OP-ED CONTRIBUTOR

My Medical Choice

By ANGELINA JOLIE

Published: May 14, 2013 1603 Comments

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MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.

We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer andovarian cancer.

My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.

Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.

Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.

On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.

But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.

My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.

Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.

Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.

I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.

It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.

I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.

For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.

I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.

Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.

I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.

Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.

Angelina Jolie is an actress and director.

The Next Pandemic: Not if, but When

By DAVID QUAMMEN

Published: May 9, 2013 41 Comments

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TERRIBLE new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention. Such reports have been coming in recent months from two countries, China and Saudi Arabia.

You may have seen the news about H7N9, a new strain of avian flu claiming victims in Shanghai and other Chinese locales. Influenzas always draw notice, and always deserve it, because of their great potential to catch hold, spread fast, circle the world and kill lots of people. But even if you’ve been tracking that bird-flu story, you may not have noticed the little items about a “novel coronavirus” on the Arabian Peninsula.

This came into view last September, when the Saudi Ministry of Health announced that such a virus — new to science and medicine — had been detected in three patients, two of whom had already died. By the end of the year, a total of nine cases had been confirmed, with five fatalities. As of Thursday, there have been 18 deaths, 33 cases total, including one patient now hospitalized inFrance after a trip to the United Arab Emirates. Those numbers are tiny by the standards of global pandemics, but here’s one that’s huge: the case fatality rate is 55 percent. The thing seems to be almost as lethal as Ebola.

Coronaviruses are a genus of bugs that cause respiratory and gastrointestinal infections, sometimes mild and sometimes fierce, in humans, other mammals and birds. They became infamous by association in 2003 because the agent for severe acute respiratory syndrome, or SARS, is a coronavirus. That one emerged suddenly in southern China, passed from person to person and from Guangzhou to Hong Kong, then went swiftly onward by airplane to Toronto, Singapore and elsewhere. Eventually it sickened about 8,000 people, of whom nearly 10 percent died. If not for fast scientific work to identify the virus and rigorous public health measures to contain it, the total case count and death toll could have been much higher.

One authority at the Centers for Disease Control and Prevention, an expert on nasty viruses, told me that the SARS outbreak was the scariest such episode he’d ever seen. That cautionary experience is one reason this novel coronavirus in the Middle East has attracted such concern.

Another reason is that coronaviruses as a group are very changeable, very protean, because of their high rates of mutation and their proclivity for recombination: when the viruses replicate, their genetic material is continually being inaccurately copied — and when two virus strains infect a single host cell, it is often intermixed. Such rich genetic variation gives them what one expert has called an “intrinsic evolvability,” a capacity to adapt quickly to new circumstances within new hosts.

But hold on. I said that the SARS virus “emerged” in southern China, and that raises the question: emerged from where? Every new disease outbreak starts as a mystery, and among the first things to be solved is the question of source.

In most cases, the answer is wildlife. Sixty percent of our infectious diseases fall within this category, caused by viruses or other microbes known as zoonoses. A zoonosis is an animal infection transmissible to humans. Another bit of special lingo: reservoir host. That’s the animal species in which the zoonotic bug resides endemically, inconspicuously, over time. Some unsuspecting person comes in contact with an infected monkey, ape, rodent or wild goose — or maybe just with a domestic duck that has fed around the same pond as the wild goose — and a virus achieves transcendence, passing from one species of host into another. The disease experts call that event a spillover.

Researchers have established that the SARS virus emerged from a bat. The virus may have passed through an intermediate species — another animal, perhaps infected by cage-to-cage contact in one of the crowded live-animal markets of the region — before getting into a person. And while SARS hasn’t recurred, we can assume that the virus still abides in southern China within its reservoir hosts: one or more kinds of bat.

Bats, though wondrous and necessary animals, do seem to be disproportionately implicated as reservoir hosts of new zoonotic viruses: Marburg, Hendra, Nipah,Menangle and others. Bats gather in huge, sociable aggregations and have long life spans, circumstances that may be especially hospitable to viruses. And they fly. Traveling nightly to feed, shifting occasionally from one communal roost to another, they carry their infections widely and spread them to one another.

As for the novel coronavirus in Saudi Arabia, its reservoir host is still undiscovered. But you can be confident that scientific sleuths are on the case and that they will look closely at Arabian bats, including those that visit the productive date-palm groves at the oases of Al Ahsa, near the Persian Gulf.

What can we do? The first obligation is informed awareness. Early reports arrive from afar, seeming exotic and peripheral, but don’t be fooled. One emergent virus, sooner or later, will be the Next Big One. It may show up first in China, in Congo or Bangladesh, or maybe on the Arabian Peninsula; but it will globalize. Most people on earth nowadays live within 24 hours’ travel time of Saudi Arabia. And in October, when millions of people journey to Mecca for the hajj, the Muslim pilgrimage, the lines of connections among humans everywhere will be that much shorter.

We can’t detach ourselves from emerging pathogens either by distance or lack of interest. The planet is too small. We’re like the light heavyweight boxer Billy Conn, stepping into the ring with Joe Louis in 1946: we can run, but we can’t hide.

David Quammen, a contributing writer for National Geographic, is the author, most recently, of “Spillover: Animal Infections and the Next Human Pandemic.”

Miracle Noodle News Report

http://www.miraclenoodle.com/

Novel coronavirus infection - update

2 May 2013 - The Ministry of Health in Saudi Arabia has informed WHO of seven new laboratory confirmed cases of infection with the novel coronavirus (nCoV), including five deaths.

Two patients are currently in critical condition.

The government is conducting ongoing investigation into this outbreak.

Preliminary investigation show no indication of recent travel or animal contact of any of the confirmed cases. The confirmed cases are not from the same family.

From September 2012 to date, WHO has been informed of a global total of 24 laboratory confirmed cases of human infection with nCoV, including 16 deaths.

Minocycline, a microglial inhibitor, reduces ‘honey trap’ risk in human economic exchange

• Motoki Watabe,
• Takahiro A. Kato,
• Sho Tsuboi,
• Katsuhiko Ishikawa,
• Kazuhide Hashiya,
• Akira Monji,
• Hideo Utsumi
• & Shigenobu Kanba

• Affiliations
• Contributions
• Corresponding authors

Scientific Reports

 

3,

 

Article number:

 

1685

 

doi:10.1038/srep01685

Received

 

17 December 2012 

Accepted

 

27 March 2013 

Published

 

18 April 2013

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Recently, minocycline, a tetracycline antibiotic, has been reported to improve symptoms of psychiatric disorders and to facilitate sober decision-making in healthy human subjects. Here we show that minocycline also reduces the risk of the ‘honey trap’ during an economic exchange. Males tend to cooperate with physically attractive females without careful evaluation of their trustworthiness, resulting in betrayal by the female. In this experiment, healthy male participants made risky choices (whether or not to trust female partners, identified only by photograph, who had decided in advance to exploit the male participants). The results show that trusting behaviour in male participants significantly increased in relation to the perceived attractiveness of the female partner, but that attractiveness did not impact trusting behaviour in the minocycline group. Animal studies have shown that minocycline inhibits microglial activities. Therefore, this minocycline effect may shed new light on the unknown roles microglia play in human mental activities.

Subject terms:

• Microglia
• Cooperation
• Decision
• Psychology

At a glance

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Introduction

• Introduction•
 
• Results•
 
• Discussion•
 
• Methods•
 
• References•
 
• Acknowledgements•
 
• Author information

In movies, a female spy often wins the trust of her male target using her physical attractiveness. The male target usually suspects that she is a spy, but because of her attractiveness, he becomes amorously entangled with the female spy despite concerns regarding her trustworthiness. For males, allocating valuable resources to physically attractive females may be evolutionarily adaptive, in that it may increase the probability of producing attractive offspring under natural selection. However, this tendency toward resource allocation to attractive females creates ‘noise’ that complicates decisions in short-term economic exchanges, leading to the tendency to ‘honey trap’ males with this behaviour.

In an economic exchange, attractiveness in a female increases sexual arousal in a male that automatically (without careful evaluation of her trustworthiness) facilitates trusting behaviour. While these traits should be adaptive in terms of mate-choice¹, experimental studies have shown that they also affect decisions in social and economic exchange^2, 3. These traits lead to the question of how males can avoid the honey trap.

Recent studies with human subjects show that minocycline, a commonly used tetracycline antibiotic, may facilitate focus on appropriate environmental cues for social decision-making, possibly by reducing noise and other factors (e.g. personality and arousal) that can obstruct decisions. In an economic exchange, one study showed that subjects treated with minocycline make more sober decisions compared to participants treated with placebo⁴. In another study, participants were given dextroamphetamine and those treated with minocycline report less of a ‘high’ feeling compared to those who did not receive minocycline⁴. Minocycline is also known to improve symptoms associated with psychiatric disorders such as schizophrenia and depression^5, 6,7. There are past studies examining the effects of physical attractiveness on cooperation in social/economic exchange in different sex pairs, but no study has examined the effects of minocycline on such behaviour in different sex pairs. The hypothesis of this study was that minocycline reduces the risk of the honey trap effect and leads to more appropriate decisions in a short-term economic exchange, through a reduction in the noise triggered by physical attractiveness.

In this experiment, 98 healthy males played a trust game with 8 photographed young females after a 4-day oral treatment course of either minocycline or placebo. Looking at a picture showing a female's face, male players decided how much out of 1300 yen (approximately 13 USD) they would give to each female. Males then evaluated how trustworthy each female was and how physically attractive she was using a 11-point Likert Scale (0: Not at all – 10: Perfectly so). Of note, all of the photographed females had actually decided, in advance, to choose ‘betray’ against the male players. Therefore, male participants played with untrustworthy female partners, but were unaware of the deception. The impact of attractiveness and trustworthiness on the amount of money given to female partners was analysed. The independent variables were the evaluations/scores of physical attractiveness and trustworthiness given by the male participants.

Results

• Introduction•
 
• Results•
 
• Discussion•
 
• Methods•
 
• References•
 
• Acknowledgements•
 
• Author information

Table 1 summarizes the mean scores for the major variables and results of a t-test used to compare the placebo and minocycline conditions. Consistent with previous reports in which trust games were conducted between healthy male participants^8, 9, the offering rate differed marginally between conditions. The State and Trait Anxiety Inventory (STAI)¹⁰ was measured and no significant differences were found for either State or Trait Anxiety scores between conditions.

Table 1: Mean scores and results of t-tests comparing major variables

Full table

• Figures/tables index

The primary hypothesis of this study was that the minocycline group would be less affected by the attractiveness of pictured females than the placebo group. To test this hypothesis, an ANOVA was performed with condition (minocycline vs. placebo) and attractiveness (high vs. low) as independent variables and the offering rate of money by participants as the dependent variable. The attractiveness score was not normally distributed (P = 0.0004), therefore the score was sub-divided into 2 categories (high vs. low). Figure 1 shows the mean offer rate by condition and the level of attractiveness. There is a significant interaction effect between condition and attractiveness (F (1,776) = 7.78, P = 0.005). Consistent with the primary hypothesis, participants in the placebo group gave larger amounts of money when the partner was more attractive, while participants in the minocycline group did not. According to a simple main effect test, a main effect of attractiveness was detected in the placebo group (P = 0.0004), but not in the minocycline group (P= 0.223). In addition, Figure 1 shows that, for partners with high attractiveness, the offering rate in the placebo group was significantly higher than in the minocycline group (P = 0.0004), but not for less attractive partners (P = 0.590).

Figure 1: Mean Offering Rate (percentage of money offered) by the Male Participants to Less- and More-Attractive Female Partners.

Error bars represent the standard deviation for each condition. *** For the placebo group, the offering rate to highly attractive female partners is higher than that to partners with low attractiveness (P = 0.0004). ### The offering rate to highly attractive partners in the placebo group is higher than that in the minocycline group (P = 0.0004).

Boy and His Atom

U.S. to Defend Age Limits on Morning-After Pill Sales

The Obama administration moved Wednesday to keep girls under 15 from having over-the-counter access to morning-after pills, as the Justice Department filed a notice to appeal a judge’s order that would make the drug available without a prescription for girls and women of all ages.

Neurology

Adherence to a Mediterranean diet and risk of incident cognitive impairment

Objective: We sought to determine the relationship of greater adherence to Mediterranean diet (MeD) and likelihood of incident cognitive impairment (ICI) and evaluate the interaction of race and vascular risk factors.

Methods: A prospective, population-based, cohort of individuals enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003–2007, excluding participants with history of stroke, impaired cognitive status at baseline, and missing data on Food Frequency Questionnaires (FFQ), was evaluated. Adherence to a MeD (scored as 0–9) was computed from FFQ. Cognitive status was evaluated at baseline and annually during a mean follow-up period of 4.0 ± 1.5 years using Six-item-Screener.

Results: ICI was identified in 1,248 (7%) out of 17,478 individuals fulfilling the inclusion criteria. Higher adherence to MeD was associated with lower likelihood of ICI before (odds ratio [lsqb]OR[rsqb] 0.89; 95% confidence interval [lsqb]CI[rsqb] 0.79–1.00) and after adjustment for potential confounders (OR 0.87; 95% CI 0.76–1.00) including demographic characteristics, environmental factors, vascular risk factors, depressive symptoms, and self-reported health status. There was no interaction between race (p = 0.2928) and association of adherence to MeD with cognitive status. However, we identified a strong interaction of diabetes mellitus (p = 0.0134) on the relationship of adherence to MeD with ICI; high adherence to MeD was associated with a lower likelihood of ICI in nondiabetic participants (OR 0.81; 95% CI 0.70–0.94; p = 0.0066) but not in diabetic individuals (OR 1.27; 95% CI 0.95–1.71; p = 0.1063).

Conclusions: Higher adherence to MeD was associated with a lower likelihood of ICI independent of potential confounders. This association was moderated by presence of diabetes mellitus.

Periodic Table - Discovery Nation

Attention-Deficit Drugs Face New Campus Rules

Matt Black for The New York Times

Lisa Beach said it took months before Fresno State’s health service would give her an A.D.H.D. diagnosis. She had to sign a contract for medications.

By ALAN SCHWARZ

Published: April 30, 2013

FRESNO, Calif. — Lisa Beach endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract — promising to submit to drug testing, to see a mental health professional every month and to not share the pills.

• Harvard Student’s Suicide as a Case Study (May 1, 2013)

• Drowned in a Stream of Prescriptions (February 3, 2013)

• Health Guide: ADHD

“As much as it stunk, it’s nice to know, ‘O.K., this is legit,' ” said Ms. Beach, a senior at California State University, Fresno. The rigorous process, she added, has deterred some peers from using the student health office to obtain A.D.H.D. medications, stimulants long abused on college campuses. “I tell them it takes a couple months,” Ms. Beach said, “and they’re like, ‘Oh, never mind.’ ”

Fresno State is one of dozens of colleges tightening the rules on the diagnosis of A.D.H.D. and the subsequent prescription of amphetamine-based medications like Vyvanse and Adderall. Some schools are reconsidering how their student health offices handle A.D.H.D., and even if they should at all.

Various studies have estimated that as many as 35 percent of college students illicitly take these stimulants to provide jolts of focus and drive during finals and other periods of heavy stress. Many do not know that it is a federal crime to possess the pills without a prescription and that abuse can lead to anxiety, depression and, occasionally, psychosis.

Although few experts dispute that stimulant medications can be safe and successful treatments for many people with a proper A.D.H.D. diagnosis, the growing concern about overuse has led some universities, as one student health director put it, “to get out of the A.D.H.D. business.”

The University of Alabama and Marist College, like Fresno State, require students to sign contracts promising not to misuse pills or share them with classmates. Some schools, citing the rigor required to make a proper A.D.H.D. diagnosis, forbid their clinicians to make one (George Mason) or prescribe stimulants (William & Mary), and instead refer students to off-campus providers. Marquette requires students to sign releases allowing clinicians to phone their parents for full medical histories and to confirm the truth of the symptoms.

“We get complaints that you’re making it hard to get treatment,” said Dr. Jon Porter, director of medical, counseling and psychiatry services at the University of Vermont, which will not perform diagnostic evaluations for A.D.H.D. “There’s some truth to that. The counterweight is these prescriptions can be abused at a high rate, and we’re not willing to be a part of that and end up with kids sick or dead.”

Changes like these, all in the name of protecting the health of students both with and without attention deficits, involve legal considerations as well. Harvard is being sued for medical malpractice by the father of a student who in 2007 received an A.D.H.D. diagnosis and Adderall prescription after one meeting with a clinical nurse specialist.

Still, many student health departments regard A.D.H.D., a neurological disorder that causes severe inattention and impulsiveness, as similar to any other medical condition. Eleven percent of American children ages 4 to 17 — and 15 percent of high school students — have received the diagnosis, according to a survey by the Centers for Disease Control and Prevention.

New college policies about A.D.H.D. tend not to apply to other medical or psychiatric conditions — suggesting discrimination, said Ruth Hughes, the chief executive of the advocacy group Children and Adults With Attention-Deficit/Hyperactivity Disorder. Such rules create “a culture of fear and stigma,” she said, adding that if students must sign a contract to obtain stimulants, they should have to do so for the painkillers that are also controlled substances and are known to be abused.

“If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners,” Ms. Hughes said. “Nonprescribed use of stimulant medications on campus is a serious problem that can’t just be punted to someone else outside the school grounds.”

Fresno State officials said a disquieting surge of students requesting A.D.H.D. diagnoses — along with news media reports of stimulant abuse and questionable diagnostic practices nationwide — led the university to change several policies last year. Now, students with an outside diagnosis of A.D.H.D. can fill their prescriptions at the Student Health Center only after providing documentation of a thorough evaluation by qualified mental health practitioners — which typically involves hours of neuropsychological testing and conversations with parents and teachers to assess impairment and other possible explanations.

Fresno State no longer makes diagnoses, largely because of the substantial time required “to do it right,” said Catherine Felix, its director of health and psychological services. Many universities, including North Carolina State, Georgia Tech and Penn State, also said they could no longer handle the volume of requests.

In addition to requiring students to sign the contract, Fresno State does not allow early refills to replace lost or stolen medication. Urine tests can be required should a university clinician suspect that a student is not taking the pills as prescribed.

And in a rare policy among colleges, students receiving prescriptions to treat A.D.H.D. must see a Fresno State therapist regularly — not for a cursory five-minute “med check” but for at least one 50-minute session a month.

“It’s not just taking a pill every day,” said Dr. Daniel Little, who counsels several students with A.D.H.D. under this arrangement. “It’s about learning coping skills.”

Students said little could be done to curb misuse of amphetamines on campus, even as some colleges are tightening their policies.

Many students bring their prescriptions from doctors back home. Pills can not only be used to study but also to generate spending money, usually selling for $5 to $10, depending on the dose. Ms. Beach said she was offered up to $150 per pill during finals last year.

Misuse has become common enough for student newspapers to make light of it. The Miami Hurricane at the University of Miami ran an editorial in November that was headlined “Magic Pill Can Enhance Focus, Drive” and said that students “shouldn’t look down on those who need — and welcome — the extra push” of Adderall. In another article, an undergraduate encouraged students: “Medicate, Miami. You’ve earned it.” The university responded in a short news release that the articles did not represent its views on the subject.

Some universities go beyond student health to address amphetamine misuse on campus. Two years ago, Duke included “the unauthorized use of prescription medication to enhance academic performance” as a category of academic dishonesty, essentially cheating.

After the 2010 suicide of a Vanderbilt student named Kyle Craig — who abused Adderall to keep up his grades, his family said, using prescriptions from a doctor near his New Jersey home — the university devoted part of freshman orientation to highlighting the temptations and perils of stimulant misuse, similar to programs on safe sex and binge drinking.

Several Vanderbilt students maintained that those efforts were futile, partly because they distribute pills themselves. One student, who asked to be identified only by his middle name, Andrew, said he was prescribed 60 pills a month from his hometown psychiatrist, although he needs only 30 or 40. He gives the extras to other students in need.

“I don’t think they’re doing enough,” he said with a laugh, “to stop people like me.”