Breast Cancer Controversies
Clifford Hudis, M.D. is Chief of the Breast Cancer Medicine Service and attending physician at Memorial Sloan-Kettering Cancer Center in New York City, where he is also a professor of medicine at the Weill Medical College of Cornell University. He is co-leader of the Breast Disease Management Team at MSKCC, co-chair of the Breast Committee of the Cancer and Leukemia Group B (CALGB), past chair of the Internet Services Committee and present chair of the Information Technology Committee of the American Society of Clinical Oncology (ASCO). He is also past president of the New York Metropolitan Breast Cancer Group and chair of the Scientific Advisory Board of the Breast Cancer Research Foundation.
Question: When is chemotherapy the wrong choice?
Clifford Hudis: Well, that’s a hard question to answer because that gets to a real nitty-gritty issue: Why do we use chemotherapy? How does it work? And so there are very specific clinical situations I can describe that would answer your question but they wouldn’t be applicable to most people. They wouldn’t even relate to what most people are going through. An easy example is chemotherapy is not the right choice when somebody does not have an invasive breast cancer. There are some breast cancers that while present have no ability to spread to other parts of the body. The second thing which is-- becomes a little more of a slippery slope is there are some patients with very
low-risk breast cancer where chemotherapy is not the right choice and there are patients who have metastatic breast cancer-- that’s the kind of breast cancer that’s not curable-- where chemotherapy may be the right choice later but maybe not initially. So it’s hard to be more specific than that.
Question: Is breast cancer linked to environmental destruction?
Clifford Hudis: Well, that’s a very complex issue because specifically there are certainly links. Ozone depletion with increased UV light exposure causes melanoma and less scary skin cancers like basal cells and squamous cells. Toxins in high concentration certainly cause some specific cancers like bladder cancer, lung cancer and so forth. The more general question people are asking is whether their overall environment that they transit through over the course of decades does that cause cancers that are common like breast or colon? And that’s a pretty tough thing to answer. Very carefully done studies for example of the low-level pesticide exposures that you might get living in a rural community have not-- and I want to emphasize that-- have not shown the expected association with breast cancers yet that’s a popular assumption out there. The other thing that I just will interject and at the risk of being a little bit controversial I want to point this out-- Not talking about industrial accidents or egregious abuse of the environment, but some of the low-level toxins in the environment are there for reasons that in the net sum may be worth it. For example, a very healthy food supply protected by pesticides may raise some risks but this week it’s a topical issue because there’s concerns about the quantity of food produced on earth, and the truth is that we need some kind of management of those crops to feed 6, 7, 9 billion people expected over the next decades. And so we’re balancing kinds of risks and yes, we could have for example a purely organic food supply but what would we trade off to get that? Would we trade off starvation in poor countries? Would we trade off occasional poisonings of healthy people because there were bacterial over- there was bacterial overgrowth in those foods and so forth? And I know venturing a little beyond my narrow area of expertise but I think you have to think somewhat globally about all of this. So an ideal world you’d have perfectly safe pesticides that never caused a problem and that’s what we should work towards but the attribution of causality from the environment to breast cancer in particular remains a very, very difficult issue.
Question: Does mercury in fish cause cancer?
Clifford Hudis: Mercury in fish has been associated with other very specific neurotoxic effects but not specifically breast cancer. I’ll give you a very concrete story. Now again I’m venturing outside my area of expertise but there’s a kind of controversy regarding cell phone use and brain cancer that’s been highlighted by recent events in the news. What’s interesting about it is that the issue was raised, it was refuted by every study that’s looked at it so far, and there’s kind of a second wave of skepticism saying, “Well, how do we know that over the decades to come we won’t discover that it does?” So then we do basic science and the truth is that at the basic science level right now it’s been very hard to even demonstrate a mechanism by which cell phones would cause brain tumors, and yet the concern lives on and it’s addressed in a very expensive fashion in some cases. So we have to admit that we bring biases to it. In the example I just gave, there is a bias that cell phones must cause some kind of bad outcome, cancers, and we’re willing to explore it ad infinitum as it were, and maybe it does but we don’t have evidence that it does.
Question: Are pharmaceutical companies doing enough?
Clifford Hudis: Very, very complex question. Pharmaceutical companies are doing what they can do primarily to raise shareholder value. That is of course always embedded in an idea that they’re trying to make the world better but they try to make the world better in part because it improves their profitability. Right?
In an ideal world more of this work would be done by unbiased investigators funded publicly so that there would be no need to let’s say increase shareholder value, but that’s not the world we live in. In the world we have right now, a modest amount of work is done on the public side and a lot is done on the private side. I would like more to be done but it’s expensive and people make choices based on economics as opposed to health.
Question:Is the government doing enough?
Clifford Hudis: Well, at the risk of sounding self-serving and recognizing that there’s no government on earth that devotes as much money to cancer research as the U.S., I have to point out that the rate of growth in that funding has been essentially zero for many, many years now. In inflationary terms, the purchasing power of the U.S. federal budget for cancer research has gone down. The estimates I’ve heard are about 20% over the last eight to ten years and so we have to ask ourselves as a society, “Is this reduced investment in cancer research specifically and health care research in general actually the way we want to direct our focus?” If collectively our society says, “Yes. We don’t want to do public sector research,” then I guess we’re doing the right thing. I personally would hope we would come to a different conclusion. I think the public funding of science overall, health overall, and cancer specifically all is important. About a third of Americans are going to die of cancer. The proportion of money we spend on that relative to other less life-threatening concerns is somewhat disheartening at times.
From mercury in fish to whether government does enough.
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Whether or not women think beards are sexy has to do with "moral disgust"
- A new study found that women perceive men with facial hair to be more attractive as well as physically and socially dominant.
- Women tend to associate more masculine faces with physical strength, social assertiveness, and formidability.
- Women who display higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, are more likely to prefer hairy faces.
Beards and perceptions of masculinity<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg0MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzkxMjM3N30.cH-GqNwP5GVqvstgJWAhBPn1B_lYpVEAI0I7iax7EQw/img.jpg?width=1245&coordinates=0%2C1900%2C0%2C849&height=700" id="caae6" class="rm-shortcode" data-rm-shortcode-id="cb0a355a4e8e1899789bc45f3f7aef56" data-rm-shortcode-name="rebelmouse-image" />
Photo Credit: Wikimedia<p>The study used 919 American (mostly white) women ages 18-70 who rated 30 pictures of men they were shown with various stages of facial hair growth. The photographs depicted men with faces that had been digitally altered to look more feminine or more masculine, with a beard and without a beard. The women rated the men according to perceived attractiveness for long-term and short-term relationships. The study found that the more facial hair the men had, the higher the men were rated on their attractiveness, particularly for their suitability for a long-term relationship.</p><p>Part of this might be attributed to facial masculinity — i.e. protruding brow ridge, wide cheekbones, thick jawline, and deeply set narrow eyes — which conveys information to a woman about a man's underlying health and formidability. Women tend to associate more masculine faces with physical strength and social assertiveness. It can also indicate a man with a superior immune response. The researchers suggested that their findings favoring bearded men could be due to the fact that facial hair enhances the masculine facial features on a man's face, like creating the illusion of a thicker jaw line. This could communicate direct benefits to women like resources and protection that would enhance survival among mothers and their infants. In other words, while a beard doesn't mean superior genetics in and of itself, it might be a primitive, ornamental way of saying, "Hey girl, I'm a testosterone-fueled lean, mean, pathogen fighting machine." <br></p><p>It could also be that a beard becomes its own destiny. The researchers in this study cite prior research that found that by growing a beard, men felt more masculine and had higher levels of serum testosterone, which was linked to a higher level of social dominance. They also tended to subscribe to more old-school beliefs about gender roles in their relationships with women as compared to men with clean-shaven faces.<span></span><br></p>
What does disgust have to do with beard preference?<p>Obviously, not all women dig beards. The researchers were particularly interested in what traits make a women prefer bearded men over clean-shaven faces. They looked into several factors including a woman's disgust levels on various concepts, her desire to become pregnant, and her exposure to facial hair in her personal life. </p><p>According to the study, women who were not into facial hair were turned-off by potential parasites or other critters they imagined could be in the hair or skin. Women ranking high on this "ectoparasite disgust" scale might have viewed beards as a sign of poor grooming habits. However, women who ranked higher in levels of "pathogen" did find the bearded men to be desirable, possibly because they perceived beards as a signal of good health and immune function. An intriguing discovery in the study was links to morality. Women who displayed higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, were more likely to prefer hairy faces. The authors opined that this could reflect a link between beardedness, politically conservative outlooks, and traditional views regarding performances of masculinity in heterosexual relationships.</p>
Additional findings<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg1My9vcmlnaW4uZ2lmIiwiZXhwaXJlc19hdCI6MTYyNDI1NjUyOX0.P9B8WbmJR0q4nfzYZKbuNSA-2SAigVWJgrQE-_Gxlds/img.gif?width=980" id="49143" class="rm-shortcode" data-rm-shortcode-id="2ed3b1d6f20fc170bf2974646e565e8d" data-rm-shortcode-name="rebelmouse-image" />Giphy<p>The correlations that existed between married and single women's rating on the attractiveness of beards were not particularly clear, although the researchers noted that single and married women who wanted children tended to find beards more attractive than the women who didn't want children. They also found that women with bearded husbands found beards to be more attractive, which might indicate that social exposure to beards influences how desirable they are perceived of as being. Or it could be that men with wives who like beards grow beards.</p><p>It's important to note that culture plays a huge role in how attractive women perceive certain male characteristics as being. This study looked at a small, culturally specific group of American women, so no big, universal claims should be made about masculinity, facial hair, and male desirability to women. However, research like this is important in highlighting how human grooming decisions are driven by much more than fashion trends. Sociobiological, economic, and ecological factors all play a part in the way we choose to present ourselves.</p>
Yet 80 percent of respondents want to reduce their risk of dementia.
- A new MDVIP/Ipsos survey found that only 35 percent of Americans know the symptoms of Alzheimer's disease.
- Eighty percent of respondents said they want to reduce their risks.
- An estimated 7.1 million Americans over the age of 65 will suffer from Alzheimer's by 2025.
Credit: logika600 / Shutterstock<p>Remaining healthy requires regular screenings. Here again we see a disassociation between risk reduction and proactivity. Seventy-seven percent of respondents don't talk to their doctors about lifestyle habits that support brain health; 51 percent have never been screened for depression; 44 percent have never had a neurological exam; and 32 percent have never been screened for hearing problems. </p><p>Common early warning signs of dementia, <a href="https://news.yahoo.com/americans-worry-alzheimers-disease-survey-140644803.html" target="_blank" rel="noopener noreferrer">according to</a> Dr. Jason Karlawish, co-director of the Penn Memory Center, include repetitive questions and stories, difficulties with complex daily tasks, and trouble with orientation. </p><p>In terms of intervention, <a href="https://bigthink.com/21st-century-spirituality/does-lack-of-exercise-lead-to-dementia" target="_self">exercise</a>, <a href="https://bigthink.com/surprising-science/obesity-dementia" target="_self">diet</a>, building a <a href="https://bigthink.com/mind-brain/brain-reserve" target="_self">brain reserve</a>, and challenging your brain (such as learning a new language or musical instrument) are all proven methods for staving off the ravages of Alzheimer's. Oxytocin has also <a href="https://bigthink.com/mind-brain/alzheimers-oxytocin" target="_self">showed promise</a> in brain-addled mice, while researchers found positive results for a <a href="https://bigthink.com/mind-brain/intermittent-fasting" target="_self">group of intermittent fasters</a> in promoting neurogenesis. </p><p>Epidemiologist Bryan James says that dementia is <a href="https://www.npr.org/sections/health-shots/2013/04/15/176920391/how-exercise-and-other-activities-beat-back-dementia" target="_blank">not an inevitable result</a> of aging. </p><p style="margin-left: 20px;">"It's simply not pre-destined for all human beings. Lots of people live into their 90s and even 100s with no symptoms of dementia." </p><p>Professor of neurology at Boston University School of Medicine, Andrew Budson, <a href="https://news.yahoo.com/americans-worry-alzheimers-disease-survey-140644803.html" target="_blank" rel="noopener noreferrer">recommends</a> aerobic exercise and the Mediterranean diet. As has long been known, whole grains, fruits and vegetables, fish and shellfish, and healthy fasts like nuts and olive oil seem to have brain-boosting properties. </p><p>To learn more, take the <a href="https://www.mdvip.com/brain-health-iq-quiz" target="_blank">Brain Health IQ quiz</a>.</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank" rel="noopener noreferrer">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>