ボンソワール書房日誌 Les Éditions Bonsoir Journal

B [医療解説] コレステロール… 高めは「危険」 「長生き」 主張対立 : 医療大全 : yomiDr./ヨミドクター(読売新聞)

リンク: [医療解説] コレステロール… 高めは「危険」 「長生き」　主張対立 : 医療大全 : yomiDr./ヨミドクター(読売新聞).

ちょっと太っていたほうが長生きするともいわれていますが，高コレステロールか低コレステロールか，学会どうしで意見対立していて，話し合いの動きはないという記事です。まあ，どっちでもいいのですが...，基準値を厳しくすると，病院に行く人が増えて，お薬もたくさん使います。

（以下，引用です）

[医療解説] コレステロール… 高めは「危険」 「長生き」　主張対立

　コレステロールが高いと心臓病の危険性が高まり、「下げるべきだ」とする従来の“常識”に対し、「高めの方が長生きで良い」との主張が出され、論争が起きている。どちらが正しいのか。（利根川昌紀）

数値めぐり議論百出
　
　日本動脈硬化学会は、ＬＤＬ（悪玉）コレステロール（以下ＬＤＬ）１４０ミリ・グラム／デシ・リットル以上か、ＨＤＬ（善玉）コレステロール（同ＨＤＬ）４０ミリ・グラム／デシ・リットル未満を、脂質異常症とする診断基準を定めている。

　とりわけ、ＬＤＬが高いと心臓病（心筋梗塞）の危険が高まるとし、数値を下げる運動や食事療法、薬物治療を勧めている。

　一方、日本脂質栄養学会は、「コレステロールは高めの方が長生きで良い」とする診療指針を２０１０年９月に公表した。

　神奈川県伊勢原市の約２万６０００人を平均約８年間調べた研究で、男性はＬＤＬ１００以上１６０未満で死亡率が低く、１００未満で上昇。女性は男性ほど影響はみられないが１２０未満で死亡率が高まった。この結果などをもとに、「数値が高い方が死亡者が少ない」としている。

　両学会は、それぞれの主張に反論する声明を、ホームページに掲載しているが、話し合いの動きなどはない。

　一方、「臨床研究適正評価教育機構」理事長の桑島巌さん（東京都健康長寿医療センター副院長）は同月、「一律の基準値はなじまない」との見解を示した。

　高血圧や高血糖、心臓病の経験者は、心臓病を招く危険が高く、コレステロールは下げた方がいい。一方、閉経後にコレステロールが高くなった女性は、ほかの数値に異常がなければ、心臓病になる危険は低く、必ずしも治療の必要はない。

　コレステロール値を巡って見解が異なる論文も相次いで公表されている。１１月には、コレステロール値と心臓病などの関係をみた２６の試験を解析すると、数値を下げた方が心臓病になる危険や死亡を減らせたとする海外の研究が医学誌に発表された。

　一方、自治医大のグループは１２月、「総コレステロール値が低いと死亡危険度が高まる」とする研究を公表。約１万２３００人を数値別に４集団に分け、約１２年間追跡したところ、男女とも数値が低い集団の死亡危険度が最も高かった。

　日本動脈硬化学会が決めたＨＤＬの診断基準は、メタボ健診の判定に用いられている。厚生労働省は「現時点で健診の基準を変える予定はない」としている。

G 薄着するとダイエットによいらしい：Turn Down the Heat, Lose Weight? : Discovery News

リンク: Turn Down the Heat, Lose Weight? : Discovery News.

薄着すると体重が減りやすいという記事です。寒い→代謝が増える→体重が減るという機序は生理学的にはかなっているようにも思いますが，まあ，そう簡単ではないでしょう。ちなみに冬場の（温水）プールでの運動はかなり寒いですが，かえって脂肪が薄く覆うような気がするのは，私だけでしょうか...。

A small adjustment to your thermostat may do more than just save the planet; it could also help trim your waistline.

If saving energy isn't enough to convince you to turn down the heat a notch, perhaps this will: Colder temperatures may help you lose weight.

In an article published in Obesity Reviews, Fiona Johnson of University College London and colleagues gather evidence in support of the notion that upwardly creeping indoor temperatures and reduced cold exposure may be a contributor to rising obesity.

Although no studies yet address the question directly, several threads of evidence "seem to suggest that increases in indoor temperatures could be having a significant effect on body weight," Johnson said.

"I think it's quite important to say that we wouldn't expect that this is the major contributor to obesity," she added. Still, many researchers believe that conventional explanations regarding diet and exercise are not enough to fully explain the obesity problem, so this may be part of the picture.

Johnson and colleagues document that household heating has increased in both the United States and the United Kingdom over the last decades.

"What we're seeing is not only people turning up their thermostats a degree or two, but people heating the whole of the home, rather than just certain areas," Johnson said, "People used to turn their heat off at bedtime."

This, combined with adults and children spending less time outdoors in cold temperatures commuting or playing, means people are probably not exposed to as much cold as they used to be, the researchers note.

This reduction could affect how many calories we burn in two ways.

First, it means we use less energy just maintaining our body temperature.

"As the temperature goes down below 27 degrees Celsius (80.6 Fahrenheit), energy expenditure increases," Johnson told Discovery News. "That's simply the expenditure of the body staying warm."

The second effect is that without cold exposure, our inner furnace seems to reduce its ability to stoke our internal fires.

This furnace comes in the form of our stores of brown fat, a type of fat distinct from white fat, which is just stockpiled calories. Brown fat burns energy to create heat, and studies have shown that obese people have less brown fat than thin people, Johnson said.

Babies are born with a lot of brown fat, and those amounts decrease over time. "For a long time it was thought that adults didn't have enough to create a significant effect," she said. Now researchers have found otherwise.

Brown fat becomes activated in response to mild cold and begins to create heat, burning calories. But, "it's use it or lose it," Johnson said. Reduced exposure to cold reduces stores and decreases their effectiveness at burning energy.

Johnson notes that gains from turning down the heat would be tempered by people's natural responses to feeling chilly: seeking more clothes and more food. But evidence suggests layering up and eating more don't completely negate the extra energy expenditures from cold exposure, she said.

All of this points to a connection between shrinking cold exposure and expanding waistlines. However, Johnson notes that direct evidence still is lacking, as is information on how cold one would have to be or for how long to have what effects.

"It is perhaps too early to tell people to turn down the thermostat or make sure they get cold," she said.

It is certainly a case for doing studies to expose people to cold and seeing what effect this has on brown fat levels, energy expenditure, capacity to create heat, and body weight.

Small effects could add up, said Arne Astrup of the University of Copenhagen.

"Even 100 calories a day can mean a lot over a year or in the long term," Astrup said, citing a 2003 Science paper that suggested that reducing net calorie intake by 100 per day could prevent weight gain for most of the population.

"This paper provides some quite good evidence that (cold exposure) is something we should consider," he added. It would be easy to comply with compared to diets or workout regimens, he noted, and comes with other benefits.

"It will save you energy and money, but it will also be more healthy," he said.

G ビタミンKの影響のない抗凝固薬：納豆食べても大丈夫！脳卒中予防の新薬発売へ : 医療ニュース : yomiDr./ヨミドクター(読売新聞)

リンク: 納豆食べても大丈夫！脳卒中予防の新薬発売へ : 医療ニュース : yomiDr./ヨミドクター(読売新聞). 　

「ワーファリンの禁忌といえば？――納豆」が正解でしたが，新薬が発売される模様。

（以下引用です）

　血管を詰まらせる血栓をできにくくして脳卒中を予防する新しい抗凝固薬の製造・販売が２１日に承認され、今春にも国内で発売される見通しとなった。

　従来薬「ワーファリン」は、納豆を食べると効かなかったが、新薬は食べ合わせなどの影響はない。

　独製薬大手べーリンガーインゲルハイムが開発した「プラザキサ」（成分名ダビガトラン・エテキシラート）。血液を固めるトロンビンという酵素に直接作用する。心臓病の一種の「心房細動」の患者が１日２回服用すると、従来薬よりも３５％、脳卒中や全身性塞栓症の発症が減る。

　１９５０年代から使われているワーファリンは、心房細動後の脳卒中予防のほか、人工関節や人工心臓弁の装着など血栓ができやすい手術の後に欠かせないが、血液中の凝固成分を増やすビタミンＫの作用を抑える薬なので、納豆やクロレラなどビタミンＫを豊富に含む食品は禁忌だった。

（2011年1月23日 読売新聞）

G うつ病治療に埋め込み電極，さらに脳・帯状回切除：BBC News - Bristol team pioneers depression surgery technique

リンク: BBC News - Bristol team pioneers depression surgery technique.

深刻なうつ病を治療する深部脳刺激療法。脳の帯状回に電極を埋め込んで刺激を与える方法は，欧米ではすでに行われている方法だと思いますが，この記事がそれと同じかどうかはわかりません。帯状回を切除する手術も行われていますが，予後はまだよくわかっていないようです。うつ病による自殺を防ぐためには必要な治療でしょう......か？

Surgery aims to tackle depression

A medical team at Frenchay Hospital in Bristol is pioneering a new form of surgery to treat long term depression.

The technique is called deep brain stimulation and involves the use of electrodes which are implanted into the brain through holes drilled in the skull.

The electrodes are then inserted into a battery pack which delivers small amounts of electricity to stimulate or inhibit specific areas in the brain.

A trial is underway involving eight patients to compare the effects of stiumulating two different areas of the brain.

The first patient to have the electrodes inserted was Sheila Cook, 62, from Torquay who had been suffering from severe depression for nine years.

She said: "I just wanted life to end. It was like being in a dark tunnel, but instead of there being light at the end of it, it was just darkness."

In Sheila's case the deep brain stimulation only had a short term benefit so she went on to have a second operation, called ablative surgery, to further improve her condition.

She says: "I suddenly woke up in the morning and I thought I feel different, I want to get up, I want to do things. And my whole view of life changed."

The research team hopes that deep brain stimulation might one day replace the more destructive ablative surgery that Sheila received.

The results from seven further participants on the trial will be published later in the year.

G がん患者はこれまで考えられていたほどには，うつ症状で苦しんでいないようだ：Fewer Cancer Patients May Be Depressed Than Thought - Yahoo! News

リンク: Fewer Cancer Patients May Be Depressed Than Thought - Yahoo! News.

がん患者では，これまで考えられているほどには，うつ症状に陥っている人は少ないという国際研究です。うつや不安を訴える人の割合は，緩和医療を受けている人と受けていない人で違いがなかった，という結果に基づいています。うつまではいかなくても気分障害になっている人は多いようであり，さらに，当然ですがうつはがんの重大な合併症であることを，医療者は認識すべきことが強調されています。がんの生存率が高くなっていること，欧米と日本では患者のがんのとらえ方が多少異なるようなので同じことが日本でもいえるのか，など，気になるところです。

THURSDAY, Jan. 20 (HealthDay News) -- The rate of depression among cancer patients may be lower than previously believed, a new study indicates.

An international team of researchers analyzed 94 studies involving more than 14,000 patients and found that about one-sixth of cancer patients suffer depression and about one-third have a more widely defined mood disorder.

Only modest rates of depression and anxiety occurred in cancer patients in the first five years after diagnosis, which suggests that depression is not inevitable in these patients, the researchers said.

Only when it was combined with other mood disorders was depression common, occurring in 30 percent of hospitalized cancer patients.

The study is published online Jan. 19 in The Lancet Oncology.

Rates of depression and anxiety were not significantly different between patients receiving palliative care (care designed to ease pain and increase comfort in patients with terminal cancer) or non-palliative care (care designed to fight the cancer while easing symptoms). This suggests that the effects that differences in cancer care settings and possibly cancer stage have on depression may have been previously overemphasized, the researchers said in a journal news release.

They also concluded that cancer patients' age and sex do not influence their risk of depression.

"Although these rates (of depression) are modest, this group of patients should not be overlooked. Improvements in survival and high prevalence of most cancers actually increase rates of depression, amounting to what we estimate to be 340,000 people in the UK and 2 million in the USA with major depression and cancer at any time," noted the researchers in the release.

"Our study shows that depression alone is not as common as previously thought in cancer settings, occurring in one in six patients, about the same as the rate seen in primary care settings. Although depression remains an important and overlooked complication of cancer, clinicians must also be vigilant for other related emotional problems such as anxiety, adjustment disorder or simply any form of significant distress," concluded the researchers, who stressed that "there is still an urgent need" for screening programs to detect depression, anxiety and mood disorders among cancer patients.

G? 介護福祉士：上級職を新設へ 厚労省 - 毎日ｊｐ(毎日新聞)

リンク: 介護福祉士：上級職を新設へ　厚労省 - 毎日ｊｐ(毎日新聞).

認定介護福祉士。現在のホームヘルパー２級相当→一定の実務を積んで国家試験に合格すれば介護福祉士→認定介護福祉士。

（以下引用）

　厚生労働省は２０日、介護施設などで高齢者のケアに当たる介護福祉士について、高度な技術を活用して職員を指導する上級職の「認定介護福祉士（仮称）」を新たに設けることを決めた。

　介護福祉士は「国家資格なのに給料が安く、仕事も厳しい」とされ、人手不足に直面している。上級の職を設けることで職員の意欲を高めるとともに、人材確保と介護の質の向上を図る狙いだ。

　介護人材養成の在り方を検討する厚労省の有識者検討会が同日、新設の方針を盛り込んだ報告をまとめた。

　認定介護福祉士については、認知症ケアなどで幅広い知識を持ち、他の職員を指導して介護の質を高める役割を求める。関係団体が技術などを評価して認定する仕組みを想定しており、導入時期などは今後検討する。

　厚労省は、介護職員のキャリア形成の全体像について、現在のホームヘルパー２級相当を基本とし、一定の実務を積んで国家試験に合格すれば介護福祉士となり、その上に認定介護福祉士を位置付ける考えだ。

B? 介護士試験、研修義務化３年先送り…負担に配慮 : シニアニュース : yomiDr./ヨミドクター(読売新聞)

リンク: 介護士試験、研修義務化３年先送り…負担に配慮 : シニアニュース : yomiDr./ヨミドクター(読売新聞).

介護福祉士試験を受けるための研修ですが，研修時間を600→450時間に短縮，実施を３年先送りだそうです。

（以下引用です）
　介護福祉士の国家試験について、厚生労働省は２０日、実務経験者が受験する場合に新たに研修の受講を要件とする法律の施行を、２０１２年度から３年延期することを決めた。

　人手不足の介護現場で、「研修は負担が大きい」との声が強いのを受けた措置で、通常国会に関連法案を提出する方針。

　介護現場で３年以上働く実務経験者に対する研修の義務化は、介護福祉士の資質向上が狙い。０７年の法改正で、認知症への理解を深めたりするため、国家試験前に養成施設などで６００時間の研修を受けることを義務づけた。

　だが、「研修時間が長すぎる」「人手が足りず、研修のために職員を休ませるのは難しい」などの指摘が事業者や受験予定者から上がったため、研修時間を４５０時間に短縮、実施を３年先送りし、１５年度とする。

（2011年1月21日 読売新聞）

B イレッサ被害「防げたはず」 : 医療ニュース : yomiDr./ヨミドクター(読売新聞)

リンク: イレッサ被害「防げたはず」 : 医療ニュース : yomiDr./ヨミドクター(読売新聞).

ちょうど昨日（1月19日），東京駅でイレッサ関連の抗議行動をみかけました。また，ちょうど昨日はテレビでも，海外で使用されている新薬承認の省略化に関する番組がくまれていました。いろいろと難しい問題が含まれています。

（以下引用）
元薬系技官トップが厚労省批判
　肺がん治療薬イレッサ（一般名ゲフィチニブ）の副作用で死亡した患者の遺族らが国とアストラゼネカ社に損害賠償を求めた訴訟で、東京・大阪両地裁が被告の救済責任を認め和解を勧告したことについて、旧厚生省の薬系技官トップだった土井脩氏（６７）が読売新聞の取材に応じ、イレッサを巡る厚生労働省の審査・安全対策の問題点を指摘し、早期解決を求めた。

　薬務行政の元責任者が古巣の施策を批判するのは異例で、波紋を広げそうだ。

　土井氏は、イレッサ問題が起きる前年の２００１年１月まで、医薬安全担当審議官を務めた。１９９３年、抗ウイルス剤ソリブジンと抗がん剤を併用した患者が死亡した薬害の発生当時は、安全対策の担当課長だった。

　イレッサは０２年７月、世界に先駆けて日本で承認されたが、まもなく間質性肺炎の副作用で死亡例が次々に報告された。土井氏は「最初に承認したのはよいが、前後の対応が問題。行政がやるべきことをやっていれば被害はかなり防げたはず」と話す。間質性肺炎については審査で指摘され、薬の添付文書にも盛り込まれたが、目立たない記載で現場に浸透しなかった上、その後の安全対策にも問題があった、という。

　まず承認の際、条件として全例調査を義務づけなかったのを「間違い」と言う。全例調査は、懸念のある薬の場合、使える医師を限定し、すべての投与患者を把握して、承認後も安全監視を続ける仕組み。土井氏は「イレッサにはこの条件が付かず、無防備に使用が拡大した」と指摘する。

　事後の対策では、「重大な副作用報告があったら迅速に対応すべきだ。イレッサの場合、緊急安全性情報を出して現場に注意喚起するまで３か月もかかった」と問題視する。ソリブジン薬害では、報告１週間後に緊急安全性情報が出た。

　厚労省は、今回の裁判で国の責任を認めると、薬の審査を慎重にせざるを得なくなり、抗がん剤などの承認が難しくなるとの懸念を示している。

　土井氏は「国があつものに懲りてなますを吹く対応をせず、懸念材料があれば条件つきで承認し、責任を持って審査から市販後まで一貫した安全対策を強化すれば、そんな問題は起きない」と断言。「裁判で無駄な時間を費やすより、患者の立場に立った対策に力を尽くすべきだ」と語った。

　地裁和解勧告でも土井氏同様の所見

　イレッサ訴訟で東京地裁が７日に示した和解勧告では、土井氏の指摘通り、ソリブジン薬害の教訓が生かされなかったことを問題視する所見が示されていた。

　イレッサの添付文書では、間質性肺炎についての記載が「重大な副作用」を示す欄の４番目と、目立たない扱いだった。ソリブジンもイレッサ同様、添付文書の記載が医療現場で見落とされ、被害につながった。ソリブジン薬害を契機に、重要な事項は前に記すよう添付文書の記載要領が改められたが、イレッサで同じ過ちが繰り返された。

　所見はソリブジン薬害に触れた上で、「（イレッサでも）重大な副作用欄の初めに記載したうえ、致死的なものとなりうることについて記載する行政指導を行うことが適切であった」などと指摘した。和解勧告への回答期限は今月２８日。原告は受け入れを表明したが、被告は国、アストラゼネカ社とも態度を保留している。

（2011年1月19日 読売新聞）

B 米国の外科医で16人のうち1人は自殺を考えたことがある：One in 16 U.S. surgeons consider suicide: survey | Reuters

リンク: One in 16 U.S. surgeons consider suicide: survey | Reuters.

米国の外科医で16人のうち1人は，自殺を考えたことがある。原因はバーンアウトと医療事故らしい。

One in 16 U.S. surgeons consider suicide: survey
5:32pm EST
By Frederik Joelving

NEW YORK (Reuters Health) - A considerable number of U.S. surgeons struggle with thoughts of suicide, according to a new survey that highlights burnout and past medical errors as possible reasons.

Researchers found more than 6 percent of surgeons had thought about killing themselves within the past year. Among those aged 55 to 64, the number was three times higher than the national levels for that age group.

"What we are seeing through this work is that there is a high amount of burnout and stress among America's physicians, with potentially serious consequences for both physicians and their patients," said Dr. Tait Shanafelt of the Mayo Clinic in Rochester, Minnesota, whose findings appear in the Archives of Surgery.

"It isn't necessarily that having thoughts of suicide endangers patient health," he added, "but some of the same root causes, particularly burnout, do appear to have a strong relationship with quality of care."

In a survey published last year, Shanafelt's team found surgeons who reported high degrees of emotional exhaustion on the job also had higher odds of making major errors when they dealt with patients.

They used the same survey, based on responses from more than 7,900 physicians, for the current study.

While younger surgeons had rates of suicidal thinking that were similar to those in the general population -- between 6 and 7 percent -- those older than 45 were at increased risk.

At 55 to 64 years, for instance, 7 percent of surgeons had considered suicide in the past year, compared to about 2 percent of the general population.

Only about a third of the surgeons who received the survey responded, but Shanafelt said that was unlikely to influence the results much.

Doctors who felt burned out, or said they'd made a "major medical error" in the past 3 months were more prone to suicidal thoughts.

While depression also played a role, it didn't explain the effect of burnout.

"We've known for some time that physicians are at a greater risk for suicide than other professions, although why that is has never really been understood," Shanafelt told Reuters Health.

Married surgeons, and those working in large university-based medical centers, were at lower risk for suicidal thoughts.

The new findings also show that only a fourth of the troubled surgeons had sought professional help -- most said they hadn't done so out of fear that they would lose their medical license.

Instead, some chose to self-prescribe antidepressants or have friends do it for them, Shanafelt said.

According to the National Institutes of Mental Health, there were about 11 suicide deaths per 100,000 Americans in 2007.

"We fear for the '80-hour work-week' generations of surgeons now coming into practice," two surgeons at the University of Pittsburgh commented in the journal.

"We are human, to err is inevitable, and suicide is not the right answer for those tormented by the expectation of perfection."

SOURCE: bit.ly/f50r53 and bit.ly/gOMRz3 Archives of Surgery, January 17, 2011.

G 高血圧に対して2剤を併用すると効果が高まる：BBC News - High blood pressure combination pill 'better than one'

リンク: BBC News - High blood pressure combination pill 'better than one'.

抗高血圧薬であるアムロジピン（カルシウムチャネル拮抗薬）とアリスキレン（レニン阻害薬）を併用すると，高血圧をコントロールしやすいという記事です。ノバルティスがバックアップした研究だそうです。

The research was funded by the pharmaceutical company Novartis, which makes amlodipine and aliskiren.

A combination of drugs is better than a single one in treating high blood pressure, a UK study has suggested.

The study in the Lancet involved 1,200 people and found starting treatment with two drugs gave better and faster results, with fewer side effects.

The approach challenges conventional medical practice where doctors give a patient one drug, then add another later if blood pressure stays high.

Almost 10 million people in the UK have high blood pressure.

Treatment with anti-hypertensive drugs is known to reduce the risk of stroke and heart disease.

A team led by researchers at the University of Cambridge, University of Glasgow and University of Dundee followed 1,254 patients with high blood pressure in 10 countries.

They compared the effects of giving one drug (either aliskiren or amlodipine) or a combination of both.(The drug aliskiren is a type of renin inhibitorAmlodipine is a long-acting calcium blocker.)
Patients given the combination of drugs had a 25% better response during the first six months compared with those on conventional treatment, the study found.

This equates to a 6.5mmHg greater reduction in systolic blood pressure.

Participants were also less likely to stop taking their medication due to side effects.

The two drugs can be given as a single pill, making it easier for patients to take.

Professor Morris Brown of the University of Cambridge said the study "breaks the mould for treating hypertension".

He said: "Most patients can now be prescribed a single combination pill and know that they are optimally protected from strokes and heart attacks."

The British Heart Foundation, which is funding follow-up research, said good control of blood pressure is hard to achieve in many patients.

The research was funded by the pharmaceutical company Novartis, which makes amlodipine and aliskiren.

The combination pill was approved by the FDA for use in the US last year.

B タバコの害は秒単位で生じている：BBC News - Smoking 'causes damage in minutes', US experts claim

リンク: BBC News - Smoking 'causes damage in minutes', US experts claim.

Smoking damages the body in minutes rather than years, according to research in the US.

The report, published in Chemical Research in Toxicology, shows that chemicals which cause cancer form rapidly after smoking.

Scientists involved in the small-scale study described the results as a stark warning to people considering smoking.

Anti-smoking charity Ash described the research as "chilling" and as a warning that it is never too early to quit.

The long term impact of smoking, from heart disease to a range of cancers, is well known. This study suggests the damage begins just moments after the first cigarette is smoked.

Faster than you might think

The researchers looked at the level of chemicals linked with cancer, polycyclic aromatic hydrocarbons (PAH), in 12 patients after smoking.

A PAH was added to the subject's cigarettes, which was then modified by the body and turned into another chemical which damages DNA and has been linked with cancer.

The research shows this process only took between 15 and 30 minutes to take place.

Professor Stephen Hecht, from the University of Minnesota, said: "This study is unique, it is the first to investigate human metabolism of a PAH specifically delivered by inhalation in cigarette smoke, without interference by other sources of exposure such as air pollution or the diet.

The results reported here should serve as a stark warning to those who are considering starting to smoke cigarettes."

Martin Dockrell, director of policy and research at Ash (Action on Smoking and Health), said: "Almost everybody knows that smoking can cause lung cancer.

"The chilling thing about this research is that it shows just how early the very first stages of that process begin - not in 30 years but within 30 minutes of a single cigarette for every subject in the study.

"The process starts early but it is never too late to quit and the sooner you quit the sooner you start to reduce the harm."

The research was funded by the US National Cancer Institute.

G 抗がん剤の最大の欠点カプセルで克服…東大開発 : 科学 : YOMIURI ONLINE（読売新聞）

リンク: 抗がん剤の最大の欠点カプセルで克服…東大開発 : 科学 : YOMIURI ONLINE（読売新聞）.

（以下引用）

人体が医薬品を異物として解毒したり、がん細胞が抗がん剤を排出したりする防御網をかいくぐり、抗がん剤をがん細胞の奥まで運べる微細カプセルの開発に、東京大などが成功した。

　効率的ながん治療を可能にする成果で、米医学誌サイエンス・トランスレーショナル・メディシンに６日発表する。

　カプセルの大きさは、ウイルスとほぼ同じ直径１０万分の４ミリ・メートル。表面が水になじむよう素材を工夫し、血液中にまぎれさせて人体の免疫機能に捕捉されないようにした。また、薬剤耐性を獲得したがん細胞は少ない分子からなる抗がん剤を外へ排出するポンプのような構造を持つため、細胞が取り込む栄養分に見せかけるよう、分子の数が多いカプセルを設計した。

　その結果、カプセルはがん細胞の遺伝子が収納された核の近くまで届いて初めて破壊されるようになり、抗がん剤が遺伝子の働きを邪魔してがん細胞の増殖を抑制できるようになった。

　開発した片岡一則教授は「カプセルは『トロイの木馬』のように、がん細胞に気付かれず入り込める。様々なタイプの抗がん剤が利用できるので、治療の幅が大きく広がる」と話している。

B 米国では埋め込み型除細動器が不要な人が，除細動器を入れている場合が少なくない：Many Defibrillators Implanted Unnecessarily, Study Says - NYTimes.com

リンク: Many Defibrillators Implanted Unnecessarily, Study Says - NYTimes.com.

米国では，本当は埋め込み型除細動器が不要な人が，除細動器を入れている場合が少なくない。さて日本では...？

Doctors are implanting high-tech heart devices in thousands of people who probably do not need them, a new study finds. The procedures cost more than $35,000, involve surgery and anesthesia, and may unnecessarily harm some patients.

The devices, called defibrillators, fire an electrical shock to jolt the heart back into a normal rhythm if it starts to beat in a disordered way that can cause sudden death. In people who truly need them, for conditions that can fatally disrupt heart rhythm, defibrillators can be life-saving.

Each year, about 100,000 are implanted in the United States. Former Vice President Dick Cheney received one in 2001.

The new findings fit into a larger pattern of misuse of defibrillators: paradoxically, previous research has also found that many people who need defibrillators do not get them. The reasons are not known, but may include the cost and also a reluctance by both doctors and patients to accept a surgically implanted device, especially if the patient is feeling fine and has no symptoms of the underlying problem.

Professional societies set guidelines that specify when the defibrillators should be used, based on studies showing which patients they help. To find out if doctors have been complying, researchers examined the records of 111,707 people who received the implants at 1,227 hospitals in the United States from January 2006 to June 2009. The records were part of a national registry, and the National Heart, Lung and Blood Institute paid for the study.

The researchers were surprised to find that more than 25,000 people — 22.5 percent of all those who got defibrillators — did not match the guidelines. Most of the patients were 64 to 68. For unknown reasons, blacks and Hispanics were more likely than whites to get defibrillators they probably did not need. At many centers, more than 40 percent of the devices went to patients outside the guidelines.

“I didn’t expect the rate to be that high,” said Dr. Sana M. Al-Khatib, an associate professor of medicine at Duke University and the lead author of the study, which is being published Wednesday in The Journal of the American Medical Association. Dr. Khatib said experts did not expect rigid adherence to the guidelines, and knew that doctors would sometimes make judgment calls for individual patients.

“I’m sure some of these cases were reasonable,” she said. “The physicians did what they thought was best. But even taking that into account, 22.5 percent is way too high.”

Why are doctors not following the expert advice? Apart from the reasonable judgment calls, Dr. Khatib said she thought many doctors did not know the guidelines or understand the evidence behind them, and thought they were helping patients by putting in the devices to save them just in case their heart rhythms went away.

“Take patients who just had a heart attack,” Dr. Khatib said. “Two randomized controlled studies show that defibrillators do not benefit patients who just had a heart attack.

“You have to be cognizant of the evidence out there and learn from what has been published. Not only do we have one clinical trial, we have two. And these patients are more likely to have complications. You’re truly not helping these patients.”

Even so, 37 percent of the devices implanted outside the guidelines went to people who had had heart attacks in the previous 40 days.

Some of those patients will eventually need defibrillators anyway, but 30 to 40 percent will not, said Dr. Alan Kadish, a cardiologist who is president of Touro College (based in New York), and who wrote an editorial accompanying the article in the journal.

The study found that electrophysiologists — cardiologists with extra training in heart-rhythm disorders — were less likely than other doctors to implant defibrillators inappropriately. Both Dr. Kadish and Dr. Khatib are electrophysiologists.

Dr. Kadish said he thought it possible but unlikely that some doctors were implanting devices unnecessarily to make money. Physician fees for the implantation are only $1,000 to $2,000, he said, adding that the device itself costs $20,000 to $30,000, and hospital fees for the procedure are generally about $10,000.

He said that if a defibrillator was recommended, it was reasonable for patients to ask their doctors if they met the guidelines, and also to ask if the doctor was an electrophysiologist.

Implanting the device is not minor surgery, Dr. Khatib said.

“It is an invasive procedure,” she said. “You’re putting wires in the patient’s heart. You’re putting a needle in the subclavian vein next to the lung, threading two wires down to the heart, and implanting the device.

“And in some patients we test the defibrillator by causing the heart to go into a life-threatening rhythm, to make sure the defibrillator can recognize it and shock them out of it. It’s not a minor procedure by any means.”

Patients who did not match the medical guidelines for receiving an implant but were given one anyway were more likely to die in the hospital or suffer complications than people who got the device and met the guidelines.

The death rate for the first group was 0.57 percent; for those who met the guidelines, it was just 0.18 percent. The causes of death were not available, and part of the explanation for the disparity may be that patients given the defibrillators inappropriately were sicker to begin with.

But Dr. Kadish said, “We can’t exclude the possibility that indeed some people are being harmed.”

Even so, he said, the problem of people who need defibrillators not getting them is far worse. He estimated that as many as 100,000 patients a year were missing out on the device, which could save their lives.

“We’re not doing as good a job as we should in putting them in the right people,” Dr. Kadish said.

Both Dr. Khatib and Dr. Kadish said the solution was better education for doctors. Neither wanted hospital panels, insurance companies or the government to be given the power to decide who should receive a defibrillator.