TIME Cancer

Tom Brokaw’s Cancer and His Hopeful Future

Harry & Jeanette Weinberg Inter-Generational Center Tour
Tom Brokaw attends the tour of the Harry & Jeanette Weinberg Inter-Generational Center in Silver Spring, Maryland. Kris Connor—Getty Images

Time 100 honoree Kathy Giusti explains how multiple myeloma patients' expected lifespan has doubled from what it was 16 years ago

My personal JFK moment came on January 12, 1996. I will never forget that day. I remember where I was, what time it was, even the weather that morning when I was diagnosed with multiple myeloma. Unlike many patients who hear about the disease for the first time I knew too well what this incurable blood cancer was all about. Partially my knowledge came from running worldwide operations for a major pharmaceutical company. The other reason was this rare cancer also ran in my family—my grandfather had myeloma. To my amazement, I was being offered the same medicines to treat my illness that patients were taking back in the late 1950’s.

My future looked grim. I was happily married with a beautiful one year old girl and suddenly I was facing an uphill battle with an uncommon and heterogeneous cancer with virtually no modern treatments available and no drugs in the pipeline. I was told to get my affairs in order—I had three years to live, if I was lucky. Despite those odds, it wasn’t in my nature to pull the covers over my head and hide. With the help of brilliant partners, donors, friends and family we started the Multiple Myeloma Research Foundation (MMRF) with the hope of one day finding a cure.

That was 16 years ago. For decades so little progress had been made in the field of multiple myeloma. So, why now, over the past 10 years has there been so much progress, and why are we so equally as hopeful for the next 10 years to come?

The answer I believe lies in the myeloma community itself, which has worked skillfully to identify the barriers to cures and develop a plan to show patients and their families that the tiniest cancer is making the greatest stride as a result of this tight knit, integrated collaboration.

Today we work with the best scientists, pharmaceutical partners, biotech companies and academic centers in the world to facilitate progress in drug development. We remain eternally grateful for the work they do and the amazing trials of these pioneering drugs they produce so quickly. In the past decade myeloma patients have seen the FDA approve six multiple myeloma treatments, and counting – an unthinkable timeline in oncology. As a result, we have witnessed the doubling of our patient’s life span.

Our hope for the future is equally exciting due to the rapid advancement of technology in terms of genomic sequencing and the ability to store, integrate and share data in an open access world where patients have become more empowered in driving toward a cure.

We’re seeing today a more robust pipeline of treatments for the many subtypes of the disease than ever before. Treating patients with the precise combinations of treatments for their subtype is the way of the future. The world has changed since I was diagnosed and patients who once felt so alone now hold the key to the cure. The more we raise awareness, the faster cures will be found. And the acceleration of finding cures won’t take decades any more thanks to these new technologies. Now patients can play a major role in not only elevating the consciousness of the disease, but by providing their tissue, sharing data and entering new trials, they are transforming outcomes for themselves and for those future patients who have yet to be diagnosed.

Kathy Giusti is Founder and CEO of the Multiple Myeloma Research Foundation (MMRF), the leading private funder of multiple myeloma research.

TIME Cancer

Breast Cancer Screening Isn’t Going Away—At Least Not Yet

Mammography
Brand X—Getty Images

The American Cancer Society reviewed the ongoing study years ago and concluded mammograms were still warranted

Just because a new study shows that mammography may not save lives, don’t expect the organizations that set breast cancer screening guidelines to automatically adjust their recommendations on who should get mammograms and how often.

A Canadian study published this week in the British Medical Journal tracked some 90,000 women over 25 years and found that women who underwent annual mammograms were no less likely to die from breast cancer than those who simply examined their own breasts for signs of disease. In light of this finding—along with the fact that the study included a large sample size tracked over a long period of time—it might seem logical that groups like the American Cancer Society (ACS) will alter their recommendation that all women over 40 get mammograms every year. Not so fast.

MORE: What Now? 4 Takeaways From the Newest Mammogram Study

Otis Brawley, chief medical officer for the ACS, has been outspoken about the downside of various types of cancer screening, arguing that benefits are often over-stated. But even he points out that the ACS examined the ongoing Canadian study when the group last updated its breast cancer screening guidelines seven years ago and concluded that annual mammograms for women over 40 were still warranted. (Findings from the study back then were similar to those published this week.) The ACS will take a fresh look at the research on mammography this year and may change its recommendations, but there’s no guarantee.

The U.S. Preventive Services Task Force, a government panel that exhaustively analyzes research and writes its own breast cancer screening guidelines, has concluded that annual mammograms for women in their forties reduces the relative risk of death by 15%. This means that for every 1,900 women who undergo annual mammograms, one life will be saved due to early detection. The downside of such population-based screening, which the Canadian researchers pointed out in their study, is that some women will undergo surgery, radiation and other treatments unnecessarily when non-fatal cancers or masses that look like cancer but are not are detected. Weighing this, the government panel revised their recommendations in 2009 to mammogram screenings every two years beginning at age 50.

MORE: The Screening Dilemma

But even beyond the tricky business of weighing benefits against harms, Brawley says there are aspects of the Canadian mammogram study that may undercut its findings. Although the trial used randomization, the gold standard in clinical research, women were assigned to receive or skip mammograms after they underwent breast exams. “That’s not a clean randomization,” says Brawley, “There might be some biases.”

Still, Brawley says be believed mammography has merit. “I understand peoples’ frustration,” he says, “but the truth is that medical science is not an exact science. It’s called research because you’re continuing going back to search and find the truth.”

MORE: Lessons from Angelina: The Tricky Calculus of Cancer Testing

Just as important than screening, Brawley adds, are advances in treatment, which can sometimes get lost in the public push to encourage women to get mammograms. “The talk about screening versus no screening takes away from the fact that there are thousands of women who get no treatment after they get screened and diagnosed.”

Critical improvements in treatment for breast cancer, like better chemotherapy and drugs, have saved countless lives and reduced the benefits of screening over time because cancers detected later (and without the use of mammography) are now more treatable than before. “The ultimate goal is that screening is not needed because treatment is so good,” says Brawley. “But I don’t plan on seeing that in my lifetime.”

MORE: The Mammogram Melee: How Much Screening Is Best?

TIME Cancer

Do Mammograms Save Lives? ‘Hardly,’ a New Study Finds

Samuel Ashfield / Getty Images

In fact, they may contribute to "overdiagnosis"

A study of mammograms spanning 25 years and thousands of patients has come to a startling conclusion: mammograms appear to be useless, at best.

The New York Times reports that the study, published on Tuesday in the British Medical Journal, has shaken the medical community in part because it’s one of the most thorough studies of the procedure to date.

Researchers tracked more than 89,835 Canadian women, half of whom were randomly assigned to mammogram screenings. The other half had no mammograms and performed breast exams on themselves.

Twenty-five years later, the researchers found an identical rate of breast-cancer deaths in both groups. The mammograms’ only discernible impact was to elevate the diagnosis rate by 22%, or “overdiagnose” patients who were suffering from nonlethal forms of cancer and therefore could have avoided surgeries, chemotherapy and radiation treatments.

It’s not the first study to highlight the elusive impact of mammograms, nor is it the final word in this notoriously hard-to-measure field, but the New York Times reports that the American Cancer Society will include it, along with every other study on mammography, in an official review of its guidelines this year. Whether it can nudge the advice of medical experts depends on how much weight they put on the polarizing new findings. For now, the consensus across every country’s medical guidelines, save Switzerland’s, is to keep screening.

[NYT]

TIME medicine

Nearly 20 Patients Exposed To Fatal Brain Disease

The cause might have been improper sterilization of surgical tools

+ READ ARTICLE

Almost 20 neurological patients in North Carolina may have been exposed to an incurable and degenerative brain disease while undergoing surgery because surgical instruments were insufficiently sterilized, Reuters reports.

Surgeons at the Novant Health Forsyth Medical Center in Winston-Salem operated on 18 patients using surgical equipment that had not been sufficiently sterilized after they were used on a patient who tested positive for Creutzfeldt-Jakob Disease (CJD), the hospital said in a statement.

CJD kills 90 percent of patients within one year and causes failing memory, blindness, and coma, according to the National Institute of Neurological Disorders and Stroke.

About 200 cases of Creutzfeldt-Jakob disease are recorded annually in the United States, according to the National Institutes of Health. Just last year, at least 15 patients in Connecticut, Massachusetts and New Hampshire may have been exposed to the disease in similar cases tied to unsanitary surgical instruments, health officials said.

[Reuters]

TIME Sexual Health

FDA Hiccup Means You’ll Have to Keep Waiting for Female Viagra

Agency has asked maker Sprout Pharmaceuticals for more studies on libido drug for women

The Food and Drug Administration says it needs more evidence before it approves a new drug that promises to boost female sex drive.

The agency told Sprout Pharmaceuticals that it needs to complete three additional human studies on their drug flibanserin, an experimental daily pill used to treat female sexual dysfunction, most specifically Hypoactive Sexual Desire Disorder (HSDD). The disorder causes women to experience a lack of sexual desire. If the drug receives approval, it will be the first on the market to treat women’s libidos.

The agency wants more information on how the drug interacts with other medications, whether it impairs driving, and whether it causes sleepiness. About 10 percent of women taking the drug have reported extra sleepiness. Once the company submits the evidence, the FDA can consider it for approval.

Since erectile dysfunction drug Viagra became a hit over a decade ago, the pharmaceutical industry has been searching for a similar drug that would stimulate dormant sexual appetites in women. Flibanserin is thought to interact with neurotransmitters in the brain that influence sexual desire. The drug has been rejected in the past for lack of evidence, but Sprout Pharmaceuticals wants the FDA to give their drug another look.

Cindy Whitehead, president and chief operating officer of Sprout Pharmaceuticals says they are pleased with the new FDA guidance. “In the absence of an approved solution, women with HSDD today are faced with the dilemma of trying unapproved products which could pose a safety risk or living with a condition that has important impact on their lives,” says Whitehead.

TIME medicine

What’s Happening With Bob Costas’ Eye and How You Can Avoid It

Bob Costas with Matt Lauer Today" show.
Bob Costas with Matt Lauer Today" show. Peter Kramer—NBC

After a battling and ultimately losing to what appears to be a rapidly-spreading eye infection, the NBC broadcaster is ceding his nightly Olympics hosting duties to fellow anchor Matt Lauer for the first time since 1988

Bob Costas put forth an Olympian effort, but his red, swollen eyes have gotten the best of him. For the first time since 1988, the veteran sports anchor will cede his his nightly Olympics hosting duties to Matt Lauer while his mysterious infection clears.

It’s not clear how Costas’ eyes got so inflamed – but pink eye, or conjunctivitis, is the most common infection among U.S. children and adults. It’s caused by both bacteria like staph and strep, and viruses like the cold virus (which means it is highly contagious). It can also be caused by allergies or chemicals. Pink eye causes red, inflamed, and swollen conjunctiva, or the membranes that cover the white parts of the eyes. Infections are common wherever people are in close contact: day care centers, classrooms, college dorms and work places. Worried about your risk? Here’s what you need to know.

How do I avoid getting eye infections?

There’s no way to foolproof yourself, especially if you have an allergic reaction to something you touch or something that you are exposed to in the air.

But the best way to protect against the bacteria and viruses that trigger infections is to wash your hands and not share things like washcloths, pillows, sheets or eyewear.

If someone near you is already infected, make sure you avoid touching anything that has been near their eyes. It’s also a good idea to disinfect common areas such as bathroom and kitchen surfaces.

How do I know if my eyes are infected?

Infections can cause a runny discharge that can dry to form a crusty layer, making it hard to open your eyes in the morning. You may also feel some pain and itchiness in your eyes. Use a disposable paper towel and warm water to clear away any residue, or, if you use a towel, wash it thoroughly afterward.

Costas appeared on air Thursday with one swollen pink eye, but as of Monday evening, this is how he looked:

How long do infections last?

Viral infections can cause redness and itching for up to a week, while other reactions, particularly those caused by allergic responses to chemicals or smoke, can last as long as three weeks or more.

What’s the best treatment?

For viral infections, there is no real treatment other than artificial tear drops, which can help to relieve itchiness and pain. Doctors may prescribe antibiotics for bacterial infections, which can clear up pink eye in several days. See your doctor to determine which treatment is appropriate for your case.

TIME medicine

TV’s ‘House’ Helps Solve Real-Life Medical Mystery

Doctor Juergen Schaefer diagnosed a patient after seeing an episode of the hit TV medical drama "House."
Doctor Juergen Schaefer diagnosed a patient after seeing an episode of the hit TV medical drama "House." Center for Undiagnosed Diseases—AP

Diagnosed patient with cobalt poisoning thanks to recognizing symptoms from an episode he had seen

The medical-mystery drama House helped a German doctor diagnose a patient whose case had stumped every other doctor he had seen.

Nobody could figure out what was wrong with a German man who was suffering from severe heart failure, blindness, deafness, and enlarged lymph nodes, until Dr. Juergen Schaefer took a look. Dr. Schaefer, who works at the Center for Undiagnosed Diseases near Frankfurt, almost instantly recognized the man’s symptoms from an episode of House in which Dr. House diagnoses a patient with cobalt poisoning. “After five minutes, I knew what was wrong,” Dr. Schaefer told the Associated Press.

Dr. Schaefer says he often uses the medical mystery show to teach medical students, and had recently lectured about the episode when Dr. House diagnoses his future mother-in-low with cobalt poisoning after a botched hip replacement. Dr. Schaefer’s patient also had a hip replacement, which he found to be the root of the problem–fragments of a removed ceramic hip were grinding into his metal hip, leaking cobalt into his blood stream.

But Dr. Schaefer says he would have diagnosed the patient anyway, even without Dr. House’s help. “You could have also typed his symptoms into Google and gotten the diagnosis,” he said.

[AP]

TIME Weight loss

What Happens When Your Body Loses Half Its Weight?

Rachel Frederickson lost 155 lbs on The Biggest Loser.
Rachel Frederickson lost 155 lbs on The Biggest Loser. Trae Patton—NBC/Getty Images

The spectacle of extreme weight loss if the point of shows like 'The Biggest Loser,' but there's a part of the transformation audiences can't see

Biggest Loser winner Rachel Frederickson shocked audiences Tuesday when she revealed she had dropped 155 pounds, nearly 60% of her starting weight. Earlier this week a Saudi man also made headlines for losing an astronomical 700 pounds, shedding 50% of his original weight. With the success of shows like The Biggest Loser, Extreme Makeover, and My 600-lb Life, extreme weight loss has become somewhat of a gawking pastime among American audiences. But while audiences can witness these people’s external changes in appearance, what’s happening internally when a body shrinks to half its size?

Obesity is typically measured by body mass index (BMI), with a BMI of 30 and above considered obese, and BMI of 40 and above considered severely obese. For people with a BMI above 40 to reach a healthier weight and actually maintain it, weight-loss surgery is usually the only option. For a 5’10” man, that’s about 280 pounds, and for 5’5″ woman, approximately 240 pounds.

Once the pounds start shedding, people’s perception of their own size remains skewed while they internalize their new bodies. As they adjust, they continue to make a lot of space for themselves, like selecting large spaces to sit. “Internally, people still think they are large. They swing their arms further out from their body like a helicopter, thinking their hips are still as wide as they used to be, even though they aren’t,” says Dr. Roxanne Sukol, a preventive medicine specialist at Cleveland Clinic.

The first 25 to 30 pounds are the easiest to drop, and usually accompanied by immediate improvements in blood pressure, blood sugar, and breathing. It becomes harder to lose the pounds after that initial period, but with each additional pound lost, physicians notice improvements in virtually every organ system.

However, if an individual’s weight has caused significant health problems, like heart issues or diabetes, such problems don’t go away so easily. Even when a person recovers, ailments developed along the way can remain. “We see blood pressure and sugar improve rapidly, but if your obesity caused you to have a dilated heart, that might take longer to heal–if it ever heals,” Dr. Sukol says. Excess skin can also remain after weight is dropped, but it usually adapts to the body after a period of time.

Physical therapy is nearly always needed to continue the healing process. If an individual has not been mobile for years, their muscle and skeletal systems are likely damaged. Our knees and lower extremities aren’t meant to hold the amount of weight severely obese individuals carry, and that weight can interfere with blood flow to the heart, which is one of the reasons obese people experience bloating. The good news, according to Dr. Sukol, is that, with every five pounds lost, an enormous amount of pressure on the knee caps is relieved.

Appetite can also change. When individuals replace foods like white breads and potato chips with intact carbohydrates like beans, vegetables, fruits, and whole grains, they tend to lose weight and feel more satiated from eating more nutritious food.

Lastly, the mental health effects that come from significant weight loss are immeasurable. From a biological level, neurotransmitters in the brain work better when a person is on a healthy diet. But socially, the effect of weight loss is just as great. “Being obese is such a stigma in our society, that I think the stress of being obese and having to cope with how people look at you is something impossible to relate to,” says Dr. Sukol. And that’s a considerable weight off someone’s shoulders.

(MORE: The Biggest Loser Goes Too Far)

TIME Doctor

My Doctor, the Concierge

Patients who pay an extra $5,000 a year can reach the doctor via office phone and email, but their return call is from the support staff. Patients who pay $10,000 per year may also reach the doctor via texting, Skype, Facetime and Google Hangout, and feedback is from the doctor, who will also make house calls. Getty Images

Forget the Hippocratic oath--welcome to a world of Gold and Platinum patients

It’s not like I’ve never been dumped before. Still, I was ill prepared to be dumped by my GP. For 12 years I thought we got along O.K. Now I continually ask myself, “Was I not sick enough for her?”

The first warning sign was the single-serve coffee machine in the waiting room, featuring festive flavored international coffees and chai.

I eyed it nervously. Had there been an article in an AMA journal offering hints on transforming your drab, predictable reception area into an upscale medi-café? At my next Pap smear, would I meet a barista and be offered a selection of croissants?

“No, no,” I said to myself. “Current wisdom dictates that when her practice becomes successful, she must personalize her brand.”

If this were a movie, the tone of the music cues would begin to get darker as we arrived at the day the glass display cases containing lovingly arranged bottles of moisturizer were installed. “I guess pricey moisturizers are considered medicine now,” I rationalized, wondering about the ever more porous boundaries between beauty and health.

The music cues would grow darker yet as we cut to a scene where I had the flu and found myself waiting for an appointment, surrounded by pamphlets for “facial fillers” and “injectables” like Juvéderm. If she writes me a prescription for a spray tan, I am going to walk, I thought.

But I remained loyal. She was my doctor. Her office still called to remind me about getting my checkups. She was entitled to branch out.

Then, about a month ago, I got The Letter.

“I’d like to wish you and your family a happy holiday season and a prosperous new year,” it began.

Interesting word choice, I thought. Prosperous rather than healthy.

Her reasoning became clearer as the letter went on to explain that we were all being dropped as patients–unless we paid a $5,000- or $10,000-a-year retainer for her services, depending on the plan.

“Our nation is faced with the most difficult time in the history of our health care system,” the letter went on. “As a result, I will now be transitioning my practice to a concierge medical service.”

Concierge? Another interesting word choice. Defined in the dictionary as “a member of a hotel staff in charge of special services such as arranging for theater tickets or tours. A porter. A doorman. A janitor.” Did my doctor now offer restaurant recommendations and tickets to The Lion King?

The letter explained that there would still be a charge for medical visits and that patients would still need health insurance. But the new annual fees would entitle us to a variety of rock-star privileges like “Direct access to the doctor, 24/7.”

As it turned out, the doctor was offering a two-tiered plan with levels designated Gold and Platinum. In Gold, her patients could reach her only via office phone and email. But for an extra $5,000 a year, Platinum patients’ options widened to include texting, Skype, Facetime and Google Hangout.

I admit I was impressed that someone had figured out how to monetize Google Hangout.

There were other differences between the two plans. Platinums got house calls, 20% off on Botox, a complimentary session with a fitness trainer and “prompt telephone feedback with test results by [the doctor] herself.”

Presumably the Golds, with only $5,000 extra to spend, would be called by whoever–whenever they got around to it.

Both plans, however, were eligible for “fast and easy prescription renewals” and “a dedicated support staff.” All of which I seem to recall were always an expected part of going to a regular doctor. The letter contained no information regarding the availability of complimentary lollipops.

In its new capacity as a concierge service, my doctor’s website claims, her practice will traverse a medical high wire reaching from “congestive heart failure” to “muffin top.”

It’s all making me rather nostalgic for the good old days of 2012–when I naively assumed doctors took the Hippocratic oath seriously. That oath ends, “May I long experience the joy of healing those who seek my help.”

If this concierge trend continues, perhaps they’ll update it to include “and for an extra $10,000, I will LIKE your rash on my fan page.”

Markoe won multiple Emmy Awards as a writer for Late Night With David Letterman. Her most recent book is Cool, Calm & Contentious.

TIME Weight loss

Winter Workout: Shiver Away the Pounds

Man in hat with sweater pulled up over face
Getty Images/Altrendo

Being really cold may actually help you burn fat

If you can’t get to the gym today, consider spending a little time out in the cold.

A new study reports that shivering can lead to some of the same slimming benefits as exercise.

Researchers from the National Institute of Diabetes and Digestive and Kidney Diseases conducted a study of 10 healthy volunteers. During the first experiment, the participants’ energy expenditure was measured and blood samples taken after working out at their highest capacity. In a second experiment, the same participants laid in beds that with blankets cooled to a chilly 53 degrees Fahrenheit, cold enough to cause the participants to shiver.

Researchers found that both exercise and shivering produced similar amounts of a hormone called irisin, which is known to stimulate body tissue and produce heat. This process creates what’s called brown fat, which actually eats away at the body’s white fat–the stuff that builds up around the hips. White fat cultures in the lab also burned more energy when exposed to irisin.

So should we be skipping our workouts for some quality time in the freezing snow? Not quite, researchers say, but they are hopeful that the findings could lead them on a path to finding a new treatment for obesity.

(MORE: Don’t Knock the Polar Vortex: It Could Help You Lose Weight)

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