Weight Loss Tips: Lose Weight Fast and Burn Those Excess Calories

Weight-loss tactics and following a few easy eating plan changes anyone can shed unwanted bodyweight quickly, get rid of those unwanted nutrient consumption and shed some of that irritating fat that just doesn't ever want to go away.

Who wouldn't like to shed unwanted bodyweight and get rid of some of that unwanted baggage? The key may be as easy as enhancing your metabolic rate and helping your human body to use-up more nutrient consumption.

Here are a few simple and fast factors that you can easily add into your life and eventually you can expect to create a significant difference in your health and well being.

Make a psychological today to start shifting a little more every day. Create a game of it if that's what it takes. You have probably heard this before, and if you have you can be pretty sure that the idea is true and will work if you stay with it.

Let's look at the first of our Healthier Weight Reduction Tips:

Something as easy as vehicle parking your car in the last row at the retail center or food market can add up to quite a few additional actions over an occasion interval. Let the people who will always be obese and don't care battle it out for the close to the door areas. You may even earn the regard of some of your other customers by walking your shopping trolley returning to the trolley corral.

Healthy Weight Reduction Quick way

Do you spend lots of your energy and effort discussing on the phone? I know I do, and I discovered that by shifting around while I'm discussing I can get some additional actions in and I don't even realize I'm doing it. Capture, you don't have to sit in a chair you can walk all over the home or even stop in some vehicle car park somewhere and probably see some factors you might never have observed before.

Natural Weight Reduction

Use the upper level bathroom or the one in the underground room if you have one; if you live on one floor take a trip of the home on the way, a several additional actions everytime really contributes up eventually.

Shortcut

When you're watching TV and the commercial comes on stand up and expand, speed returning and forth, tap your feet, move your hands, bend your muscles and then rest them, anything to help take your mind off of those oily poultry and great nutrient treats ads so you can keep targeted on your goal of following eating plan plans that allows you to shed unwanted bodyweight quickly.

Free Weight Reduction Quick way

The experts say that eating smaller foods throughout the day will help keep your metabolic rate burning nutrient consumption a bit longer. It seems to me to be a whole lot better to eat healthy weight-loss foods than to stuff yourself on great nutrient super size foods and feeling bad all day.

Healthy Weight Reduction Tips

By keeping your human body well moisturized with ice cold the water the nutrient consumption are consumed when your human body heats up the the water after you drink it. Hot beverages don't have the same effect, and if you keep gulping those great nutrient sodas down you are losing everything you obtained. Force yourself to stick with the the water.

Getting up and shifting and following these easy healthy weight-loss tactics you can actually get rid of about a third more nutrient consumption a day. The good part is you don't have to do all this at once although it would be nice if you could. Add a number of additional factors a day and eventually both your human body and your lifestyle will benefit more than you could imagine.

Razors Electric

If you probably have locks in locations you don't want it (e.g. encounters and supports for men and feet and underarms for women). When you want to get rid of this locks, you have options. You can have it wax off (ouch!), have it eliminated with a laser device (expensive!), or you can cut it off. Males is a well-known option because it is pain-free, cost-effective, and takes very little effort. However, even when you do select to cut, you still have options. You can use a guide knife or a powered shaver. Both are well-known options, but power shavers take the advantage for many reasons:

They Are Safer

When you think of shaving, there is no question that you probably image little dings and reduces on your epidermis. With a guide knife these are almost a assurance. The knife is distinct and your hands can be unreliable. However, with power shavers you do not have to fear about this. Since the knife has a hurdle that stops the knife from actually touching your epidermis, it will not get cut.

They Are Faster

Since you don't have to fear about dings and reduces, you can cut a lot quicker. Instead of having to lather up, cut, and then clean away the staying shaving gel, you simply have to run the knife over your epidermis. Think of how plenty of your energy and effort you can save by removing all of those extra actions.

They Are More Convenient

You already know that you can use a knife without shaving gel, but you can also use them without water. This implies that you can basically use them anywhere. Provided that they are billed and ready to go, you do not even need to be near power. This makes power shavers ideal for taking with you on quick a business trip or even on hiking visits. An power shaver does not hold you down to your drain.

They Are Price Effective

Yes, it is real that originally power shavers be more expensive than guide razor blades. However, guide razor blades are non reusable. You have to regularly substitute them. What this indicates is that extra time you will be investing a lot more money than you would on one knife. This is especially real if you select a well-made product, such as Panasonic, when choosing your knife. Provided that you take care of your knife by not overcharging it and keeping it protected when not in use, your power shaver can last you a while with no additional costs.

When it comes to techniques, there are many different options. Electric razor blades are clearly a sensible option. They allow you cost-effective versatility while making simpler.

Looking Great of Hair Salon Style

After you have frequented the beauty and locks salon, you will keep with a wonderful new cut and design, which you will want to show off to all your buddies and family. Although the beauty and locks salon beautician has done most of the effort in developing the design, you also have a significant part to play in keeping the new design. To make sure that your design has durability, it is important that you keep your locks in as excellent a situation as possible. It is also suggested to have planned training therapies at your beauty and locks salon after your consultation to keep your locks looking as excellent as the day it was first developed.

There are a lot of ways in which locks can become broken, such as as caused by extreme substance, heat or technical design pressure, as well as due to extreme warm, wetness and breeze which it is revealed to as part of the daily climate. It is even possible for locks to get minimal harm from things like the air conditioner techniques in your car, or in your office. The destruction to your locks may be very actually apparent, or it may be inner, and less apparent to the undressed eye.

Over use of warm design resources such as hair hairdryers, or styling clubs and hair styling clubs, may cause to harm to the cortex of the locks, but there are items which are available from beauty parlors which can help to secure locks from warm design resources. If your new design will require you to sustain it using warm design resources, ask your beautician which items are best to secure your locks. It may be worth making an investment in better high quality warm design resources which are much better for your locks than low high quality, inexpensive resources.

Over contact with the sun can also harm your locks, especially if you invest a lot of time in the sun on the seaside, where the salt-water of the sea and the high sodium air are also a large harm threat. Although the "sun bleached" look may be suitable to some customers, it is actually a indication that the locks is broken, and is not excellent for locks in the long run. Fortunately there are also items available which are exclusively engineered to secure the locks when you are on a "beach holiday".

Incorrect use of home locks colorant items is also a major cause inner harm, especially if individuals try to use items which contain a advanced level of lighten. These items can damage the proteins cross-links and create the locks very dry and weak. The consequences may be especially bad in situations where individuals have used warm design resources within 24 hours of using substance colorants, but without using any way of warm defending product. Hair beauty parlors will be able to offer you color security items which can help to secure the locks before it is colored, and to further secure large and to create it last longer after large has been done.

How To Starting a Small Business

There are many phases to starting your own small business. Lots of steps to go through to get from that initial idea to a fully functioning business. My husband and I are just beginning this journey, and as we do so, I want to walk you through the steps we are taking based on the advice and insight we've received from successful entrepreneurs and my years of business marketing experience.

Phase one is at once simple. Almost like taking a breath it can come unexpectedly and give you everything you need to dive into the depths of a new adventure. It is simultaneously complex. Just like breathing, if you stop to think about it too much, you may just freeze up and forget how to get started.

Jon Acuff talks about a rule he and his wife have. He is allowed to talk through his dreams and she just listens. No questions of how or the cost from her planning brain, and no spontaneous purchases from him during this "Wow" time. When I first heard this concept, I knew it was perfect. For every dreamer out there, they probably have a close relationship with a planner. Spouse, friend, business partner, whoever that person is for you, this safe atmosphere to dream is a must.

As you start dreaming about your small business idea, find someone you can safely dream with, maybe several people even. Jot down your ideas or have your phone take a voice memo. Just keep thinking of things you enjoy, things you are passionate about, things you think will make a difference or that need changed.

Truth be told, you may not even realize you have a small business idea during the dreaming phase. You may just be dissatisfied with your job or you may have a frustration that you see a solution to that no one has thought of. While the first phase of starting a small business is dreaming, often this phase will be over before you realize you do want to start a small business.
But even if you have already begun your business or if you a veteran business owner, you should always be dreaming. It is in the creativity of imagination that we continue to grow and find new avenues for enjoyment and even profit.

The dreaming phase may be the beginning, but it should also flow throughout the life of your small business. In our family, my husband is the dreamer. He has tossed out a lot of ideas brainstorming about his goals. He has finally settled on one that is a great starting point, meets a real need, and has a low starting overhead. This dream is one that we can both latch onto, and in the coming months, I will share our journey in launching our very own small business.

Definition of Adenocarcinoma Lung Cancer

Glandular tissue cancer is a type of adencarcinoma, and can affect different parts of the body. Such affected regions in the body include the stomach, the breasts, the colon, cervix, prostate and pancreas just to name a few. One particularly common type of glandular cancer is adenocarcinoma of the lung.

Adenoid cystic carcinoma of the lung is responsible for approximately 40 to 50 percent of diagnosed lung cancers each year. It is a form of non-small cell lung cancers, which accounts for close to 80% of all lung cancers. Detecting such illnesses early on in its journey will definitely increase survival rates in addition to helping alleviate many its side effects. Nevertheless, adenoid cystic carcinoma may not be easily visible during its early stages.

Its origin is typically found surrounding parts of the lungs and is often found in women, even in non-smokers. One of its subtypes known as BAC or bronchioloalveolar carcinoma is found in many non-smoking women. The majority of patients tend to be of Asian decent, and most sufferers are usually under the age of 45. Lung cancer in general is continuing to increase over the years, perhaps due to the increasing amount of smokers across the globe. There have been many suggestions as to the increase in cancer numbers. One being the addition of cigarette filters which have demonstrated to potentially allow even more smoke to be inhaled deeper in the lungs, thus triggering adenoid cystic carcinoma.

Even though early symptoms, for example chest pain or fatigue, tend to be overlooked, there have been some well-known symptoms associated with ACC. Since this form of cancer is prone to spreading from the outer lung, symptoms including coughing up blood and a chronic chough are generally seen. It's imperative to consult your doctor if you have been experiencing any of these signs.

Obviously daily life choices including diet, alcohol consumption, tobacco smoking known as the main cause, and other environmental factors will make you more or less susceptible to adenocarcinoma cancer.

Unfortunately adenoid cystic carcinoma of the lungs have affected non-smokers, most commonly caused by radon exposure in the home. While the severity of this cancer varies significantly depending on the affected organ or glandular tissue, there are a few common symptoms. Anything from fatigue, unexplained weight loss or bleeding can all occur, regardless of the organ affected. Because lung adenocarcinoma is a multi-factorial illness, many factors may be the cause of such a serious condition.

The British Sun Pipped Out

Home is where the heart is, in our case as well our beautiful dogs, but the sun has gone away again.  The beautiful heat and sun on holiday made my back feel much better, I didn't seem to wake up with as many pains in the ribs, only my leg!  We came home to sunshine and I thought yeah I can enjoy the feeling, but alas the sun is out till 10 then rain up here in the North of England.

 

We have guests who are ex pats from Australia and currently live in Asia, they have come to see us after meeting us last September and are having a relax.  There we were planning trips here and there and they just want to relax and play with the dogs. 

 

Today my book is being delivered here from the printers, I can't wait.  I have received an unbounded copy just to set my mind at rest the printing on the pages didn't miss out my first sentences.  I am pleased they are arriving and hope that I can meet up with Chris Knighton to give her quite a few to sell at her forthcoming events. 

 

I was going to cancel my physio with having guests but as we aren't doing much running around I may as well keep hold of the appointment and see if they can do anything else. 

 

I went for my scan on Tuesday, I was so pleased Jean was again the nurse in charge of the needle.  I had my elma cream on and off she went.  She told me the vein in my left arm is starting to move and become hard, probably due to the last chemo and the amount of times it has been used over the years.  I thought she was going to have to start probing to get the tip in but she told me after she had got it.  I didn't think veins could move the moment the needle went through the skin, you learn something everyday.  She is a wonderful lady who is now reducing her hours, I just hope that she is on when I need my next scan, I never have a problem with needles in this department, but there again she has administered about 95% of them over the years.  She lost her husband a couple of years ago, just as they were planning retirements, why does life do that?

 

It's 8 years since my Dad died today, I still remember the call at 7.30, I hadn't been that long since my last chemo treatment and I remember I hadn't really got dressed, just pulled on some joggers as my brother came to get me.  I think I was in shock, I had seen him only the day before but something told me then that I may not see him again, one of those 6th sense feelings.  I wanted to go back and see him but hubby told me I was being emotional due to the chemo, how wrong he was and how right I was.  I think he had given up, he died of a massive stroke, he was far to young at 74.  I am sure he felt guilty for my illness and that brought about his own demise.  Guilt eats us up and I wish I could lose this negative feeling.

 

It seems quite a few warriors are going through a hard time at the moment, Tess, Mavis and Debbie are on or starting another round of chemo, I am pleased to say Ray and Steve are at the moment doing well, I hope that I too will get a good result even though I fear I have a little growth, as long as it remains slow growing then it isn't too much of a worry as yet.  I have received some good news from a friend in the states, she has been receiving a new treatment at Sloan Kettering and is still stable, hopefully this drug will come into its own and maybe be the one that turns meso from a terminal to a chronicle disease.  My other friend's husband is having a lot of fluid around the lung.  Back in 04 after my surgery I had fluid, but they couldn't drain it as the fluid had gathered in pockets, now from this friend, I understand those pockets are fissures created by the meso.  It is frightening when you can't get fluid out, quite a few people I know tap fluid on a daily basis.  This to me is a brave thing, how they can have an alien tap fitted to them scares me.  My body can't stand cannula's inside my veins so imagine having a tap constantly attached.

 

On such a note I guess I will close for today but post a picture to remind me of the lovely weather we left behind together with the new friends we met on the cruise.

Don't I look healthy, I did look funny in the bikini where I had remembered to cover some of the radiation patches and not others and also burnt.  My skin has changed again due to the recent chemo, so if you are out sunbathing remember to use factor 50 on scars and radiation patches, 30 and 20 on the rest of you.  Don't miss any parts of the skin otherwise you will end up multi-coloured!

Maybe I am getting a little to old to wear such clothes!

"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

The Hunt for A Cure: W&C responds to WSJ article

The Wall Street Journal, which is in the business of putting asbestos trial lawyers out business, contacted me over a year ago. They wanted to run an article about my donations to medical research.

As a journalist myself in college, it didn’t take long for me to figure out their angle. They wanted to show that somehow my practice of sponsoring medical research, as opposed to spending oodles on TV and Google ads, was “fishy” if not “rotten.”

The result of that year long quest appeared today in the crusty WSJ under the byline of reporter Dionne Searcey. The title: “Mesothelioma Doctors, Lawyers Hunt for Valuable Asbestos Cases.” 

Right away you get a feel for the slant. We are “hunters.”  Now, I’ve gotten to know Ms. Searcey fairly well and my guess is she didn’t write the headline.  Contrary to the splenetic anti-lawyer bias of the WSJ’s editorial board,  Ms. Searcey actually went the extra mile to check her facts, question her own biases, and listen to contrary points of view. To her credit, she even previewed with me the accuracy of the quotes she attributed to me and others.  In sum, she has shown a degree of professionalism I did not expect from her employer, and I respect her methods greatly.

But I wanted to clarify just a few points.

First, we wouldn't be in this mess if the asbestos industry hadn’t created it.  Nor would we be fussing about the ethics of sponsoring medical research if the asbestos industry itself had not steadfastly and stupidly refused to clean up their horrific mess.

Second, if the parties responsible for the asbestos cancer mess won’t clean it up, who will? The Federal government has not invested in medical research commensurate with the size of the problem, their responsibility (for Navy vets, meso is a “service connected disability) or their own fault. Meanwhile, the number of people diagnosed with meso is “too small” for Big Pharma to justify any serious investment. The labor unions are broke. If not the patients and their advocates, who will step up? 

Third, if money curries favor, from a strict profits and losses perspective, why hasn’t the asbestos industry donated to research?  A few years ago, Dr. Cameron was invited to speak to 600 asbestos defense lawyers, insurance adjusters and company reps.  He talked about the medical and ethical benefits of sponsoring research. How much did they pony up? Zero. Now, that’s “disgraceful.”

The asbestos industry is notorious for corrupting the medical and scientific literature with false and deceptive articles they paid for designed to prove to juries that asbestos is as benign as mother’s milk. If anyone knows how to curry favor with money, it’s the asbestos industry.

It simply boggles my mind that the industry, after 50 years of wasting tens of billions of dollars on phony research and medical mercenary “experts,” still has yet to see the economic benefits from finding a cure.  Put lawyers like me out of business! Save asbestos-tainted companies from bankruptcy! Spare millions of people agony, misery and death! It makes dollars and sense.

Fourth, the only “stakeholders” that really don’t want to see a cure for mesothelioma are the legions of “bill to kill” defense lawyers. They get paid by the hour. It’s in their economic interest to drag out tedious, life-sucking litigation, as the John Johnson case sadly but clearly demonstrates.

That said, over the past 25 years, I have met several honorable defense lawyers who agree with me that their clients should indeed invest in a cure.  They agree with me that they should find a way to resolve meritorious cases early before racking up thousands and thousands in legal fees. And they agree that it makes no sense at this late date for asbestos defendants to invest in crackpot “experts” to gin up junk science to bamboozle juries, when the money should instead be invested in cleaning up their horrific mess. 

We are quick to forgive in this country.  People, like corporations, make mistakes. What’s unforgivable is the perpetuation of that mistake by stubbornly refusing to own up to it.

Finally, maybe I’m wrong about the “benefits” of keeping meso patients alive. Unfortunately, as long as certain states limit or eliminate the damages available in wrongful death cases, then the bad guys will indeed have an economic incentive to hasten their victim’s demise.  It’s no secret that here in California the asbestos companies generally settle wrongful death claims for far, far less than they do for living claims.  The law encourages this wicked behavior.  In this dark and dusty light, it’s no wonder the bad guys don’t invest in a cure.

My firm’s motto has always been: “Asbestos Lawyers for Life.”  Yes, it’s in my firm’s interest to help my clients live long and prosper.  The day that in this great country we hold in contempt efforts to cure cancer but applaud and reward the cancer creators, well, that’s a day I’d rather put off, and I don’t think I’m alone.

RGW

5/6/13

Hunters for Justice and a Cure for Meso: The John Johnson "Fight Meso" Family, sponsors of the Dana Point Grand Prix

Home Again

Why is it the days seem to roll into one when you are coming to the end of your holidays and what you did on day one you can't remember.  The holiday is truly over and this morning I will call in to work to try and catch up before Monday morning's onslaught of everyone needing a piece of me.

 

I have to say I have enjoyed the time away, ok a few ups and downs, my leg being the most annoying and hopefully when I see the physio on Thursday I may get some relief as the massages didn't really do it.

 

The internet access drove me to distraction along with only having the Ipad to work with, how many of you can use this for typing and emailing I just don't know, I found it hard going most of the time.  I wish I could say to Amanda I have brought the sunshine back for you in a big bottle but unfortunately it never seems to reach us, as we flew through the blue sky's yesterday across from Italy I thought hey it may be nice and sunny in good old blighty but as we crossed the white cliffs banks of cloud approached us.  In fact our decent was through heavy thick cloud that whipped the plane or way and another.

 

I read a couple of good articles on living after cancer and one on MKMRF.  Living with mesothelioma certainly has it's ups and downs, this pain in my leg and butt cheek for instance, I am worrying, hopefully needlessly, that it is a bit of growth on the bottom left of my lung which is now pressing on a nerve instead of me perhaps doing something like sitting the wrong way and pulling a muscle.

 

The last day of our cruise was in Sorrento, but you know I just couldn't be bothered to get off the ship and visit, yes it looked lovely from out in the water and I should have made the effort but I needed a day of relaxation.  I felt guilty for not visiting but I am sure we will get there again.  We spent a cold night up on deck having dinner with people who were strangers 10 day ago but became friends over the course of the holiday.  Because of the internet I am sure we will be in touch, not like the olden days where you just could never be in touch so easily.

 

Two of the party we befriended have a large Doctor's practise in Pittsburgh, they told me they hadn't had a case of meso for ten years.  Pittsburgh was a notorious hot spot for this disease and now they have a total decline so how come the rest of the world is still on an upward rating.

 

The dog's were certainly pleased to see us, we dropped the bags off and took them straight out for a walk, I haven't seen both tails go so much from left to right for ages.  Bear ran around the fields sniffing who had been around his property over the last week, boy did he have fun, whereas Lexi stayed by our sides.

 

Well that's it for now, have a busy night tonight, a 65th birthday party to attend, just hope I don't over do myself today and find I'm tired!

 

Time for me to catch up on everyone's blogs and see what's being happening while I've been away.  I truly hope that Amanda and Ray have finally found themselves out and about enjoying themselves.

Workers Memorial Day--Remember the Dead, Fight for the Living

In recognition of Workers Memorial Day 2013,  Worthington & Caron would like to acknowledge all of the working men and women who have been hurt, taken ill or have died in pursuit of their piece of the “American Dream”. This, of course, includes hundreds of thousands of workers who have been diagnosed with mesothelioma, lung cancer or asbestosis as a result of exposure to asbestos in the workplace.

The Occupational Safety and Health Administration (OSHA) was established on April 28, 1971 with the mission of assuring safe and healthful working conditions by setting and enforcing standards and providing training, outreach, education and assistance. The anniversary of this day has been designated Worker’s Memorial Day, a day to honor all men and women who have been injured or have lost their lives due to a workplace accident or exposure.

According to the World Health Organization approximately 125 million people in the world were exposed to asbestos at the workplace, and more than 107,000 people die each year from asbestos-related disease. One in every three deaths from occupational cancer is estimated to be caused by asbestos.

Even though OSHA established regulations regarding the handling of asbestos in the early 1970s, many manufacturers continued using asbestos in their products for many years--in some cases decades later. The OSHA regulations proved to be of some effect in reducing exposures to existing asbestos that had been installed years earlier and could be marked and cordoned off at jobsites such as factories, refineries and power plants. However, the regulations proved to be less effective in limiting exposures to new products that were used by workers or by others in their presence at jobsites. As disease caused by asbestos typically doesn’t manifest until 20 to 50 or more years after exposure, it is anticipated that the incidence of asbestos disease will remain at its current rate for years to come.

Many believe that the conduct of asbestos companies from the 1930s through the 1980s is one of the worst examples of companies placing profits ahead of public safety in our nation’s history. Worker’s Memorial Day is a powerful reminder of the importance of worker health and the need to prevent this situation from ever occurring again. 

Kudos to The New York Times Magazine for Examining the "Feel-Good War" on Breast Cancer!

In last week's The New York Times Magazine, Peggy Orenstein wrote an article called "Our Feel-Good War on Breast Cancer".  The piece is lengthy but well researched, insightful, and well worth the reading time.

Peggy, a breast cancer survivor herself, hits every key public health issue- cancer screenings, treatment options, "awareness" raising, message framing, funding, and research.  As someone who has been critical of "awareness" raising, I was happy to see the issue discussed front and center.  For me, her interview with Dr. Gayle Sulik (Sociologist and Founder of the Breast Cancer Consortium) was the most striking.  A key quote from Dr. Sulik (I added the bolding):

“You have to look at the agenda for each program involved.  If the goal is eradication of breast cancer, how close are we to that? Not very close at all. If the agenda is awareness, what is it making us aware of? That breast cancer exists? That it’s important? ‘Awareness’ has become narrowed until it just means ‘visibility.’ And that’s where the movement has failed. That’s where it’s lost its momentum to move further.”

Peggy also tackles the issue that is an ongoing challenge in public health and medicine:  screening.  Screenings are tests that look for diseases before you have symptoms.  Ideally, screening will identify diseases early when they are easier to treat and have better outcomes.  For breast cancer, the key screening test is a mammogram (x-ray of the breasts).  However (as Peggy points out), we seldom hear about the research that demonstrates limited effectiveness of mammograms for reducing cancer death.  This is not the research cited in the communication materials from advocacy organizations.  We also tend not to hear about the negative side effects of screening large segments of the population.  There can be false positive tests: which subject the patient to unnecessary medical intervention and emotional distress.  There can also be over-treatment for the detected cancer, even if it turns out to be a non-aggressive tumor.

When I was working in suicide prevention, one of the best articles I read was "Screening as an Approach for Adolescent Suicide Prevention" by Dr. Juan Pena and Dr. Eric Caine.  The authors dedicate a section of the paper to key decisions and tasks to resolve before implementing a screening program.  While the public health issue and screening tests are different, I believe many of their decision points are generalizable to almost any health issue.  The table presenting these decisions and tasks is a great reminder to public health professionals and clinicians that recommending and undertaking a screening program should be strategic and the decision should be re-visited regularly.  For example, the authors highlight:

• Key Decision:  Population and Setting- Is the screening program consistent with the target population's community or cultural values?
• Key Decision:  Screening Instrument- What will be the false positives and false negatives rates in the population to be screened?  Are these rates acceptable?
• Key Decision:  Staffing and Referral Network- Are there effective treatments available for the types of conditions being screened for?
• Key Decision:  Quality Assurance- How will the screening program be monitored to ensure that protocols are followed?
• Key Decision:  Legal and Ethical Issues- Has sufficient informed consent been given to parents and youth about risks, benefits, and limits of screening?

Going back to the "Feel-Good War" article:  I like that Peggy did not just point out all the flaws in our current breast cancer screening and treatment systems.  Instead, she invited her interviewees to recommend potential improvements.  Some ideas were noted in two key areas:

• Message Re-Framing:  Rather than offering blanket assurances that “mammograms save lives,” advocacy groups might try a more realistic campaign tag line. The researcher Gilbert Welch has suggested this message, “Mammography has both benefits and harms — that’s why it’s a personal decision.”

• Funding Re-Distribution:  Peggy asked scientists and advocates how some of that "awareness" money could be spent differently. She highlights the February recommendations of a Congressional panel (made up of advocates, scientists and government officials) that called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities. 

Tell Me What You Think:

• What do you think about the "pink culture" or awareness raising around breast cancer?  Will it effectively lead us to our goal of prevention?
• In addition to message re-framing and funding re-distribution, what else would you recommend to help improve the approach to breast cancer prevention, screening, and treatment?