Rare Disease Advocates Call For Registry

How do you convince the Government that your particular medical problem needs money?

Especially when said medical problem comes under the umbrella of rare diseases.

With non-communicable diseases like diabetes, cardiovascular disease and cancer affecting so many Malaysians – and by extension, taking up much of the Health Ministry’s budget – how do you get any attention for diseases that only affect one in a few thousand people?

Says Hospital Kuala Lumpur’s Paediatric Department head Dr Hishamshah Mohd Ibrahim: “In Malaysia, because we are a higher middle-income country, our emphasis has always been to prioritise healthcare where the needs are most glaring.

“So, in that sense, when we devise our national programme, we tend to put our resources more towards the commoner causes of disease that can result in higher mortality and morbidity.”

He adds that for rare diseases, the small number of cases and few treatment options, with those options that are available being very expensive and not easily accessible, make budgeting for them very challenging.

In the 10 countries Lee has been to as MLDA president, no NGO can come up with sufficient funds to completely cover the treatment for rare disease patients, only the Government has enough resources for that, he says. — Photos: Handout

However, the senior consultant paediatrician and paediatric haematologist-oncologist says: “Rare diseases, being rare in themselves, are very costly if you look at one individual patient, but if you look at the big picture – that they are part of our community – for us to show humanity, we need to handle the less fortunate in our community the best that we can.

“That goes to show our values as human beings, to be empathetic to those who are less fortunate than us.”

He points out that the Government actually provided a specific allocation of RM10mil for rare diseases in the 2018 Budget.

This is an increase over the RM8.5mil allocated annually in the Budget since 2009.

However, according to the Malaysian Lysosomal Diseases Association (MLDA), the average cost of enzyme replacement therapy (ERT) for one patient ranges between RM500,000 and RM1mil a year.

This means that only a limited number of patients can benefit from the annual allocation.

Although rare diseases affect a comparatively small number of people individually, collectively, the number of these patients is significant.

According to the University Malaya Specialist Centre, around 16,500 of the 550,000 Malaysian babies born every year are afflicted with congenital abnormalities, the majority of which are caused by rare diseases.

Says Dr Hishamshah: “I have a lot of positive feeling that the ministry is still going to support rare diseases further, but we need to actually demonstrate that the health dollars that we spend are health dollars that are well spent.

“For that, you actually need to have outcome data, and for that, you’ll actually need to have a very good registry for rare diseases.”

Registry challenges

Rare diseases, registry, Dr Ngu Lock Hock, Star2.com

According to Dr Ngu, there are now better lab facilities for testing rare diseases, better accessibility to treatment, and more clinical geneticists to treat patients, compared to when he first started practising 16 years ago.

A registry is a place where all the official records of something – in this case, rare disease patients – are collated and kept.

According to Dr Hishamshah, there are 32 national disease registries in Malaysia.

As someone who has been involved in the setting up of a few registries himself, Dr Hishamshah recalls suggesting a rare diseases registry about 10 years ago to his then-officemate, consultant paediatrician and geneticist Dr Choy Yew Sing, who was treating patients with rare diseases, but without any specific budget for them.

Says Associate Professor Dr Asrul Ahmal Shafie: “I think, in our current age, what we always need is information.

“And I think this is what is lacking in Malaysia – we cannot describe how big the problem is because no one can actually give the percentage, the right figure, the size of the problem, and even if there is such problem.

“And if let’s say, someone says, ‘I can give you money’, we cannot say how much because we do not know the exact size of the problem.”

The Universiti Sains Malaysia (USM) social and administrative pharmacy lecturer notes that a registry would provide epidemiological data (i.e. the “who, when, where and how” of the disease) and prevalence (number of cases) of each of the rare diseases.

However, there are a number of challenges that face the setting-up of a national rare diseases registry.

“One of the biggest challenges to collecting data is having the people and infrastructure to support the collection,” he says.

Manpower is needed to enter the data accurately, and dedicated software needs to be available to collate the information.

Assoc Prof Asrul adds that a more specific challenge for rare diseases is the lack of ICD-10 coding.

ICD-10 is the 10th, and latest, revision of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems.

This classification provides an internationally-standardised way of defining and categorising diseases.

However, rare diseases are not properly provided for in the ICD-10. This makes it more difficult to enter data accurately and in a consistent manner for a registry.

Rare diseases, registry, Dr Hishamshah Mohd Ibrahim, Star2.com

Dr Hishamshah says that the health information available from a registry is very important in providing advice to policymakers for healthcare spending.

Hospital Kuala Lumpur Genetics Department Clinical Division deputy head Dr Ngu Lock Hock notes that there are between 6,000 and 7,000 rare diseases, many of which are genetic in origin.

He says: “It’s not to say that the Health Ministry does not have these statistics; at the individual clinics, we do have all these statistics.

“But, as Assoc Prof Asrul highlighted, many of these rare diseases do not have ICD-10 coding, so, a lot of times, they are probably classified as ‘other’ diseases.

“If you look at the health statistics by the Health Ministry, a lot of diseases are ‘congenital’ or ‘other’ conditions.

“These rare diseases are inside there, but you cannot identify them as separate entities.”

The consultant paediatrician and clinical geneticist adds that it is also essential for there to be an accurate diagnosis in the first place.

“That is a challenge for rare diseases.

“Some rare diseases require a very difficult diagnostic pathway – some need difficult and specialised tests to confirm the diagnosis,” he says.

“Because there are so many different types, there is no single doctor who will be familiar with every condition.

“So, if we want to have a registry, it will really need a concentrated effort from every party – not just geneticists, but also paediatricians, cardiologists, ophthalmologists, every discipline.

“Because a patient with a rare disease may not just see a geneticist, they may present to an ophthalmologist or a cardiologist or another specialist,” he adds.

Rare diseases, registry, Dr Asrul Ahmal Shafie, Star2.com

Assoc Prof Asrul (right) says that one of the main problems with setting up a rare diseases registry is the lack of ICD-10 coding, which affects how data on these diseases can be collected. Listening to him is Zabidi, whose son has Sly syndrome (mucopolysaccharidosis VII).

Improvement over the years

However, Dr Ngu notes that things have certainly improved since he first started practising clinical genetics in 2002.

“At that time, we had very little access to all these treatments for rare genetic diseases and to diagnostic facilities.

“But over the last 10 to 15 years, we have slowly built up our capacity in our laboratories in the Health Ministry to diagnose all these rare diseases.

“And for those rare diseases that we do not have tests in the country, the ministry actually provides funding for outsourcing, so we can actually send the test to laboratories overseas,” he says.

For example, when MLDA president Lee Yee Seng’s two daughters were first diagnosed with Pompe disease in 2005, it took two to three months for the test to be sent to Australia and analysed.

Today, Dr Ngu says the test can be done in two weeks locally.

He adds that tests for almost 80 genetic diseases can now be done in Malaysia.

“In terms of treatment, at the time when I joined, it was very difficult to access drugs for these rare diseases and the special milk formula needed to treat rare inborn errors of metabolism.

“But over the years, the Government has provided dedicated funds for these patients.

“And in fact, if you compare to other countries in Asean, we are probably the only country where the patients can come into the clinic, pay RM5 and get all the drugs and special milk they need,” he says.

The number of clinical geneticists in the country have also increased over the years, although the number is still quite small – around a dozen in total.

All of them are based in the Klang Valley, except for two in Hospital USM, Kubang Kerian, Kelantan, according to Dr Ngu.

He shares, however, that the eight geneticists in Hospital Kuala Lumpur frequently provide consultation to other doctors around the country via phone and e-mail, as well as take turns running monthly clinics at the general hospitals in Penang, Johor Bahru, Kuching, and Likas in Sabah.

As Lee says, it is hope that keeps us alive.

Dr Hishamshah, Assoc Prof Asrul, Dr Ngu, Lee and MLDA vice-president Zabidi Ali were speaking at a group dialogue held recently at Hospital Kuala Lumpur, in conjunction with World Rare Disease Day, organised by the biotechnology company Sanofi Genzyme.

Why One Polyp Becomes Cancerous But Another Doesn’t

Researchers at Mayo Clinic in the United States are closer to answering the question, why does one colon polyp transform to cancer while another seemingly identical polyp does not?

A colon polyp is a small clump of cells that forms on the lining of the colon.

While most colon polyps are harmless, some can develop into colon cancer, which can be fatal if found too late.

“The molecular determinants that distinguish normal, benign polyps from those at risk for becoming cancer are unclear,” says Dr Lisa Boardman, a gastroenterologist at Mayo Clinic.

“In our paper, published in the journal Scientific Reports, we asked the question: Why does one polyp transform to cancer while another, that is clinically and histologically identical, does not?”

To answer this question, Dr Boardman and her colleagues used next-generation sequencing techniques to molecularly characterise and compare colorectal polyps from Mayo Clinic patients that were associated with cancer with those from patients with polyps that were benign.

Next-generation sequencing is sophisticated DNA and RNA sequencing technology that allows researchers to study biological systems at a level never before possible.

Dr Boardman and her colleagues found that polyps adjacent to cancerous tissue exhibited distinct genetic alterations from polyps that remained cancer free.

“By integrating multiple sequencing platforms, we identified a panel of 124 genes that were differentially altered between polyps that were associated with cancer and polyps that did not progress to colorectal cancer,” she says.

“These results serve as a foundational study showing that polyps with and without cancer exhibit distinct molecular signatures.”

Dr Boardman says the ability to identify molecular features that predict whether a polyp will transform to cancer would be a major clinical step in individualising the care of patients with polyps.

She says current guidelines for polyp surveillance are still based only upon polyp size, number, histology and degree of dysplasia.

She adds that there are currently no blood or tissue-based molecular tests used to tailor surveillance intervals for patients with polyps.

Dr Boardman says the ability to determine a polyp’s risk for progression to cancer could have significant benefits for patients and the healthcare system, including reducing costs, reducing risks and improving the use of colonoscopy.

“This study is also the first step in our efforts to establish a pre-cancer biobank at Mayo Clinic, which will support future studies on polyps in order to prolong health by preventing pre-malignancy in the colon.” – Mayo Clinic News Network/Tribune News Service

Heads Up: A Pain In The Neck

What are cancers of the head and neck? You might imagine that there is a lot going on in that area, and you would be right.

Consultant clinical oncologist Dr John Low explains head and neck cancers as cancers that occur anywhere from the neck up.

“The cancers are categorised according to the areas of the head and neck from which the cancer cells arise.

“Treatment is challenging due to the complex anatomy and the vital physiological functions of this region.” he says.

The anatomical regions generally referred to are:

Oral cavity: This includes the lips, tongue, gums, the lining inside the cheeks and lips, the floor of the mouth (under the tongue) and the bony top of the mouth (the hard palate).

Pharynx: This is essentially the throat, which can be described as a hollow tube about 13cm long that starts behind the nose and leads to the oesophagus.

The pharynx is further divided into three parts:

• Nasopharynx – the upper part of the pharynx, behind the nose.

• Oropharynx – the middle part of the pharynx, including the soft palate, the base of the tongue and the tonsils.

• Hypopharynx – the lower part of the pharynx.

Larynx: Also called the voicebox, this is a short cartilaginous passageway below the pharynx in the neck. This is where the vocal cords are.

The epiglottis also lies in the larynx. It covers the larynx in order to prevent food from entering the air passages.

Nasal cavity and paranasal sinuses: The nasal cavity is essentially the nose, while the paranasal sinuses (of which there are four pairs) are small hollow spaces in the bones of the head surrounding the nose.

Salivary glands: There are four pairs of the major salivary glands: parotid, submandibular, sublingual and buccal, plus numerous other small glands.

Thyroid gland: This is a butterfly-shaped gland that lies in front of the windpipe, just below the larynx in the neck, and secretes hormones regulating growth and metabolism.

Dr Low: Nasopharyngeal cancer is endemic in the Chinese population. Photo: SunMed

Risk factors

Whilst head and neck cancers are not as common as breast and lung cancers, nasopharyngeal cancer is of particular interest amongst these type of cancers.

“This is a cancer that’s endemic in the Chinese population. It is prevalent in Malaysia, Singapore, China and Vietnam. It is far less common in the West.

“It could be related to the unique dietary habits, specifically the preserved foods like salt-cured fish and meat.

“There is possibly some genetic link as studies have shown that when the same ethnic population migrates to the West, their risk for this cancer doesn’t decrease despite the absence of the same external risk factors,” says Dr Low.

The other recognised risk factors for head and neck cancers are:

• Alcohol and tobacco use – Their role as causal factors cannot be overstated. A 1988 study in the journal Cancer Research found that at least 75% of head and neck cancers are caused by tobacco and alcohol use.

• Infection with certain strains of human papillomavirus (HPV) is a risk factor for some types of head and neck cancers, particularly oropharyngeal cancers.

• Poor oral health and the habit of chewing betel quid have been suggested as causes of cancers of the oral cavity.

• Occupational exposure to wood dust, asbestos and synthetic fibres have been associated with nasopharyngeal cancer and cancer of the larynx.

• It has been observed that prior infection with the Epstein-Barr virus is a risk factor for nasopharyngeal cancer and cancer of the salivary glands.

• Genetic disposition, given that a person of Chinese ethnicity has a higher chance for nasopharyngeal cancer.

Head cancer, neck cancer, nasopharyngeal cancer, soft palate cancer, cancer, tumour, treatment, Star2.com

Soft palate cancer.

Signs and symptoms

Early symptoms of head and neck cancers can be vague and non-specific, and are often mistaken for symptoms of common ailments such as cold and flu.

“Many patients often dismiss these symptoms, and unfortunately, they progress to something more sinister,” says Dr Low.

Early symptoms include:

• A lump or a sore in any area of the head and neck that does not resolve.

• Difficulty or pain in swallowing.

• A change or hoarseness in the voice.

• An ulcer on the gums, tongue or lining of the mouth that fails to heal or any unusual pain or bleeding in the mouth.

• Chronic ringing or pain in the ears, or hearing impairment.

• Chronic sinus infections that do not respond to treatment with antibiotics or frequently blocked sinuses.

• Frequent nose bleeds.

• Pain in the eyes or visual impairment.

Following the initial consultation and thorough examination, further tests like nasolaryngoscopy, CT scans and other imaging studies might be required.

And depending on the findings, a tissue biopsy is usually needed to confirm the diagnosis.

Managing head and neck cancers is a complex and difficult task, given the site of the tumour.

It involves a multidisciplinary team of doctors from various specialties working together with rehabilitation units, speech therapists, dieticians and physiotherapists.

Managing head and neck cancers

The treatment plan for a patient depends on the type, location and the stage of the cancer.

In general, treatment for head and neck cancer, can include a combination of surgery, radiation therapy and chemotherapy.

According to Dr Low, treatment of head and neck cancers have progressed tremendously, especially with regards to radiotherapy.

“We can now fine-tune radiotherapy and deliver it precisely with tumour tracking and image guidance.

“This is called Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT).

“The radiation beams can be modulated to conform precisely to the shape, size and location of the cancer, hence maximally avoiding collateral damage to the surrounding healthy vital tissues or organs.

“We can adjust the dose of radiation in each of these beams.

“In addition, especially for patients with recurrent head and neck cancer, we can give Intraoperative Radiation Therapy (IORT).

“This involves delivering a concentrated dose of radiation to the tumour bed during surgery in a single treatment session. In this way, we can help reduce side effects and the need to return for repeated radiation treatments.”

Head cancer, neck cancer, nasopharyngeal cancer, tongue cancer, cancer, tumour, treatment, Star2.com

Lateral tongue cancer.

Another advancement in the treatment of cancer is immunotherapy.

Recent studies have confirmed the effectiveness of a new class of medicine called checkpoint inhibitors. These have been proven to be effective in heavily pretreated patients with recurrent disease.

Checkpoint inhibitors remove the inhibitory signals from the cancers that evade our immune system. Once the inhibitory signals are removed, our immune system will be activated to attack the cancer from within.

It has long been known that radiation therapy can evoke the ascopal effect – a phenomenon where radiation treatment to the primary cancer can effect the shrinkage and disappearance of the metastatic cancer cells elsewhere in the body.

The likely cause of this phenomenon is the activation of the immune system after radiotherapy.

Radiation therapy from without, and the immune system from within, can work together to fight the cancer. This synergistic effect of radiotherapy and immunotherapy is very promising.

Dr Low advises that both patient and doctor should discuss and consider the recommended standard treatment options available.

“We are treating not just the cancer itself, but the patient as a whole in his own unique context.

“We have to consider the possible consequences and side effects of the various therapies, some of which may be permanent.” he says.

This is particularly pertinent in head and neck cancers. Surgery may sometimes be overwhelmingly disfiguring, and thereafter, challenges the patient’s confidence and identity.

It may also potentially leave the patient with permanent difficulty in chewing, swallowing, speech, and other vital head and neck functions, that would undermine the patient’s quality of life.

Patients who have received radiation therapy to the head and neck region may develop sores in the mouth with painful swallowing, changes in taste and a dry mouth. These side effects can be severely debilitating.

Dr Low concludes: “Though early symptoms can be non-specific and vague, always be vigilant and mindful.

“Head and neck cancers are highly curable, especially with early detection. Prompt diagnosis and timely treatment offer us an advantage in doing the best that we can for our patients.

This article is courtesy of SunMed.

Can you really afford to be ill?

Health is determined by genetics, age and the environment. While some factors are beyond individual and societal control, wealth and poverty play crucial roles in the health status of a society.

Poverty undermines a whole range of human capabilities, possibilities and opportunities.

Poverty and health are inseparably linked, although the relationship may be complex. There are several factors involved including low income, poor diet and living conditions, limited access to healthcare, lack of educational opportunities, and the stresses associated with poverty.

When there is limited or no income, there are the inevitable stresses of attempting to obtain the basic needs for survival.

The diet of the poor is likely to be deficient and consists mainly of foods that are not nutritious.

This impacts on breastfeeding and is associated with an increase in heart disease, obesity and cancer.

When basic nutritional requirements are unaffordable, malnutrition and even hunger results. This contributes directly and indirectly to weakened immunity, recurrent infections and premature death.

Infections are common among the malnourished and poor. Poor living conditions, nutritional status, hygiene practices and education; overcrowding; and limited or no access to healthcare increase the likelihood and prevalence of recurrent infections.

There is global evidence of the link between poverty, malnutrition and poor child health.

In fact, poverty is the root cause of increased child morbidity and mortality. Children whose childhood is spent substantially in poverty will have poor health later on in life.

This leads to poor school performance and subsequent inability to secure good work opportunities and support for the family in the next generation.

Poverty leads to increased health dangers. The workplaces of the poor often have more environmental risks for illness and disability.

Amenities like access to clean environments, good sanitation and even access to clean water affect the poor disproportionately.

The housing and living of the poor are often not conducive to the maintenance of health. There may be increased exposure to toxic materials, inadequate sanitation and a dirty physical environment.

The poor are usually less educated, which leads to decreased knowledge about health-promoting activities and when to access healthcare.

Whilst healthcare in the public sector is available at a nominal payment, there are factors that impact on its access to the poor, such as transport costs, forgoing work to keep appointments at the healthcare facility and inability to purchase recommended medicines that are unavailable at public sector facilities.

This leads to delay or forgoing of healthcare until absolutely necessary and/or seeking healthcare when, in many instances, it is too late.

The poor are less likely to receive timely and appropriate healthcare with consequent mortality from an illness they could have been saved from. This leads to an increase in chronic and life-threatening illnesses, and premature mortality.

As a result of the above, the long, tedious and painful spiral of deprivation that maintains poverty continues.

Urban poverty

The United Nations Children’s Fund (Unicef) Malaysia published its report, “Children without – A study of urban child poverty and deprivation in low-cost flats in Kuala Lumpur” in February 2018.

This was a comprehensive study of child poverty involving 966 heads of households and 2,142 children in 17 different locations in Kuala Lumpur and Petaling Jaya conducted between Aug 20 and Sept 30, 2017.

The measurements included that of income, living standards, education, nutrition and safety.

The report summary stated: “While Kuala Lumpur has an income per capita equal to developed countries, the children residing in its low-cost flats are not doing well… Adjusted for household size, the relative poverty rate of these children is almost 100%.”

The findings in the report in respect of health included:

• More than one in five households felt that the public areas in their community were not clean;

• 12 in 100 children had less than three meals a day;

• 97 of 100 households stated that high food prices prevented the preparation of healthy meals for their children; one in two did not have enough money to buy food in recent months;

• Seven of 100 children lived in absolute poverty; in relative terms and adjusting for household size, almost all of them lived in poverty;

• Of the children under five years, 15 in 100 were underweight; 22 in 100 were stunted; 20 in 100 were wasted; and 23 in 100 were overweight or obese;

• The prevalence of malnutrition increased after the children were weaned off breastfeeding.

It was higher among older children with 23, 22 and 32 in 100 of four-year-olds stunted, underweight and wasted respectively, compared to 15, 5 and 17 in 100 of two-year-olds respectively.

“Malnourishment is a major concern in Malaysia – one in five is stunted and one in 10 is underweight…

“In terms of stunting, Malaysian children perform worse than Ghana, despite Malaysia’s GDP per capita being six times higher.”

Local data were worse than that of some lower-income countries in Asean: “The prevalence of stunting and anaemia have also increased in a decade.

“In the same period, wasting among children has decreased, but it still remains high, as in every 10 children in Malaysia, one is wasting.”

Whilst noting that there are existing social protection programmes, the recommendations in the Unicef report were “providing a universal child care allowance; ensuring proper exclusive breastfeeding for mothers for at least six months; implementing taxes on sugar-sweetened beverages; providing safe social spaces for school-aged children and revisiting poverty indicators, namely the Poverty Line Income (PLI); and using multidimensional indicators that include the nutritional status of children and relative income poverty.”

It is obvious that there is an urgent need for action to ensure that social protection is child-sensitive to improve access to basic services for the poor and marginalised.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Coffee In California To Require Cancer Warning

Starbucks and other coffee purveyors will probably have to use warning labels after a Los Angeles judge ruled that they failed to prove they should be exempt from a California law on carcinogens and toxic chemicals.

Los Angeles County Superior Court Judge Elihu M. Berle wrote in a tentative decision in April 2018 that the coffee companies did not meet their burden to prove that there was a safe level for consumers for a chemical compound created in roasting coffee.

The long-running lawsuit, first filed in 2010, concerns whether coffee drinkers should be warned about acrylamide, which is among the more than 850 confirmed or suspected carcinogens listed under California’s Proposition 65.

More than 90 coffee roasters, retailers and distributors, including Whole Foods, Kraft and Green Mountain Coffee Roasters, stand to be affected by the decision.

The law, enacted as part of the Safe Drinking Water and Toxic Enforcement Act of 1986, requires businesses with 10 or more employees to warn people of exposure to the listed substances.

Acrylamide is created when coffee is roasted and is also found in fried potatoes and burnt toast.

It has been found to increase cancer risk in rodents. Its effect on humans remains inconclusive.

Berle said scientists who testified on behalf of the coffee companies failed to prove that there was an acceptable level of acrylamide to which consumers can be exposed.

Earlier in the trial, he also ruled that the coffee companies failed to show the chemical was not a significant risk or that requiring them to include the warnings would violate the First Amendment in the US Constitution.

“While Plaintiff offered evidence that consumption of coffee increases the risk of harm to the foetus, to infants, to children and to adults, Defendants’ medical and epidemiology experts testified that they had no opinion on causation,” he wrote.

The coffee industry has contended that it is impossible to eliminate acrylamide without affecting flavour, and that the exposure is harmless to consumers.

Raphael Metzger, the attorney for the nonprofit Council for Education and Research on Toxics, the plaintiff in the case, said he hoped the judge’s decision would push the companies to agree to reduce acrylamide levels in coffee.

“I would very much prefer that, when my addiction compels me to drink coffee, I can drink acrylamide-free coffee,” he said.

“They just don’t want to change. They want to keep doing business the way they have been doing.”

Berle will issue a final decision after giving each side an opportunity to object.

The next phase of the trial will determine the civil penalties to be levied on the defendants. – Los Angeles Times/Tribune News Service

No Science To Back Up Coffee Cancer Label Requirement

A California court ruling in April 2018 that a cancer warning label should be required on coffee has left the scientific community puzzled.

There is plenty of research showing that coffee doesn’t cause cancer, and can actually prevent liver and endometrial cancer.

The World Health Organization announced two years ago that there was “no conclusive evidence for a carcinogenic effect of drinking coffee”.

The decision has put US public health experts at odds with a state law aimed at safeguarding the health of Californians.

“I can understand the logic of the judge by going by the book. But I can also understand the science,” said Mariana Carla Stern, a University of Southern California professor who studies diet and cancer.

“From the science standpoint, there’s no reason the public should worry about drinking coffee.”

California’s Proposition 65, officially known as the Safe Drinking Water and Toxic Enforcement Act of 1986, requires that businesses warn customers if they could be exposed to any of the more than 900 confirmed or suspected carcinogens.

One of compounds on the list is acrylamide, which is found in french fries, burnt toast and roasted coffee beans.

Some studies in animals have found that exposure to high levels of acrylamide causes cancer, but there’s little evidence of that in humans, said Kathryn Wilson, a Harvard senior research scientist who studies links between diet and cancer.

Researchers also warn that it’s unwise to extrapolate acrylamide studies in animals to humans because the species metabolise the compound differently.

“I think it’s crazy,” Wilson said of the court’s decision. “Reducing coffee or french fries to their acrylamide content isn’t how we study diet and nutrition.”

Many pointed out that Proposition 65 doesn’t account for the positive benefits of coffee.

“This is an unfortunate ruling that demonises coffee as a carcinogen when the overwhelming evidence in humans is for benefit, or at least, no detrimental effect,” Dr Nigel Brockton, director of research at the American Institute of Cancer Research, said in a statement.

Nina Fujii, who was picking up a cup of coffee at Starbucks in Los Feliz recently, said a label would make her rethink her coffee consumption.

The 24-year-old actress said she remembered seeing a cancer warning at an El Pollo Loco restaurant two years ago. The sign is part of the reason she stopped going there, she said.

More than 90 coffee roasters, retailers and distributors, including Whole Foods, Kraft and Green Mountain Coffee Roasters, stand to be affected by the decision.

William Murray, president of the National Coffee Association, said the industry is considering legal action.

The decision “does nothing to improve public health”, he said in a statement.

The Council for Education and Research on Toxics sued ready-to-drink coffee companies in 2010 for not providing cancer hazard warnings due to the acrylamide content.

In a tentative decision, Los Angeles County Superior Court Judge Elihu M. Berle said that the coffee companies failed to prove there was a safe level of acrylamide in their products.

He wrote that while the plaintiff showed that coffee can harm people, “defendants’ medical and epidemiology experts testified that they had no opinion on causation”.

Berle will issue a final decision after giving each side an opportunity to object. The next phase of the trial will determine the civil penalties to be levied on the defendants.

The law allows for as little as a cent (4 sen) and up to US$2,500 (RM9,685.50) for each time a consumer was exposed to the chemical without being warned, said Raphael Metzger, the plaintiff’s attorney.

Public health experts said they worried the ruling would confuse the public, who already often feel that nutrition science is constantly shifting.

Wilson said she feared it would detract attention from things that are clearly linked to cancer, such as obesity and lack of exercise. “It’s too bad for public health,” she said.

Dr Frank Hu, chair of the nutrition department at the Harvard T.H. Chan School of Public Health, pointed out that coffee has been found to reduce the risk of diabetes and heart disease.

The latest American dietary guidelines say the beverage is fine to drink (up to five cups a day).

Dr Hu said the ruling seemed meaningless given the “minuscule amount” of acrylamide in coffee.

“If the concentration level is so low, then what’s the meaning of labeling those foods?” he said.

Will Kiker, 37, said a warning wouldn’t keep him from his daily large coffee with an extra shot.

He doesn’t eat processed food or high-fructose corn syrup, but he smokes cigarettes and walks into friends’ apartment buildings even if they have posted signs about carcinogens.

He said he could understand a need for labels on a new product, but he found it pointless for coffee.

“You could put a warning label on LA. You’re breathing in toxic fumes if you put your windows down on the freeway,” said the music manager. “It’s a little ridiculous to put a warning on coffee.” – Los Angeles Times/Tribune News Service

Eating Out May Raise Your Risk Of Cancer

Foodies beware: A recent study has shown that the habit of dining out may raise your risk of cancer.

According to a new University of California and George Washington University study, as Newsweek reports, dining out may put you at risk for elevated levels of potentially harmful chemicals called phthalate that are linked to diseases like cancer. Many are wary of phthalates, which are often used in plastics.

These chemicals, which can leach into food from processed materials such as food packaging, takeout boxes and gloves, can disrupt hormones in the body. A number of studies have linked several specific phthalates to breast cancer, type 2 diabetes and fertility issues, according to Newsweek.

Scientists from UC Berkeley were among those who examined data from the US National Health and Nutrition Exam-ination Survey (collected between 2005 and 2014), in which 10,253 people were asked to recall what they ate and where their food came from over the previous 24 hours.

Levels of phthalate biomarkers were measured in each participant, as the Guardian reported. In all, 61% reported eating out the previous day. Levels of phthalate were nearly 35% higher than those who ate at home and the link was particularly strong for young people, said the researchers, reporting their findings in the journal Environment International.

“This study suggests food prepared at home is less likely to contain high levels of phthalates, chemicals linked to fertility problems, pregnancy complications and other health issues,” said senior author Ami Zota, an assistant professor of environmental and occupational health at Milken Institute School of Public Health at the George Washington University, as Newsweek cited.

“Our findings suggest that dining out may be an important and previously under-recognised source of exposure to phthalates for the US population.”

The scariest part of the study is the impact in growing bodies, notably children, teens and babies.

“Pregnant women, children and teens are more vulnerable to the toxic effects of hormone-disrupting chemicals, so it’s important to find ways to limit their exposures,” said lead author Dr Julia Varshavsky, from the University of California at Berkeley in the Guardian.

Dinner at home just got a lot more appetising. – The Mercury News/Tribune News Service/Karen D’Souza

Enjoy Healthy Weight Loss with TruVision

Owing to the unhealthy lifestyle and improper eating habits that people follow weight gain has become one of the most important concerns. Some people even suffer from obesity which invites more trouble. Obesity can cause various illnesses including hypertension, heart problems, diabetes, and so on.

To help you lose weight and thus avoid such problems, various supplements are being introduced to the market every day. Though this is good news as some supplements do help you lose weight, it is not easy to find out which amongst these is actually a trustworthy supplement. Many companies are here just to make money without giving you the results and you need to stay away from them.

Company that you can trust

Yes, there are a few companies that are safe, healthy, and have actually helped people lose weight. To help make things easier for you we shall now share with you the name of a company that is gaining more and more popularity each day. This company is none other than TruVision. TruVision helps you enjoy true weight loss, and this is why they have earned so much love and support from their customers. They are known for helping with the fat burning and weight loss process without affecting present store of energy. Furthermore, you do not have to formulate and follow any specific diet plan while you use this supplement. However, it will be better to opt for foods that are good for your heart health.

What exactly is TruVision?

TruVision health or TruVision weight loss as it is known is the manufacturers of two Tru weight loss products – TruFix dietary supplement and TruControl supplement. Both these supplements have their own package that certainly will help you shed the unwanted weight. These products are made using natural ingredients that increase the metabolism of your body without inviting any harmful side effects.

How do TruControl and TruFix work

Both these supplements are just a combination of helpful strong natural ingredients that help you enjoy the kind of results you have always desired. Let us now get to learn what these ingredients are and how do they work.

  • Cinnulin – This is an amalgamation of cinnamon extracts and some polyphenol compounds. It helps regulate the blood pressure levels and also projects the strong properties of antioxidants.
  • Raspberry Ketones – This natural ingredient is known for breaking down fat and that too fast. This is why the rate at which your body melts extra fat also increases. Furthermore, owing to their antioxidant properties they improve the supply of adiponectin, a hormone that makes the metabolic process in your body better.
  • Copper – Copper helps produce more red blood cells which prevent anemia, and copper also improves the fat burning process.
  • Alpha-lipoic acid – Free-radicals are known to cause great problems in your body. Alpha-lipoic acid is one strong antioxidant that controls their effects and also gets rid of the harmful effects that the free-radicals have already caused in your body. It even helps in the cell-regenerative and anti-aging processes.

  • Iron – Iron helps in the movement of oxygen in our bodies. If you have more oxygen you will have more energy and owing to this your muscles will get the push that allows you to enjoy a better fat loss.
  • Vanadium – This helps improve glucose absorption and improves the sensitivity of your body to insulin and helps with the weight loss process.
  • Magnesium – Magnesium improves the stabilization and regulation of pressure and blood sugar levels, and this gives your body the energy that it needs for better weight loss.
  • Vitamin B6 – This vitamin makes the adrenaline more effective in breaking down and burning fat.
  • Chlorogenic acid – Chlorogenic acid minimizes the concentration of glucose after you eat and thus keeps the blood circulation and blood sugar levels regulated. When it gets converted into energy, it also helps in burning fat.
  • Chromium – Chromium helps build lean muscles and prevents calcium loss, thus helping improve energy levels and makes the bones stronger.

TruVision Package Benefits –

  • Completely natural weight loss
  • No need to follow any special diet
  • Help lose weight while keeping energy levels high
  • Guaranteed toned body and lean muscle building
  • Affordably priced
  • A money back guarantee (90days)

The right dose – At morning and at night take one tablet of TruControl and TruFix to enjoy maximum benefits.

However, if you are pregnant or trying to conceive then you should not take these supplements.

Make sure to keep these any other medications out of reach of your children.

To conclude – This Tru weight loss package has every important ingredient that can help you enjoy better fat loss and reduce cholesterol effectively.

If you really want to lose weight in a healthy way that too without having to follow any strict diet plans then TruVision, without a doubt, is your best option.