Podcasts about us preventive task force

In this JCO Article Insights episode, Davide Soldato summarized finding from the original article published in the September JCO issue: “Mortality Benefit of a Blood-Based Biomarker Panel for Lung Cancer on the Basis of the Prostate, Lung, Colorectal, and Ovarian Cohort”. The summary provides information regarding the ability of a blood-based panel of 4 biomarkers in improving the identification of individuals at risk of developing lethal lung cancer and potential of combined screening strategies to improve trade-off between potential harms and benefit of the screening process. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Davide Soldato: Welcome to the JCO Article Insights episode for the September issue of the Journal of Clinical Oncology. This is Davide Soldato, your host, and today I will be providing a summary on one article focused on the refinement of screening strategies for lung cancer. The article, titled "Mortality Benefit of a Blood-Based Biomarker Panel for Lung Cancer on the Basis of the Prostate, Lung, Colorectal, and Ovarian Cohort" by Dr. Irajizad and colleagues, investigated the ability of a panel of circulating blood biomarkers in improving the identification of individuals at risk of developing lethal lung cancer. We already know that lung cancer screening based on the use of low dose CT is associated with a reduction in mortality, as already demonstrated by the National Lung Cancer Screening Trial and the NELSON Trial. Furthermore, the US Preventive Task Force has recently recommended an expansion of screening criteria for lung cancer. Currently, based on this recommendation, screening strategies are recommended for individuals 50 years of age and older with a smoking history of at least 20 pack-years and who are current smokers at the moment of the screening time or have quit within the past 15 years. Despite this positive data and this recommendation, the uptake of lung cancer screening in the US is still low, with reported uptake rates below 15%. The risk of false positive results, the unnecessary follow-up procedures, uneven access to lung cancer screening programs, and fear of cancer diagnosis and treatment have all been identified as potential barriers to optimal implementation and uptake of lung cancer screening. And so, in order to overcome some of these barriers, several efforts have been made in the last years to develop lung cancer screening prediction models with the aim of selecting a higher risk population who would derive higher benefit from lung cancer screening.  In the present manuscript, the author builds on their previous work where they developed and tested a clinical prediction model and a blood-based prediction model in the context of the PLCO cohort. The Prostate, Lung, Colon and Ovarian Cancer Screening Trial was a randomized, multicenter trial in the US which aimed to evaluate the impact of early detection procedures on disease-specific mortality for the aforementioned cancers. Two lung cancer screening prediction model had already been developed and tested in the cohort. The PLCOm2012 model is based on several clinical and demographic characteristics, including age, race and ethnicity group, education, BMI, chronic obstructive pulmonary disease, personal history of cancer, family history of lung cancer, smoking status and intensity, duration and quit time. In a previous study, this model demonstrated a higher sensitivity and positive predictive value with no loss in specificity for lung cancer diagnosis compared to the National Lung Screening Trial criteria. Additionally, in the same cohort, the 4MP was a blood-based panel that included the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment. In a previous study, a combination of this blood-based panel and the PLCOm2012 model was associated with a better identification of patients at high risk of developing lung cancer that would consequently benefit from lung cancer screening. In the manuscript that was published in the current issue of the JCO, the authors aim to expand on these previous results and test the ability of the combined 4MP and PLCO model to identify individuals at high risk of developing lung cancer death. The study used prediagnostic sera of 552 individuals that were diagnosed with lung cancer within one year from the blood draw and 2000  non-cases. In the study, the authors assessed the performance of this combined four 4MP and PLCO model at a risk threshold of 1% and 1.7% of developing lung cancer at six years. Among the more than 500 individuals who were diagnosed with lung cancer, 70% died from it and 18% died of other causes, and the median survival times for lung cancer cases was 2.7 years. The combined 4MP and PLCO model had an area under the curve (AUC) of 0.88 for the prediction of lung cancer-specific mortality. The performance of this combined model using both clinical demographic and also a blood-based panel was higher than the ones of the two models considered alone. Furthermore, the model had similar predictive performance for both non small cell lung cancer and small cell lung cancer-related deaths.  Subsequently, the authors compared the performance of the combined 4MP and PLCO model with the 2013 and 2021 US Preventive Task Force criteria and observed that the combined model had improved sensitivity, specificity, and positive predictive value for the prediction of lung cancer-specific mortality compared to both types of criteria. Finally, the authors assessed whether the combined 4MP and PLCO model were able to determine the survival probability among individuals who had a smoking history of at least 10 pack-years. Cases and non-cases were classified as either test positive or negative according to model scores at the 1.7 and 1% risk threshold at six years. For both thresholds, the combined 4MP and PLCO model identified a significantly higher number of lung cancer deaths in test positive individuals compared with test negative ones. So, in conclusion, these studies identify patients who are at higher risk of developing lung cancer-specific mortality using a combination of blood-based biomarkers and clinical demographic characteristics. The combined models showed higher sensitivity and specificity and positive predictive value compared to the standard US Preventive Task Force criteria. The results of this study are important because the identification of individuals at higher risk of lung cancer diagnosis and death offers the opportunity for a more favorable tradeoff between potential harms and benefits of the screening process. And so these results could assist in the design of future screening and intervention studies as well as facilitate the uptake of lung cancer screening, especially for those test-positive patients that have a higher risk of lung cancer death. Application of this model could potentially lead to a higher number of patients diagnosed in earlier stages and thus eligible for curative intent treatment.  That concludes this episode of JCO Article Insights regarding a summary of the article "Mortality Benefit of a Blood-Based Biomarker Panel for Lung Cancer on the Basis of the Prostate, Lung, Colorectal, and Ovarian Cohort" by Dr. Irajizad and colleagues.  This is Davide Soldato. Thank you for your attention and stay tuned for the next episode of JCO Article Insights.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Dr. Kevin Most of Northwestern Medicine drops by The Steve Cochran Show for his weekly roundup of medical news to help you live a happier, healthier life. This week, he shares the ranges of depression, what happens if anxiety is left untreated, and the new major guideline changes for mammogram screening.  Read all of Dr. Most's notes below and listen every Tuesday morning for more medical news. May is Mental health awareness month Most important message- public needs to eliminate the stigma of mental health We need to understand that mental health is a medical condition, just like hypertension, diabetes, heart disease Stop being afraid to discuss it, look for signs, it is one illness that the public can identify as quickly as a physician can Support individuals with mental health, encourage treatment Understand that depression can't be just shaken off, or a simple comment of “c'mon smile” is not a treatment Prevalence of mental health is increasing, yet treatment options are stagnant Estimates have over 20 million have had one MAJOR depressive episode, and over 40 million have some form of anxiety Depression, Anxiety, Substance Abuse Disorders and thoughts of Suicide have risen dramatically in the past 3 years The rise in untreated substance use disorders has also contributed to an increase in overdoses, with over 100,000 overdose deaths occurring in the United States in 2022  Depression in adults in the US has risen to the highest levels ever 21% of adults, 1 in every 5 adults are experiencing one mental illness. 18% of adults say they are depressed or receiving treatment for depression 3 in 10 have been clinically diagnosed with depression at some time in their life Yet over 50% have never received any treatment We saw a big jump of mental health issues during the Covid epidemic, the stress, disruption and loss during the past 3 years has impacted mental health Is it a true increase or is more about awareness and acceptance The sites for treatment and professionals for treatment have not kept pace with the need Estimates are that we are short about 10,000 mental health physicians Younger generations are more aware and willing to address depression and thus have higher rates of depression 25% of those under the age of 30 say they are currently suffering from depression Clinical depression rates are significantly higher in women What are the symptoms of Depression? Continuous low mood or sadness that lasts nearly all day on most days Feeling hopeless and helpless. Having low self-esteem. Feeling tearful with no reason Feeling guilt-ridden or worthless. Feeling irritable and intolerant of others. Finding it difficult to make decisions. Loss of interest in activities that the individual previously enjoyed Sleep disturbances- both insomnia and excessive sleeping Significant weight loss or gain What are the symptoms of Anxiety? Anxiety is the body's response to worry and fear There are many anxiety disorders that appear as worry and stress due to social interactions, personal health, work or a particular phobia Panic disorders, PTSD and Obsessive compulsive disorder are very common Symptoms include restlessness, feeling on edge, fatigue, muscle tension Panic attacks can be debilitating and occur quickly- intense fear triggered by something or a situation General anxiety is the most common- individuals have anxiety on most days and lasting at least 6 months Treatment options for Depression-Anxiety Psychotherapy can be very effective and this can be done with a psychiatrist, a psychologist, a social worker or a primary care physician Psychotherapy can come in many methods Medications can be used- these often take over a month to actually work ECT- electroconvulsive therapy has been shown to work well on severe depression Self-treatment coping is also important- stay engaged- be active-decrease alcohol use-eat healthy Acupuncture has been shown to help in some people Breast Cancer Screening Changes Breast Cancer the most common cancer in women (excluding skin cancer) 300,000 new cases of Breast cancer are identified each year Death rates from Breast cancer have been going down since 1989- due to earlier identification with increased screening as well as better treatments Current screening recommendations from 2016 recommend breast cancer screening begin at 50 yrs old New recommendations out last week from the US Preventive Task Force, lower that age to 40 yrs old and screening every other year The recommendations from this task force are what insurance companies often follow American Cancer Society also recommends Breast Cancer Screening to begin at age 40 yrs old The recommendation is every other year from 40- to – 74 yrs of age, many feel it should be annual screening This recommendation is available for public comment until June 5th This recommendation would be for all women, not high risk alone We know there are racial inequities in breast cancer with black women with higher rates, yet lower opportunities for care in many cases. Black women are more likely to develop more aggressive cancers at a younger age The review showed that earlier screening had benefits that outweighed the risks Breast cancer rates in younger women has been increasing each year Many cancers are being noted earlier, including breast, thyroid and colon cancer Breast cancers identified at s localized state have a 99% survival rate at 5 years, this drops to 30% when the cancer has spread to lungs, liver or bones American Cancer Society also recommends screening to start at 40, but done every year for the first 5 years Some doctors are still recommending screening every year for younger patients  See omnystudio.com/listener for privacy information.

In today's episode, I interviewed Elizabeth Yurth, Medical Director of Boulder Longevity Institute which she co-founded in 2006. When it comes to hormone treatment for women, they have often been fed unchecked facts. In this episode, Elizabeth broke down the myths about women's hormone therapy and how it can effectively treat them. Go to www.thestandard.academy/magazine to become one of the first to get my digital magazine for free that'll help you create a kick-ass life. Elizabeth Yurth, MD is the Medical Director of the Boulder Longevity Institute which she co-founded in 2006.  The Boulder Longevity Institute specializes in advanced, research-based longevity medicine including treatments such as Bioidentical Hormone Replacement Therapy, Regenerative Orthopedic Procedures, and Regenerative Peptide Therapy, with a result-oriented approach to health optimization. Dr. Yurth obtained her Medical Degree from the University of Southern California Keck School of Medicine and completed her residency at the University of California – Irvine. Along with her 25-plus years as a practicing orthopedist specializing in sports and spine medicine, Dr. Yurth has made it her mission to learn and share the latest scientific research on how to truly heal the body at the cellular level. She is double board-certified in Physical Medicine & Rehabilitation and Anti-Aging/Regenerative Medicine. As a specialist in Sports, Spine, and Regenerative Medicine, Dr. Yurth has a Stanford-affiliated Fellowship in Sports and Spine Medicine, and a dual-Fellowship in Anti-Aging and Regenerative Medicine (FAARM) and Anti-Aging, Regenerative and Functional Medicine (FAARFM) through the American Academy of Anti-Aging Medicine (A4M). Dr. Yurth has also completed Fellowship training in Human Potential & Epigenetic Medicine and Cellular Medicine, is part of the first cohort of providers to receive the A4M National Peptide Certification, and is a founding faculty member and national lecturer for SSRP (Seeds Scientific Research and Performance).    Website & Social Links:  Boulder Longevity Institute (BLI): www.boulderlongevity.com  BLI's Human Optimization Academy: www.bli.academy  BLI's curated supplement & product store: www.OHPHealth.com  Instagram: @boulderlongevity, @dryurth  Facebook: https://www.facebook.com/BoulderLongevityInstitute/    A bit about me (Dr. Orest Komarnyckyj) Dr. Orest Komarnyckyj enjoyed a prestigious career as a periodontal regenerative surgeon moving to a new passion in June 2018. He retired after a 33-year career to pursue new passions. At 70 Dr. Orest has taken on a new role as a Men's Life Coach and Podcaster.  If you want to find out if Dr. Orest can help you regain the vibrancy in your life then use this link https://calendly.com/thestandardacademy/orest-komarnyckyj-zoom-video-call-appointments  to schedule a short                               GET TO KNOW YOU CALL  He lives with his wife of 30 years, Oksana. His status as an empty-nesters with two out of college-employed children has left him with time and energy to share decades of successes, failures, and wisdom. Dr. Orest is not afraid to talk about uncomfortable topics on his podcast and with men he coaches.  Very often he brings the unexpected.   Timestamps 00:00 - Precap 00:42 - Intro 01:51 - Guest introduction 04:28 - Myths surrounding women's hormone therapy 07:47 - Hormone replacement - Insanity starts 10:33 - Women should not be on hormones 11:20 - Women's hormones, increase the rate of breast cancer 13:11 - US Preventive Task Force released a statement 15:54 - Commercial Starts 16:27 - Commercial ends 16:43 - Can hormones cause cancer? 17:05 - Metabolizing Hormones 18:09 - Does testosterone cause cancer in men? 19:10 - Know how hormones metabolize 21:20 - Liver-protecting process 24:25 - What's the process of going through hormone replacement therapy? 26:28 - Women have estrogen dominance 28:00 - Birth control pills block testosterone 29:50 - Testosterone is always bioidentical 30:28 - Outro

The House advances the $3.5 trillion social spending package. Despite job losses from the pandemic, the uninsured rate stayed about the same. And the US Preventive Task Force is lowering the recommended age for Type 2 diabetes screening. To take the 5 question survey go to Gisthealthcare.com/survey

Episode 17 – Tension HeadacheThe sun rises over the San Joaquin Valley, California, today is June 19, 2020. This week we welcomed a new group of residents who started on June 15, 2020. Welcome aboard, Drs. Amodio, Civelli, Grewal, Lorenzo, Lundquist, Martinez, Nwosu, and Viamontes. We are excited for you and all the experiences you will have in the next 3 years. On Jun 9, the USPSTF recommended to screen for unhealthy drug use all adults age 18 years or older. This a Grade B recommendation (moderate to substantial benefit). Screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. Screening in this case refers to asking questions about unhealthy drug use, not testing biological specimens(1).The search for the miraculous antiviral drug against COVID-19 continues. We previously mentioned remdesivir, which was granted Emergency Use Authorization (EUA) by the FDA on May 1, 2020 in the US. Another drug you should be aware of is avifavir. Avifavir is based on Favipiravir, originally sold in Japan as an antiviral medication to treat influenza. Avifavir has been approved to be used in Russia, and is being tested in the US and the UK as well. Let’s keep avifavir on our radar, if it works, we’ll surely know about it.Welcome to Rio Bravo qWeek, the podcast of the Rio Bravo Family Medicine Residency Program, recorded weekly from Bakersfield, California, the land where growing is happening everywhere.The Rio Bravo Family Medicine Residency Program trains residents and students to prevent illnesses and bring health and hope to our community. Our mission: To Seek, Teach and Serve. Sponsored by Clinica Sierra Vista, Providing compassionate and affordable care to patients throughout Kern and Fresno counties since 1971. “[Feedback], like rain, should be gentle enough to nourish a man’s growth without destroying his roots.” – inspired by Frank A. ClarkBeing corrected is not easy. It takes a lot of courage to accept that we may be wrong sometimes, and trying to fix our mistake requires diligence. Remember that your attendings are not trying to humiliate you (or at least the attending I know), but they are correcting you to help you succeed in your career. Today we have a resident who is excited to talk about his topic. Welcome, Dr Brito.1. Question Number 1: Who are you?I was born and raised in the center of the Cuban island. I had the opportunity to study and practice Medicine in my native country. After graduating from medical school, I completed my social service year in an underserved area on the beautiful north coast. Most of my patients were farm workers or fishermen. I also worked in the ER for 6 years before emigrating to the United States. Once in the US, and after years of preparation, I was accepted into the UCLA IMG Program in 2018, and the following year I matched in the Rio Bravo program.I like fish keeping, outdoor sports such as running, sports in general, my favorite Movie director is Pedro Almodovar. I also love jazz music, Miles Davis, and Chucho Valdes. 2. Question number 2: What did you learn this week?I learned about the treatment of Tension-type Headache (TTH).PREVENTIVE THERAPYProphylactic therapy ranges from drugs to nonpharmacologic therapies such as behavioral and cognitive interventions. Prophylactic treatment is indicated if headaches are frequent, long-lasting, or account for a significant amount of total disability. Such as, frequent episodic subtype (1 to 14 headache-days a month) and chronic subtype (>15 headache-days a month) Preventive therapy may be also indicated when acute therapy (such as acetaminophen and NSAIDs) fails or is inappropriate because of inadequate response, adverse events, overuse, or contraindications. Pharmacologic preventive therapies: Evidence of efficacy is limited and inconsistent, but perhaps is strongest for the tricyclic antidepressants such as amitriptyline. Other medications - mirtazapine and venlafaxine, topiramate, gabapentin, tizanidine have limited data. Trigger point injections require more research. In contrast, SSRIs are not effective.  Dosing and duration of therapy: Start the drug at the lowest dose, and increase the dose gradually until therapeutic benefit is achieved. Benefit is often first noted only after four to six weeks of therapy. Avoid overuse of analgesic medication, in fact eliminate it, or preventive therapy will likely be ineffective. Measure the effectiveness of therapy by use of a patient headache diary. For example, amitriptyline at 10-12.5 mg nightly, and increase the dose in 10 to 12.5 mg steps every two to three weeks as tolerated, maximum dose of 100 to 125 mg. TCA are associated with cardiac conduction abnormalities and arrhythmias. Before initiating treatment, patient should be screened, 40 years and older with EKG, younger than 40 can be screened by history for evidence of cardiac disease.  Behavioral therapies: Regulation of sleep, exercise, and meals. CBT, relaxation, biofeedback—These therapies may be suited for patients who prefer no pharmacologic treatment; those who have insufficient response to, or poor tolerance to pharmacologic treatments; pregnant, nursing, excessive use of analgesics; those who have significant stress or deficient stress-coping skills. Studies suggest treatment using biofeedback combined with relation therapy rather than other behavioral therapy options. Biofeedback: Electrical sensors connected to a monitor are hooked up to your body. The sensors measure one or more signs of stress. This can include heart rate, muscle tension, or body temperature. The measurements provide feedback about how your body responds to different stimuli. Patients learn to interpret those signals and control them.Other no pharmacologic therapies such as acupuncture which suggests any benefit is likely to be modest and Physical therapies with unproven benefits. ACUTE TREATMENTThe acute or abortive therapy of TTH ranges from nonpharmacologic therapies to simple and combination analgesic medications. In most cases, the treatment of TTH is largely self-directed using OTC medications without any input from a medical provider. Nonpharmacologic treatments include heat, ice, massage, rest, and biofeedback.  Precipitating factors include of TTH: Stress and mental tension are reported to be the most common precipitants. Other precipitants anxiety, major depression, overwork, Lack of sleep, Incorrect posture, etc. Controlling these triggers may help in the acute treatment of TTH.Medications: Given the available data, the recommended treatment is with simple analgesics such as NSAIDs or aspirin for patients with pure episodic TTH. Acetaminophen 1000 mg is probably less effective than NSAIDs or aspirin. Reasonable choices include ibuprofen (200-400), naproxen (220 or 550 mg) or aspirin (650 to 1000). For failing, diclofenac (25 to 100 mg). For those who cannot tolerate NSAIDs or aspirin, acetaminophen 1000 mg is the preferred choice. How to judge the success of acute treatmentReasonable goals:- Is the patient pain-free and functioning normally in two to four hours after treatment? - Does the treatment work consistently without routine headache recurrence? - Is the patient able to plan his or her day? (disability)- Is it tolerable?The treatment should be considered ineffective if two or more of these criteria are consistently not met. What to do in case of treatment failure Consider diagnosis of TTH is inaccurate, less likely secondary etiology, most likely migraine without aura Dx is correct but wrong medication choice, inadequate dose, timingMedication overusePatient has depression, and/or anxiety disorder. Other acute interventions: Combination analgesics containing caffeine (recommended in suboptimal response), butalbital and codeine (not recommended as initial therapy), Parenteral (chlorpromazine, metoclopramide (limited evidence), Ketorolac, Muscle relaxant (not recommended) 3. Question number 3: Why is that knowledge important for you and your patients? Tension-type headache is the most prevalent headache in the general population and the second-most prevalent disorder in the world. Yearly, prevalence rates for episodic TTH are approximately 80 % in men and women. Understanding the pathophysiology and clinical aspects of TTH is important for accurate diagnosis and optimum treatment. However, TTH is a relatively featureless HA, making it the least distinct of all the primary HA phenotypes. In addition, it is the least studied of all the primary HA disorders, despite having a high socioeconomic impact. Societal impact: The prevalence of TTH is greater than migraine and the overall cost of TTH is high. In one population study, persons with episodic TTH reported a mean of nine lost workdays and five reduced- effectiveness days, while persons with chronic TTH reported a mean of 27 lost workdays and 20 reduced-effectiveness days.  4. Question number 4: How did you get that knowledge?That knowledge came first from medical school, and second, after years of practicing Medicine. During those years, we as doctors, evaluate and manage a large number of patients with one of the most common medical complaints, headache. In terms of finding out more of what to do with patients, how to make them feel better, I had to look some stuff up. My trusty sources in clinic are 1) Up to Date, 2) Faculty, 3) Review/Journal articles. Not necessarily in that order. 5. Question number 5: Where did that knowledge come from?The information comes from multiple reliable medical sources such as “Frequent Headaches: Evaluation and Management” by Anne Walling, downloaded from the AAFP website, and “Tension-type headache in adults: Preventive treatment and Acute Treatment” in Up-to-Date. ____________________________Speaking Medical: CholuriaHi this is Harjinder Sidhu, I’m a 3rd-year medical student. I’m here to present the medical word of the week: Choluria. Has your patient ever inform you their urine color is brown (Coca-Cola color)? Choluria has 2 roots, “chol” and “uria.” “Chol” is the combination of bile and gallbladder. “Uria” is the presence of something in urine that should not be present. So choluria is the presence of bile in the urine. What causes the urine to become brownish in color? The presence of bile in urine is caused by an underlying liver disease such as cirrhosis, hepatitis and/or hemolysis. Choluria usually manifests when the serum levels of bilirubin are above 1.5mg/dl. Now that you understand what choluria is, in the future you can look out for our patients by asking any changes in urine as a sign of potential liver problems. Stay tuned for next week’s word of the week!____________________________Espanish Por Favor: Señale con un dedoHi this is Dr Carranza on our section Espanish por favor. This week I wanted to share a tool for a follow-up question. Not too long ago we learned that DOLOR means pain, and we learned about body parts like “cabeza” head, “rodilla” knee, “pecho” chest, etc. Next you will probably want to ask where the “dolor” exactly is, and to simplify things we can ask the patient to point with one finger to where it hurts. We can do this by saying “dónde” which means where, followed by “señale con un dedo”, which means point with one finger. “Señalar” means to point, and “dedo” means finger.I hope you can use this in your practice, “señale con un dedo”, and you can always ask nicely and add “por favor” which means please. Have a great week!Now we conclude our episode number 17 “Tension Headache”. Dr Brito briefly explained the treatment of tension headache. Lifestyle modifications are key in the treatment, and many non-pharmacological options are available with different degrees of evidence. Thinking about prophylaxis of tension headaches? Amitriptyline is likely a good choice, but remember the side effects as well. Dr Carranza taught us how to ask about location of pain with the phrase “señale con un dedo”, and then we remembered the word choluria, which is bilirubin in the urine. Stay tuned for more next week.This is the end of Rio Bravo qWeek. We say good bye from Bakersfield, a special place in the beautiful Central Valley of California, United States, a land where growing is happening everywhere.If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. Our podcast team is Hector Arreaza, Ariel Brito, Claudia Carranza, and Harjinder Sidhu. Audio edition: Suraj Amrutia. See you soon! _____________________References:Unhealthy Drug Use: Screening, June 09, 2020, US Preventive Task Force, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/drug-use-illicit-screening“Avifavir, first COVID-19 drug from Russia: What you need to know”, MSN News, https://www.msn.com/en-ae/news/other/avifavir-first-covid-19-drug-from-russia-what-you-need-to-know/ar-BB14UKvN, accessed on June 15, 2020.“Biofeedback” by Healthline, https://www.healthline.com/health/biofeedback#procedure, accessed on June 15, 2020.Walling, Anne, Am Fam Physician. 2020 Apr 1; 101(7):419-428Taylor, Frederick R, “Tension-type headache in adults: Preventive treatment” (https://www.uptodate.com/contents/tension-type-headache-in-adults-preventive-treatment?search=tension%20type%20headache%20treatment&source=search_result&selectedTitle=2~108&usage_type=default&display_rank=2), and “Tension-type headache in adults: Acute treatment” (https://www.uptodate.com/contents/tension-type-headache-in-adults-acute-treatment?search=tension%20type%20headache%20treatment&source=search_result&selectedTitle=1~108&usage_type=default&display_rank=1), Up to Date, accessed on June 15, 2020.

This article is part of the 2019 Oncology Special Issue of Natural Medicine Journal. Read the full issue here.    Tina Kaczor, ND, FABNO, interviews Shauna Birdsall, ND, FABNO, on what clinicians need to know about skin cancers. From preventing squamous cell carcinomas to recognizing melanoma, Birdsall details the essentials of cancer-related dermatology. This interview includes a broad review of what you can do to help patients prevent skin cancer. Do you remember the ABCDE’s of recognizing melanoma? Where do squamous and basal cell carcinomas usually occur? What is the ideal range for serum vitamin D? What other supplements have evidence for reducing the risk of squamous cell cancers? We cover all this and more in this in-depth discussion between integrative oncology experts. About the Expert Shauna M. Birdsall, ND, FABNO, is a naturopathic physician and fellow of the American Board of Naturopathic Oncology. Birdsall graduated from National University of Natural Medicine in 2000. After completing a residency at Cancer Treatment Centers of America (CTCA) at Midwestern Regional Medical Center in 2002, she provided patient care and supervised naturopathic medical students there until 2008. She took on a leadership role at Western Regional Medical Center at CTCA in Goodyear, AZ, in 2008 and was later elected vice chief of the medical staff there. She also chaired the Medical Executive Committee, Credentials Committee, Peer Review Committee, and served as the Medical Director of Integrative Oncology until 2018. Birdsall recently joined Avante Medical Center in Anchorage, AK. One of Phoenix Magazine’s Top Doctors 2014-2018, Birdsall is strongly committed to providing individualized, compassionate, evidence-based care to empower and provide hope to cancer patients. Transcript Tina Kaczor, ND, FABNO: Hello. I'm Tina Kaczor, editor-in-chief here at the Natural Medicine Journal. I'm talking today with Dr. Shauna Birdsall about skin cancers, and Dr. Shauna Birdsall has graduated from the National College of Natural Medicine in the year 2000. After that, she went to Cancer Treatment Centers of America, and she has been a specialist in integrative oncology since graduation. She's most recently taken a position at Avante Medical Center in Anchorage, Alaska, where she'll be providing patient care in a hospital-based setting. Shauna, thanks so much for joining me. Shauna Birdsall, ND, FABNO: Oh, thank you for having me. Kaczor: Dr. Birdsall, you've recently worked closely with a lot of dermatologists in a dermatologist setting, and you and I got talking about that. I was intrigued by a lot of the things that you learned, and I would like you to elaborate a little bit on how working closely alongside these dermatologists maybe changed your perspective of oncology and skin cancer specifically. Birdsall: I have to say I was blown away, and this is a bit embarrassing. Working with patients undergoing chemotherapy and radiation for cancers like breast cancer and pancreatic cancer, I had always seen dermatology as more on the periphery. Working with dermatologists showed me how often dermatologists are diagnosing things like melanoma and really saving people's lives. It completely changed my perception around the integral nature of the specialty. Kaczor: Yeah. I think that's what struck me, because you and I have parallel universes in the idea of our professions. We both graduated in the same year, and we've both been doing integrative oncology. I have to say I haven't worked closely with dermatologists. I share your inclination to say, "Ah, yeah, skin, we can catch that. No problem. We always catch skin cancer," and, I mean, that's despite the fact that of course we've both worked with people with metastatic melanoma. We'll get to that and the importance of prevention, especially to prevent such tragedies as metastatic disease. I'd like you to give us a primer, and just give us a really basic overview for the clinicians out there on the types of skin cancers that there are, and who they most likely effect as well. Birdsall: Sure. First of all, skin cancer is the most common type of cancer, and in the United States this year, more than 5 million people will be diagnosed with skin cancers. First and foremost, we like to talk about actinic keratoses. These are also known as AKs, and they are really precancerous lesions. You'll hear, the resounding themes of those that have sun exposure as being at risk for these cancers as I go on, but essentially actinic keratoses are often flaky or scaly patches of skin, and it's important that those are identified and treated, as sometimes they can lead to squamous cell carcinoma. The most common type of skin cancer is basal cell carcinoma or BCC. This accounts for about 80% of skin cancers, and BCCs usually look like a flesh-colored pearl or bump, or a pinkish patch of skin. All of these skin cancers are going to be more prevalent in patients with fair skin, although patients with skin of all colors can develop these skin cancers. Then, as I mentioned we're going to repeatedly talk about risk with sun exposure, and that means that the areas of the body that are most frequently exposed to sun such as the face, head, chest, arms and legs are going to be the most prevalent areas that you can see these cancers. Squamous cell carcinoma is the most second type of skin cancer, and you're going to also see squamous cell cancers on areas like the rim of the ear. You really need to be able to make sure that those are identified, as those cancers can spread more deeply into tissues and cause additional damage, as well as metastasize elsewhere. Melanoma, as we talked about earlier, is the deadliest form of skin cancer. It's actually been on the rise for the last 50 years. Melanoma in situ annual incidents in the United States is 9.5%, and in the United States melanoma has become the fifth-most common cancer in men and women. Melanoma increases with age, and you do see again the sun exposure and fair skin as common risk factors. I think later on, we'll talk about more risk factors for melanoma. Kaczor: Yeah. That's an incredible statistic. Nearly 10% incidence for in situ melanoma. Wow. Birdsall: Yes. Which is why I really started waking up to the issues with skin cancer detection and prevention, working with dermatologists, because I just was blown away, as I mentioned, with how often they were diagnosing either melanoma in situ or melanomas. Kaczor: That's just checking. I mean, that's just skin checks, not coming in with that complaint. Birdsall: Yes. Kaczor: Most of our listeners are practitioners that are primary practitioners. Very few are going to be specialists in skincare, of course. I'd like us to maybe, if you could, go through how to recognize melanoma, and maybe making sure that when we are seeing our patients ... and this could be in a specific skin exam, or it could also just be an incidental finding on their arm or their face or whatever. What are we looking for with melanoma? Birdsall: Melanomas frequently develop in a mole or suddenly appears as a new dark spot on the skin. If you'll recall, we have the ABCDE warning signs, and I'm just going to go through those just for all of our review. A stands for asymmetry. B stands for border, either irregular, scalloped or poorly defined. C stands for color, varied really from one area to another in the same mole, and you can see shades of tan and brown, black, white, pink, red or blue. I think one of the most shocking melanomas that I saw was a melanoma inside the web of the toes in a patient that just looked like a little pink spot. D stands for diameter. While melanomas are usually greater than 6 millimeters in size, which is the size of a pencil eraser, when initially diagnosed they can be smaller. E stands for evolving, a mole or a skin lesion that looks different from the rest or is changing in size, shape or color. What is important to know as well is that melanomas don't necessarily read the textbooks. As I mentioned, they can look like something that, for those of us who are not dermatologists, may not look like something of concern, which is why I became aware of the need for annual skin exams. Kaczor: Yeah. Yeah. It is remarkable that some of them don't look like much, and I think that erring on the side of caution, especially as our patients get older and older, because aging is a risk factor for all cancers, and I'm assuming skin cancer is included in there. Okay. Is there anything else? Last notes besides ABCD and E, and anything else that people should be looking for clinically before we close that discussion? Birdsall: An area that's itching, bleeding. An area that opens up and appears to heal over, and then opens up again. Anything like that also needs to be evaluated. Kaczor: Okay. Yeah. Referral to a dermatologist is simple enough that I think it's ... again, erring on the side of caution seems like a smart thing to do. We talked about melanoma, and experience shows us that of course it's the most likely to go somewhere. It's most likely to spread and become fatal for some patients, but I'm curious. Basal cell and squamous cell carcinoma, what is the risk of any local or metastatic disease with those? Birdsall: In the majority of patients with cutaneous squamous cell carcinoma or basal cell carcinoma, the disease remains limited to the skin and with appropriate treatment is considered, "cured," which you and I both know we don't get to use that word very often in oncology. It's exciting that something can be cured with appropriate treatment. However, in 3 to 7% of patients with cutaneous squamous cell carcinoma, and rarely in individuals with basal cell carcinoma, local, regional or distant metastases can occur, which increases the risk for mortality or death. Kaczor: Do you happen to know, is this analogous to melanoma in that the depth of the lesion has anything to do with it? Do you know? Birdsall: Yes. For both basal cell and squamous cell carcinomas, both the depth and the size can contribute to risk, which is why even though a patient might only have a small spot, why it's important that it be caught early and treated, because left to its own devices, the larger it gets, the more at risk a patient is. Kaczor: Okay. Well, that makes logical sense. As far as melanomas go, you mentioned in situ is nearly 10%. Are most of them still caught in the early stages, before they go anywhere? Birdsall: Yes. Yeah. About 85% of melanomas are caught when there's only localized disease, so Stage I or Stage II at presentation, which as you and I both know, that's when you see the best survival rates. At diagnosis, about 15% have regional nodal disease, and only about 2% have distant metastases at the time of diagnosis. We're getting better at diagnosing skin cancers and melanoma, and it's theorized that dermatologists are more likely to biopsy these days because of seeing a higher prevalence. Kaczor: I see. Okay. Can I ask one question? That is, in some states, including where I am in Oregon, naturopathic physicians can do minor surgery. The question I have ... I know my opinion on this, but I want to hear your opinion on this. It's not uncommon for shave biopsies to happen in-office. This is true of primary care physicians across the board, not just naturopaths. If someone suspects a melanoma, yea or nay on something like a biopsy of that, whether it's a punch biopsy or a shave biopsy? Birdsall: Nay, and the reason is that there is research that the sooner after initial diagnosis ... so the sooner after initial biopsy ... that patient is able to get definitive treatment for their melanoma, the better. One of the risks, if someone other than a dermatologist or another health professional biopsies melanoma, is that there's then a delay potentially in getting the patient in to the provider that's going to be able to provide definitive treatment for that melanoma. That's one of the risks. Really, you want to see the highest level of specialty if you suspect a melanoma. Kaczor: Okay. I think that needs to be reiterated time and again, because every once in a while you come across those patients, and your hair stands up when they tell you what first happened to their lesion, and you just hope that it didn't go anywhere. Okay. Let's talk about, again, we're talking to our audience is generally practitioners that are frontline folks, and which patient populations, which types of people, should there be particular vigilance for skin cancers, like higher levels of suspicion, and who exactly? Birdsall: Okay. I warned you that we'd keep going back to a couple of things. Fair-skinned individuals, particularly those with blonde hair, red hair, lighter-colored eyes, blue eyes, although again, the warning that skin cancers can occur in patients of any skin color, and then that hallmark UV, exposure to UV radiation. More sun exposure, more risk. Also, however, living in sunny climates or higher altitudes, again because you're getting more direct exposure to UV radiation, as well as lower latitudes. Moles, patients that have more than 50 moles are at higher risk, and patients that have had a history of dysplastic nevi nearby or abnormal moles. Patients with actinic keratoses are at higher risk. Patients with either a family history of skin cancer or a personal history of skin cancer, and immune suppression. I want to just take a moment to talk about immune suppression, because that can include a variety of different patient populations. That can include patients living with HIV or AIDS, or oncology patients that maybe are receiving chemotherapy or maybe their immune system hasn't recovered from prior chemotherapy, and it does include patients on immunosuppressive drugs such as for organ transplants. Patients who've had an organ transplant are at high risk for skin cancers because they're likely to have a lifetime of immune suppression because of those immunosuppressive drugs. Lastly, exposure to radiation. You and I think of patients that have been exposed to radiation like breast cancer patients, lung cancer patients, et cetera. However, sometimes patients are exposed to radiation for skin conditions like basal cell carcinoma or eczema or acne, just different types of radiation. Then, exposure to chemical substances like arsenic can also increase risk, and then age increases risk. We're just at higher risk, the longer that we're living a lifetime out, being exposed to the sun. Kaczor: Is it true that childhood exposures can have an effect decades later? Like someone who grew up down in San Diego, for example, but they live in Minnesota? Birdsall: Yes, especially to melanoma. I am a-fair skinned person and I had an unfortunate history of a couple of different blistering sunburns, and that history of childhood sunburns and history of blistering sunburns can increase risk, especially for melanoma. Kaczor: Okay. Yeah. That's good to have validated, because I've always heard that. Maybe in our patient intakes, it's something we should put on our intake forms. Not only where did you grow up, but did you get burned, sunburned? Birdsall: Yes. Kaczor: Back in the day, of course, there was a time when people intentionally went out there and called a burn halfway to a tan. Birdsall: That actually reminds me. I don't think of indoor tanning frequently these days, but exposure to indoor tanning and tanning beds. Maybe your patient is very responsible now as an adult, but maybe in their teenage years had a long history of exposure to tanning beds. Kaczor: Yeah, yeah. It's something that's easily overlooked in an intake. Maybe we should make sure that that's top of mind. Let's talk a little bit about screening and prevention, and how can we make sure that we do catch things early, especially melanoma. What are the current recommendations, even, for skin cancer prevention? Birdsall: It's interesting. As far as screening, it remains somewhat of a controversy, which surprised me. US Preventive Task Force is considered one of the authorities on screenings, and to date, the US Preventive Task Force hasn't found sufficient evidence either for or against skin screenings. What's interesting is there is a lot of debate amongst other experts in the field. The American Cancer Society actually recommends a cancer-related checkup every three years for patients between age 28 to 40, and then also encompassed in that cancer-related checkup is other kinds of screenings in addition to skin cancer screenings, and then every year for anyone over 40. Interestingly, the American Medical Association really sees it as individualized, and recommends that a patient should talk to their physician about frequency for skin cancer screenings, and those at moderate risk even should see their PCP or dermatologist annually. The American Academy of Dermatology issued a statement regarding their disappointment over the recommendation by the US Preventive Task Force, and felt that the public should know that that recommendation that was neither for nor against annual skin cancer screening did not apply to individuals with suspicious skin lesions or those with increased skin cancer risk, and does not apply to the practice of skin self-exams. The American Academy of Dermatology recommends that patients really function as their own health advocate by regularly conducting skin self-exams and that if the patients see anything unusual, that they should see a dermatologist. Unfortunately, we all know that there's not always consistency with patients regarding advising for self-exam, and a patient can't necessarily see the back of their neck or their back, that may have had a lot of sun exposure. A number of dermatology providers still recommend annual skin exams, which after working with dermatologists, I'm definitely an advocate for as well. Kaczor: Yeah. Yeah, that makes sense. All it takes is a few cases. We're all a product of our experience, right? You see a few cases where it could have been prevented, and it seems and it is tragic. What can we do? I guess once we identify patients who are at higher risk, due to either childhood or exposure or fair skin or immune suppression, like what can we do to prevent skin cancers? Birdsall: Again, not to sound like a broken record, but decreasing sun exposure is the first thing. Interestingly enough, while I was just reviewing the research when I was preparing for our interview, I was looking at the Environmental Working Group and sunscreens, because there are definitely sunscreen ingredients these days that people have concerns about. For a patient that might be more holistically inclined, they might feel somewhat reluctant to put some of the ingredients that are in sunscreens on their skin, and so there's still a number of things that we can recommend. One is the physical sunscreens that are more of a barrier, and zinc oxide and titanium dioxide were considered generally safe and effective by the Environmental Working Group, and those are sunscreens with definitely friendlier ingredients that people may feel a lot more comfortable using and recommending. Secondly, wearing clothing shields our skin from sun exposure. There's some really interesting sun-protective clothing that is coming out as well if people are in the sun more frequently. Just trying to stay out of the sun during the peak periods or during high heat indexes is also something that patients can do as well. Then, doing annual skin exams. Because as you and I talked about, we may not feel concerned about a lesion that a dermatologist may instantly pick up on as something that may need to be further evaluated. Kaczor: Yeah. On that note, I don't remember when I read this, but years ago I remember reading they did surveys of lesions, and they had primary care physicians and dermatologists assess them and see who was most accurate. Nobody bats a thousand, but it was remarkable how much better the dermatologists were at visually assessing lesions correctly. Birdsall: Well, what was interesting working with dermatologists is I'd ask them why they were attracted to their field, why they went into dermatology, and they said because it's actually a field of medicine that you visually diagnose. You can visually see what's going on. Internal medicine, you might look at the results of a patient's lab work or a chest X-ray, but dermatology, you can actually see pathology and treat it. Kaczor: Yeah. How interesting. Yeah, so I guess you're good at that. Some people are better than others, I think. We are naturopaths, and so let's talk a little bit about diet and supplements and other things that we can do. What can we do from a supplement standpoint? Is there anything we can add or anything we should avoid, for that matter, that could lower the risk of developing cancer, skin cancer specifically? Birdsall: There was a really interesting Phase 3 randomized trial of nicotinamide for skin cancer prevention published in the New England Journal of Medicine in October of 2015, and in the study, 386 participants who had a history of at least 2 non-melanoma skin cancers ... again, that's basal cell carcinoma or squamous cell carcinoma ... in the past 5 years were randomized to receive 500 milligrams of nicotinamide twice daily or placebo for 12 months. They were seen by dermatologists every 3 months. At the end of the study, the rate of new non-melanoma skin cancers was lowered by 23% in the nicotinamide group, and noteworthy was the fact that there was no benefit after the nicotinamide was discontinued. I would say about 70% of the dermatologists that I was working with recommended nicotinamide to their patients. That's actually compelling data from my perspective in regards to a supplement. There's another supplement that has less research but is something interesting to watch called polypodium leucotomos, which is a fern from Central and South America. It was actually shown in studies to prevent both UVA- and UVB-induced toxicity and DNA damage. There was a study showing that 240 milligrams of a supplement containing that ingredient twice daily suppressed sunburn, and was found to extend the time outdoors before skin started to tan, so that's another possibility. I think we know as naturopathic doctors that vitamin C, E, zinc, beta carotene, omega-3 fatty acids, lycopene and polyphenols, especially in things like green tea, do also help to prevent free radical damage, which is what the exposure to UV radiation causes as well. Kaczor: Okay. Yeah. Is there a specific role ... I don't I honestly don't remember where I have this idea from, so you can validate or invalidate my presumption ... about using vitamin A specifically for actinic keratosis? Birdsall: Sure. There was a study on high-dose vitamin A reducing the incidence of actinic keratosis converting to squamous cell carcinoma, and the study looked at doses ranging from 25,000 IU a day, 50,000 IU a day and 75,000 IU a day. They did indeed find that that did prevent those AKs from turning into SCCs pretty significantly. However, from my perspective, there'd need to be a risk/benefit weighing of that for any particular patient. Kaczor: Yeah. Because 25,000 to 75,000 IU daily for an extended period is ... Birdsall: Correct. I had some concern after looking at that. Kaczor: Yeah. Yeah. Recently, I mean, I generally wasn't too concerned with vitamin A levels as we gave them until ... because we would often use this dose for antiviral effects. Recently I came across a study that did suggest that high doses for prolonged periods actually can lead to or at least are correlated with fatty liver. I was a little surprised by that. I came upon it, of course, by way of patient care and doing a little due diligence. Anyways, that's just a little caveat Birdsall: Right. I just am looking at that study and thinking about the fact that you would need to be on that long-term. I just had some concerns about using that particular amount of time. Kaczor: Yeah, yeah. Not just the known, but the unknowns. Okay. Let's turn to vitamin D, because that whole "Do I'd get enough sun for vitamin D, am I getting so much sun that I'm increasing my risk of skin cancer," it seems to be a bit of a conundrum. On the same note and maybe in the context of this, is there a difference between sunburns and suntans and their link to skin cancer? Birdsall: Okay. I think that there's definitely good evidence to suggest that vitamin D production from sun exposure poses too much of a risk for skin cancer. That's probably not the way that we want to be getting enough vitamin D, and there is more risk with a sunburn. However, suntans, our concept of tanning as being something that adds to our attractiveness, which I think in this day and age has faded with all the concern and the risk. Tanning does pose a risk too. That is still damage to your skin. Actually, as I was reviewing the research and thinking about this interview ... I'm just going to throw this in now, even though it's a little tangential and random ... if you have patients that are worried about the anti-aging, about the appearance of their skin, really the very best thing that they could do is to avoid sun exposure, to apply sunscreen, et cetera, because even that tanning still actually represents damage. Kaczor: Okay. The vitamin D, what I hear you saying is it's best taken supplementally. Birdsall: Yes. Kaczor: Because we have access of doing labs for our patients and such, is there an ideal dose to give, or do we base it on laboratory values? What is your opinion on that? Birdsall: My opinion is that we need to base it on laboratory values, because there's so much individual variation on intake of vitamin D and the impact of that intake. One patient may consume a lot of dietary sources of vitamin D and actually be at perhaps not an optimal, optimal level, but not be deficient in vitamin D. Another patient may take some vitamin D supplements and actually get to pretty high levels of vitamin D pretty quickly. I think the only thing that we can do for our patients right now is to do lab testing. Having said that, there is a lot of controversy over what the right values are, what the right range is. Again, when I was doing research just to make sure that I was totally up to date before we talked, it looks like people are in agreement over the fact that a 25-hydroxy vitamin D level below 20 nanograms per milliliter is considered deficient and does need repletion. We have more concurrence over that value. What's still controversial is what is that optimal range? Is it between 30 and 40? Is it 50? What we do know is that vitamin D can reach toxic levels, and that that's not good either, and that there is more and more data on too high of a level of vitamin D posing risk. I think that that again argues for making sure that we're adequately testing our patients, because say they're deficient, we decide that they need repletion. It's still hard to monitor, without doing that testing, where they're at from a vitamin D level as you're doing repletion. Kaczor: Sure. Sure. Yeah, I totally agree. I think that laboratory values should be just part of a routine lab for most people, given the many ways that vitamin D adequacy protects us from so many diseases. My last question is having to do with those who know they have a family history of skin cancers, maybe even particularly melanoma, but skin cancers in general. Is it appropriate, I suppose, for certain patients with a strong family history to look at genetic predispositions and hereditary syndromes that include skin cancer? Birdsall: That's interesting, again still a little bit of a controversy. We can test for a couple of genetic mutations related to melanoma. People who have a mutation on a gene known as CDKN2A have a higher risk of developing melanoma, pancreatic cancer, or a tumor of the central nervous system. A mutation on the gene called BAP1 means a higher risk of getting melanoma, melanoma of the eye or mesothelioma, and kidney cancer. However, the challenge is that if a patient carries a mutation on one of those genes, their lifetime risk of getting melanoma ranges from 60% to 90%. However, only about 10% of the people who develop melanoma have one of these genes. What we do know is that we're still evolving our scientific knowledge of genetic mutations, and it's highly likely that there are additional genetic mutations that we just haven't found yet for melanoma. This is a really important conversation for a patient to have with their healthcare provider, or even ideally with a genetic counselor, who can counsel them on the risks and benefits of genetic testing overall. Kaczor: Yeah. Yeah. Genetic counselors are a great referral for us to have, because we don't need to figure everything out and they have it all either at their fingertips or in their minds, so they're they're great professionals to ally with. All right. Well, I think that that's a really good survey and a nice review of reminders of things we may know, and maybe some things that are definitely new to our listeners. I can't thank you enough for taking some time and sharing your expertise with us today. Thanks, Shauna. Birdsall: Thanks. Thanks for having me. Kaczor: Take care.

I continue to be horrified by guidelines issued by the American Heart Association and American College of Cardiology, which speak of giving statin drugs to healthy people. Meanwhile, draft recommendations from the US Preventive Task Force have issued new directives claiming that healthy people should be taking statin drugs as a “preventative against possible future illness.” Their main plan is to see one third of all adults in the United States are put on statin drugs—44% of all men and 22% of all women—even if none of these people have ever had a previous heart attack or stroke. Statins are the most widely prescribed drugs on the market. One in four Americans over 45 are already on statins, despite more than 900 studies reporting dangerous side effects from these drugs. These range from heightened risks of cancer and diabetes to sexual problems, neuropathy, and liver dysfunction, as well as immune system suppression, and even a higher risk of cataracts. In Britain too, statins are the most commonly prescribed drugs, costing the NMS £450 million a year. Now 40% of adults (175 million people) are being advised to take the drug. If the new directives are put into practice by the UK medical establishment—as they are likely to be—the numbers of men and women being prescribed statins could well become legion. What are statins anyway? Statins are a group of drugs prescribed to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Statins have many different names, such as Lipitor, Lescol, Mevacor, Altocor, and Zocor. These drugs are prescribed on the assumption that they will lower the risks of cardiovascular events and strokes. The new directives assert that, if given to healthy people, they could help protect the population from heart attacks and strokes at some time in the future. Happily, a growing number of cardiologists are strongly opposed to the new directives. What's the problem with statins? Plenty: • They deplete your body of CoQ10, which is essential for every cell in your body, and ubiquinol. Both CoQ10 and ubiquinol keep the so-called bad cholesterol from doing harm to your body. However, very few mainstream doctors are ever aware of these dangers. One exception is cardiologist Steven Sinatra, founder of the New England Heart Center. Sinatra recommends that anyone taking statins should take between 100 and 200 mg of CoQ10 or ubiquinol each day as protection. • Statins lower Vitamin K2 in the body. This puts you at risk of deficiency of this vitamin, which contributes to chronic diseases, such as osteoporosis, cancer, and brain disease. • Long-term statin use—10 years or so—has been shown to increase your risk of diabetes, neurogenerative diseases, musculoskeletal problems, and even cataracts.

I continue to be horrified by guidelines issued by the American Heart Association and American College of Cardiology, which speak of giving statin drugs to healthy people. Meanwhile, draft recommendations from the US Preventive Task Force have issued new directives claiming that healthy people should be taking statin drugs as a “preventative against possible future illness.” Their main plan is to see one third of all adults in the United States are put on statin drugs—44% of all men and 22% of all women—even if none of these people have ever had a previous heart attack or stroke. Statins are the most widely prescribed drugs on the market. One in four Americans over 45 are already on statins, despite more than 900 studies reporting dangerous side effects from these drugs. These range from heightened risks of cancer and diabetes to sexual problems, neuropathy, and liver dysfunction, as well as immune system suppression, and even a higher risk of cataracts. In Britain too, statins are the most commonly prescribed drugs, costing the NMS £450 million a year. Now 40% of adults (175 million people) are being advised to take the drug. If the new directives are put into practice by the UK medical establishment—as they are likely to be—the numbers of men and women being prescribed statins could well become legion. What are statins anyway? Statins are a group of drugs prescribed to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Statins have many different names, such as Lipitor, Lescol, Mevacor, Altocor, and Zocor. These drugs are prescribed on the assumption that they will lower the risks of cardiovascular events and strokes. The new directives assert that, if given to healthy people, they could help protect the population from heart attacks and strokes at some time in the future. Happily, a growing number of cardiologists are strongly opposed to the new directives. What’s the problem with statins? Plenty: They deplete your body of CoQ10, which is essential for every cell in your body, and ubiquinol. Both CoQ10 and ubiquinol keep the so-called bad cholesterol from doing harm to your body. However, very few mainstream doctors are ever aware of these dangers. One exception is cardiologist Steven Sinatra, founder of the New England Heart Center. Sinatra recommends that anyone taking statins should take between 100 and 200 mg of CoQ10 or ubiquinol each day as protection. Statins lower Vitamin K2 in the body. This puts you at risk of deficiency of this vitamin, which contributes to chronic diseases, such as osteoporosis, cancer, and brain disease. Long-term statin use—10 years or so—has been shown to increase your risk of diabetes, neurogenerative diseases, musculoskeletal problems, and even cataracts. Dr. Eric Topol, highly respected cardiologist and Professor of Genomics at Scripps Research Institute in California, wrote an excellent article for The New York Times Opinion Page in which he warns: “We’re overdosing on cholesterol-lowering statins.” Topol is especially concerned about the sharp increase in the prevalence of Type 2 Diabetes that is occurring in people using them. He writes: “Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years. When all the data available from multiple studies was pooled in 2010 for more than 91,000 patients randomly assigned to be treated with a statin or a sugar pill (placebo), the risk of developing diabetes with any statin was one in every 255 patients treated. But this figure is misleading since it includes weaker statins like Pravachol and Mevacor—which were introduced earlier and do not carry any clear-cut risk. It is only with the more potent statins—Zocor (now known as simvastatin), Lipitor (atorvastatin), and Crestor (rosuvastatin)—particularly at higher doses—that the risk of diabetes shows up. The cause and effect was unequivocal because the multiple large trials of the more potent statins had a consistent excess of diabetes.” Meanwhile, a recent study by Jean A. McDougall and her colleagues in the Journal of Cancer Epidemiology, Biomarkers & Prevention reveals that long-term use of statins increases the risk of both lobular and ductal breast cancer in women between 55 and 74. I am no doctor, but what I have learned during my more than forty years of writing and broadcasting on health is this: When a body is restored to healthy functioning naturally, the need for medication is either dramatically reduced or, more often than not, eliminated altogether. Statins, like most pharmaceuticals, only mask symptoms—they do not heal. Only nature can heal from within. My advice to anyone thinking of accepting the new directives is this: Before you agree to take statins, research the implications of doing so. Learn as much as you can about statin drugs. There are excellent natural alternatives, such as inexpensive dietary changes. So, if your doctor wants to prescribe statins for you, you can be sure you have done your homework. Then you’ll know yourself if these drugs are appropriate for you. Chances are they are not. Here are a few recommendations for where to start your research: U-T San Diego “Doctors assail new guidelines for statins: 18 November, 2013 Cancer Epidemiology, Biomarkers & Prevention; Published Online First July 5, 2013; doi: 10.1158/1055-9965.EPI-13-0414 http://www.greenmedinfo.com/toxic-ingredient/statin-drugs. This is an excellent compilation of dangers from statin drugs, with links to abstracts. www.ncbi.nlm.nih.gov/pubmed/24052188 Association of statin use with cataracts: a propensity score-matched analysis. This is a good source of information on the use of statins for the elderly. A. Sultan and N. Hynes, "The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 3, 2013, pp. 179-185. doi: 10.4236/ojemd.2013.33025.

I continue to be horrified by guidelines issued by the American Heart Association and American College of Cardiology, which speak of giving statin drugs to healthy people. Meanwhile, draft recommendations from the US Preventive Task Force have issued new directives claiming that healthy people should be taking statin drugs as a “preventative against possible future illness.” Their main plan is to see one third of all adults in the United States are put on statin drugs—44% of all men and 22% of all women—even if none of these people have ever had a previous heart attack or stroke. Statins are the most widely prescribed drugs on the market. One in four Americans over 45 are already on statins, despite more than 900 studies reporting dangerous side effects from these drugs. These range from heightened risks of cancer and diabetes to sexual problems, neuropathy, and liver dysfunction, as well as immune system suppression, and even a higher risk of cataracts. In Britain too, statins are the most commonly prescribed drugs, costing the NMS £450 million a year. Now 40% of adults (175 million people) are being advised to take the drug. If the new directives are put into practice by the UK medical establishment—as they are likely to be—the numbers of men and women being prescribed statins could well become legion. What are statins anyway? Statins are a group of drugs prescribed to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Statins have many different names, such as Lipitor, Lescol, Mevacor, Altocor, and Zocor. These drugs are prescribed on the assumption that they will lower the risks of cardiovascular events and strokes. The new directives assert that, if given to healthy people, they could help protect the population from heart attacks and strokes at some time in the future. Happily, a growing number of cardiologists are strongly opposed to the new directives. What’s the problem with statins? Plenty: They deplete your body of CoQ10, which is essential for every cell in your body, and ubiquinol. Both CoQ10 and ubiquinol keep the so-called bad cholesterol from doing harm to your body. However, very few mainstream doctors are ever aware of these dangers. One exception is cardiologist Steven Sinatra, founder of the New England Heart Center. Sinatra recommends that anyone taking statins should take between 100 and 200 mg of CoQ10 or ubiquinol each day as protection. Statins lower Vitamin K2 in the body. This puts you at risk of deficiency of this vitamin, which contributes to chronic diseases, such as osteoporosis, cancer, and brain disease. Long-term statin use—10 years or so—has been shown to increase your risk of diabetes, neurogenerative diseases, musculoskeletal problems, and even cataracts. Dr. Eric Topol, highly respected cardiologist and Professor of Genomics at Scripps Research Institute in California, wrote an excellent article for The New York Times Opinion Page in which he warns: “We’re overdosing on cholesterol-lowering statins.” Topol is especially concerned about the sharp increase in the prevalence of Type 2 Diabetes that is occurring in people using them. He writes: “Statins have been available since the 1980s but their risk of inducing diabetes did not surface for nearly 20 years. When all the data available from multiple studies was pooled in 2010 for more than 91,000 patients randomly assigned to be treated with a statin or a sugar pill (placebo), the risk of developing diabetes with any statin was one in every 255 patients treated. But this figure is misleading since it includes weaker statins like Pravachol and Mevacor—which were introduced earlier and do not carry any clear-cut risk. It is only with the more potent statins—Zocor (now known as simvastatin), Lipitor (atorvastatin), and Crestor (rosuvastatin)—particularly at higher doses—that the risk of diabetes shows up. The cause and effect was unequivocal because the multiple large trials of the more potent statins had a consistent excess of diabetes.” Meanwhile, a recent study by Jean A. McDougall and her colleagues in the Journal of Cancer Epidemiology, Biomarkers & Prevention reveals that long-term use of statins increases the risk of both lobular and ductal breast cancer in women between 55 and 74. I am no doctor, but what I have learned during my more than forty years of writing and broadcasting on health is this: When a body is restored to healthy functioning naturally, the need for medication is either dramatically reduced or, more often than not, eliminated altogether. Statins, like most pharmaceuticals, only mask symptoms—they do not heal. Only nature can heal from within. My advice to anyone thinking of accepting the new directives is this: Before you agree to take statins, research the implications of doing so. Learn as much as you can about statin drugs. There are excellent natural alternatives, such as inexpensive dietary changes. So, if your doctor wants to prescribe statins for you, you can be sure you have done your homework. Then you’ll know yourself if these drugs are appropriate for you. Chances are they are not. Here are a few recommendations for where to start your research: U-T San Diego “Doctors assail new guidelines for statins: 18 November, 2013 Cancer Epidemiology, Biomarkers & Prevention; Published Online First July 5, 2013; doi: 10.1158/1055-9965.EPI-13-0414 http://www.greenmedinfo.com/toxic-ingredient/statin-drugs. This is an excellent compilation of dangers from statin drugs, with links to abstracts. www.ncbi.nlm.nih.gov/pubmed/24052188 Association of statin use with cataracts: a propensity score-matched analysis. This is a good source of information on the use of statins for the elderly. A. Sultan and N. Hynes, "The Ugly Side of Statins. Systemic Appraisal of the Contemporary Un-Known Unknowns," Open Journal of Endocrine and Metabolic Diseases, Vol. 3 No. 3, 2013, pp. 179-185. doi: 10.4236/ojemd.2013.33025.

In the first report I review new guidelines for papsmears by the US Preventive Task Force and the American Cancer Society released earlier this week. In the second report I review a research study that looked at telling people to choose healthy foods isn't working and propose a better solution may be to let people eat whatever they want--just not to increase their calories over time.

Melissa talks with Dr. Hooks about her upcoming article, which covers the controversy surrounding the US Preventive Task Force breast cancer screening guidelines.