Ahad, 8 Disember 2013

The Star Online: Lifestyle: Health

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The Star Online: Lifestyle: Health

Crowdsourcing for research


Impatient with the US NIH, a cancer researcher turns to crowdfunding for his work.

DR DANIEL Saltzman says he can prove that bacteria that ordinarily cause food poisoning in people can be modified for use as guided missiles to deliver cancer-killing payloads into tumours.

But he needs US$500,000 (RM1.61mil) for some preliminary work, and despite his project's potential, he's not holding his breath for funding from the National Institutes of Health (NIH), America's leading source of biomedical research grants.

So, Dr Saltzman has teamed up with an entrepreneur in the television industry and Twin Cities advertising and public relations professionals to make an unusual direct appeal to the public. In the process, he's helping to bring so-called crowdsourcing to the field of medical research.

"This is very different... and so there has to be a leap of faith" for the research to be funded, said Dr Saltzman, surgeon-in-chief at Amplatz Children's Hospital in Minneapolis, US, and an associate professor at the University of Minnesota (U of M).

To convince people of his work's promise, Dr Saltzman and his partner have built a website branding his research "Project Stealth", created an eye-catching plush toy to represent the salmonella bacterium, made a video featuring Dr Saltzman and a golden retriever named Buddy, and turned to private fundraising events and crowdfunding avenues like Razoo.com.

Dr Saltzman, who has raised about US$32,000 (RM103,067) since launching Project Stealth in mid-October, acknowledges that the approach is unusual.

But he says that, with US federal research funds getting tighter every year, he had little choice. "The bottom line is, there's a lot of competition, a lot of labs, and only so much money."

An ethical move?

He is not the first scientist who turned to public appeals for funding in an era of tight federal research budgets.

Over the past decade, inflation has eroded more than 20% of the buying power of NIH grants for scientists studying genomics, neurology, cancer, heart disease and countless other health issues.

With so many competing projects, NIH has reduced the percentage of requests it has funded.

Such novel fundraising methods raise concerns because they don't go through the conventional peer-review process, said Dr Arthur Caplan, a medical ethicist at New York University's Langone Medical Center.

And when they rely on celebrities, as some do, they can draw money for reasons other than scientific merit, he said.

But after reviewing Dr Saltzman's video at the request of the Star Tribune, Dr Caplan said in an email: "One can always niggle at these things, but it seems fine... (a) strong plea for money, but from a very legit research program."

Dr Caplan's only concern was why the project hadn't drawn NIH or foundation funding, given its promising results in animals.

Dr Saltzman has been studying the use of bacteria as a potential way to fight cancer since 1993, and thinks he's on the verge of a breakthrough.

He says he needs about US$250,000 (RM805,915) a year for two years to develop the data required to convince the US Food and Drug Administration to authorize human testing.

If approved, he said, the U of M has committed to pay for the $800,000 (RM2.58mil) it would take to run the phase I clinical trial in humans.

Although the university provides researchers with expensive tools like electron microscopes and a fertile environment for the exchange of ideas, Dr Saltzman said: "They give you a room and they turn on the lights. They charge rent for the room. But every lab and every... principal investigator is basically charged with raising their own funds to do research."

Small steps

The idea of crowdfunding Dr Saltzman's work came from Max Duckler, a semiretired entrepreneur, who, in 1993, founded CaptionMax, a closed-captioning service for television.

Duckler has a degree in biology and a lifelong fascination with medicine. He attended a fundraiser where he bid to spend a day with a surgeon.

He won, shadowed Dr Saltzman on six surgeries, and learned about the cancer research.

Duckler said he was disturbed to find that Dr Saltzman and his lab workers were worried whether they could afford to spend $600 (RM1,934) to buy special research mice.

"Six hundred dollars, and you have to ask whether you can afford it? This is not good," Duckler said.

A medical advertising firm called StoneArch and a public relations firm named PineappleRM donated their services to publicize Dr Saltzman's work, and the Twin Cities office of BusinessWire distributed the news release at no charge.

In the marketing video, Dr Saltzman describes how the engineered salmonella penetrate a tumour and activate the body's immune system to destroy it.

"We have tested this therapy in over 4,000 mice. In addition, in small pilot studies in humans and dogs with cancer, we have not seen any side effects at all. Can you imagine a cancer treatment without side effects, whatsoever?"

Dr Jeff Miller, deputy director of the U of M's Masonic Cancer Center, said Dr Saltzman's pitch in the video goes a little far for some researchers, who prefer to seek the university's institutional funds for basic research.

"Lots of people have good ideas here," Dr Miller said. "I don't think what Dan is doing is being looked down upon. I think the issue is that we just want people to be honest and realistic about their claims when they're tied to the institution."

Project Stealth donations go directly to the University of Minnesota Foundation and are subject to its controls and management, said Sarah Youngerman, a spokeswoman.

She said Dr Saltzman hasn't misrepresented himself. "This guy is changing people's lives – kids' lives," she said.

Crowdsourcing, which other U of M researchers have used occasionally, "isn't where you're going to raise big, big dollars," Youngerman said, but it can help with public awareness.

"A lot of people feel like they can make a difference in a very small way. And certainly they can, as you aggregate those US$10 (RM32.24) gifts or those US$50 (RM161.20) gifts."

Dr Saltzman says he has applied for 11 grants. One was rejected, one was awarded US$30,000 (RM96,720), and he's awaiting responses on the rest.

This isn't his first effort to prove the salmonella concept. He got a US$375,000 (RM1.21mil) grant from the US National Cancer Institute a few years ago, and has won support from several smaller funds.

All told, he said, he has spent US$125,000 (RM402,984) to US$250,000 (RM805,915) a year on the project in the last 13 years. – Star Tribune (Minneapolis)/MCT Information Services

Eat right for less cholesterol


Check out these 10 foods that will help lower your cholesterol levels, and keep your heart healthy.

When it comes to general health nowadays, there is a basic triumvirate of factors that most people are familiar with: weight, glucose or sugar, and cholesterol.

They are all related in one way or the other, of course, but each is also a star in measuring unhealthiness in its own right.

With the advent of commercial medical laboratories providing personalised blood tests direct to the public, anyone with the cash to spare can get their glucose and cholesterol levels tested with a prick of a needle.

Although it doesn't usually come with a medical professional's advice, most people are satisfied just to check if their levels fall within the normal ranges provided.

But what to do if they don't?

Before starting on statins – those cholesterol-lowering wonder drugs that doctors prescribe – why not try a non-pharmaceutical method like modifying your diet first?

Here is a list of the top 10 cholesterol-lowering foods, as recommended by Pantai Cheras Hospital, Kuala Lumpur, dietitian Ang Bee Xian:

Oatmeal and oat bran

These two items are probably the best-known celebrities of cholesterol-lowering foods, and rightfully so.

Oatmeal and oat bran are filled with soluble fibre, whose main function is to help absorb cholesterol from what you eat and bring it along out of your body when it gets passed out.

Eating 1½ cups of cooked oatmeal provides 6g of soluble fibre, which falls within the range of 5-10g necessary per day to decrease total and low-density lipoprotein (LDL), also known as "bad", cholesterol.


A well-known protein source for vegetarians, soy helps lower cholesterol in two ways: by providing an alternative to meats, which contain more saturated fat, and by helping to lower LDL cholesterol.

The US Food and Drug Administration (FDA) recommends taking at least 25g of soy protein daily, as part of a cholesterol-lowering diet.

Examples of soy foods are tofu, soymilk, edamame, miso and tempeh.


A wholegrain sibling to oatmeal, barley is a lesser known cholesterol-lowering food star.

Also containing lots of the soluble fibre called beta-glucan, barley can help lower total and LDL cholesterol, as well as trigylcerides.

Fatty fish

Eating fatty fish like salmon, mackerel, tuna and sardines, two or three times a week, provides you with enough omega-3 fatty acids to help lower your triglyceride levels.

Try not to fry them though – the extra oil will do your cholesterol level no favours; instead, cook them using healthier methods like grilling or baking.


Probably not as well-known as wholegrains, beans are also an excellent source of soluble fibre.

In addition, they take longer to digest, meaning that you will feel full for longer after eating them, thus, reducing the temptation to snack between meals.


If you really crave a snack, then why not help lower your LDL cholesterol at the same time with some nuts?

A handful (around 42.5g) of plain almonds, walnuts, peanuts, hazelnuts, pine nuts or other types of nuts, a day can not only lower LDL cholesterol by about 5%, but also provide other heart-healthy nutrients.

However, they are also high in calories, so a handful around three to four times a week should be your limit.

Vegetable oils

Although it would be best to minimise using oil at all, the type you should use, if needed, are liquid vegetable oils.

Oils like olive, canola, sunflower and corn, are a better alternative than butter, lard or shortening, as they contain phytosterols that help block the body from absorbing dietary cholesterol.

Plant sterols and stanols

In addition to using vegetable oils, it is also recommended to take foods specifically fortified with phytosterols, also known as plant sterol and stanol esters.

Examples include margarines, yoghurt drinks, milk and orange juice. Check the food labels for phytosterol content.

About 2g of phytosterols a day can lower LDL cholesterol by about 10%.

Fruits rich in pectin

Apples, prunes, blackberries and citrus fruits like oranges and grapefruits are all examples of fruits rich in pectin, which is a type of soluble fibre that helps lower LDL cholesterol.


Avocados are full of monounsaturated fats that help lower LDL cholesterol, while at the same time, increasing high-density lipoprotein (HDL) or "good" cholesterol.

It also contains fibre and a chemical called beta-sitosterol, which helps reduce the amount of cholesterol absorbed from food.

But it is also high in calories, so don't overdose on them. One whole avocado is enough to fulfil your entire daily quota of monounsaturated fat for a regular 1,800-calorie diet, according to the American Heart Association.

Coming too quickly


Many guys suffer in silence from premature ejaculation, even though there is a highly effective drug to treat it.

Even in our modern enlightened age, a man's self-image is still often tied up with his ability to perform in bed.

Crucially, this includes his ability to control his orgasm or ejaculation.

This is because men, in general, tend to climax faster than women during intercourse, and the ability to delay their ejaculation allows them more time to stimulate their partners to orgasm.

That is why premature ejaculation (PE) can be such a big problem in a relationship.

In fact, consultant sexual health physician Dr Chris McMahon defines PE as "simply when a man is unable to delay ejaculation for a sufficient period of time to guarantee his partner gets an adequate response".

The International Society for Sexual Medicine president shares that large community-based studies have found that the average amount of time from penetration to ejaculation for males is around 5.4 minutes.

However, he adds that there is a range from very fast to very slow, with some not experiencing ejaculation at all.

"We generally regard PE as ejaculation that occurs within about one minute," he says, adding that this is the time reported by around 80% of males who come in to see the doctor about this problem. The remaining 20% report a time of one to two minutes.

But PE is not just about how long (or short) you last.

Dr McMahon explains: "There are three dimensions of PE: time or latency, a lack of control or inability to delay or defer ejaculation, and most important, (the) presence of what we call negative psychological consequences, such as patients feeling bothered, frustrated, annoyed (and) developing a pattern of avoiding sex.

"Each of these dimensions must be present to secure a diagnosis of PE."

So, for example, a man who ejaculates within 30 seconds and has no control over his ejaculation, but is not bothered about it, is not really considered to have PE.

Similarly, someone who has little control, is very bothered about it, but ejaculates in about five minutes, is also not considered to have PE.

Root causes

There are essentially two types of PE: lifelong and acquired.

Patients with lifelong PE experience rapid ejaculation right from their very first sexual experience, with every one of their sexual partners, and in virtually all their sexual encounters.

Says Dr McMahon: "There is a compelling amount of evidence to suggest that some of us are born with a genetic predisposition to PE."

Research has shown that first-degree relatives of a man with PE – father, sons, brothers – are 25 times more likely to have PE as well. Male identical twins are also likely to both have PE.

In addition, it was recently found that one variation of the gene that controls the production of serotonin – a chemical messenger in our nervous system that helps regulate ejaculation – was associated with PE, while the other type was not.

"So, it may be that some of us were doomed to have PE from the moment of conception," says Dr McMahon.

Meanwhile, there are those males who initially had normal ejaculatory times, but developed PE over time. These patients have acquired PE.

The two most common causes for acquired PE are psychological – basically, performance anxiety, and erectile dysfunction (ED).

Commenting on performance anxiety, Dr McMahon says: "Most of the things that we do in life, the harder we try, the better we do. Except for sex, where the harder you try, the worse you do.

"The more you fail, the more negative you become about the chances of success the next time.

"Eventually, it becomes a bit of a runaway train, and you get to a point where you're failing before you start."

Meanwhile, he explains that there is a two-way link between PE and ED.

"For example, a man who has got ED might rush intercourse, for fear that if he kicks back and takes his time, he will lose his erection, and hence, he ejaculates quickly.

"Similarly, a man who has got PE might intentionally limit the amount of arousal during foreplay (to stop from ejaculating too quickly), and fail to get an erection."

Around 30-50% of men with ED will develop PE, and specifically in the Asia-Pacific region, the chances of an ED patient developing PE is 6.9 times higher than someone without ED.

A single, effective solution

Unfortunately, the effect of having this condition goes far beyond the bedroom walls.

"These are not happy men.

"There is a substantial psychological burden from having PE; it can destroy relationships, and it can be an obstacle to forming new relationships.

"In the Asia-Pacific Pepa (Premature Ejaculation Perceptions and Attitude) study conducted about three years ago, there was a significant increase in the prospect of divorce for men with PE, because of the stress it places upon the relationship.

"So, these are men and (their) partners who have a reduced quality of life, and they're not happy," Dr McMahon says, adding that links between chronic anxiety and chronic depression with PE respectively, have also been found.

It doesn't help that men either tend to avoid talking about this problem or go into denial mode, while their partners are equally loath to bring up the subject for fear of embarrassing or upsetting their men.

"Many men will choose to seek treatment only at a crisis point in their relationship, and usually the factor that instigates treatment-seeking is an ultimatum from the wife."

The irony is that there is an easy and effective solution for PE.

While there are a few different options for managing PE, including behavioural therapy, anaesthetic creams and certain drugs that do help with PE as a side effect, but are not officially approved to treat it, there is one oral medication that was directly developed and approved to treat this condition.

According to Dr McMahon, dapoxetine, a short-acting selective serotonin reuptake inhibitor, has an over 95% success rate of treating PE.

It works by increasing the amount of serotonin in the body, thus, enabling patients to exert greater control over their ejaculation.

"Men will respond very, very quickly to this medication, and once their PE resolves, all of the psychological burden just dissipates.

"Their relationship improves, their quality of life improves, everyone's happy."

He explains: "It is an on-demand drug, so it is taken with a glass of water anywhere from one to three hours prior to intercourse.

"And the data we have shows it is effective from the first dose.

"There is an average threefold increase in ejaculatory time on the first dose, and with continued dosing, at six months, the threefold increase will go up to a fourfold increase."

He adds that the lack of control and psychological distress caused by PE will also decrease, and the patient's sexual satisfaction will naturally increase.

The key to managing this condition is recognition, says Dr McMahon.

He shares that even though 20-30% of men will admit to having PE when specifically asked, very few of them actually seek treatment for it.

"We can educate men to understand that this is a surprisingly common condition, that it is totally treatable, (and) that no man should suffer in silence."

If you think you might have PE, go to www.controlPE.com and take the PEDT (Premature Ejaculation Diagnostic Tool) questionnaire to see if you have this common sexual condition.

Kredit: www.thestar.com.my

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