Episode #0039—August 24, 2007
Time: 00:17:42 | Size: 16.2 MB

Schmalfeldt: Welcome to episode thirty-nine of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—I'll have a discussion about Cancer Prevention with the chair of the President's Cancer Panel, Dr. LaSalle Lefall. Lauren Waddell tells us how one institute at the NIH is reaching out to the Hispanic community. And Frances Sanchez has some good news about lower income kids who take part in early childhood education. But first, with the start of school right around the corner, a report from 2005 about how trained screeners can help identify vision problems in preschoolers. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: The opening of school is coming up very soon. It's already started in some locations. Wally Akinso has this report from August 2005 about how trained screeners can help identify vision problems in pre-schoolers.

Trained Screeners Identify Vision Problems In Pre-Schoolers

Akinso: A study funded by the National Eye Institute, has determined that trained screeners can identify preschoolers with vision disorders. Doctor Maryann Redford, group leader of the Collaborative Clinical Research, Division of Extramural Research says the vision in preschoolers study was designed to provide scientific evidence to address key questions .

Redford: "The number 1 question is it feasible to screen 3, 4, and 5-year-olds for vision disorders? And the number 2 question, are there specific tests that perform better than others? Finally who needs to administer the test. What kind of skill level or training, do the people, who administer the test need?"

Akinso: Among the trained screeners, nurses correctly identified up to 68 percent of children with vision disorders, compared to 62 percent of these children. Doctor Redford feels that the data is very encouraging.

Redford: "There's a lot of vision screening being proposed and conducted in the united states. And I think this data will inform the people in future vision screening programs how to design them bes, so that they can get the most effective use of their resources."

Akinso: This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.

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Schmalfeldt: Now here's Lauren Waddell with a story about one institute's effort to reach out to the Hispanic Community.

NINDS Announces Effort To Promote Stroke Awareness In The Hispanic Community

Waddell: Increasing stroke awareness among the Hispanic community in America is the goal of a new education program sponsored by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. As part of the NINDS campaign known as Know Stroke. Know the Signs. Act in Time, the program will work towards raising awareness about the symptoms of stroke, according to Dr. Jose G. Merino, staff clinician in the Section of Stroke Diagnostics and Therapeutics at NINDS.

Merino: We are interested in getting the message about brain attack, or stroke, and knowledge of the symptoms and the importance of rapid response, to the Latin community. So, in order to do this, the NINDS put together a toolbox, which contains several educational materials that can be used by health educators out in the community. These materials are in Spanish, they include a tape; some visual prompts that will help get the conversation going about stroke warning signs and the importance of calling 911 and getting to the hospital as soon as possible.

Waddell: The toolkit mentioned by Dr. Merino will contain video testimonials from survivors of stroke, as well as brochures with helpful information. Dr. Merino said the campaign is fortunate to be supported not only by members of the NINDS, but by supporters of Hispanic health education as well.

Merino: We're partnering with very well known Hispanic organizations, like the National Council of La Raza and the National Alliance for Hispanic Health, to use their resources and their networks to help us get the message out, so that these organizations which already are working on health issues, and have a vast network of clinics and health educators, can then help us disseminate our message.

Waddell: According to Dr. Merino, the Latino community is ideal for this campaign because, overall, Hispanics have a higher rate of risk factors that act as contributors, and increase the likelihood, of stroke. These risk factors include smoking, diabetes, high blood pressure and excessive weight. Although this campaign focuses mainly on the Latino community, according to Dr. Merino, the slow response to stroke symptoms is a nation-wide concern. For more information about the new community education program, and other stroke information, call NINDS at 1-800-352-9424, or visit the Web site at www.ninds.nih.gov/stroke. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, MD.

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Schmalfeldt: When we come back, I'll sit down for a chat with Dr. LaSalle Lefall, Chair of the President's Cancer Panel. That's next on NIH Research Radio.

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Interview With Dr. Lasalle Lefall—Chair Of The President's Cancer Panel

Schmalfeldt: Welcome back to NIH Research Radio, and our guest today is Dr. LaSalle Lefall. He's the Charles R. Drew Professor of Surgery at Howard University College of Medicine in Washington, DC; past Chair of the Board at the Susan G. Komen Breast Cancer Foundation—now known as Susan G. Komen for the Cure; a surgeon, oncologist, medical educator and leader in professional and civic organizations. And in May 2002, he was appointed by President George W. Bush as a member and Chair of the President's Cancer Panel. He was recently reappointed for a three year term ending in February 2010. Welcome to NIH Research Radio, sir.

Lefall: I'm pleased to be here.

Schmalfeldt: And quite a prestigious appointment, it sounds like. The President's Cancer Panel. You sit with Dr. Margaret Kripke and Tour de France champion Lance Armstrong. Why don't you tell us a little bit about the function of the President's Cancer Panel?

Lefall: Well, the role of the President's Cancer Panel is to monitor the development and execution of the National Cancer Program and to report directly to the President if we see any obstacles. Certainly, we would report it if we see any opportunities that are not being realized. We also want to really see if there are any obstacles to be sure that the National Cancer Program can be carried out to successful completion.

Schmalfeldt: Now, there's going to be a report issued here, "Promoting Healthy Lifestyles: Policy, Program and Personal Recommendations for Reducing Cancer Risk". Over the last year, you've looked at the links between physical activity, obesity, nutrition, tobacco use and environmental tobacco smoke exposure and cancer risk. And you've heard from over 40 experts from a variety of disciplines and organizations. Can you give us a little sneak peek at what this report is going to have to say? LEFALL: Yes. One thing the report wants to emphasize is prevention. We hear so much about diagnosis and treatment, and they are important also. But we want to emphasize prevention. If you eat in a healthy manner, if you avoid tobacco in any form, what you can do to improve your health and decrease the risk for developing cancer.

Schmalfeldt: And it makes sense. If you don't get cancer, you don't have to fight it.

Lefall: That is correct. And prevention is very important.

Schmalfeldt: That's going to be the main focus of the report?

Lefall: The main focus is going to emphasize that. And what we can do, what the government can do. For example, if we could have the Food and Drug Administration have the ability to regulate tobacco and what is going on with tobacco sales. If we could increase the tax on tobacco so we have more money to fight cancer. If we can emphasize the fact that eating in a healthy manner—being sure that healthy foods are available in all areas of our country, not just in certain areas and in affluent areas, but in low income areas so that everyone can get the benefit of eating a healthy diet. Avoiding obesity—very important. Increasing physical activity. All of these things, we think, will help decrease cancer.

Schmalfeldt: I saw a report not long ago. It seems like our lifestyles have contributed to the cancer rates in our country. Will this report try to modify some of those risks we take on a daily basis?

Lefall: Well, you certainly want to let people know—something we've talked about over and over again—to emphasize the risk of tobacco, smoked or smokeless tobacco and the harm that it can cause. Eating in a healthy manner. Decreasing obesity, because with obesity there's an increased risk of the development of the common cancers: colorectal cancer, breast cancer, prostate cancer. And we want to avoid that.

Schmalfeldt: Now you're working in collaboration with the National Cancer Institute here at the National Institutes of Health. What's your relationship with the NCI?

Lefall: Well, the President's Cancer Panel works closely with the National Cancer Institute. But we do not report to the National Cancer Institute. So that lets us have that "hands off" relationship, so we can look at it in a dispassionate way, and if we see something that isn't going quite right, we can report directly to the President. And that's important. We report directly to the President of the United States but work closely with the National Cancer Institute for the National Cancer Program.

Schmalfeldt: All right, now this report again is called "Promoting Healthy Lifestyles: Policy, Program and Personal Recommendations for Reducing Cancer Risk." And that represents the previous year's investigation. What's coming up next?

Lefall: Next year, we're going to talk about strategies to see if we can maximize the nation's investment in cancer. We spend a lot of money in cancer, cancer research with what we can do to decrease the risk of cancer, the incidence of cancer, to decrease mortality. So we want to find out what we can do to actually increase the return we're going to get on the money that we are spending on the fight against cancer.

Schmalfeldt: We're certainly thrilled to have you here with us today on NIH Research Radio. And as long as we've got you here, is there anything else you'd like our listeners to know?

Lefall: I'd just like to emphasize that if you prevent cancer, then you don't have to treat it. And there are things we can do. One-third of all human cancer, we believe, is caused by tobacco and tobacco products, one-third is related to nutritional factors and diet.

Schmalfeldt: Thank you so much, Dr. LaSalle Lefall. He's Chair of the President's Cancer Panel, joining us here today on NIH Research Radio.

Lefall: Thank you very much.

Schmalfeldt: When we come back, a story we first brought to you in August 2005 about a link between alcohol and cancer. That's next on NIH Research Radio.

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Finding May Explain Alcohol/Cancer Link

Schmalfeldt: Drinking alcohol has been linked to an increased risk of upper gastrointestinal cancer, as well as other types of cancers. But researchers don't yet understand the basic molecular reasons why. Now, a new study by scientists from the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Standards and Technology may shine some light on the link between alcohol and cancer. Doctor P.J. Brooks, one of the co-leaders of the research team, said the search for a biochemical link is now focused on a chemical called "acetaldehyde" which forms when the body metabolizes alcohol and its reaction with small molecules called "polyamines" that are naturally present in our cells.

Brooks: What we found is that the acetaldehyde can react with this other chemical that is present in our cells, and that causes kind of a chain reaction that ultimately results in a particularly dangerous type of DNA damage. We did these studies using concentrations of acetaldehyde that are within the range that might actually occur, particularly in the mouth, when people drink alcohol. So we believe then that these studies are biologically relevant, although it is important to point out that these are "test tube" studies still. So we still have to verify this work in living cells.

Schmalfeldt: Doctor Brooks said that researchers have long suspected acetaldehyde's role in the link between alcohol and cancer. He said the study gives scientists important new clues about its involvement. From the National Institutes of Health, I'm Bill Schmalfeldt in Bethesda, Maryland.

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Schmalfeldt: It turns out that involvement in early childhood education pays lifelong benefits for lower income children. Frances Sanchez has the story.

Intensive Early Childhood Program Leads To Gains In Adulthood: Greater College Attendance, Lower Crime And Depression

Sanchez: Lower income children who participated in an intensive early childhood education program showed higher rates of educational achievement, and lower rates of serious crimes and depression, according to a study funded by the National Institute of Child Health and Human Development, part of the National Institutes of Health. By becoming heavily involved in this intensive educational program participants achieved academic success from age 3 through the duration of college and beyond; Dr. James Griffin, Director of the Early Learning & School Readiness Program, at NICHD said parental involvement was a key component to the program's success.

Griffin: They really stressed parent involvement. They had the parents come into the classroom, they had them help out with field trips and they even offered services to the parents. Like helping them get their high school equivalency degree, their GED, parent child training, so they really did involve the parents.

Sanchez: The Child-Parent Centers program in the Chicago Public School System provided students with intensive instruction in subjects such as Math and reading in combination with educational field trips. The study followed children from age 3 or 4 through 24; however children only attended the program from pre-kindergarten through third grade. Researchers found that early investment in a child's life was highly associated with high academic success, a high economic status, low to no crime involvement, and good mental health.

Griffin: The children from a very young age were encouraged by their parents that education was a way out of the kind of poverty that they were experiencing. So what you see at age 24 is that they have less depression, probably because they're just a little bit more optimistic about life.

Sanchez: The study showed that children who completed the program had a greater appreciation for education and saw it as a vital tool for success which had enduring effects into adulthood. The CPC program also offers career development skills workshops, professional training and has a low teacher to student ratio and emphasizes oral and written communication. The findings of this study were published in the August issue of Archives of Pediatrics & Adolescent Medicine. From the National Institutes of Health I'm Frances Sanchez in Bethesda, Maryland.

(THEME MUSIC)

Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, September 7th when episode 40 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website... www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me... the info is right there on the podcast web page. That e-mail address... ws159h@nih.gov—once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland... an agency of the US Department of Health and Human Services.

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Episode #0038—August 10, 2007
Time: 00:14:27 | Size: 13.2 MB

Transcript:

Schmalfeldt: Welcome to episode thirty-eight of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—a report about how "sooner" is better than "later" when it comes to treating HIV-infected infants. Wally Akinso has a story about how it doesn't matter if it's diet or regular... people who indulge in soft drinks are at increased risk of developing metabolic syndrome. I'll have a report on how treating expectant mothers with a female hormone known as progesterone did not prove to be useful in preventing preterm birth in women carrying twins. And Lauren Waddell will tell us about some new, faster-acting anti-depressant drugs that are in the works. But first, an interesting study shows that your social networks may have something to do with your body style. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

NIH-Supported Study Characterizes Social Networks of Family, Friends Influencing Obesity

Schmalfeldt: Your social network of friends and family seems to have an influence on your chances for developing obesity. That's the finding of a study funded by the National Institute on Aging, part of the National Institutes of Health. The study showed that obesity spreads within social networks and that the closer the social connection the greater the influence on developing obesity—even if people live in different households many miles apart—. Dr. Richard Suzman, Director of the Behavioral and Social Science Program at the NIA, explained the significance of the study.

Suzman: There are important implications, one of which is that it may be quite difficult to lose weight by one's self and it may be much easier to lose it as part of a group or network. And I think some of the weight loss groups have recognized this.

Schmalfeldt: A sedentary lifestyle and increased consumption of high-calorie foods are critical factors in the steep rise in the prevalence of obesity, the researchers noted. But the study suggested that a hierarchy of influence exists among family and friends on developing obesity, in which the attitudes, behaviors, and acceptance of obesity also might play an important role. Now, while these findings may give pause to a person fighting "the battle of the bulge", this is not to say that you should ditch your overweight friends or shun your chubby relatives. In fact, Dr. Suzman said, the opposite is true.

Suzman: It helps if you can get the support of friends, and you work on it together. And let me say this: There are other data that show that friends and social relationships have a substantial impact on people's health and, indeed, longevity. So, keep all the friends you have, make more.

Schmalfeldt: The findings were published in the July 26, 2007 issue of the New England Journal of Medicine.

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Schmalfeldt: And on the subject of obesity and potential heart disease, it turns out that it doesn't matter whether that soda is diet or regular—not as far as your chances of developing metabolic syndrome are concerned. Wally Akinso has the details.

Adults Drinking Soft Drinks At Increased Risk of Developing Metabolic Syndrome

Akinso: Are you a middle-aged adult? Do you drink more than one softdrink per day? It doesn't matter if it's diet or regular. According to a study by the National Heart, Lung and Blood Institute at the National Institutes of Health, you may have a more than 40 percent greater rate of either having or developing metabolic syndrome—that's a cluster of conditions that increase the risk for heart disease. While the increased risk of metabolic syndrome associated with high-calorie, high-sugar regular soft drinks might be expected, the similar risk found among those drinking diet sodas may cause a few raised eyebrows, according to Dr. Caroline Fox, co-author of the study.

Fox: What's very intriguing about this study's finding is that it was both regular and diet soft drinks that were associated with metabolic syndrome. And what these results suggest is that soft drink consumption whether diet or regular maybe a marker for increased metabolic syndrome risk.

Akinso: Dr. Fox said the findings point to the importance of long-term observational studies, which allow researchers to take a closer look at how aspects of diet are interrelated with health risks. The results are from the Framingham Heart Study's, "Soft Drink Consumption and Risk of Developing Cardio-Metabolic Risk Factors and the Metabolic Syndrome in Middle Aged Adults in the Community," which was published online in the Circulation in July. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.

Schmalfeldt: When we come back, Lauren Waddell will tell us about some new, faster-acting anti-depressants that may be available soon. That's next on NIH Research Radio.

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Schmalfeldt: One of the problems with the current stable of anti-depressant medications is they seem to take so long to become effective. But those days may soon be over. Lauren Waddell has the story.

Faster-Acting Antidepressants Closer to Becoming a Reality

Waddell: In the past, those who suffer from depression have often had to wait many weeks, or even months, for their antidepressant treatment to start kicking in. Now, scientists at the National Institute of Mental Health, part of the National Institutes of Health, are discovering new ways to develop faster-acting antidepressant medications, ones that may start working in just a few hours. The most recent treatment is a drug called ketamine. Though it is not on the market due to certain side effects, researchers believe it holds great potential in the search for faster-acting anti-depressants. The rewards of having faster-acting treatments would be immense, both on a personal and public health level, according to Dr. Carlos Zarate, Chief of the Mood and Anxiety Disorders Research Unit at the NIMH, who worked on the study that developed and researched ketamine.

Zarate: The problems with the delay in onset of antidepressant action is people suffer tremendously. People may be bedridden; they may have disruption in their personal, professional lives. For example they can't hold their job, they might have problems with marriage, raising their children because if you're away for six weeks, eight weeks, literally unable to function adequately, that really disrupts your life. Not only that, there's an increase risk of suicide during the first month until our antidepressant takes effect. So, imagine if you could have an antidepressant effect within hours, or even one day, you would minimize the disruption in the personal, professional life of that individual, and in theory, one could argue that you would decrease the risk for suicide, in a sense that you are relieving depression symptoms very rapidly, in hours or a day, as opposed to weeks or months.

Waddell: Dr. Zarate suggested that as researchers come closer to developing faster-acting antidepressants, minus the difficult side effects present in ketamine, the true magnitude of these treatment options will become apparent. For more information on depression and current treatment options, visit NIMH on their Web site at www.nimh.nih.gov/healthinformation. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, MD.

Progesterone Treatment Does Not Prevent Preterm Birth in Twin Pregnancy

Schmalfeldt: Treating expectant mothers with a female hormone known as progesterone did not prove to be useful in preventing preterm birth in women carrying twins, according to a study supported by the National Institute of Child Heath and Human Development, part of the National Institutes of Health. Previous studies had shown that progesterone therapy was helpful in preventing preterm birth in women who carry a single child who were at risk because of a previous preterm birth. Dr. Catherine Spong, Chief of the Pregnancy and Perinatology Branch of the NICHD explains.

Spong: We tested in women who had twins and women who had triplets. Did the addition of progesterone in the same time period, starting in between 16 and 20 weeks and going through delivery, prevent preterm birth? And it was not efficacious, it did not reduce preterm birth in that cohort.

Schmalfeldt: Dr. Spong said this means physicians should not assume that progesterone therapy is useful in preventing preterm birth in all groups of at-risk pregnant women.

Spong: Clearly preterm birth is a major public health issue and we need to be able to reduce the rates of preterm birth. But there's no magic bullet. Progesterone is not something that everyone should be taking. We need to identify the women who meet the needs for progesterone, give them progesterone, and find other ways to stop preterm births in the other groups, such as multi-fetal gestation.

Schmalfeldt: Researchers will continue to test the effectiveness of progesterone on other at-risk women, such as women with shortened cervixes and women pregnant with triplets.

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Schmalfeldt: When we come back, how "sooner" is better than "later" when it comes to treating HIV-infected infants. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT

Treating HIV-Infected Infants Early Helps Them Live Longer

Schmalfeldt: When it comes to treating infants infected with HIV, earlier is better than later. That's what's been learned from the initial results of an ongoing clinical trial in South Africa sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, which showed that more HIV-infected infants survive if they are given therapy early on, regardless of their apparent state of health. NIAID Director Dr. Anthony S. Fauci explains.

Fauci: Children were looked with regard to what the most appropriate time to treat them is, vis a vis the long range positive or negative effect. And groups of children were treated sooner rather than later. And another group was treated only when the CD4 count dropped to a certain level indicating that there was clear cut progression of disease. So, the fundamental principle is either treat early before you get evidence of deterioration, or wait until you start to see evidence of deterioration. And those two components of the study were compared. And at the end of the study it became very, very clear that the children who were treated earlier did far better than those that were not treated until it was very clear that they needed to be treated. So the thinking now is leaning much more towards earlier treatment of children for the long term benefits of that.

Schmalfeldt: This finding came to light after a routine review by the trial's data and safety monitoring board—an independent committee that regularly reviews interim data from the study to ensure the safety of participants. As a result of these preliminary findings, Dr. Fauci said all children in the study will now be treated sooner, rather than waiting to see if they show signs of deterioration.

Fauci: The data was so powerful to indicate that the children who were treated earlier as opposed to delayed did so much better, it would have been unethical to continue the limb of the study to delay treatment in other children.

Schmalfeldt: For more information, log on to www.niaid.nih.gov.

(THEME MUSIC)

Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, August 24th when episode 39 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website... www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me… the info is right there on the podcast web page. That e-mail address...ws159h@nih.gov—once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland... an agency of the US Department of Health and Human Services.

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Episode #0037—July 27, 2007
Time: 00:17:35 | Size: 16.1 MB

Coming up on this edition—Lauren Waddell has a story about how child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism. We'll look at an NIAAA survey that shows there's a "Lost Decade" between the age of onset of an alcohol use disorder and treatment. Wally Akinso has a report about a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases that indicates that surgery may be the preferred option for some back conditions. And Lauren will be back with a story about inherited listening skills. But first, there's a new National Institute of Aging publication designed to help folks better understand Older America.

Transcript:

Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.

(THEME MUSIC)

Schmalfeldt: Welcome to episode thirty-seven of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—Lauren Waddell has a story about how child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism. We'll look at an NIAAA survey that shows there's a "Lost Decade" between the age of onset of an alcohol use disorder and treatment. Wally Akinso has a report about a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases that indicates that surgery may be the preferred option for some back conditions. And Lauren will be back with a story about inherited listening skills. But first, there's a new National Institute of Aging publication designed to help folks better understand Older America. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

New NIA Publication Features Health and Retirement Study

Schmalfeldt: It's a comprehensive look at the state of "Older America." A new publication, "Growing Older in America: The Health and Retirement Study", is available online from the National Institute on Aging, part of the National Institutes of Health. This study offers a look at the condition of older Americans, their health, work and economic status, as well as their retirement and family lives. It's based on the Health and Retirement Study, a national survey of Americans over age 50. Dr. Richard Suzman, Director of the Behavioral and Social Science Program at the NIA, said there are some surprising findings in the study.

Suzman: One of the things the study has done is (it has) given rise to other countries producing copies of the study so we can do comparisons. And we were very surprised to find out that those in the US, and we just looked at whites to keep it more controlled, but they had objectively worse health than their counterparts in England. When they controlled for things like smoking, exercise, obesity and other risk factors, there's still a significant amount - unexplained - of difference, so it's given rise to some interesting puzzles.

Schmalfeldt: Dr. Suzman said another surprising finding of the study was the impact of a serious illness within the age 65 and older group, and its effect on the family's financial status.

Suzman: It appeared that the onset of a serious disease, especially when coupled with some chronic resulting disability, ate up a fairly large fraction of peoples' wealth over a short time. And a good deal of that was not out-of-pocket medical expenditures, but loss of earnings, either from the individual affected or somebody else in the family like a spouse. So it seemed as if people were relatively uninsured for disability.

Schmalfeldt: The online publication is intended to familiarize policymakers, researchers, health and retirement experts, the news media and anyone interested in examining data on the combined health and economic conditions of older Americans. For more information, log on to www.nia.nih.gov.

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Schmalfeldt: Could child abuse in her past have an effect on a woman's risk for alcoholism? Lauren Waddell filed this report.

Gene Variant Increases Risks for Alcoholism Following Childhood Abuse

Waddell: Child abuse may be a contributor to a number of discontrolled behaviors in women, according to a study at the National Institute on Alcohol Abuse and Alcoholism, at the National Institutes of Health. Researchers for the study have found that the existence of a particular variant of the monoamine oxidase A - or MAOA gene can have a significant impact on an individual's resiliency to intense childhood trauma. Dr. Francesca Ducci, a visiting fellow with the Laboratory of Neurogenetics at the NIAAA, did significant work on the study and found that.

Ducci: Subjects who are exposed to sexual abuse during childhood are more likely to later on develop alcoholism and ASPD.

Waddell: ASPD stands for Anti-Social Personality Disorder, and is one of the possible risks stemming from childhood abuse. Dr. David Goldman, Chief of the Laboratory of Neurogenetics at NIAAA, said that linking abuse to serious psychiatric disorders, more than just everyday behavioral problems, is an important key finding.

Goldman: Now this study, for the first time, really underlines that the gene also has an important effect on discontrolled behaviors in women. And it's really the first time that this gene has been linked not just to discontrolled behaviors or personality, but to a major psychiatric diagnosis, namely alcoholism, and also to the Anti-Social Personality Disorder. Moving this from the realm of a behavioral difference to the realm of vulnerability to a devastating disease like alcoholism, is a further advance in knowledge.

Waddell: Dr. Goldman added that this study is particularly interesting because it clearly shows how a gene-environment interaction can have significant effects on serious diseases, such as alcoholism. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, Maryland.

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Schmalfeldt: When we come back, Wally Akinso has a report on whether or not back surgery is the preferred treatment for some common back ailments. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: If you've ever had a back problem, you're familiar with the argument: Surgery or conservative treatment. Now, there's evidence that surgical treatment is the treatment of choice for some common back problems. Wally Akinso has this report.

NIAMS Says Surgery May Be Preferred Option for Some Back Problems

Akinso: Surgery versus conservative therapy: That's the choice that faces many people with a variety of common back problems. Now a study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases indicates that surgery may be the preferred option for some conditions. The study shows that for degenerative spondylolisthesis with spinal stenosis, surgery provides significantly better results than nonsurgical alternatives. Degenerative spondylolisthesis is a condition in which the breakdown of cartilage between the vertebrae of the spine causes one vertebra to slip over the one below, causing stenosis, or a narrowing of the canal through which spinal nerves pass. Dr. James N. Weinstein lead author of the study and Chairman of the Departments of Orthopaedics at Dartmouth-Hitchcock Medical Center and Dartmouth Medical School discusses the trial.

Weinstein: SPORT is the acronym we use which is Spine Patients Outcomes Research Trial. And the reason we did that is we wanted to look at several of the most common reasons for which patients have surgery in the United States. The study was designed to look at the three most common reasons for which patients have surgery in the United States and that's the herniated disk or where a disk is pressing on a nerve in your lower back. Spinal stenosis, imagine if you had your right hand grabbing your small middle and ring finger and squeezing them as tight as you could that's spinal stenosis of varying degrees. And then we looked at spinal stenosis with one vertebra slipping forward with the same kind of compression of the fingers but one of the bones in the back moving slightly forward on the other. The idea was to understand whether surgical or nonsurgical treatment would be better for patients with those 3 conditions.

Akinso: Dr. Weinstein said degenerative spondylolisthesis can result in narrowing of the spinal column, which can put pressure on the nerves, resulting in pain in the buttocks or legs with walking or standing. Dr. Weinstein added that it's important to give physicians and patients solid information about treatment.

Weinstein: I think the idea that we hope to provide through SPORT is the benefits of surgical versus nonsurgical treatment and to put that information into what I would like to call an informed choice format. Typically when a patient goes to their doctor, the doctor gives them a diagnosis. Iif they're going to recommend surgery, asking them to sign an informed consent. I think the informed consent process is rather outdated and arcane. And what we should be moving towards is an informed choice method, so patients who face a decision of one treatment versus another when the results might be equivalent or similar should be left in the patient's hand in consultation with their doctor. So the SPORT information provides significant information to patients about making a choice about surgical and nonsurgical treatment for these conditions.

Akinso: The study, published in the May 31st issue of the New England Journal of Medicine, is the second in a series reporting findings of SPORT. Dr. Weinstein said while it is generally not a good idea to rush into back surgery, the trial shows that there are conditions for which surgery clearly is the most effective treatment choice. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.

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Schmalfeldt: Are you one of those people who can listen to two things at once and understand both? Thank your Mom and Dad for that. Lauren Waddell explains.

Waddell: The ability to hear, and actually comprehend, two distinct conversations simultaneously, such as a phone conversation in one ear and a friend talking in the other, isn't just a reflection of your dedicated friendship. It is also largely a result of your genes, according to a new study by the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health. The study, which took place at a twins convention in Twinsburg, Ohio, was led by NIDCD scientist Dr. Robert Morell, and shows a genetic link to auditory processes.

Morell: Our novel finding is that because we gave these tests to sets of twins, we were able to demonstrate that that variability is actually due to shared genes, so it's largely a heritable trait.

Waddell: Dr. Morell worked alongside Dr. Carmen Brewer, who is Chief of the Audiology Otolaryngology Branch at the NIDCD. Both Dr. Morell and Dr. Brewer brought up the high heritability of dichotic listening, which is the ability to listen to two things at once, and at about 75 percent is comparable to the heritability of diabetes or height. Dr. Brewer explains the significance of understanding the causes of poor dichotic listening.

Brewer: It helps us to understand the potential causes of poor dichotic listening performance that don't seem to be related to an insult or an injury and when a person has poor performance, you want to know what's causing it. So this leads us to have an understanding of a potential ideologic diagnosis or a potential underlying cause, that this child is doing poorly not because they have necessarily a disease, or they've had an injury to their auditory system, but because this is a trait that they've inherited.

Waddell: Researchers believe this information will benefit both older people who struggle with hearing loss and loss of comprehension, as well as children who experience auditory processing disorders. For more information about NIDCD research and programs, see the web site at www.nidcd.nih.gov. From the National Institutes of Health, I'm Lauren Waddell in Bethesda, Md.

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Schmalfeldt: When we come back, they're calling it "The Lost Decade". We'll explain, coming up next on NIH Research Radio.

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Alcohol Survey Reveals 'Lost Decade' Between Ages of Onset Disorder and Treatment

Schmalfeldt: They're calling it "The Lost Decade." It's the nearly 10-year gap between the time when a person experiences onset of alcohol dependence or abuse and the time that person eventually seeks treatment. According to the National Institute of Alcohol Abuse and Alcoholism's 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions - also known as NESARC - this gap is nearly unchanged from what was reported in 1991-1992. Dr. Mark Willenbring, Director of the Division of Treatment and Recovery Research at the NIAAA said this is dismaying information, given the effectiveness and availability of proven treatments and the fact that alcoholism is not a difficult disease to diagnose.

Willenbring: Clinicians should basically be screening for the presence of heavy drinking, and by that we mean exceeding our guidelines which is no more than three drinks in one day for a woman and no more than four for a man. If they simply ask about that, then they will identify heavy drinkers earlier in the course of the illness.

Schmalfeldt: . Willenbring said that reluctance to seek treatment plays a role in this "lost decade" between onset and treatment.

Willenbring: Alcoholism is a very stigmatizing disease and people are very reluctant to accept a diagnosis. Entering a treatment program is in some ways a kind of public procedure. It changes a lot of things in your life. Also, people lack access to treatment. Insurance companies, for example, often set higher co-pays and more limits on care than they do for other chronic disorders. And finally, the treatments that are offered in most centers around the country, which is group counseling and AA, are treatments for the most part that people don't like much.

Schmalfeldt: However, Dr. Willenbring said there is some optimism to be found in the NESARC survey.

Willenbring: The good news is that the average length of the longest episode of alcoholism is about four years, and 72 percent - almost three quarters of people who have alcoholism - only have one episode. So a lot of people are getting well from this disorder.

Schmalfeldt: For more info, log on to www.niaaa.nih.gov.

(THEME MUSIC)

Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, August 10th when episode 38 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address.ws159h@nih.gov - once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.

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Episode #0036—July 13, 2007
Time: 00:17:53 | Size: 16.3 MB

Coming up on this edition - even though Father's Day has come and gone, Wally Akinso has some advice for dads that can help them assure they'll be around for many Father's Days to come. We'll have a report about a study shows that retinopathy - or deterioration of the retina - may be prevented or lessened by a change in the diet. Wally returns with a look at the first anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. But first, analyses of a national sample of individuals with alcohol dependence reveals five distinct subtypes of the disease, according to a new study by scientists at the National Institute of Alcohol Abuse and Alcoholism.

Transcript:

Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.

(THEME MUSIC)

Schmalfeldt: Welcome to episode thirty-six of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition—even though Father's Day has come and gone, Wally Akinso has some advice for dads that can help them assure they'll be around for many Father's Days to come. We'll have a report about a study shows that retinopathy—or deterioration of the retina—may be prevented or lessened by a change in the diet. Wally returns with a look at the first anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. But first, analyses of a national sample of individuals with alcohol dependence reveals five distinct subtypes of the disease, according to a new study by scientists at the National Institute of Alcohol Abuse and Alcoholism. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Researchers Identify Alcoholism Subtypes

Schmalfeldt: In a report that should help dispel the notion of the "typical alcoholic," five distinct subtypes of the disease have been identified by scientists at the National Institute of Alcohol Abuse and Alcoholism, part of the National Institutes of Health. Previous efforts to identify alcoholism subtypes focused primarily on individuals who were hospitalized or otherwise receiving treatment of their alcoholism. However, recent reports from the NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions - also known as NESARC - suggest that only about one-fourth of people with alcoholism have ever received treatment, meaning a substantial proportion of people with alcoholism were not represented in the samples previously used to define subtypes of this disease. The current study focused on the nearly 15-hundred NESARC survey respondents who met diagnostic criteria for alcohol dependence, and included individuals in treatment as well as individuals not seeking treatment. The researchers identified unique subtypes of alcoholism based on the respondents' family history of alcoholism, age of onset of regular drinking and alcohol problems, symptom patterns of alcohol dependence and abuse, and the presence of additional substance abuse and mental disorders. There's the "Young Adult" subtype - comprising 31.5 percent of American alcoholics. These are young adult drinkers with relatively low rates of co-occurring substance abuse and other mental disorders, a low rate of family alcoholism, who rarely seek any kind of help for their drinking. There's the "Young Antisocial" subtype - 21 percent of US alcoholics. They tend to be in their mid-twenties, had early onset of drinking and alcohol problems. More than half come from families with alcoholism, and about half have a psychiatric diagnosis of Antisocial Personality Disorder. Many have major depression, bipolar disorder and anxiety problems, and more than 75 percent of this group smoked cigarettes and marijuana. Many also had cocaine and opiate addictions. More than a third of this group seek help for their drinking. Third is the "Functional" subtype. This group makes up about 19.5 percent of American alcoholics. They are typically middle-aged, well-educated with stable jobs and families. About a third of them have a multigenerational family history of alcoholism, about a quarter of the group had major depressive illness sometime in their lives - nearly 50 percent were smokers. The fourth group is the "Intermediate Familial" subtype. This group makes up 19 percent of US alcoholics. They are middle-aged with about 50 percent coming from families with multigenerational alcoholism. Almost half have suffered from clinical depression, and 20 percent had bipolar disorder. Most were tobacco smokers, and nearly one in five had problems with cocaine and marijuana use. Only 25 percent of this group ever sought treatment for problem drinking. Finally, there's the "Chronic Severe" subtype. Making up 9 percent of American alcoholics, this group is mostly middle-aged individuals who had early onset of drinking and alcohol problems with high rates of Antisocial Personality Disorder and criminality. Almost 80 percent of this group come from families with multigenerational alcoholism. They have the highest rates of other psychiatric disorders, including depression, bipolar disorder, and anxiety disorders as well as high rates of smoking, and marijuana, cocaine and opiate dependence. Two-thirds of these alcoholics seek help for their drinking problems, making them the most prevalent type of alcoholic in treatment. The study authors also reported that co-occurring psychiatric and other substance abuse problems are associated with the severity of alcoholism and entering into treatment. Attending AA meetings and other 12-step programs is the most common form of help-seeking for drinking problems - yet help-seeking remains relatively rare. You can read more about this study in the online journal "Drug and Alcohol Dependence" .

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Schmalfeldt: After this short break, Wally Akinso has a little post Father's Day advice for American Dads. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: Father's Day may have come and gone, but Wally Akinso has some advice for Dads who want to be around for many Father's Days to come.

Fathers Take Care of Yourselves when dealing with CVD and Diabetes

Akinso: Dads of the world, it's time to put the sweets down and get physically active if you want to spend many healthy years with your family on father's day. Cardiovascular disease is a major complication and the leading cause of early death among people with diabetes. In fact, 2 out of 3 people with diabetes die from heart disease or stroke. In the U.S., almost 11 million of all men aged 20 years or older have diabetes. Dr. Lawrence Blonde, Chair of the National Diabetes Education Program shared some ideas on how men can deal with diabetes.

Blonde: Men can learn to manage their diabetes by regularly seeing their health care professionals; making sure that they get diabetes education that is provided to them ideally by certified diabetes educators working as part of a diabetes team. And then they can go to resources like the National Diabetes Education program's website.

Akinso: Dr. Blonde said men with diabetes can lower their risk of having a heart attack, stroke or other diabetes complication by managing the ABC of diabetes, which are A1C - a measure of average blood glucose, while also keeping a close eye on their blood pressure, and cholesterol. Dr. Blonde said men should ask for support from their loved ones to make managing their diabetes a family affair.

Blonde: People with diabetes there's a greater risk that their family members may have diabetes and so it's important that those individuals also get appropriately screened for diabetes.

Akinso: Dr. Blonde added that men should work with their health care team to develop a self-care plan, which includes eating healthy and being more physically active. The NDEP is apart of the National Institute of Diabetes, Digestive, and Kidney Diseases. For more information, visit www.ndep.nih.gov or call 1-800-438-5383. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.

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Omega-3 Fatty Acids Protect Eyes Against Retinopathy, Study Finds

Schmalfeldt: A study shows that retinopathy - or deterioration of the retina - may be prevented or lessened by a change in the diet. The study - a collaborative effort by researchers at the National Eye Institute and the National Institute on Alcohol Abuse and Alcoholism at the NIH, along with Children's Hospital Boston, Brigham and Women's Hospital, Massachusetts General Hospital and the University of Goteborg in Sweden, demonstrated that omega-3 polyunsaturated fatty acids protected against the development of retinopathy in mice.

SanGiovanni: What we found was that there is obviously an influence on these inflammatory processes - things that would lead to inflammation in the eye - and the omega-3 fatty acid-fed animals actually had a lower intensity of inflammation within the retina to the point that it actually helped new vessels - damaged vessels or missing vessels - grow back within the retina.

Schmalfeldt: That was Dr. John Paul SanGiovanni, an NEI staff scientist and one of the lead authors of the study, which looked at the effect of the omega-3 fatty acids EPA and DHA - derived from fish. Although this study provides new evidence suggesting the possibility that omega-3 fatty acids act as protective factors in diseases that affect blood vessels in the retina, Dr. SanGiovanni said more research is needed.

SanGiovanni:We have a 4,000-person trial that's currently underway. It's known as the Age-Related Eye Disease Study -2. And in that study we're actually giving people omega-3 fatty acids and will follow them for five years.

Schmalfeldt: The clinical trial will, in part, assess the affect of omega-3 fatty acids DHA and EPA on the progression of age-related macular degeneration, the leading cause of vision loss in Americans 60 years of age and older. An upcoming clinical trial at Children's Hospital Boston will test the effects of omega-3 supplements in premature infants. For more information on the Age-Related Eye Disease Study-2, log on to www.clinicaltrials.gov.

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Schmalfeldt: When we come back, Wally Akinso tells us about the one year anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: Father's Day may have come and gone, but Wally Akinso has some advice for Dads who want to be around for many Father's Days to come.

Celiac Disease Awareness Campaign Marks First Anniversary

Akinso: It's the one year anniversary of the National Institute of Diabetes, Digestive and Kidney Diseases' Celiac Disease Awareness Campaign. The campaign's mission is to heighten awareness of celiac disease among health professionals and the public. Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in products we use every day, such as stamp and envelope adhesive, medicines, and vitamins. Dr. Frank Hamilton, NIDDK's Chief of the Digestive Diseases Program in the Division of Digestive Diseases and Nutrition, discusses the campaign's accomplishments within the year.

Hamilton: I think our biggest accomplishment is really getting the awareness about celiac disease. We've been very pleased and honored that we've invoked the community to really go out and do some public speaking as well as having the societies join with NIH and highlighting the importance of celiac disease not only among physicians but also among the lay community. Some of the major contributions we think that we've accomplished in this last year is a heighten awareness of what celiac disease; there been several publications not only in the Washington, D.C. area but also in the USA Today and Parade Magazine about what celiac disease is. So theses are some major accomplishments that we've been very pleased that the campaign has really done to make people aware of this condition.

Akinso: Dr. Hamilton said the disease is largely under diagnosed for several reasons, for instance celiac disease can present through a broad range of symptoms, many of which physicians do not readily associate with the disease. For more information about celiac disease and campaign materials, visit www.celiac.nih.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.

(THEME MUSIC)

Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, July 27th when episode 37 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address.ws159h@nih.gov - once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.

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Episode #0035 — June 29, 2007
Time: 00:32:04 | Size: 29.3 MB

Coming up on this edition, an interview with the Director of the Office of Cancer Survivorship at the National Cancer Institute. We have a report on how urological diseases cost Americans $11 billion each year. And Bill Schmalfeldt shares a final report on his experience as a patient in a clinical trial. But first, Wally Akinso has a report about a blood test that might signal good news for folks suffering from throat cancer.

Transcript:

Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland, this is NIH Research Radio.

(THEME MUSIC)

Schmalfeldt: Welcome to episode thirty-five of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, an interview with the Director of the Office of Cancer Survivorship at the National Cancer Institute. We have a report on how urological diseases cost Americans $11 billion each year. And I'll have a final report on my experience as a patient in a clinical trial. But first, Wally Akinso has a report about a blood test that might signal good news for folks suffering from throat cancer. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: And now, Wally Akinso with some possible good news for folks suffering from throat cancer.

Blood Test May Help Signal Tumor's Remission, Return in Throat Cancer Patients

Akinso: A blood test that detects proteins commonly released by a growing tumor could one day become a tool for monitoring the effectiveness of chemotherapy and radiation treatment in people with advanced throat cancer, according to a study by the National Institute on Deafness and Other Communication Disorders and the National Cancer Institute. Scientists found that throat cancer patients who showed a decline in several cancer-related proteins following chemotherapy and radiation treatment were more likely to remain in remission, while those who experienced a large rise over time in those proteins frequently exhibited a return of throat cancer. In the study, researchers tested the blood of 30 patients who had undergone chemotherapy and radiation treatment for advanced throat cancer. Dr. Carter VanWaes NIDCD's Chief of the Head and Neck Surgery Branch, talked about the findings.

VanWaes: The study showed that blood levels of most of the factors went down in the patients who responded well and went into long-term remission. But the blood levels rose in those patients who had a relapse of cancer, in some cases, before doctors could see them.

Akinso: Dr. VanWaes added that the findings could help lead to the development of a blood test that enables doctors to detect the recurrence of throat cancer early on, when there is still time to pursue a second line of treatment, such as surgery or drug therapy.

VanWaes: Doctors hope that someday soon blood test like this will lead to earlier diagnosis and help them advise their patients about which treatments might be best for different types of cancer. And new drugs targeting a master switch controlling these factors are being studied at NIH and elsewhere for throat and other cancers.

Akinso: Dr. VanWaes said that the importance of this study is that it presents the ability to have a test that can be used for individual patients and show whether or not they're responding to their treatment or if the cancer is coming back. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.

Urologic Diseases Cost Americans $11 Billion a Year

Schmalfeldt: $11 billion a year! That's how much Americans pay to treat bladder, prostate and other urinary tract diseases, according to a new report from the National Institutes of Health. Medicare's share of that burden exceeds $5.4 billion. According to the authors of "Urologic Diseases in America" - a report funded by the National Institute of Diabetes and Digestive and Kidney Diseases - the five most expensive urologic problems, in descending order, are urinary tract infections, kidney stones, prostate and bladder cancers, and benign prostate enlargement. The report described more than a dozen diseases of children and adults - among them congenital abnormalities, erectile dysfunction, chronic prostatitis, interstitial cystitis, urinary incontinence, and a chapter on sexually transmitted diseases contributed by the Centers for Disease Control and Prevention. You can learn more by logging on to http://kidney.niddk.nih.gov - click on "statistics" to find Urologic Diseases in America.

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Schmalfeldt: When we return we'll discuss the challenges that face cancer survivors with Dr. Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Schmalfeldt: Cancer survivorship - it's a topic that you really don't hear a whole lot about, and that's interesting in itself because more and more people are surviving cancer. It's not a death sentence any more, in many cases, it's a life sentence. You might be surprised to know that here at the National Institutes of Health we actually have an Office of Cancer Survivorship. And here with us right now on NIH Research Radio is the Director of the Office of Cancer Survivorship at the National Cancer Institute, Dr, Julia Rowland. Thank you for joining us today.

Rowland: Bill, it's lovely to be here today and I really welcome the opportunity.

Schmalfeldt: Tell us a little, if you will, about the mission at the Office of Cancer Survivorship.

Rowland: Well, the ultimate goal at the office is really to enhance the length and quality of life of all those who carry a diagnosis of cancer.

Schmalfeldt: I know that when you hear about people who have survived some horrible event, you hear about the "guilt of survivorship." Does that enter into cancer survivorship at all?

Rowland: That's certainly an issue for many individuals who carry this history - "why me? Why did I do well? Why did I recover from this when there are so many like me who have succumbed to this disease?" So certainly there is an issue of that. And along with it, of course, there's the fear that many survivors tell us that they live with from day to day, and that's the fear that the disease will come back.

Schmalfeldt: Do you ever get over that?

Rowland: That's a really good question. In general, people will tell you it never really goes away. But people will find they can park it somewhere and get on with their lives and live rich, full, rewarding existences. For some, though, it's a real hurdle with daily reminders - and certainly we've seen a lot of stories in the press recently about public figures talking about their illness coming back. And when those events occur they raise a lot of anxiety in people who are survivors themselves.

Schmalfeldt: How did the National Cancer Institute come about this decision to start the Office of Cancer Survivorship?

Rowland: Well, the office was actually established back in 1996 in direct response to compelling and articulate response out of the advocacy community saying "it's wonderful you have all these advances, the earlier detection, the better treatments, more supportive care, and that people are living long term with this illness, but what we don't know is to what you are returning individuals, what are the kinds of problems that individuals face after treatment, and what are you doing about that?" Essentially, it was a challenge back to the NCI to say "congratulations on your success, but you need to be cognizant that cancer cures and care come with a cost."

Schmalfeldt: And what got you interested in this particular field?

Rowland: Well, I actually stumbled into this area in some ways in my graduate career. I was doing research in developmental psychology, so I was very interested in illnesses that occur across the life course, when in the time of an individual's life do they become ill. and one of my professors referred me to a physician who at that time was doing research up in the Bronx, looking at women who were breast cancer survivors and talking to them about their quality of life. And I was instantly hooked. I thought this was as fascinating area with lots of work to be done.

Schmalfeldt: What is on the horizon in the area of cancer survivorship? What research are you guys doing? What exciting things are we going to be hearing about in the future?

Rowland: I think some of the exciting things we're looking at, partly it goes back to the mission of the office, which is "tell us a little bit more about what happens to individuals post treatment". So, what has happened in the past 10 years since the office was created is that the medical community now recognizes that cancer survivorship - that post treatment period is an area of unique issues in and of itself. And that's very exciting because it has placed this solidly in the area of what we sometimes refer to as the "cancer control continuum." It has its own unique issues and there are researchers and clinicians who are addressing specifically that particular piece of recovery and wellness. What's been very exciting as we listen to the voice of survivors is recognizing we need to attend to their health behaviors after cancer. Interestingly, some relatively simple things - recommendations to stay physically active after your cancer diagnosis - may have important impact on disease recurrence and possibly long-term survival. So those kind of findings are very provocative, very exciting, because this is something everybody could do.

Schmalfeldt: Now this goes beyond the cancer patient him or herself. This is everyone who knows and loves the cancer patient.

Rowland: Absolutely. Back in 1986 a group of about 24 individuals gathered and created what is now known as the National Coalition for Cancer Survivorship. And when they did that at the time and looked at how a survivor was labeled, essentially, in that early period, the medical definition for "survivor" was someone who remained five years disease free. And in their wisdom, they said this is no longer acceptable, because you can't not be thinking about the quality of life issues for five years. You can't decide five years later, "Gee, I would have liked to have had kids."

Schmalfeldt: You're thinking about those every day.

Rowland: Absolutely. And they need to be part of the decision making in your care. And when they decided they needed to change that definition, it was the coalition that gave us the language that we use for survivors now, that anybody who is diagnosed with cancer may refer to him or herself as a cancer survivor from the moment of diagnosis.

Schmalfeldt: From day one.

Rowland: From day one through the balance of their lives, whether they want to call themselves a survivor or not, but they're entitled to that. And there were two important messages they wanted to convey. Hope. You have a life, you have the opportunity to think about a life after cancer. As you said, we're turning these more and more into curable diseases, or more often, chronic illnesses that you can live long term with. Included under that larger umbrella were family members and caregivers because they recognize that they are part of this journey - often, an integral part of it.

Schmalfeldt: Well, I know that as a person with a chronic condition myself, and the listeners to this podcast know that I have Parkinson's Disease and have been going through some clinical trial surgery for that, if you're not careful, you tend to think of everything that happens in your life in terms of the disease. How do you convey to a cancer survivor that there's more to you than just the fact that you had cancer?

Rowland: That's a really important point, Bill, and you know as you talk about your own experience with Parkinson's Disease, cancer survivors will tell you that after this diagnosis and treatment a headache is no longer a headache - it's a metastatic brain tumor. This is what you worry about, and it's part of the territory. We talked earlier about fear of recurrence. It's trying to find some place to park that worry but get on with your life. And that's one of the challenges that individuals must deal with and find some comfortable resolution around if they're going to move forward.

Schmalfeldt: We hear so much about the fight to research the causes of cancer, the research for new treatments, preventions, We don't really hear enough, I think, about what to do when you've had cancer and what to do afterwards. And that's why I think this is a very valuable discussion we're having today. What are some of the web resources available - your own web site, for instance?

Rowland: Absolutely. The URL is www.survivorship.cancer.gov. You can come and find out what kind of research we're supporting with public dollars here in the United States, very cutting edge research here. We also have on that site links to major reports that have come out. There have been in the last five years five major reports addressing the issue of cancer survivorship. So this is an issue that has really garnered public attention. People are excited about it. And these major reports we're hoping are not only going to stimulate more attention to, more funding for this kind of research and answers to those very questions you've posed.

Schmalfeldt: Anything else you want to add before we wrap it up?

Rowland: Well, we were talking earlier about language. Many people don't like to label themselves as a survivor.

Schmalfeldt: Some people don't even like to say the word "cancer" as if saying the word will get the tumor to start growing again.

Rowland: Absolutely. And I think that when the coalition adopted that language it was not their intent to "label" people, but rather to change the culture of care, to take away the stigma of having the disease, but also to say there's a lot of hope here and to say that people can live very satisfying and productive lives after cancer. An important take home message here is that after you've had a cancer diagnosis, it is important to ask what you can be doing to promote and maintain your health after these treatments.

Schmalfeldt: A patient is his or her own best advocate in this case.

Rowland: Absolutely! And needs to be actively engaged in it, knowledgeable about it, asking those questions about it, "What can I do, what do I need to know, how do I promote and ensure my health going forward?"

Schmalfeldt: A lot of reason to be optimistic, it sounds like.

Rowland: Absolutely. 10-point-8 million survivors in the United States alone today, a very promising figure.

Schmalfeldt: Well thank you for being with us and sharing some of that optimism with us today. Dr. Julia Rowland, Director of the Office of Cancer Survivorship at the National Cancer Institute, thanks for spending a few minutes with us on NIH Research Radio.

Rowland: My pleasure, Bill.

Schmalfeldt: When we come back, a personal account of what it was like being a patient in a clinical trial, along with some reasons why you might want to consider helping in the ongoing search for new discoveries and treatments yourself. That's next on NIH Research Radio.

(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)

Brain Stimulation - First Hand

Schmalfeldt: It was about four months ago, on the February 23rd edition of NIH Research Radio, that I announced I would be taking part in a clinical trial to study the safety and tolerability of Deep Brain Stimulation of the Subthalamic Nucleus in Early Parkinson's Disease. This procedure, sometimes referred to as a "pacemaker for the brain", involves the implantation of a device which sends electrical impulses to specific parts of the brain. The FDA approved DBS for Parkinson's disease in 2002, but only in cases of advanced disease where medications are no longer effective. One purpose of this clinical trial is to determine whether or not DBS, if performed earlier in the progression of the disease, will in fact slow down or halt the progression of PD. This research is being conducted at Vanderbilt University Medical Center in Nashville, TN. However, much of the science that led to the FDA approval of DBS was conducted by and supported by the National Institute of Neurological Disorders and Stroke here at the NIH. Dr. Joseph Pancrazio is the NINDS Extramural Program Director for Neural Engineering and Neural Prostheses. He talked about how NIH Research led to the development of DBS.

Pancrazio: The NIH has supported a lot of the fundamental work, a lot of the fundamental studies of neural circuitry that are responsible for the control of movement. That helped identify what the neural targets were for Deep Brain Stimulation. It's also had a very long-term effort in supporting the development of neural prosthetics, of neural electrodes, and a lot of the work that was done under the neural prosthesis program here at NIH has identified the safety levels that are necessary for electrical stimulation and have identified what are the maximal levels of stimulation currents, what are the right types of materials that can be used in implanted stimulators.

Schmalfeldt: Different institutions perform the surgery in different ways. At Vanderbilt, the surgery is divided into three different phases. Phase one involves the implantation of several small, short-term anchors into the surface of the skull with the patient under general anesthesia. This allows imaging caps, and then - eventually - an individually-crafted platform - to be mounted securely on the skull. The imaging caps can be seen in CT and MRI scans done on the same morning as the markers are installed with the patient still unde