Multivitamin link to breast cancer
(My personal experience and opinion with taking vitamins
over the entire 30 years is that they were/are better taken in smaller
quantities than the "mega" "super" lots they make today
and most of the harm if not all is created by the binders, fillers,
preservatives etc as well as the factor that many individuals
take them and expect them to do a general good without taking
in consideration their personal needs or contra-indications
such as for example taking fish oil for arthritis which is
a blood thinner when a person has problems in the blood area,
or containing benzoates that affect the lungs,
when the person has asthma or other lung difficulties etc.
One needs to be educated about what vitamins do, what additives
they are included in them, and their specific problems as well as
any changes when starting taking any -or any new ones or stopping
taking any, The body often gives signs, then it is a matter of correct
interpretation. )
Multivitamin link to breast cancer
WOMEN who take a daily multivitamin pill are nearly 20 per cent more likely to develop breast cancer, a major study has revealed.
The shock finding has rattled Australia's $2.5 billion complementary health industry, which is urging consumers not to panic.
In a 10-year study of more than 35,000 women, researchers discovered those who regularly took a multi-vitamin pill increased the risk of developing a tumour by 19 per cent.
They said the result was concerning and needed investigation as many women used multi-vitamins in the belief they prevented chronic diseases such as cancer.
A "biologically plausible" explanation was that taking vitamin and mineral supplements significantly increased the density of breast tissue, a strong risk factor for breast cancer. Folic acid, often present in a potent form in multi-vitamins, may also accelerate tumour growth.
Breast cancer is the most common cancer among females in Australia, affecting more than 12,000 and killing more than 2,700 women every year. One in nine women will be diagnosed with it by the age of 85.
The study, conducted by Sweden's Karolinska Institute and published in the American Journal of Clinical Nutrition, has been greeted with interest and caution by Australian experts.
Women who took a multivitamin pill in the study had higher breast tissue density than those who took no vitamin supplements.
"Results from this prospective study suggest that the use of multivitamins may increase the risk of breast cancer," the lead author of the study, Susanna Larrson, said.
Multi-vitamins are big business in Australia, with leading maker Blackmores posting a before-tax profit of $30.6 million last financial year. Some nutritionists and dietitians argue supplements are unnecessary, as people absorb nutrients far better from food.
Panic
Kathy Chapman, of the Cancer Council Australia, told The Sunday Telegraph the study would add to a growing body of evidence that multi-vitamins were "not all they're cracked up to be".
"It reinforces the importance of eating fresh fruit and vegetables rather than people thinking they can get more of their nutrition from a pill," she said. "What we've learned over time in cancer is that quick fixes aren't a good idea."
Taking a multi-vitamin pill was linked to a smaller increase in breast cancer risk than being overweight or drinking too much alcohol, she said.
The Complementary Healthcare Council of Australia said "consumers need not panic" at the findings. It cited "concerns over limitations to the study", such as its reliance on self-administered questionnaires and failure to look at the bioactivity of multi-vitamin ingredients.
Blackmores advised customers "not to be alarmed" by the study, which it claims is inconclusive and conflicts with other research.
Professor John Boyages, director of the Westmead Breast Cancer Institute and spokesman for the National Breast Cancer Foundation, said he "wouldn't put any weight" on the study, as there were many complicated risk factors involved in breast cancer.
Delaying pregnancy until the age of 35, drinking alcohol every day and early-onset periods may each raise the risk by as much as 30 per cent, he said.
Nutrition Australia (NA) advocates getting vitamins and minerals from a varied diet rather than supplements.
"Your body will absorb vitamins and minerals so much better from food," NA dietician Nicole Frederiksen said.
http://www.news.com.au/national/multivitamin-link-to-breast-cancer/story-e6frfkvr-1225855021929
6.4.10
Half a century of the pill
Role of Big Pharma in question after half a century of the pill
LESLIE CANNOLD
April 5, 2010
An independent study is needed of the pill's impact on women's lives.
IF YOU don't know it yet, you will soon. This year in the US, Bayer Schering Pharma is celebrating the 50th anniversary of the oral contraceptive pill. Our turn comes next. The company launched the pill in Australia in 1961.
As head of a women's reproductive rights advocacy group, I got the news early, in a letter from Bayer's business unit telling of their planned "national communication program" to inform the public of "this important milestone in women's healthcare".
It invited me to "begin a dialogue of collaboration" that involved, as far as I could tell when I rang the number supplied, my group singing from the Bayer song sheet about the company's "proud heritage" and current practice of "providing women with reliable and trusted contraceptive options".
Already the media blitz has begun, with reports of a study showing that women taking the pill have a lower risk of dying from any cause when compared with women who have never taken it. In fact, the research, partly funded by Schering - and with authors who list as competing interests the receipt of payments from Schering Plough and Wyeth Pharmaceutical - concludes only that "at least in … [a] relatively healthy … cohort, oral contraception is not significantly associated with a major public health problem".
A more critical non-profit-driven analysis of the pill's impact on women's health and lives reveals long-standing feminist scepticism about the first drug in history to be approved for long-term use by a healthy person. It was known before the first pill ever hit the market that estrogen increased the risk of cancer, but the first pill contained massive amounts of it - seven times as much as is used today.
In 1969, investigative journalist Barbara Seaman blew the whistle with The Doctor's Case against the Pill. The book prompted a US Senate investigation that saw the pill become the first prescription drug to be accompanied by package insert warnings. Seaman was blacklisted for her trouble.
Magazines, under pressure from the pharmaceutical industry threatening to withdraw advertising dollars, refused to run her stories.
The pill provides no protection against sexually transmitted infections, as some of those who came of age in the era of HIV/AIDS learned at their peril.
Second and third-generation pills may put users at increased risk of deep vein thrombosis (especially if they are overweight), heart trouble (if they smoke), breast cancer (in the short term) and cervical cancer (in the longer term), although for some cancers, the drug seems protective.
The pill is contraindicated for women with a history of migraines, jaundice or liver problems and safety scares are not a thing of the past. In the mid-1990s, women in some parts of Europe were told that "third generation" pills posed a greater risk of potentially fatal blood clots than their just-as-effective predecessors.
The accumulation of such data led Public Citizen, a US consumer advocacy group, to petition the US Food and Drug Administration in 2007 to remove the pills from sale.
Despite all this, Seaman said shortly before her death in 2008 that if her daughters had wanted to go on the pill, she might have cried, but if her granddaughters should choose to, she could "live with that". Not that she believed no questions remained, including those about possible interactions between the pill and antidepressants, the most common drug prescribed to Australian women.
Indeed, what becomes clear from looking at what data exists, is the corruptive effect of pharmaceutical money on the knowledge necessary to give women the information they need to make informed medical choices. Drug company-sponsored research tends to focus on potential new indications for old pharmaceuticals, or the relative benefits of a company's new drug, compared with older offerings. Little research is available that compares drugs with non-pharmaceutical responses to women's healthcare needs.
The sexual revolution underwritten by the pill was, on balance, a boon for women, though it too came with downsides. The enthusiastic promotion of the pill by population control agencies, the medical establishment and the pharmaceutical industry - a tripartite cheer squad that continues to this day - led quickly to a view that all women were or should be "on it".
This has largely absented men from fiscal and social responsibility for contraception and the consequences of unplanned pregnancies (bye-bye shotgun marriages), despite the persistence of unlawful abortion
and the stigma of single motherhood.
Drug companies aren't feminist organisations, nor deliberate drivers of radical social innovation designed to benefit women. They are businesses, seeking profits for shareholders through the creation and marketing of pills that, ideally, we can be persuaded to ingest every day for much of our lives.
The anniversary of the contraceptive pill is indeed a time for reflection on the role of Big Pharma in our health and lives. Just remember what the aptly named band Public Enemy says: Don't Believe the Hype.
Dr Leslie Cannold is a feminist, a medical ethicist and an author.
Source: The Age
http://www.smh.com.au/opinion/society-and-culture/role-of-big-pharma-in-question-after-half-a-century-of-the-pill-20100404-rlk2.html
LESLIE CANNOLD
April 5, 2010
An independent study is needed of the pill's impact on women's lives.
IF YOU don't know it yet, you will soon. This year in the US, Bayer Schering Pharma is celebrating the 50th anniversary of the oral contraceptive pill. Our turn comes next. The company launched the pill in Australia in 1961.
As head of a women's reproductive rights advocacy group, I got the news early, in a letter from Bayer's business unit telling of their planned "national communication program" to inform the public of "this important milestone in women's healthcare".
It invited me to "begin a dialogue of collaboration" that involved, as far as I could tell when I rang the number supplied, my group singing from the Bayer song sheet about the company's "proud heritage" and current practice of "providing women with reliable and trusted contraceptive options".
Already the media blitz has begun, with reports of a study showing that women taking the pill have a lower risk of dying from any cause when compared with women who have never taken it. In fact, the research, partly funded by Schering - and with authors who list as competing interests the receipt of payments from Schering Plough and Wyeth Pharmaceutical - concludes only that "at least in … [a] relatively healthy … cohort, oral contraception is not significantly associated with a major public health problem".
A more critical non-profit-driven analysis of the pill's impact on women's health and lives reveals long-standing feminist scepticism about the first drug in history to be approved for long-term use by a healthy person. It was known before the first pill ever hit the market that estrogen increased the risk of cancer, but the first pill contained massive amounts of it - seven times as much as is used today.
In 1969, investigative journalist Barbara Seaman blew the whistle with The Doctor's Case against the Pill. The book prompted a US Senate investigation that saw the pill become the first prescription drug to be accompanied by package insert warnings. Seaman was blacklisted for her trouble.
Magazines, under pressure from the pharmaceutical industry threatening to withdraw advertising dollars, refused to run her stories.
The pill provides no protection against sexually transmitted infections, as some of those who came of age in the era of HIV/AIDS learned at their peril.
Second and third-generation pills may put users at increased risk of deep vein thrombosis (especially if they are overweight), heart trouble (if they smoke), breast cancer (in the short term) and cervical cancer (in the longer term), although for some cancers, the drug seems protective.
The pill is contraindicated for women with a history of migraines, jaundice or liver problems and safety scares are not a thing of the past. In the mid-1990s, women in some parts of Europe were told that "third generation" pills posed a greater risk of potentially fatal blood clots than their just-as-effective predecessors.
The accumulation of such data led Public Citizen, a US consumer advocacy group, to petition the US Food and Drug Administration in 2007 to remove the pills from sale.
Despite all this, Seaman said shortly before her death in 2008 that if her daughters had wanted to go on the pill, she might have cried, but if her granddaughters should choose to, she could "live with that". Not that she believed no questions remained, including those about possible interactions between the pill and antidepressants, the most common drug prescribed to Australian women.
Indeed, what becomes clear from looking at what data exists, is the corruptive effect of pharmaceutical money on the knowledge necessary to give women the information they need to make informed medical choices. Drug company-sponsored research tends to focus on potential new indications for old pharmaceuticals, or the relative benefits of a company's new drug, compared with older offerings. Little research is available that compares drugs with non-pharmaceutical responses to women's healthcare needs.
The sexual revolution underwritten by the pill was, on balance, a boon for women, though it too came with downsides. The enthusiastic promotion of the pill by population control agencies, the medical establishment and the pharmaceutical industry - a tripartite cheer squad that continues to this day - led quickly to a view that all women were or should be "on it".
This has largely absented men from fiscal and social responsibility for contraception and the consequences of unplanned pregnancies (bye-bye shotgun marriages), despite the persistence of unlawful abortion
and the stigma of single motherhood.
Drug companies aren't feminist organisations, nor deliberate drivers of radical social innovation designed to benefit women. They are businesses, seeking profits for shareholders through the creation and marketing of pills that, ideally, we can be persuaded to ingest every day for much of our lives.
The anniversary of the contraceptive pill is indeed a time for reflection on the role of Big Pharma in our health and lives. Just remember what the aptly named band Public Enemy says: Don't Believe the Hype.
Dr Leslie Cannold is a feminist, a medical ethicist and an author.
Source: The Age
http://www.smh.com.au/opinion/society-and-culture/role-of-big-pharma-in-question-after-half-a-century-of-the-pill-20100404-rlk2.html
25.3.10
Australian scientists in TB drug breakthrough
Australian scientists in TB drug breakthrough
March 24, 2010 - 6:59PM
Australian scientists said Wednesday they had discovered a drug which could cure tuberculosis at its non-infectious stage and could be the first major breakthrough on the disease in 50 years.
Bacteriologist Nick West said researchers at Sydney's Centenary Institute had developed a drug which could essentially combat the disease before it takes hold, potentially saving millions of lives around the world.
"We have investigated a protein that is essential for TB to survive and we have had some success in developing a drug that will inhibit this protein," said West.
"Our goal over the coming months is to find out the full extent of this drug's potential."
West said it would be the first time in history that dormant or asymptomatic, non-infectious TB would be able to be treated, potentially stemming a deadly tide of infection which claimed two million lives every year.
"Unfortunately, the antibiotics we use to fight TB aren't effective against latent TB and can only be used when the disease becomes active," he explained.
"This is a major problem as one out of 10 people who have latent TB will develop the active disease, becoming sick and contagious."
"If we can figure out a way to treat TB when it's in a latent stage, then we could save millions of lives throughout the world," West added.
If successful the drug would be the the first new treatment for TB since 1962, according to the institute which is affiliated with the University of Sydney.
One third of the world's population, or two billion people, are estimated to be infected with TB, with the disease growing fastest in South East Asia.
Lethal multidrug-resistant strains of the disease were becoming a serious threat to global health, infecting almost half a million people in 2008, of whom one-third died, the World Health Organisation warned last week.
Almost half the drug resistant cases were estimated to have occurred in India and China, the WHO said, with an extensively drug-resistant form, found in 58 countries, "virtually untreatable".
© 2010 AFP
This story is sourced direct from an overseas news agency as an additional service to readers. Spelling follows North American usage, along with foreign currency and measurement units.
http://news.theage.com.au/breaking-news-world/australian-scientists-in-tb-drug-breakthrough-20100324-qwjt.html
March 24, 2010 - 6:59PM
Australian scientists said Wednesday they had discovered a drug which could cure tuberculosis at its non-infectious stage and could be the first major breakthrough on the disease in 50 years.
Bacteriologist Nick West said researchers at Sydney's Centenary Institute had developed a drug which could essentially combat the disease before it takes hold, potentially saving millions of lives around the world.
"We have investigated a protein that is essential for TB to survive and we have had some success in developing a drug that will inhibit this protein," said West.
"Our goal over the coming months is to find out the full extent of this drug's potential."
West said it would be the first time in history that dormant or asymptomatic, non-infectious TB would be able to be treated, potentially stemming a deadly tide of infection which claimed two million lives every year.
"Unfortunately, the antibiotics we use to fight TB aren't effective against latent TB and can only be used when the disease becomes active," he explained.
"This is a major problem as one out of 10 people who have latent TB will develop the active disease, becoming sick and contagious."
"If we can figure out a way to treat TB when it's in a latent stage, then we could save millions of lives throughout the world," West added.
If successful the drug would be the the first new treatment for TB since 1962, according to the institute which is affiliated with the University of Sydney.
One third of the world's population, or two billion people, are estimated to be infected with TB, with the disease growing fastest in South East Asia.
Lethal multidrug-resistant strains of the disease were becoming a serious threat to global health, infecting almost half a million people in 2008, of whom one-third died, the World Health Organisation warned last week.
Almost half the drug resistant cases were estimated to have occurred in India and China, the WHO said, with an extensively drug-resistant form, found in 58 countries, "virtually untreatable".
© 2010 AFP
This story is sourced direct from an overseas news agency as an additional service to readers. Spelling follows North American usage, along with foreign currency and measurement units.
http://news.theage.com.au/breaking-news-world/australian-scientists-in-tb-drug-breakthrough-20100324-qwjt.html
17.3.10
Why doctor does not always know best
Why doctor does not always know best
MICHAEL HOCHMAN
March 17, 2010
Health research priorities should not be determined by corporate agendas, write Michael Hochman and Danny McCormick.
Some doctors treat patients with early-stage prostate cancer with radiation. Others favour surgery, while some advocate only close monitoring. Which approach is most successful? No one knows.
When it comes to diabetes management, doctors do not have answers to key questions: At what point should insulin be started? Is it safe to lower the blood sugar to normal levels? What is the best way to monitor blood sugar control?
Similarly, endocrinologists do not know what is the best way to treat patients with hyperactive thyroids. Doctors in Europe typically use medications, while those in the US more frequently give radioactive iodine. Only limited evidence is available to guide the decision.
It may seem perplexing that there is so much uncertainty about these relatively simple questions. All of the above treatments have been around for decades. Shouldn't we have definitive answers by now?
In The Journal of the American Medical Association last week we reported the results of a study that may help explain why we don't. In the study, we analysed 328 medication studies recently published in six top medical journals and found that just 32 per cent were aimed at determining which available treatment is best. The rest were either aimed at bringing a new therapy to market or simply compared a medication with a placebo. Whether the therapy was better or worse than other treatments was simply not addressed.
Research involving new therapies is, of course, crucial for medical progress, but there is also a need for research that compares the effectiveness of the rapidly growing array of existing therapies and approaches.
So why, then, did only a third of medication studies focus on helping doctors use existing therapies more effectively? The answer lies in the fact that pharmaceutical companies fund nearly half of all medication research, including the lion's share of large clinical trials. For obvious reasons, commercially funded research is primarily geared towards the development of new and marketable medications and technologies. Once these products have won approval for clinical use, companies no longer have incentives to study exactly how and when they should be used.
In support of this claim, we found that 87 per cent of the comparative effectiveness studies we analysed were funded entirely or in part by non-commercial sources, such as non-profit foundations or government institutions. In addition, 91 per cent of studies comparing medications with non-pharmacologic therapies (such as surgery or lifestyle changes) received non-commercial funding, as did 94 per cent of studies comparing different medication strategies (such as different blood sugar targets in patients with diabetes) and 90 per cent of studies comparing the safety profiles of medications. Non-commercial sources funded 100 per cent of studies comparing the cost-effectiveness of different treatments, though only 2 per cent of the studies we reviewed included such analysis.
We believe studies that address fundamental clinical decisions - such as when to use medications versus surgery or how to use therapies more effectively - should be favoured over those that simply compare two alternative medications. There is also clearly a need for more research on the comparative safety and costs of different treatments. Reform is also necessary to ensure that commercially funded research is designed in a way that is more helpful to doctors.
Our study showed that two-thirds of commercially funded randomised trials compared medications with a placebo rather than with another active therapy. Though placebos are appropriate when no alternative therapies are available, in many of the trials we examined, we suspect alternative therapies could have been used instead.
As medical science advances, decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing treatments and healthcare services to their best use. Doing so would ensure that research priorities are determined by patient needs rather than by corporate agendas.
Los Angeles Times
Michael Hochman is an assistant professor of clinical medicine at the University of Southern California. Danny McCormick is an assistant professor of medicine at Harvard Medical School.
http://www.smh.com.au/opinion/politics/why-doctor-does-not-always-know-best-20100316-qchi.html
MICHAEL HOCHMAN
March 17, 2010
Health research priorities should not be determined by corporate agendas, write Michael Hochman and Danny McCormick.
Some doctors treat patients with early-stage prostate cancer with radiation. Others favour surgery, while some advocate only close monitoring. Which approach is most successful? No one knows.
When it comes to diabetes management, doctors do not have answers to key questions: At what point should insulin be started? Is it safe to lower the blood sugar to normal levels? What is the best way to monitor blood sugar control?
Similarly, endocrinologists do not know what is the best way to treat patients with hyperactive thyroids. Doctors in Europe typically use medications, while those in the US more frequently give radioactive iodine. Only limited evidence is available to guide the decision.
It may seem perplexing that there is so much uncertainty about these relatively simple questions. All of the above treatments have been around for decades. Shouldn't we have definitive answers by now?
In The Journal of the American Medical Association last week we reported the results of a study that may help explain why we don't. In the study, we analysed 328 medication studies recently published in six top medical journals and found that just 32 per cent were aimed at determining which available treatment is best. The rest were either aimed at bringing a new therapy to market or simply compared a medication with a placebo. Whether the therapy was better or worse than other treatments was simply not addressed.
Research involving new therapies is, of course, crucial for medical progress, but there is also a need for research that compares the effectiveness of the rapidly growing array of existing therapies and approaches.
So why, then, did only a third of medication studies focus on helping doctors use existing therapies more effectively? The answer lies in the fact that pharmaceutical companies fund nearly half of all medication research, including the lion's share of large clinical trials. For obvious reasons, commercially funded research is primarily geared towards the development of new and marketable medications and technologies. Once these products have won approval for clinical use, companies no longer have incentives to study exactly how and when they should be used.
In support of this claim, we found that 87 per cent of the comparative effectiveness studies we analysed were funded entirely or in part by non-commercial sources, such as non-profit foundations or government institutions. In addition, 91 per cent of studies comparing medications with non-pharmacologic therapies (such as surgery or lifestyle changes) received non-commercial funding, as did 94 per cent of studies comparing different medication strategies (such as different blood sugar targets in patients with diabetes) and 90 per cent of studies comparing the safety profiles of medications. Non-commercial sources funded 100 per cent of studies comparing the cost-effectiveness of different treatments, though only 2 per cent of the studies we reviewed included such analysis.
We believe studies that address fundamental clinical decisions - such as when to use medications versus surgery or how to use therapies more effectively - should be favoured over those that simply compare two alternative medications. There is also clearly a need for more research on the comparative safety and costs of different treatments. Reform is also necessary to ensure that commercially funded research is designed in a way that is more helpful to doctors.
Our study showed that two-thirds of commercially funded randomised trials compared medications with a placebo rather than with another active therapy. Though placebos are appropriate when no alternative therapies are available, in many of the trials we examined, we suspect alternative therapies could have been used instead.
As medical science advances, decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing treatments and healthcare services to their best use. Doing so would ensure that research priorities are determined by patient needs rather than by corporate agendas.
Los Angeles Times
Michael Hochman is an assistant professor of clinical medicine at the University of Southern California. Danny McCormick is an assistant professor of medicine at Harvard Medical School.
http://www.smh.com.au/opinion/politics/why-doctor-does-not-always-know-best-20100316-qchi.html
Overuse of scans causes cancers
Overuse of scans causes cancers
MARK METHERELL
March 15, 2010
THE unjustified use of potentially cancer-causing CT scans has alarmed the Medicare watchdog and prompted calls from senior radiologists for doctors to stop the indiscriminate ordering of scans.
More than 400 new cases of cancer a year in Australia are attributable to diagnostic radiology, medical research has found. Despite this, the number of computerised tomography scans, which generate far more radiation than X-rays, is growing about 12 per cent a year.
The prevalence of CT scans has led the director of the Professional Services Review, Tony Webber, to take the unusual step of publishing an expert's call for doctors to reverse the trend towards use of CTs as a first-choice diagnostic tool for such conditions as lower-back pain.
''I have been alarmed at the number of these scans ordered without clinical justification,'' Dr Webber says in his Report to the Professions issued today.
The warning comes as a study shows that more than 50 per cent of senior medical students in Perth underestimated radiation doses from commonly used radiological procedures.
In the US, exposure to medical radiation is estimated to have increased by more than six times in 30 years but research has shown up to 40 per cent of CT scans could be avoided without compromising patient care.
Dr Webber, whose agency investigates doctors suspected of abusing Medicare payments, told the Herald he was surprised at how often he came across inappropriate CT referrals by doctors under investigation for other reasons.
In his report he cites several cases of doctors referring patients for CT scans without clinical justification, including one who ''regularly ordered CT scans on any patient presenting with back pain''.
The Report to the Professions includes an appeal from a leading radiologist, Richard Mendelson, who said most authorities on radiation accepted there was no dose of ionising radiation deemed to be without risk.
But Professor Mendelson, who heads radiology at Royal Perth Hospital, said that in the past 20 years there had been a marked increase in the population's exposure to medical ionising radiation, largely due to the increased use of CT.
''Although the risk of a CT scan is relatively small, a CT of the abdomen and pelvis may expose the patient to a dose of up to about 20 millisieverts and thus an increased risk of inducing a fatal cancer of one in 1000.''
Professor Mendelson said the risks of CT scans in young or middle-aged patients with lower- back pain or, for example Crohn's disease, were significant, especially where recurrent imaging was likely to be required since the risks were cumulative.
He said likely reasons for inappropriate referral for CT scans included some doctors' lack of knowledge about the role of imaging, lack of time to perform clinical assessment and the substitution of imaging, patient pressure for a scan and fear of litigation for a ''missed'' diagnosis.
Improved education of medical students about radiology is ''absolutely essential'', a director of research in diagnostic imaging at Melbourne's Southern Health Service, Stacy Goergen, says.
Associate Professor Goergen says there is a strong argument that many deaths have been delayed or prevented by use of diagnostic imaging.
But in an editorial in the Journal of Medical Imaging and Radiation Oncology, she says ''inappropriate use of imaging is commonplace and provides little or no benefit to the patient but exposes him or her to risk''.
''Paradoxically, as imaging has become more complex, the amount of time spent teaching it to non-radiologists has diminished in many tertiary institutions,'' Professor Goergen says.
http://www.smh.com.au/national/overuse-of-scans-causes-cancers-20100314-q675.html
MARK METHERELL
March 15, 2010
THE unjustified use of potentially cancer-causing CT scans has alarmed the Medicare watchdog and prompted calls from senior radiologists for doctors to stop the indiscriminate ordering of scans.
More than 400 new cases of cancer a year in Australia are attributable to diagnostic radiology, medical research has found. Despite this, the number of computerised tomography scans, which generate far more radiation than X-rays, is growing about 12 per cent a year.
The prevalence of CT scans has led the director of the Professional Services Review, Tony Webber, to take the unusual step of publishing an expert's call for doctors to reverse the trend towards use of CTs as a first-choice diagnostic tool for such conditions as lower-back pain.
''I have been alarmed at the number of these scans ordered without clinical justification,'' Dr Webber says in his Report to the Professions issued today.
The warning comes as a study shows that more than 50 per cent of senior medical students in Perth underestimated radiation doses from commonly used radiological procedures.
In the US, exposure to medical radiation is estimated to have increased by more than six times in 30 years but research has shown up to 40 per cent of CT scans could be avoided without compromising patient care.
Dr Webber, whose agency investigates doctors suspected of abusing Medicare payments, told the Herald he was surprised at how often he came across inappropriate CT referrals by doctors under investigation for other reasons.
In his report he cites several cases of doctors referring patients for CT scans without clinical justification, including one who ''regularly ordered CT scans on any patient presenting with back pain''.
The Report to the Professions includes an appeal from a leading radiologist, Richard Mendelson, who said most authorities on radiation accepted there was no dose of ionising radiation deemed to be without risk.
But Professor Mendelson, who heads radiology at Royal Perth Hospital, said that in the past 20 years there had been a marked increase in the population's exposure to medical ionising radiation, largely due to the increased use of CT.
''Although the risk of a CT scan is relatively small, a CT of the abdomen and pelvis may expose the patient to a dose of up to about 20 millisieverts and thus an increased risk of inducing a fatal cancer of one in 1000.''
Professor Mendelson said the risks of CT scans in young or middle-aged patients with lower- back pain or, for example Crohn's disease, were significant, especially where recurrent imaging was likely to be required since the risks were cumulative.
He said likely reasons for inappropriate referral for CT scans included some doctors' lack of knowledge about the role of imaging, lack of time to perform clinical assessment and the substitution of imaging, patient pressure for a scan and fear of litigation for a ''missed'' diagnosis.
Improved education of medical students about radiology is ''absolutely essential'', a director of research in diagnostic imaging at Melbourne's Southern Health Service, Stacy Goergen, says.
Associate Professor Goergen says there is a strong argument that many deaths have been delayed or prevented by use of diagnostic imaging.
But in an editorial in the Journal of Medical Imaging and Radiation Oncology, she says ''inappropriate use of imaging is commonplace and provides little or no benefit to the patient but exposes him or her to risk''.
''Paradoxically, as imaging has become more complex, the amount of time spent teaching it to non-radiologists has diminished in many tertiary institutions,'' Professor Goergen says.
http://www.smh.com.au/national/overuse-of-scans-causes-cancers-20100314-q675.html
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