sleep a night' are often overplayed and can cause undue worry. Although this important study seems to support this concern, the participants had their sleep suddenly restricted to an unusually low level, which must have been somewhat stressful.

"We must be careful not to generalise such findings to, say, habitual six-hour sleepers who are happy with their sleep. Besides, sleep can adapt to some change, and should also be judged on its quality, not simply on its total amount."

6 Gerakan Yoga yang Mudah Dilakukan di Rumah

http://wolipop.detik.com/read/2013/02/05/133201/2161550/849/6-gerakan-yoga-yang-mudah-dilakukan-di-rumah
Hestianingsih - wolipop

Latihan yoga bisa membuat tubuh lebih lentur, fleksibel dan pikiran relaks. Tidak harus selalu dilakukan di klub kebugaran atau dengan instruktur yoga. Anda bisa melakukan beberapa gerakan yoga di rumah agar tubuh selalu fit. Yang Anda perlukan hanya matras dan baju yang nyaman. Agar hasilnya maksimal, lakukan latihan ini empat kali seminggu. Ini dia enam gerakan Yoga untuk latihan di rumah, seperti dikutip dari Canadian Living.

1. Mountain Pose



Gerakan ini membantu Anda bernapas lebih stabil dan tenang. Berdiri dengan kedua tangan menutup di depan dada, dalam posisi seperti berdoa. Lebarkan kedua kaki sejajar dengan pinggul, lalu ambil napas dalam-dalam dan keluarkan secara perlahan. Jika ingin variasi, bisa mengangkat salah satu kaki untuk melatih keseimbangan tubuh.

2. Upward Hand Pose



Membantu peregangan di tubuh bagian depan seperti bahu, dada, perut dan pinggul. Tarik napas dalam-dalam, lalu ayunkan kedua tangan ke atas. Saat kedua tangan menutup di atas kepala, tarik punggung ke arah dalam hingga dada membusung. Lakukan gerakan ini di tempat yang sepi dan tenang serta cahaya redup agar pikiran lebih relaks.

3. Standing Forward Bend



Gunanya meregangkan bagian belakang tubuh seperti punggung, tulang belikat, bokong dan betis. Tarik napas, lalu keluarkan secara perlahan ketika Anda membungkuk dengan kaki tetap lurus. Luruskan tangan ke arah bawah sampai menyentuh lantai. Rasakan kontraksi pada kedua paha. Jika tidak kuat, bisa sedikit menekukkan lutut.

4. Half-standing Forward Bend



Berfungsi menguatkan punggung bagian bawah dan paha belakang. Gerakannya hampir sama seperti Standing Forward Bend, namun badan dibungkukkan sejajar dengan bokong, wajah melihat ke depan. Turunkan tangan sebatas mata kaki.

5. Plank Pose



Gerakan yoga ini untuk menguatkan bahu dan perut. Tekuk lutut hingga kedua tangan bisa menyentuh matras. Tarik dan keluarkan napas, lalu luruskan kaki belakangan, seperti hendak melakukan push-up. Pastikan tubuh dalam posisi lurus, tangan sejajar bahu.

6. Four-limbed Staff Pose



Memperkuat bahu, perut dan otot tricep (dekat lengan dan siku). Dalam posisi telungkup, tempelkan tubuh ke matras dengan menekukkan siku. Jaga siku tetap menempel pada tubuh, sementara kaki lurus.

Pour on the olive oil: Big study finds Mediterranean-style diet cuts heart attack, stroke risk

http://www.washingtonpost.com/national/health-science/pour-on-the-olive-oil-big-study-finds-mediterranean-style-diet-cuts-heart-attack-stroke-risk/2013/02/25/8b83f40e-7f3f-11e2-a671-0307392de8de_story.html

By Associated Press, Updated: Monday, February 25, 6:39 PM

Pour on the olive oil, preferably over fish and vegetables: One of the longest and most scientific tests of a Mediterranean diet suggests this style of eating can cut the chance of suffering heart-related problems, especially strokes, in older people at high risk of them.

The study lasted five years and involved about 7,500 people in Spain. Those who ate Mediterranean-style with lots of olive oil or nuts had a 30 percent lower risk of major cardiovascular problems compared to others who were told to follow a low-fat diet. Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries.

Mediterranean diets have long been touted as heart-healthy, but that’s based on observational studies that can’t prove the point. The new research is much stronger because people were assigned diets to follow for a long time and carefully monitored. Doctors even did lab tests to verify that the Mediterranean diet folks were consuming more olive oil or nuts as recommended.

Most of these people were taking medicines for high cholesterol and blood pressure, and researchers did not alter those proven treatments, said the study’s leader, Dr. Ramon Estruch of Hospital Clinic in Barcelona.

But as a first step to prevent heart problems, “we think diet is better than a drug” because it has few if any side effects, Estruch said. “Diet works.”

Results were published online Monday by the New England Journal of Medicine and were to be discussed at a nutrition conference in Loma Linda, Calif.

People in the study were not given rigid menus or calorie goals because weight loss was not the aim. That could be why they found the “diets” easy to stick with — only about 7 percent dropped out within two years. There were twice as many dropouts in the low-fat group than among those eating Mediterranean-style.

Researchers also provided the nuts and olive oil, so it didn’t cost participants anything to use these relatively pricey ingredients. The type of oil may have mattered — they used extra-virgin olive oil, which is richer than regular or light olive oil in the chemicals and nutrients that earlier studies have suggested are beneficial.

The study involved people ages 55 to 80, just over half of them women. All were free of heart disease at the start but were at high risk for it because of health problems — half had diabetes and most were overweight and had high cholesterol and blood pressure.

They were assigned to one of three groups: Two followed a Mediterranean diet supplemented with either extra-virgin olive oil (4 tablespoons a day) or with walnuts, hazelnuts and almonds (a fistful a day). The third group was urged to eat a low-fat diet heavy on bread, potatoes, pasta, rice, fruits, vegetables and fish and light on baked goods, nuts, oils and red meat.

Independent monitors stopped the study after nearly five years when they saw fewer problems in the two groups on Mediterranean diets.

Doctors tracked a composite of heart attacks, strokes or heart-related deaths. There were 96 of these in the Mediterranean-olive oil group, 83 in the Mediterranean-nut group and 109 in the low-fat group.

Looked at individually, stroke was the only problem where type of diet made a big difference. Diet had no effect on death rates overall.

The Spanish government’s health research agency initiated and paid for the study, and foods were supplied by olive oil and nut producers in Spain and the California Walnut Commission. Many of the authors have extensive financial ties to food, wine and other industry groups but said the sponsors had no role in designing the study or analyzing and reporting its results.

Rachel Johnson, a University of Vermont professor who heads the American Heart Association’s nutrition committee, said the study is very strong because of the lab tests to verify oil and nut consumption and because researchers tracked actual heart attacks, strokes and deaths — not just changes in risk factors such as high cholesterol.

“At the end of the day, what we care about is whether or not disease develops,” she said. “It’s an important study.”

Rena Wing, a weight-loss expert at Brown University, noted that researchers provided the oil and nuts, and said “it’s not clear if people could get the same results from self-designed Mediterranean diets” — or if Americans would stick to them more than Europeans used to such foods.

A third independent expert also praised the study as evidence diet can lower heart risks.

“The risk reduction is close to that achieved with statins” — widely used cholesterol drugs, said Dr. Robert Eckel, a diet and heart disease expert at the University of Colorado.

“But this study was not carried out or intended to compare diet to statins or blood pressure medicines,” he warned. “I don’t think people should think now they can quit taking their medicines.”

___

Online:

Journal: http://www.nejm.org

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

New Theory on Why Men Love Breasts

http://www.livescience.com/23500-why-men-love-breasts.html
Natalie Wolchover, Life's Little Mysteries Staff Writer

Why do straight men devote so much headspace to those big, bulbous bags of fat drooping from women's chests? Scientists have never satisfactorily explained men's curious breast fixation, but now, a neuroscientist has struck upon an explanation that he says "just makes a lot of sense."

Larry Young, a professor of psychiatry at Emory University who studies the neurological basis of complex social behaviors, thinks human evolution has harnessed an ancient neural circuit that originally evolved to strengthen the mother-infant bond during breast-feeding, and now uses this brain circuitry to strengthen the bond between couples as well. The result? Men, like babies, love breasts.

When a woman's nipples are stimulated during breast-feeding, the neurochemical oxytocin, otherwise known as the "love drug," floods her brain, helping to focus her attention and affection on her baby. But research over the past few years has shown that in humans, this circuitry isn't reserved for exclusive use by infants.

Recent studies have found that nipple stimulation enhances sexual arousal in the great majority of women, and it activates the same brain areas as vaginal and clitoral stimulation. When a sexual partner touches, massages or nibbles a woman's breasts, Young said, this triggers the release of oxytocin in the woman's brain, just like what happens when a baby nurses. But in this context, the oxytocin focuses the woman's attention on her sexual partner, strengthening her desire to bond with this person.

In other words, men can make themselves more desirable by stimulating a woman's breasts during foreplay and sex. Evolution has, in a sense, made men want to do this.


Attraction to breasts "is a brain organization effect that occurs in straight males when they go through puberty," Young told Life's Little Mysteries. "Evolution has selected for this brain organization in men that makes them attracted to the breasts in a sexual context, because the outcome is that it activates the female bonding circuit, making women feel more bonded with him. It's a behavior that males have evolved in order to stimulate the female's maternal bonding circuitry."

So, why did this evolutionary change happen in humans, and not in other breast-feeding mammals? Young thinks it's because we form monogamous relationships, whereas 97 percent of mammals do not.

"Secondly, it might have to do with the fact that we are upright and have face-to-face sex, which provides more opportunity for nipple stimulation during sex. In monogamous voles, for example, the nipples are hanging toward the ground and the voles mate from behind, so this didn't evolve," he said.

"So, maybe the nature of our sexuality has allowed greater access to the breasts."Attraction to breasts "is a brain organization effect that occurs in straight males when they go through puberty,"

Young told Life's Little Mysteries. "Evolution has selected for this brain organization in men that makes them attracted to the breasts in a sexual context, because the outcome is that it activates the female bonding circuit, making women feel more bonded with him. It's a behavior that males have evolved in order to stimulate the female's maternal bonding circuitry."

Young said competing theories of men's breast fixation don't stand up to scrutiny. For example, the argument that men tend to select full-breasted women because they think these women's breast fat will make them better at nourishing babies falls short when one considers that "sperm is cheap" compared with eggs, and men don't need to be choosy.

But Young's new theory will face scrutiny of its own. Commenting on the theory, Rutgers University anthropologist Fran Mascia-Lees, who has written extensively about the evolutionary role of breasts, said one concern is that not all men are attracted to them. "Always important whenever evolutionary biologists suggest a universal reason for a behavior and emotion: how about the cultural differences?" Mascia-Lees wrote in an email. In some African cultures, for example, women don't cover their breasts, and men don't seem to find them so, shall we say, titillating.

Young says that just because breasts aren't covered in these cultures "doesn't mean that massaging them and stimulating them is not part of the foreplay in these cultures. As of yet, there are not very many studies that look at [breast stimulation during foreplay] in an anthropological context," he said.

Young elaborates on his theory of breast love, and other neurological aspects of human sexuality, in a new book, "The Chemistry Between Us" (Current Hardcover, 2012), co-authored by Brian Alexander.

Follow Natalie Wolchover on Twitter @nattyover or Life's Little Mysteries @llmysteries. We're also on Facebook & Google+.

Anal Cancer

http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-risk-factors

What are the risk factors for anal cancer?

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposure to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancer of the lung and many other cancers. But risk factors don't tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get cancer. Also, people without risk factors can still get cancer.

Human papilloma virus infection

Most squamous cell anal cancers seem to be linked to infection by the human papilloma virus (HPV), the same virus that causes cervical cancer. In fact, women with a history of cervical cancer (or pre-cancer) have an increased risk of anal cancer.

HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause papillomas, which are more commonly known as warts. There are several subtypes of the virus, but the one most likely to cause anal cancer is called HPV-16. HPV-16, as well as HPV 18, HPV 31, HPV 33, and HPV 45 are considered high-risk types of HPV because they are strongly linked to cancer. They can also cause cancers of the cervix, vagina, and vulva in women, as well as cancer of the penis in men, and throat cancer in both women and men.

Other subtypes of HPV can cause warts in the genital and anal areas. The medical term for these warts is condyloma acuminatum. The 2 types of HPV that cause most cases of anal and genital warts are HPV 6 and HPV 11. They are called low-risk types of HPV because they tend to cause warts but not cancer. HPV infection can cause anal and genital warts, but most people infected with HPV do not have genital warts or any other signs of infection.

HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. HPV can be spread during sex -- including vaginal intercourse, anal intercourse, and oral sex - but sex doesn't have to occur for the infection to spread. All that is needed is for there to be skin-to-skin contact with an area of the body infected with HPV. The virus can be spread through genital-to-genital contact. It is even possible for a genital infection to spread through hand-to-genital contact.

An HPV infection also seems to be able to be spread from one part of the body to another. This means than an HPV infection may start in the genitals and then spread to the anus.

It can be very hard to avoid being exposed to HPV. It might be possible to prevent genital HPV infection by not allowing others to have contact with your anal or genital area, but even then there could be other ways to become infected that aren’t yet clear.

Infection with HPV is common, and in most cases the body is able to clear the infection on its own. But in some cases the infection does not go away and becomes chronic. Chronic infection, especially when it is with high-risk HPV types, can eventually cause certain cancers, including anal cancer.

For men, the 2 main factors influencing the risk of genital HPV infection are circumcision and the number of sexual partners. Men who are circumcised (have had the foreskin of the penis removed) have a lower chance of becoming and staying infected with HPV. The risk of being infected with HPV is also strongly linked to having many sexual partners (over a man's lifetime).

In women, HPV infections occur mainly at younger ages and are less common in women over 30. The reason for this is not clear. Certain types of sexual behavior increase a woman's risk of getting a genital HPV infection, such as having sex at an early age and having many sexual partners.

Although women who have had many sexual partners are more likely to get infected with HPV, a woman who has had only one sexual partner can still get infected. This is more likely if she has a partner who has had many sex partners or if her partner is an uncircumcised male.

In a study that looked at risk factors for anal HPV infection in women, risk was increased in younger women and in those who had more than 5 sexual partners in their lifetime. Ever having anal sex also increased risk.

Circumcision and HPV: Men who have not been circumcised are more likely to be infected with HPV and pass it on to their partners. The reasons for this are unclear. It may be that the skin on the glans of the penis goes through changes that make it more resistant to HPV infection. Another theory is that the surface of the foreskin (which is removed by circumcision) is more easily infected by HPV. Still, circumcision does not completely protect against HPV infection -- men who are circumcised can still get HPV and pass it on to their partners.

Condoms and HPV: Condoms can provide some protection against HPV, but they do not completely prevent infection. One study found that when condoms are used correctly they can lower the genital HPV infection rate in women by about 70% - but they need to be used every time sex occurs. This study did not look at the effect of condom use on anal HPV infection. In another study, men who used condoms less than half of the time had a higher risk of HPV infection. Condoms cannot protect completely because they don't cover every possible HPV-infected area of the body, such as skin of the genital or anal area. Still, condoms provide some protection against HPV, and they also protect against HIV and some other sexually transmitted diseases. Condoms (when used by the male partner) also seem to help genital HPV infections clear (go away) faster in both women and men.

Other cancers

Ever having cancer of the cervix, vagina, or vulva is linked to an increased risk of anal cancer. This is likely because these cancers are also caused by infection with HPV. Although it is likely that having penile cancer, which is also linked to HPV infection, would increase the risk of anal cancer, this link has not been shown in studies.

HIV infection

People infected with the human immunodeficiency virus (HIV), the virus that causes AIDS, are much more likely to get anal cancer than those not infected with this virus.

Sexual activity

Having multiple sex partners increases the risk of infection with HIV and HPV. It also increases the risk of anal cancer.

Receptive anal intercourse also increases the risk of anal cancer in both men and women, particularly in those younger than the age of 30. Because of this, men who have sex with men have a high risk of this cancer.

Smoking

Smoking also increases the risk of anal cancer. Current smokers are several times more likely to have cancer of the anus compared with people who do not smoke. Quitting smoking will reduce the risk. People who used to smoke but have quit are only slightly more likely to develop this cancer compared with people who never smoked.

Lowered immunity

Higher rates of anal cancer occur among people with reduced immunity, such as people who have had an organ transplant and must take medicines that suppress their immune system.

Race and gender

Anal cancer is more common in African-Americans than in whites. Overall, it is more common in women than men, but in African Americans it is more common in men than in women.

http://well.blogs.nytimes.com/2011/02/09/saving-lives-from-anal-cancer/

By RONI CARYN RABIN

Saving Lives From Anal Cancer

Paulette Crowther’s three children were grown and she was plotting a midlife career change when a routine colonoscopy picked up cancer, but not of the colon — of the anus.

The diagnosis was a shock. Ms. Crowther, a 51-year-old mother of three from New York City, had had no symptoms and was feeling just fine. It felt like a bolt from the blue. The cancer had already spread.

But as Ms. Crowther and her children scoured the Internet for information, they couldn’t help but wonder whether the cancer could have been prevented, or caught earlier at least.

Some 80 to 90 percent of anal cancers are caused by the human papillomavirus, or HPV, the same kind of virus that causes cervical cancer. And decades earlier, when Ms. Crowther was in her 20s, she had been treated for cervical dysplasia, a condition that often precedes cervical cancer – and is also caused by an HPV infection.

If only she had known.

“We think Mom could have been saved if she’d been monitored and screened more often,” said Ms. Crowther’s oldest child, Justine Almada, 27. “Studies show that if you have cervical dysplasia, you’re at higher risk. At the very least, she should have been made aware of that.”

She added, “Anal cancer is quite treatable if it’s found early.”

The same types of human papillomavirus implicated in cervical cancer, HPV 16 and 18, are also linked to anal cancer. And in December, the Food and Drug Administration expanded the approved uses of the HPV vaccine Gardasil to include prevention of anal cancer and precancerous lesions.

Ms. Crowther — who was fiercely devoted to the brood she raised in Lower Manhattan, largely on her own after a divorce, and whom the children call their “best friend” — died last April. Within three months, Justine and her siblings, Tristan and Camille Almada, ages 25 and 23, had established the HPV and Anal Cancer Foundation.

The foundation’s aim is to raise awareness about the link between the human papillomavirus, an incredibly common sexually transmitted infection, and a whole list of cancers, each of which affects a relatively small number of people but which, taken together, affect tens of thousands. Besides anal cancer, HPV infections are linked to some gynecological cancers, like vulvar and vaginal cancers, certain penile cancers in men and certain head and neck cancers.

With a robust Web site — analcancerfoundation.org — and an expert scientific advisory board, the organization also aims to increase awareness about preventive screening, provide support to family members and caregivers and raise money for research on treatment, which remains limited for metastatic disease.

“What keeps us going is the thought that if someone had done this already, it could have prevented what happened to Mom,” said Camille, who recently stepped in to run the tax-exempt foundation.

The irony is that while Ms. Crowther was still alive, she never told anyone what kind of cancer she had. Experts say that’s not unusual for people with anal cancer, who often are ashamed of their disease. “The assumption most people make is that if you have anal cancer, you had anal sex,” Camille said. “That’s not true. Heterosexual men also have HPV in their anus, because HPV is so prevalent. But also: who cares if you had anal sex?”

Dr. Cathy Eng, an associate professor in gastrointestinal medical oncology at M.D. Anderson Cancer Center in Houston, said: “It’s really important to emphasize that the average person is in fact a female in her late 50s, early 60s — that’s the average patient.” The actress Farrah Fawcett, of “Charlie’s Angels” fame, who documented her battle with anal cancer on film, was fairly typical; she was 62 when she died of the disease in 2009. Dr. Eng added, “People associate anal cancer in general with men who have sex with men who are H.I.V.-positive; that’s not the case.”

While men who have sex with men are at elevated risk for developing anal cancer, the disease strikes more women than men: cases are diagnosed in some 2,000 men and 3,260 women each year in the United States. The disease is on the rise, with new diagnoses increasing by 2 percent a year in both men and women, according to national cancer statistics. Each year, 720 people die of anal cancer.

Other risk factors include having a history of cervical cancer or other gynecological malignancies, having a suppressed immune system, an atypical Pap smear and testing positive for HPV 16 or 18. Having had multiple sex partners, having a history of sexually transmitted disease and having had receptive anal intercourse, even without full penetration, likewise increase risk.

Early symptoms like blood in the stool or a feeling of pressure can easily be mistaken for hemorrhoids. “An important message is: if your hemorrhoids don’t get better, you need to talk to your doctor,” Dr. Eng said.

There is no clear medical consensus on screening for anal cancer. Choices include a digital rectal exam or digital anal exam, done as part of a physical or gynecological checkup, or an anal Pap smear. Dr. Joel Palefsky, an infectious disease specialist at the University of California, San Francisco, offers a screening procedure called high-resolution anoscopy, which may be an especially sensitive screening technique. But it is not widely available.

“If a woman has had cervical cancer, she is clearly at increased risk for anal cancer,” Dr. Palefsky said. “We’ve known about the connection for a while. People didn’t pay a lot of attention until recently.”

Another of the foundation’s goals is to destigmatize the disease and end the isolation many patients feel. “When you have cancer, you shouldn’t be ashamed of it; it’s terrible enough to have cancer,” Camille said.

Behind the fetish of vitamin B12 shots

http://www.kevinmd.com/blog/2013/02/fetish-vitamin-b12-shots.html
ROY BENAROCH, MD | FEBRUARY 3, 2013

Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like thefalse dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if there’s a medical diploma on the wall.

The story: a woman brings in her teenage daughter, complaining that the girl is tired a lot. It turns out that mom herself has had some blood tests that showed a low vitamin B12 level, so her doctor is giving her regular B12 injections. Can her daughter get some, too?

I realize that B12 injections are common. Many docs administer these, and many adults get these—probably some of you reading this. So what’s the science behind this practice?

Vitamin B12 deficiency is a real thing. It can occur because of a poor diet, or because some medications (like acid blockers) interfere with absorption. Or it can occur because of a specific autoimmune disorder called “Pernicious Anemia.” Whatever the cause, the health consequences of vitamin B12 deficiency can include anemia, neuropathy, irritability, and depression.

There is a simple blood test to measure vitamin B12 levels, though the levels in the blood don’t always correlate with whether there is enough B12 levels in the cells themselves. We can test for this, too, indirectly, through other blood tests including methylmalonic acid and homocysteine levels. So we can, in fact, know if a person is truly deficient. These confirmatory tests are rarely done.

Instead, many adults are told that their vague symptoms of tiredness or fatigue are caused by B12 deficiency, instead of actually trying to address genuine issues like insufficient sleep, sleep apnea, overreliance on caffeine, and depression (to name a few of the many genuine causes of fatigue.)

It gets worse. The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.

So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—withacupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.

So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?

I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.

More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using  genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.