Prominent oncologist suspended for professional misconduct

Dear Dr. Chris,
How are you and Mdm. Beng Im? Hope everything is okay.
I’ve just got this information from my friend in Singapore a couple minutes ago.
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Prominent cancer doctor Ang Peng Tiam given 8-month suspension by Supreme Court

Dr Ang Peng Tiam of Parkway Cancer Centre has been given an eight month suspension in lieu of a $25,000 fine.

SINGAPORE – Prominent cancer specialist Ang Peng Tiam of Parkway Cancer Centre, who had appealed to the Supreme Court against a Singapore Medical Council (SMC) fine of $25,000, has been given an eight-month suspension instead of the fine.

It would have been a 16-month suspension had the SMC acted on the complaint more expeditiously, said Chief Justice Sundaresh Menon, who delivered the Court of Three Judges’ decision on Tuesday.

Two daughters of a former patient made a complaint against Dr Ang in 2010. The patient died in October that year. But the SMC served the notice of enquiry on Dr Ang in April 2015.

The SMC’s disciplinary tribunal had found Dr Ang, 59, guilty of two of the charges: That he made false representation to the patient who was suffering from lung cancer that there was a “70 per cent” chance of responding to the treatment he suggested and that he failed to offer her surgery as an option.

The disciplinary tribunal found that Dr Ang “had no reasonable basis” for saying there was a 70 per cent chance of response and felt that he had “wrongly held out false hope” to the patient and her family.

It also found him guilty of not offering surgery when that was “the preferred initial treatment option”.

A statement from the SMC on Wednesday (June 28) said the disciplinary tribunal found that there was an “intentional, deliberate departure from standards observed or approved by members of the profession of good repute and competency”.

Dr Ang had claimed that he has seen about 16,000 new patients over the past 16 years, of whom 10 to 15 per cent suffered from lung cancer.

It felt that his actions “merit severe penalty” but given testimonials in favour of Dr Ang as well as his community work, it decided against a suspension.

Instead, it imposed a fine of $25,000, a censure, an undertaking not to repeat the offence and for him to pay 60 per cent of the cost of the proceedings.

Dr Ang appealed against the tribunal’s decision to the Court of Three Judges which on Tuesday (June 27) upped his sentence from a fine to an eight-month suspension.

The SMC had also filed an appeal against what it considered was a light penalty from its disciplinary tribunal and had urged the court to impose a six-month suspension for each of the two offences for which Dr Ang had been found guilty.

Instead of taking his “eminence and seniority” as a mitigating factor, the court saw it as an “aggravating” factor and his “unblemished record” of more than 30 years had limited relevance in mitigation.

However, the court took into account the 41/2 years it took the SMC to serve notice of enquiry on Dr Ang after receiving the complaint. This “inordinate delay” caused suffering to Dr Ang.

Justice Menon said the appropriate sentence in the light of the seriousness of the offence would have been a suspension of 16 months for the two charges. But given the long delay by the SMC, it halved the sentence to an aggregate of eight months.

Source: http://www.straitstimes.com/singapore/health/prominent-cancer-doctor-ang-peng-tiam-given-8-month-suspension-by-supreme-court?xtor=CS11-88

Air travel comes at a price: Slightly elevated risk of cancer

Radiation doses from body scanners and baggage X-ray machines at airport security checks are minimal, compared to actual radiation exposure from the flight itself.

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In April, Mr Tom Stuker, 63, became the world’s most frequent flier, logging 18 million miles of air travel over the last 14 years.

If his travelling behaviour is typical of business fliers, he may have eaten 6,500 inflight meals, drunk 5,250 alcoholic beverages, watched thousands of inflight movies and made around 10,000 visits to airplane toilets.

He would also have accumulated a radiation dose equivalent to that of about 1,000 chest X-rays.

COSMIC RAYS COMING AT YOU

You might think the radiation dose comes from the body scanners and baggage X-ray machines.

But radiation doses from airport security checks are trivial.

The major source of radiation exposure is from the flight itself.

This is because at high altitude, the air gets thinner. The farther you go from the earth’s surface, the fewer molecules of gas there are per volume of space.

Thinner air means fewer molecules to deflect incoming cosmic rays – radiation from outer space.

In fact, it is the accumulation of radiation dose that is the limiting factor for the maximum length of manned space flights. Too long in space and astronauts risk cata- racts, cancer and potential heart ailments when they return home.

So, what would Mr Stuker’s cumulative radiation dose be and what are his health risks?

It depends entirely on how much time he has spent in the air.

Assuming an average flight speed of 550mph, his 18 million miles would translate into 32,727 hours or 3.7 years of flight time.

The radiation dose rate at typical commercial airline flight altitude of 35,000 feet is about 0.003 millisieverts per hour.

By multiplying the dose rate by the hours of flight time, we can see that Mr Stuker has accumulated about 100mSv dose of radiation.

The primary health threat at this dose level is an increased risk of some types of cancer later in life.

Studies of atomic bomb victims, nuclear workers and medical radiation patients have allowed scientists to estimate the cancer risk for any particular radiation dose.

Assuming that low doses have risk levels proportionate to high doses, then an overall cancer risk rate of 0.005 per cent per mSv is a reasonable estimate.

Thus, Mr Stuker’s 100mSv dose would increase his lifetime risk of contracting a potentially fatal cancer by about 0.5 per cent.

The question is whether that is a high level of risk.

Most people underestimate their risk of dying from cancer. Although the exact number is debatable, about 25 per cent of men ultimately contract a potentially fatal cancer.

Mr Stuker’s 0.5 per cent cancer risk from radiation should be added to his baseline risk – from 25 per cent to 25.5 per cent.

A cancer risk increase of that size is too small to measure in a scientific way, so it must remain a theoretical increase in risk.

If you want to know your cancer risk from flying, estimate your airline miles over the years.

If you have clocked 370,000 miles, you would have a 0.01 per cent increase in the risk of contracting cancer.

However, most people do not fly 370,000 miles, which is equal to 150 flights from Los Angeles to New York, within their lifetimes.

So, for the average flier, the increased risk is far less than 0.01 per cent.

List all the benefits that you have derived from your air travel, such as job opportunities, vacation travel and family visits, and look at your increased risk again.

If you think your benefits have been meagre compared to the elevated cancer risk, maybe it is time to rethink flying.

But for many people, flying is a necessity of life and the small elevated cancer risk is worth the price.

Source: http://www.straitstimes.com/singapore/air-travel-comes-at-a-price-slightly-elevated-risk-of-cancer

The surprising number of American adults who think chocolate milk comes from brown cows

Seven percent of all American adults believe that chocolate milk comes from brown cows, according to a nationally representative online survey commissioned by the Innovation Center of U.S. Dairy.

If you do the math, that works out to 16.4 million misinformed, milk-drinking people. The equivalent of the population of Pennsylvania (and then some!) does not know that chocolate milk is milk, cocoa and sugar.

 

For decades, observers in agriculture, nutrition and education have griped that many Americans are basically agriculturally illiterate. They don’t know where food is grown, how it gets to stores — or even, in the case of chocolate milk, what’s in it.

Source: https://www.washingtonpost.com/news/wonk/wp/2017/06/15/seven-percent-of-americans-think-chocolate-milk-comes-from-brown-cows-and-thats-not-even-the-scary-part/?utm_term=.f7e1c9540535&wpisrc=nl_az_most&wpmk=1

 

Evidence grows linking grilled meat and cancer, but you can lower the risk

By Emily Sohn June 3 at 8:30 AM

When cooked at high temperatures or over open flames, according to accumulating evidence, compounds in red and processed meats undergo biochemical reactions that produce carcinogenic compounds capable of altering the eater’s DNA.

Grilled vegetables don’t harbor the same risks.

The case for meat as a cancer risk has been building for decades, with plenty of studies showing that people who report eating diets heavy in red and processed meats have higher risks of certain types of cancer, as well as heart disease and other chronic illnesses. Enough of those studies — together with lab work — have built up to make a convincing case that meat carries risks, according to a 2015 analysis by the World Health Organization’s International Agency for Research on Cancer, which considered more than 800 studies conducted around the world.

Overall, the IARC review found that the strongest evidence linked processed meats (such as hot dogs, beef jerky, bacon and ham) to colorectal cancer — with each hot-dog-size serving of processed meat eaten daily raising the risk by 18 percent over a lifetime.

More than 34,000 cancer deaths are caused around the world each year by diets high in processed meat, according to data referenced in the IARC report. By comparison, tobacco causes about a million cancer deaths annually. Alcohol consumption causes 600,000. And air pollution is responsible for 200,000.

The IARC review also found evidence for an association between unprocessed red meat (such as beef or pork) and colorectal cancer, along with some evidence that red meat might contribute to pancreatic and prostate cancers, too.

Cooking methods make a difference, according to studies that have zeroed in on two groups of chemicals that appear in particularly large quantities when meat, fish or poultry is cooked under high heat by grilling, barbecuing, boiling or even pan-frying. One group, called HAAs (heterocyclic aromatic amines), form during high-temperature reactions between substances in muscle tissue.

PAHs (polycyclic aromatic hydrocarbons), which form when meat is smoked, charred or cooked over an open flame, are also found in tobacco smoke.

Turesky is beginning to turn up evidence that it might. In a study published last year, he and colleagues studied biopsies of prostate tumors and found that DNA in the cancer cells had been damaged by HAAs.

“This is the first unequivocal proof that, once you eat the cooked meat mutagens, some of them find their way to the prostate and damage the prostate,” Turesky says. The study doesn’t prove that meat caused the cancer, he adds. “It could just be an association. Now we have to show that the mutations are attributed to the chemicals in cooked meat.”

Source: https://www.washingtonpost.com/national/health-science/evidence-grows-linking-grilled-meat-and-cancer-but-you-can-lower-the-risk/2017/06/02/f946078c-4549-11e7-a196-a1bb629f64cb_story.html?utm_term=.65bccab06061&wpisrc=nl_az_most&wpmk=1

New study finds a high blood platelet count is ‘strong predictor’ of cancer

LONDON, May 24 — A new UK study has revealed the first new strong indicator of cancer in 30 years, finding that having a high blood platelet count can predict who will go on to be diagnosed with cancer, and the researchers urge that it should be used by doctors in order to try to catch the disease early.

Known as thrombocytosis, up to half a million people (two per cent) of those over the age of 40 in the UK have a raised blood platelet count, with around 1 per cent of the general population developing cancer each year.

Led by the University of Exeter Medical School, the large-scale study is the first to thoroughly investigate the association between thrombocytosis and cancer, looking at 40,000 patient records in the UK.

The team found that 11per cent of men and 6per cent of women over the age of 40 with thrombocytosis went on to be diagnosed with cancer within a year.

This number rose to 18per cent of men and 10per cent of women being diagnosed with cancer if a second raised platelet count was found within six months.

The most commonly diagnosed cancers after a thrombocytosis diagnosis were lung and colourectal cancer, and one third of these patients had no other symptoms that would indicate to their GP that they had cancer — except for thrombocytosis.

The team are now urging GPs to consider that those with unexpected thrombocytosis may go on to also be diagnosed with cancer, in order to try to catch the disease early on.

“We know that early diagnosis is absolutely key in whether people survive cancer. Our research suggests that substantial numbers of people could have their cancer diagnosed up to three months earlier if thrombocytosis prompted investigation for cancer.

This time could make a vital difference in achieving earlier diagnosis,” commented lead author Dr Sarah Bailey, of the University of Exeter Medical School.

Professor Willie Hamilton, of the University of Exeter Medical School, also added that, “The UK lags well behind other developed countries on early cancer diagnosis. In 2014, 163,000 people died of cancer in this country.

“Our findings on thrombocytosis show a strong association with cancer, particularly in men — far stronger than that of a breast lump for breast cancer in women. It is now crucial that we roll out cancer investigation of thrombocytosis. It could save hundreds of lives each year.”

The paper can be found online published in the British Journal of General Practice— AFP-Relaxnews

 Note: At CA Care we have been using your Platelets Count as a monitor for cancer since the past twenty years!

– See more at: http://www.themalaymailonline.com/features/article/new-study-finds-a-high-blood-platelet-count-is-strong-predictor-of-cancer#sthash.I1bcR7Ob.dpuf

J&J loses US$110 million verdict over talc cancer-link claim

DETROIT — Johnson & Johnson was ordered by a St Louis jury to pay more than US$110 million (S$154 million) to a Virginia woman who blamed her ovarian cancer on the company’s talcum products.

Imerys Talc America, which provided the talc to J&J, was ordered by the jury to pay about US$100,000. Imerys Talc is a unit of Paris-based Imerys SA.

There are more than 3,000 lawsuits accusing the world’s largest health-care company of ignoring studies linking its baby powder and Shower to Shower talc products to ovarian cancer and failing to warn customers about the risk.

Ms Carol Goodrich, a spokeswoman for J&J, didn’t immediately respond to a request for comment on the verdict. Mr Orlando Richmond, an attorney for the company, declined to comment.

J&J lost jury verdicts of US$72 million, US$55 million and US$70 million last year, while winning the first trial in 2017. J&J, based in New Brunswick, New Jersey, is appealing the trial losses. A New Jersey state court judge last year threw out two talc cases set for trial, finding inadequate scientific support for the claims. That decision is also on appeal.

In St Louis, Ms Lois Slemp, 62, said she used J&J’s baby powder and Shower to Shower talc products for more than 40 years before her diagnosis with ovarian cancer in 2012. J&J sold its Shower to Shower brand in 2012.

ASBESTOS CLAIM

Ms Slemp, whose cancer has since spread to her liver, also claims J&J talc was contaminated with asbestos, a rare allegation in these cases. A company lawyer told jurors that J&J’s products didn’t cause Ms Slemp’s cancer and don’t contain asbestos.

The lawsuit is among more than 1,000 filed in St Louis by women across the US, taking advantage of a Missouri law that allows suits to be brought there by people with no connection to the state.

The company faces trial in another talc claim in St Louis city court next month, brought by the family of a former competitive figure skater who died of ovarian cancer. The trial after that is set for July in Los Angeles.

J&J didn’t warn women of studies linking talc to ovarian cancer to protect the company’s image, Mr Allen Smith, Ms Slemp’s attorney, told jurors.

“What is the corporate image of Johnson & Johnson?” Mr Smith asked. “It’s a mother and baby.’’

Ms Slemp, a retired nurse’s assistant, is undergoing chemotherapy and was too ill to attend the trial.

J&J doesn’t need to warn women about talc because there is no link, Mr Richmond argued. The Food and Drug Administration was asked in 2014 whether a warning label should be put on baby powder, he said.

“They said ‘No.’ The science doesn’t warrant it,” Mr Richmond said. BLOOMBERG

http://www.todayonline.com/world/americas/jj-loses-us110-million-verdict-over-talc-cancer-link-claim

Diet high in saturated fats linked to gut inflammation: Study

Probiotic content in food items such as yoghurt and kimchi help improve gut health

SINGAPORE — Scientists have found more evidence that a diet high in saturated fats is linked to more inflammation in the gut that, in turn, could cause colorectal cancer.

The study by scientists from Nanyang Technological University (NTU) also found that probiotic content in food items such as yoghurt and kimchi help in improving gut health.

In examining what causes inflammatory bowel disease (IBD), the team led by Associate Professor Andrew Tan Nguan Soon discovered that a lower level of Angiopoietin-like 4 (ANGPLT4) — a protein found in the gut — led to more inflammation.

Assoc Prof Tan said: “In our experiments, we observed that when gut microbes processed saturated fats, they will emit certain chemicals that lower the amount of ANGPLT4 produced by the cells, which then leads to more inflammation.”

When inflammation is prolonged, it could lead to IBD and, later, increase the risk of colon tumours.

Colorectal cancer is one of the most common cancers in Singapore, with more than 9,300 cases diagnosed from 2010 to 2014.

In a press release yesterday, NTU said that the team of NTU scientists led by Assoc Prof Tan discovered this new protein-linked factor that contribute to IBD, and have published their results recently in Scientific Reports, a peer-reviewed journal.

Worldwide, about five million people suffer from IBD, which can cause diarrhoea, abdominal pain, weight loss, blood in stools and fever.

In Singapore, about 2,000 people suffer this yearly, and the numbers are rising sharply, NTU said.

Assoc Prof Tan said that their findings supported the conventional advice of eating wholesome foods with less saturated fats and with more probiotic content, usually found in fermented foods such as yoghurt or kimchi.

“The types of food being processed by the gut will change the microbe community. A high intake of saturated fat could increase the prevalence and replication of harmful pathogens, suppressing ANGPLT4 and causing even more inflammation,” he explained.

In the study, the team also found that dietary probiotics favour beneficial microbes that form a protective barrier along the gut. Retaining a barrier in the gut may be one way the ANGPTL4 protein prevents harmful bacteria from joining the microbe community.

In a related study, Assoc Prof Tan worked with a team from Wageningen University in the Netherlands to discover the effects that trans fat has on gut health. Published last week in the Journal of Lipid Research, the study found that while saturated fat led to massive IBD in mice that are lacking the ANGPTL4 protein, eating trans fat did not contribute to IBD symptoms but may result in the hardening and narrowing of arteries in the long term.

“In short, the public should eat foods that are high in unsaturated fats, like avocado and olive oil, while avoiding foods containing saturated fat, like butter, and trans fat, like margarine,” Assoc Prof Tan said.

“At the same time, foods containing probiotics, such as yoghurt, should also be consumed, as they improve the health of the gut.”

Source: http://www.todayonline.com/singapore/diet-high-saturated-fats-linked-gut-inflammation-study