Prostate drug doesn’t limit sexual function in most men
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Prostate Cancer and Sexual Dysfunction in Men.
Men and their physicians need not hesitate to use a drug proven effective in preventing prostate cancer out of concern that it is likely to cause sexual dysfunction, say authors of a study conducted by the Southwest Oncology Group.
The authors, who surveyed more than 17,000 men 55 and older for seven years, reported their results in the July 4 Journal of the National Cancer Institute. The study found that men given finasteride reported on average more dysfunction than did men given a placebo. That small effect diminished over the seven years.
The results allay concerns about a negative side effect associated with finasteride up till now. Physicians usually warn that sexual dysfunction is a possibility when they discuss the drug with patients. Finasteride is an FDA-approved drug for the treatment of benign prostatic hyperplasia, but it is not yet FDA-approved for the prevention or reduction in risk for prostate cancer.
The study’s large sample and long follow-up period allowed researchers to examine whether or not finasteride negatively affected sexual function and, if so, whether this effect was lasting, said Carol Moinpour, Ph.D., of the Fred Hutchison Cancer Research Center in Seattle, the study’s lead author. She coordinates quality-of-life studies for the Southwest Oncology Group, the nation’s largest National Cancer Institute-funded clinical trials network.
The study grew out of the Prostate Cancer Prevention Trial, a large double-blind National Cancer Institute-funded study which found that finasteride, a drug which curbs the proliferation of prostate gland cells, is effective at preventing prostate cancer in men age 55 and older. The 2003 results of that trial, conducted by the Southwest Oncology Group in more than 18,000 men, showed that finasteride could reduce a man’s chances of getting prostate cancer by almost 25 percent.
The authors of the newly published sexual function results wanted to assess how many men in the Prostate Cancer Prevention Trial reported experiencing sexual dysfunction, and whether the problems decreased or increased over time. In earlier studies, some men taking finasteride reported decreased libido, impotence and other signs of diminished sexual function. But these studies were short-term and didn’t try to assess the effects of age and other health factors, as well as individual variation.
The study authors used two surveys, a widely used Sexual Problems Scale and another questionnaire which they created, the Sexual Activity Scale. They also gathered other data to take into account other health factors that affect sexual function, such as age, medical conditions and smoking status. They surveyed the subjects three times in the first year and then annually for seven years.
“Was this average decrease (in sexual function) an important difference” We concluded it was not,” Moinpour said, adding that there were much larger differences due simply to individual variation among men in the trial.
The study suggests that finasteride will cause little or no sexual dysfunction for most men who decide to take it, conclude the authors.
Clinicians Clash Over New Lyme Disease Guidelines
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Lyme disease can be a confusing ailment, with symptoms differing between patients — and sometimes even within the same patient — as the infection runs its course.
That confusion now has spread to its treatment, with physicians locked in a fierce debate over how long the course of antibiotics needed to kill the infection should last.
The Infectious Disease Society of America (IDSA) came up with new guidelines in November, stating that “95 percent of cases of Lyme disease are cured with 10 to 28 days of oral antibiotics.”
The guidelines also strongly object to the use of antibiotics in patients beyond 30 days, since long-term antibiotic treatment can cause drug resistance and create other medical risks.
But a substantial number of doctors and patients are arguing against the guidelines, saying that chronic cases of the infection require antibiotic treatment for much longer than one month.
About 20,000 Americans contract Lyme disease every year, said Dr. Gary Wormser, the infection disease specialist who chaired the panel that created the new guidelines.
Lyme disease has been reported in nearly all states, but more than 98 percent of all cases are found in coastal New England and the mid-Atlantic states, as well as Wisconsin, Minnesota and northern California.
The IDSA last updated its guidelines in 2001. The new guidelines represent the latest in scientific knowledge about Lyme disease, Wormser said.
“The available scientific evidence is compelling that there is no indication to treat patients with months-on-end of antibiotic therapy,” said Wormser, who is chief of the division of infectious disease and vice chairman of the department of medicine at New York Medical College, in Valhalla, N.Y.
“Indeed, such prolonged antibiotic therapy is not only not beneficial but also places the patient at risk for serious adverse effects from the antibiotics, some of which can be life-threatening,” Wormser added.
Other doctors disagree, arguing that the guidelines could keep chronic sufferers from receiving the antibiotics that would cure them.
“We’re seeing the danger,” said Dr. Raphael Stricker, president of the International Lyme and Associated Diseases Society, the largest medical organization devoted to Lyme illnesses, and medical director of Union Square Medical Associates in San Francisco. “You’ve got literally thousands of people with chronic infection and persistent symptoms that are often disabling and can disrupt their whole life and work, and they are facing the prospect of treatment that will not cure them.”
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans by the bite of infected deer ticks, according to the U.S. Centers for Disease Control and Prevention.
One of the first signs of Lyme disease can be a rash at the site of the tick bite, beginning as a small red spot and growing larger, according to the American Academy of Family Physicians. The center of this rash, called erythema migrans, may fade, creating a “bull’s eye” or ring appearance.
Other symptoms include fever, chills, headaches, stiff neck, fatigue, muscle aches and joint pain. In some cases, Lyme disease can spread to the heart or the nervous system, causing an irregular or slow heartbeat.
If Lyme disease goes untreated, it can spread to other parts of the body, causing arthritis and nervous system problems. Trouble concentrating, loss of memory, muscle weakness, and tingling and numbness in the arms and legs can be caused by late-stage Lyme disease, although it rarely causes such nervous system problems, according to the academy.
Stricker and other opponents of the IDSA guidelines said they could lead to more people suffering chronic Lyme disease. Although there’s no rule that physicians must follow the IDSA’s ruling, insurance companies often base their coverage on these types of guidelines. State medical boards could also refer to the guidelines when investigating allegations of malpractice.
“They don’t allow for a clinician’s best judgment,” Stricker said. “Guidelines usually give you an idea of ‘you can do this, you can do that.’ These guidelines tell you that you can’t do this, you can’t do that. They are very restrictive.”
Wormser disagrees, saying the guidelines allow for re-treating an exceptional patient who doesn’t respond to the recommended course of antibiotics. “The guidelines clearly and expressly acknowledge that they do not substitute for a practitioner’s clinical judgment in the care of individual cases,” he said.
Stricker believes the federal government ultimately will have to intervene to help resolve the dispute.
“What’s going to resolve this controversy is everyone sitting down under the aegis of some government organization and coming to a meeting of the minds,” Stricker said. “If it goes as it has been going, the people who are going to suffer are going to be the patients.”
More information
To learn more about Lyme disease, visit the U.S. Centers for Disease Control and Prevention.
Two in three believe radiation from phones damaged their health
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Two-thirds of Britons believe radiation from mobile phones and their masts has affected their health, a startling official survey shows. And huge majorities are dissatisfied with government assurances about the potential threat.
The survey is the result of a giant European Union exercise that polled more than 27,000 people across the continent, 1,375 of them in Britain. It shows that concern about the radiation is far greater than even the most ardent campaigners had dared to believe, and that official attempts to downplay the issue have backfired.
It also goes some way to explain the overwhelming public response received by The Independent on Sunday since we started raising questions about the effect of the radiation on people and wildlife in April.
This month, two councils - Haringey in London and Carmarthenshire in Wales - will be considering whether to allow Wi-Fi in their schools, after concern expressed by Sir William Stewart, the chairman of the Health Protection Agency. Sir William told the BBC’s Panorama, “I believe that there is a need for a review of the Wi-Fi and other areas … I think it’s timely for it to be done now.”
The survey, by the EU’s Eurobarometer programme, which samples opinion across the continent, found 65 per cent of Britons believed mobile phones affected their health, and 71 per cent thought the masts did.
Across Europe, the figures were 73 and 76 per cent respectively, sharply up from 55 and 58 per cent five years ago.
Recent years have seen increasing evidence of risks from the phones. Scandinavian studies have suggested that people who have used them for more than 10 years are much more likely to get brain tumours, and thatthe radiation kills brain cells, which could lead to today’s young people being senile from their forties.
There is much less evidence on effects from the masts, but studies have revealed a worrying incidence of symptoms such as headaches, fatigue, nausea and memory problems. Campaigners also claim they may cause cancers.
The survey shows that more than half of Britons are “very” or “fairly” concerned about such potential health effects, despite efforts at reassurance by ministers, officials and some scientists. Moreover, it reveals great dissatisfaction with the information they are given.
Nearly three-quarters of Britons say they are “not very well” or “not at all” informed about the official “protection framework” against the “potential health risks” from the radiation.
By Geoffrey Lean
Black, White Women Differ on Dieting
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Overweight or obese white American women are more likely than their black peers to ask for dieting assistance, such as counseling from a medical professional, a doctor’s prescription, membership in a weight-loss group, or advice from a trainer, a new study finds.The study authors, who surveyed 120 women in Philadelphia, also found that body image was an important motivator for white women in seeking dieting help but not as important to black women.
The findings are published in the current issue of the journal Ethnicity & Disease.
“We found that African-American women did not differ from Caucasians in terms of concerns about body shape and weight,” but those concerns were more likely to motivate white women to seek dieting assistance, said lead author Rachel Annunziato, assistant professor in the department of psychiatry, Mount Sinai School of Medicine, New York City.
Obesity-related health concerns were not cited by either black or white women in the study as a primary motivation for losing weight.
Annunziato said cultural factors likely play an important role in influencing whether, when, and where women seek help with dieting and the type of assistance they prefer.
“Community-based approaches appear to be promising vehicles for promoting weight loss in ethnic minorities; however, there is much work to be done in terms of developing programs that improve both weight loss and successful maintenance of weight loss,” Annunziato said in a prepared statement.
Modifying weight-loss programs to better address the needs of black women and other minorities may be an important step.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases offers advice on choosing a safe and effective weight-loss program.
England Goes Smokefree In Enclosed Public Places
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On Sunday, 1st Jully, 2007, the Health Act 2006 came into force - it is now illegal to smoke in virtually every enclosed public place and workplace in England. Shops, offices, factories, pubs, cafes, restaurants, membership clubs, public transport, and work vehicles used by more than one person are all covered by the smokefree legislation.
New Health Secretary Alan Johnson said:
“I am thrilled that my first major announcement as Health Secretary enacts the single most important public health legislation for a generation. The scientific and medical evidence is clear - secondhand smoke kills. There is no safe level of exposure. This legislation means that thousands of lives will be saved and the health of everybody will be protected.
“Support for a smokefree England is strong, with almost almost 80 per cent of the public backing the legislation. The vast majority of people who do smoke say they want to give up. Over time, this legislation will result in some 600,000 fewer smokers. A smokefree England will help provide a supportive environment for those who want to quit.
“We have worked hard over the last seven months to ensure that everyone is aware of the new law, how it affects them and what they need to do. Support has been provided to businesses and individuals by the Department of Health and local councils and we are confident that England is ready.
“But we are not stopping here. Hot on the heels of the smokefree legislation, on October 1st 2007, we will be raising the legal minimum age for buying tobacco from 16 to 18 years old. Smoking is dangerous at any age, but the younger people start, the more likely they are to become life-long smokers and to die early. The law change demonstrates our determination to protect people from the harmful effects of tobacco.
“I would like to thank everyone, from health and business groups to the leisure and hospitality industry, for their involvement and support in the Smokefree England campaign and for helping to make a smokefree England a reality.”
Comprehensive information on the smokefree legislation can be found online at http://www.smokefreeengland.co.uk/
The new law will mean that virtually all enclosed public spaces and workplaces will be required to be smokefree. This means:
– it will be an offence to smoke in smokefree premises or vehicles
– it will be an offence for those who control or manage smokefree premises or vehicles to permit other to smoke in the premises or vehicle
– it will be an offence for people who occupy or manage smokefree premises or vehicles not to display the required no smoking signs at premises or within the vehicle
Smokefree England and enforcement officers from local authorties have been working closely with businesses in the lead up to the implementation. Enforcement officers will be on duty to ensure that compliance with the legislation is maintained.
The penalties and fines are set out in the Health Act 2006:
Smoking in a smokefree premises or vehicle: a fixed penalty of £50 (discounted to £30 if paid within 15 days from the issue of a notice) or a fine by a court not exceeding level 1 on the standard scale (up to £200)
Failure to display no smoking signs in smokefree premises and vehicles as required by the new law: a fixed penalty notice of £200 (discounted to £150 if paid within 15 days from the issue of a notice) or a fine by a court not exceeding level 3 on the standard scale (up to £1000)
Failing to prevent smoking in a smokefree premises or vehicle: a fine by court not exceeding level 4 on the standard scale (up to £2500).