The war on cancer: failure of therapy and research

A generally-held beliefby both the medical profession and the lay public is that therapeutic medicine greatly affects health. Providing more hospital beds, doctors and resources is viewed as the path to improve health. Therapeutic medicine is of much benefit to sick people. However, with the exception of several highly contagious infections, it has not reduced the incidence of disease. This generalization applies particularly to cancer. Despite this fact most ofthe expense and effort devoted to the management of cancer is directed towards early diagnosis (screening) and improved therapy. Evidence has steadily accrued that this strategy is essentially a failure: little impact has been made on the toll taken by the major cancers. The failure of therapy, coupled with the realization that the overwhelming majority of cancer is related to environmental, particularly lifestyle, factors, dictates that prevention should be our foremost aim. It follows, therefore, that cancer research should concentrate on those environmental factors which may cause or prevent cancer. Instead, most research looks at either the detailed mechanisms of cancer formation or else investigates new types of therapy. Medicine should admit its severe limitations in therapy and redirect itself. Using the fruits of an expanded research programme into such areas as diet and exercise, medicine should strive to apply this knowledge to cancer prevention

Towards a new system of health: the challenge of western disease

Over the last three decades, the concept of Western disease has become well established. Medicine has approached this group of diseases by searching for new cures but has achieved relatively little success. We argue that medicine should now accept the failure of this strategy and place a major emphasis on prevention. The key objective is to change the climate of opinion so that prevention is taken seriously by the general population. The chief activity should be a wide ranging public education campaign so as to persuade people to live a healthier lifestyle. Medicine will require restructuring in order to carry out this work. Medical education needs to be reformed so that medical students receive the necessary training. This must be done as part of an integrated approach in which government, industry and medical research all play a major role. Governments should use taxation and subsidies in areas such as food and tobacco so as to shift consumption patterns towards healthier products. Governments must also tighten laws on tobacco sales and advertising, support health education, and improve food labelling. Industry must be made far more responsive to the health needs of the population. This should be done both by public education, so as to alter demand, and by government action. Medical research should change its emphasis from studying the detailed mechanisms of disease ("complex research") to studying the role of lifestyle factors ("simple research")

Innovations agro écologiques en Martinique : freins et leviers organisationnels techniques et économiques

Les résultats montrent tout d'abord que la filière de produits dits « biologiques » se structure en deux organisations de producteurs qui se différencient, tant par le mode de certification choisie que par leur niveaux d'insertion dans les dispositifs institutionnels conventionnels. Dans les deux cas néanmoins, un frein important est l'absence de maîtrise d'indicateurs sur les conditions d'évaluation économique et financière des produits biologiques. Par ailleurs, trois freins majeurs sont mis en évidence par l'analyse technico-économique et agronomique des exploitations (i) l'absence de référentiels et d'appui technique adaptés aux conditions locales, (ii) la faiblesse et la dispersion concernant l'approvisionnement et l'accès aux intrants adaptés et enfin (iii) la faible productivité du travail. Une action collective de coordination impliquant les collectivités locales, les organisations de producteurs, les organismes techniques et la recherche est nécessaire

Polarization perception in humans: on the origin of and relationship between Maxwell’s spot and Haidinger’s brushes

Under specific conditions of illumination and polarization, differential absorption of light by macular pigments is perceived as the entoptic phenomena of Maxwell’s spot (MS) or Haidinger’s brushes (HB). To simulate MS and HB, an existing computational model of polarization-dependent properties of the human macula was extended by incorporating neuronal adaptation to stabilized retinal images. The model predicted that polarized light modifies the appearance of MS leading to the perception of a novel phenomenon. The model also predicted a correlation between the observed diameters of MS and HB. Predictions were tested psychophysically in human observers, whose measured differences in the diameters of each entoptic phenomenon generated with depolarized and linearly polarized light were consistent with the model simulations. These findings support a common origin of each phenomenon, and are relevant to the clinical use of polarization stimuli in detecting and monitoring human eye disorders, including macular degeneration. We conclude: (i) MS and HB both result from differential light absorption through a radial diattenuator, compatible with the arrangement of macular pigments in Henle fibres; (ii) the morphology of MS is dependent on the degree of linear polarization; (iii) perceptual differences between MS and HB result from different states of neural adaptation

A Guide to Non-Alcoholic Fatty Liver Disease in Childhood and Adolescence

Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most prevalent form of chronic liver disease, affecting 10%–20% of the general paediatric population. Within the next 10 years it is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence in the Western world. While our understanding of the pathophysiological mechanisms underlying this disease remains limited, it is thought to be the hepatic manifestation of more widespread metabolic dysfunction and is strongly associated with a number of metabolic risk factors, including insulin resistance, dyslipidaemia, cardiovascular disease and, most significantly, obesity. Despite this, ”paediatric” NAFLD remains under-studied, under-recognised and, potentially, undermanaged. This article will explore and evaluate our current understanding of NAFLD in childhood and adolescence and how it differs from adult NAFLD, in terms of its epidemiology, pathophysiology, natural history, diagnosis and clinical management. Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention

Diet, nutrition and the prevention of type 2 diabetes

Objectives: The overall objective of this study was to evaluate and provide evidence and recommendations on current published literature about diet and lifestyle in the prevention of type 2 diabetes. Design: Epidemiological and experimental studies, focusing on nutritional intervention in the prevention of type 2 diabetes are used to make disease-specific recommendations. Long-term cohort studies are given the most weight as to strength of evidence available. Setting and subjects: Numerous clinical trials and cohort studies in low, middle and high income countries are evaluated regarding recommendations for dietary prevention of type 2 diabetes. These include, among others, the Finnish Diabetes Prevention Study, US Diabetes Prevention Program, Da Qing Study; Pima Indian Study; Iowa Women’s Health Study; and the study of the US Male Physicians. Results: There is convincing evidence for a decreased risk of diabetes in adults who are physically active and maintain a normal body mass index (BMI) throughout adulthood, and in overweight adults with impaired glucose tolerance who lose weight voluntarily. An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity; and maternal diabetes. It is probable that a high intake of saturated fats and intrauterine growth retardation also contribute to an increased risk, while non-starch polysaccharides are likely to be associated with a decreased risk. From existing evidence it is also possible that omega-3 fatty acids, low glycaemic index foods and exclusive breastfeeding may play a protective role, and that total fat intake and trans fatty acids may contribute to the risk. However, insufficient evidence is currently available to provide convincing proof. Conclusions: Based on the strength of available evidence regarding diet and lifestyle in the prevention of type 2 diabetes, it is recommended that a normal weight status in the lower BMI range (BMI 21–23) and regular physical activity be maintained throughout adulthood; abdominal obesity be prevented; and saturated fat intake be less than 7% of the total energy intake

The UK Ministry of Defence Project Orientated Environmental Management System (POEMS)

The Project Orientated Environmental Management System (POEMS) is the UK Ministry of Defence (MoD) bespoke environmental management system for the acquisition and use of equipment. The full implementation of a site-specific environmental management system is challenging for the MoD because there are many permanent MoD sites with transient populations, frequently changing site activities and diverse types of equipment. Nevertheless, MoD policy requires that all sites are covered by an environmental management system. POEMS is based on international standards ISO14001 and ISO14040, which focus on environmental management systems and life cycle assessment, respectively. The primary aim of POEMS is to identify and manage any environmental aspects (causes) and impacts (effects) by scrutinising MoD equipment and activities during acquisition, operation and disposal. This is achieved by drawing up a priority list of activities associated with the equipment based on anticipated environmental impact scores, resulting in an environmental management plan that spans the life cycle of the equipment and any corresponding activities. This article describes the POEMS procedure for both experts and non-experts, and demonstrates the implementation of POEMS using a 105-mm artillery round as a theoretical case study. The results anticipated at each stage of the POEMS procedure are discussed in detail, and the documentation necessary to verify the correct application of POEMS is demonstrated

Food items consumed by students attending schools in different socio-economic areas in Cape Town, South Africa

Objective: We investigated the food consumption patterns of adolescent students at schools. Our findings are intended to reveal the overall nutritional quality of foods eaten by students at school, including foods brought to school and foods purchased at school. Methods: A questionnaire was completed by 476 students, mostly from grades 7 and 10, from 14 schools in Cape Town, South Africa. The schools were representative of the various ethnic groups and socioeconomic strata of the population. The questionnaire requested information on eating habits at school, foods brought to school and food purchases, and breakfast consumption before school. We also tested whether students knew which foods are healthy and which are less healthy choices. Results: The students were mostly 12 to 16 y of age (mean age 14.5 y). The large majority had breakfast before school (77.8%) and ate at school (79.7%). Food was brought to school by 41% to 56%, whereas 69.3% purchased food at school, mainly at the school store (tuck shop). Predefined “unhealthy” foods brought to school outnumbered “healthy” ones by 2 to 1. Among students who purchased food at school, 70.0% purchased no healthy items, whereas 73.2% purchased two or more unhealthy items. With six foods 84% of students correctly stated whether they were healthy or unhealthy; however, with cola drinks, samoosas (deep-fried pastry with spicy filling), and pies, only 47% to 61% knew that these were less healthy choices. Students’ scores on this question were unrelated to whether they purchased healthy or unhealthy foods. Students who attended schools of high socioeconomic status were twice as likely to bring food to school (64.7% versus 31.0%, P < 0.001), scored higher marks on the quiz of healthy versus unhealthy foods (P < 0.01), but were no more likely to purchase healthy food. Conclusions: The large majority of food eaten by adolescent students in Cape Town is classified as being unhealthy choices. This applies to foods brought to school and food purchases. Consideration needs to be given to policy measures to improve this situation and to improve education of students and their parents