1. Study: Many Women with Breast cancer Can Skip Chemotherapy

    Research Report By Daniel Weber PHD, MSC, Panaxea 

    Daniel Weber cautions:

    “Professional advice is required, this is not something a patient or a practitioner untrained in oncology should decide. The article is generally correct but only specific testing will demonstrate which patients will benefit or which will need chemotherapy”.

    The New-York Times, By Denise Grady, June 3, 2018

    Many women with early-stage breast cancer who would receive chemotherapy under current standards do not actually need it, according to a major international study that is expected to quickly change medical treatment.

    “We can spare thousands and thousands of women from getting toxic treatment that really wouldn’t benefit them,” said Dr. Ingrid A. Mayer, from Vanderbilt University Medical Center, an author of the study. “This is very powerful. It really changes the standard of care.” The study found that gene tests on tumor samples were able to identify women who could safely skip chemotherapy and take only a drug that blocks the hormone estrogen or stops the body from making it. The hormone-blocking drug tamoxifen and related medicines, called endocrine therapy, have become an essential part of treatment for most women because they lower the risks of recurrence, new breast tumors and death from the disease.

    “I think this is a very significant advance,” said Dr. Larry Norton, of Memorial Sloan Kettering Cancer Center in New York. He is not an author of the study, but his hospital participated. “I’ll be able to look people in the eye and say, ‘We analyzed your tumor, you have a really good prognosis and you actually don’t need chemotherapy.’ That’s a nice thing to be able to say to somebody.”

    “The results indicate that now we can spare chemotherapy in about 70 percent of patients who would be potential candidates for it based on clinical features,” Dr. Sparano said.
    But Dr. Sparano and Dr. Mayer added a note of caution: The data indicated that some women 50 and younger might benefit from chemo even if gene-test results suggested otherwise. It is not clear why. But those women require especially careful consultation, they said. (Most cases of breast cancer occur in older women: The median age at diagnosis in the United States is 62.)

    The study, called TAILORx, is being published by The New England Journal of Medicine and was to be presented on Sunday at a meeting of the American Society of Clinical Oncology in Chicago. The study began in 2006 and was paid for by the United States and Canadian governments and philanthropic groups. Genomic Health, the company that makes the gene test, helped pay after 2016.

    This year, about 260,000 new cases of breast cancer are expected in women in the United States, and 41,000 deaths. Globally, the most recent figures are from 2012, when there were 1.7 million new cases and more than half-a-million deaths. Chemotherapy can save lives, but has serious risks that make it important to avoid treatment if it is not needed. In addition to the hair loss and nausea that patients dread, chemo can cause heart and nerve damage, leave patients vulnerable to infection and increase the risk of leukemia later in life. TAILORx is part of a wider effort to fine-tune treatments and spare patients from harsh side effects whenever possible. Endocrine therapy also has side effects, which can include hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles. Tamoxifen can increase the risk of cancer of the uterus.

    Patients affected by the new findings include women who, like most in the study, have early-stage breast tumors measuring one to five centimeters that have not spread to lymph nodes; are sensitive to estrogen; test negative for a protein called HER2; and have a score of 11 to 25 on a widely used test that gauges the activity of a panel of genes involved in cancer recurrence.

    The gene test, called Oncotype DX Breast Cancer Assay, is the focus of the study. Other gene assays exist, but this one is the most widely used in the United States. It is performed on tumor samples after surgery, to help determine whether chemo would help. The test is generally done for early-stage disease, not more advanced tumors that clearly need chemo because they have spread to lymph nodes or beyond. The test, available since 2004, gives scores from 0 to 100. It costs about $3,000, and insurance usually covers it. Previous research has shown that scores 10 and under do not call for chemotherapy, and scores over 25 do. But most women who are eligible for the test have scores from 11 to 25, which are considered intermediate.

    “This has been one of the large unanswered questions in breast cancer management in recent times, what to do with patients with intermediate scores,” Dr. Norton said. “What to do has been totally unknown.” He added, “A lot of patients in that range are getting chemo.”

    Dr. Sparano said many patients have been receiving chemo because in 2000 the National Cancer Institute recommended it for most women, even those whose disease had not spread to lymph nodes, based on studies showing it could prevent the cancer from recurring elsewhere in the body and becoming incurable. “Recurrences were being prevented, and lives prolonged,” Dr. Sparano said. “But we were probably overtreating a lot of these women. For every 100 women we were treating, we were probably preventing about 4 distant recurrences.” Dr. Mayer said, “We couldn’t figure out who we really needed to treat.” The availability of the gene test in 2004 helped researchers sort out women with very high or very low risk. “But we really didn’t know what to do with women in the middle,” Dr. Mayer said. “Some seemed to benefit and some didn’t. We were back to square zero, safe rather than sorry, giving chemo to a lot who didn’t need it.”

    Data began to emerge suggesting that women in the middle were not being helped by chemo, and many doctors began recommending it less often. But a definitive study was needed, which is how TAILORx came about. The study began in 2006 and eventually included 10,253 women ages 18 to 75. Of the 9,719 patients with complete follow-up information, 70 percent had scores of 11 to 25 on the gene test. They had surgery and radiation, and then were assigned at random to receive either endocrine therapy alone, or endocrine therapy plus chemo. The median follow-up was more than seven years.

    Over time, the two groups fared equally well. Chemo had no advantage. After nine years, 93.9 percent were still alive in the endocrine-only group, versus 93.8 percent in those who also got chemo. In the endocrine group, 83.3 percent were free of invasive disease, compared with 84.3 percent who got both treatments. There were no significant differences. But the researchers wrote that the chemotherapy benefit varied with the combination of recurrence score and age, “with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25.”

    Bari Brooks, 58, a patient of Dr. Mayer’s from White House, Tenn., learned from a mammogram that she had breast cancer in 2009 when she was 49. Dr. Mayer told her she was a candidate for chemo, and also for the study — in which she might or might not get chemo. Could she handle the risk of missing out on a treatment that might save her life? Or the risk of side effects that might be needless? “It wasn’t even a decision I had to think about,” said Ms. Brooks, who works in human relations for Vanderbilt University. “It was yes, I want to do it.” She added: “You realize how insignificant everything is. Money, it doesn’t matter how much you have. Work, what projects you have, it doesn’t matter. What have I contributed in my life and what do I want to contribute? This was a situation where I could also contribute. I was honored and grateful to be part of it.”

    She decided that if she was assigned to chemo, “I would approach it that I was being cleansed rather than poisoned.”She did land in the group that got both chemo and endocrine therapy. Did the chemo help? Maybe, maybe not. She has no regrets. And no evidence of cancer. Dr. Mayer said that Ms. Brooks’ philosophical attitude was not unusual, and that women who signed up for studies understood they were taking a leap of faith and might wind up getting the ‘wrong’ or less desirable treatment.

    “They’re grateful that they helped to advance knowledge for other women,” Dr. Mayer said. “I never underestimate how nice and how altruistic people can be. Women look out for each other.”

  2. Screen Time for Kids

    By Leslie Hendrickson-Baral,

    Neurofeedback, Dyslexia, Asperger Syndrome, ADHD Testing, Irlen Syndrome, Think Fast Coaching, Sport-Mind Coaching
    Learn more about how screen time affects your children at Mom Loves Best

  3. Calls to Reign In Antibiotic Use After Study Shows 65% Worldwide

    Research report by Daniel Weber PHD MSC of Panaxea Int, from the  The Guardian, By Ian Sample, March 26, 2018

    A dramatic rise in global antibiotic consumption has led public health experts to call for fresh strategies to rein in excessive use of the drugs, and for major investments to provide clean water, sanitation and vaccines in countries where infectious diseases are rife. The unrestrained use of antibiotics is the main driver for the rise in drug-resistant infections which now kill more than half a million people a year worldwide, including 50,000 in Europe and the US combined. Left unchecked, the spread of drug resistance could claim millions of lives a year by 2050, according to a 2014 report for David Cameron, the former prime minister.

    Despite efforts to encourage more prudent use of antibiotics, an international team of researchers found a 65% rise in worldwide consumption of the drugs from 2000 to 2015. The sharp upturn, revealed in sales figures from 76 countries, was driven almost entirely by rising use in poorer nations, the study found.

    “We saw a dramatic increase in antibiotic use globally and this is mostly from gains in low and middle income countries where economic growth means they have greater access to the drugs,” said Eili Klein, an author on the study at the Center for Disease Dynamics, Economics and Policy in Washington DC.

    “While it’s generally a positive that there’s better access to effective antibiotics in these countries, there’s the potential for serious problems down the road from overuse. We know there’s a lot of inappropriate use in high income countries, and many of these lower income countries do not have the same controls in place.”

    Last month, Public Health England reported that at least a fifth of antibiotics prescribed by GPs in England for coughs and sore throats were unnecessary. A panel of experts convened by PHE found that while only 13% of people with a sore throat should get antibiotics, 59% did when they visited their GP.

    The danger posed by drug-resistant infections is so serious that England’s chief medical officer, Dame Sally Davies, has added antimicrobial resistance to the UK’s national risk register of civil emergencies. Five years ago, she warned of an “apocalyptic scenario” where people die of common infections and simple operations because antibiotics no longer work.

    “As access to antimicrobials improves it is inevitable that overall use will increase,” Davies told the Guardian on Monday. “It is crucial that we concentrate on appropriate use of quality-assured medicines in both humans and animals. The importance of clean water, sanitation and vaccination must not be forgotten to avoid infections occurring in the first place.”

    The latest study, published in Proceedings of the National Academy of Sciences, found that on average poorer nations still use antibiotics far less intensely than richer ones. In low and middle income nations, the number of “defined daily doses” handed out per 1,000 people rose 77% from 7.6 to 13.5 over the 16 years studied. But richer nations consume antibiotics at nearly twice that rate. According to the study, consumption rates in high income countries fell on average by a modest 4%, to 25.7 doses per 1,000 people.

    Of particular concern, the report states, is the steep rise in global use of antibiotics of last resort, such as colistin, a drug that has been reintroduced despite being all but abandoned in the 1970s because of its toxicity. Colistin has been used to treat infections that cannot be shifted with other drugs, but in the past decade bacteria with colistin-resistant genes spread around the world after they emerged in a Chinese pig in the mid-2000s.

    Klein and his co-authors criticise the global response to the public health crisis as “slow and inadequate”. They call for a “radical rethinking” of policies to reduce antibiotic consumption, and advocate major investments to boost hygiene, sanitation, and vaccinations in countries where antibiotic use is rocketing. Without fresh interventions to curb overuse, the number of antibiotics handed out globally could rise more than 200% by 2030, from 42bn doses per day in 2015 to 128 billion, the researchers predict.

    “In high income countries, the most important thing that reduced mortality from infectious disease in the 20th century was infrastructure,” Klein said. “Separating waste from drinking water and chlorinating it was one of the most important things we did.”

    Beyond clean water supplies, Klein said vaccination programmes could also help to curb excessive antibiotic use, and so drug-resistant infections. While antibiotics are not effective against viruses, vaccines that protect against the flu and viruses that cause diarrhoeal disease would reduce the number of people being handed antibiotics unnecessarily. “The reality is that a lot of antibiotic overuse is for viral infections,” Klein said.

    “Our modern medical system is built on effective antibiotics,” Klein added. “If our antibiotics stop working, if bacteria become resistant to most of them, medicine will be in trouble. The worry is that people don’t do anything about it.”

    At LotusRain, we carry both both of these products.

  4. It is time to eat your green, leafy veggies!

    Posted from www.econugenics.com

    Did your mother always tell you to eat your vegetables while you were growing up? Most kids hated being told to eat green things, but guess what? Your mother was right. Eating your greens is scientifically proven to offer numerous health benefits.

    While spinach and kale are favorites of those looking to stay physically fit, a study from the University of Illinois released data that shows these green, leafy vegetables could also keep people cognitively fit. Now there’s an additional reason to eat nutrient-rich foods!

    The study, which included 60 adults aged 25 to 45, found that middle-aged participants with higher levels of lutein — a nutrient found in green leafy vegetables, and avocado and eggs — had neural responses that were more on par with younger individuals. Interestingly, their neural responses were higher when compared to their low-lutein peers, insinuating they were able to engage more of their brain power.

    Lutein is a nutrient that the body can’t make on its own, so it must be acquired through diet. Lutein accumulates in brain tissues, but also accumulates in the eye, which allows researchers to measure levels without relying on invasive techniques.

    So, come on – no more excuses! It is time to eat your green, leafy veggies; if not to appease your mother, do it for your cognitive health.

     

  5. Has Dopamine Got Us Hooked On Technology?

    Research Report by Daniel Weber PHD, MSC Nr124, March 6th 2018.

    In an unprecedented attack of candour, Sean Parker, the 38-year-old founding president of Facebook, recently admitted that the social network was founded not to unite us, but to distract us. “The thought process was: ‘How do we consume as much of your time and conscious attention as possible?’” he said at an event in Philadelphia in November. To achieve this goal, Facebook’s architects exploited a “vulnerability in human psychology”, explained Parker, who resigned from the company in 2005. Whenever someone likes or comments on a post or photograph, he said, “we… give you a little dopamine hit”. Facebook is an empire of empires, then, built upon a molecule.

    Dopamine, discovered in 1957, is one of 20 or so major neurotransmitters, a fleet of chemicals that, like bicycle couriers weaving through traffic, carry urgent messages between neurons, nerves and other cells in the body. These neurotransmitters ensure our hearts keep beating, our lungs keep breathing and, in dopamine’s case, that we know to get a glass of water when we feel thirsty, or attempt to procreate so that our genes may survive our death.

    In the 1950s, dopamine was thought to be largely associated with physical movement after a study showed that Parkinsonism (a group of neurological disorders whose symptoms include tremors, slow movement and stiffness) was caused by dopamine deficiency. In the 1980s, that assumption changed following a series of experiments on rats by Wolfram Schultz, now a professor of neuroscience at Cambridge University, which showed that, inside the midbrain, dopamine relates to the reward we receive for an action. Dopamine, it seemed, was to do with desire, ambition, addiction and sex drive.

    Schultz and his fellow researchers placed pieces of apple behind a screen and immediately saw a major dopamine response when the rat bit into the food. This dopamine process, which is common in all insects and mammals, is, Schultz tells me, at the basis of learning: it anticipates a reward to an action and, if the reward is met, enables the behaviour to become a habit, or, if there’s a discrepancy, to be adapted. (That dishwasher tablet might look like a delicious sweet, but the first fizzing bite will also be the last.) Whether dopamine produces a pleasurable sensation is unclear, says Schultz. But this has not dented its reputation as the miracle bestower of happiness.

    Dopamine inspires us to take actions to meet our needs and desires – anything from turning up the heating to satisfying a craving to spin a roulette wheel – by anticipating how we will feel after they’re met. Pinterest, the online scrapbook where users upload inspirational pictures, contains endless galleries of dopamine tattoos (the chemical symbol contains two outstretched arms of hydroxide, and a three-segmented tail), while Amazon’s virtual shelves sag under the weight of diet books intended to increase dopamine levels and improve mental health.

    “We found a signal in the brain that explains our most profound behaviours, in which every one of us is engaged constantly,” says Shultz. “I can see why the public has become interested.”

    In this way, unlike its obscure co-workers norepinephrine and asparagine, dopamine has become a celebrity molecule. The British clinical psychologist Vaughan Bell once described dopamine as “the Kim Kardashian of molecules”. In the tabloid press, dopamine has become the transmitter for hyperbole. “Are cupcakes as addictive as cocaine?” ran one headline in the Sun, citing a study that showed dopamine was released in the orbital frontal cortex – “the same section activated when cocaine addicts are shown a bag of the class A drug” – when participants were shown pictures of their favourite foods. Still, nowhere is dopamine more routinely name-dropped than in Silicon Valley, where it is hailed as the secret sauce that makes an app, game or social platform “sticky” – the investor term for “potentially profitable”.

    “Even a year or two before the scene about persuasive tech grew up, dopamine was a molecule that had a certain edge and sexiness to it in the cultural zeitgeist,” explains Ramsay Brown, the 28-year-old cofounder of Dopamine Labs, a controversial California startup that promises to significantly increase the rate at which people use any running, diet or game app. “It is the sex, drugs and rock’n’roll molecule. While there are many important and fascinating questions that sit at the base of this molecule, when you say ‘dopamine’, people’s ears prick up in a way they don’t when you say ‘encephalin’ or ‘glutamate’. It’s the known fun transmitter.”

    Fun, perhaps, but as with Kardashian, dopamine’s press is not entirely favourable. In a 2017 article titled “How evil is tech?”, the New York Timescolumnist David Brooks wrote: “Tech companies understand what causes dopamine surges in the brain and they lace their products with ‘hijacking techniques’ that lure us in and create ‘compulsion loops’.” Most social media sites create irregularly timed rewards, Brooks wrote, a technique long employed by the makers of slot machines, based on the work of the American psychologist BF Skinner, who found that the strongest way to reinforce a learned behaviour in rats is to reward it on a random schedule. “When a gambler feels favoured by luck, dopamine is released,” says Natasha Schüll, a professor at New York University and author of Addiction By Design: Machine Gambling in Las Vegas. This is the secret to Facebook’s era-defining success: we compulsively check the site because we never know when the delicious ting of social affirmation may sound.

    Randomness is at the heart of Dopamine Labs’ service, a system that can be implemented into any app designed to build habitual behaviour. In a running app, for example, this means only issuing encouragement – a high-five badge, or a shower of digital confetti – at random intervals, rather than every time the user completes a run. “When you finish a run, the app communicates with our system and asks whether it would be surprising to him if we congratulated him a little more enthusiastically,” explains Brown. Dopamine Labs’ proprietary AI uses machine learning to tailor the schedule of rewards to an individual. “It might say: actually, right now he’d see it coming, so don’t give it to him now. Or it might say: GO!”

    While the sell seems preposterously flimsy (with a slot machine, for example, at least the random reward is money, a much more compelling prize than any digital badge), Brown says that the running app company has seen significant positive results. “If you do this properly, we see an average 30% improvement in the frequency of how often a person goes for a run.” Dopamine Labs, which currently has 10 clients, has seen similar positive results with many other kinds of app. In one dieting service, which encourages people to track the food they eat, the company saw an 11% increase in food-tracking after integrating Dopamine Labs’ system. A microloan service saw a 14% improvement in how frequently people would pay back their loans on time or early. “An anti-cyberbullying app saw a 167% improvement in how often young people sent encouraging messages to one another by controlling when and how often and when we sent them an animated gif reward,” claims Brown.

    The capacity for so-called “persuasive technology” to influence behaviour in this way is only just becoming understood, but the power of the dopamine system to alter habits is already familiar to drug addicts and smokers. Every habit-forming drug, from amphetamines to cocaine, from nicotine to alcohol, affects the dopamine system by dispersing many times more dopamine than usual. The use of these drugs overruns the neural pathways connecting the reward circuit to the prefrontal cortex, which helps people to tame impulses. The more an addict uses a drug, the harder it becomes to stop.

    “These unnaturally large rewards are not filtered in the brain – they go directly into the brain and overstimulate, which can generate addiction,” explains Shultz. “When that happens, we lose our willpower. Evolution has not prepared our brains for these drugs, so they become overwhelmed and screwed up. We are abusing a useful and necessary system. We shouldn’t do it, even though we can.” Dopamine’s power to negatively affect a life can be seen vividly in the effects of some Parkinson’s drugs, which, in flooding the brain with dopamine, have been shown to turn close to 10% of patients into gambling addicts.

    Brown and his colleagues are aware that they’re playing with fire and claim to have developed a robust ethical framework for the kinds of companies and app-makers with which they will work. “We spend time with them, understand what they’re building and why,” he says. “The ethics test looks something like: should this work in this app? Should this change human behaviours? Does this app encourage human flourishing? If not, does it at least not make the human condition shittier?” To date, Brown claims that Dopamine Labs has turned down both betting companies and free-to-play video game developers, who wanted to use the company’s services to form habits in their players.

    Well-intentioned strategies often produce unintended consequences. “I don’t know whether [these apps] can generate addiction,” says Schultz, who, along with two other researchers, was awarded Denmark’s €1m Brain prize in 2017 for discovering dopamine’s effects. “But the idea behind behavioural economics, that we can change the behaviour of others not via drugs or hitting them on the head, but by putting them into particular situations, is controversial. We are telling other people what is good for them, which carries risks. Training people via systems to release dopamine for certain actions could even cause situations where people can’t then get away from the system. I’m not saying technology companies are doing bad things. They may be helping. But I would be careful.”

    For Brown, however, co-opting these systems to produce positive effects is the safest and most logical way in which to evolve the human mind, and use a natural molecule to form intentional, positive habits. “We can close the gap between aspiration and behaviour and build systems that enrich the human condition and encourage human flourishing,” he says. “Our product is a slot machine that plays you.”

    What dopamine does

    Dopamine, as one of the major neurotransmitters – the bicycle couriers of the brain – carries many different kinds of message, only some of which are known and understood.

    As well as its core function in learning, through identifying the extent to which a reward differs from expectations, dopamine is also vital for movement control, and plays a role in memory, attention, mood, cognition and sleep.

    Recent research has shown that dopamine levels are one of the key differentiators between human beings and other apes; Nenad Sestan and André Sousa of the Yale School of Medicine in New Haven, Connecticut discovered that 1.5% of the neurons in the human striatum produce dopamine, three times more than in the ape striatum.

    “We’re not yet sure of the extent to which our observations explain differences between the human, chimpanzee and other primate brains,” Sestan told New Scientist in November last year. “But we hypothesise that these cells could contribute to human-specific aspects of cognition or behaviour.”