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By Elizabeth M. Whelan, Sc.D., M.P.H., Gilbert Ross, M.D.
Posted: Friday, April 8, 2005

EDITORIAL
Publication Date: April 8, 2005

Ever since ABC News anchor Peter Jennings announced last week that he had been diagnosed with lung cancer, we have observed an increased interest in the disease--particularly the probability of it occurring in former smokers.  We have spoken with dozens of former smokers and read reports of anxiety in this group, and, drawing on the American Council on Science and Health's past research, we offer facts and advice on lung cancer.  Our advice is tailored to three different groups: a) ex-smokers, b) current smokers, and c) non-smokers who are candidates to take up the habit.

Risks

First, some hard facts:

--Cigarette smoke is the leading cause of preventable death in America today, accounting for at least 450,000 premature deaths.

--Approximately 160,000 cases of lung cancer are diagnosed annually in the U.S., which means that on any given day (such as the day Mr. Jennings received his diagnosis) some 460 other Americans get the same bad news.

--Just over 90% of all lung cancers are causally linked with cigarette smoking. Indeed before cigarette smoking became popular around World War I, lung cancer was an exceedingly rare disease (tobacco was used relatively safely in the form of pipes, cigars, and snuff prior to that time).

--During the 1960s nearly 70% of American men smoked, and about 50% of American women were smokers.  We have dramatically reduced the prevalence of smoking in our country, with smokers giving up the habit and fewer young people taking up smoking--but the reality is that even among those who have quit, health risks associated with past smoking remain.  That explains why approximately 50% of the 160,000 diagnoses now made for lung cancer are made among former smokers.

--One popular argument the scientific community often makes to encourage smokers to quit stems from the theory that all of the health effects of smoking are reversible shortly after cessation, regardless of the duration or intensity of smoking exposure.  Unfortunately, this is just not true.

--Regarding lung cancer, smoking for about 25 years appears to trigger a biological switch that drives the growth of lung cells towards the development of lung cancer--even if the smoker quits.  Thus, while quitting is the best option for a smoker of any age, damage to the respiratory system, including those that can result in cancer, may continue to plague the ex-smoker for years after quitting.

--Smokers (one pack a day for twenty or more years) have a ten- to fifteen-fold greater risk of developing lung cancer compared to those who have never smoked.  The more you smoke--or smoked in the past--the greater your risk of lung cancer (and other smoking-related diseases).  Public health experts have long argued that risk declines with time after you stop, but this may be much more true for risks of heart disease than for risks of cancer, particularly with a very long history of heavy smoking.

The Case of Peter Jennings

Take the case of Peter Jennings.  News reports indicate he started smoking when he was thirteen years old (for him that would have been around 1951) and continued smoking heavily until the mid or late 1980s.  That would be more than thirty-one years of exposure to the risks of smoking.  It is unclear how much he smoked after giving up cigarettes in the 1980s (he acknowledges taking up smoking again after the 9/11/01 terrorist attacks).

Mr. Jennings, even if he was an ex-smoker after 2001, was at greatly elevated risk of lung cancer given the long history of exposure.  The question then is this: what are the lessons to be learned from Peter Jennings?  What can and should we do to reduce our own risk of being diagnosed with life-threatening lung cancer?

Advice for Risk Groups

For nonsmokers: Do not start smoking.  Do not delude yourself into believing that you can "smoke 'til I'm thirty" or "smoke until I want to have kids" and come away unscathed, returning to the same risk file as a never-smoker.  Smoking directly irritates and damages the respiratory tract.  Each year, a one-pack-a-day smoker smears the equivalent of a cup of tar over his or her respiratory tract.  This irritation and damage cause a variety of adverse effects, ones that can be reduced--but not entirely reversed--by quitting.

For current smokers: Quit now.  Get assistance if necessary.  Even if you have been smoking for many decades, you will be rewarded with health benefits, especially a rapid decline in risk from the number one cause of cigarette death: cardiovascular disease.

For (newly worried) former smokers: Be grateful you quit when you did.  If you have smoked for many years--maybe decades--and now realize you have an elevated risk of lung cancer, consider the fact that among long-term, current smokers, the chances of developing lung cancer are in the 10%-15% range.  If you quit ten or more years ago, your personal risk is below that range.

Screenings

What about regular lung cancer screenings?  Well, talk it over with your own physician--but be keenly aware of the limitations here.  Your physician may recommend a yearly chest X-ray.  This may or may not assist in diagnosing lung cancer at an early, curable stage.  (The American Cancer Society stopped recommending annual X-rays for smokers many years ago, although some physicians think such rays can be useful in finding early cancers.)

There has been some excitement in the medical community, and among the public, about screening using lower-dose CT scans--spiral or helical CTs--to enhance detection of early-stage lesions.  There are several studies now underway to see if such techniques will lead to an improvement in the real bottom line: survival rate.  Thus far, no study has shown an improvement in mortality rate from lung cancer in patient groups screened by chest X-ray or CT scan, but there have been some indications that larger-scale studies may show some beneficial impact.  Meanwhile, the fact is that many more benign lesions or indolent growths of no importance to lifespan get detected than dangerous, early-stage tumors--in other words, these CT type tests can yield lots of "false positives," causing needless anxiety and even needless surgery.  It seems counter-intuitive, but early detection has not proven to be helpful in saving lives from lung cancer...yet.

Whelan and Ross head the American Council on Science and Health, which runs the sites ACSH.org, HealthFactsAndFears.com, and theScooponSmoking.org.



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Posted: Monday, November 14, 2005

PRESS RELEASE
Publication Date: November 14, 2005

New York, NY -- November 14, 2005. Scientists associated with the American Council on Science and Health (ACSH) once again present an analysis of the natural foods that make up a traditional holiday dinner. Results indicate that our favorite foods are loaded with chemicals that can cause cancer in laboratory animals when administered in very high doses -- but none of these "carcinogens" are manmade or added to the foods. Instead, they occur naturally. But ACSH scientists have good news: these natural "carcinogens" pose no hazard to human health -- nor, for that matter, do manmade ones.

"The widespread presence of natural carcinogens in our food is clear evidence of why trace levels of manmade chemicals that cause cancer in lab animals should not be a concern," notes Dr. Elizabeth Whelan, president of ACSH.

Much of the concern about the health effects of chemicals stems from the indiscriminate application of the so-called Delaney Clause of the Food, Drug, and Cosmetic Act. As ACSH's Holiday Dinner Menu -- a publication listing natural carcinogens in a typical holiday meal -- explains, the Delaney clause originally banned from American foods any artificial substance, whether pesticide residue or food additive, that could be shown to cause cancer in lab animals, no matter how minuscule the amount found in the human food supply or how high the dose given to the animals.

Over the years, the Delaney Clause has triggered regulatory action against a number of chemicals, including food colors and the artificial sweeteners cyclamates and saccharin. These compounds are animal carcinogens at high doses but are not suspected of causing human cancer. (Saccharin escaped a Delaney-instigated ban by the Food and Drug Administration only through an act of Congress.)

Usually, the chemicals examined by regulators were synthetic, since it was assumed that only manmade substances would cause cancer in laboratory animals. This, in fact, is not the case. Toxicologists have confirmed that natural chemicals, too, can be animal carcinogens when administered in high doses.

"If the Delaney clause were applied to the carcinogens that occur naturally in our foods, we would have to ban much of our holiday dinner -- and the rest of the foods we eat all year," adds Dr. Whelan. It should not be assumed that man-made chemicals are any more dangerous than natural chemicals.

The Food Quality Protection Act of 1996 was a glimmer of light at the end of the regulatory tunnel. The act exempts pesticides from the "zero risk" provisions of the Delaney Clause and demands instead a new standard of "reasonable certainty of no harm." Unfortunately, the new bill leaves standing the application of the Delaney Clause's zero-risk standard to food additives, which still must pass this scientifically insupportable threshold.

ACSH's Holiday Dinner Menu highlights the chemicals -- and the carcinogens -- that Mother Nature herself has put in our food. These natural carcinogens, by and large, have been shown to cause cancer only in very high doses given over a lifetime to lab animals. These chemicals are present in such small amounts in our food that they do not endanger consumers. This fact hasn't dampened the ardor of self-styled consumer activists, who "warn" consumers about the supposed dangers of, for example, acrylamide, which is produced naturally when carbohydrate-rich foods are cooked at high temperatures. "Acrylamide, like the majority of the other rodent carcinogens listed in the menu, has never been shown to be a human carcinogen," observed ACSH nutrition director Dr. Ruth Kava.

The American Council on Science and Health strongly endorses the progress Congress has made thus far in removing pesticides from the purview of Delaney, and ACSH urges Congress to continue to apply common sense and scientific reasoning to our food-protection programs. Says Dr. Whelan: "We must continue the progress we have made in changing our food laws -- and particularly the Delaney Clause -- to bring them into line with scientific reality. Removing the Delaney Clause entirely from our food safety laws would be highly desirable and consistent with our modern-day understanding of food technology and toxicology."


Contact: Dr. Ruth Kava 212-362-7044 x234 (kava[at]acsh.org) or Dr. Elizabeth Whelan 212-362-7044 x237 (whelan[at]acsh.org)



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By Robert A. Greenwald, M.D.
Posted: Tuesday, April 5, 2005

ARTICLES
Publication Date: April 5, 2005

This reflection was written before the FDA request, in the second week of April, for the withdrawal of Bextra and new warning label for Celebrex but is made all the more timely by recent events:

COX-2 inhibitors such as Vioxx have become the targets of Congressional hearings and a proposed post-approval drug monitoring body, but in all the hype about their hoped-for benefits and hubbub over their newfound side effects, it's easy to forget that these drugs do, after all, have important benefits -- and that we were on the verge of finding new and even more important uses for the drugs when the controversy over them arose, potentially squelching valuable research. 

The "law of unintended consequences," well known to social scientists, states that the actions of people, and especially of governments, often have unplanned effects that are not necessarily beneficial. The recent actions of the FDA and the pharmaceutical industry regarding the COX-2 inhibitors (Vioxx, Celebrex, and Bextra) are a prime example.

COX-2 refers to an enzyme that participates in inflammation and pain of the sort that might be endured by patients with rheumatoid or osteoarthritis. The COX-2 selective drugs interfere with the action of this enzyme but spare a similar enzyme that protects the stomach, thereby lessening the risk of stomach-related side effects which might be seen with older, conventional arthritis drugs. (Both COX-2 drugs and the older non-selective drugs are referred to as non-steroidal anti-inflammatory drugs, or NSAIDs.) The COX-2 drugs were developed primarily for treatment of subjects at high risk for stomach problems, including the elderly, smokers, and patients with a history of gastrointestinal problems such as ulcers. However, they rapidly became much more widely used, largely due to aggressive marketing by their manufacturers. Now the concept has been called into question by the finding that in some studies using these agents, an increase in cardiac and/or cerebrovascular (stroke) events was observed. Vioxx was temporarily withdrawn, and the usage of Celebrex and Bextra plummeted.

Several other promising lines of research were underway at the time of these events: studies to determine if COX-2 drugs would either benefit or prevent Alzheimer's disease, studies to see if these agents would prevent colon polyps from turning into cancer, and ironically, the concept that a COX-2 drug might prevent rather than cause heart disease. As an unintended consequence, these and other lines of investigation, which might potentially benefit many thousands (or millions) of people, may be curtailed.

Alzheimer?s Disease (AD): One of the methods used to clarify how a chronic disease develops is to study a large number of patients, collecting extensive information about their backgrounds, including detailed drug histories. About 15 years ago, studies of AD suggested that patients who had taken NSAIDs were protected against AD, i.e., their risk was lower. At first this effect was attributed to a general anti-inflammatory action, but in subsequent test tube and animal experiments, NSAIDs were shown to prevent the formation of a substance called amyloid which is present in large amounts in the brains of persons with AD and which is believed to cause many of the mental changes that occur in that condition.

This has led to the design of large-scale clinical trials in which it was planned to administer an NSAID to a population at risk to determine if a preventive effect could be demonstrated. Since it is the elderly who are at risk for both AD and gastrointestinal side effects, and since COX-2 activity is enhanced in brain tissue from AD patients, a COX-2 inhibitor drug would be the obvious choice of NSAID for such a study, even though several small-scale clinical trials have so far been negative. It hardly seems likely now that a major trial will take place. In fact, on December 20, 2004, the NIH announced that their ADAPT study (AD Anti-inflammatory Prevention Trial) using Celebrex had also been suspended.

Colon cancer: The situation with colorectal cancer (CRC) is similar: epidemiologic, test tube, and animal studies all suggest that preventive treatment with an NSAID, especially a COX-2 selective NSAID, might prevent CRC. The discovery was based on the chance observation of a subject who suffered from a familial disorder of frequent colon polyp formation with a high risk of cancer. The patient had been given an old NSAID called sulindac, and his doctor noted that the number of polyps had dramatically decreased. This led to many studies involving NSAID administration to subjects with both familial and sporadic colon polyps, with many of the studies utilizing Celebrex. The rationale for such an approach was enhanced by test tube and animal experiments showing that COX-2 was important in development of CRC. Celebrex had been FDA-approved for prevention of colon polyps in people with familial polyposis since 1999. Vioxx (Merck's COX-2 drug) was being evaluated for this usage when it was withdrawn -- but the preliminary results showed that it too was effective in chemoprevention of colorectal polyps. The COX-2 hypothesis of cancer causation is not limited to CRC: it might also be applicable to many other cancers. Surely the new findings on heart disease will seriously impede the search for a cancer-preventative role for the COX-2 drugs.

C-reactive protein (CRP): CRP has been in the news for the last few years because of statistical and epidemiologic studies showing that a high CRP level in the blood is a possible predictor of heart disease. CRP is elevated as a result of inflammation of any sort, from periodontal (gum) disease to severe arthritis. It has been surmised, without any proof, that reducing CRP might help prevent heart disease. Most patients with cardiac risk factors should, of course, be doing all they can to lower their cholesterol, stop smoking, lose weight, and get more exercise. The major quandary is, would taking an anti-inflammatory drug that is known to lower CRP yield any further benefit regarding cardiac disease? The COX-2 agents surely lower CRP, as do all NSAIDs. But how can it be true that the COX-2 agents increase the risk of heart disease while lowering one of the known risk factors for heart disease? A quandary for risk/benefit evaluation!

Conclusion: Aggressive marketing by the manufacturers of the COX-2 drugs backfired into the current controversy. The drugs were originally intended only for high-risk populations, e.g., the elderly, those with prior gastrointestinal events, etc. A forty-year old male with a tennis elbow and no ulcer history was not the target population for these drugs. Over-enthusiasm for prescribing the COX-2 drugs has now backlashed into over-avoidance. Had the COX-2 agents been restricted to the populations for which they were originally intended, they might still be enjoying widespread use, and their potential for other, lifesaving indications would still be under exploration, and not on the shelf.  Let us hope the recent FDA decision to keep the drugs on the market enables their most beneficial uses to continue, including any yet to be discovered.

Robert A. Greenwald, M.D., is Professor of Medicine at Albert Einstein College of Medicine.



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Posted: Thursday, December 14, 2006
Publication Date: December 14, 2006

 1. Focus your efforts on things that matter; inform yourself about possible risks.

The American Council on Science and Health is dedicated to helping you set rational priorities for a healthy and long life. While it is tempting to focus our anxiety on mysterious threats that lie largely beyond our own control, such as a possible terrorist attack (see ACSH's terrorism preparedness report), the truth is that when it comes to achieving long life and good health, we largely determine our own fate, through routine, everyday decisions.

One threat that was in the news a lot in early 2006 that we would do well to avoid panicking about is avian flu, or "bird flu." Although the strain of influenza that has passed from birds to humans (mostly in Southeast Asia) seems quite virulent, thus far it has not demonstrated the ability to pass from one person to another -- which would have to happen in order for a true pandemic to occur. Currently, individuals should be alert to news about this possible pandemic but should understand that the risk is still theoretical. For more information on avian flu, see the ACSH report.

As we get ready to start a new year, instead of brooding over worst-case scenarios, a more effective plan would be to improve important health-related aspects of our lifestyles -- by quitting smoking (or, better, not starting in the first place), engaging in regular exercise, and taking advantage of technology that protects us against health and safety hazards, such as bicycle helmets and appropriate immunizations. To make the best health choices, resolve to sift carefully through the health advice that surrounds us, and focus your efforts on the things that really matter.

2. Don't smoke.

If you don't smoke, don't start. If you do smoke, resolve to quit this year. Half of all adults who once smoked cigarettes have kicked the habit. You can, too. For more information on quitting, see ACSH's booklet Kicking Butts in the Twenty-First Century. If you have tried to quit multiple times but haven't stayed off cigarettes, consider an alternative nicotine source such as gum, lozenge, patch, or smokeless tobacco: these substitutes won't diminish your nicotine addiction but will eliminate your exposure to the many toxins and carcinogens in tobacco smoke.

Unfortunately, while many adults are trying to kick the habit, many teens are getting hooked. Over 20% of high school student are current smokers, and will be prone to all the negative health consequences of the habit.(1) ACSH's teen-friendly site on the facts about smoking can be accessed at: http://thescooponsmoking.org.

This is our major New Year's resolution because cigarette smoking is the number one cause of preventable deaths in this country. Smoking is responsible for over 400,000 deaths in the U.S. each year and more than $50 billion in medical expenditures. One in every five deaths in the United States is smoking-related, and half of all lifelong smokers die of a smoking-related disease.(2)

So don't let another year go up in smoke. Start the New Year smoke-free.

3. Achieve and maintain a healthy weight. Eat a balanced diet and handle foods safely.

Over half of Americans are overweight, and about a third are obese (meaning that they have a Body Mass Index of 30 or more).(3) The proportion of the population that is overweight has been increasing rapidly in the U.S. for the past 20 years in both the adult and the pediatric population.(4) Excess weight is associated with increased risks of heart disease, diabetes, high blood pressure, stroke, arthritis, gallbladder disease, and some types of cancer.(5) Obesity is hard to treat once established: prevention is a better route to take. To help reduce excess weight and to maintain a healthy weight, experts recommend that Americans eat a balanced diet, moderate total calorie intake and portion sizes, and exercise regularly.(6)

The keys to good nutrition are variety, moderation, and balance. There are no "good" or "bad" foods -- but there certainly are "good" and "bad" diets. Recently "trans fatty acids" have been singled out as a particularly evil ingredient in our food supply -- some have stated that they are responsible for literally thousands of deaths from heart disease each year. But be aware that the science does not support all this hyperbole: get the straight facts from the ACSH paper on trans fats.

In addition, many people worry too much about hypothetical hazards from traces of pesticides or other chemical residues in food while paying too little attention to more important food-related risks. For an informative look at the "carcinogenic" chemicals naturally present in food, see ACSH's Holiday Dinner Menu.

One of the most important food-related risks is contamination by microorganisms (bacteria, viruses, and some parasites). Diseases caused by microorganisms in food cause an estimated 5,000 deaths, 325,000 serious illnesses, and 76 million cases of gastrointestinal illness in the U.S. each year.(7)

Be aware that foodborne illness can be contracted from any type of food: fruits and vegetables, as well as meat and poultry products, can carry disease-causing microbes. Keep foods safe, and follow the four principles of the President's National Food Safety Initiative: 1) Clean: Wash hands and surfaces often. 2) Separate: Don't cross-contaminate. 3) Cook: Cook to proper temperatures. 4) Chill: Refrigerate promptly.(8)

For more information, read ACSH's booklet on food safety, Eating Safely: Avoiding Foodborne Illness.

4. Exercise regularly -- with caution.

Regular exercise will help you control your weight, improve your overall health, and reduce your risk of medical problems such as heart disease and osteoporosis. To get the most benefit, exercise for at least 30-45 minutes three to five times a week.(9)

When you exercise, make sure to take all the safety precautions that are recommended for the activities that you choose. It's especially important always to wear a helmet while cycling or skating. Wearing a bicycle helmet can reduce your risk of head injury by up to 85%.(10) Other safety equipment, such as kneepads and wrist guards, can also reduce your risk of injury.

Although exercise is beneficial for almost everyone, some people need to consult a doctor to find out what level and types of physical activities are safe for them. This precaution is especially important for heart disease patients, people who have a medical condition that might be aggravated by exercise, and people who are taking any type of medication (especially medicines for high blood pressure or heart disease).(11)

5. Separate drinking and driving.

Never drink and drive. Equally important, never ride as a passenger in a car driven by someone who has been drinking alcohol.

Forty percent of all traffic fatalities in the U.S. are alcohol-related.(12) One American is injured in an alcohol-related driving incident every two minutes.(13) Rates of fatal crashes have begun to rise after a decade of decline in alcohol-related crashes. Since 1999, they have increased slightly by 4% to 10% for all age groups except for ages 16 to 17 years,(14) so there's plenty of room for improvement There are nearly 160 million self-reported episodes of impaired driving in the U.S. every year.(15) Every one of these episodes puts people's lives at risk.

So if you plan to drink, make safe transportation arrangements. If no designated driver is available, use mass transit or call a taxi.

6. If you drink alcoholic beverages, keep your intake moderate.

Moderate drinking is OK for most adults (those without a family history of problematic drinking, for example). If you're middle-aged or older, it may even benefit your health by reducing your risk of heart disease. What's moderate? For men age 65 and under, the limit is two drinks per day; for men over 65 and women of all ages, it's one drink per day.(16)

Heavy drinking (that is, drinking that goes beyond the limits of moderation) is not healthful. The heavy drinking of alcohol is associated with increased risks of injury, liver disease, heart disease, high blood pressure, and several types of cancer. It's responsible for more than 100,000 deaths in the U.S. each year.(16)

For more information on the health effects of moderate drinking, see ACSH's booklet Moderate Alcohol Consumption and Health.

7. Take your body to the shop for preventive maintenance.

Your car comes equipped with a maintenance schedule. So does your body. Health authorities recommend that all adults and children should have certain types of preventive care -- such as screening tests and immunizations -- on a regular schedule. The timing of these services depends on your body's "model" and "mileage" (that is, your gender, family history, and age).

Unfortunately, many Americans have fallen way behind on their maintenance schedules. For example, yearly mammograms and breast exams are recommended for women over the age of 40 (if not younger), but over 24% of women in this age group reported not having had these exams for the previous two years.(17)

Everyone over the age of 65 should consult with their physician about being vaccinated against pneumococcal pneumonia and against shingles. Those over 65 should also receive an annual flu shot -- but more than a third of all Americans in this age group didn't get a flu shot last year, and more than 40% have never received the pneumococcal vaccine.(18) Influenza and pneumonia together killed over 60,000 Americans in 2002 (the seventh leading cause of death that year); appropriate vaccinations could substantially reduce this unnecessary death toll.(19)

New vaccines against human papilloma virus, the virus strongly linked to cancer of the uterine cervix, have recently become available. It has been suggested that pre-teen girls be vaccinated against this virus to prevent later development of cervical cancer. Parents should consult their pediatricians about obtaining this vaccine for their daughters. (20)

If you haven't been taking routine care of your body (or your child's body), resolve to make an appointment with your doctor this year to find out what preventive services are recommended. And then follow up by getting the necessary tests and immunizations.

For more information on children's immunizations see ACSH's booklet Vaccinations: What Parents Need to Know.

8. Protect yourself against AIDS and other sexually transmitted diseases.

The best ways to protect yourself against AIDS are to:

* Never use a non-sterile needle to inject anything into your body.
* Either abstain from sex or have sex only with an uninfected partner in a mutually monogamous relationship.

If you choose to have multiple sex partners (or your partner does), you can reduce your risk of AIDS and other sexually transmitted diseases in the following ways:

* Urge all prospective sexual partners to be tested for sexually transmitted infections.
* Use condoms properly and consistently.
* Avoid sexual intercourse with people who engage in high-risk behaviors such as unprotected sex or intravenous drug use.

9. Check "alternative" practices with your doctor.

More than 40% of Americans use some kind of "alternative" therapy,(21) such as herbal medicine, massage, chiropractic, or aromatherapy. Some people think that all alternative practices are harmless, but this isn't necessarily true -- especially for people with special medical concerns. For example, people with Parkinson's disease should never take the herb kava-kava because it can worsen their disease symptoms.(22) People with osteoporosis should not receive chiropractic therapy because the manipulation could cause a fracture.(23) For more information on possible drug-supplement interactions, see ACSH's brochure What's the Story? Drug-Supplement Interaction.

Even if an alternative therapy isn't dangerous in itself, it can hurt you if you use it as a substitute for proper medical care. Most alternatives have not been proven effective, and many don't work at all. If your problem turns out to be serious, you could endanger your health -- or even your life -- by experimenting with unproven therapies instead of seeing a physician promptly.

If you use alternative therapies, you should let your medical doctor know. However, more than 60% of Americans who use alternative methods don't do this.(24) To find out whether any alternative practices you would like to try are safe for you, resolve that you will always check out these methods with your doctor before you start.

10. Use automobile safety devices every time.

A recent survey showed that 81% of all Americans now buckle up -- at this rate, seat belts prevent 15,700 deaths, 350,000 serious injuries, and $67 billion in economic costs associated with traffic injuries and deaths every year.(25) This year, resolve that everyone in your car will be buckled into the proper restraint every time. That means seat belts for adults, booster seats (in the rear seat) for older children, and properly installed safety seats (in the rear seat) for small children and infants.

11. Protect your dental health.

You can help keep your teeth healthy by brushing and flossing, getting regular dental care, using fluoride as recommended by your doctor or dentist, eating balanced meals, and limiting snacks. While most people know this, here's something you may not know: more than two million teeth are knocked out every year, many of them from sports-related injuries.(26) Many of these injuries could have been avoided if the person were wearing a mouth protector. So if you play sports that involve a risk of mouth injury, resolve to wear a mouth guard every time.

12. Install and maintain a working smoke detector.

Smoke detectors save lives. They're your best protection against death or injury in a nighttime fire in your home. But they won't protect you if they're not working. The American Red Cross recommends that you test your smoke detectors once a month, replace the batteries at least once a year, and replace the detectors themselves every ten years. You can also protect your family from fire by planning at least two escape routes from every room in your home and making sure that all family members know how to use them.(27)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

1. Centers for Disease Control and Prevention. Cigarette use among high school students -- United States, 1991-2005. MMWR. 2006: 55(26);724-726. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5526a2.htm

2. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Life Lost, and Productivity Losses -- United States, 1997-2001.MMWR 2005:54(25):625-628. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm

3. Hedley A, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of Overweight and Obesity Among U.S. Children, Adolescents, and Adults, 1999-2002. JAMA 2004; 291: 2847-2850.

4. Ibid.

5. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH, The disease burden associated with overweight and obesity. JAMA 1999;282:1523-1529.

6. From a Surgeon General page entitled "Choose a Healthy Weight for Life." Available at http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_advice.htm

7. From a CDC press release dated Sept. 16, 1999 and titled "CDC data provides the most complete estimate on foodborne disease in the United States." Available at http://www.cdc.gov/od/oc/media/pressrel/r990917.htm

8. These principles are listed in many government documents. They came from an FSIS "food safety feature" dated July 1999 and titled "Cleanliness Helps Prevent Foodborne Illness." It's available at http://www.fsis.usda.gov/OA/pubs/cleanliness.htm

9. The American College of Sports Medicine, available at www.acsm.org/pdf/Guidelines.pdf .

10. According to a Consumer Product Safety Commission press release dated April 21, 1999 and available at http://www.cpsc.gov/cpscpub/prerel/prhtml99/99099.html

11. From the American Heart Association’s recommendations on physical activity, available at http://216.185.112.5/presenter.jhtml?identifier=4563

12. From the National Center for Injury Prevention and Control's "Impaired Driving." http://www.cdc.gov/ncipc/factsheets/drving.htm

13. Ibid.

14. Ibid.

15. Ibid.

16. References for this statement can be found in ACSH's report on moderate drinking.
http://www.acsh.org/publications/pubID.391/pub_detail.asp

17. From the National Center for Chronic Disease Prevention and Health Promotion’s Behavioral Risk Factor Surveillance System Prevalence Data, 2002. http://apps.nccd.cdc.gov/brfss/Trends/trendchart.asp?qkey=10060&state=US

18. This statistic comes from a Behavioral Risk Factor Surveillance System survey in 2002, which asked, "During the past 12 months, have you had a flu shot?" In the age group 65+, 35.1% said no. When asked if they’d received the pneumococcal pneumonia vaccine, 37.0% of people 65 or older said no. http://apps.nccd.cdc.gov/brfss/Trends/TrendData.asp

19. National Vital Statistics Reports, Vol. 53, No. 17, March 7, 2005. Available at http://www.cdc.gov/nchs/data/dvs/nvsr53_17tableE2002.pdf

20. From the CDC’s "HPV and HPV Vaccine -- Information for Healthcare Providers," revised August 2006. http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm

21. Eisenberg DM et al, Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-1575.

22. References for this statement can be found in our draft report on supplements and the elderly.

23. From a National Safety Council fact sheet called "Is Alternative Medicine Going Mainstream?" http://www.nsc.org/pubs/fsh/archive/spr99/altmed.htm

24. From the article by Eisenberg cited above.

25. National Highway Traffic Safety Administration, November, 2006. http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2006/810677.pdf

26. From an American Dental Association press release entitled "Mouth Protectors: Don't Play Without One." http://www.ada.org/public/topics/mouthguards.asp

27. From the American Red Cross fact sheet "Are You Ready for a Residential Fire?" http://www.redcross.org/services/disaster/0,1082,0_584_,00.html

(Resolutions updated by Ruth Kava, Ph.D., R.D., Director of Nutrition at the American Council on Science and Health.)

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By Josh Bloom, Ph.D.
Posted: Monday, August 15, 2005

ARTICLES
Publication Date: August 15, 2005

"Indications: (partial list) Asthma, Cancer, Chickenpox, Cholera, Depression, Diarrhea, Flu, Headache, Herpes, Nervousness, Paralysis, Ringworm, Sciatica, Toothache, Ulcers, Warts."

--from The Handbook of Medical Herbs, second edition; J.A. Duke (CRC Press, 2002), p. 579

Must be pretty good stuff if it's being promoted for us against all those ills, right? Or perhaps you're wondering: "Hmm -- if this one herb can treat all of that (and more) why would anyone ever be sick?" Or, if you?re a bit skeptical, "maybe it doesn't really work all that well, but at least it's an herb and can't do any harm, right?"

The herb in question is poison ivy. And there are sixty-nine other conditions it is useful in treating, if you believe what the herbalists tell you. Celery has seventy-eight indications. Echinacea has ninety. Pussy Willow has seventeen, including loneliness and hemorrhoids. Rice has forty-six, including thirst, breast cancer, and tuberculosis.

Perhaps I'm jaded, but I don't really believe that poison ivy will help my insomnia any more than celery will help my asthma. In fact, browsing through the hundreds of herbs in this book, I couldn't find any disease that wasn't treatable by an herb. The logical conclusion, apparently, is that no one has to die of anything, given the right combination of herbs.

In all seriousness, though, some plants and herbs are useful. Drug companies have been conducting natural products research for decades. This involves searching the natural world for crude isolates (from plants, marine life, or microorganisms) and painstakingly purifying and testing the derived compounds against a variety of diseases. Many modern drugs have been discovered in this manner, including some for heart disease, pain, infection, and cancer. A San Francisco-based startup called Shaman Pharmaceuticals was founded in 1989 to search rain forests and speak to indigenous people about plants they used, trying to exploit this knowledge to invent new therapies. Nice idea -- but then again, they filed for bankruptcy in 2001.

The main difference between herbal therapies (those that are useful) and modern drugs is that herbs contain complex mixtures of dozens (or even hundreds) of chemicals, with the active substance, if there is one, typically being one minor component. Sometimes there can be several active components. The other components are either irrelevant or perhaps harmful.

And harmful is not that unusual. There are plenty of toxic herbs -- ephedra, mistletoe, and nightshade being a few examples. These contain poisonous chemicals that can damage your liver, kidneys, and central nervous systems. Modern natural-product-derived drugs are usually the single active component, without all the other stuff.

The mistake people make is to assume that there is no harm in using herbs, since they are natural and have been used for years. I've written at length about the lack of correlation between natural and safe. As for the historical argument, I don't buy it. Mercury was once used as a laxative. Now, if some gets spilled in a lab, the Hazmat team shows up in spacesuits. People used to be pretty sure that the sun went around the earth. Cats and dogs were killed en masse in London in the 1600s because people thought they were spreading the plague. All this did was make things worse, since the disease was actually being spread by fleas living on rats, which, in the absence of the cats, proliferated even faster. Slavery used to be considered OK. So was disco. Just because something was done in the past doesn't make it a good idea in the present.

Like them or not, modern drugs go through a tortuous approval process, where safety and efficacy need to be demonstrated, first in animals, then in large numbers of people. The system isn't perfect, but it works most of the time. There is no such requirement for most herbal remedies, so in effect, if you use herbal remedies you are the laboratory animal unwittingly participating in a poorly run toxicity study involving something that may or may not have any benefit.

Given the absence of legal controls, consumer ignorance, and the huge amount of money to be made, you might expect a bit of fraud here. And you would not be disappointed. The worst of it takes the herbal safety myth and extends the idea one step further. Unscrupulous manufacturers attach the "herbal" label even to the names of known drugs and then sell them as if they were some improved, natural, and safe alternative to the real drug. This is nothing more than a modern version of selling snake oil.

Not Always an Altermative

The premise that there exist plant-based (and thus safer) versions of known drugs is a fairy tale, one the Brothers Grimm themselves might consider dark and twisted. Let me be clear about this: if you see a bottle labeled "Herbal XYZ," you can bet that it means one of the following: (1) an herbal preparation that allegedly has medicinal properties similar to XYZ (but is not XYZ) or (2) something that has no use but has real XYZ added to it. Here are some examples of each.

St. Johns' Wort has been used for centuries (especially in Europe) for treatment of mood disorders, including depression. In the 1990s, some companies started selling it as "Herbal Prozac." This enabled people to delude themselves into believing they weren't really taking a drug, since it was something natural. But the active ingredients in the herb are chemicals called hypericin and hyperformin. And guess what? They are drugs. As such, they have side effects, including gastrointestinal disturbances, allergic reactions, fatigue, dizziness, confusion, dry mouth, and photosensitivity. The plant extract also contains small amounts of dozens of other chemicals, including some found in gasoline (source: PDR for Herbal Medicines, second edition, p. 719).

This isn't to say that the herb doesn't work. A 1999 German clinical trial compared the herb to Prozac and found similar efficacy, but it took forty times the dose for the herb to achieve the Prozac result. This brings up a few questions herbal users might want to ask. What dose are you taking? Is there a correct dose? How much of the active ingredient is actually in each capsule? What else is in there? Is the herb more or less effective or toxic than the pharmaceutical product? Are there interactions with other drugs? Do you want to take something that has not been approved by the FDA? And, perhaps most important, should you really be treating yourself for a disease as serious as depression?

Similarly, after fenfluramine (the fen in the diet aid fen-phen) was withdrawn in 1997, something called "Herbal Fen-Phen" quickly popped up. Safe and effective substitute? I think not. The stuff was actually a Chinese herb called Ma Huang or ephedra (for the FDA warning see: http://www.fda.gov/bbs/topics/ANSWERS/ANS00832.html). Last April, the FDA banned ephedra-containing diet aids after more than 16,000 adverse events and deaths were reported. It is ironic that the active ingredient in ephedra is ephedrine, a little-used decongestant and appetite suppressant that is actually rather dangerous. It causes a number of undesired effects, including insomnia, restlessness, irritability, headache, nausea, vomiting, rapid heartbeat, and increased blood pressure.

A different use of "herbal substitutes" involves outright fraud. Here, herbs (or any substance, really) that do little or nothing are actually spiked with the genuine drug. A couple of examples: A group from the University of Toronto (Urology Times, June 1, 2004) recently analyzed a number of "herbal" erectile dysfunction treatments with delightfully understated names such as "Stamina Rx" and "Super X." And guess what? Some of these contained the active ingredients from Viagra and Cialis. If you happen to take these with certain medical conditions, or along with nitroglycerin, you could die. Likewise, in the late 1990s, a number of "natural" psoriasis creams (one of which was Dead Sea Extracts) were found to contain the same potent steroid that the users were trying to avoid in the first place. Without the steroid, the creams were useless. Same idea, same scam.

That one can buy serious drugs (completely unregulated) under the guise of herbal treatments or "food supplements" points out the inadequacy of our current supplement laws. There is an obvious disconnect between science, law, and common sense, with American consumers being the ultimate target.


Dr. Bloom, who resides in Nyack, NY, is an organic chemist and writes regularly for HealthFactsAndFears.com.  He has worked in the pharmaceutical industry for about twenty years.



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By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Friday, August 5, 2005

EDITORIAL
Publication Date: August 5, 2005

Last week Senator Bill Frist made headlines with his apparent turnabout in favor of federal funding for research using embryonic stem cells (ESC) -- a break with the policy of President Bush. Almost all proponents of ESC (potentially far more flexible and thus conducive someday to far more treatments than adult stem cells) saw this as terrific news, while opponents -- including a full spectrum of religious groups and social conservatives -- characterized Frist as a traitor.  But Frist may not have changed enough to keep him from stifling ESC after all. 

True, Frist says he now supports legislation that would allow the use of federal funds for research using "leftover" fertilized eggs from in vitro fertilization procedures. Four years ago, President Bush approved federal funding for such research -- but limited it to the seventy-eight embryonic stem cell lines created before an arbitrarily chosen date: August 2001. The limitations of this restriction quickly became apparent: as of today, only twenty-two of these lines have proven to be useful for research.

Newspapers around the country, including the New York Times, editorialized in praise of Senator Frist, saying that the Senator "deserved credit" and that his reversal was "very welcome." Even with Frist's change of heart, the passage of legislation to approve federal funding of ESC is still not certain, but nearly everyone hearing of the Frist move was either (a) very encouraged, envisioning the United States finally getting into the race to derive life-saving therapies using embryonic in addition to adult stem cells, or (b) very discouraged, proclaiming that even normally "pro-life" politicians are now succumbing to surging popular support for all forms of stem cell research.

The reality is more complicated that this dichotomy of reaction suggests. Much more complicated.

The problem, one which may in the long run be a devastating blow to U.S. scientists who want to advance stem cell research, is one of public confusion, incomplete information, and just plain ignorance about what stem cell research is, and what techniques are involved.

Members of the scientific community are partly to blame for this sorry state affairs and now run the risk of the public rejecting this line of research and the potential life-saving therapies it may produce -- all because the public may now feel "out of the loop" on what this research is really all about.

The primary problem here is that American consumers have been led to believe that if only President Bush -- or a Congress overruling him -- would allow federal funding for research on fertilized eggs from fertility clinics (ones which would otherwise be discarded), then we would be well on our way to cures for Parkinson's disease, diabetes, and a whole host of other maladies.

If you believe that making available the 400,000 fertilized eggs now in the freezers of medical facilities around the country will give researchers what they need to forge ahead with new breakthrough technologies, then of course you would applaud Senator Frist's announcement. And you would ask for no more.

But the well-guarded secret is that access to these few hundred thousand embryos, while it may assist researchers temporarily, is only part of what is needed to keep America in competition with other nations seeking stem-cell based therapies.

What American stem cell scientists need is what is granted to scientists in countries around the world: federal funding for research that involves what is technically known as "somatic cell nuclear transfer" (SCNT). This process involves removing the genetic material (the nucleus) from a donated human egg, replacing it with genetic material from a living person -- a nucleus from a donor's cell -- and stimulating the egg to develop. The result is equivalent to a human embryo -- but one which was not created through the fusion of an ovum and sperm. Nonetheless, the resulting product is a "blastocyst," which if implanted in a womb might develop into a baby -- who would have the same genetic profile as the donor.

That brings us to the word "cloning."

Indeed, SCNT is another term -- albeit a less charged one -- for the term "therapeutic cloning." The difference between therapeutic cloning and what is known as "reproductive cloning" lies not in methodology but in intent. Reproductive cloning is performed with the intention of creating a fully-formed organism, a clone like the sheep Dolly. But blastocysts created for therapeutic cloning, as in the example above, are not intended to be implanted in a uterus. In fact, they are never allowed to develop for more than five days. Instead, these blastocysts are seen as sources of cells with the unique potential to form any cell type in the human body. It is these cells that scientists hope to understand well enough to guide their formation into neurons that could treat Parkinson disease, insulin cells that could cure diabetes, and more.

By his "turnabout," Senator Frist implies no more than that he would approve federal funding for research on already-existing embryos from fertility clinics. Not only did he fail to endorse SCNT, but there is reason to suspect that any Senate legislation he and his colleagues might vote for would have a provision specifically prohibiting federal funding for "any form of cloning."

If this happens, advocates of stem cell research will find themselves in a "one step forward, fifty steps back" scenario. The leftover IVF embryos will provide some research potential -- but the real promise for advancing new therapies lies with SCNT using donated eggs. The tragedy here is that there has been so much emphasis on freeing up fertility clinic embryos for research with federal dollars that if this happens, an overwhelming majority of Americans will think we are home free. Scientists subsequently announcing "No, this is not sufficient" will not be well-received and will anger those who wish to prevent the creation of research embryos of any type, who often use the argument "We must not create life to destroy life."

Scientific advocates for embryonic stem cell research must step up to the plate and do a better job of educating the public, specifically:


--explaining what techniques are involved in such research

--comparing and contrasting the results of reproductive cloning with those of nuclear cell transfer (therapeutic cloning)

--repeatedly explaining that at all times researchers are motivated by a respect for human life. 


Creating embryos through nuclear transfer is not a pointless technological stunt. The efforts underway are intended to save human lives and prevent human suffering.

We are at a critical time in shaping the future of stem cell research. Keep an eye on the Senate. If Sen. Frist signs onto legislation that permits federal funding of research on fertility clinic embryos but the bill includes a rejection of funding for the cutting-edge research of nuclear transfer, then that great "turnaround" that got the headlines last week will turn out to be an ominous mirage.


Dr. Elizabeth M. Whelan is President of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).



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Posted: Thursday, December 15, 2005

ARTICLES
Publication Date: December 15, 2005

1. Focus your efforts on things that matter; inform yourself about possible risks.

The American Council on Science and Health (http://www.acsh.org) is dedicated to helping you set rational priorities for a healthy and long life. While it is tempting to focus our anxiety on mysterious threats that lie largely beyond our own control, such as a possible terrorist attack (see ACSH's terrorism preparedness report at http://www.acsh.org/publications/pubID.228/pub_detail.asp ), the truth is that when it comes to achieving long life and good health, we largely determine our own fate, through routine, everyday decisions.

One new health threat on the horizon that we would do well to avoid panicking about is avian flu, or "bird flu." Although the strain of influenza that has passed from birds to humans (mostly in Southeast Asia) seems quite virulent, thus far it has not demonstrated the ability to pass from one person to another?which would have to happen in order for a true pandemic to occur. Currently, individuals should be alert to news about this possible pandemic but should understand that the risk is still theoretical.

As we get ready to start a new year, instead of brooding over worst-case scenarios, a more effective plan would be to improve important health-related aspects of our lifestyles?by quitting smoking (or, better, not starting in the first place), engaging in regular exercise, and taking advantage of technology that protects us against health and safety hazards, such as bicycle helmets and appropriate immunizations. To make the best health choices, resolve to sift carefully through the health advice that surrounds us, and focus your efforts on the things that really matter.

2. Don't smoke.

If you don't smoke, don't start. If you do smoke, resolve to quit this year. Half of all adults who once smoked cigarettes have kicked the habit. You can, too. For more information on quitting, see ACSH's booklet Kicking Butts in the Twenty-First Century at http://www.acsh.org/publications/pubID.220/pub_detail.asp .

Unfortunately, while many adults are trying to kick the habit, many teens are getting hooked. Over 20 percent of high school student are current smokers, and will be prone to all the negative health consequences of the habit.(1) ACSH's teen-friendly site on the facts about smoking can be accessed at: http://thescooponsmoking.org/ .

This is our major New Year's resolution because cigarette smoking is the number one cause of preventable deaths in this country. Between 1997 and 2001, smoking was responsible for 438,000 deaths in the U.S. each year and more than $50 billion in medical expenditures. One in every five deaths in the United States is smoking-related, and half of all lifelong smokers die of a smoking-related disease.(2)

So don't let another year go up in smoke. Start the New Year smoke-free.

3. Achieve and maintain a healthy weight. Eat a balanced diet and handle foods safely.

Over half of Americans are overweight, and about a third are obese (meaning that they have a Body Mass Index of 30 or more).(3) The proportion of the population that is overweight has been increasing rapidly in the U.S. for the past 20 years in both the adult and the pediatric population.(4) Excess weight is associated with increased risks of heart disease, diabetes, high blood pressure, stroke, arthritis, gallbladder disease, and some types of cancer.(5) Obesity is hard to treat once established: prevention is a better route to take. To help reduce excess weight and to maintain a healthy weight, experts recommend that Americans eat a balanced diet, moderate total calorie intake and portion sizes, and exercise regularly.(6)

The keys to good nutrition are variety, moderation, and balance. There are no "good" or "bad" foods?but there certainly are "good" and "bad" diets.

In addition, many people worry too much about hypothetical hazards from traces of pesticides or other chemical residues in food while paying too little attention to more important food-related risks. For an informative look at the "carcinogenic" chemicals naturally present in food, see ACSH's Holiday Dinner Menu at: http://www.acsh.org/publications/pubID.103/pub_detail.asp .

One of the most important food-related risks is contamination by microorganisms (bacteria, viruses, and some parasites). Diseases caused by microorganisms in food cause an estimated 5,000 deaths, 325,000 serious illnesses, and 76 million cases of gastrointestinal illness in the U.S. each year.(7)

Be aware that foodborne illness can be contracted from any type of food: fruits and vegetables, as well as meat and poultry products can carry disease-causing microbes. keep foods safe, follow the four principles of the President's National Food Safety Initiative: 1) Clean: Wash hands and surfaces often. 2) Separate: Don't cross-contaminate. 3) Cook: Cook to proper temperatures. 4) Chill: Refrigerate promptly.(8)

For more information, read ACSH's booklet on food safety, Eating Safely: Avoiding Foodborne Illness at: http://www.acsh.org/publications/pubID.317/pub_detail.asp .

4. Exercise regularly?with caution.

Regular exercise will help you control your weight, improve your overall health, and reduce your risk of medical problems such as heart disease and osteoporosis. To get the most benefit, exercise for at least 30-45 minutes three to five times a week.(9)

When you exercise, make sure to take all the safety precautions that are recommended for the activities that you choose. It's especially important always to wear a helmet while cycling or skating. Wearing a bicycle helmet can reduce your risk of head injury by up to 85%.(10) Other safety equipment, such as kneepads and wrist guards, can also reduce your risk of injury.

Although exercise is beneficial for almost everyone, some people need to consult a doctor to find out what level and types of physical activities are safe for them. This precaution is especially important for heart disease patients, people who have a medical condition that might be aggravated by exercise, and people who are taking any type of medication (especially medicines for high blood pressure or heart disease).(11)

5. Separate drinking and driving.

Never drink and drive. Equally important, never ride as a passenger in a car driven by someone who has been drinking alcohol.

Forty percent of all traffic fatalities in the U.S. are alcohol-related.(12) One American is injured in an alcohol-related driving incident every two minutes.(13) Rates of fatal crashes have begun to rise after a decade of decline in alcohol-related crashes. Since 1999, they have increased slightly by 4% to 10% for all age groups except for ages 16 to 17 years,(14) so there's plenty of room for improvement. There are more than 120 million episodes of impaired driving in the U.S. every year.(15) Every one of these episodes puts people's lives at risk.

So if you plan to drink, make safe transportation arrangements. If no designated driver is available, use mass transit or call a taxi.

6. If you drink alcoholic beverages, keep your intake moderate.

Moderate drinking is OK for most adults (those without a family history of problematic drinking, for example). If you're middle-aged or older, it may even benefit your health by reducing your risk of heart disease. What's moderate? For men age 65 and under, the limit is two drinks per day; for men over 65 and women of all ages, it's one drink per day.(16)

Heavy drinking (that is, drinking that goes beyond the limits of moderation) is not healthful. The heavy drinking of alcohol is associated with increased risks of injury, liver disease, heart disease, high blood pressure, and several types of cancer. It's responsible for more than 100,000 deaths in the U.S. each year.(16)

For more information on the health effects of moderate drinking, see ACSH's booklet Moderate Alcohol Consumption and Health at: http://www.acsh.org/publications/pubID.391/pub_detail.asp .

7. Take your body to the shop for preventive maintenance.

Your car comes equipped with a maintenance schedule. So does your body. Health authorities recommend that all adults and children should have certain types of preventive care?such as screening tests and immunizations?on a regular schedule. The timing of these services depends on your body's "model" and "mileage" (that is, your gender, family history, and age).

Unfortunately, many Americans have fallen way behind on their maintenance schedules. For example, yearly mammograms and breast exams are recommended for women over the age of 40 (if not younger), but over 24% of women in this age group reported not having had these exams for the previous two years.(17) Everyone over the age of 65 should receive a single immunization against pneumococcal pneumonia and an annual flu shot?but more than a third of all Americans in this age group didn't get a flu shot last year, and more than 40% have never received the pneumococcal vaccine.(18) Influenza and pneumonia together killed over 60,000 Americans in 2002 (the 7th leading cause of death that year); appropriate vaccinations could substantially reduce this unnecessary death toll.(19)

If you haven't been taking routine care of your body (or your child's body), resolve to make an appointment with your doctor this year to find out what preventive services are recommended. And then follow up by getting the necessary tests and immunizations.

For more information on children's immunizations see ACSH's booklet Vaccinations: What Parents Need to Know at: http://www.acsh.org/publications/pubID.411/pub_detail.asp .

8. Protect yourself against AIDS and other sexually transmitted diseases.

The best ways to protect yourself against AIDS are to:

* Never use a non-sterile needle to inject anything into your body.
* Either abstain from sex or have sex only with an uninfected partner in a mutually monogamous relationship.

If you choose to have multiple sex partners (or your partner does), you can reduce your risk of AIDS and other sexually transmitted diseases in the following ways:

* Urge all prospective sexual partners to be tested for sexually transmitted infections.
* Use condoms properly and consistently.
* Avoid sexual intercourse with people who engage in high-risk behaviors such as unprotected sex or intravenous drug use.

9. Check "alternative" practices with your doctor.

More than 40% of Americans use some kind of "alternative" therapy,(20) such as herbal medicine, massage, chiropractic, or aromatherapy. Some people think that all alternative practices are harmless, but this isn't necessarily true?especially for people with special medical concerns. For example, people with Parkinson's disease should never take the herb kava-kava because it can worsen their disease symptoms.(21) People with osteoporosis should not receive chiropractic therapy because the manipulation could cause a fracture.(22) For more information on possible drug-supplement interactions, see ACSH's brochure What's the Story? Drug-Supplement Interaction at: http://www.acsh.org/publications/pubID.515/pub_detail.asp .

Even if an alternative therapy isn't dangerous in itself, it can hurt you if you use it as a substitute for proper medical care. Most alternatives have not been proven effective, and many don't work at all. If your problem turns out to be serious, you could endanger your health?or even your life?by experimenting with unproven therapies instead of seeing a physician promptly.

If you use alternative therapies, you should let your medical doctor know. However, more than 60% of Americans who use alternative methods don't do this.(23) To find out whether any alternative practices you would like to try are safe for you, resolve that you will always check out these methods with your doctor before you start.

10. Use automobile safety devices every time.

A recent survey showed that 82% of all Americans now buckle up?at this rate, seat belts prevent 15,700 deaths, 350,000 serious injuries, and $67 billion in economic costs associated with traffic injuries and deaths every year.(24) This year, resolve that everyone in your car will be buckled into the proper restraint every time. That means seat belts for adults, booster seats (in the rear seat) for older children, and properly installed safety seats (in the rear seat) for small children and infants.

11. Protect your dental health.

You can help keep your teeth healthy by brushing and flossing, getting regular dental care, using fluoride as recommended by your doctor or dentist, eating balanced meals, and limiting snacks. While most people know this, here's something you may not know: more than two million teeth are knocked out every year, many of them from sports-related injuries.(25) Many of these injuries could have been avoided if the person was wearing a mouth protector. So if you play sports that involve a risk of mouth injury, resolve to wear a mouth guard every time.

12. Install and maintain a working smoke detector.

Smoke detectors save lives. They're your best protection against death or injury in a nighttime fire in your home. But they won't protect you if they're not working. The American Red Cross recommends that you test your smoke detectors once a month, replace the batteries at least once a year, and replace the detectors themselves every ten years. You can also protect your family from fire by planning at least two escape routes from every room in your home and making sure that all family members know how to use them.(26)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

1. Centers for Disease Control and Prevention. Cigarette use among high school students ?United States, 1991-2003. MMWR. 2004: 53(23);499-502. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5323.pdf .

 2. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Life Lost, and Productivity Losses?United States, 1997-2001.MMWR 2005:54(25):625-628.  Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5425a1.htm .

3. Hedley A, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM.  Prevalence of Overweight and Obesity Among U.S. Children, Adolescents, and Adults, 1999-2002.  JAMA 2004; 291: 2847-2850.

4. Ibid.

5. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH, The disease burden associated with overweight and obesity. JAMA 1999;282:1523-1529.

6. From a Surgeon General page entitled ?Choose a Healthy Weight for Life.?  Available at www.surgeongeneral.gov/topics/obesity/calltoaction/fact_advice.htm .

7. From a CDC press release dated Sept. 16, 1999 and titled ?CDC data provides the most complete estimate on foodborne disease in the United States.?  Available at www.cdc.gov/od/oc/media/pressrel/r990917.htm .

8. These principles are listed in many government documents. They came from an FSIS "food safety feature" dated July 1999 and titled "Cleanliness Helps Prevent Foodborne Illness." It's available at http://www.fsis.usda.gov/OA/pubs/cleanliness.htm .

9. The American College of Sports Medicine, available at www.acsm.org/pdf/Guidelines.pdf .

10. According to a Consumer Product Safety Commission press release dated April 21, 1999 and available at www.cpsc.gov/cpscpub/prerel/prhtml99/99099.html .

11. From the American Heart Association?s recommendations on physical activity, available at http://216.185.112.5/presenter.jhtml?identifier=4563 .

12. From the National Center for Injury Prevention and Control's "Quick Facts About Impaired Driving." http://www.cdc.gov/ncipc/duip/spotlite/3d.htm

13. Ibid.

14. Ibid.

15. Ibid.

16. References for this statement can be found in ACSH's report on moderate drinking.
http://www.acsh.org/publications/pubID.391/pub_detail.asp

17. From the National Center for Chronic Disease Prevention and Health Promotion?s Behavioral Risk Factor Surveillance System Prevalence Data, 2002. http://apps.nccd.cdc.gov/brfss/Trends/trendchart.asp?qkey=10060&state=US

18. This statistic comes from a Behavioral Risk Factor Surveillance System survey in 2002, which asked, "During the past 12 months, have you had a flu shot?" In the age group 65+, 35.1% said no. When asked if they?d received the pneumococcal pneumonia vaccine, 37.0% of people 65 or older said no. http://apps.nccd.cdc.gov/brfss/Trends/TrendData.asp

19. National Vital Statistics Reports, Vol. 53, No. 17, March 7, 2005. Available at tp://www.cdc.gov/nchs/data/dvs/nvsr53_17tableE2002.pdf .

20. Eisenberg DM et al, Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-1575.

21. References for this statement can be found in our draft report on supplements and the elderly.

22. From a National Safety Council fact sheet called "Is Alternative Medicine Going Mainstream?" http://www.nsc.org/pubs/fsh/archive/spr99/altmed.htm

23. From the article by Eisenberg cited above.

24. National Highway Traffic Safety Administration  September, 2005. http://www.nhtsa.dot.gov/portal/site/nhtsa/template.MAXIMIZE/menuite
http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2005/809932.pdf

25. From an American Dental Association press release entitled "Mouth Protectors: Don't Play Without One." http://www.ada.org/public/topics/mouthguards.asp

26. From the American Red Cross fact sheet "Are You Ready for a Residential Fire?" http://www.redcross.org/services/disaster/0,1082,0_584_,00.html .

Resolutions updated by Ruth Kava, Ph.D., R.D.



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