Thoughts & InCytes A forum for news & views on public health & social justice.
Cancer InCytes approaches the cancer epidemic with a holistic perspective. Our articles cover cancer research, medical practice and ethics, public health research, and sociological factors and legal policies that hinder access to healthcare for disadvantaged groups. Human disease and society comprise one complex system of interconnected subnetworks.
By Thoughts & InCytes | February 13, 2013 at 02:40 AM EST | No Comments
The Lack of Conviction: Why Human Traffickers Remain Free
By Christine Balarezo, M.A., Ph.D. (Candidate)
There have been relatively few human trafficking convictions worldwide in comparison to the number of traffickers apprehended (1). In 2003, Lithuania prosecuted 24 people but only 8 were convicted whereas the Netherlands prosecuted 117 people but only 106 were convicted that same year (1). In September 2006, Nigeria sought its first human trafficking conviction (2). Even with the establishment of the Palermo Protocol in 2000 – an international instrument which sought to standardize the definition of human trafficking at the international level – convictions have remained low and/or varied. So why are some countries more successful at convicting human traffickers than others?
While there have been a variety of good explanations for this, the research has not yet looked at the legal anti-human trafficking instruments, and the relationship it has with conviction rates. In particular, I argue that conviction rates are largely a result of the existence of a clear, legal definition of human trafficking at the domestic level, and specifically one that is in conformity with the international definition of human trafficking as contained in the Palermo Protocol. The Palermo Protocol – or the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime – is an international instrument that defines what human trafficking is, and more importantly, does so broadly to encompass all forms of sexual and non-sexual exploitation. While conformity of domestic and international law is important, it is not enough to obtain human trafficking convictions. Therefore, enforcement in addition to conformity of these domestic anti-human trafficking laws is an important factor that determines whether or not human traffickers are being apprehended.
Preliminary statistical analysis confirms this argument. Countries that have more stringent anti-human trafficking laws – or those whose domestic anti-human trafficking laws have a similar human trafficking definition as the Palermo Protocol, and whose laws are enforced – obtained human trafficking conviction about 8 times more than countries that did not have such stringent laws. These results matter for a few reasons. First, human trafficking is a multi- and interdisciplinary issue – especially a human rights and criminal justice one – and therefore affects many people and countries. Having well-defined laws at both the domestic and international level for any crime (not just human trafficking) has the potential to increase conviction rates, capture criminals, reduce crime, and more importantly, increase human and national security. This means protecting vulnerable populations like women and children, migrants, and refugees, and preventing transnational crimes, like human trafficking, from spilling over into other countries or regions. Finally, given that human trafficking has the potential to be very mobile and can spill over into other countries or regions, it is imperative for countries to make their domestic anti-human trafficking laws more uniform so that they can cooperate between and across countries, which will help to better protect the people that need it most.
Christine Balarezo is a PhD candidate in the Department of Political Science at the University of North Texas. She studies human rights, specifically human trafficking and contemporary slavery, and is currently writing her dissertation on why human traffickers do what they do, and why conviction rates remain so low/varied. Learn more about her work at: http://christinebalarezo.weebly.com.
References: 1. United Nations Office on Drugs and Crime (UNODC). 2006. Trafficking in Persons: Global Patterns. Anti-Human Trafficking Unit (AHTU), Global Programme against Trafficking in Human Beings (GPAT). New York: United Nations. . 2. FoxNews.com. 2006. “Nigerian Authorities Seek First Human Trafficking Conviction. “ Fox News, September 29. .
Early Breast Cancer Diagnosis, Survival Rates Low in Rural India
Women in developed countries survive roughly 10 years longer after a breast cancer diagnosis compared to women in poor-to-middle-income countries, a new University of Michigan study suggests.
The report demonstrates the lack of access to good health care faced by women in poor countries, said the study's principal investigator Rajesh Balkrishnan, an associate professor at the U-M schools of Pharmacy and Public Health.
Early diagnosis and sustained treatment were the biggest hurdles and also the main indicators of patient survival, he said.
Balkrishnan and colleagues looked at roughly 300 women in the southern rural district of Udupi, India. Patients received one of three chemotherapy drug regimens depending on the stage of cancer. Only about 27 percent of patients were diagnosed in the early stages of cancer, and they survived an average of 11 years. The majority of patients were diagnosed in later or advanced stages, and they survived from about one to two-and-a-half years after diagnosis and treatment.
Many diagnoses occur at later stages because screening isn't available in those rural areas, Balkrishnan said. Fear, poverty and ignorance about breast cancer also delay treatment and diagnosis. And, if the diagnosis does come early, access and use of breast cancer chemotherapy treatments -- even the generic inexpensive options -- aren't readily available. Only the latest-stage patients receive the most current and expensive treatments, he said.
"I think if the tumor is diagnosed early and treated aggressively, a patient can expect an additional decade of survival," Balkrishnan said. "But access and adherence to optimal treatment remains very difficult for women in poorer countries."
Breast cancer is a growing problem in India, with estimates as high as 1 in 22 women predicted to develop the disease. While the breast cancer rate is much higher in the United States at 1 in 8 women, the survival rate is also much higher. For instance, the five-year survival rate for Indian women is about 60 percent; in developed countries, it is 79-85 percent. Additionally, studies have shown that Indian women develop breast cancer roughly a decade earlier than women in Western countries.
There are about 1.4 million new cases of breast cancer worldwide annually, and it comprises 10 percent of all cancers, making it the second most common cancer in the world.
Other researchers included: Daisy Augustine, Anantha Naik Nagappa, Nayanibhirama Udupa and B.M. Vadiraja, all affiliated with Manipal University in India.
University of Michigan. "Early breast cancer diagnosis, survival rates low in rural India." ScienceDaily, 4 Feb. 2013. Web. 6 Feb. 2013.
Survivor of Nazi 'Twin Experiments' Talks to Doctors About Human Subjects Research
Eva Kor will never forget the day her childhood ended. The images of that day, and the weeks after, are burned into her memory, as brutally permanent as the tattoo on her left forearm.
On a spring day in 1944 Kor and her twin sister Miriam, 10 years old at the time, were taken from their family and herded into the Auschwitz concentration camp. The twins became part of a group of children used for human experimentation by Josef Mengele, known as the Angel of Death.
Now 78 years old, Kor tells this story to groups across the country and the world. She shared her memories with a group of physicians, researchers and other medical professionals at The Methodist Hospital Research Institute on Dec. 5, as part of the conference “Human Subjects Research After the Holocaust.”
A number of speakers examined the ethical lessons of medical experiments carried out on unwilling subjects in the years before and during World War II. Kor joined the panel to put a human face on the brutality she experienced at the Nazi death camp.
Identical twins Eva and Miriam Mozes were chosen for experimentation by Mengele, who subjected children as young as two to horrific surgeries and injections.
“Nothing can prepare a person for a place like Auschwitz,” she told the audience. Upon seeing bodies of children sprawled on a bathroom floor, Kor said she pledged to herself to survive any way she could.
“Each day I was determined to live one more day,” she said, “and survive one more experiment.”
Even at such a young age, Kor said she and her sister knew they had no choice but to submit to Mengele’s experiments if they hoped to survive. They would often sit naked in a room for up to eight hours at a time, as blood was drawn from one arm and unknown substances were injected into the other arm. The rumor spread around the barracks was that if one was taken to the hospital that person never came back.
“It was very easy to die in Auschwitz,” Kor said. “Surviving was a full time job.”
Eva stole potatoes to keep her and her sister alive. Guards sometimes looked the other way when she stole food, because the girls were protected by Mengele. “As long as he wanted us alive, no one would harm us,” she said.
Then, just four days before the girls’ 11th birthday, Auschwitz was liberated by the Soviet Army. The twins were marched out of the death camp before Russian movie cameras, and eventually they were allowed to move to Israel.
Eva met and married Michael Kor, another Holocaust survivor, and moved to Indiana. Her sister Miriam also married but stayed in Israel. The sisters worked together to organize CANDLES, Children of Auschwitz Nazi Deadly Lab Experiments Survivors, to help locate other survivors of Mengele’s deadly experiments. Through their efforts, 122 twins living in 10 countries around the world were eventually reconnected.
“I do believe in the need for medical research and ethical human experimentation,” she told the audience of scientists and physicians. She introduced them to her son, Dr. Alex Kor, a podiatrist at Johns Hopkins Medical Center in Baltimore.
“Alex was diagnosed with advanced cancer that had metastasized to other parts of his body. The treatments he received saved his life,” she said. “I am so very grateful that you (the medical community) found a cure for my son.”
Medical advances also helped Eva’s sister Miriam, the only other survivor of the Mozes family. Miriam suffered kidney failure after the birth of her first child, and doctors in Israel found her kidneys had been damaged, most likely by Mengele’s experiments. Miriam eventually died in 1993 of complications from the condition.
Kor implored all physicians and scientists to remember Mengele’s human subjects when they are conducting their own medical research. “Medical science can only benefit mankind when the researchers respect the wishes of their human subjects and treat them with dignity,” she said. “Science should be for the sake of mankind, not for the sake of science alone.”
In 1995 Kor was able to meet face to face with repentant Nazi physician Hans Munch, and they traveled together back to Auschwitz to commemorate the 50th anniversary of the liberation of the death camp. On that journey, she said she discovered a way for her to heal both her body and her soul.
“I forgave the doctor, who oversaw the gas chambers where the rest of my family was killed,” she said. “And I realized I had the power to even forgive the Angel of Death. Now, I am no longer a victim of Auschwitz.
“This act of forgiveness is an act of self-healing. I believe forgiveness is a modern miracle of medicine.”
Methodist Hospital, Houston (2012, December 6). Survivor of Nazi 'twin experiments' talks to doctors about human subjects research.
By Thoughts & InCytes | February 01, 2013 at 09:04 PM EST | No Comments
By CiM Staff
The US Department of State releases its 2012 Trafficking in Persons Report. Below are excerpts from the press conference. Cancer InCytes (CiM) wishes to highlight the connection between social injustice and healthcare injustice, which is our focus [Emphasis added by CiM].
Comments by Maria Otero, Under Secretary for Civilian Security, Democracy, and Human Rights
"Trafficking challenges are one of the problems that we have. And it is also the one area that deals with one of our most fundamental values. That is the basic freedom and dignity of every individual. Trafficking also tears at the very fabric of society. It rips families apart. It devastates communities. It holds people back from becoming full participants in their own political processes in their own economies. And it challenges the ability of countries to build strong justice systems and transparent governments. That’s why fighting modern slavery is a priority for the United States."
"While governments bear this responsibility of protecting their individual citizens, this fight depends on a broader partnership as well. Without the efforts of civil society, the faith community, the private sector, we would not be able to advance and we would not be able to see the advances that the report highlights. The report that we are issuing today guides our work. It represents the very best knowledge and information on the state of modern slavery in the world today. It shows the fruit of partnerships around the world."
Comments by Luis CdeBaca, Ambassador-at-Large, Office to Monitor and Combat Trafficking in Persons
"And just as trafficking takes many forms, the way that we fight slavery today, the way that we provide hope for those who have been exploited, is growing. It is growing more diverse and more innovative, and so are the people who are stepping up."
"We see it in the private sector, where corporate leaders are using their business skills. They’re hearing from consumers who don’t want to buy things tainted by modern slavery. Leaders like CEO Tom Mazzetta. When he read a report about forced labor in the fishing industry, he wasn’t just shocked. He acted. He wrote two letters. The first was to the company he used, until that day, to source calamari. The second was an open letter to all of his customers telling them that his brand was his family, his family name, and he would not taint it or his customers with slavery in his supply chain. We’re inspired by his principled stand."
"We see it in people’s day to day lives, like when Aram Kovach was watching CNN one day. He saw the story of a young boy castrated because he refused to take part in a begging ring. He wasn’t just horrified by the reality of modern slavery. Aram did something. He got in touch with the boy’s family and he paid for him to come to the United States for surgery. Mr. Kovach we’re moved by your compassion."
By Thoughts & InCytes | January 29, 2013 at 08:26 PM EST | No Comments
Moffitt Study Explores Links between Sociodemographic Factors and Cancer Screenings
By Uduak Thomas, M.A.
A recent study done by researchers at Moffitt Cancer Center suggests that Hispanics are less likely than other populations to trust health care providers, a situation which they say negatively impacts cancer screening rates within the population.
In a paper published in the November issue of the Journal of Health Care for the Poor and Underserved, the researchers explained that they conducted a random telephone survey of a subset of blacks, whites, and Hispanics in New York, Baltimore, and San Juan, Puerto Rico.
They were trying to understand the sociodemographic factors associated with fears and mistrust as it relates to patient-provider relations and its impact on cancer screenings.
The survey included responses from 355 blacks in New York and Baltimore, 311 Hispanics in San Juan and New York, and 482 whites in New York and Baltimore. Participants' ages ranged between 18 to 94, and incomes between $20,000 to more than $75,000 per year.
The researchers found that compared to whites, Hispanics were nearly twice as likely to report fear of being used as a guinea pig and lack of trust in medical professionals as factors that would contribute to their unwillingness to participate in cancer screenings.
Because cancer screenings offer opportunities for early detection diagnosis, and treatment, the researchers encourage health care providers to do a better job of instilling trust and dispelling certain fears, particularly among Hispanics, in order to improve rates among lower-income minorities.
Uduak Thomas, M.A., is a science writer specializing in life science research and healthcare.
Jenna L. Davis, Shalanda A. Bynum, Ralph V. Katz, Kyrel Buchanan, and B. Lee Green. "Sociodemographic Differences in Fears and Mistrust Contributing to Unwillingness to Participate in Cancer Screenings." Journal of Health Care for the Poor and Underserved 23.4 (2012): 67-76.
By Thoughts & InCytes | January 23, 2013 at 02:44 PM EST | 1 comment
By M. R. Raju, D.Sc.
The Nobel Laureate, Henri Bergson, succinctly stated as early as 1927 that: “Progress in mechanical inventions took place during 19th century. It was assumed that the material development would raise the moral level of mankind. Experience proved that it does not automatically result in moral perfection in men—[it] may even present dangers unless accompanied by a corresponding spiritual effort.”
I was very happy to note that the American President, Mr. Obama, brought out the name of Mahatma Gandhi in his election campaign while no such sincere mention is being made by Indian political leaders. Some of the best human resources from all over the world are contributing to America’s progress. I am glad to note that the new public health magazine Cancer InCytes focuses on the healthcare needs of disadvantaged populations.
In spite of the major developments in science and technology, the health care needs of the common man are not being satisfactorily met, especially in developing countries. In India, nearly 75% of the population lives in rural areas, while most of the cancer centers and medical specialists live in major cities. Mahatma Gandhi believed that the future of India depended on the future of villages. Long before the Indian Independence Movement, he launched, by direct participation, a unique movement to improve sanitation, which included efforts to clean public toilets. The movement recognized that a practical solution for many health problems, including cancer, is prevention. It is important to note that the lowered mortality from infectious diseases in the industrialized world was achieved through sanitary engineering, public health measures, and better nutrition, long before the introduction of modern medical practices using immunization and antibiotics. Malnutrition is a leading cause of immune deficiency, especially in the developing world.
Unfortunately, disease treatment has become a business, and the modern practice of specialized medicine is not separate from monetary gain. The famous physician Dr. William Osler said: “If you listen to the patient, he is telling you the diagnosis.” Modern diagnostic centers are proliferating like cancer in India, but what are the diagnostic centers doing wrong? Because of the dependency on readily available diagnostic procedures, medical practitioners are not devoting enough time for interacting with patients and thus too quickly concluding the clinical examinations.
Partly because of the distance between urban cancer centers and rural areas, more than 75% of cancer patients present themselves when their cancers are in advanced and mostly incurable stages. The International Cancer Center, Mahatma Gandhi Memorial Medical Trust was developed to provide much needed radiation treatment of cancer in a rural area, from a purely patient-centric point of view. We are hoping that the proximity of a cancer center to patients, combined with a non-commercial patient-centric approach, along with good cancer awareness programs, would help in reducing this unacceptably high percentage of advanced cancers at the time of presentation.
Although radiation therapy is one of the primary modes of cancer treatment, people are more afraid of radiation than they are of cancer. To add insult to injury, people in India generally call radiation therapy “electrical current treatment” implying that it shocks, burns and could even kill. Radiation is perhaps the only agent that has been studied for more than a hundred years around the world, more than any other agent, and has very high standards of application internationally. Radiation therapy, instead of becoming a good model for safety for all other therapeutic agents, has become a source of fear. There is a need to improve communication with the public along with community service. This can be achieved more effectively when some of the socially conscious scientists are involved in improving the human condition.
From research in nuclear particles for cancer treatment in the United States to providing practical radiation treatment for cancer in rural India
It has been nearly 20 years since I voluntarily retired from Los Alamos National Laboratory in order to devote myself to providing appropriate radiation treatment of cancer in rural India. Before that, I enjoyed doing research in the use of nuclear particles for cancer treatment. I started at Massachusetts General Hospital and MIT studying neutron capture therapy from 1961-1963, then moved to Lawrence Radiation Laboratory [now Lawrence Berkeley National Laboratory] from 1963-1971. From 1971-1993, I researched negative pi-mesons and did comparative radiobiological studies of all nuclear particles being considered for cancer treatment.
We concentrated first on cancer awareness by writing the needed material in the local language of Telugu. Then we recognized that it cannot be effective unless we provide treatment when needed. We established a radiation treatment facility using a Cobalt-60 external beam, high dose rate brachy therapy, Spiral CT and other associated equipment, and started treating patients in 1994. This International Cancer Center was formally inaugurated by the then President of India, Prof. A.P.J. Abdul Kalam, in January, 2006. We have now treated about 1,300 patients for various types of cancer. The patients and their families are happy to get treated here in their familiar natural surroundings, not too far from where they live. We found out that they are the best spokespersons to dispel the fear of radiation and to promote its potential role in cancer treatment. We are interacting with high school students by emphasizing the importance of nutrition and hygiene in general, including the importance of cancer prevention and early signs of cancer. I find that this work is as equally satisfying as my earlier research work.
Scientists are altruistic by nature and there is a global need for some of them to be involved by direct participation through social action, especially students and scientists from the developing countries studying and working in the United States. Again, as stated by the Nobel Laureate Ilya Prigogine: it helps us to remember that, “The aim of science is to improve the human condition.”
Dr. M. R. Raju spent nearly thirty five years as a leading physicist who studied methods of applying nuclear physics to cancer therapy. Since 1994, he has been working in public health for nearly 20 years to bridge the access gap between radiation therapy and residents of rural India. He is now the Managing Trustee of the International Cancer Center, Mahatma Gandhi Memorial Medical Trust. Pedaamiram, Bhimavaram-534204, A.P. India. He can be reached at mgmtrust2 [at] gmail.com.
By Thoughts & InCytes | January 20, 2013 at 02:58 PM EST | No Comments
We want to bring your attention to a fabulous book that presents the problem of human disease as a construct of both sociological and biological factors; the solving of which requires addressing multiple layers.
Excerpts from Sick Societies: Responding to the Global Challenge of Chronic Disease, Oxford University Press, 2011.
David Stuckler and Karen Siegel, eds.
From the preface: [The emphasis is by a CiM editor]
“No matter how hard such a child tries to exercise or be healthy, he or she cannot overcome the powerful forces that make them more likely to die too young from diabetes or heart disease. Before they were born, their bodies were at much greater risk of becoming ill, ‘pre-polluted’ by toxic exposures in the womb. By the time they become adolescents, their blood pressure will be too high, their arteries calcified with plaque and fatty streaks, and their chance of developing ‘adult-onset diabetes’ will be significantly elevated1. These conditions will cause their bodies and organs to age at a pace five times faster than the previous generation, reducing their life expectancy by over 10 years.”
“The consequences of chronic diseases for human development, however, will be even greater in the very poorest countries where these rises will add to the unfinished challenge of fighting hunger, HIV/AIDS, and tuberculosis. When parents smoke, children go hungry and tuberculosis spreads; when men drink dangerously, women are at risk of abuse and can end up in hospitals. The main risks of heart disease, such as tobacco, indoor smoke, and diabetes, are also leading threats in tuberculosis epidemics; similarly, antiretroviral therapy, which has allowed many people with AIDS to stay alive, also has the undesirable side effect of increasing risks of diabetes and heart disease. Increasingly we have come to realize that the causes of poor health, be the chronic or infectious, have common roots and interconnected consequences. Until we begin to address comprehensively the risks that confront people living in resource-poor communities, which are increasingly becoming chronic, we will fail to achieve our basic goals to improve the health of the poorest and most vulnerable groups.”
“While it is easy to blame victims of chronic disease, Sick Societies suggests that their choices are not as free as we would first believe. As John Dunne put it, ‘No man is an island’; people make choices but not in the circumstances of their own choosing. The choices to eat poorly, drink dangerously, smoke to cope with stress, and the lack of time or money for exercise are all strongly shaped by the world around us. As few examples, in India, cell phones are now more abundant than toilets; ice cold Coca-Cola is more widespread than insulin to treat diabetes; and Western supermarkets and food companies are taking over traditional farmers’ jobs and markets, forcing workers to migrate to the cities or other countries in search of work, often ending up in slums. In these rapidly changing circumstances, the capacity for individuals and parents to make real, free choices is limited.”
By Thoughts & InCytes | January 12, 2013 at 05:17 PM EST | No Comments
This article is cross-posted from Science Daily. The original article can be found here.
Jan. 10, 2013 — Spin and bias exist in a high proportion of published studies of the outcomes and adverse side-effects of phase III clinical trials of breast cancer treatments, according to new research published in the cancer journal Annals of Oncology on January 10.
In the first study to investigate how accurately outcomes and side-effects are reported in breast cancer trials, researchers at the Princess Margaret Cancer Centre and University of Toronto (Toronto, Canada) found that in a third of all trials that failed to show a statistically significant benefit for the treatment under investigation, the reports focused on other, less important outcomes in order to influence positively the interpretation of the results.
In two-thirds of the reports there was bias in the way adverse effects of the treatment were reported, with more serious side-effects (those with toxicities graded as III or IV) poorly reported. This was particularly the case in trials that showed a significant benefit for the treatment under investigation. Only 32% of articles gave details of the frequency of grade III or IV toxicities in the summary (known as the "abstract").
The authors of the study call for authors, journals and experts who review the articles for journals to be more rigorous in encouraging unbiased reporting of trial results and in enforcing guidelines.
Professor Ian Tannock, medical oncologist and senior scientist in the Division of Medical Oncology and Hematology at the Princess Margaret, who led the research, said: "Better and more accurate reporting is urgently needed. Journal editors and reviewers, who give their expertise on the topic, are very important in ensuring this happens. However, readers also need to critically appraise reports in order to detect potential bias. We believe guidelines are necessary to improve the reporting of both efficacy and toxicity."
Prof Tannock and his colleagues identified all randomised controlled, phase III clinical trials for breast cancer therapies that had been published between January 1995 and August 2011. Out of a total of 568 articles, 164 were eligible for inclusion in the analysis. Phase III trials usually evaluate the efficacy and/or the best dose for a particular therapy that has already been tested in earlier, small trials, and they usually involve more patients than phase I or II trials. Often, they are the final stage that a drug or other therapy has to pass before the treatment can be licensed for use in patients in normal clinical practice, outside of the trial setting.
Trials always have a "primary endpoint" -- the specific event that is measured at the end of the trial to see whether or not the given treatment works. The primary endpoint is decided before the study begins. Often it relates to overall survival: did more patients survive or live longer on the new treatment than patients on the existing standard treatment? However, there can also be "secondary endpoints"; these are additional events that are of interest to the investigators, but which the study has not been designed specifically to address, and for this reason investigators have to be cautious in analysing and drawing conclusions from them. Secondary endpoints can include how much longer patients on the new treatment live without the disease progressing, spreading to other parts of the body or recurring, compared to patients on the standard treatment; what are the adverse side-effects and what is the quality of life.
Prof Tannock and his colleagues defined bias as "inappropriate reporting of the primary endpoint and toxicity, with emphasis on reporting of these outcomes in the abstract." They defined spin as "the use of words in the concluding statement of the abstract to suggest that a trial with a negative primary endpoint was positive based on some apparent benefit shown in one or more secondary endpoints."
They found that 54 (33%) trials were reported as positive, based on secondary endpoints, despite not finding a statistically significant benefit in the primary endpoint. "These reports were biased and used spin in attempts to conceal that bias," write the authors. They found that 58% of 92 trials that showed no benefit for patients from the experimental therapy (negative primary endpoint) used secondary endpoints to suggest benefit from the treatment.
A total of 110 (67%) of papers reported adverse side-effects of the experimental therapy in a biased manner. If a trial showed a benefit for the treatment (positive primary endpoint), then toxicities were more likely to be under-reported.
The first author of the study, Dr Francisco Vera-Badillo, clinical research fellow at the Princess Margaret, said: "We found a high incidence of biased reporting of the outcomes of clinical trials. In those with outcomes that were either negative or did not show a statistically significant benefit, spin was used frequently to influence positively the interpretation of the results, by focusing on apparent benefits from secondary endpoints.
"Where trials showed a positive outcome, the toxicities were less likely to be reported. A possible explanation for this could be that the investigators, sponsors or both, prefer to focus on the efficacy of the experimental treatment and downplay toxicity to make the results look more attractive."
The source of funding for trials (industry or academic) was not associated with bias or spin in the reporting of results and toxicities.
The above story is reprinted from materials provided by Oxford University Press (OUP), via AlphaGalileo.
F.E. Vera-Badillo, R. Shapiro, A. Ocana, E. Amir, I.F. Tannock. Bias in reporting of endpoints of efficacy and toxicity in randomized clinical trials for women with breast cancer. Annals of Oncology, 2013 DOI: 10.1093/annonc/mds636
By Thoughts & InCytes | December 23, 2012 at 07:57 PM EST | No Comments
By David H. Nguyen, Ph.D.
The Problem Behind the Problem
Cancer biologists cannot solve the cancer problem by themselves, nor can anyone else for that matter. I’m a cancer biologist, so what do I mean when I say this? Allow me to explain. I’m not talking about understanding the staggering complexity of cancer, which requires many researchers ranging from engineers to physicians. That’s another topic, for another (many other) article. What I want to talk about here is a higher order complexity at the societal level that prevents people from having access to cancer treatment, or to something as basic as a preventive measure. The fact of the matter is, no matter how good our cancer treatments or preventive knowledge become, if people don’t have access to them or cannot implement them, then their effectiveness is not applicable. This is why advocates in the fields of public health and social welfare are so important. Simply teaching people in third world countries to wash their hands regularly can have a tremendous impact on decreasing mortality. Washing hands isn't “rocket science”—it’s “people science”; and, it’s quite effective against the spread of germs. While hand washing doesn’t prevent cancer, it’s a great example of how public health information can go a long way in dealing with healthcare issues.
Case Study: Effective Pesticides, More Crops, More Cancer
The plight of migrant farm workers is a great example of the societal complexity that is beyond the prowess of cancer biology. Migrant farm workers are exposed to chemical pesticides at doses that cause cancer, among other ailments. Let’s take a step back and look at the web of problems beyond what can be seen through the lens of a microscope. In addition to the cancer problem, there is the public health issue of widespread chemical exposure, the lack of legal representation required get compensation and to secure future prevention, and the lack of access to health care, let alone the inability to afford health care. Thus, the problem is actually much bigger than just cancer. Having more effective chemotherapies only addresses one issue in this web.
Seeing the Whole Elephant, Not Just It’s Parts
During graduate school, I attended a commencement ceremony for graduate students from a biology department. The commencement speaker was a biochemist whose career had spanned many decades, which gave him a front row seat to the intellectual explosion that occurred in the past 60 years of molecular biology. Speaking to the dozens of graduate students on stage whom were about to be awarded their degrees, he gave them a charge. He reflected upon the ways in which his generation had solved many societal problems, but acknowledged that in the wake of their success, they created new ones. “This is why we need you,” he said, “to solve the problems that we have created.” Indeed, this charge will remain true for any future generation. Science has produced many materials and chemicals for the purposes of human flourishing—with no sign of letting up—but these inventions can negatively impact human health in unintended ways. As always, disadvantaged populations are the most vulnerable to these negative effects. As people who are privileged with adequate information, it falls upon us to ensure that others are protected. It’s not just about inventing better treatments, which is part of the answer. It’s about making sure that people are treated humanely, which can be done regardless of whether or not treatments improve.
David H. Nguyen, Ph.D., is Editor-in-Chief of Cancer InCytes Magazine. His research focuses on how non-tumor cells help tumors to grow, and how puberty makes young women more susceptible to breast cancer.
By Thoughts & InCytes | December 22, 2012 at 03:35 PM EST | No Comments
By Uduak Thomas, M.A.
Cancer and mHealth: A Case Study in India
The World Health Organization (WHO) defines “mobile health,” or mHealth, as a subset “electronic health” that is concerned with the “use of mobile and wireless technologies to support the achievement of health objectives.” It covers things such as health call centers, emergency tool-free telephone services, mobile telemedicine, mobile patient records, decision support systems, and other services.
It’s clear that mobile technologies, particularly cellular phones, are becoming cheaper and gaining in popularity globally including in poorer countries. One statistic from the International Telecommunication Union puts the number of wireless subscribers at around 5 billion with over 70 percent living in low and middle income countries.
The international healthcare community is finding ways to use these technologies to its benefit. According to the WHO, in a survey completed by 114 member states, 83 percent of respondents offered at least one type of mHealth service with many offering between four to six programs. While currently, the bulk of mHealth activity related to oncology is concentrated in higher income nations, the cancer burden in developing countries is growing and will demand increased attention from the global community in the years to come.
Currently, there are some ongoing mHealth projects in these regions. One example is a partnership that began two years ago between India’s Narayana Hrudayalaya Hospital and Harvard/MIT to use the latter’s Sana platform to screen at-risk individuals for oral cancer in rural and semi-urban regions in India.
Sana is an open-source software system that supports audio, images, location-based data, and text. It can be downloaded to the phone so that decision support is available even when the connection is poor or non-existent.
As of last summer, the tool had been used to screen up to 6,000 patients and they plan to scale that number up to 1.5 million people this year. In addition to screening individuals, the project investigators are training health workers and general physicians to use Sana to screen and manage oral cancer and other diseases. They are also studying the cost-effectiveness, scalability, and sustainability of their program. The Sana software promises to bring much needed help to the healthcare infrastructure of developing nations.
Uduak Thomas, M.A., is a science writer specializing in life science research and healthcare.
By Thoughts & InCytes | December 13, 2012 at 04:51 PM EST | No Comments
Q&A with Juliana Zhu, Esq., Senior Editor of Culture & Policy
Question: The initial title of one of our departments at Cancer InCytes was "Law & Policy," but this was later changed to "Culture & Policy." Why “Culture”? And why does it matter?
Answer: Those privileged to live in countries where the rule of law is reliable know the power of the law to protect people and deliver justice. Unfortunately, groups of people in those countries can choose to render the law powerless by collectively agreeing to perpetuate abuses. Take, for example, Lance Armstrong’s long and drawn out doping scheme, which enabled him to win all those Tour de France titles. Nearly a dozen of his own teammates witnessed him taking performance enhancing substances. One even confessed on national television that he had proof because he and Armstrong doped together! The public wonders just how much doping is known and ignored by professional athletes, only to be revealed years later, if at all. This collective disregard of rules and regulations is a cultural problem which can render even the most stringent laws powerless. With regard to the social injustices that are discussed at Cancer InCytes Magazine, cultural behaviors can be permissive and at times conducive to abuse and injustice. Advocates, including former victims, against sex trafficking agree that misogynistic views in Hip Hop music and culture objectify women as sex toys, thus creating the illusion in many young girls that being taken advantage of is cool or glamorous. In some cases, certain cultures harbor notions that domestic violence against women is normal, and that the community, let alone the victim, is powerless to change things. In other cases, cultures maintain that people can be treated as slaves, paid unfairly, and/or harmed without repercussion or consequences. For example, during World War II, it was culturally acceptable, and even legislatively enforced, to abuse and kill Jewish people on a national scale. Thus, culture can actually be more powerful than law, which is why one of our main departments was renamed from “Law & Policy” to “Culture & Policy.” Surrendering to culture as something that cannot be changed prevents us from helping those who are being abused. Culture is maintained by people, which means it can be changed by people.
By Thoughts & InCytes | September 13, 2012 at 01:01 AM EDT | No Comments
"It is a new day for cancer research and for cancer patients. Rapidly evolving technology is enabling extraordinary advances in cancer research that deepen our understanding of how cancer develops, grows and threatens the lives of millions. By exploiting this growing body of knowledge about cancer biology, we can be more strategic and innovative than ever before in the way we attack cancer."
"Unfortunately, continued progress against cancer is in jeopardy due to the current crisis in funding for cancer research and biomedical science at the federal level."
"Because of a decade of essentially flat budgets, compounded further by biomedical inflation, the NIH and NCI have effectively lost $6 billion or nearly 20 percent of its ability to support lifesaving research."
"Together, we can make a difference and ensure that cancer and biomedical research becomes a strong national priority."
By Thoughts & InCytes | June 20, 2012 at 02:10 AM EDT | No Comments
Special Briefing on the 2012 Trafficking in Persons Report
Ambassador-at-Large, Office To Monitor and Combat Trafficking in Persons
June 19, 2012
Now, this particular type of crime...is a crime that more countries and more governments are addressing. The report this year notes that the number of convictions globally reported is up from 3,619 last year to 3,969, and those are convictions of traffickers. That is not, however, a large number when one compares that to the global estimates of the victim population. A study released two weeks ago by the International Labor Organization estimates at least 21 million people held in bondage worldwide, and other estimates show it up to 27 million.
In this report the State Dept. defines human trafficking as:
It doesn’t matter if someone is in their own country; it doesn’t matter if they’re in sex or if they’re in labor. If the person is not free to leave, if the person is unable to go get another position and is being held through some type of coercive force, that person is considered a trafficking victim, and that person is entitled to the protections that we look to governments to provide.
By Thoughts & InCytes | May 24, 2012 at 11:53 PM EDT | No Comments
Country Reports on Human Rights Practices for 2011
From US Secretary of State's "Secretary's Preface":
Our reports are founded on the simple truth at the heart of the Universal Declaration of Human Rights – that all people are born free and equal in dignity and rights. Respect for human rights is not a western construct or a uniquely American ideal; it is the foundation for peace and stability everywhere.
The world changed immeasurably over the course of 2011. Across the Middle East, North Africa, and far beyond, citizens stood up to demand respect for human dignity, more promising economic opportunities, greater political liberties, and a say in their own future.
By Thoughts & InCytes | May 14, 2012 at 03:31 AM EDT | No Comments
ICTR Judgment Against Perpetrators of Genocide in Rwanda
Department Spokesperson, Office of the Spokesperson
May 9, 2012
The United States welcomes the May 8, 2012 International Criminal Tribunal for Rwanda (ICTR) appeal decisions in the cases of Gaspard Kanyarukiga, Aloys Ntabakuze, and Ildephonse Hategekimana. The Appeals Chamber of the ICTR affirmed the convictions of these three individuals for genocide and crimes against humanity, among other crimes. Although some counts against Ntabakuze were set aside by the Appeals Chamber, the decision indicates a careful, transparent, and balanced judicial process.
The three were sentenced to 30 years, 35 years, and life in prison, respectively. Ntabakuze and Hategekimana were both officers in the Rwandan Army (commander and lieutenant). Kanyarukiga, a businessman, was convicted of genocide based on his participation in the planning of the destruction of a church in Kivumu, which resulted in the death of approximately 2,000 civilians.
There are still nine ICTR fugitives at-large and the United States urges all countries to redouble their cooperation with the ICTR so that these fugitives can be expeditiously brought to justice.
By Thoughts & InCytes | April 23, 2012 at 01:00 AM EDT | No Comments
Two young women with bright futures turn down other universities so that they can serve our country at prestigious military academies. But their careers are ruined by rape and institutional denial. The charges are allegations at this point, but a thorough investigation is necessary to bring justice and stop such crimes in the military. Our taxpayer dollars fund the military.
By Thoughts & InCytes | April 20, 2012 at 03:29 PM EDT | No Comments
The New York Times Opinion Pages has an 8-person debate over whether legalized prostitution is "safe." Can an industry with such a poor record of human rights ever be made safe by laws if greedy people are always trying to find legal, yet unethical, loopholes in current laws?
By Thoughts & InCytes | April 14, 2012 at 05:20 PM EDT | No Comments
We are excited to announce that the inaugural issue of Cancer InCytes magazine will be available for free download in November of 2012. In addition to discussing topics relevant to cancer research, there will also be stories about cancer survivors and victims of human trafficking. Input your email on our Main page or follow us on Facebook (Search for Cancer InCytes) to receive updates.