While Dr. Dukan is still enjoying an excellent reputation among the general public, despite the controversy surrounding the diet which bears his name, his peers do not see him in quite the same light. The Paris Departmental Office of the French General Medical Council as well as the National Office of the French General Medical Council are criticising Dr. Dukan for breaking the code of medical ethics.
Dr. Dukan, the man who has sold 4 million books needs no introduction. In January 2012, in his “Open letter to the future president of the Republic”, Dr. Dukan did not reveal his latest method for slimming but his “Grand project for France”. Most notably, this plan introduced the question of placing a ‘healthy weight’ option on the syllabus for the baccalaureate (OPEB). This option would give baccalaureate students a higher overall score if they remained at a body mass index (BMI) between 18 and 25 in their second and final years... This was a step too far for Dr. Dukan’s medical colleagues who are now criticising him as much for his ideas as for his method. He is now facing two main complaints.
The Paris Departmental Office of the French General Medical Council have just issued a complaint against Dr. Dukan under Article 13 of the code of medical ethics, according to which “a doctor must pay attention to the repercussions of his comments for the public”.
The National Office of the French General Medical Council has criticised Dr. Dukan for making money rather than practising medicine, using Article 19 of the code of ethics to support this; “Medicine must not be practised as a commercial business”. According to the information relayed by Europe1.fr, the French General Medical Council considers that, with his annual turnover of 100 million euros, Dukan’s business can no longer be thought of as a simple medical practice.
After seeing the Dukan diet blown apart by the French Agency for Food, Environmental and Occupational Health (Anses), Dr. Dukan’s propositions raise numerous contentious issues, and he finds himself once more at the heart of controversy...
For an athlete it’s recognition, for a student it’s passing exams, for a worker, it’s a pay rise… Each one of us needs a precise goal to stay motivated, a kind of perpetual carrot. According to a group of French scientists, the brain houses a centre for such motivation… But what if this same centre was implicated in both our mental and physical effort?
That’s what Mathias Passiglione, research coordinator at INSERM’s Neuroscience research centre at the Paris Pitié-Salpêtrière hospital, and his team set out to discover. To do this, the team studied neuronal mechanisms stemming from activities combining both action and cognition. 20 volunteers participated in a 360-exercise test, conjugating both mental and physical effort, while lying down with their heads in an MRI scanner.
From the cognitive side, they had to find the highest number amongst a group of differently sized numbers and for the action side, they had to select the number in question by squeezing either their right or left fist, depending on which side the number was situated. Through the exercise results, the participants got more or less points, in other words were recompensed.
By analysing the MRI images, Mathias Pessiglione’s team identified that, "In the depth of the brain, there exists a general motivational system, that is a structure capable of activating any kind of activity, whether mental (such as concentrating on what you’re doing) or physical (such as lifting up something) In addition, according to the researchers’ observations, the higher the amount in play, the higher the corresponding activation in the ventral striatum. They also noticed that the “motivational centre” connects to different zones depending on the type of activity – for cognitive tasks, the median part of the striatum (caudate nucleus) is activated; for physical tasks, the lateral part of the striatum (putamen) is activated.
In conclusion, Mathias Passiglione’s team suggests that the ventral striatum codes the motivation: "The ventral striatum can commute the connections on demand, meaning it amplifies the neuronal activity in the caudate nucleus for a cognitive task and in the putamen for a physical task," explains Mathias Pessiglione.
- "Existe-t-il dans les profondeurs du cerveau un centre général de la motivation?" Press release INSERM/CNRS, February 2012
- Neural Mechanisms Underlying Motivation of Mental Versus Physical Effort, L. Schmidt and al, PLoS Biology, February 2012, volume 10
While some foods are a contributing factor to the prevention of some cancers, certain nutrients could also contribute to improved performance of a number of cancer treatments. This is the case for docosahexaenoic acid, or DHA, a polyunsaturated acid from the Omega-3 family. This mechanism is today better understood, as explained by Prof Stephan Chevalier from the Nutrition, growth and cancer unit at Inserm in France, during a Cancer League research symposium.
Over a number of years, the links between DHA and responses to chemotherapy had been explored in various studies. DHA is mostly taken from foods, notably in fish such as salmon, albacore tuna, swordfish and herrings. The concentration of DHA in mammal’s adipose tissue (record of food intake) is directly linked to the efficiency of the chemotherapy treatment1. Efficiency that has been proven in vitro2. This improvement in the efficiency of treatments was also proven in animals treated with radiotherapy3, with anthracyclines4 and with taxanes5.
The studies directed by Stéphan Chevalier have contributed to proving that an intake of DHA is likely to improve the efficiency of different chemotherapy treatments used to treat breast cancer. According to the studies, various hypothesises could explain this effect. The DHA could remodel the vascularisation of tumours, thus increasing the distribution of anti-cancer agents into the tumour; it could decrease cellular proliferation by regulating nuclear receptors of the breast’s tumoural cells; it could intervene on the cancerous cells by blocking certain signals linked to the cancer’s aggressivity6 and to its capacity to migrate to other organs (to form metastases) 7.
A phase II study conducted with women suffering from metastasized breast cancer underlined the importance of such a supplementation in DHA8. Another study, conducted with people suffering from lung cancer with metastases also produced promising results9. Today, the interest of a supplementation in DHA during chemotherapy to treat metastasized breast cancer is being explored in a large clinical multi-centric phase III study10, 11, with the results expected in 2013
1 – “Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial,” Bougnoux P et al - Br J Cancer. 2009 Dec 15;101(12):1978-85. Epub 2009 Nov 17 -
2 – “Enhancement of doxorubicin cytotoxicity by polyunsaturated fatty acids in the human breast tumor cell line MDA-MB-231: relationship to lipid peroxidation,” Germain E et al - Int J Cancer. 1998 Feb 9;75(4):578-83.
3 – “Enhanced radiosensitivity of rat autochthonous mammary tumors by dietary docosahexaenoic acid,” Colas S et al.- Int J Cancer. 2004 Apr 10;109(3):449-54.
4 – “Sensitization by dietary docosahexaenoic acid of rat mammary carcinoma to anthracycline: a role for tumor vascularization,” Colas S et al - Clin Cancer Res. 2006 Oct 1;12(19):5879-86.
5 – “Omega-3 fatty acids induce apoptosis in human breast cancer cells and mouse mammary tissue through syndecan-1 inhibition of the MEK-Erk pathway,” Sun H et al - Carcinogenesis. 2011 Oct;32(10):1518-24. Epub 2011 Jul 18.
6 – “P2X(7) receptor activation enhances SK3 channels- and cystein cathepsin-dependent cancer cells invasiveness,” Jelassi B et al - Oncogene. 2011 May 5;30(18):2108-22. doi: 10.1038/onc.2010.593. Epub 2011 Jan 17.
7 – “Identification of SK3 channel as a new mediator of breast cancer cell migration,” Potier M -Mol Cancer Ther. 2006 Nov;5(11):2946-53.
8 – “Improving outcome of chemotherapy of metastatic breast cancer by docosahexaenoic acid: a phase II trial,” Bougnoux P et al - Br J Cancer. 2009 Dec 15;101(12):1978-85. Epub 2009 Nov 17.
9 – “Supplementation with fish oil increases first-line chemotherapy efficacy in patients with advanced nonsmall cell lung cancer,” Murphy RA et al - Cancer. 2011 Aug 15;117(16):3774-80. doi: 10.1002/cncr.25933. Epub 2011 Feb 15.
10 – Etude DHALYA, Programme hospitalier de recherche Clinique Cancer 2011
11 – Lipides et sensibilisation du cancer du sein aux agents anticancéreux, Stéphan Chevalier - Colloque de la recherche de la Ligue contre le cancer 2012 – 26 janvier 2012
For some, hitting the 40s can be the moment for a new start… but this period could also mark the beginning of cognitive decline. Until now, it was accepted that brain functionalities started slipping at round 60, but a recent Franco-British study suggests that it actually starts at around 45. Could this be one of the factors provoking mid-life crisis?
Lifespan is expanding and with it come some problems, such as aged care, retirement funding etc. Add to this, the discovery made by Archana Singh-Manoux, INSERM France, which risks complicating the challenge of ageing well. Her research team has determined the starting age of cognitive decline, previously thought to be 60, but still under discussion. And the news isn’t all good…
The study analysed cognitive date from more than 7,000 Londoners aged from 45 to 70. These people had been monitored over a 10 year period (from 1997) under the auspices of an epidemiological study – Whitehall II. Over 10 years, the cognitive functions of these 5198 men and 2192 women were evaluated 3 times, using the following criteria: memory, vocabulary, reason and verbal fluency.
In the end, it appears that their cognitive scores decreased across all the categories, except vocabulary, which remains stable with age. It should be noted that the research team factored differing education levels into the study. Over 10 years, the cognitive capacities of those aged between 45-49 decreased by 3.6 % and by 9.6 % for those between 65-70.
“Previous research shows small differences in cognitive performance in earlier life to predict larger differences in risk of dementia in later life,” said Archana Singh-Manoux. “Understanding cognitive aging might enable early identification of those at risk for dementia.”
- "Le déclin cognitif apparait dès 45 ans", INSERM press release, France, January 2012
- "Timing of onset of cognitive decline: results from Whitehall II prospective cohort study," A Singh-Manoux and a BMJ 2012; 344 doi: 10.1136/bmj.d7622 (January 2012)
According to a study published in the British Medical Journal, the life expectancy of people HIV-infected people in the UK has increased by an average of 15 years since 1996. This increase is principally due to earlier diagnosis, more efficient treatments and an overall increase in British life expectancy.
With the advent of tri-therapy treatments, HIV has become a chronic illness with a reasonably good prognosis, if it is diagnosed early on and treatment is undertaken at an early stage of the illness, when the level of CD4 lymphocytes has yet to fall. That being said, life expectancy for HIV-infected people remains lower than that of the general UK population.
To calculate the exact number of years of life lost to HIV infection, researchers from Bristol University analysed data collected between 1996 ad 2008 of 17,661 patients aged 20+, whose treatment included at least three medications.
The study results showed that life expectancy for an HIV-infected patient at the age of 20 had increased from 30 to 46 years of age across the studied period. As is often the case, men and woman aren’t equal, and men have an inferior life expectancy to that of women – 40 for men and 50 for women, compared to 58 and 62 as seen in the general UK population.
It appears that the earlier the anti-retroviral treatment is begun, the more positive effect it has on the patient’s life expectancy. This moves from 38 to 48, then 53, depending on whether at the start of treatment the level of CD4 is less than 100, between 100-199 or between 200-350/mm.
For the authors, this study points to a trend that seem to confirm the importance of early treatment and the usefulness of tri-therapy treatment to promote further improvement in life expectancy for those infected with HIV.
Medical uniforms are veritable microbe traps according to a recent American study, which showed that more than 60% of hospital nurses and doctors are carrying around germs on their uniforms.
Yonit Wiener-Well and his team at the Shaare Zedek Medical Center in Jerusalem took samples from three different places on the uniforms (stomach and pocket levels, the cuffs) of 75 nurses and 60 doctors. Half the samples, representing 65 % of the nurses’ uniforms and 60% of the doctors’, carried germs.
Among the germs identified, 21 of those found on the nurses’ uniforms and 6 of those found on the doctors’ were resistant to a number of antibiotics. And 8 of those resistant germs were from the golden staphylococcus family, which is also resistant to methicillin.
While the uniforms themselves don’t pose a risk for direct contamination, these results reveal the prevalence of bacteria resistant to antibiotics in an environment extremely close to hospitalised patients.
"It is important to put these study results into perspective," Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology (APIC), said in an association news release. "Any clothing that is worn by humans will become contaminated with microorganisms. The cornerstone of infection prevention remains the use of hand hygiene to prevent the movement of microbes from these surfaces to patients."
According to the World Health Organisation (WHO), the risk of nosocomial infection can be up to 20 times higher in certain developing countries as compared to developed countries. A risk that is costly and often fatal. The study authors thus insist on the importance of prevention through hygiene – the surest way to ensure patient safety.
- “Doctors’ and Nurses’ Hospital Uniforms Contain Dangerous Bacteria a Majority of the Time, Study Shows,” press release, APIC, August 2011
- “Nursing and physician attire as possible source of nosocomial infections,” AJIC, Volume 39, Issue 7, p. 555-559, September 2011
According to a European study published in the British Medical Journal, better treatment is more likely to have led to the falling number of deaths from breast cancer rather than mammography screening.
The team of French, British and Norwegian researchers wanted to find out how much early screening and improved treatment could account to the reduction of breast cancer deaths over the last 20 years. To do this, they compared the breast cancer mortality statistics from six countries from 1989 to 2006. Countries were paired in regard to their health systems and risk factors for death from breast cancer, but in which screening was implemented 10-15 years later in the second country of each pair (Northern Ireland and Republic of Ireland, the Netherlands and Flanders/Belgium, Sweden and Norway).
The research team expected to an earlier reduction in the number of breast cancer deaths in those countries that implement screening first, but there was actually a very small difference between the two countries in each pair. According to WHO statistics, breast cancer deaths fell by 29% in Northern Ireland and 26% in the Republic of Ireland; by 25% in the Netherlands, 20% in Belgium and 25% in Flanders; and by 16% in Sweden and 24% in Norway.
In addition, the most important decrease in mortality was observed in women between the ages of 40-49, whether they had long-term access to mammography screening or not.
For the study authors, "The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality".
In conclusion it was suggested that improved health systems and treatments contribute more to the reduction in breast cancer mortality.
"I was myself an ardent defender of mammography screening for breast cancer,” explains the study’s co-author Philippe Autier. “But we notice that widespread mammography screening does not reduce the number of advanced breast cancer cases, nor does it reduce mortality rates.” On the contrary, “Screening detects lots of little cancers which would never become large,” and thus contributes to a detrimental over-diagnosis of breast cancer.
For epidemiologist at the International Prevention Research Institute (iPRI), it seems clear that mass screening should be abandoned in favour of better access to diagnostic mammography or MRIs for women who have detected a worrying sign through self-examination.
This study will no doubt revive the debate about the usefulness of blanket breast cancer screening, even though certain are already criticising the study method, based on the difficulty of isolating certain parameters to will improve breast cancer detection. It should also be remembered that early detection generally results in lighter, less invasive treatments and therefore less carry through effects for those women affected by breast cancer.
- "Breast cancer mortality in neighboring European countries with different level of breast screening but similar access to treatment: Trend analysis of WHO mortality database", Philippe Autier, research, Mathieu Boniol, Anna Gavin, Pr. Lars J Vatten. British Medical Journal
- Interview with Philippe Autier, epidemiologist at the International Prevention Research Institute (iPRI), Lyon, July 2011
The European Food Safety Authority has banned the importation of sprouted fenugreek grain from Egypt after having established link between a stock of fenugreek and the E.coli infections. This ban also includes Egyptian sprouted rocket and soya grain – until October 31, 2011.
In addition to ingestion of contaminated food, an E.coli infection can also occur through contact with an infected person who secretes the bacteria in their stools. This is known as a secondary infection. To prevent such infection, it’s vital to adhere to good basic hygiene:
- Systematic hand washing before preparing or eating food, as well as after going to the toilet or returning home from outside. Hand washing means using soap, not just plain water. As an emergency solution the hands can be disinfected with a hydro alcoholic.
- Those suffering from an E.coli infection (or gastroenteritis) should close contact with people at risk (particularly infants), regularly wash their hands and avoid preparing food for others.
Source: EFSA Press Release, June 2011
The health focus and slogan put forward by the World Health Organisation for the April 7, 2011 World Health Day is: Antimicrobial resistance: no action today, no cure tomorrow.
So what is antimicrobial resistance that makes it so important that a World Health Day is dedicated to it? Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. In layman’s terms this means an infection or virus that no longer responds to established antimicrobial treatments.
A lot has been said about the dangers of over-prescribing antibiotics, treating livestock with antibiotics, or the importance of completing appropriately prescribed antibiotic treatments, and AMR is the result of such misuse of antimicrobial drugs. Such infections are ‘intelligent’ and many evolve to new forms, thereby making previous treatments redundant.
In short, a host of viruses, bacteria and parasites are able to withstand treatment by antimicrobial medicines, allowing the infections to continue on, and spread further. Some concrete examples include:
- 440,000 cases of drug-resistant tuberculosis annually, causing 150,000 deaths;
- A large number of hospital-acquired infections are caused by highly resistant bacteria;
- Only one antibiotic is recommended in the treatment of shigellosis (an acute intestinal infection linked to hygiene and causing bloody diarrhoea, particularly in children), but this is now showing resistance too;
- Resistance to earlier antimalarial medicines is widespread in most malaria-endemic countries.
“The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures,” said WHO Director-General Dr Margaret Chan. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”
For more information, visit WHO’s dedicated World Health Day 2011 webpages.
The OECD has published a special edition of its annual ‘Health at a Glance’ series; a 2010 version dedicated to health in Europe. There’s both good new and bad news on the European health front…
The report focuses on health issues across the 27 European Union member states, three European Free Trade Association countries (Iceland, Norway and Switzerland) and Turkey, including into life expectancy, children’s health, obesity, health workers and health spend.
First the good health news…
- Life expectancy is on the way up across Europe, gaining 6 years since 1980. In 2007 the average life expectancy stood at 74.3 year for men and 80.8 years for women. France had the highest life expectancy for women (84.4 years), while Romania had the lowest (76.2 years).
- Tobacco consumption has dramatically reduced in a number of European countries. For instance, less than 18% of adults in Sweden and Iceland now smoke, compared to 30% in 1980.
- Alcohol consumption has fallen over the last 30 years in many EU countries, with wine-producing countries such as Italy, Spain and France seeing a substantial drop.
And then the bad health news…
- Weight issues are taking a front seat on the European health stage with more than 50% of the total population either overweight or obese. The spread of obesity ranges from less than 10% in Romania through to 20% in the United Kingdom. The rate of obesity has more than doubled over the last 20 years in most EU countries that track this data, for instance the UK and the Netherlands.
- A shortage of health workers is causing concern in a number European countries, in particular GPs, as well as trained nurses. While the overall number of doctors and nurses has increased per capita across Europe, there are a number of countries facing shortages, such as Poland, Romania, the UK and Finland.
If you would more detailed information, you can click through and download the Health at a Glance: Europe 2010 report free of charge from the OECD iLibrary. You’ll also find lots of other reports, papers and statistics, including the Health at a Glance: Asia/Pacific 2010 report.
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