Treating cancer in low-income countries


Kerr DJ, Midgley R. Can we treat cancer for a dollar a day? Guidelines for low-income countries. N Engl J Med. 2010 Aug 26;363(9):801-3. PubMed PMID: 20818843.

Writing from the Sidra Medical and Research Center in Qatar and Department of Clinical Pharmacology, University of Oxford, David Kerr and Rachel Midgley propose a multidisciplinary approach to cancer treatment in low-income countries.

They begin with some revelatory statistics:

“In 2002, approximately 7.6 million people worldwide died of cancer. These deaths accounted for 13% of all deaths worldwide in that year and, perhaps surprisingly, exceeded the number of deaths from HIV–AIDS, tuberculosis, and malaria combined (which totaled approximately 5.6 million). The World Health Organization has estimated that if current trends continue, the global cancer burden will increase from 10 million new cases per year in 2000 to 16 million by 2020. Remarkably, 70% of these cases will be in the developing world, where the number will grow from 5.2 million annually to 8.8 million by 2020.”

Kerr and Midgley note that in low-income countries where the simplest generic treatments are often beyond the reach of the average citizen, oncologists with access to the latest online clinical guidelines can find them frustrating. They find that very little has been done to develop evidence-based guidelines for cost-effective cancer treatments that they can use.

The authors posit that an interdisciplinary task force could adapt existing pharmacoeconomic models to assess the cost-effectiveness of previously established chemotherapy regimens and develop cost-effective cancer-treatment guidelines for low-income countries without establishing a permanent two-tier global system:

“Does this mean that cancer medicine in low-income countries will always be rooted in the past? Not necessarily, for we have seen some innovative and successful projects in which pharmaceutical companies have provided new drugs free of charge to poorer countries — for example, the Glivec International Patient Assistance Program for patients with chronic myeloid leukemia. More could be made of these open access projects, especially if they are sufficiently flexible to answer key research questions about tolerability, efficacy, and pharmacokinetics, to help refine treatment regimens that would be feasible for treatment of people in developing countries who have cancer.”

The full text is freely available via PubMed.

A low-cost, integrated treatment for lymphedema


de Godoy JM, de Godoy Mde F. Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations. Int J Med Sci. 2010 Apr 15;7(2):68-71. Review. PubMed PMID: 20428336

José Maria Pereira de Godoy and Maria de Fátima Guerreiro de Godoy have developed a treatment regimen for lymphedema that integrates manual lymph drainage, mechanisms of compression using a low-cost cotton-polyester material, active and passive exercise apparatuses, and adaptation of daily activities.

In the North, lymphedema is largely known as a side effect of breast cancer surgery; however, lymphedema also affects poor populations in the South, where there is a need for low-cost therapies. The Godoys describe an integrated therapy with a delivery system involving professionals trained in lymphedema, psychologists, nutritionists, occupational therapists, physiotherapists, seamstresses, and social assistants.

Among the innovations developed by the Godoys are the development of a technique of manual lymph drainage that aims at draining lymph and stimulating the flow of lymph, and the use of a low-cost material (known in Brazil as gorgurão), to produce compression stockings, sleeves, and gloves.

In their article, the Godoys note that they have established a model center for the treatment and research of lymphedema in Brazil.

The free full-text article is available via PubMed.

The information on my blog is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition.

The use of medicinal plants in Mustang district, Nepal


Bhattarai S, Chaudhary RP, Quave CL, Taylor RS.
The use of medicinal plants in the trans-Himalayan arid zone of Mustang district, Nepal.
J Ethnobiol Ethnomed. 2010 Apr 6;6:14.
PubMed PMID: 20370901

Investigators at the Nepal Academy of Science and Technology conducted field research in the Mustang district of north-central Nepal from 2005 to 2007 to document the use of medicinal plants in traditional botanical medicine.

Interviewing residents of 27 communities, the investigators recorded traditional uses of 121 medicinal plant species, mostly herbs, but also including shrubs, trees, and climbers. Plant-based medicine is used extensively in the region, within a number of medical systems including Ayurveda, traditional Chinese medicine, Unani (a tradition of Graeco-Arabic medicine), and Tibetan Amchi medicine.

Recent loss of biodiversity in Mustang – a fragile, mountainous ecosystem – prompted this ethnobotanical project to document the use of medicinal plants and indigenous ethnobotanical knowledge. The investigators interviewed Amchi healers, medicinal plant traders, farmers, hotel and shop owners and managers, traders, homemakers, and village elders.

The study found that medicinal plants play a pivotal role in primary healthcare in Mustang, that traditional Amchi medical practitioners maintain deep knowledge about their use, and that, “while over-harvesting of some important medicinal plants has increased, many Amchi are working towards both biological conservation of the medicinal plants through sustainable harvesting and protection of wild species and conservation of their cultural heritage.”

To maintain biodiversity and ethnobotanical knowledge, the authors recommend collaborative research projects between the local people and national and international partners with relevant expertise.

A study of Korean herbal remedies for tinnitus


Kim NK, Lee DH, Lee JH, et al. Bojungikgitang and banhabaekchulchonmatang in adult patients with tinnitus, a randomized, double-blind, three-arm, placebo-controlled trial–study protocol. Trials. 2010
Mar 28;11:34. PubMed PMID: 20346181.

Investigators at Wonkwang University undertook a randomised, double-blind, placebo-controlled trial to determine the efficacy and safety of the herbal medications bojungikgitang and banhabaekchulchonmatang in the treatment of tinnitus.

Neither the US Food and Drug Administration (FDA) nor the European Medicines Agency (EMA) have approved treatments for this disorder, defined as a perception of hearing a sound for which there is no external acoustic source and that is often associated with sudden, temporary hearing loss.

Bojungikgitang and banhabaekchulchonmatang are herbal preparations used in Traditional Korean Medicine. Both are approved by the Korea Food and Drug Administration as herbal medications for adults with tinnitus.

In this study, Bojungikgitang was prepared from extracts of Astragali radix, white ginseng, Atractylodes rhizome white, Glycyrrhizae resina, Angelicae gigantis radix, Fraxini cortex, Cimicifugae rhizoma, and Bupleuri radix. Banhabaekchulchonmatang was prepared from extracts of Pinelliae rhizoma, Hordei fructus germinatus, Fraxini cortex, Atractylodes rhizome white, Massa medicata fermentata, Atractylodis rhizoma, Zingiber officinale, Astragali radix, Ginseng radix alba, Ginseng radix alba, Gastrodiae rhizoma, Polyporus, Alismatis rhizoma, Zingiberis rhizoma siccus, and Phellodendri cortex.

Participants received bojungikgitang, banhabaekchulchonmatang, or a placebo for eight weeks, prepared as a tea with tepid water. Each participant was examined for signs and symptoms of tinnitus before and after taking their medication. Posttreatment follow-up was performed two weeks after the final administration.

The authors found evidence for the efficacy of bojungikgitang and banhabaekchulchonmatang, based on the Tinnitus Handicap Inventory, an acoustic examination and visual analogue scale. Safety was demonstrated by complete blood cell count, erythrocyte sedimentation rate, blood chemistry, urine analysis, PA chest film, brain computed tomography, otologic examination, and vital signs.

The information on my blog is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition.

From Galen to Gleevec


The Emperor of All Maladies: A Biography of Cancer
Siddhartha Mukherjee
Scribner; 2010 (Amazon)

Siddhartha Mukherjee, assistant professor of Medicine at Columbia University and staff physician at the CU/NYU Presbyterian Hospital, has written an epic history of Western medicine and its ultimate nemesis, the disorder of fundamental life processes we call cancer. Combining the tools of journalism, history, true crime, and memoir with a novelist’s grasp of character and plot, a physician’s compassion, and a scientist’s perspective, Mukerjee delivers an absorbing, credible, and deeply meaningful narrative that also benchmarks for future readers the art and science of oncology today.

Tracing the history of oncology from Hippocrates and Galen through the centuries to the beginning of small-molecule targeted therapy with the introduction of Gleevec for chronic myeloid leukemia, Mukherjee highlights legendary players including Andreas Vesalius; John Bennett; Gregor Mendel; Rudolf Virchow; Robert Koch; William Stewart Halsted; Pierre and Marie Curie; Oswald Avery; Lucy Wills; Sidney Farber; Mary Lasker; Emil Freireich and Emil Frei; Min Chiu Li; Thomas Hodgkin; Henry Kaplan; Donald Pinkel; Peyton Rous; Mary Cole; Gianni Bonadonna and Umberto Veronesi; Richard Doll and Bradford Hill; Bruce Ames; Baruch Blumberg; Marcus Conant and Paul Volberding; David Baltimore; Michael Bishop and Harold Varmus; Janet Rowley; Peter Nowell and David Hungerford; Robert Weinberg; Bert Vogelstein; Judah Folkman; Axel Ullrich, Dennis Slamon, Alex Matter, and Nick Lydon; Brian Druker, Charles Sawyers, Moshe Talpaz, and Hagop Kantarjian; and Francis Collins.

Mukherjee also delves into the work and motivations of more than twice this number of investigators, and quotes liberally from humanist writers, including Susan Sontag, William Carlos Williams, and Rose Kushner. Perhaps most important, much of the book details the experience of cancer patients, including those of the author.

Essential reading that is also most enjoyable.

Holism and Life Manifestations – Research from Prague


Krecek J. Holism and life manifestations: molecular and space-time biology. Physiol Res. 2010;59(2):157-63. PubMed PMID: 20482219.

From the conclusion:

“Holism is an achievement of mind concerning limited importance of individual experience. Reasoning about holism, taking in mind the existence of molecular and space-time biology and separating the supply of energy from other life manifestations, could become a guide to the birth of the new step of synthetic approach in biology.”

Yoga in Diabetes


Kutty BM, Raju TR. New vistas in treating diabetes–insight into a holistic approach. Indian J Med Res. 2010 May;131:606-7. PubMed PMID: 20516530.

Kutty and Raju, researchers in the Department of Neurophysiology at the National Institute of Mental Health & Neurosciences in Bangalore, note that in India, presently about 30 million people are diabetic which will rise to about 60 million by 2017.

They undertook a meta-analysis of studies of yoga and meditation in the treatment of diabetes, with the following conclusion:

Practice of yoga and meditation is known to induce hypometabolic state with parasympathetic predominance, suggesting that yogic practices per se would create a conducive internal atmosphere from the cellular to system level. This would help to manage the stress and anxiety effectively in addition to its positive regulatory role on other systems. Considering its health there is a need to integrate yoga in the conventional treatment regimen as an adjunct/add on therapy for an effective treatment of DM. This paper provides a convincing evidence for the effectiveness of combination therapy over conventional treatment in enhancing cognitive functions in diabetes. More studies need to be carried out along this line, in order to increase awareness among public.

The information on my blog is not intended as a substitute for medical professional help or advice but is to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition.

Foreign Affairs – The World Ahead


“The World Ahead,” a special issue of Foreign Affairs, presents essays on the impact of resurgent religions, transforming technologies, demographic implosions, food shortages, energy competitions, and educational rivalries.

U.S. Secretary of State Hillary Rodham Clinton writes on civilian power abroad. Roger C. Altman, CEO of Evercore Partners, and Richard N. Haass, President of the Council on Foreign Relations, propose that the US end its debt addiction now, before global markets turn punitive. Leslie H. Gelb, President Emeritus of the Council on Foreign Relations, offers evidence that economic security and not military security is the key to US foreign policy. And Arne Duncan, US Secretary of Education, writes on enhancing US education and competitiveness.