A New Year Reuters news article titled British charity issues anorexia Internet warning caught my eye. The Eating Disorders Association in England was highlighting the danger of pro-eating disorder web sites that promote anorexia and bulimia as a lifestyle choice rather than as diseases. (Anorexics are individuals who have a distorted image of themselves as being overweight and who go to great lengths to stay thin and become even thinner. Bulimics are people who eat lots and then induce vomiting to get rid of the food they have consumed or take laxatives to purge themselves.)  These sites present themselves as support networks and, while denying that they are encouraging people to stay thin, they offer tips to readers on how to become thinner alongside glamorous images of slim celebrities and models.

Staying healthy by not becoming overweight or obese is a commendable aspiration.  Going to the other extreme of becoming excessively thin is a well known health hazard. In United Kingdom, 1% of the female population suffers from some form of eating disorder. The percentage goes up to 5 – 10% when you look at the female population aged 14 – 24. In United States there are 5 – 10 million women and 1 million boys and men struggling with eating disorders. As a result of their eating disorders, about 1 in 5 of these individuals will die prematurely.

A recent study from Stanford University studied 698 families of patients with an eating disorder diagnosed at Stanford between 1997 and 2004 (Pediatrics 2006; 118: e1635 – 1643). The researchers looked at the awareness and usage of pro-eating disorder Web sites among adolescents with eating disorders and their parents. Just over 50% of parents were not aware of pro-eating disorder sites and 62.5% of parents were also not aware about pro-recovery sites. Only one quarter of the parents had discussed these sites with their children. Half of the parents did not know whether their child visited such sites. Ninety six percent of children visiting these pro-eating disorder sites learnt new weight loss or purging techniques. Children who visited pro-recovery sites also managed to learn new thinning techniques but much less (46%).

Having a weighing scale in the bathroom is a common practice by some. Is this practice setting up a good example for the young kids in the family or is this going to create obsessive weight-watching behaviour later in their adolescent life? A study from University of Minnesota asked the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviour over a 5-year period among adolescent females and males? (J Adolesc Health 2006; 39: 811 – 818) A total of 2516 adolescents who were transforming from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort) were studied. In the younger cohort, but not the older cohort, frequent self-weighing in the first 5 years of the study was predictive of a higher number of adolescents developing disordered eating behaviour, such as unhealthy weight control behaviour and binge eating later in adolescent life. This finding only applied to the females in the younger cohort.

Children and adolescents with eating disorders will experience hospitalization in their life time. What is the societal health care cost? A recent study from the George Washington University looked at the annual hospitalization cost for patients with eating disorders, aged 9 – 17 years, in the State of New York for the year 1995. (J Adolesc Health 2006; 39: 806 – 810) In that year, there were 352 hospitalisation episodes involving 312 females and 40 males. The ethnicity of the population was: Caucasians (79.3%), African Americans (9.9%) and others (10.8%). The diagnostic categories were anorexia nervosa (242), bulimia (59) and eating disturbance not otherwise specified (63). The mean cost of each hospitalization was 10,019 US dollars.

Pictures of glamorous looking thin models in glitzy magazines, on TV screens and on the silver screens give the impression that thin is beautiful. The presence of advertisements for slimming programs in the newspaper adds further ‘glamour’ to the idea of being thin. In a large part of the world, millions are dying because they do not have enough to eat. Ironically in other parts of the world, society and the fashion industry are extolling the virtues of being very thin. To achieve this, many have or will develop eating disorders.

Late last year the issue of eating disorders was under the global spotlight when two models suffering from anorexia died in Brazil and Uruguay. In September 2006, the city of Madrid banned models below a certain weight from its fashion week show. Unfortunately the Milan fashion show did not follow Madrid’s example. While society has to take responsibility for this, parents can and should do their part too. After all, beauty is relative.

Christmas has come and gone. Thank goodness the kids are getting bored with those noisy presents meant to entertain and amuse. However, little did we know that some of these goodies can damage a child’s hearing. A recent study commissioned by Deafness Research UK has found that 14 of 15 popular toys, if held close to the ears by children, will harm their hearing. The recommended top noise limit for toys is 85 decibels. When held close to the ear, 14 of the toys, including Fireman Sam’s Action Jupiter, Tomy’s Spin n Spound remote-controlled car, Pixar Cars Lightning McQueen, had average noise levels between 84 and 115 decibels. Toy guns are the worst offenders, emitting 130 – 143 decibels. Noise of 140 decibels or above can cause immediate hearing damage. The only toy with a noise level below the safety threshold was a VTECH cell phone for babies. Huh, cell phone for babies? Guess some do want to start their kids young on being a real techie!

There are ‘toys’ in the field of medicine as well! Recent examples in the field of radiology include a 64-slice CT scanner for scanning coronary arteries for calcium scoring and to perform virtual colonoscopy. In the field of treating hepatocellular carcinoma (HCC) or primary liver cancer, a recent therapeutic ‘toy’ for palliating HCC is radio-frequency ablation (RFA). The crux of the treatment is to ‘cook’ the tumour with a special needle inserted under X-ray guidance or during open surgery. Up to 5 years ago, in Europe, percutaneous ethanol injection (PEI) was the ablation treatment of choice for inoperable HCC. Then RFA became the new kid on the block and displaced PEI because it could be done faster and it was thought that RFA was more ‘scientifically appealing’. Initial reports suggested that RFA led to higher rates of complete response, lower rates of recurrence and gave better prolongation of survival compared to PEI. However, with the passage of time, more recent studies have not confirmed these initial findings about the excellent efficacy of RFA.

A recent Italian multi-centre study looked at the efficacy and safety of RFA in 401 patients with HCC (Aliment Pharmacol Ther 2006; 24: 1495 – 1502). In 77% of patients there was only one lesion but this was not suitable for curative surgery. In 18% of patients, there were 2 – 3 lesions and the remaining 5% of patients had multiple lesions. The mean size of the tumour was 3cm. Following the initial RFA, in 61% of patients, additional treatment in the form of repeat RFA, PEI, transarterial chemoembolization (TACE), surgery or medical treatment was necessary, either immediately or during follow-up, because of partial response or disease recurrence. Major complications occurred in 5% of cases during or after treatment. These included portal vein thrombosis, seeding of tumour along the RFA needle tract, abscess in the liver, bleeding and perforation of the colon, to name a few. The complete response rate, as assessed by CT scanning, at one month was 67%, which is much less than the earlier reports of 90 – 98% response rates. The overall survival of this group of patients was 40% at 3 years, a very respectable figure indeed.

With the passage of time, more studies and more data on increasing numbers of patients treated with RFA has helped the medical community to refine their recommendations on the use of these ‘new toys’ in treating patients. After a recent Consensus Conference on HCC held in Barcelona, involving the European Association for the Study of Liver Disease, the American Gastroenterological Association and the Japanese Cancer Society, the take-away message was that, in practice, RFA may well be only indicated for HCC nodules ranging from 2 – 3 cm in size only. This does not mean that RFA is not a good treatment for HCC. It merely means that we have to be selective in its use and we must use it in patients with the right disease characteristics.

It is fortunate that the medical community is endowed with many ‘toys’, be it gadgets or new medicine. There is always the initial flurry at the start when each new tool is hailed as the ‘holy grail’ for treating a condition by the enthusiasts. With time and more information, the picture becomes clearer and all doctors become more informed of the scope of use for that particular ‘toy’. In the fight against cancer, we need all the ‘toys’ we can to give the patients more hope. However, we must use the ‘toy’ or ‘tool’ with care and caution so that we do not cause harm or give unrealistic hopes to the patients. As the saying goes “A fool with a tool is still a fool!”

Today heralds the beginning of another year. As the year passes, the medical community will gain more information and knowledge about various tools and how to use them better. I wish all my readers a Joyous and Healthy New Year!