Friday, February 18, 2011

7-Minute Abs: The Science and Sense Behind Our "8 Ways to Stay Healthy and Prevent Cancer"

There is a great scene in the movie There's Something About Mary where the crazy hitchhiker is talking to Ted about his genius new idea - 7-Minute Abs.

"Think about it. You walk into a video store, you see 8-Minute Abs sittin' there, there's 7-Minute Abs right beside it. Which one are you gonna pick, man? "

I often think about this when talking to people about our 8 Ways to Stay Healthy and Prevent Cancer.  I often hear: "Why not 9 ways to prevent cancer?" "Why not 10 ways?"  Wouldn't that be even better?!? The 8 ways can sound so "simple" or "obvious" or "common sense" that it is easy to forget that there is an incredible depth of quality research behind them.

Yes, there are more than 8 things you can do to prevent cancer. But, the 8 ways were selected based on a scientific review of over 30 years of cancer prevention research to identify the biggest contributors to cancer risk and the ones with a strong body of convincing science behind them.

I recently saw an advertisement on a professional networking group I belong to for a seminar on cancer prevention. I was excited - how great that this group is bringing in an expert to talk about health and wellness - something we tend to forget to prioritize in the hustle and bustle of work, family and life. Imagine my disappointment upon clicking over and seeing that the seminar leader had no expertise in this area - no formal education, no experience conducting or reviewing research. This so-called "expert" merely had a laundry list a mile long of factors that prevent cancer - in her opinion. Many of those things have very little (or no) good science behind them. In fact, she listed things that have been shown to be not true.

Here's where I think the harm in this kind of post comes - we are all busy and most of us don't have time to do everything right every day. So we make choices about what to prioritize. If we mislead people about what can and what cannot prevent cancer, we send them down a path of prioritizing something with little or no impact instead of encouraging them to focus on the things where they are most likely to get a return on their investment (be it time or money or both).

That is what our 8 ways are about - identifying the factors that are going to reduce risk of several cancers, where there is a lot of quality science. The other important difference between the 8 ways and the "health tip" laundry lists you might see, is that our 8 ways are based on our evidence-based validated risk assessment tool Your Disease Risk. Again, we're using science to build science.

So while the 8 ways might seem like "simple health tips" they are really evidence-based medicine for prevention.

On the Internet, it's reader beware.  So it pays to take some time to learn how to assess what you're actually reading.  Surely, there are reputable organizations that have slightly different takes on the science than we do, but knowing who these groups are and what their background is helps determine what credence to give them.

For some tips on finding good health information online, see this piece we put together with the Komen Foundation: Using the Internet to Find Health Information.

New Maps, Same Problem: Inactivity

It's no real surprise.  Not only are most of us not getting enough exercise to meet health guidelines, a large chunk of us aren't getting any physical activity at all.  New data from the Centers for Disease Control and Prevention (CDC) show that 25 percent of adults spend none of their free time exercising or doing any other type of physical activity.

This rate, though, can vary greatly from region to region, and even county by county.  The latest report shows that some counties had inactivity rates as low as 10 percent, while others had rates as high as four times that.

As the map below shows (Figure 1), states with the highest rates of inactivity were largely in the south, while states on the west and east coasts had generally lower rates.  Not likely by coincidence, this clustering of inactivity tracks very closely with poverty rates (Figure 2) and highlights the multi-layered issues that come into play when it comes to health and disease.

Figure 1 - Physical Inactivity
Figure 2 - Poverty
Poverty, education, income, health care access, and quality of infrastructure (like sidewalks and bike paths) all play an important role in the healthy choices we make.  Yes, it all comes down to a personal choice - choosing to get out the door for a walk or sit on the couch and watch TV - but the healthy choice is always easier to make when the people, places, and policies that surround us support that choice.

Thursday, February 17, 2011

Lifestyle changes to prevent premature mortality will trump screening for cancer

This month in the Journal of Clinical Oncology a report from the Prostate, Lung, Colorectal, and Ovarian Cancer screening trial (PLCO) highlights priorities for cancer prevention 1. In a detailed analysis that addresses the potential for PSA screening to reduce mortality from prostate cancer in this randomized trial, the authors report that more than 9,500 men who were participating in the PLCO prevention trial died during 10 years of follow-up. Only 164 of these 9565 men died from prostate cancer (1.7% of deaths). The men were ages 55 to 74 at enrolment into the study and came from 10 study centers across the United States. Given so few deaths were due to prostate cancer among these men who were otherwise healthy at entry to the study, it is clear that other chronic diseases far outweighed or dominated prostate cancer as a cause of premature death among men (defined as death before age 85, the approximate mid point age for all deaths in the US with half occurring in those younger than 85 and half in those older than 85).

Why do we focus so “religiously” on seeking new causes of specific cancers, early detection methods, and strategies to reduce mortality from such relatively rare causes of premature mortality, when at the same time the population becomes more obese, and men are dying from many preventable causes other than prostate cancer?

As Mokdad 2 notes the leading preventable causes of death in the United States in 2000 were tobacco (18.1% of total US deaths), poor diet and physical inactivity (15.2%), and alcohol consumption (3.5%). These common causes of death can be changed – as we have noted previously.  Risk is reduced after cessation from smoking and after weight loss or increase in physical activity. Unnecessary premature deaths can be avoided. See the Your Disease Risk site for personalized tips to lower your risk of disease.

Related CNiC posts
How are those New Years' Resolutions?
Untapped Benefits of Physical Activity and Weight Loss in Breast Cancer Prevention
Tobacco Control Works - Now Implement It
Study of 1.4 Million Shows Early Deaths Linked to Overweight & Obesity - What Now?

 Literature cited

Monday, February 14, 2011

Practicing Prevention: Cooking with a Toddler

A few weeks back, we took our toddler to see Sesame Street Live - a groan-inducing rite of passage for many parents of toddlers. This year's subtitle was "Elmo's Healthy Heroes," and the show followed Grover in his efforts to locate his "superness," which he regained through 4 healthy habits: eating right (in this case, eating fruits and vegetables), exercising, taking a bath and sleeping. A good message. The irony came in that said event was at one of those big sports arena, which offered a kids meal for the event. Said kids meal contained: a hot dog, chips, a cookie, a crispy marshmallow rice bar and a juice. Now granted, there was a "healthy" kids meal option. It contained some sad (truly) looking celery sticks, a few slices of orange, an orange juice and one of those prepackaged peanut butter and jelly sandwiches that are crimped together with the crusts cut off. This was my first encounter with this particular food-like item and one I hope to not repeat (the peanut butter was of an unnatural consistency and there was about 5 times as much jelly as I think is reasonable for a sandwich all together on a really dry "bread"). My PB&J loving toddler ate about half and lost interest.

This got me thinking about the need for our behaviors to reinforce our words when it comes to raising kids who will make healthy choices and like healthy food. A number of food writers and bloggers (not to mention researchers, advocates and NGOs) have discussed that kids who participate in food growing and preparing are more interested in eating the food, even when it contains things previously considered "yucky". (For some resources on this, see this PDF from our colleagues at Planet Health & the Harvard School of Public Health)

With that in mind (and it being winter so we aren't growing anything), I wanted to make more of an effort to include my toddler in food preparations. I figured that the best way to start was to involve her in cooking something she DOES like. And my kid LOVES cake, which is, according to Cookie Monster post-2006, a “sometime snack.” That said, me being me, I wanted to find a cake that was healthier than the average standby. I found Martha Rose Shulman’s flourless carrot cake, which featured a few things I liked: it didn’t make a gigantic cake that would have us eating this “sometime snack” for days; it didn’t have a ton of sugar; it didn’t have any oil (other than what you use to grease the pan); it didn’t have white flour, relying on grounds almonds instead and instead; and it wasn’t covered in a sickly-sweet frosting. The last one being a significant “con” in my daughters eyes.

Sunday morning, we set up shop in the kitchen. It turns out the bags of whole almonds at the grocery store have 1 ¼ cups and the recipe calls for 1 ½ cups, so we tossed some sliced almonds we also had in the food processor. The recipe calls for turbinado (raw) sugar. We have white sugar and some demerara sugar so we mixed the two and hoped for the best.

Warning: pulverizing nuts in the food processor may scare the heck out of a small child.

but it looks tasty

(next time, I'd grind it a bit more, but we needed to cease the loud noise making!)

Toss in the flavor adding goodies

Shulman then has you grate carrots on the smallest holes of your grater. If I'm going to go through the trouble of getting the food processor out and washing all those parts, you better believe the carrots are getting grated in the food processor. So I dumped the almond meal mixture into a bowl, swapped in the grating attachment and we went to work. (My daughter didn't mind this noise - it wasn't quite as loud.)

Thankfully, we grated a lot of carrots as my daughter was quite interested in sampling at this stage and I was happy to oblige.

I tried to involve my daughter in as many of the steps as I could including measuring, pouring, grinding and mixing. Here she is adding the carrots to the beaten egg/sugar mixture (remember, this is healthiER food...)

When it comes out of the oven, it doesn't look super pretty

A quick shake of confectioners sugar solves this, but takes you one teensy step away from the healthy part of healthier. I like my desserts a bit pretty so I did it.

As you might expect with a toddler adventure, this one involved some clean-up, but we had so much fun it was well worth it.

The end result was fantastic. My whole family, including the most important voter, my daughter, LOVED it. I brought leftovers into the office, and it got good reviews there, too. This isn't the carrot cake you find in the dessert case at your local diner or coffee shop, but it is a tasty "sometimes treat" you can make with your kid.

Biomedical research to advance human heath

Recent articles call for speeding the translation from discovery and documentation of the human genome and application to clinical medicine and public health. In addition in the New England Journal of Medicine, Moses and Martin 1 identify gaps and opportunities for biomedical research. They note the need for greater collaboration and new models of collaboration in academic medicine (see article). We are pursuing new strategies for transdisciplinary science in teaching and research at Washington University in St Louis (see the Institute for Public Health).

They also note the need for cost-effective targets and new incentives for researchers to focus on diseases that are common. Years ago I wrote on the absence of training in emergency medicine and the common ailments that physicians encounter on a daily basis. Seems to me that not much has changed in our approach to training physicians who can meet the needs of the communities they serve 2.

Finally, they emphasize the need for improved data on clinical value of interventions. They call for physicians and surgeons to commit to a new level of objectivity in judging the clinical value of interventions 1

At Washington University School of Medicine the Department of Surgery has created a Division of Public Health Sciences to integrate these quantitative disciplines into the full spectrum of research and training in the department – from bench, to bedside, to community.  The Division Provides a platform for investigators from multiple disciplines to collaborate on innovative projects, it supports an exceptional academic base through education, training and mentoring of students, fellows and faculty and aims to improve the health and wellbeing of people and communities in the St. Louis region and beyond.

The Division of Public Health Sciences is also home to the new Master of Population Health Sciences (MPHS) degree at Washington University that aims to equip clinicians and others with clinical doctorates with the advanced population health research expertise that is necessary for successful careers as independent clinician-researchers. The goal of the MPHS program is to ensure students can transfer and apply the sophisticated population health research methods skills learned in the program throughout their careers. This goal is accomplished in several ways, including:
  • Required quantitative courses – The MPHS program has a unique depth of required quantitative methods courses. The quantitative curriculum emphasizes the role of epidemiology and biostatistics in approaching clinical effectiveness and outcomes research.
  •  Applied coursework – The MPHS does not require a research thesis/capstone. Instead, the program makes innovative use of applied coursework to focus on the long-term application of skills. Using topics relevant to their careers and interests, the applied coursework allows MPHS students to practice the art of developing research study protocols, performing systematic reviews, designing epidemiologic studies and more. By developing these skills across a thematic research area of interest, students are well positioned to apply this knowledge to future studies as their careers advance.
  • Focused concentrations – Three concentration options (Clinical Epidemiology, Health Services and Quantitative Methods) allow students to further hone their population health research skills to match clinical interests.

Literature Cited

Wednesday, February 9, 2011

We're Back - With ENERGY, 8 Ways, and the New Dietary Guidelines

The CNiC team hasn't gone on a month long vacation (though that sure sounds nice with the snow we've had). We're just been busy with writing grants and papers and gearing up for some other exciting things around here. We'll be back with real content shortly, but in the meantime, here are some of what's been occupying us:

Our 8 Ways to Stay Healthy and Prevent Disease is going to be featured in an exciting new partnership with KSDK news beginning next month. I also hope we'll get to highlight our new Cancer Survivors' 8 Ways to Stay Healthy After Cancer.

The USDA released the new Dietary Guidelines. I've enjoyed reading the opinions of my colleagues on these. As our colleagues at AICR have pointed out, the guidelines include some things that are important for cancer prevention, including eating less, eating fruits and vegetables and managing portions. A few other favorites on the guidelines in general:
Michele Simon at Appetite for Profit
Harvard Nutrition Source
and of course,
Marion Nestle
Our ENERGY study is about to start our first wave of women in the weight control program. We are continuing to recruit, as are our colleagues in San Diego, Denver and Birmingham. This is a weight management program for overweight breast cancer survivors.

And I've learned that engaging a toddler in the cooking process, while great on many levels, is not conducive to food photography - and thus, prevention cooking posts!