Biological rather than chronological age may be a better way of assessing a patient's ability to react to treatment and recover from disease, according to Prof. Jim Cassidy, a leading colon cancer researcher and clinician at the University of Glasgow, who visited Israel recently.
The gastro-oncology expert, who was invited to address physicians at five medical centers around the country, said colon cancer and many other tumors affect mostly older people. But how does one define "old"? The eastern side of Glasgow, he noted, is populated mostly by poor people. "At 50, many of them look 120," he said, with only a little exaggeration. But the western side of the Scottish city has residents who are upper and upper-middle class, able to take care of themselves. "At 50, they look 30."
When the results of chemotherapy for colon cancer are compared between populations, some studies show that older groups tolerate these drugs less well than younger populations, while some say tolerance is the same. How does one explain it?
Cassidy, clinical editor of the British Journal of Cancer, says biological age - determined by how one has cared for one's body and one's living conditions - is a more accurate measure of health and responsiveness to drugs than the age on one's birth certificate. "I hope we can begin to get away from chronological age" in medicine, he added.
The expert from Scotland, who has been a consultant to Roche Pharmaceuticals, lectured to local oncologists about Cepacitabine, an oral chemotherapy drug made by Roche and known by the commercial name Xeloda. This drug has been shown by many researchers around the world to be "at least as effective" as the older injected chemotherapeutic drugs fluorouracil plus leucovorin in colon cancer patients who have had a tumor removed. Their findings were published recently in the New England Journal of Medicine and presented as a "breakthrough."
This drug, Cassidy told the Israeli audience, is an "effective alternative to intravenous" chemotherapy in the adjuvant treatment of colon cancer, meaning it helps prevent a recurrence. Disease-free survival in the 1,000 colon cancer patients who received Xeloda was at least equivalent to that in the 983 who received the injected agents. Xeloda has been approved by Britain's National Health Service for treating relevant patients, but has not yet been added to Israel's basket of health services for adjuvant treatment of colon cancer.
He noted that such an addition would be welcome, as nearly one million people are diagnosed annually with colorectal cancer, and of these, 230,000 are eligible for adjuvant chemotherapy. Half a million people die of it each year. While not a cure, adjuvant chemotherapy can reduce the risk of relapse and prolong the survival of patients who have had a tumor removed, especially in Stage III of the disease, said Cassidy, whose Glasgow medical center has 200 oncology beds.
TO GARGLE WITH WATER OR NOT?
Daily gargling with water appears to ward off colds among healthy people, according to Japanese researchers reporting in the November issue of the American Journal of Preventive Medicine. But an American expert is throwing cold water on the study.
"The most important finding in our study is that the common cold could be prevented over 30% of the time by daily gargling with water," said lead author Prof. Kazunari Satomura, an internal medicine and epidemiology specialist at Kyoto University. "This simple hygienic habit could contribute to public health, and would have obvious economic benefits," he added.
The investigators enrolled 387 healthy volunteers aged 18 to 65. They were randomly assigned to gargling water, gargling with the antiseptic povidone-iodine or receiving usual care. The participants then led their normal lives for 60 days, or until they caught an upper respiratory tract infection - whichever came first. They were asked to keep up with normal hand-washing and avoid cold remedies during that time. A total of 130 subjects contracted a cold, sore throat, sinus infection or bronchitis. There was no significant difference in the rate of first infection between the control group and the povidone-gargling group, but there was a 36% decrease among water garglers compared to controls.
However, the results may not be as impressive as they appear, according to Prof. Peter Muennig of the School of Public Health at New York's Columbia University. Muennig says that while the researchers found a "borderline statistically significant effect" for water gargling, there was no true placebo group - that is, there was no control group in which people could gargle with "fake" water. Sometimes, those who believe falsely they are being treated get better on their own. "In this case, there was no such group," Muenning said. "Because people in Japan, and Asia in general, tend to believe that [gargling] is an effective preventive modality, it is possible that the positive result noted was due to the placebo effect."
The researchers acknowledge that participants knew which treatment they were receiving, but argue that the general population believes povidone-iodine is more effective than water, so any bias likely would have been against water. Muennig says the investigators report no clear mechanism by which gargling reduces one's chances of getting a cold, but speculate that gargling might clear the throat of germs before they have a chance to spread.
"If that is the case," he added, "we would expect eating and drinking to do the same thing. Their claim that there is a 36% reduction in the chances of getting a cold with gargling must be taken with a gargle of salt."
Administrators at Soroka University Medical Center in Beersheba were surprised recently to get an unscheduled visit from a 20-year-old student named Simona from the University of Cologne who came to study Hebrew. She arrived with an envelope containing 500 Euro. Why? Because her uncle, Reinhold Frei, had been flown to Soroka from Ein Gedi in 1962 after being bitten by a poisonous snake. The head of emergency medicine, a Dr. Levine, saved his life. As an expression of gratitude, he asked his niece to bring his belated donation to the hospital.