found this cool place, actually, not even sure I want to share my secret source
hehe. But you know what, Im a generous guy so i guess ill help you out, plenty
of potential partners on there to share around i guess. anyway
http://www.howamazingisthis.info/kfth is the spot im talking about. ive only
been on there bout a week or two, already met up with two ppl and talked to
tonns of hotties on webcameras. heap of fun.
In case you missed Antonia's other posts from the prostate cancer symposium,
I have included them for your review.
ASCO - Advanced Prostate Cancer and Investigational Therapy
Antonia Scatton at the ASCO Prostate Cancer Symposium in San Francisco, CA |
02.26.2006
In another fast-paced session, presenters got into the nitty-gritty of how
advanced prostate cancer works, including how prostate cancer becomes
androgen independent and what we might be able to do to stop it.
Dr. Elizabeth Wilson, from University of North Carolina - Chapel Hill, spoke
about androgen receptors, and how ³co-activators² bind to androgen
receptors, activating them even when testosterone levels are very low.
Levels of these co-activators are higher in advanced hormone-independent
prostate cancer, even when levels of the androgen receptors themselves stay
relatively the same. Researchers hope to find a way to stop the process of
androgen-independence by blocking the binding of the co-activators to
androgen receptors.
Dr. Robert Fletterick, from the University of California - San Francisco,
described the search for substances capable of blocking the co-activators¹
binding to androgen receptors. In searches of over 150,000 chemical
substances, few were found to have the qualities needed. Researchers are
continuing their work to develop these substances to effectively block
co-activators.
Other potential targets for treatment were discussed by Maha Hussein, from
the University of Michigan, including micro-tubules, which are the target
for taxane-based drugs (like Taxotere) - so far the only approved
chemotherapy for advanced prostate cancer. Other drugs which also target
micro-tubules have been developed, and so far seem to be showing some
positive effects in attacking cancers which have become resistant to
taxanes.
Dr. Eric Small, from the University of California - San Francisco, spoke
about developments in immunotherapy. GMCSF, GVAX, PROSTVAC and Provenge
(APC8015) are in clinical studies. So far, Provenge has been the first to
show a survival benefit, although it has been less successful in extending
time before disease progression. The short time before disease progression
in men with hormone-refractory prostate cancer may not have allowed the time
needed for an immune reaction to get up to fighting speed. Future studies in
earlier-stage cases may provide this lead time, and show results in time to
disease-progression.
Some immunotherapy drugs work by teaching the immune cells (T-cells) to
attack prostate cancer. Others work by stopping other substances, such as
CTLA-4, which interfere with the T-cells¹ ability to do their jobs. CTLA
blockers are being developed, such as ipiluminab, which was intended to help
other treatments work better, but may have some effects by itself. New
trials will investigate CTLA blockers in conjunction with androgen
deprivation, chemotherapy and immunotherapy.
Dr. Martin Gleave, from Vancouver Hospital, gave a presentation about
³cytoprotective chaperones² such as clusterin and heat-shock protein 27
(Hsp27), which allow prostate cancer cells to become androgen independent
and chemotherapy resistant. Anti-sense drugs are designed to be
mirror-opposites of the molecules they target. Anti-sense versions of
clusterin and heat-shock proteins have been developed, with the intention of
binding with those substances and rendering them inert. They have been
successful in delaying tumor progression in early lab studies. OGX-011 is
being tested in men, prior to surgery.
Researchers at Memorial Sloan-Kettering Cancer Center are working on a drug
to target Hsp90 (heat shock protein 90) with some positive results in
patients who have become resistant to Herceptin or Taxotere. They are
working on a version of the drug patients can take in pill form over time,
in order to lessen toxic effects of taking a large doses intravenously.
ASCO - Treating Low-risk and High-risk Patients
Antonia Scatton at the ASCO Prostate Cancer Symposium in San Francisco, CA |
02.25.2006
This morning¹s program began with a series of presentations about the merits
of surgery versus radiation, versus watchful waiting, but the most
interesting comments were more about psychology than physiology.
A talk on the ProtecT Trial in the U.K., a randomized comparison of surgery,
radiation and waiting in men with localized low-risk disease, turned into a
discussion on how to successfully recruit patients when they will not be
able to choose their own course of treatment, a significant problem for
prostate cancer research.
In the ProtecT trial, potential participants met with doctors and nurses who
presented the three treatment option in a neutral fashion - or so they
thought. Analysts watching videotape of their presentations found signs of
bias in the language used to describe the trial and the treatment options,
and in the body language of presenters. After extensive training for the
presenters, the percentage of men who consented to random assignment into a
treatment group increased from around 40 percent to over 80 percent - a
critical difference for the test¹s validity.
Other topics discussed in this morning¹s session:
For low-risk initial treatment: There is no evidence of a benefit from
combination therapy over mono-therapy (surgery or radiation alone).
For high-risk initial treatment: There is strong agreement on the failure of
monotherapy and the need for more options in combination therapy.
Brachytherapy: The quality of the brachytherapy is the key to successful
treatment, more so than the dosage alone. The type of seeds and the
placement are extremely important, but the success rates can be very high.
External Beam Radiation: There is a debate over whether to deliver higher
doses in fewer sessions, or lower doses over a larger number of sessions.
Prostate cancer may have some unique qualities in terms of its reaction to
radiation, compared with other cancers, allowing for more prostate cancer
cells to be damaged compared with healthy cells, in fewer sessions of
treatment.
Radiation Therapy: Advances in accuracy include the placement of gold seeds
used to track changes in the location of the prostate from one treatment to
the next. Newer seeds actually send out a GPS-like beacon, allowing external
radiation targeting to be adjusted even during the treatment itself.
Chemotherapy: Early results of studies involving docetaxel (taxotere) as an
addition to initial treatment in high risk men, show some promise as an
alternative to hormone treatment, but far more studies are needed.
To Screen or Not To Screen, That is the Question
Antonia Scatton at the ASCO Prostate Cancer Symposium in San Francisco, CA |
02.24.2006
To screen or not to screen, that is the question posed Friday afternoon,
here at Prostatepalooza. Not ones to shy away from controversy, the prostate
cancer crowd got right into the screening debate, with a series of
presentations entitled ³PSA and Prostate Cancer².
³Harm Outweighs Benefit² was the position taken by James A. Talcott, M.D.
from Massachusetts general Hospital, followed by ³Benefit Outweighs Harm²
addressed by William Catalona of Northwestern University.
According to Talcott, there is no proof screening saves lives, and plenty of
evidence that broader scale diagnosis increases unnecessary biopsy and
treatment, resulting in side effects and reduced quality of life. He also
explained away some of the findings of screening trials as a result of bias
- suggesting men diagnosed at a very early stage of prostate cancer simply
have a larger window of time in which to die of something other than
prostate cancer, than men diagnosed as a result of symptoms or other
clinical factors.
Catalona hit back with a volley of statistics showing reduced mortality
rates from prostate cancer, and in some larger epidemiological studies,
strong correlations between PSA screening levels, extent of cancer at
diagnosis, and reduced mortality rates. An audience member brought up a
study showing a decrease in mortality rates in the United Kingdom despite
low screening rates, a statistic Catalona deflected as the direct result of
a new method of calculating prostate cancer mortality in the UK.
One study mentioned several times was a study in the town of Tyrol,
Australia, wherein the population was heavily encouraged to screen for
prostate cancer, and mortality rates from prostate cancer subsequently
dropped to 55 percent of those in the rest of Austria.
Despite the debate, no-one argued for the abolishment of the PSA test. All
looked forward to the results of the big screening tests due over the next
few years, and all supported the need for tests which are not more sensitive
for prostate cancer, but more specific, more able to distinguish aggressive
cases of prostate cancer from more harmless cases.
Skip Lockwood
Executive Vice President and COO
National Prostate Cancer Coalition
1154 15th St., N.W.
Washington, DC 20005
202-463-9455 (main)
202-463-9456 (fax)
www.fightprostatecancer.org
slockwood@...
All the breaking news about prostate cancer is available in Aware ‹ NPCC¹s
free electronic newsletter. Subscribe today -- www.fightprostatecancer.org
Following are Cancer Support Groups
http://www.health-post.com/cancer_support_groups%20.html
Regards
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I thought people might be interested in the discussions and presentation at
the ASCO prostate cancer symposium. You can read all of Antonia's
dispatch's at www.fightprostatecancer.org.
Live from San Francisco - ASCO Prostate Cancer Symposium 2006
Noon - Friday, February 24, 2006
Greetings from the ASCO Prostate Cancer Symposium in San Francisco! The
prostate cancer research community is off to a roaring start today. Only
three hours into the conference and we¹ve already delved into the
relationship between prostate cancer and obesity, considered age-adjusted
cut-off rates for PSA velocity, looked at the effects of combining
Œmicronutrients¹, heard a fascinating talk about how we need a Google-type
system to cross reference all cancer related epidemiological data, and
participated in a major debate over whether or not doctors should be widely
prescribing Finasteride (Proscar) for the prevention of prostate cancer. Wow
- and it¹s only lunchtime.
Obesity and Anti-Oxidants
Is there a connection between dietary fat and prostate cancer? Probably so,
but what kind of connection? Does obesity cause later diagnosis? Are there
behavioral differences in screening? What about hormone levels? Are people
who have more fat in their diet consuming higher levels of hormone-mimicking
pesticides? What role does dietary fat play in cell-oxidation?
Dr. Neil Fleshner of the University of Toronto says when you account for
cell oxidation, the cancer-causing process that Œanti-oxidants¹ fight, all
the other factors have no effect. Debates rage on over the effects of
micronutrients, like genestein (from soy), alpha tocopherol (Vitamin E) but
more, larger, definitive studies are on the way.
Dr. Fleshner showed us some very convincing pictures of mice with prostate
cancer, compared with mice whose cancers were completely eliminated by a
cocktail of lycopene, selenium, and Vitamin E. Apparently these nutrients
have different effects on different types of cancers. Some work better on
hormone-dependent cancers, some on hormone-independent, but evidence seems
to point to impressive effects when used together. We eagerly await the
results of future studies on this topic.
Age and PSA Velocity
We now know the rate of increase of PSA is related to prostate cancer
aggression. But what rate of increase? And does it vary by age? Apparently
so. Dr. Judd Moul of Duke University has developed some suggested cut-off
rates, by age group, which would account for the natural changes in PSA
velocity in each age group.
His recommendations?
Age 50-59 .40
Age 60-69 .60
Age 70+ .75
Cancer Epidemiology and the Google Effect
Editor and health writer Clifton Leaf of Fortune Magazine gave a very
entertaining talk on the subject of how information travels, and how cancer
research could be transformed by a new Google-style information marketplace
for cancer-related epidemiological data.
Given how complicated the causes of cancer are, being affected by diet,
behavior, environment and more, Leaf suggests we need to be able to compare
millions if not billions of bits of data, across a wide range of studies, in
order to discover what really causes cancer. Like the stock market or
Google, the larger the pool of data and the number of contributors, the more
we can weed out the variations and find the definitive answers.
The Finasteride Debate
This topic is so complicated, I will definitely have to revisit it later,
when I have more time for details. The Prostate Cancer Prevention Trial
(PCPT) found a 25 percent decrease in prostate cancer incidence in men
taking Finasteride versus placebo, however, the men in the Finasteride group
had a slightly higher rate of advanced prostate cancer.
Dr. Ian Thompson, from the University of Texas Health Center argued the
finding of higher Gleason scores among the Finasteride group could be a
result of bias caused by other effects of Finasteride, such as the shrinking
of the prostate (allowing for more accurate biopsies) and the effects of
Finasteride on PSA levels (apparently making the PSA level a clearer
indicator of prostate cancer. In short - the men may not have had higher
Gleason levels, merely more accurate diagnosis, whereas men in the placebo
group may have had their cancers missed during biopsy.
Dr. Peter Scardino, of Memorial Sloan-Kettering Cancer Center, took the
counterpoint, arguing that a higher standard needs to be used before
advocating wide scale medication for prevention, as even small or rare
effects will reach a lot of people. He claimed the cancers prevented by
Finasteride were ones which would never have needed treatment anyway.
A rousing debate continued with questions from the audience, including some
from such prostate cancer notables as Dr. Anthony D¹Amico and Dr. William
Catalona. In the end - all agreed we have a long way to go before we have
clear guidelines as to when and for whom to prescribe Finasteride.
Lunch is over. I¹ll be back later with more of the latest news in prostate
cancer research.
- Antonia
Skip Lockwood
Executive Vice President and COO
National Prostate Cancer Coalition
1154 15th St., N.W.
Washington, DC 20005
202-463-9455 (main)
202-463-9456 (fax)
www.fightprostatecancer.org
slockwood@...
All the breaking news about prostate cancer is available in Aware ‹ NPCC¹s
free electronic newsletter. Subscribe today -- www.fightprostatecancer.org
Narrowing the Global Technology Gap with Support from Microsoft Research
'Digital Inclusion' Awards
The proposal winners of $1.2 million in Academic Research Funding span the
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and socioeconomic conditions
For detail
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I don't know if everyone is aware of the prostate cancer symposium in San
Francisco this weekend but it may prove to have some interesting
information. Antonia Scatton, the editor of Aware will be attending the
symposium and providing daily updates on the presentations and materials.
You can see her updates by going to www.fightprostatecancer.org.
I have included a brief synopsis of the meeting from the ASCO website.
--Skip
2006 Prostate Cancer Symposium
A Multidisciplinary Approach
February 24-26, 2006
San Francisco Marriott
San Francisco, CA
For a second consecutive year, the American Society of Clinical Oncology,
American Society for Therapeutic Radiology and Oncology, the Prostate Cancer
Foundation, and the Society of Urologic Oncology are co-sponsoring a
three-day, multidisciplinary symposium on prostate cancer. The 2006 Prostate
Cancer Symposium will consist of didactic and oral scientific presentations
by thought leaders and researchers in the field, as well as poster
presentations with ample room for discussion and interactions with
colleagues. Topics will include:
* Risk factors and epidemiology
* Screening
* Prevention
* PSA as a marker of outcome (all disease states)
* Risk assessment strategies/imaging
* Advances in treatment of localized, locally advanced, metastatic, and
hormone-refractory disease
* PSA failure
* Complications of therapy
* Developmental therapeutics
Skip Lockwood
Executive Vice President and COO
National Prostate Cancer Coalition
1154 15th St., N.W.
Washington, DC 20005
202-463-9455 (main)
202-463-9456 (fax)
www.fightprostatecancer.org
slockwood@...
All the breaking news about prostate cancer is available in Aware ‹ NPCC¹s
free electronic newsletter. Subscribe today -- www.fightprostatecancer.org
I met my future wife here! hehe. And thought I should share it with any other
men who are worried about ending up alone like I was. Check it out if you
like http://urwelcomehere.info/twio
Hey guys! Im getting married finally, cant believe this came true (thought it
would never happen). Thanks to this thing http://greatspottobe.info/faqo
managed to meet a beautiful girl, who also has a bit of freak in her (just how i
like it ;)). Wish me luck, I wish you all the same!
Contact lenses main place
http://www.technology-post.com/contact-lenses.php
Regards
---------------------------------
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Do you know about Chemosynthesis. u can find it here
http://www.technology-post.com/chemosynthesis.php
Regards
---------------------------------
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Definitions of designations in office
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This message is about Human beings, Democracy, UNHCR, Refugees, The Iraqis,
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Investors News Alert!!
THIS IS UNDISCOVERED GOLD ( MDEX.PK)
Watch out the st0ck go crazy on Monday morning
February's Feature Company...
Madison Explorations, Inc.
Symbol: MDEX.PK
CURRENT SHARE PRICE $0.36
Madison Explorations, Inc. (MDEX.PK; $0.36) S.T. Target $2.75
Madison is incorporated in Nevada. Shares trade in New York under the ticker
symbol MDEX. Current price per share is just 36 cents, nearly 300% above its
September low. Opportunities as clear and sparkling as this one come along
rarely. Carpe diem!
There are those rare times when the decision to invest in a particular stock or
industry is a no-brainer: homeland security in the wake of 9-11, gold in the
fall of 2001, and China in early 2002, for example, to name a few prescient
calls. The Canadian diamond industry and diamond explorer Madison Explorations
present us with just such a unique opportunity.
Canadian Diamonds: An Industry in the Rough
Canada is entering only its sixth year as a diamond player, but already it's the
world's #3 diamond producer, behind Botswana and Russia. From 2002 to 2003,
Canadian diamond production more than doubled to 11.2 million carats. In a very
short time, Canada has gone from a non-entity in the diamond biz to a supplier
of about 15% of the world's rough diamonds. Today, nearly half of all funding
for diamond exploration goes to Canada.
Even more impressive than the huge growth itself is the fact that that huge
growth has come on the strength of just two active diamond mines: Ekati, jointly
operated by Dia-Met and BHP, and Diavik, jointly operated by Aber and Rio Tinto.
Tahera's Jericho Mine will go online next year. Snap Lake, a joint venture
between De Beers and Winspear - is slated for full production in 2007. It will
propel Canada passed Russia into the #2 spot amongst the world's diamond
producers - with just four active mines! In terms of end-market, Canadian
diamonds have a crucial advantage over the competition: Unlike diamonds from
Angola, Liberia, and Sierra Leone, for instance - "blood diamonds" used to
finance bloody political conflict, Canadian diamonds are "clean." Consumers'
preference for clean diamonds is one of the reasons Tiffany struck a deal with
Tahera to buy or market all the diamonds Tahera's Jericho Mine produces. Tiffany
refuses to sell "blood diamonds."
Madison Explorations: An Investor's Best Friend
The Northwest Territories has been the preferred target area for diamond
explorers. Shore Gold's discovery of a 19.7 carat rock at its Star Diamond
Project last year intensified exploration in Saskatchewan, the second most
active exploration area in the Northwest Territories as measured by money
inflows. Madison Explorations is the most active explorer in Southern
Saskatchewan. That includes the De Beers-Kensington partnership. Madison's
primary area of exploration is Scout Lake, which, according to the Saskatchewan
Geological Survey, is one of the two most promising diamond areas in the
province. That conclusion confirms the work of Dr. Joseph Montgomery, the
director of five mining companies and Madision's lead diamond explorer. Dr.
Montgomery has spent more than a decade surveying the area. He is a person of
considerable expertise and is exceptionally well regarded in the metals and
minerals discovery business. Dr. Montgomery has been involved in more than 300
prosperous mineral explorations all over the world, including projects for
Diamond Fields. Based on his ten years surveying Scout Lake, Dr. Montgomery
believes it is one of the most promising diamond locations he's ever seen and
that the area could be home to the largest diamond deposit in the province
Madison is the only active explorer in Scout Lake, which, from a geological
standpoint, has many of the same characteristics as Fort à la Corne, where Shore
Gold made last year's spectacular discovery. Madison is currently exploring two
other potential diamond properties in Southern Saskatchewan, Bulls-eye and
Bronco. The results of early indicator studies at both properties have been very
favorable.
Winspear, Dia-Met, and Aber each partnered with a more senior diamond producer.
Madison is currently the only active explorer in one of the most potentially
diamond-rich regions within a national industry that is experiencing dazzling
growth and whose full potential is only just now being tapped. We would not be
surprised to see Madison follow the trend and partner up with a De Beers, for
instance. In the meantime, look for additional diamond property acquisitions and
discoveries by this aggressive upstart - and for substantial share price
appreciation over the mid- to long-term.
Thanks
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check out <www.mercola.com>; put "TEFLON" in the search window...
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--- PAUL LIMA <perezpr30@y...> wrote:
> Do you know where I may findgood studies on the effects of teflon. I
noticed the recent FDA concern.
Do you know where I may findgood studies on the effects of teflon. I noticed the
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Links, info and detail on Xanax and Anti Aging
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Regards
---------------------------------
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Well even if you're not looking for love, and just a bit of fun thought I'd give
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Well even if you're not looking for love, and just a bit of fun thought I'd give
you all this tip. So you can stay away from all the BS fake profiles places.
This is what I've been using http://www.chatroomcity.info/snrd . No joke, I've
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honestly I stand totally corrected. This place
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and within no time at all I was talking to a few great ladies over it.
Anyway, I recommend it to everyone here!
Useful Links on Mesothelioma Cancer
http://www.ittopinterviewquestions.com/Mesothelioma_Cancer.html
---------------------------------
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Useful Links on Mesothelioma Cancer
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Regards
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PLEASE PASS THE INFO ON TO FAMILY AND FRIENDS
Diabetes and Its Awful Toll Quietly Emerge as a Crisis: PART 1 OF 3
By N. R. KLEINFIELD Published: January 9, 2006
Begin on the sixth floor, third room from the end, swathed in fluorescence: a
60-year-old woman was having two toes sawed off. One floor up, corner room: a
middle-aged man sprawled, recuperating from a kidney transplant. Next door:
nerve damage. Eighth floor, first room to the left: stroke. Two doors down:
more toes being removed. As always, the beds at Montefiore Medical Center in
the Bronx were filled with a universe of afflictions. In truth, these assorted
burdens were all the work of a single illness: diabetes. Room after room, floor
after floor, diabetes. On any given day, hospital officials say, nearly half
the patients are there for some trouble precipitated by the disease.
An estimated 800,000 adult New Yorkers - more than one in every eight - now
have diabetes, and city health officials describe the problem as a bona fide
epidemic. Diabetes is the only major disease in the city that is growing, both
in the number of new cases and the number of people it kills. And it is growing
quickly, even as other scourges like heart disease and cancers are stable or in
decline. Already, diabetes has swept through families, entire neighborhoods in
the Bronx and broad slices of Brooklyn, where it is such a fact of life that
people describe it casually, almost comfortably, as "getting the sugar" or
having "the sweet blood."
But as alarmed as health officials are about the present, they worry more
about what is to come. Within a generation or so, doctors fear, a huge wave of
new cases could overwhelm the public health system and engulf growing numbers
of the young, creating a city where hospitals are swamped by the disease's
handiwork, schools scramble for resources as they accommodate diabetic
children, and the work force abounds with the blind and the halt. The prospect
is frightening, but it has gone largely unnoticed outside public health
circles. As epidemics go, diabetes has been a quiet one, provoking little of
the fear or the prevention efforts inspired by AIDS or lung cancer.
In its most common form, diabetes, which allows excess sugar to build up in
the blood and exact ferocious damage throughout the body, retains an outdated
reputation as a relatively benign sickness of the old. Those who get it do not
usually suffer any symptoms for years, and many have a hard time believing that
they are truly ill. Yet a close look at its surge in New York offers a
disturbing glimpse of where the city, and the rest of the world, may be headed
if diabetes remains unchecked. The percentage of diabetics in the city is
nearly a third higher than in the nation. New cases have been cropping up close
to twice as fast as cases nationally. And of adults believed to have the
illness, health officials estimate, nearly one-third do not know it. One in
three children born in the United States five years ago are expected to become
diabetic in their lifetimes, according to a projection by the Centers for
Disease Control and Prevention. The forecast is even bleaker
for Latinos: one in every two.
New York, perhaps more than any other big city, harbors all the ingredients
for a continued epidemic. It has large numbers of the poor and obese, who are
at higher risk. It has a growing population of Latinos, who get the disease in
disproportionate numbers, and of Asians, who can develop it at much lower
weights than people of other races.
It is a city of immigrants, where newcomers eating American diets for the
first time are especially vulnerable. It is also yielding to the same forces
that have driven diabetes nationally: an aging population, a food supply spiked
with sugars and fats, and a culture that promotes overeating and discourages
exercise.
Diabetes has no cure. It is progressive and often fatal, and while the
patient lives, the welter of medical complications it sets off can attack every
major organ. As many war veterans lost lower limbs last year to the disease as
American soldiers did to combat injuries in the entire Vietnam War. Diabetes is
the principal reason adults go blind.
So-called Type 2 diabetes, the predominant form and the focus of this series,
is creeping into children, something almost unheard of two decades ago. The
American Diabetes Association says the disease could actually lower the average
life expectancy of Americans for the first time in more than a century.
Even those who do not get diabetes will eventually feel it, experts say - in
time spent caring for relatives, in higher taxes and insurance premiums, and in
public spending diverted to this single illness. "Either we fall apart or we
stop this," said Dr. Thomas R. Frieden, commissioner of the New York City
Department of Health and Mental Hygiene.
Yet he and other public health officials acknowledge that their ability to
slow the disease is limited. Type 2 can often be postponed and possibly
prevented by eating less and exercising more. But getting millions of people to
change their behavior, he said, will require some kind of national crusade.
The disease can be controlled through careful monitoring, lifestyle changes
and medication that is constantly improving, and plenty of people live with
diabetes for years without serious symptoms. But managing it takes enormous
effort. Even among Americans who know they have the disease, about two-thirds
are not doing enough to treat it. Nearly 21 million Americans are believed to
be diabetic, according to the Centers for Disease Control, and 41 million more
are prediabetic; their blood sugar is high, and could reach the diabetic level
if they do not alter their living habits.
In this sedentary nation, New York is often seen as an island of thin people
who walk everywhere. But as the ranks of American diabetics have swelled by a
distressing 80 percent in the last decade, New York has seen an explosion of
cases: 140 percent more, according to the city's health department. The
proportion of diabetics in its adult population is higher than that of Los
Angeles or Chicago, and more than double that of Boston. There was a pronounced
increase in diagnosed cases nationwide in 1997, part of which was undoubtedly
due to changes in the definition of diabetes and in the way data was collected,
though there has continued to be a marked rise ever since. Yet for years,
public health authorities around the country have all but ignored chronic
illnesses like diabetes, focusing instead on communicable diseases, which kill
far fewer people. New York, with its ambitious and highly praised public health
system, has just three people and a $950,000 budget to
outwit diabetes, a disease soon expected to afflict more than a million people
in the city.
Tuberculosis, which infected about 1,000 New Yorkers last year, gets $27
million and a staff of almost 400. Diabetes is "the Rodney Dangerfield of
diseases," said Dr. James L. Rosenzweig, the director of disease management at
the Joslin Diabetes Center in Boston. As fresh cases and their medical
complications pile up, the health care system tinkers with new models of
dispensing care and then forsakes them, unable to wring out profits. Insurers
shun diabetics as too expensive. In Albany, bills aimed at the problem go
nowhere. "I will go out on a limb," said Dr. Frieden, the health commissioner,
"and say, 20 years from now people will look back and say: 'What were they
thinking? They're in the middle of an epidemic and kids are watching 20,000
hours of commercials for junk food.' "
Of course, revolutionary new treatments or a cure could change everything.
Otherwise, the price will be steep. Nationwide, the disease's cost just for
2002 - from medical bills to disability payments and lost workdays - was
conservatively put by the American Diabetes Association at $132 billion. All
cancers, taken together, cost the country an estimated $171 billion a year.
"How bad is the diabetes epidemic?" asked Frank Vinicor, associate director for
public health practice at the Centers for Disease Control. "There are several
ways of telling. One might be how many different occurrences in a 24-hour
period of time, between when you wake up in the morning and when you go to
sleep. So, 4,100 people diagnosed with diabetes, 230 amputations in people with
diabetes, 120 people who enter end-stage kidney disease programs and 55 people
who go blind. "That's going to happen every day, on the weekends and on the
Fourth of July," he said. "That's diabetes."
One Day in the Trenches
The rounds began on the seventh floor with Iris Robles. She was 26, young for
this, supine in bed. She wore a pink "Chicks Rule" T-shirt; an IV line
protruded from her arm. For more than a year, she had had a recurrent skin
infection. The pain overwhelmed her. Then came extreme thirst and the loss of
50 pounds in six weeks. In the emergency room, she found out she had diabetes.
She was out of work, wanted to be an R & B singer, had no insurance. It was her
fourth day in Montefiore Medical Center. Her grandmother, aunt and two cousins
have diabetes. "I'm scared," she said. "I'm still adjusting to it."
Next came Richard Dul, watching news chatter on a compact TV. Now 64, he has
had diabetes since he was 22. A month before, he had a blockage in his heart
and needed open-heart surgery. He was home a few days, but an infection arose
and he was back. Postoperative infections are more common with diabetes. This
was his 21st straight day in the hospital. Here, then, was the price of
diabetes, not just the dollars and cents but the high cost in quality of life.
Simply put, diabetes is a condition in which the body has trouble turning food
into energy. All bodies break down digested food into a sugar called glucose,
their main source of fuel. In a healthy person, the hormone insulin helps
glucose enter the cells. But in a diabetic, the pancreas fails to produce
enough insulin, or the body does not properly use it. Cells starve while
glucose builds up in the blood.
There are two predominant types of diabetes. In Type 1, the immune system
destroys the cells in the pancreas that make insulin. In Type 2, which accounts
for an estimated 90 percent to 95 percent of all cases, the body's cells are
not sufficiently receptive to insulin, or the pancreas makes too little of it,
or both. Type 1 used to be called "juvenile diabetes" and Type 2 "adult-onset
diabetes." By 1997, so many children had developed Type 2 that the Diabetes
Association changed the names. What is especially disturbing about the rise of
Type 2 is that it can be delayed and perhaps prevented with changes in diet and
exercise. For although both types are believed to stem in part from genetic
factors, Type 2 is also spurred by obesity and inactivity. This is particularly
true in those prone to the illness. Plenty of fat, slothful people do not get
diabetes. And some thin, vigorous people do.
The health care system is good at dispensing pills and opening up bodies, and
with diabetes it had better be, because it has proved ineffectual at stopping
the disease. People typically have it for 7 to 10 years before it is even
diagnosed, and by that time it will often have begun to set off grievous
consequences. Thus, most treatment is simply triage, doctors coping with the
poisonous complications of patients who return again and again.
Diabetics are two to four times more likely than others to develop heart
disease or have a stroke, and three times more likely to die of complications
from flu or pneumonia, according to the Centers for Disease Control. Most
diabetics suffer nervous-system damage and poor circulation, which can lead to
amputations of toes, feet and entire legs; even a tiny cut on the foot can lead
to gangrene because it will not be seen or felt.
Women with diabetes are at higher risk for complications in pregnancy,
including
miscarriages and birth defects. Men run a higher risk of impotence. Young
adults have twice the chance of getting gum disease and losing teeth.
And people with Type 2 are often hounded by parallel problems - high blood
pressure and high cholesterol, among others - brought on not by the diabetes,
but by the behavior that led to it, or by genetics. Dr. Monica Sweeney, medical
director of the Bedford-Stuyvesant Family Health Center, offered an analogy:
"It's like bad kids. If you have one bad kid, not so bad. Two bad kids, it's
worse. Put five bad kids together and it's unmanageable. Diabetes is like five
bad kids together. You want to scream." The Caro Research Institute, a
consulting firm that evaluates the burden of diseases, estimates that a
diabetic without complications will incur medical costs of $1,600 a year -
unpleasant, but not especially punishing. But the price tag ratchets up quickly
as related ailments set in: an average $30,400 for a heart attack or
amputation, $40,200 for a stroke, $37,000 for end-stage kidney disease.
One of the most horrific consequences is losing a leg. According to the
federal Agency for Healthcare Research and Quality, some 70 percent of
lower-limb amputations in 2003 were performed on diabetics. Sometimes, the
subtraction is cumulative. One toe goes. Two more. The ankle. Everything to the
knee. The other leg. Studies suggest that as many as 70 percent of amputees die
within five years. Yet medical experts believe that most diabetes-related
amputations are preventable with scrupulous care, and that is why the offices
of conscientious doctors post signs like this: "All patients with diabetes:
Don't forget to bare your feet each visit."
To witness the pitiless course that diabetes can take, simply continue on the
hospital tour. This one day will do. Dr. Rita Louard, an endocrinologist, and
Anne Levine, a nurse diabetes educator, were making their way through the rooms
at Montefiore.
Here was Julius Rivers, 58, on the sixth floor. Three years with diabetes. He
had been at home in bed when he saw a light like a starburst and told his wife
to take him to the emergency room. His blood sugar was 1,400, beyond the pale.
(A fasting level of 126 milligrams per deciliter is the demarcation point of
diabetes.) This was his third trip to the hospital in seven months. At the
moment, he had a blood clot in his left leg. He had a heart attack a few years
ago. He was on dialysis. "Tuesday, Thursday and Saturday," he said.
On the sixth floor was Mauri Stein, 58, a guidance counselor, a diabetic for
20 years. She had been at a party recently and "zoned out." Her words slurred.
Foam appeared on her mouth. She had had a mild stroke. Now she tried to control
her emotions, tried not to cry. She had had repeated laser surgery on her eyes,
and was effectively blind in one. She had recovered from the stroke, but
doctors had also found a tumor on her heart and said it would need surgery. "My
feet burn," she said. "My toes burn all the time. My days of wearing my pumps
are over. I've gotten more cortisone shots in my feet than I'm sure are legal."
She mentioned her brother, who lived in California. Diabetes had ransacked his
body - an amputation, kidney dialysis, heart disease, blindness in one eye. He
now resided in an assisted-living center. He was 53. Ms. Stein's husband walked
in and sat on the bed. Six months ago, he found out the same truth: he had
diabetes. This was one day in one hospital.
Inside the Incubator
Little about diabetes is straightforward, and to comprehend why New York is
such an incubator for the disease, it is necessary to grasp that diabetes is as
much a sociological and anthropological story as a medical one. While it
assaults all classes, ages and ethnic groups, it is inextricably bound up with
race and money. Diabetes bears an inverse relationship to income, for poverty
usually means less access to fresh food, exercise and health care. New York's
poverty rate, 20.3 percent, is much higher than the nation's, 12.7 percent.
African-Americans and Latinos, particularly Mexican-Americans and Puerto
Ricans, incur diabetes at close to twice the rate of whites. More than half of
all New Yorkers are black or Hispanic, and the Hispanic population is growing
rapidly, as it is around the nation. Some Asian-Americans and Pacific Islanders
also appear more prone, and they can develop the disease at much lower weights.
Asians constitute one-tenth of New York's population, more than twice their
proportion nationwide. The nature of these groups' susceptibility remains under
study, but researchers generally blame an interplay of genetic and
socioeconomic forces. Many researchers believe that higher proportions of these
groups have a "thrifty gene" that enabled ancestors who farmed and hunted to
stockpile fat during times of plenty so they would not starve during periods of
want. In modern America, with food beckoning on every corner, the gene works
perversely, causing them to accumulate unhealthy
quantities of fat.
But the velocity of new cases among all races has accelerated significantly
from just a few decades ago. Genetics cannot explain this surge, because the
human gene pool does not change that fast. Instead, the culprit is thought to
be behavior: faulty diet and inactivity. Dr. Vinicor, of the Centers for
Disease Control, likes to use this expression: "Genetics may load the cannon,
but human behavior pulls the trigger." Of the country's spike in diabetes cases
over the last two decades, C.D.C. studies suggest that about 60 percent stem
from demographic changes: a population increasingly comprising older people
and ethnic groups with a higher risk. The studies ascribe the other 40 percent
to lifestyle changes: the fundamental shift that has people eating jumbo meals
and shunning exercise as if it were illegal. At every turn, technology has made
physical activity unnecessary or unappealing. Gym class has largely been
deleted from schools. Fewer than a third of junior high
schools require physical education at all, the C.D.C. says.
On the whole, New York's corpulence is below the national average, with 20
percent of adults qualifying as obese, compared with 30 percent for the
country, the C.D.C. says. But the figure is much higher in poor areas like the
South Bronx and East Harlem.
When the health department studied diabetes in the city's 34 major
neighborhoods, the distribution echoed demographic patterns: Diabetes left only
a light imprint on more affluent, white areas like the Upper West Side and
Brooklyn Heights. The prevalence was about average in working-class Ridgewood,
Queens, and almost nil on the Upper East Side. But that apparent immunity is
weakening. Of those 34 neighborhoods, 22 already have diabetes rates above the
national average, and the numbers are rising all over as the city continually
remakes itself.
"New York is switching from a mom-and-pop type of environment to a
chain-store type of environment, a proliferation of fast food, even in
high-rent neighborhoods they haven't had access to before, like the East
Village and Lower Manhattan," said Peter Muennig, an assistant professor of
health policy and management at Columbia. If changes in daily living can bring
on diabetes, they can also delay it, though it is uncertain for how long.
A federal program studied people around the country at high risk of getting
diabetes, and concluded that 58 percent of new cases could be postponed by
shifts in behavior - most notably, shedding pounds.
But Dr. Frieden, New York's health commissioner, says meaningful prevention
cannot be achieved at the city level. "I can urge people until I'm blue in the
face to walk and take the stairs and eat less, and it won't make much
difference," he said. His emphasis is on trying to better treat those who
already have diabetes, an ambitious goal in its own right. Most primary care
doctors treat too many patients to provide the attention that diabetics need,
or to check for the disease, he said. Specialists are scarce. And compliance
among patients is notoriously poor. Even the most basic step in controlling the
disease - watching one's blood sugar - is too much for many diabetics. Doctors
recommend that two to four times a year, patients take a so-called A1c test,
which gauges the average sugar level over the prior 90 days and is more
revealing than daily at-home measurements.
But in 2002 , the health department found that 89 percent of diabetics did
not know their A1c levels. Of those who did, presumably the most conscientious,
four out of five had readings over the level the American Diabetes Association
says separates well-controlled from poorly controlled diabetes. The patients in
the survey were not much better at knowing their blood pressure and
cholesterol, which are also crucial for diabetics to control. "Diabetes is an
interesting beast," said Dr. Diana K. Berger, who heads the diabetes division
at the health department. "It's probably one of the easier conditions to
diagnose but one of the hardest to manage."
Shortages and Shipwrecks
There is an underappreciated truth about disease: it will harm you even if
you never get it. Disease reverberates outward, and if the illness gets big
enough, it brushes everyone. Diabetes is big enough. Predicting the path of a
disease is always speculative, but without bold intervention diabetes threatens
to hamper some of society's most basic functions.
For instance, no one with diabetes can join the military, though service
members whose disease is diagnosed after enlisting can sometimes stay. No
insulin-dependent diabetic can become a commercial pilot.
Shereen Arent, director of legal advocacy for the American Diabetes
Association, says she already fields 150 calls a month from diabetics who
complain that they are being discriminated against in the workplace, double the
number just a couple of years ago. She mentioned a typical case, a man rejected
for a job at a baked-bean factory in Texas as a safety risk. "If this
continues," she said, "we're in big trouble." Dr. Daniel Lorber is an
endocrinologist in Queens who thinks a lot about the disease's present and
future. "The work force 50 years from now is going to look fat, one-legged,
blind, a diminution of able-bodied workers at every level," he said, presuming
that current trends persist.
As more women contract diabetes in their reproductive years, Dr. Lorber said,
more babies will be born with birth defects. Those needy babies will be raised
by parents increasingly crippled by their diabetes. "At a time when we are
trying to shift health care out of hospitals, with diabetics you don't have a
choice," he said. "Nursing homes are going to be crammed to the gills with
amputees in rehab. Kidney dialysis centers will multiply like rabbits. We will
have a tremendous amount of people not blind but with low vision. And we have
lousy facilities in this country for low-vision problems. These people will not
be able to function in society without significant aid."
Cost pressures have been slashing the number of hospital beds, and some
exasperated doctors are known to denigrate advanced diabetics as "shipwrecks,"
because they have so many health problems and virtually live in the hospital.
Not only will the future mean too few beds and unsupportable drains on Medicaid
and Medicare, Mr. Muennig said, but if an emergency strikes - a terrorist
attack, an earthquake - the city health system's ability to respond may be
compromised because all the beds will be full of diabetics. Most schools do not
have full-time nurses. Some public schools, Ms. Arent said, try to turn away
children with diabetes, even though that is illegal. Others ban them from field
trips and sports teams. And this is now, when diabetes is still relatively rare
among children.
If trends continue, people will live through years blighted by disability,
then die too young. Diabetes is thought to shave 5 to 10 years off a life.
"Life expectancy usually decreases because there's a plague or there's a
massive economic trauma," Mr. Muennig said. "In this case, we will see a
decline in life expectancy due to a chronic condition."
In 2003, diabetes vaulted past stroke and AIDS from the sixth-leading cause
of death in New York to the fourth. It was fifth, slightly behind stroke, in
2004. But the health department says it believes the actual toll is much worse
because doctors who fill out death certificates may ascribe the death to a
complication rather than to the diabetes at its root. Lorna Thorpe, deputy
health commissioner, combed through medical charts and concluded that diabetes
should be third, trailing cardiovascular disease and cancer.
Laurie Raps is a claims representative for Social Security on Staten Island,
31 years on the job. From her perspective, interviewing people embarking on
full-time disability, she has seen the disease's long tentacles. When she
started, she saw people in their 50's and 60's, hobbled by the usual problems
of age: arthritis, herniated discs, heart conditions. Now, every week, she gets
diabetic after diabetic, people as young as 30. In fact, a 2004 study by
UnumProvident, a major provider of disability insurance, found that the number
of workers filing claims for Type 2 diabetes doubled between 2001 and 2003.
"It's a double whammy," Ms. Raps said. "You don't have these people working
and paying into the system, and then you have these people collecting from the
system."
Ten years ago, Ms. Raps developed diabetes. Her husband has it. Both her
parents have it, their lives being washed away. "When I look at the people who
sit before me with disability claims, I have to check the birth date in their
records," she said. "They look 10 or 20 years older. Diabetes does that. It
wears you down and wears you down. We're looking at a future of people 10 or 20
years older in sickness than they are. What kind of future is that?"
'A 15-Year-Old Is Immortal'
"I'm Linda and I've had diabetes for 13 years." "I'm Dominique and I've had
diabetes for seven years." "I'm Joseph and I've had diabetes for two months."
The brisk introductions went on, the ritual start to the monthly meeting of a
support group called Sugar Babes Place. All the members had diabetes. All were
children. Sugar Babes is the idea of Dr. Yolaine St. Louis, chief of pediatric
endocrinology at Bronx-Lebanon Hospital Center. When she started practicing
medicine 16 years ago, the only children she saw with diabetes had Type 1. Now,
of Sugar Babes' 90 official members, roughly 40 percent have Type 2. One is 8.
Another is 7. It scares Dr. St. Louis. It scares many doctors who see the same
thing, because they know it does not have to be. Type 2 was supposed to be an
old person's disease. Diabetes still increases with age in an almost linear
fashion - today, one in five New Yorkers age 65 and older have it - but the
starting point used to be mostly in their 50's.
Dr. Alan Shapiro, a pediatrician with the Children's Health Fund and
Montefiore Medical Center who has spent 13 years ministering to children in the
South Bronx, said there was an easy way to illustrate the change. When he
began, there was a "failure-to-thrive" clinic, meant to address the
undernourished, because so many children were dangerously thin and small. "Now
I don't think we hardly ever see a failure-to-thrive case," he said.
In the clinic's place is an obesity program. Dr. Shapiro never saw children
with Type 2 diabetes in his early years in medicine. Now, the program has about
10 cases. One concern he and fellow doctors have is the surge in children who
take antipsychotic drugs for anxiety and conditions like autism. Some newer
drugs can promote weight gain and thus elevate the risk of diabetes. Dr.
Shapiro has an autistic patient who he feels needs the new medication. But
since taking it, the young man has markedly put on weight and, at 18, developed
diabetes. This extension of the disease to the young is where health care
professionals feel society and public policy have most glaringly failed.
Diabetes, they say, should never have gotten there.
There has been little research into the long-term impact of Type 2 diabetes
on children. But doctors have a rough idea. The harsh consequences that can
accompany diabetes tend to arrive 10 to 15 years after onset. If people
contract diabetes when they are 15, 10 or even 5, they may well start
developing complications, not on the cusp of retirement but in the prime of
their lives. There is a big difference between losing a limb at 21 and at 70.
There is a big difference between going on dialysis at 30 and at 65. "I heard a
horror story a few weeks ago," Dr. Lorber said, "of a girl who was born deaf,
got diabetes at 11 or 12 and went blind from diabetes at 30." The C.D.C. has
projected that a child found to have Type 2 diabetes at age 10 will see his
life shortened by 19 years. "Imagine if kids were showing up at emergency rooms
in cardiac arrest," said Dr. David L. Katz, director of the Prevention Research
Center at the Yale University School of Medicine. "Frankly, I
think that's the next big thing. It's that dramatic. If diabetes doesn't
respect age, why should coronary disease? Lord knows, I hope this never
happens. But this is what keeps me up at night."
Yet children can be the most reluctant to accept the truths of their
condition.
"A lot of them are in denial," Dr. St. Louis said. "They have blood sugars of
300, 400, and they tell me right to my face they don't have diabetes. 'You're
wrong,' they say. 'I don't feel anything.' I tell them what can happen down the
road, and they shrug. A 15-year-old doesn't care what's going to happen at 35
or 45. A 15-year-old is immortal."
The doctor was telling the Sugar Babes that everyone should have two compact
blood-sugar meters, one for home and one for school. Then she warned them, "If
your sugar is bad and you don't do anything, you're going to be dropping down
all over the Bronx."
Interest was tepid. Some children couldn't keep their eyes off the waiting
dinner arranged at a buffet table by the wall. No rapt attention from Joseph,
12, who had begged not to come, until his mother put her foot down. He moaned
that he had schoolwork.
"Look at that," said Dorothy Morris-Swaby, a diabetes nurse educator who
worked with Dr. St. Louis, nodding at a girl who was talking on her phone.
"We're educating about diabetes, and she's on her cellphone. Typical teenager."
As time ran out, hula hoops were brought out. Dr. St. Louis was trying to
identify activities other than video games and TV that the children might try.
Last meeting, they held a jump-rope contest. "They have 10,000 excuses why they
can't do something," the doctor said. "So you have to give them ideas and then
hope." The meeting wound up. The hoops were stashed away. Some of the children
stepped toward the buffet table and began to eat.
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