Why is it that the incidence of breast cancer has gone up so dramatically since screening mammography has been introduced?

H.Gilbert Welch, Per-Henrik Zahl and Jan Maehlen developed an ingenious way to address the question and reached the almost unfathomable conclusion that some breast cancers disappear without treatment.

The scientists knew Norway’s health system adopted a biannual screening program in 1996, so they compared the cumulative incidence of breast cancer in two age-matched groups of 100,000 Norwegian women.

The first group, followed from 1992-1997, received one mammogram at the end of the observation period. The second, followed from 1997-2002, had 3 mammograms over the same time duration.

Women in the frequently screened group had a 22% higher cumulative incidence of breast cancer.

The difference could not be attributed to differential use of hormone therapy or risk factor profiles. Nor was it caused by the use of more sensitive mammograms in the latter group. The possibility that multiple mammograms somehow increase screening yields, though plausible, explained almost none of the difference and no one believes the mammograms actually caused cancer.

In commenting on the study Barnett Kramer, director of the Office of Disease Prevention at the NIH, told the New York Times, “People who are familiar with the broad range of behaviors of a variety of cancers know spontaneous regression is possible. “But what is shocking is that it can occur so frequently.”

Even if true, the astounding possibility has no immediate implications since at the time of diagnosis there is no way to tell which cancers will regress and which ones will not.

So in the end came reassurances that mammograms save lives, warnings to continue all screening programs until further notice, and a lot of people asking for more.  Like, can the study ever be replicated?

Yes, it turns out. Mexico is introducing mammography screening as we speak.

The man had to know this day would come.

The fall of Joe Biederman began last summer when a Congressional investigation led by Iowa Republican Charles Grassley accused the famous child psychologist of failing to report more than $1 million in income from Johnson & Johnson and other drug makers.

At the time Biederman defended himself by saying his “interests are solely in the advancement of medical treatment through rigorous and objective study.”

So Biederman wasn’t saying much last week when J & J documents came to light showing he had lobbied the drug maker to fund a research center at Massachusetts General Hospital whose goal it would be to “move forward the commercial goals of J & J.”

Biederman is the man who almost singlehandedly put pediatric bipolar disorder on the map, in part by publishing many studies that were funded by drug makers. Diagnoses of pediatric bipolar disorder increased 40-fold between 1994 and 2003.

Biederman also happened to champion the use of expensive new antipsychotic medicines for this and other psychiatric conditions in children as young as 6 years of age, beginning at least 5 years before the FDA approved the drugs for this purpose.

The new medicines, so-called atypical antipsychotics include Risperdal, Zyprexa, Seroquel, Abilify and Geodon. J & J makes Risperdal. These drugs have nasty side effects including marked weight gain, metabolic abnormalities and tics. 1,200 children have suffered serious complications from Risperdal and 31 died.

The newly released documents were part of a routine filing made by lawyers representing individuals claiming to have been injured by the atypical antipsychotics produced by J & J, AstraZeneca and Eli Lilly. The filing ended up compelling Beiderman to testify under oath in the case. That will happen in January.

(more…)

Suppose you had two groups of 70 year olds, one whose parents had lived to be 100 years old and the other whose parents died at a younger age. Which group would you expect to live longer?

This isn’t a trick question and the answer is no surprise but the question is why. Why do the offspring of centenarian parents live longer?

httpv://www.youtube.com/watch?v=KOXa8mkPpeY

Dellara F. Terry and colleagues from Boston University make a persuasive case that the benefit is conferred through reductions in cardiovascular risk.

They report in the Journal of the American Geriatrics Society that septuagenarian children of centenarian parents were 81% less likely to die during a 3.5-year follow-up than age-matched controls, and same group was 78% less likely to have a heart attack, 83% less likely to have a stroke, and 86% less likely to develop diabetes.

And yet the children of centenarians were just as likely as the second group to develop cancer, depression, glaucoma, bone fractures, thyroid disease, hypertension, macular degeneration and dementia.

“The most dramatic difference we’ve seen among centenarian offspring, one that’s been consistent throughout the period we’ve been following them, is the decreased prevalence of heart disease and its risk factors,” Dr. Terry told the New York Times.

OK so is it nature or nurture?

“Just because something is familial doesn’t mean it’s all genetic,” Terry explained to the Times. “It could be there are health-related behaviors they have learned from their parents. It’s also possible it’s genes, or the absence of bad genes, they inherited from their parents.”

Which is another way of saying we don’t know right now but if we can figure it out we’ll let you know.