Category: Health

Sept. 1, 2022 – Warning labels on alcoholic drinks need to be updated to spell out details of potential harm in order to make them more effective, two U.S. researchers say.

The current labelling has not changed for 30 years and focuses only on risks during pregnancy and with operating machinery, with a vague statement that alcohol “may cause health problems.”

This is “so understated that it borders on being misleading,” the researchers say.

The science has moved on, and there is now firm evidence of harm. Alcohol has been classified by the International Agency for Research on Cancer as a group 1 carcinogen and has been linked to an increased risk of many cancers. It has also been linked to a wide range of diseases, from liver disease to pancreatitis to some types of heart disease.

Yet the public is mostly unaware of the most serious health risks that are associated with drinking, they point out.

“We believe Americans deserve the opportunity to make well-informed decisions about their alcohol consumption,” said Anna H. Grummon, PhD, of the Harvard T.H. Chan School of Public Health in Boston, and Marissa G. Hall, PhD, of the University of North Carolina, Chapel Hill.

“Designing and adopting new alcohol warning labels should therefore be a research and policy priority,” they said.

The two researchers set out their arguments in The New England Journal of Medicine.

“Alcohol consumption and its associated harms are reaching a crisis point in the United States,” they pointed out.

It now accounts for more than 140,000 deaths per year in the U.S., according to the latest data from the CDC. The COVID-19 pandemic has made the problem even worse, with a 25% increase in alcohol-related deaths reported in 2020.

New, well-designed warning labels on alcohol is a commonsense way to give consumers information and lessen alcohol-related harm, they suggest.

What Makes a Good Warning Label?

Warning labels are most effective when they are prominently displayed, when they include pictures of some type, and when the content is rotated to avoid any one message from becoming “stale,” the researchers say. This has worked well for cigarette packets, where this type of warning has increased smoking quit rates, as compared with smaller, side-of-pack, text-only warning labels.

There is also some evidence that this type of labeling can work for alcohol. When large warnings about cancer risk that included pictures were temporarily added to the front of alcohol containers in some stores in Yukon, Canada, alcohol sales declined from 6% to 10%, they point out.

But pressure from the alcohol industry led to changes in the Yukon project, and while a general health warning remains, the label about increased cancer risk was removed.

The researchers say the alcohol industry gets in the way of efforts to educate the public. The industry spends more than $1 billion each year to market its products in the U.S.

The authors caution that if the government doesn’t get involved, the alcohol industry has little reason to share the risks.

And some companies even link their products to health campaigns, such as selling pink ribbon-themed alcoholic drinks in October to promote efforts to raise funds for breast cancer research, despite compelling evidence linking alcohol to a higher risk of breast cancer.

Calling on Congress for New Labels

This is not the first call for a change in alcohol warning labels.

Last year, several medical groups petitioned Congress for a new cancer-specific warning label for all alcoholic beverages.

The petition was signed by the American Society of Clinical Oncology (ASCO), the American Institute for Cancer Research, and Breast Cancer Prevention Partners, along with the American Public Health Association, the Consumer Federation of America, the Center for Science in the Public Interest, Alcohol Justice, and the U.S. Alcohol Policy Alliance.

They are calling for a label that would say: “WARNING: According to the Surgeon General, consumption of alcoholic beverages can cause cancer, including breast and colon cancers.”

But that petition is still pending, said Melissa Maitin-Shepard, a policy expert at the American Institute for Cancer Research.

In addition, the institute is “working to advocate for the addition of a cancer warning label to alcoholic beverages through multiple channels,” she said. “Given the strong evidence linking alcohol use with at least six types of cancer – and low awareness of the alcohol and cancer connection – there is a tremendous need to educate the public about alcohol and cancer risk.”

Noelle LoConte, MD, an associate professor of medicine at the University of Wisconsin, Madison, and the lead author of the ASCO statement on alcohol and cancer risk, stressed that there is no doubt that alcohol is a carcinogen, causing about 5% of cancers globally, and also that its use has increased during the pandemic.

“Initiatives that raise awareness around this issue could help generate more public support for policies that limit alcohol access and thereby decrease the number of alcohol-associated cancers,” she said. “In ASCO’s statement on alcohol and cancer, we recommend several key strategies to reduce high-risk alcohol consumption, including limiting youth access to alcohol, giving municipalities more control over alcohol outlet density and points of sale, and increasing taxes on alcohol.”

But she also had a small criticism of one point in the New England Journal of Medicine article. It shows a sample diagram that lists gastric cancer as caused by alcohol.

“But as of today, gastric cancer is not on the IARC [International Agency for Research on Cancer] list of alcohol associated cancers,” she said. “I think this brings to mind one critical point, that these warning labels have to contain scientifically established facts.”

Lily Coulter, a 17-year-old high school senior from Charleston, SC, isn’t sure what finally set her off last March.

She was at volleyball practice when she suddenly broke down into uncontrollable sobs. It was quite out of character for Coulter, an academic high-achiever, an athlete, and now senior class president.

“It all came quickly, but it was built up from 2 weeks of prior anxiety,” she says.

“I was stressed about my school work and I felt like practice was taking away from my time to get things done,” Lily says.

At home that evening, Lily’s mom, Krysten, could hear that things were off as her daughter tried to talk it out. “I remember just listening because what she was saying was irrational and she just needed a chance to vent,” says her mom.

Afterward, Lily tucked herself away in her bedroom for some alone time. She sat down at her beloved piano and got lost in her music for a few hours. After some time, she was able to calm herself down.

“I’m lucky that both times I’ve had panic attacks, I was able to work through it on my own,” she says.

Still, Krysten Coulter was truly concerned for daughter that night. The pressure to perform at school had just become too much. She worried that it was starting to take a toll on Lily’s mental health. She wonders where it will stop.

Next year, Lily plans to leave home for her first year of college. Lily’s mom is already nervous about that. “She’s put pressure like this on herself since kindergarten. I worry how she’ll cope if we’re not there.”

The Pressure Is Real

The scenario is all too common, says psychologist Madeline Levine, PhD, author of Ready or Not: Preparing Our Kids to Thrive in an Uncertain and Rapidly Changing World. Kids like Lily feel the weight of academic pressure more than ever before, Levine says.

“Twenty-five years ago, when you asked a child about their biggest source of stress, they would say that there was a divorce or that they were fighting with their sibling.”

“Now it’s always the stress of school,” Levine says.

And the pandemic hasn’t helped. Rates of depression and anxiety have doubled in school-age kids during the pandemic, according to some studies. The source of the increase isn’t clear, but kids often internalize the expectations in the culture around them, Levine says.

That could be from their friends or from social media or from their parents. “Messages come from all over the place, but the most salient messages come from your parents,” Levine says.

Tools for Reducing Academic Pressure

Here are some things that parents can do to help their kids keep school in a healthy perspective, Levine says:

• Avoid sole focus on grades. “If you’re only focused on grades, you end up having an 11-year-old who’s thinking they’re only as good as their last performance,” she says.
• Ask questions and be curious – and not just about school performance. For example: What subjects do they like? What don’t they like? What clubs or teams or activities are they involved in? Do they have a healthy social group? Are they lonely? “You can never listen to your child too much,” Levine says.
• Allow for unstructured time. Kids and teens need to have at least some time each day just to “mess around.” It doesn’t always have to be schoolwork or planned extracurricular activities. It’s even better if this downtime can happen outdoors in nature.
• Have dinner with your kids whenever possible. It’s a good chance to listen for problems and get ahead of them so they’re easier to deal with. It’s also important for your child to know that the family unit is protective against stress. The family is there no matter how school is going.
• Avoid too much conversation about material wealth in front of your kids. Instead of talking about a neighbor’s fancy new car or swimming pool, focus on what people do to help each other and their community. Try and teach kids to value the social worker, not just the Silicon Valley billionaire genius, Levine says.

The stress of academic pressure can show itself in different ways. Pay attention to big shifts in mood or behavior. While it’s normal for kids to be in a bad mood now and then, big shifts might be a sign of more serious problems.

Some teens make it obvious. They make threats, start fights, or disrupt school and social events. But these are the exceptions, Levine says. More often, school pressures lead a young person to become depressed, withdrawn, and anxious.

This can be harder to spot. You might notice excessive self-criticism, sleep problems, sudden changes in body weight, loss of interest in activities they used to like, or talk of self-harm (including suicide).

In these cases, it may be time for professional help. A doctor can recommend an appropriate mental health counselor or psychiatrist in your area.

Looking Ahead

Lily Coulter knows firsthand how hard it can be to balance academics, music, sports, friends, and family and mental health. So she took some time to think over the summer, and she decided to make a change.

To lift some of the pressure she felt last spring, she decided to pass on the volleyball team for her senior year. She says she already feels better about it and she’s excited for her final year of high school.

THURSDAY, Sept. 1, 2022 (HealthDay News) — The U.S. Drug Enforcement Administration (DEA) is warning the public that colorfully dyed fentanyl — dubbed “rainbow fentanyl” — is readily available across the United States.

“Rainbow fentanyl — fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes — is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults,” said DEA administrator Anne Milgram.

“The men and women of the DEA are relentlessly working to stop the trafficking of rainbow fentanyl and defeat the Mexican drug cartels that are responsible for the vast majority of the fentanyl that is being trafficked in the United States,” Milgram added in an agency news release.

The DEA and other law enforcement officials seized brightly colored fentanyl and fentanyl pills in 18 states in August. The confiscated drugs include pills, powders and blocks that resemble sidewalk chalk.

Despite assertions that some colors might be more potent than others, DEA laboratory testing has found no evidence to support these claims. Still, fentanyl is extremely dangerous, no matter the color, shape or size, the DEA said.

A synthetic opioid, fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. A lethal dose of fentanyl is thought to be as little as 2 milligrams, or about 10 to 15 grains of table salt. It is impossible to determine how much fentanyl is concentrated in a pill or powder without conducting laboratory testing, according to the DEA.

Moreover, fentanyl remains the most lethal drug threat to the United States. The U.S. Centers for Disease Control and Prevention estimates that 107,622 Americans overdosed and died in 2021, with synthetic opioids like fentanyl the cause of 66% of those deaths. Drug poisoning is the leading cause of death for Americans between the ages of 18 and 45.

If you encounter any form of fentanyl, refrain from handling it and call 911 immediately, the DEA advised.

More information

The DEA’s Fentanyl Awareness page lists additional community and parental resources.

Sept. 1, 2022 – It’s hard figuring out what the road ahead will look like for a cancer patient. A lot of evidence is considered, like the patient’s health and family history, grade and stage of the tumor, and traits of the cancer cells. But ultimately, the outlook comes down to health professionals who analyze the facts.

That can lead to “large-scale variability,” says Faisal Mahmood, PhD, an assistant professor in the Division of Computational Pathology at Brigham and Women’s Hospital. Patients with similar cancers can end up with very different prognoses, with some being more (or less) accurate than others, he says.

That’s why he and his team developed an artificial intelligence (AI) program that can form a more objective – and potentially more accurate – assessment. The aim of the research was to tell if the AI was a workable idea, and the team’s results have been published in Cancer Cell.

And because prognosis is key in deciding treatments, more accuracy could mean more treatment success, Mahmood says.

“[This technology] has the potential to generate more objective risk assessments and, subsequently, more objective treatment decisions,” he says.

Building the AI

The researchers developed the AI using data from The Cancer Genome Atlas, a public catalog of profiles of different cancers.

Their algorithm predicts cancer outcomes based on histology (a description of the tumor and how quickly the cancer cells are likely to grow) and genomics (using DNA sequencing to evaluate a tumor at the molecular level). Histology has been the diagnostic standard for more than 100 years, while genomics is used more and more, Mahmood notes.

“Both are now commonly used for diagnosis at major cancer centers,” he says.

To test the algorithm, the researchers chose the 14 cancer types with the most data available. When histology and genomics were combined, the algorithm gave more accurate predictions than it did with either information source alone.

Not only that, but the AI used other markers – like the patient’s immune response to treatment – without being told to do so, the researchers found. This could mean the AI can discover new markers that we don’t even know about yet, Mahmood says.

What’s Next

While more research is needed – including large-scale testing and clinical trials – Mahmood is confident this technology will be used for real-life patients someday, likely in the next 10 years.

“Going forward, we will see large-scale AI models capable of ingesting data from multiple modalities,” he says, such as radiology, pathology, genomics, medical records, and family history.

The more information the AI can factor in, the more accurate its assessment will be, Mahmood says.

“Then we can continuously assess patient risk in a computational, objective manner.”

Cough syrup, aspirin, toilet paper…and hearing aids. That may be some consumers’ drugstore shopping list this fall, thanks to a new FDA rule making some hearing aids available without a prescription in pharmacies, electronics stores such as Best Buy and online.

Is that good news or bad news for the 38 million American adults estimated to have trouble hearing?

It depends on whom you ask. Some advocates for those with hearing loss lobbied for the rule change, which they hope will make hearing aids cheaper, more accessible and less stigmatized. Hearing aid manufacturers are cheering expanded opportunities to market and sell their products.

But audiologists, even those who generally support the idea of non-prescription hearing aids, worry that without an initial evaluation and ongoing care, people will buy the devices without understanding how to use or adjust them. In addition, they won’t know the cause of their hearing loss, which could be triggered by earwax, fluid in the ear or, in rare cases, a tumor requiring surgery.

At the Hearing Loss Association of America, a Maryland-based consumer advocacy group that provides education and support to people with hearing loss who embrace technological fixes (as opposed to those born Deaf and who use American Sign Language), executive director Barbara Kelley says over-the-counter hearing aids mean “a new pathway to care” for millions of people.

“Eighty percent of people who could benefit from a hearing aid don’t get one,” she says—due to some combination of stigma, denial, cost and lack of access. They may live in rural areas, far from an audiologist; they may lack medical insurance that would pay for ongoing hearing health care. “If this makes those devices affordable and accessible, normalizing them, we think it’s a good thing.”

The FDA rule creates a category of hearing aids, available for those over 18 with mild-to-moderate hearing loss, that can be sold—as early as mid-October—without a prescription, fitting adjustment or hearing test required.

“I would say it’s not good news,” says Cindy Simon, Au.D., whose practice, based in South Miami, includes many older patients. “I spend two hours dispensing a hearing aid, showing [patients] how to use it, having them come back weekly for four weeks to make adjustments.

“Can you imagine going into Walgreen’s, buying a hearing aid and expecting the girl at the counter to sit down and teach you how to use it?”

Sherrie Davis, Au.D., Associate Director of Audiology and the Dizziness & Balance Center at Penn Medicine in Philadelphia, notes that it’s difficult for an individual to assess whether their hearing loss is mild, moderate or severe; minus a test, there’s no chance to catch other causes of poor hearing—from mild conditions like allergies to more serious ones such as an acoustic neuroma, a benign tumor on the nerves leading from the inner ear to the brain.

Some audiologists fear that consumers could damage their hearing by setting the devices for too high a volume; they advocated for limits on the “gain output”—the difference between the unamplified sound a patient hears and that same sound heard with a hearing aid. The FDA did not include limits on gain, though—in response to some of the more than 1,000 public comments received on the rule—it did cap the maximum sound output of OTC hearing aids at 117 decibels (nearly the level of a jet plane during take-off).

“We don’t want people putting devices on their ears and causing more hearing loss,” says Tricia Ashby-Scabis, Au.D., senior director of audiology practices at the American Speech-Language-Hearing Association, which represents speech pathologists, audiologists and similar professionals.

For the makers of hearing aids, the FDA rule is cause to celebrate. Gary Rosenblum, president of the hearing-aid company Oticon and chair of the Hearing Industry of America, the manufacturers’ association, says making hearing aids available over-the-counter (OTC) will lower their cost and boost accessibility.

But even he cautions that “over-the-counter hearing aids aren’t necessarily a panacea” and urges that people who buy non-prescription aids should still see a hearing care professional and ask pointed questions about return policies and warranties.

Currently, hearing aids cost anywhere from several hundred to nearly $8000 per pair, depending on their technological sophistication and the package of “bundled services” that come with an audiologist’s care; those may include a free 30- or 45-day trial, weekly visits for adjustment and questions, and several years of follow-up care.

The current market includes a wide array of hearing-aid types—from tiny buds that tuck inside the ear canal to behind-the-ear models with a transparent wire; rechargeable and battery-operated; hearing aids that sync with a smart phone and have Bluetooth capability.

“It’s naïve to think people can just buy something, program it, put it on their ear and have it work for them” says Ashby-Scabis. “I think there needs to be some thought to how we’re going to provide follow-up. I’m not sure [over-the-counter] hearing aids are going to be as simple a fix as was desired.”

Ashby-Scabis and other audiologists worry that consumers will try an over-the-counter hearing aid, find it frustrating to use on their own and give up on the devices entirely. “We don’t want people to think, ‘Hearing aids don’t work,’” she says.

On a community-health level, hearing loss amounts to far more than missed conversation at the dinner table or exasperating phone calls with Grandpa. Untreated hearing loss can lead to isolation, depression, anxiety, a heightened incidence of dementia and increased risk of falling.

It’s possible, audiologists suggest, that having hearing aids more visible—right next to the revolving kiosk of over-the-counter reading glasses at your local pharmacy—will raise awareness about hearing health while also reducing negative stereotypes and shame about hearing loss.

That stigma is already changing, they say, because of the popularity of ear buds and Bluetooth devices; it’s become normal to see people of any age with bits of plastic in their ears.

At the least, say audiologists, the buzz about over-the-counter hearing aids will make hearing loss a less-taboo topic. “Patients say, ‘I hate my hearing aids, and I can’t live without them,’” Ashby-Scabis says. “I hope there’s more awareness of the impact hearing loss has on health. I hope we’ll see that change in the years moving forward.”