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Category Archives: health

7 Simple Ways to Cut Your Cell Phone Cancer Risk

Does the World Health Organization’s statement that cell phones may cause cancerhave you thinking twice about making that phone call?

Of course it’s alarming to think that something that’s become such a can’t-live-without can be linked to brain cancer, but there’s a lot even the most cell phone-addicted people can do to minimize health risks.

Any potential links to cancer stem from the low levels of radiation cell phones emit. Lower your exposure to the radiation, and you’ll reduce the potential links to cancer or other health problems:

  1. Use a headset. Sounds obvious, but headsets emit much less radiation than cell phones do, according to the Environmental Working Group (EWG), and they keep your cell phone away from your head. The farther away you are from a source of radiation, the less damage it can do.
  2. Text when you can. Your constantly texting teens are onto something: Cell phones use less energy (and emit less radiation) when you text than when you talk, says the EWG. Texting also keeps the radiation source farther away from your brain.
  3. Use cell phones for FYI-only calls. Don’t use your cell phone for that long overdue, hour-long catch-up with your sister. Keep calls as short as possible —Do you need me to get the dry cleaning, honey? — and switch to a landline if they’re veering off into chitchat territory.
  4. Watch the bars. Can you hear me now? If you’re struggling to maintain a connection, ditch the call and wait until you have better service. When your phone has fewer signal bars, it has to work harder (and, therefore, emit more radiation) to connect.
  5. Keep the phone away from your ear when you can. EMF-Health.comrecommends waiting for the call to connect before you bring the phone to your ear, which minimizes radiation exposure. And when you talk, tilt the phone away from your ear and bring it in close when you’re listening. That’s because the radiation levels are “significantly less when a cell phone is receiving signals than when it is transmitting,” Lin Zhong, assistant professor of electrical and computer engineering at Rice University in Houston, told The New York Times.
  6. Don’t make calls in elevators or cars. You already it’s dangerous to talk and drive; EMF-Health.com says that cell phones use more power to establish a connection in enclosed metal spaces like cars and elevators.
  7. Make sure your kids use the landline. It seems like even toddlers are using cell phones today, but experts say kids are the most vulnerable to potential radiation dangers. The EWG says children’s brains absorb twice as much cell phone radiation as adults. According to The New York Times, health authorities in Britain, France, Germany, and Russia all have warnings against letting children use cell phones.

The Truth About Everyday Radiation Exposure

Japan’s ongoing nuclear crisis understandably has people around the world worried about radiation exposure and the potential health risks it may pose. According to the latest reports, radiation from Japan was detected in Southern California late this week, but experts are quick to point out that the levels are far from dangerous. The readings were “about a billion times beneath levels that would be health threatening,” a diplomat with access to United Nations’ radiation tracking told the Associated Press.

Nor is it unexpected. “Whenever radioactive particles get in the atmosphere, they have the potential to spread around the world,” says James Thrall, MD, president of the American College of Radiology. “But they get diluted as they travel, so they’re unlikely to pose any real health problem.”

In fact, we’re probably exposed to significantly more radiation every day than the miniscule fallout arriving from Japan. Here’s a quick tutorial on radiation to put our collective anxiety in perspective:

What Is Radiation?

Radiation is a form of energy in waves. It exists on a spectrum, with low-frequency radiation (from radio waves and microwaves) on the low end and high-frequency radiation (from gamma rays and x-rays) on the high end. All radiation affects the cells in our bodies to some extent, but the lower the frequency of the waves and the lower the exposure, the less dangerous it is.

To understand the risks of high-frequency radiation — the kind we’re talking about in this article — think back to high school physics: These waves have enough energy to knock electrons off molecules, which can cause damage to cell DNA that can ultimately lead to cancer.

How Are We Exposed to Radiation?

We encounter radiation each day from a variety of sources. The average American is exposed to about 6 millisieverts (mSv) of radiation annually, according to the United States Nuclear Regulatory Commission (USNRC). Half of this typically comes from background radiation that occurs naturally in the environment, and half comes from medical tests, such as X-rays, mammograms, and CT scans.

According to Kelly Classic, MS, spokesperson for the Health Physics Society, sources of environmental radiation include:

  • Radioactive compounds in soil and building materials like concrete, brick, and stone
  • Radiation from outer space that your encounter when you fly on airplanes or visit high-altitude places
  • The mineral potassium in your own body (a small fraction of potassium, which our bodies need to function, is radioactive)
  • Radon gas in the home, which accounts for about 2 mSv of exposure each year, and is the largest contributor of background radiation

Finally, there’s the kind of radiation released during nuclear reactions, such as what’s disseminating from Japan’s Fukushima Daiichi plant.

Here’s a look at various sources of radiation exposure (dose of radiation in millisieverts (mSv)), according to data from the Health Physics Society and the U.S. Environmental Protection Agency (EPA). By way of comparison, a single dose of radiation below 0.01 mSv is considered negligible by the National Council on Radiation Protection and Measurements.

  • Banana: 0.0001
  • Dental X-ray: 0.005
  • Living within 50 miles of a nuclear power plant: 0.01 (per year)
  • A flight from New York to Los Angeles: 0.04
  • Smoking 1 ½ packs of cigarettes: 0.08
  • Chest X-ray: 0.1
  • Living at sea level: 0.25 (per year)
  • Mammogram: 0.3
  • Living in Denver: 0.5 (per year)
  • Abdominal CT scan: 14
  • Measures between reactors No. 3 and No. 4 during the March 15 explosion at the Fukushima plant: As high as 400 per hour

What Level of Radiation Exposure Is Safe?

It’s well-established that exposure to large amounts of radiation at once can cause acute sickness and even cancer. (A 1,000 mSv-dose can trigger acute radiation sickness, causing symptoms such as nausea and vomiting; 3,000 mSV can be lethal, according to Thrall.)

But there’s no good data on the long-term risks of the low levels of radiation to which we’re continually exposed.

According to the World Nuclear Association, annual exposure to 100 mSv or greater carries a measurable, though small, increase in cancer risk. Below that level, it’s believed that your body’s cells are able to heal themselves from radiation. “There are enzyme systems in the body that repair damage from these low levels of background radiation,” says Thrall.

But even small levels of radiation exposure may impact cancer risks later in life.

This has been of particular concern in the medical community, where some experts worry that increasing use of diagnostic CT scans (which has skyrocketed from 3 million annual scans nationwide in 1980 to 70 million in 2007, according to MedPage Today) will impact future cancer rates. For example, in one 2009 study, National Cancer Institute researchers estimated that one in 270 women and one in 595 men who had a heart CT at age 40 would eventually develop cancer related to the test.

While the health benefits of necessary diagnostic imaging usually outweigh the small risks of secondary cancers, it’s always a good idea to talk to your doctor before any procedure involving radiation to understand exactly what you’re getting, why you need it, and what the potential health risks may be.

Bottom line: Americans are exposed to far more radiation in their daily lives — and especially from certain medical tests — than from dispersed particles traveling across the Pacific. “With what we know now about the situation in Japan, there are no personal or public health risks apparent for people in the United States,” Thrall says.

Do Cell Phones Cause Cancer?

Though it seems hard to believe, cell phone technology only became widely available in the 1990s. By December 2008, about 87 percent of the United States population had cell phone service — that’s an estimated 270 million users.

But the growing popularity of cell phones has prompted concerns about their cancerrisk. Some think that low-level radiation produced by cell phones could increase that risk, particularly related to head or neck tumors.

Cancer Risk and the Cell Phone: About the Exposure

It is true that cell phone users are exposed to radiofrequency (RF) energy, which is a low-frequency form of radiation. Cell phones emit this radiation mainly through their antennas. A cell phone user’s total exposure to RF energy from the device depends on:

  • The amount of time they spend on the phone
  • The amount of RF energy produced by their specific cell phone
  • The distance from the cell phone to the nearest cellular tower — the farther away the phone is, the more RF energy it must produce to provide a clear signal
  • The amount of cell phone traffic at the time — again, the phone must produce more RF energy to compete with other calls
  • The use of a Bluetooth headset or other hands-free device, which puts distance between the cell phone and the user

Cancer Risk and the Cell Phone: Myth vs. Fact

Researchers are doubtful that RF energy in and of itself has the potential to be harmful, says Michael J. Thun, MD, vice-president emeritus of epidemiology and surveillance research for the American Cancer Society.

For one thing, RF energy is much less powerful than known forms of cancer radiation. “The radio frequencies that cell phones emit are halfway between a FM radio and a microwave,” Dr. Thun says. “These emissions do not have enough energy to break DNA. They are different from X-rays and other types of ionizing radiation like cosmic rays and gamma rays.”

Other people have postulated that RF energy could cause tumors by heating the cells in the head and neck, much as microwave ovens use energy to stimulate molecules and heat food. This, too, has been shown to be unlikely, Thun says. “This [theory] has been tested in mice and rats,” explains Thun. “These studies have not shown any evidence that low-level radio frequencies from cell phones promote the development of tumors.”

Cancer Risk and the Cell Phone: What Other Studies Show

Epidemiological studies and research using lab animals have so far found little evidence of a relationship between cell phones and cancer. These studies have:

  • Compared cell phone users with non-users and found no significant difference in cancer rates
  • Studied people with brain tumors and found that they do not report more cell phone use than other people
  • Exposed lab rodents to known carcinogens and RF energy and found that the energy didn’t have any impact on tumor development
  • Found no evidence of a “dose response,” in which increased use of cell phones equals increased risk of brain tumors

However, cell phones are such a new phenomenon that it’s difficult to make any pronouncements regarding long-term effects. “We’ve only had 10 or 15 years of experience, so the final votes aren’t in,” Thun says.

Also, some studies have found slight evidence of a possible risk. For example, a few studies have found slightly increased cancer risk on the side of the head to which users hold their cell phones, although other studies found no such evidence.

Thun suggests a simple solution for those who worry about cancer from using a cell phone. “People who are concerned about the safety of cell phones can use a headset or speakerphone, or some other device that holds the phone away from their heads,” Thun says. “That eliminates their exposure.”

Kids and Cell Phone

Gone are the days of kids stretching the cord of the one house phone into a quiet corner to have some privacy while chatting with friends. Now kids as young as 5 years old are using cell phones.

Aside from concerns that cell phones give kids more phone privacy than you might be comfortable with, some parents are worried that cell phone radiation could be causing them physical harm. Cell phones emit low levels of electromagnetic radiation, and some are concerned that this can increase the risk for cancer and other health problems — and that children may be more vulnerable than the adult population because their brains are still developing. Also, over the course of their lifetime, they could be exposed to radiation for many more years than adults who started using cell phones much later in life.

Although several studies have been done on adults (and only adults), the results have been mixed and none has yet given a definitive answer to the question of whether cell phone use increases cancer risk. Even the largest study done to date couldn’t conclude that cell phones increase the incidence of tumors, but more, wider research is already in the works. Also, one large study involving children is under way.

What is a parent to do in the meantime? First, consider the existing research, and then make a game plan.

Cell Phone Radiation: The Research

In a recent, large study, researchers interviewed 5,117 adults in 13 countries with two of the most common types of brain tumors about their cell phone use. They found no increase in risk for brain tumors among people who used cell phones. Although those who had the highest exposure to cell phones may have had a higher risk for one particular type of brain tumor, the study authors said study biases and errors could have contributed to the results and they found it to be inconclusive.

Other studies have taken different approaches. “The best evidence comes from a surprising type of study,” says Anatoly Belilovsky, MD, medical director of Belilovsky Pediatrics in Brooklyn, N.Y. Most people have a favorite side to hold their cell phone, and researchers have compared the incidents of tumors on the favorite vs. the other side, he says. Having a tumor on the favorite side was anywhere from 1.3 to 6 times higher, Dr. Belilovsky reports. While 1.3 times is a very small increase in risk, 6 times higher is substantial, he adds. The findings also seem to suggest that people who use cell phones the most have a slightly higher risk of cancer on the same side they use it, he says.

The problem with cell phone studies is that there are so many other factors that cell phone use may be linked to and that could cause an increased cancer risk, such as job stress or being a business frequent flyer, which also exposes you to radiation, Belilovsky says.

Protect Your Kids From Potential Cell Phone Dangers

With so many unknowns, how do you answer your tween or teen’s plea for a cell phone? Here are some guidelines for parents:

Wait for a good reason to give kids their own cell phones. The age at which you give your kids phones depends on a lot of factors — need, affordability, and, yes, even how many of their friends have one.

The most important reason may be for safety. Gary Baker, a communications director in New York City, gave his twin boys cell phones in seventh grade when they were 11 and started taking public buses to school.

If there’s not a pressing reason, waiting may be a good idea. “You don’t want to leave them completely outside of their social group,” Belilovsky says. But it’s also not a good thing for them to develop a callus on their outer ear, he adds.

Allow texting. Actually talking on a cell phone is old-school for many kids. They’ve switched to texting, and that’s a good thing, Belilovsky says, because it keeps the phone away from their head.

Get a hands-free device. A cell phone emits radiation from its antenna, which is on the handset. Using a hands-free device will ensure that your kids aren’t putting the antenna next to their head when they talk.

Limit their minutes. Unlimited minutes may not be the best cell phone plan to choose if you’re concerned about health risks. It’s like giving your kids an open invitation to permanently attach the phone to their ear.

Put the cell phone to bed every night. One way to cut down on the amount of time your kids spend on the cell phones (and to help them get more sleep) is to make a rule that the phones go on a charger at bedtime. And make sure the charger is outside of their rooms. That’s what Baker did for his twin boys (who are now 12) when late-night phoning and texting started to become a problem.

Keep a land line at home. It may be a good rule of thumb to hold long conversations on a land line and tell your kids the cell phone is only to be used when they’re on the go or making a quick call.

Although results have been inconclusive, there’s no doubt that researchers will continue to study the potential effects cell phone radiation may have on kids’ brains. In the meantime, enforcing judicious cell phone use may be the best protection.

Global Warming May Pose Health Risks

Medical and public health groups are banding together to explain how global warming has taken a toll on human health and will continue to cause food-borne illnesses, respiratory problems, and deaths unless policy changes are enacted.

In a conference call with reporters, the heads of the American Medical Association (AMA) and the American Public Health Association (APHA) joined with a pediatrician and a scientist to lay out what they say is a major public health issue: climate change caused by global warming.

The “evidence has only grown stronger” that climate change is responsible for an increasing number of health ills, including asthma, diarrheal disease, and even deaths from extreme weather such as heat waves, said Dr. Georges Benjamin, executive director of the APHA.

For one, rising temperatures can mean more smog, which makes children with asthma sicker, explained pediatrician Dr. Perry Sheffield, assistant professor in the Department of Pediatrics and the Department of Preventive Medicine at the Mount Sinai School of Medicine, in New York.

There is also evidence that pollen season is also getting longer, she said, which could lead to an increase in the number of people with asthma.

Climate change also is thought to lead to increased concentrations of ozone, a pollutant formed on clear, cloudless days. Ozone is a lung irritant which can affect asthmatics, those with chronic obstructive pulmonary disease, and those with heart disease, said Dr. Kristie Ebi, who is a member of the Intergovernmental Panel on Climate Change.

More ozone can mean more health problems and more hospital visits, she said.

Aside from air-related ailments and illnesses, extreme weather can have a devastating effect on health, Sheffield said.

“As a result of global warming, extreme storms including hurricanes, heavy rainfall, and even snowstorms are expected to increase,” Sheffield said. “And these events pose risk of injury and disruption of special medical services, which are particularly important to children with special medical needs.”

Extreme heat waves and droughts are responsible for more deaths than any other weather-related event, Sheffield said.

The 2006 heat wave that spread through most of the U.S. and Canada saw temperatures that topped 100 degrees. In all, 450 people died, 16,000 visited the emergency room, and 1,000 were hospitalized, said Dr. Cecil Wilson, president of the AMA.

Climate change has already caused temperatures to rise and precipitation to increase, which, in turn, can cause diseases carried by tics, mosquitoes, and other animals to spread past their normal geographical range, explained Ebi.

For instance, Lyme disease is increasing in some areas, she said, including in Canada, where scientists are tracking the spread of Lyme disease north.

Ebi also recounted the 2004 outbreak of the leading seafood-related cause of gastroenteritis, Vibrio parahaemolyticus, from Alaskan seafood, which was attributed to increased ocean temperatures causing infected sea creatures to travel 600 miles north.

Salmonella outbreaks also increase when temperatures are very warm, Sheffield said.

A 2008 study also projected that global warming will lead to a possible increase in the prevalence of kidney stones due to increased dehydration, although the link hasn’t been proven.

Wilson said the AMA wants to make doctors aware of the projected rise in climate-related illnesses. To combat climate change, Wilson says physicians and public health groups can advocate for policies that improve public health, and should also serve as role models by adopting environmentally-friendly policies such as eliminating paper waste and using energy-efficient lighting in their practices.

“Climate instability threatens our health and life-supporting system, and the risk to our health and well-being will continue to mount unless we all do our part to stabilize the climate and protect the nation’s health,” said Wilson.

Benjamin added that doctors should pay attention to the Air Quality Index. For instance, if there’s a “Code Red” day, which indicates the air is unhealthy, physicians should advise patients (particularly those with cardiac or respiratory conditions) that it’s not the day to try and mow the grass.

“ER docs are quite aware of Code Red days because we know that when those occur, we’re going to see lots of patients in the emergency room,” Benjamin said.

The conference call came as Congress is considering what role the Environmental Protection Agency (EPA) should have in updating its safeguards against carbon dioxide and other pollutants.

While the EPA has the authority to regulate levels of CO2, a budget bill passed by the House of Representatives last the weekend prohibited the EPA from exercising that authority. Meanwhile, other bills are pending in Congress that would significantly delay the agency’s ability to regulate air pollutants.

AMA has a number of policies on the books regarding climate change, including a resolution supporting the EPA’s authority to regulate the control of greenhouse gases, and a statement endorsing findings from the most recent Intergovernmental Panel on Climate Change report that concludes the Earth is undergoing adverse climate changes, and that humans are a significant contributor to the changing weather.

In that statement, the AMA said it supports educating the medical community about climate change and its health implications through medical education on topics such as “population displacement, heat waves and drought, flooding, infectious and vector-borne diseases, and potable water supplies.”

The statement also said the AMA supports physician involvement in policymaking to “search for novel, comprehensive, and economically sensitive approaches to mitigating climate change to protect the health of the public.”

Cell Phones Affect Brain Activity

Holding a cell phone to your ear for a long period of time increases activity in parts of the brain close to the antenna, researchers have found.

Glucose metabolism — that’s a measurement of how the brain uses energy — in these areas increased significantly when the phone was turned on and muted, compared with when it was off, Dr. Nora Volkow, director of the National Institute on Drug Abuse, and colleagues reported in the Journal of the American Medical Association.

“Although we cannot determine the clinical significance, our results give evidence that the human brain is sensitive to the effects of radiofrequency-electromagnetic fields from acute cell phone exposures,” co-author Dr. Gene-Jack Wang of Brookhaven National Laboratory in Long Island, where the study was conducted, told MedPage Today.

Although the study can’t draw conclusions about long-term implications, other researchers are calling the findings significant.

“Clearly there is an acute effect, and the important question is whether this acute effect is associated with events that may be damaging to the brain or predispose to the development of future problems such as cancer as suggested by recent epidemiological studies,” Dr. Santosh Kesari, director of neuro-oncology at the University of California San Diego, said in an e-mail to MedPage Today and ABC News.

There have been many population-based studies evaluating the potential links between brain cancer and cellphone use, and the results have often been inconsistent or inconclusive.

Most recently, the anticipated Interphone study was interpreted as “implausible” because some of its statistics revealed a significant protective effect for cell phone use. On the other hand, the most intense users had an increased risk of glioma — but the researchers called their level of use “unrealistic.”

But few researchers have looked at the actual physiological effects that radiofrequency and electromagnetic fields from the devices can have on brain tissue. Some have shown that blood flow can be increased in specific brain regions during cell phone use, but there’s been little work on effects at the level of the brain’s neurons.

So Dr. Volkow and colleagues conducted a crossover study at Brookhaven National Laboratory, enrolling 47 patients who had one cell phone placed on each ear while they lay in a PET scanner for 50 minutes.

The researchers scanned patients’ brain glucose metabolism twice — once with the right cell phone turned on but muted, and once with both phones turned off.

There was no difference in whole-brain metabolism whether the phone was on or off.

But glucose metabolism in the regions closest to the antenna — the orbitofrontal cortex and the temporal pole — was significantly higher when the phone was turned on.

Further analyses confirmed that the regions expected to have the greatest absorption of radiofrequency and electromagnetic fields from cell phone use were indeed the ones that showed the larger increases in glucose metabolism.

“Even though the radio frequencies that are emitted from current cell phone technologies are very weak, they are able to activate the human brain to have an effect,” Dr. Volkow said in a JAMA video report.

The effects on neuronal activity could be due to changes in neurotransmitter release, cell membrane permeability, cell excitability, or calcium efflux.

It’s also been theorized that heat from cell phones can contribute to functional brain changes, but that is probably less likely to be the case, the researchers said.

Dr. Wang noted that the implications remain unclear — “further studies are needed to assess if the effects we observed could have potential long-term consequences,” he said — but the researchers have not yet devised a follow-up study.

“The take-home message,” Dr. Kesair said, “is that we still don’t know, more studies are needed, and in the meantime users should try to use headsets and reduce cell phone use if at all possible. Restricting cell phone use in young children certainly is not unreasonable.”

Exercise and Talk Help Ease Chronic Fatigue Syndrome

Patients with chronic fatigue syndrome who participated in programs aimed at helping them overcome their symptoms — a combination of exercise and counseling— improved more than those whose treatment was intended to help them adapt to the limitations of the disease, a large randomized trial found.

Mean fatigue scores among patients treated with graded exercise therapy — a tailored program that gradually increases exercise capacity — were 3.2 points lower than scores in patients who received specialist medical care alone, according to Dr. Peter D. White, of Queen Mary University of London, and colleagues.

Furthermore, fatigue scores were lower by 3.4 points among patients receiving cognitive behavioral therapy, in which a therapist works with the patient to understand the disease, alleviate fears about activity, and help overcome obstacles to functioning.

In contrast, among patients who were treated with a program known as adaptive pacing therapy, which emphasizes energy limitations and avoidance of excess activity, scores differed by only 0.7 points the researchers reported online in The Lancet.

In a press briefing describing the study findings, co-investigator Dr. Trudie Chalder, of King’s College London, said, “We monitored safety very carefully, because we wanted to be sure we weren’t causing harm to any patients.”

“The number of serious adverse events was miniscule,” she added.

Another co-investigator, Dr. Michael Sharpe, of the University of Edinburgh, commented that a difficulty in the management of chronic fatigue syndrome has been ambiguity — about the causes and whether these treatments recommended by NICE actually are effective.

“The evidence up to now has suggested benefit, but this study gives pretty clear-cut evidence of safety and efficacy. So I hope that addresses the ambiguity,” Sharpe said during the press briefing.

However, the investigators conceded that the beneficial effects of these treatments were only moderate, with less than one-third of participants being within normal ranges for fatigue and functioning, and only about 40 percent reporting that their overall health was much better or very much better.

“Our finding that studied treatments were only moderately effective also suggests research into more effective treatments is needed,” they wrote.

In addition, they stated that their finding of efficacy for cognitive behavioral therapy “does not imply that the condition is psychological in nature.”

The importance of cognitive behavioral therapy was further emphasized by Dr. Benjamin H. Natelson, of Albert Einstein College of Medicine in New York.

“This approach of encouragement of activity and discouragement of negative thinking should be a tool in every physician’s armamentarium,” he said.

“We know that cognitive behavioral therapy and gentle physical conditioning help people cope with any chronic disease — even congestive heart failure and multiple sclerosis,” Natelson said in an interview with MedPage Today.

Chronic fatigue syndrome is characterized by persisting or relapsing fatigue for at least six months that cannot be explained by any other physical or psychiatric disorder.

The fatigue is debilitating, and often is accompanied by joint and muscle pain, headaches, and tenderness of the lymph nodes.

In an editorial published with the study, Dr. Gijs Bleijenberg, and Dr. Hans Knoop, of Radboud University in Nijmegen, the Netherlands, explained the differences in these types of treatment for chronic fatigue.

“Both graded exercise therapy and cognitive behavior therapy assume that recovery from chronic fatigue syndrome is possible and convey this hope more or less explicitly to patients. Adaptive pacing therapy emphasizes that chronic fatigue syndrome is a chronic condition, to which the patient has to adapt,” Bleijenberg and Knoop wrote.

Graded exercise therapy and cognitive behavioral therapy have both been recommended by the U.K. National Institute for Health and Clinical Excellence, although evidence supporting these approaches remains sparse.

Some patient groups have expressed strong disagreement with these recommendations, arguing that cognitive behavioral and graded exercise therapies actually have caused harm to some patients.

These groups advocate exercise pacing and specialist medical care, according to the investigators.

To address this controversy, White and colleagues conducted the largest trial thus far of treatment for chronic fatigue, enrolling 641 patients from six U.K. specialty clinics.

Patients were randomized to receive specialist medical care alone, or specialist medical care plus cognitive behavioral therapy, graded exercise therapy, or adaptive pacing therapy for 24 weeks.

More than three-quarters were women, average age 38, and most had been diagnosed with chronic fatigue syndrome almost three years before entering the study.

At week 52, these percentages of patients improved by at least two points on the fatigue scale and by eight points or more on a physical function scale:

  • Cognitive behavioral therapy, 59 percent
  • Graded exercise therapy, 61 percent
  • Adaptive pacing therapy, 42 percent
  • Specialist medical care, 45 percent

The investigators also looked at percentages of patients who were in the normal range for fatigue and functioning at 52 weeks:

  • Cognitive behavioral therapy, 30 percent
  • Graded exercise therapy, 28 percent
  • Adaptive pacing therapy, 16 percent
  • Specialist medical care, 15 percent

Better outcomes also were seen for cognitive behavioral therapy and graded exercise therapy in a number of secondary outcomes such as social adjustment and sleep disturbances.

Serious adverse events were seen in 2 percent of patients in the cognitive behavioral therapy group, and in 1percent of each of the other three groups.

White’s group acknowledged that the trial had certain limitations, including the exclusion of patients unable to attend the therapy sessions, self-rating by participants, and the unblinded structure of the study.

They plan further study of factors such as cost-effectiveness of the treatments, possible differences in response among subgroups of patients, and long-term outcomes.

Chemical Found in Blood Holds

Even within the normal range, higher bilirubin levels appear to be associated with reduced risks of lung cancer, chronic obstructive pulmonary disease (COPD), and death, a longitudinal, prospective analysis of a large database showed.

For every 0.1-mg/dL increase in bilirubin level, the rate of lung cancer dropped by 8 percent in men and 11 percent in women, according to Laura Horsfall, MSc, of University College London, and colleagues.

In addition, the same incremental increase in bilirubin was associated with a 6 percent decline in the rate of COPD and a 3 percent decline in mortality for both sexes, the researchers reported in the Feb. 16 issue of the Journal of the American Medical Association.

“Based on our findings, bilirubin levels within the normal range appear to capture information about patients that may reflect a combination of environmental and genetically determined susceptibility to respiratory diseases,” they wrote.

Most people are familiar with bilirubin because of its role in jaundice — the yellowing of the skin that is sometimes seen in newborns but is also associated with liver disease.

Bilirubin is actually a byproduct of the turn over of red blood cells — the cells that carry oxygen throughout the body. Healthy individuals constantly replace old red blood cells with new ones. As the old cells are broken down they produce bilirubin, a chemical characterized by a distinctive yellow color.

The spleen and the liver taking in bilirubin and use it to break down or metabolize other substances into bile, which is used to aid digestion.

Although the study cannot establish causality for any of the relationships, there is some experimental evidence that bilirubin has benefits for respiratory health because of its cytoprotective properties, including antioxidant, anti-inflammatory, and antiproliferative effects, according to the researchers.

They noted that a better understanding of the possible mechanisms linking bilirubin levels to lung cancer, COPD, and death may lead to potential therapies that target the activity of UGT1A1, a liver enzyme responsible for converting insoluble bilirubin to an excretable form.

Horsfall and her colleagues examined data from the Health Improvement Network, a U.K. primary care research database.

Their analysis included 504,206 patients ages 20 and older from 371 practices. All of the patients had recorded serum bilirubin levels but no evidence of hepatobiliary or hemolytic disease.

Median bilirubin levels were 0.64 mg/dL in men and 0.53 mg/dL in women.

Through a median follow-up of eight years, there were 1,341 incident cases of lung cancer, 5,863 incident cases of COPD, and 23,103 all-cause deaths. The corresponding rates per 10,000 person-years were 2.5, 11.9, and 42.5.

For men, the rate of lung cancer per 10,000 person-years dropped from 5.0 in the lowest decile of bilirubin levels to 3.0 in the fifth decile. Similar declines were seen for COPD (19.5 to 14.4) and death (51.3 to 38.1).

The findings were similar for all outcomes in women, and the declines in both sexes remained significant after adjustment for age, body mass index, systolic blood pressure, smoking, alcohol intake, and a measure of social deprivation.

The authors acknowledged some limitations of the study, including possible residual confounding by unmeasured environmental exposures or race/ethnicity and the inability to establish causality for the observed relationships.

Marijuana Users at Risk for Early Psychosis

Psychotic illness occurs significantly earlier among marijuana users, results of a meta-analysis suggest.

Data on more than 22,000 patients with psychosis showed an onset of symptoms almost three years earlier among users of cannabis compared with patients who had no history of substance use.

The age of onset also was earlier in cannabis users compared with patients in the more broadly characterized category of substance use, investigators reported online in Archives of General Psychiatry.

“The results of this study provide strong evidence that reducing cannabis use could delay or even prevent some cases of psychosis,” Dr. Matthew Large, of the University of New South Wales in Sydney, Australia, and co-authors wrote in conclusion.

“Reducing the use of cannabis could be one of the few ways of altering the outcome of the illness because earlier onset of schizophrenia is associated with a worse prognosis and because other factors associated with age at onset, such as family history and sex, cannot be changed.”

Psychosis has a strong association with substance use. Patients of mental health facilities have a high prevalence of substance use, which also is more common in patients with schizophrenia compared with the general population, the authors wrote.

Several birth cohort and population studies have suggested a potentially causal association between cannabis use and psychosis, and cannabis use has been linked to earlier onset of schizophrenia. However, researchers in the field remain divided over the issue of a causal association, the authors continued.

Attempts to confirm an earlier onset of psychosis among cannabis users have been complicated by individual studies’ variation in methods used to examine the association. The authors sought to resolve some of the uncertainty by means of meta-analysis.

A systematic search of multiple electronic databases yielded 443 potentially relevant publications. The authors whittled the list down to 83 that met their inclusion criteria: All the studies reported age at onset of psychosis among substance users and nonusers.

The studies comprised 8,167 substance-using patients and 14,352 patients who had no history of substance use. Although the studies had a wide range of definitions of substance use, the use was considered “clinically significant” in all 83 studies. None of the studies included tobacco in the definition of substance use.

The studies included a total of 131 patient samples.

Substance use included alcohol in 22 samples, cannabis in 41, and was simply defined as “substance use” in 68 samples.

Alcohol use was not significantly associated with earlier age at onset of psychosis.

On average, substance users were about 2 years younger than nonusers were. The effect of substance use on age at onset was greater in women than in men, but not significantly so. Heavy use was associated with earlier age at onset compared with light use and former use, but also not significantly different, the authors reported.

Substance users were two years younger at the onset of psychosis compared with nonusers. Age at onset was 2.7 years earlier among cannabis users compared with nonusers.

Acknowledging limitations of the study, the authors cited the lack of information on tobacco use and its association with earlier age at onset of psychosis, and the lack of data on individual patients inherent in all meta-analyses.

Despite the limitations, the authors said the findings have potentially major clinical and policy implications.

“This finding is an important breakthrough in our understanding of the relationship between cannabis use and psychosis,” they wrote in conclusion. “It raises the question of whether those substance users would still have gone on to develop psychosis a few years later.”

“The results of this study confirm the need for a renewed public health warning about the potential for cannabis use to bring on psychotic illness,” they added.

Painkiller Use Common Among NFL Players

Retired National Football League players who abused opioid painkillers while active were most likely to use and abuse the same drugs after leaving the sport, the results of a telephone survey and analysis found.

The survey found more than half of the retired NFL players interviewed used opioidpainkillers during their career. Of those, 71 percent reported misusing the drugs while playing, and 15 percent said they still abuse the prescription medication, Dr. Linda B. Cottler, of Washington University School of Medicine, and colleagues reported online in Drug and Alcohol Dependence.

The former broadcaster and NY Giants great, Frank Gifford, said, “pro football is like nuclear warfare. There are no winners, only survivors.”

The findings from Cottler’s survey support Gifford’s assessment.

An analysis of survey data showed the rate of opioid misuse while the retired players were active in the NFL was roughly three times greater than the lifetime rate of nonmedical use of opioids in the general population of approximately the same age.

Misuse in the past 30 days in retired players was seven percent, versus less than two percent in adults 26 and older in the general population. Looking only at men in the general population, the abuse rate is about two and half percent.

The final sample included 644 former players listed in the 2009 Retired NFL Football Players Association Directory who had retired from 1979 to 2006 and had at least one phone number listed.

They completed a phone interview that discussed general demographic data, health status, pain, impairment, alcohol use, prescription opioid use, and illicit drug use. Prescription opioid use was measured for while a player was active as well as over the past 30 days. Participants were categorized into users and nonusers. Users were subcategorized as having used the drugs as prescribed, or having misused them.

Misuse was defined as taking more of the drug than prescribed, using it in a way other than prescribed, using it after a prescription ended, using it for a different reason, or using it without a prescription.

When compared against players prescribed opioids while in the NFL and with those who were non-users during their NFL careers, 17 percent of those who misused while playing used as prescribed in the past 30 days, 15 percent misused in the past 30 days, and 68 percent reported no use.

In a multivariate analysis, moderate to severe pain, undiagnosed concussions, and drinking 20 or more alcoholic drinks a week were the strongest predictors of misuse. Undiagnosed concussions were reported by 81 percent of misusers.

“This association might have been due to the fact that those who choose not to report concussions are the same players who choose not to reveal their pain to a physician, thus managing their pain on their own,” the researchers wrote. “They may believe that if they report a concussion, they will be pulled from active play.”

The researchers noted the study may have been limited by lack of detailed pain information from while a player was active, a small sample size, a more inclusive definition of misuse that included abuse of opioids a player was prescribed, and a sample that included potentially more-healthy-than-average retired footballers — the researchers noted interviews with former players not in the Retired Players Association uncovered “multiple examples of serious and heavy opioid abuse.”

They added that future research could measure number of alcoholic drinks and level of pain while active in the NFL against opioid use and abuse.

The study received funding from ESPN and the National Institute on Drug Abuse.

The researchers reported no other financial disclosures.