What too much alcohol can do to your health

(CNN)This feature is part of CNN Parallels, an interactive series exploring ways you can improve your health by making small changes to your daily habits.

A lot of us drink. Too many of us drink a lot.
Worldwide, each person 15 years and older consumes 13.5 grams of pure alcohol per day, according to the World Health Organization. Considering that nearly half of the world doesn’t drink at all, that leaves the other half drinking up their share.
    While the majority of the world drinks liquor, Americans prefer beer. The Beverage Marketing Corp. tracks these things: In 2017,Americans guzzled about 27 gallons of beer (or 216 pints), 2.6 gallons of wine and 2.2 gallons of spirits per drinking-age adult.
    But Americans are lightweights in any worldwide drinking game, based on numbers from the World Health Organization. The Eastern European countries of Lithuania, Belarus, Czechia (the Czech Republic), Croatia and Bulgaria drink us under the table.
    In fact, measuring liters drunk by anyone over 15, the US ranks 36th in the category of most sloshed nation; Austria comes in sixth; France is ninth (more wine) and Ireland 15th (yes, they drink more beer), while the UK ranks 18th.
    Who drinks the least in the world? The Arab nations of the Middle East.

    With all this boozing going on, just what damage does alcohol do to your health? Let’s explore what science says are the downsides of having a tipple or two.

    Counting calories

    Even if you aren’t watching your waistline, you might be shocked at the number of empty calories you can easily consume during happy hour.
    Calories are typically defined by a “standard” drink. In the US, that’s about 0.6 fluid ounces or 14 grams of pure alcohol, which differs depending on the type of adult beverage you consume.

    For example, a standard drink of beer is one 12-ounce can (355 milliliters). For malt liquor, it’s 8 to 9 fluid ounces (251 milliliters). A standard drink of red or white wine is about 5 fluid ounces (148 milliliters).
    What’s considereda standard drink continues to go down as the alcohol content goes up. But what if that changes? Let’s use beer as an example.
    It used to be that light beer came in around 100 calories while regular beer averaged 153 calories per 12-fluid ounce can or bottle — that’s the same as two or three Oreo cookies.

    But beer calories depend on both alcohol content and carbohydrate level. So if you’re a fan of today’s popular craft beers, which often have extra carbs and higher alcohol content, you could easily face a calorie land mine in every can. Let’s say you chose a highly ranked IPA, such as Sierra Nevada Bigfoot (9.6% alcohol) or Narwhal (10.2% alcohol), and you’ve downed a whopping 318 to 344 calories, about as much as a McDonald’s cheeseburger. Did you drink just one?
    If you pour correctly, white wine is about 120 calories per 5 fluid ounces, and red is 125. If you fill your glass to the brim, that might easily double.
    Liquor? Gin, rum, vodka, tequila and whiskey cost you 97 calories per 1.5 fluid ounces, but that’s without mixers. An average margarita will cost you 168 calories while a pina colada weighs in at a whopping 490 calories, about the same as a McDonald’s Quarter Pounder.
    A 2013 study in the US found that calorie intake went up on drinking days compared with non-drinking days, mostly due to alcohol: Men took in 433 extra calories, while women added 299 calories.
    But alcohol can also affect our self-control, which can lead to overeating. A 1999 study found that people ate more when they had an aperitif before dinner than if they abstained.
    Take heart. If you’re a light to moderate drinker, meaning you stick to US guidelines of one “standard” drink a day for women and two for men, studies have shown that you aren’t guaranteed to gain weight over time — especially if you live an overall healthy lifestyle.
    For example, a 2002 study of almost 25,000 Finnish men and women over five-year intervals found that moderate alcohol consumption, combined with a physically active lifestyle, no smoking and healthy food choices, “maximizes the chances of having a normal weight.”
    However, it appears that heavy drinking and binge drinking could be linked to obesity. And that’s a problem. The numbers of binge drinkers — defined as five or more drinks for men and four or more drinks for women within a couple of hours at least once a month — has been rising in the United States.
    The Centers for Disease Control and Prevention says one in six adults binge about four times a month, downing about eight drinks in each binge.
    In the UK, where binge drinking is defined as “drinking lots of alcohol in a short space of time or drinking to get drunk,” a 2016 national survey found 2.5 million people admitted to binge drinking in the last week.
    Alcohol, of course, has no nutritional value and contains 7 calories per gram — more than protein and even carbs, which both have 4 calories. Fat has 9 calories per gram.
    All those empty alcohol calories have to end up somewhere.

    Heart disease and cancer

    The prevailing wisdom for years has been that drinking in moderation — again, that’s one “standard” drink a day for women and two for men — is linked to a lower risk of cardiovascular disease. But recent studies are casting doubt on that long-held lore. Science now says it depends on your age and drinking habits.
    A 2017 study of nearly 2 million Brits with no cardiovascular risk found that there was still a modest benefit in moderate drinking, especially for women over 55 who drank five drinks a week. Why that age? Alcohol can alter cholesterol and clotting in the blood in positive ways, experts say, and that’s about the age when heart problems begin to occur.
    For everyone else, the small protective effect on the heart was evident only if the drinks were spaced out during the week. Consuming heavily in one session, or binge drinking, has been linked to heart attacks — or what the English call “holiday heart.”
    Also, a 2018 study found that drinking more than 100 grams of alcohol per week — equal to roughly seven standard drinks in the United States or five to six glasses of wine in the UK — increases your risk of death from all causes and in turn lowers your life expectancy. Links were found with different forms of cardiovascular disease, with people who drank more than 100 grams per week having a higher risk of stroke, heart failure, fatal hypertensive disease and fatal aortic aneurysm, where an artery or vein swells up and could burst.
    In contrast, the 2018 study found that higher levels of alcohol were also linked to a lower risk of heart attack, or myocardial infarction.
    Overall, however, the latest thinking is that any heart benefit may be outweighed by other health risks, such as high blood pressure, pancreatitis, certain cancers and liver damage.
    Women who drink are at a higher risk for breast cancer; alcohol contributes about 6% of the overall risk, possibly because it raises certain dangerous hormones in the blood. Drinking can also increase the chance you might develop bowel, liver, mouth and oral cancers.
    One potential reason: Alcohol weakens our immune systems, making us more susceptible to inflammation, a driving force behind cancer, as well as infections and the integrity of the microbiome in our digestive tract. That’s true not only for chronic drinkers but for those who binge, as well.

    Diabetes

    The connection between alcohol and diabetes is complicated. Studies show that drinking moderately over three or four days a week may actually lower the risk of developing type 2 diabetes. However, drinking heavily increases the risk. Too much alcohol inflames the pancreas, which is responsible for secreting insulin to regulate your body’s blood sugars.
    If you have diabetes, alcohol may interact with various medications. If you take insulin or any pills that stimulate the release of insulin, alcohol can lead to hypoglycemia, a dangerously low blood sugar level, because alcohol stimulates the release of insulin as well. That’s why experts recommend never drinking on an empty stomach. Instead, drink with a meal or at least some carbs.
    And, of course, because alcohol is made by fermenting sugar and starch, it’s full of empty calories, which contributes to obesity and type 2 diabetes.

    Mood and memory

    Because alcohol is a depressant, drinking can drown your mood. It may not seem that way while you “party” your inhibitions away, but that’s just the drink depressing the part of the brain we use to control our actions. The more you drink, say experts, the more your negative emotions, such as anxiety, anger and depression, can take over.
    That’s why binge drinking or drinking a lot in one sitting is associated with higher levels of depression, self-harm, suicide and violent offending.
    Binge drinking is also associated with severe “blackouts”: the inability to remember what happened while drunk. Blackouts can range from small memory blips, such as forgetting a name, to more serious incidents, such as forgetting an entire evening.
    Alcohol does this by decreasing the electrical activity of the neurons in your hippocampus, the part of the brain responsible for the formation of short-term memories. Keep up that binge drinking, and you can permanently damage the hippocampus and develop sustained memory or cognitive problems.
    Adolescents are most susceptible to alcohol’s memory disruption but less sensitive to the intoxicating effects. That means they can easily drink more to feel as “drunk” as an adult would, causing even more damage to their brains.

    How you look

    Last but certainly not least, alcohol can have a significant effect on your good looks. First, it dehydrates you. That can leave your skin looking parched and wrinkled. It’s also linked to rosacea, a skin condition causing redness, pimples and swelling on your face.
    Do you know you can stink while you’re drinking? During the time your liver is processing a single drink, which is on average an hour but varies for everyone, some of it leaves your body via your breath, urine and sweat.

    See the latest news and share your comments with CNN Health on Facebook and Twitter.

    Another reason drinking can affect your looks has to do with sleep. Although even a little bit of alcohol can help you fall asleep quickly, as the alcohol is metabolized and leaves the body you may suffer the “rebound effect.” Instead of staying asleep, the body enters lighter sleep and wakefulness, which appears to get worse the more one drinks.
    A lack of sleep leads to dark circles, puffy eyes and stress. Keep it up, studies say, and you’re likely to see more signs of aging and a much lower satisfaction with your appearance.
    So the next time you head to the pub for tipple or two, remember: You could be paying a price for all that fun.

    Read more: https://www.cnn.com/2018/02/01/health/alcohol-health-weight-diabetes-memory-intl/index.html

    Does talcum powder cause cancer? A legal and scientific battle rages

    (CNN)Visitors who walk into Deborah Giannecchini’s ranch house in Modesto, California, will notice a well-tended garden, four small dogs who greet every visitor with enthusiasm and a sign that hangs prominently displayed in her living room that reads “It’s never too late to live happily ever after.”

    She got it when she was 62 years old, after she married her husband, Leland, but it could also represent her current mission: to help other women avoid the pain she’s experienced and allow them to have their own happy endings.
    Giannecchini is living with what is considered terminal ovarian cancer. “That’s what they say. I’m trying to prove that it’s not,” she said. “I don’t wish this on anyone else. And if I can save one person, then I’ve done my job.”
      She and thousands of others claim that they got their ovarian cancer after using a common toiletry as a part of their daily feminine hygiene routine. They used talc-based powder, commonly referred to as talcum powder or baby powder,though some baby powder products are cornstarch-based.Cornstarch products are not believed to cause any health problems.
      Some 4,800 women and their families have now sued pharmaceutical giant Johnson & Johnson, which has sold the talc-based product Johnson’s Baby Powder for more than 100 years. Many women like Giannecchini who have sought help from the courts have said they want Johnson & Johnson to, at the very least, put a warning label on the powder.
      A handful of talcum powder companies have done just that. For example, Assured’s Shower & Bath Absorbent Body Powder says that it is “intended for external use only” and adds, “Frequent application of talcum powder in the female genital area may increase the risk of ovarian cancer.”
      Johnson & Johnson argues that sucha label would be confusing, because although the company regularly expresses sympathy for these women, it vehemently denies that its powder has anything to do with their ovarian cancer. A handful of scientists have backed the companyup in court. Andother scientists back the women’s claims.
      The topic is agrowing debate in the scientific community. Some studies have found that women face an increased risk of ovarian cancer with use of talc in the genital area, but others do not. Most suggest that more research is needed.
      At the intersection of this debate are lawyers who are putting this science under the microscope in courtrooms across the country. They’ve shown juries selective internal company memos that they say suggest Johnson & Johnson has been aware of this potential problem for decades and done nothing.
      Johnson & Johnson’s lead counsel on two of the cases argues that the lawsuits are all about the money, rather than being all about the science. “My take on the talc ovarian cancer litigation is that it really is skillful and well-funded plaintiffs lawyers who are exaggerating science and taking it out of context to scare people and to frighten the public with the goal of lining their own pockets,” Bart Williams said. “I think they are wrong scientifically. I think they are wrong legally, and I think the evidence shows that the science doesn’t support using talc and ovarian cancer.”
      Johnson & Johnson is not the only talc product manufacturer being sued over ovarian cancer claims, although most includethe company because itsproducts have dominated the market the longest.Some lawsuits mention talc makers including Valeant Pharmaceuticals, which now owns the Shower to Shower brand (owned by Johnson & Johnsonuntil 2012).
      Valeant would not grant an interview, but it sent a statement. “The safety of our products and the customers who use them are our company’s highest priority. Shower to Shower is a safe and effective product, and the scientific and medical consensus is that these products do not cause ovarian cancer,” said the statement from Lainie Keller, vice president of corporate communications for Valeant Pharmaceuticals International Inc. “It’s important to note that the lawsuits nearly all allege use of Shower to Shower prior to 2012 when our company acquired the product. Given our limited role and the strong legal, factual and scientific defenses, we do not believe claims will be established successfully against our company.”
      Other lawsuits mention Gold Bond’s talcum powder, manufactured by Chattem Inc., a Sanofi company, which did not respond to requests for comment.
      Some lawsuits include Imerys Talc America, which mines the talcin some of the powders. “We remain confident in the consensus of government agencies and professional scientific organizations that have reviewed the safety of talc, that talc is safe,” Gwen Myers, a spokeswoman for Imerys Talc America, said in a statement. “Imerys Talc America sympathizes with women suffering from ovarian cancer and hopes that the scientific community’s efforts will be directed toward finding the true causes of this terrible disease.”
      One related batch of lawsuits against Johnson & Johnson argues that its Baby Powder is contaminated with asbestos and that asbestos is causing women to develop the cancer mesothelioma. The two minerals are often mined near each other, although since the 1970s, talc used in all consumer products has been required to be asbestos-free. Johnson and Johnson says their talc does not contain asbestos. A jury ruled in Johnson & Johnson’s favor in one of those asbestos lawsuits in California in November.
      The lawyers who argue that talc itself is the problem have experienced rapid success in convincing juries in South Dakota, Missouri and California that there is a cancer connection, winning hundreds of millions for their clients. In October, judges reversed two of those verdicts.
      In one case against Johnson & Johnson involving Jacqueline Fox, who died four months after a jury awarded her $72 million, a Missouri appellate court judge ruled that the Alabama woman did not use the product in Missouri and that therefore, the case should not have been heard there. The court reversed the jury verdict due to jurisdictional issues.In the other, a California case involving Johnson & Johnson and Eva Echeverria, who also died after her favorable jury verdict,the judge reversed the jury decision, saying that there was “insufficiency of the evidence as to the causation as to both defendants.”
      Each of the fivecases that has won a favorable verdict for the plaintiff is in various stages of appeal or soon will be. Johnson & Johnson won one of the talc cases in March, when a Missouri jury found that its baby powder did not cause a Tennessee woman’s ovarian cancer. Though legal teams are investigating thousands of other potential cases, what is less clear is where the science will lead and what the future will be for an iconic product that’s on bathroom shelves around the world.

      A cosmetic love

      Giannecchini has had a lifelong relationship with talcum powder. Long after she went to court to sueJohnson & Johnson and its talc supplier Imerys Talc America in 2016, she said, she found a few small bottles in an old suitcase she hadn’t used for a while.
      She’d been using Johnson & Johnson’s Baby Powder nearly every day since high school. Sometimes, she’d alsouse the Shower to Shower product, which Johnson & Johnson used to own. She liked the powders because “both felt nice,” she said. “It was smooth and made your skin smell nice and fresh. It was just part of what I did every day.”
      Her friends used it, and she knew the company’s advertising jingle by heart. “A sprinkle a day keeps the odor away,” she shyly sang ditty when she took the stand in 2016. “Have you had your sprinkletoday?”
      Health-conscious and a self-described label-reader, Giannecchini never saw anything on the powder bottle to give her pause. “If you’ve seen the ads, you know it is supposed to be a pure and innocent and harmless product that we use on babies,” she said. Like millions of others, she sprinkled away.

      Talcum powder: A short history

      Talc makes a great powder because it is among the softest minerals,reduces frictionand has a great ability to absorb oils, moisture and odor. It’s mainly mined in China, India, Brazil, Mexico and the United States, according to the US Geological Survey.Most talc isn’t actually used for cosmetics; it’s found more often in household products: the ceramics in your bathroom fixtures, the roof over your head, the paint on your wall. It’s in plastic, paper and even in the gum you chew.
      Johnson & Johnson started selling talc in 1894 after customers complained that the company’s original medicated bandages irritated their skin. To soothe it, the company’s scientific director mailed them Italian talc. It worked so well, customers also used it on their babies’ diaper rash and wrote Johnson & Johnson about it. Taking the cue, Johnson’s Toilet and Baby Powderwas born.
      Johnson & Johnson has grown into a giant $338.6 billion company offering hundreds of consumer products, medical devices and medicine, but its Baby Powder may have shaped its image the most, branding experts said, even though it doesn’t rank highest in the company’s sales.
      “Because of it, Johnson & Johnson enjoys a strong brand image as being a company that cares,” said Aimee Drolet Rossi, the UCLA Anderson School of Management marketing chairwoman. “In fact, a lot of consumers don’t understand that Johnson & Johnson is a company that makes more than Baby Powder.”
      Sales of talc-based products like general-purpose talc, baby talcum powder, perfumed talc and “liquid talcs” — perfumed liquids that can be sprayed over the body to leave a powdery feel — brought Johnson & Johnson nearly $325.2 million in 2016 alone, according to market research firm Euromonitor.
      Adults also use the powder as a dry shampoo, a foot powder and a general after-shower ritual. “I used it everywhere, like a lot of my friends did, from head to toe,” Giannecchini said.
      Some women like Giannecchini also used it for feminine hygiene. Women who sued the company have testified that they’d sprinkle it in their underwear, on their thighs to prevent chafing, on sanitary napkins and on tampons. It’s use in this area that’s concerned some scientists.

      ‘My family saved my life’

      Giannecchini didn’t know that there was some scientific concern about her favorite powder. In fact, she used it even after her ovarian cancer diagnosis, adiagnosis that came as a big surprise.
      She had gone to the ER after her family pressured her because she wascoughing constantly.
      “I didn’t come home right away from the emergency room like I thought I would,” Giannecchini said. Instead of bronchitis, like she suspected, doctors found the cancer, and it was so advanced, they had to remove her spleen and part of her stomach. The cancer spread toher colon, bowel and bladder, too. The treatment was grueling, the prognosis not good.
      Ovarian cancer, though comparatively rare, is one of the mostlethal. Withno general screening, it’s often caught late, like it was in her case.
      “It was not pleasant,” Giannecchini said. “But my family likely saved my life.”
      Giannecchini’s daughter Casey got her mom to quit her Baby Powder habit only after seeing a lawyer’s ad on TV. They’re frequently seen on late-night TV, saying things like “If you or a loved one have developed ovarian cancer after using talcum powder: call.”
      Casey gave her mother the number, and Giannecchini sent in her information. She ended up speaking with Ted Meadows at the Beasley Allen law firm in Montgomery, Alabama. Meadows would soon lead her on a legal journey halfway across the country.

      The talc team

      At the time Giannecchini called, Meadows had been working with another attorney, R. Allen Smith, on a blitz of dozensof talc cases.
      Smith and Meadows are a classic odd couple. Meadows is quiet, serious, a runner; when not consumed with work for his large firm, he roots for his alma mater, football powerhouse University of Alabama. Smith is easy to smile and quick with a story, and he looks as if he could have played for his alma mater, the Alabama rivalUniversity of Mississippi. Ole Miss memorabilia covers the walls of Smith’s small solo practitioner office in suburban Jackson, Mississippi. Where the two are in sync is on these talc cases.
      Smith learned about how women use talc in their genital area, meaning in underwear and sanitary products, whilesitting at his parents’ dinner table. His father, a retired plastic surgeon, asked whether he’d ever heard about any connection between talc and cancer. When he got home that night, Smith started googling.
      “I couldn’t believe what I saw,” he said after looking at the scientific studies and the scientific debate that followed. “And I wondered, ‘Am I the only lawyer to see this?’ “

      The scientific debate

      Smith learned that concerns about a link between talc and ovarian cancer started surfacing around 1971, when a small group of scientists wrote about finding talc particles deeply embedded in ovarian and cervical tumor tissue. The study concluded that it is “impossible to incriminate talc as a primary cause of carcinomatous changes,” based solely on what was described in the study; however, “the possibility that talc may be related to other predisposing factors should not be disregarded.” The authors hoped more people would research the issue.
      Dr. Daniel Cramer at Harvard took up the challenge in a study published in 1982. He compared records from more than 400 women and found that women who had ovarian cancer were more likely to have used talc in their genital areas.
      Cramer conductedsubsequent studies and became the first American scientist to raise alarm bells about using talc in the genital area, but his work was not alone. The conceptcomes up more than 100 times in PubMed, a search engine for medical studies, since 1971, and the results are mixed. Some study reviews show a moderate risk. A few show that it “does not appear to influence cancer risk.“Most are population-based studies and cannot prove a direct cause-and-effect relationship.
      In general, cancer causes are tricky to prove, since it takes time for cancer to develop and it can be influenced by a wide variety of factors.
      “When it comes to talc and cancer, the message is not straightforward. It’s not necessarily black and white, and it’s a bit more complicated to explain to the layperson,” said Dr. Paolo Boffetta. The professor of medicine, hematology and medical oncology at Mt. Sinai was in the room in 2006 when the International Agency for Research in Cancer, which falls under the World Health Organization, decided to classify the use of talc in the genital area as “possibly carcinogenic to humans.”
      Based on his own research, Boffetta found, “there seems to be a small increase or risk for women who are heavy users of genital talc,” he said. “However, we don’t necessarily know what causes it.”
      Boffetta, who also thinks more research is necessary, believes that talc use in the genital area, while not a strong cancer risk factor like smoking, “may be a real factor in some cases.”
      However, some studies have found no connection at all. A 2014 study of more than 61,000 postmenopausal women in the Women’s Health Initiative Observational Study suggested that talc use in the genital area “does not appear to influence ovarian cancer risk.” A study in 2016 found that douching rather than talc was associated with an increased risk of ovarian cancer after looking at more than 50,000 women enrolled in the Sister Study, a national research study for risk factors for breast cancer.
      The research that fits into the modest association category includes a 2016 study focused on talc use in the genital area in black women. Researchers looked at nearly 600 cases of ovarian cancer and found a “modestly stronger association” with people who used talc. That risk increased more in those who used it below the belt. Author Dr. Joellen Schildkraut, an epidemiologist at the University of Virginia in Charlottesville, also believes that more research is needed.
      There are some theories that talc may cause an inflammation that can become cancer, but that idea is still being tested. “I don’t think we have definitive evidence that this causes ovarian cancer, but I do think we have a hypothesis that there is a connection. Looking at my data, it should give people pause for concern,” Schildkraut said. “It is not a necessary item to use, so why take a chance with it?”
      The most recent studies seem to suggest a small connection. A January meta-analysis, or review of 24 case-control and three cohort studies, found “a consistent association” between talc use and ovarian cancer. “Some variation in the magnitude of the effect was found when considering study design and ovarian cancer subtype,” the study said.A July meta-analysisof27 studies found a “weak but statistically significant association between genital use of talc and ovarian cancer, which appears to be limited to serious carcinoma with suggestion of dose-response.”
      An August review and meta-analysis in Epidemiology found that “in general, there is a consistent association” between talc use and ovarian cancer.
      Dr. Graham Colditz, who has been used as an expert for the plaintiffs in some of the lawsuits, thinks there is a connection.
      “The evidence has really accumulated over decades and multiple studies,” said Colditz, the Niess-Gain Professor of Surgery at Washington University School of Medicine in St. Louis and deputy directorof prevention and control at the Siteman Cancer Center. He believes the testing methods have improved since the 2014 study found no connection and scientists have gotten a better handle on understanding the duration and frequency of use of the product and how a lifetime burden of exposure may create an association.
      “That evidence has really come together and built over nearly 30 years now,” Colditz said. “This kind of science takes time.”
      US and international government agencies and medical associations that track what causes cancer seem to fall in the need-more-research camp. According to Johnson & Johnson’s website, it sells its talc products around the world, but there are some restrictions on the way talc can be used in cosmetics and baby products in the European Union and in Canada.
      The US National Toxicology Program, part of the US Department of Health and Human Services, keeps a congressionally mandated list of “agents, substances, mixtures, and exposure circumstances that are known or reasonably anticipated to cause cancer in humans.” Talc is not among the 248 listed; however, in 2010, when it was up for consideration to be included in the list, the agency explained that has not fully reviewed talc as a possible carcinogen.
      “The NTP deferred consideration of listing talc (asbestiform and non-asbestiform talc) in the 10th RoC because its 2000 review of talc found that there has been considerable confusion over the mineral nature and consequences of exposure to talc, both containing asbestiform fibers and not containing asbestiform fibers. It has become evident that the literature on both forms of talc, with a few exceptions, provides an inadequate characterization of the actual materials under study to enable one to reach definitive conclusions concerning the specific substances responsible for the range of adverse health outcomes reported.”
      The National Cancer Institute website points to the 2014 study that doesn’t find a link and suggests that “the weight of evidence does not support an association between talc exposure and an increased risk of ovarian cancer,” although it also includes talc in a list of factors for which “it is not clear whether the following affect the risk of ovarian, fallopian tube and primary peritoneal cancer.”
      The American Cancer Society also says talc’s relation to cancer “is less clear” and “findings have been mixed.” It adds that “although there is some suggestion of a possible increase in ovarian cancerrisk,” its bottom-line advice is, “Until more information is available, people concerned about using talcum powder may want to avoid or limit their use of consumer products that contain it.”

      Laying out the case

      Smith spent about five more years immersed in talc research. He joined ovarian cancer associations. He’d visit experts on free nights and weekends. He read ovarian cancer blogs.
      Late one night, reading a blog, Smith saw a question from Deane Berg of South Dakota, who shared that she was a longtime talc user who had ovarian cancer. She’d read some of the talc cancer studies and wondered whether anyone knew anything about it. “So, I immediately (replied to her) and said ‘I’ve been investigating this,’ ” Smith said.
      Smith asked whether he could help, and Berg sent her medical records. Smith also got tissue samples of her ovarian cancer tumors and sent those along with the records to some of the experts he had met.
      One of those experts was Cramer, who had done the 1982 study. Cramer later testified that he found no family history or genetic predisposition to ovarian cancer in Berg’s records. Smith also sent the tissue sample to Harvard pathologist Dr. John Godleski, who found talc in Berg’sovarian cancer tissue, Smith said.
      “I asked them, could they come to court and state scientifically to a reasonable degree of medical certainty that talc was a contributing factor to Mrs. Berg’s ovarian cancer,” Smith said,”and they said ‘absolutely, yes.’ ”
      Johnson & Johnson tried to get Godleski excluded as an expert in court, but the court determined that he was qualified, “and the opinion is relevant and stems from reliable methodologies.” Johnson & Johnson went on to challenge his findings in court.

      The cases begin

      Smith decided, even as a solo practitioner, he could take on the pharmaceutical giant. He personally sifted through hundreds of thousands of records from Johnson & Johnson. “I printed out all the documents on my computer, had them stacked all around this office, filing every space. And every day for 10 months, for 10 hours a day, I looked through the documents one by one,” Smith said. “I could not believe what I would discover.”
      Godleski’s report on Berg’s cancer, which was read at trial, said that “based on the findings in this case, it can be stated to a reasonable degree of medical certainty that the talc found in this case is evidence for a causal link between the presence of talc and the development of the patient’s ovarian cancer.”
      Smith won the first talc powder case in the country in 2013. The jury found that Johnson & Johnson was negligent, but it didn’t award Berg any damages. “So, it was kind of a bittersweet result,” Smith said. “But from there, I knew this was a much larger issue.”
      When news of the trial spread, Smith’s eventual law partner on the case, Meadows, wrote a short article for his firm’s newsletter about Smith’s win. Legal experts say it’s incredibly difficult to prove exposure to a particular product may be linked to cancer. A win in South Dakota, even without damages, meant Smith might be on to something. Meadows thought after his article came out that he’d hear from women who might be interested in bringing their own cases.
      Instead, Smith called.

      A legal whirlwind

      Other women with ovarian cancer had contacted Smith. More potential cases meant more work than Smith could handle. He and Meadows decided to work together and started flushing out what became a winning strategy, at least with juries.
      In 18 months, half a dozen juries had ruled in their clients’favor, awarding tens orhundreds of millionsto five ofthe six plaintiffs in individual cases. One of those women was Giannecchini. She flew to St. Louis in 2016 and listened to every word of her trial.
      “I learned a lot from them, although it was strange to hear about your life this way,” she said. “I’m kind of a private person, so sharing every little bit of your life wasn’t easy for me, but I just felt like it was something that I had to do.”
      In court, a black cardigan wrapped around her shoulders, Giannecchini talked about how the grueling cancer treatment had left her with little energy, but she was determined to live. An attorney from her team showed a series of pictures Giannecchini would take with her grandchildren every Easter. They paused to look at one where she is surrounded by five grandkids, all dressed in robin’s egg blue. In the picture, Giannecchini wears a lavender headscarf, covering what she called her “old bald head” from chemo. “I decided to just embrace that and say ‘this is what cancer does,’ ” Giannecchini said.
      In Giannecchini’s case, and in the others, legal teams have to show general causation and specific causation. That means people with medical expertise or scientists who have peer-reviewed research on the topic have to explain how using talc in the genital area is connected to cancer and that it caused the harm in these particular cases. The strategy varies from case to case, but Giannecchini’s legal team has also regularly argued that Johnson & Johnson knew about these health concerns and ignored them. Johnson & Johnson’s legal teamhas presented experts showingthere is no link between its products and cancer.

      Johnson & Johnson’s defense

      Dr. Patricia Judson-Lancaster, an obstetrician-gynecologist now based in Utah, has testified on behalf of Johnson & Johnson. In Giannecchini’s case, she said that “talc has no relevance to ovarian cancer.”
      “Cancer is caused by genetic mutations,” she told the jury. “We don’t know what causes those gene mutations in ovarian cancer, but we specifically know from studies that talc does not cause mutations in genes,” she said, reiterating, “talc does not cause gene mutations.
      “Talc is not the cause,” she emphasized. “I almost wish it was the cause; it would be such the simple thing to do.”
      Joshua Muscat, a professor of public health sciences in the college of medicine at Penn State who also has testified for Johnson & Johnson as an expert, agreesthatthere is no link. He authored a review article looking at past studies about talc use in thegenital area.
      “We conclude that the weak statistical associations observed in a number of epidemiological studies do not support a causal association,” he said. Unlike most other scientists, he said he doesn’t think more research on the topic is necessary. He thinks the issue is settled.
      Williams, one of the lawyers for Johnson & Johnson, said that “hard science” studies in animals and human cells, compared with epidemiological studies that show a possible association, do not show that talc causes cancer, and that’s the key.
      “The most compelling argument, I think, is trying to get juries to focus on the notion that correlations or association is not the same as causation,” Williams said. “So an example we use is bald men and hats. Just because bald men wear hats more often than men who have a full head of hair doesn’t mean that wearing the hats makes their hair fall out. There is an association, a correlation, but there isn’t a cause there. Wearing a hat has nothing to do with male pattern baldness, scientists will tell you.”

      An end and a beginning

      The jury in Giannecchini’s case decided that there was an association between talc and cancer. In October 2016, it awarded her $70 million. The decision is on appeal.
      Hers came asone ofa string ofseparatejury verdicts against Johnson & Johnson. In February 2016, a jury awarded Jacqueline Fox $72 million. In May 2016, a jury awarded Gloria Ristesund $55 million. A year later, in May, a jury awarded Louis Slemp $110 million. And in August, Eva Echeverria got an award of $417 million. Johnson & Johnson won one case in March of last year, and in June, there was a mistrial. In total, juries have handed out $724.5 million in separate decisions. But that is not the end of the story.
      Judges have not completely agreed with these jury decisions, and two have been reversed. The Fox case was reversed on jurisdictional issues: The plaintiff lived in Alabama, and Johnson & Johnson is based in New Jersey. The case was heard in St. Louis, which a judge determined wasn’t allowed based on an unrelated court ruling in June.
      The other, the Echeverria case, was thrown out based on science. The judge cited”insufficiency of the evidence as to the causation as to both defendants,” Johnson & Johnson and its consumer products subsidiary.
      She also ruled that there was error in law occurring at trial and misconduct of the jury, which led to excessive damages.
      “That ruling may have taken the wind out of the sails of these cases, but it shouldn’t be a permanent setback,” said Jean Eggen, the distinguished professor emerita of law at Widener University Law School in Delaware. “These are early days still.”
      Litigation like this, unlike criminal law, “can take forever,” and “cancer is always very complicated to prove.” With tobacco and asbestos, it took decades before the science showed, and the courts believed that there may be a connection,” Eggen explained. “It does make you wonder what the next part of the story will be.”
      As far as Johnson & Johnson is concerned, it has said it will continue to fight these cases.

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Smith and Meadows — and dozens of other attorneys involved in these cases — are determined to get their day in court. “What the future holds for this litigation, I don’t know,” Smith said. “I hope and pray at a minimum Johnson & Johnson will at least put a warning label on their product.”
      Williams, one of the Johnson & Johnson lawyers, thinks that putting a label on the product would be “irresponsible.”
      “I think having a cancer warning on a product that hasn’t been shown to cause cancer, it just isn’t the right thing to do,” he said. “If 40 years of animal studies and human cell studies have failed to show some causal connection in using talc anywhere on your body and ovarian cancer, and given that, putting a cancer warning on the product wouldn’t be proper.”
      Giannecchini, who watches for news of the other trials and waits for a final ruling in her own case, continues her own personal battle with cancer. Her doctors monitor her condition closely.
      “I’m fighting it,” Giannecchini said. She hopes to continue to be around to tell her story. “So far, so good. Here I am.”

      Read more: https://www.cnn.com/2018/04/11/health/talc-ovarian-cancer-cases/index.html

      Helix Takes Clinical Genetic Testing Straight to Consumers

      During a recent Uber ride, Madhuri Hegde’s driver asked her what she did for a living. The chief scientific officer for laboratory services at PerkinElmer, she prepared to bore him with a description of the tests her company had developed—most recently to flag serious genetic disorders. Instead, he was intrigued. “Where can I get one of those?” he asked.

      For years, PerkinElmer has only offered that clinical test to doctors. It screens for all 59 genes that researchers are sure play a role in one of 34 conditions you can treat if you catch it early enough. Genes like PKP2, mutations in which can increase the risk of arrhythmogenic right ventricular cardiomyopathy, a leading cause of sudden heart failure in young people. Or ATP7B, which can point to Wilson disease, where copper accumulates dangerously in the liver. Usually physicians only prescribe the test when they think their patients might be at risk for one of those conditions. But soon, anyone curious about their health—Hegde’s Uber driver included—will be able to request it.

      PerkinElmer announced Tuesday it will start selling its test this summer through the consumer genomics marketplace Helix, a spin-out of sequencing giant Illumina. Helix launched its platform last July, with 18 products meant to inspire customers to embark on a journey of discovery through DNA. Some boasted dubious science; some were just silly. Only one of them had a hardcore health bent—a test to see if hopeful parents carried any disruptive genes they could pass on to their kids.

      Since then, though, Helix has built a number of partnerships to offer more medically relevant insights, PerkinElmer being one. Helix says it's just responding to demand; patients are into democratizing access to clinical tests. But as more people turn to their DNA to make decisions about their health, medical professionals who help make those decisions wisely worry about their ability to keep up.

      “You may think DNA is DNA regardless of what you’re looking for, but context really matters here,” says Ana Morales, a certified genetic counselor at the Ohio State University Medical Center and president-elect of the American Board of Genetic Counseling. Normally, a doctor would order a test like PerkinElmer’s when a patient starts presenting symptoms, like an abnormal heart rhythm. Maybe they even have a brother or sister with similar complaints. Algorithms and experts would then comb through the patient’s DNA looking for places in their genome where specific mutations—called variants—might appear. All mutations aren’t created equal; they’re only looking for ones that geneticists have validated as playing a role in certain diseases. How big a role changes from variant to variant, and from patient to patient. Without symptoms, matching becomes a guessing game.

      “We’re now moving away from interpreting a variant in someone who has a disease to someone who doesn’t,” says Morales. “That is possible, but the level of expertise required to do that is limited to within a few experts in the genetic community. There’s only a very select group of people in the US right now who would feel comfortable doing that on a routine basis.”

      That’s one reason a doctor might not tell all their patients about the availability of tests like this one. The other is cost. Sequencing plus analysis can run into the thousands of dollars, which insurers won’t reimburse if the test-taker is healthy. Right now insurance companies are only required to cover such screens under certain criteria—like if a woman has a family history of breast cancer. Responsible physicians are reluctant to put their patients or their institutions on the hook for that bill.

      Hegde says Helix’s infrastructure will allow them to offer the test at a greatly reduced rate when it actually launches on the platform a few months from now, though she couldn’t give an exact price tag. That includes whole exome sequencing on their Illumina machines (that’s the portion of the genome that codes for proteins), and the physician network that Helix has already built out to accommodate any products that might require a doctor’s signature. That’s right, to buy this test you’ll still need to talk to a doctor—just maybe not the one you’re used to seeing for your annual check-up.

      Customers who want to buy PerkinElmer’s test have to fill out a brief questionnaire—some basic family history and reasons why you might want to take the test—which gets routed to a hire-a-doc third party. If there’s a chance they’re already presenting symptoms or have a family history suggesting a condition that would be covered by insurance, they’ll suggest that user go the traditional testing route through their primary physician. If they appear healthy, they get the all-clear to order the test.

      Then Helix sequences all 22,000 coding regions of the customer’s genome and sends the file over to PerkinElmer for analysis, which takes about a week. If they find anything that requires further attention they’ll bring in some real humans to compare what they know about the customer with what they know about the variant—how it’s inherited, how it changes pathways in the body. It could take another week to spit out that report, which goes back to the physician network, which then contacts the customer with any variants that could require follow-up. Genetic counseling services also bundled through Helix’s platform will be available upon request.

      “We’re really trying to focus on the 99 percent of people that have never had access to this kind of testing, but of course we want it to be responsible access,” says Helix co-founder James Lu. “It’s for people who are ostensibly healthy and want to stay that way for as long as possible.”

      Access to those kinds of proactive customers are what drew Hegde to Helix. “Not a lot of people know about this kind of testing,” she says. “But for every one of the 59 genes on this list there are interventions, and earlier intervention translates to saving health care costs as well as lives.”

      It’s true that on an individual level, knowing you have a bad BRCA mutation might lead you to more regular check-ups and an earlier diagnosis of breast or ovarian cancer. But on the question of whether or not widespread genetic testing will actually lead to better outcomes and cut costs? Researchers still aren’t so sure. And with only about 4,000 certified genetic counselors total in the US—or one for every 80,000 Americans—it’s hard for most medical professionals to justify widespread testing. But hey, if your doc won’t order up a test you want, we’re betting Helix can find you one who will.

      More Consumer Genetics

      Read more: https://www.wired.com/story/helix-takes-clinical-genetic-testing-straight-to-consumers/

      I have prostate cancer. But I am happy | George Monbiot

      The three principles that define a good life will protect me from despair, says Guardian columnist George Monbiot

      It came, as these things often do, like a gunshot on a quiet street: shocking and disorienting. In early December, my urine turned brown. The following day I felt feverish and found it hard to pee. I soon realised I had a urinary tract infection. It was unpleasant, but seemed to be no big deal. Now I know that it might havesavedmy life.

      The doctor told me this infection was unusual in a man of my age, and hinted at an underlying condition. So I had a blood test, which revealed that my prostate-specific antigen (PSA) levels were off the scale. An MRI scan and a mortifying biopsy confirmed my suspicions. Prostate cancer: all the smart young men have itthisseason.

      On Monday, I go into surgery. The prostate gland is buried deep in the body, so removing it is a major operation: there are six entry points and it takes four hours. The procedure will hack at the roots of my manhood. Because of the damage that will be caused to the surrounding nerves, theres a high risk of permanent erectile dysfunction. Because the urethra needs to be cut and reattached to the bladder, I will almost certainly suffer urinary incontinence for a few months, and possibly permanently. Because the removal of part of the urethra retracts the penis, it appears to shrink, at least until it can be stretched back into shape.

      I was offered a choice: radical surgery or brachytherapy. This means implanting radioactive seeds in the parts of the prostate affected by cancer. Brachytherapy has fewer side effects, and recovery is much faster. But theres a catch. If it fails to eliminate the cancer, theres nothing more that can be done. This treatment sticks the prostate gland to the bowel and bladder, making surgery extremely difficult. Once youve had one dose of radiation, they wont give you another. I was told that the chances of brachytherapy working in my case were between 70 and 80%. The odds were worse, in other words, than playing Russian roulette (which, with one bullet in a six-chambered revolver, gives you 83%). Though I have a tendency to embrace risk, this was not an attractive option.

      It would be easy to curse my luck and start to ask, Why me? I have never smoked and hardly drink; I have a ridiculously healthy diet and follow a severe fitness regime. Im 20 or 30 years younger than most of the men I see in the waiting rooms. In other words, I would have had a lower risk of prostate cancer only if I had been female. And yet I am happy. In fact, Im happier than I was before my diagnosis. How can this be?

      The reason is that Ive sought to apply the three principles which, I believe, sit at the heart of a good life. The first is the most important: imagine how much worse it could be, rather than how much better.

      When you are diagnosed with prostate cancer, your condition is ranked on the Gleason Score, which measures its level of aggression. Mine is graded at seven out of 10. But this doesnt tell me where I stand in general. I needed another index to assess the severity of my condition, so I invented one: the Shitstorm Scale. How does my situation compare to those of people I know, who contend with other medical problems or family tragedies? How does it compare to what might have been, had the cancer not been caught while it was still apparently confined to the prostate gland? How does it compare to innumerable other disasters that could have befallen me?

      When I completed the exercise, I realised that this bad luck, far from being a cause of woe, is a reminder of how lucky I am. I have the love of my family and friends. I have the support of those with whom I work. I have the NHS. My Shitstorm Score is a mere two out of 10.

      The tragedy of our times is that, rather than apply the most useful of English proverbs cheer up, it could be worse we are constantly induced to imagine how much better things could be. The rich lists and power lists with which the newspapers are filled, our wall-to-wall celebrity culture, the invidious billions spent on marketing and advertising, create an infrastructure of comparison that ensures we see ourselves as deprived of what others possess. It is a formula for misery.

      The second principle is this: change what you can change, accept what you cant. This is not a formula for passivity Ive spent my working life trying to alter outcomes that might have seemed immovable to other people. The theme of my latest book is that political failure is, at heart, a failure of imagination. But sometimes we simply have to accept an obstacle as insuperable. Fatalism in these circumstances is protective. I accept that my lap is in the lap of the gods.

      So I will not rage against the morbidity this surgery might cause. I wont find myself following Groucho Marx who, at the age of 81, magnificently lamented: Im going to Iowa to collect an award. Then Im appearing at Carnegie Hall, its sold out. Then Im sailing to France to pick up an honour from the French government. Id give it all up for one erection. And today theres Viagra.

      The third principle is this: do not let fear rule your life. Fear hems us in, stops us from thinking clearly, and prevents us from either challenging oppression or engaging calmly with the impersonal fates. When I was told that this operation had an 80% chance of success, my first thought was thats roughly the same as one of my kayaking trips. And about twice as good as the chance of emerging from those investigations in West Papua and the Amazon.

      There are, I believe, three steps to overcoming fear: name it, normalise it, socialise it. For too long, cancer has been locked in the drawer labelled Things We Dont Talk About. When we call it the Big C, it becomes, as the term suggests, not smaller, but larger in our minds. He Who Must Not Be Named is diminished by being identified, and diminished further when he becomes a topic of daily conversation.

      The super-volunteer Jeanne Chattoe, whom I interviewed recently for another column, reminded me that, just 25 years ago, breast cancer was a taboo subject. Thanks to the amazing advocacy of its victims, this is almost impossible to imagine today. Now we need to do the same for other cancers. Let there be no moreterriblesecrets.

      So I have sought to discuss my prostate cancer as I would discuss any other issue. I make no apologies for subjecting you to the grisly details: the more familiar they become, the less horrifying. In doing so, I socialise my condition. Last month, I discussed the remarkable evidence suggesting that a caring community enhances recovery and reduces mortality. In talking about my cancer with family and friends, I feel the love that I know will get me through this. The old strategy of suffering in silence could not have been more misguided.

      I had intended to use this column to urge men to get themselves tested. But since my diagnosis, weve discovered two things. The first is that prostate cancer has overtaken breast cancer to become the third biggest cancer killer in the UK. The second is that the standard assessment (the PSA blood test) is of limited use. As prostate cancer in its early stages is likely to produce no symptoms, its hard to see what men can do to protect themselves. That urinary tract infection was a remarkably lucky break.

      Instead, I urge you to support the efforts led by Prostate Cancer UK to develop a better test. Breast cancer has attracted twice as much money and research as prostate cancer, not because (as the Daily Mail suggests) men are the victims of injustice, but because womens advocacy has been so effective. Campaigns such as Men United and the Movember Foundation have sought to bridge this gap, but theres a long way to go. Prostate cancer is discriminatory: for reasons unknown, black men are twice as likely to suffer it as white men. Finding better tests and treatments is a matter of both urgencyand equity.

      I will ride this out. I will own this disease, but I wont be defined by it: I will not be prostrated by my prostate. I will be gone for a few weeks but when I return, I do solemnly swear I will still be the argumentative old git with whom you are familiar.

      George Monbiot is a Guardian columnist

      Prostate Cancer UK can be contacted on 0800 0748383

      Read more: https://www.theguardian.com/commentisfree/2018/mar/13/prostate-cancer-happy-diagnosis-operation

      Yes, bacon really is killing us

      The long read: Decades of research proves that chemicals used to make bacon do cause cancer. So how did the meat industry convince us it was safe?

      There was a little cafe I used to go to that did the best bacon sandwiches. They came in a soft and pillowy white bap. The bacon, thick-cut from a local butcher, was midway between crispy and chewy. Ketchup and HP sauce were served in miniature jars with the sandwich, so you could dab on the exact amount you liked. That was all there was to it: just bread and bacon and sauce. Eating one of these sandwiches, as I did every few weeks, with a cup of strong coffee, felt like an uncomplicated pleasure.

      And then, all of a sudden, the bacon sandwich stopped being quite so comforting. For a few weeks in October 2015, half the people I knew were talking about the news that eating bacon was now a proven cause of cancer. You couldnt miss the story: it was splashed large in every newspaper and all over the web. As one journalist wrote in Wired, Perhaps no two words together are more likely to set the internet aflame than BACON and CANCER. The BBC website announced, matter-of-factly, that Processed meats do cause cancer, while the Sun went with Banger out of Order and Killer in the Kitchen.

      The source of the story was an announcement from the World Health Organization that processed meats were now classified as a group 1 carcinogen, meaning scientists were certain that there was sufficient evidence that they caused cancer, particularly colon cancer. The warning applied not just to British bacon but to Italian salami, Spanish chorizo, German bratwurst and myriad other foods.

      Health scares are ten-a-penny, but this one was very hard to ignore. The WHO announcement came on advice from 22 cancer experts from 10 countries, who reviewed more than 400 studies on processed meat covering epidemiological data from hundreds of thousands of people. It was now possible to say that eat less processed meat, much like eat more vegetables, had become one of the very few absolutely incontrovertible pieces of evidence-based diet advice not simply another high-profile nutrition fad. As every news report highlighted, processed meat was now in a group of 120 proven carcinogens, alongside alcohol, asbestos and tobacco leading to a great many headlines blaring that bacon was as deadly as smoking.

      The WHO advised that consuming 50g of processed meat a day equivalent to just a couple of rashers of bacon or one hotdog would raise the risk of getting bowel cancer by 18% over a lifetime. (Eating larger amounts raises your risk more.) Learning that your own risk of cancer has increased from something like 5% to something like 6% may not be frightening enough to put you off bacon sandwiches for ever. But learning that consumption of processed meat causes an additional 34,000 worldwide cancer deaths a year is much more chilling. According to Cancer Research UK, if no one ate processed or red meat in Britain, there would be 8,800 fewer cases of cancer. (That is four times the number of people killed annually on Britains roads.)

      The news felt especially shocking because both ham and bacon are quintessentially British foods. Nearly a quarter of the adult population in Britain eats a ham sandwich for lunch on any given day, according to data from 2012 gathered by researchers Luke Yates and Alan Warde. To many consumers, bacon is not just a food; it is a repository of childhood memories, a totem of home. Surveys indicate that the smell of frying bacon is one of our favourite scents in the UK, along with cut grass and fresh bread. To be told that bacon had given millions of people cancer was a bit like finding out your granny had been secretly sprinkling arsenic on your morning toast.

      Vegetarians might point out that the bacon sandwich should never have been seen as comforting. It is certainly no comfort for the pigs, most of whom are kept in squalid, cramped conditions. But for the rest of us, it was alarming to be told that these beloved foods might be contributing to thousands of needless human deaths. In the weeks following news of the WHO report, sales of bacon and sausages fell dramatically. British supermarkets reported a 3m drop in sales in just a fortnight. (It was very detrimental, said Kirsty Adams, the product developer for meat at Marks and Spencer.)

      But just when it looked as if this may be #Bacongeddon (one of many agonised bacon-related hashtags trending in October 2015), a second wave of stories flooded in. Their message was: panic over. For one thing, the analogy between bacon and smoking was misleading. Smoking tobacco and eating processed meat are both dangerous, but not on the same scale. To put it in context, around 86% of lung cancers are linked to smoking, whereas it seems that just 21% of bowel cancers can be attributed to eating processed or red meat. A few weeks after publishing the report, the WHO issued a clarification insisting it was not telling consumers to stop eating processed meat.

      Meanwhile, the meat industry was busily insisting that there was nothing to see here. The North American Meat Institute, an industry lobby group, called the report dramatic and alarmist overreach. A whole tranche of articles insisted in a commonsense tone that it would be premature and foolish to ditch our meaty fry-ups just because of a little cancer scare.

      Nearly three years on, it feels like business as usual for processed meats. Many of us seem to have got over our initial sense of alarm. Sales of bacon in the UK are buoyant, having risen 5% in the two years up to mid-2016. When I interviewed a product developer for Sainsburys supermarket last year, she said that one of the quickest ways to get British consumers to try a new product now was to add chorizo to it.

      And yet the evidence linking bacon to cancer is stronger than ever. In January, a new large-scale study using data from 262,195 British women suggested that consuming just 9g of bacon a day less than a rasher could significantly raise the risk of developing breast cancer later in life. The studys lead author, Jill Pell from the Institute of Health and Wellbeing at Glasgow University, told me that while it can be counterproductive to push for total abstinence, the scientific evidence suggests it would be misleading for health authorities to set any safe dose for processed meat other than zero.

      The real scandal of bacon, however, is that it didnt have to be anything like so damaging to our health. The part of the story we havent been told including by the WHO is that there were always other ways to manufacture these products that would make them significantly less carcinogenic. The fact that this is so little known is tribute to the power of the meat industry, which has for the past 40 years been engaged in a campaign of cover-ups and misdirection to rival the dirty tricks of Big Tobacco.


      How do you choose a pack of bacon in a shop, assuming you are a meat eater? First, you opt for either the crispy fat of streaky or the leanness of back. Then you decide between smoked or unsmoked each version has its passionate defenders (I am of the unsmoked persuasion). Maybe you seek out a packet made from free-range or organic meat, or maybe your budget is squeezed and you search for any bacon on special offer. Either way, before you put the pack in your basket, you have one last look, to check if the meat is pink enough.

      Since we eat with our eyes, the main way we judge the quality of cured meats is pinkness. Yet it is this very colour that we should be suspicious of, as the French journalist Guillaume Coudray explains in a book published in France last year called Cochonneries, a word that means both piggeries and rubbish or junk food. The subtitle is How Charcuterie Became a Poison. Cochonneries reads like a crime novel, in which the processed meat industry is the perpetrator and ordinary consumers are the victims.

      The pinkness of bacon or cooked ham, or salami is a sign that it has been treated with chemicals, more specifically with nitrates and nitrites. It is the use of these chemicals that is widely believed to be the reason why processed meat is much more carcinogenic than unprocessed meat. Coudray argues that we should speak not of processed meat but nitro-meat.

      Parma
      Prosciutto di Parma has been produced without nitrates since 1993. Photograph: Stefano Rellandini/Reuters

      Pure insane crazy madness is how Coudray described the continuing use of nitrates and nitrites in processed meats, in an email to me. The madness, in his view, is that it is possible to make bacon and ham in ways that would be less carcinogenic. The most basic way to cure any meat is to salt it either with a dry salt rub or a wet brine and to wait for time to do the rest. Coudray notes that ham and bacon manufacturers claim this old-fashioned way of curing isnt safe. But the real reason they reject it is cost: it takes much longer for processed meats to develop their flavour this way, which cuts into profits.

      There is much confusion about what processed meat actually means, a confusion encouraged by the bacon industry, which benefits from us thinking there is no difference between a freshly minced lamb kofta and a pizza smothered in nitrate-cured pepperoni. Technically, processed meat means pork or beef that has been salted and cured, with or without smoking. A fresh pound of beef mince isnt processed. A hard stick of cured salami is.

      The health risk of bacon is largely to do with two food additives: potassium nitrate (also known as saltpetre) and sodium nitrite. It is these that give salamis, bacons and cooked hams their alluring pink colour. Saltpetre sometimes called sal prunella has been used in some recipes for salted meats since ancient times. As Jane Grigson explains in Charcuterie and French Pork Cookery, saltpetre was traditionally used when brining hams to give them an attractive rosy appearance when otherwise it would be a murky greyish brown.

      In earlier centuries, bacon-makers who used saltpetre did not understand that it converts to nitrite as the meat cures. It is this nitrite that allows the bacteria responsible for cured flavour to emerge quicker, by inhibiting the growth of other bacteria. But in the early 20th century, the meat industry found that the production of cured meats could be streamlined by adding sodium nitrite to the pork in pure form. In trade journals of the 1960s, the firms who sold nitrite powders to ham-makers spoke quite openly about how the main advantage was to increase profit margins by speeding up production. One French brand of sodium nitrite from the 60s was called Vitorose or quick-pink.

      Nitro-chemicals have been less of a boon to consumers. In and of themselves, these chemicals are not carcinogenic. After all, nitrate is naturally present in many green vegetables, including celery and spinach, something that bacon manufacturers often jubilantly point out. As one British bacon-maker told me, Theres nitrate in lettuce and no one is telling us not to eat that!

      But something different happens when nitrates are used in meat processing. When nitrates interact with certain components in red meat (haem iron, amines and amides), they form N-nitroso compounds, which cause cancer. The best known of these compounds is nitrosamine. This, as Guillaume Coudray explained to me in an email, is known to be carcinogenic even at a very low dose. Any time someone eats bacon, ham or other processed meat, their gut receives a dose of nitrosamines, which damage the cells in the lining of the bowel, and can lead to cancer.

      You would not know it from the way bacon is sold, but scientists have known nitrosamines are carcinogenic for a very long time. More than 60 years ago, in 1956, two British researchers called Peter Magee and John Barnes found that when rats were fed dimethyl nitrosamine, they developed malignant liver tumours. By the 1970s, animal studies showed that small, repeated doses of nitrosamines and nitrosamides exactly the kind of regular dose a person might have when eating a daily breakfast of bacon were found to cause tumours in many organs including the liver, stomach, oesophagus, intestines, bladder, brain, lungs and kidneys.

      Just because something is a carcinogen in rats and other mammals does not mean it will cause cancer in humans, but as far back as 1976, cancer scientist William Lijinsky argued that we must assume that these N-nitroso compounds found in meats such as bacon were also carcinogens for man. In the years since, researchers have gathered a massive body of evidence to lend weight to that assumption. In 1994, to take just one paper among hundreds on nitrosamines and cancer, two American epidemiologists found that eating hotdogs one or more times a week was associated with higher rates of childhood brain cancer, particularly for children who also had few vitamins in their diets.

      In 1993, Parma ham producers in Italy made a collective decision to remove nitrates from their products and revert to using only salt, as in the old days. For the past 25 years, no nitrates or nitrites have been used in any Prosciutto di Parma. Even without nitrate or nitrite, the Parma ham stays a deep rosy-pink colour. We now know that the colour in Parma ham is totally harmless, a result of the enzyme reactions during the hams 18-month ageing process.

      Slow-cured, nitrate-free, artisan hams are one thing, but what about mass-market meats? Eighteen months would be a long time to wait on hotdogs, as the food science expert Harold McGee comments. But there have always been recipes for nitrate-free bacon using nothing but salt and herbs. John Gower of Quiet Waters Farm, a pork producer who advises many British manufacturers of cured meats, confirms that nitrate is not a necessary ingredient in bacon: Its generally accepted that solid muscle products, as opposed to chopped meat products like salami, dont require the addition of nitrate for safety reasons.

      Bacon is proof, if it were needed, that we cling to old comforts long after they have been proven harmful. The attachment of producers to nitrates in bacon is mostly cultural, says Gower. Bacon cured by traditional methods without nitrates and nitrites will lack what Gower calls that hard-to-define tang, that delicious almost metallic taste that makes bacon taste of bacon to British consumers. Bacon without nitrates, says Gower, is nothing but salt pork.

      Given the harm of nitro-meat has been known for so long, the obvious question is why more has not been done to protect us from it. Corinna Hawkes, a professor of Food Policy at City University in London, has been predicting for years that processed meats will be the next sugar a food so harmful that there will be demands for government agencies to step in and protect us. Some day soon, Hawkes believes, consumers will finally wake up to the clear links between cancer and processed meat and say Why didnt someone tell me about this?


      The most amazing thing about the bacon panic of 2015 was that it took so long for official public health advice to turn against processed meat. It could have happened 40 years earlier. The only time that the processed meat industry has looked seriously vulnerable was during the 1970s, a decade that saw the so-called war on nitrates in the US. In an era of Ralph Nader-style consumer activism, there was a gathering mood in favour of protecting shoppers against bacon which one prominent public health scientist called the most dangerous food in the supermarket. In 1973, Leo Freedman, the chief toxicologist of the US Food and Drug Administration, confirmed to the New York Times that nitrosamines are a carcinogen for humans although he also mentioned that he liked bacon as well as anybody.

      The US meat industry realised it had to act fast to protect bacon against the cancer charge. The first attempts to fight back were simply to ridicule the scientists for over-reacting. In a 1975 article titled Factual look at bacon scare, Farmers Weekly insisted that a medium-weight man would have to consume more than 11 tonnes of bacon every single day to run the faintest risk of cancer. This was an outrageous fabrication.

      But soon the meat lobby came up with a cleverer form of diversion. The AMI the American Meat Institute started to make the argument that the nitrate was only there for the consumers own safety, to ward off botulism a potentially fatal toxin sometimes produced by poorly preserved foods. The scientific director of the AMI argued that a single cup of botulism would be enough to wipe out every human on the planet. So, far from harming lives, bacon was actually saving them.

      In 1977, the FDA and the US Department of Agriculture gave the meat industry three months to prove that nitrate and nitrite in bacon caused no harm. Without a satisfactory response, Coudray writes, these additives would have to be replaced 36 months later with non-carcinogenic methods. The meat industry could not prove that nitrosamines were not carcinogenic because it was already known that they were. Instead, the argument was made that nitrates and nitrites were utterly essential for the making of bacon, because without them bacon would cause thousands of deaths from botulism. In 1978, in response to the FDAs challenge, Richard Lyng, director of the AMI, argued that nitrites are to processed meat as yeast is to bread.

      The meat industrys tactics in defending bacon have been right out of the tobacco industrys playbook, according to Marion Nestle, professor of nutrition and food studies at New York University. The first move is: attack the science. By the 1980s, the AMI was financing a group of scientists based at the University of Wisconsin. These meat researchers published a stream of articles casting doubt on the harmfulness of nitrates and exaggerating the risk from botulism of non-nitrated hams.

      Does making ham without nitrite lead to botulism? If so, it is a little strange that in the 25 years that Parma ham has been made without nitrites, there has not been a single case of botulism associated with it. Almost all the cases of botulism from preserved food which are extremely rare have been the result of imperfectly preserved vegetables, such as bottled green beans, peas and mushrooms. The botulism argument was a smokescreen. The more that consumers could be made to feel that the harmfulness of nitrate and nitrite in bacon and ham was still a matter of debate, the more they could be encouraged to calm down and keep buying bacon.

      A
      A bacon sandwich at a diner in Michigan. Photograph: Molly Riley/Reuters

      The botulism pretext was very effective. The AMI managed to get the FDA to keep delaying its three-month ultimatum on nitrites until a new FDA commissioner was appointed in 1980 one more sympathetic to hotdogs. The nitrite ban was shelved. The only concession the industry had made was to limit the percentage of nitrites added to processed meat and to agree to add vitamin C, which would supposedly mitigate the formation of nitrosamines, although it does nothing to prevent the formation of another known carcinogen, nitrosyl-haem.

      Over the years, the messages challenging the dangers of bacon have become ever more outlandish. An explainer article by the Meat Science and Muscle Biology lab at the University of Wisconsin argues that sodium nitrite is in fact critical for maintaining human health by controlling blood pressure, preventing memory loss, and accelerating wound healing. A French meat industry website, info-nitrites.fr, argues that the use of the right dose of nitrites in ham guarantees healthy and safe products, and insists that ham is an excellent food for children.

      The bacon lobby has also found surprising allies among the natural foods brigade. Type nitrate cancer bacon into Google, and you will find a number of healthy eating articles, some of them written by advocates of the Paleo diet, arguing that bacon is actually a much-maligned health food. The writers often mention that vegetables are the primary source of nitrates, and that human saliva is high in nitrite. One widely shared article claims that giving up bacon would be as absurd as attempting to stop swallowing. Out of the mass of stuff on the internet defending the healthiness of bacon, it can be hard to tell which writers have fallen under the sway of the meat lobby, and which are simply clueless nutrition experts who dont know any better.

      Either way, this misinformation has the potential to make thousands of people unwell. The mystifying part is why the rest of us have been so willing to accept the cover-up.


      Our deepening knowledge of its harm has done very little to damage the comforting cultural associations of bacon. While I was researching this article, I felt a rising disgust at the repeated dishonesty of the processed meat industry. I thought about hospital wards and the horrible pain and indignity of bowel cancer. But then I remembered being in the kitchen with my father as a child on a Sunday morning, watching him fry bacon. When all the bacon was cooked, he would take a few squares of bread and fry them in the meaty fat until they had soaked up all its goodness.

      In theory, our habit of eating salted and cured meats should have died out as soon as home refrigerators became widespread in the mid-20th century. But tastes in food are seldom rational, and millions of us are still hooked on the salty, smoky, umami savour of sizzling bacon.

      We are sentimental about bacon in a way we never were with cigarettes, and this stops us from thinking straight. The widespread willingness to forgive pink, nitrated bacon for causing cancer illustrates how torn we feel when something beloved in our culture is proven to be detrimental to health. Our brains cant cope with the horrid feeling that bacon is not what we thought it was, and so we turn our anger outwards to the health gurus warning us of its hazards. The reaction of many consumers to the WHO report of 2015 was: hands off my bacon!

      In 2010, the EU considered banning the use of nitrates in organic meats. Perhaps surprisingly, the British organic bacon industry vigorously opposed the proposed nitrates ban. Richard Jacobs, the late chief executive of Organic Farmers & Growers, an industry body, said that prohibiting nitrate and nitrite would have meant the collapse of a growing market for organic bacon.

      Organic bacon produced with nitrates sounds like a contradiction in terms, given that most consumers of organic food buy it out of concerns for food safety. Having gone to the trouble of rearing pigs using free-range methods and giving them only organic feed, why would you then cure the meat in ways that make it carcinogenic? In Denmark, all organic bacon is nitrate-free. But the UK organic industry insisted that British shoppers would be unlikely to accept bacon that was greyish.

      Then again, the slowness of consumers to lose our faith in pink bacon may partly be a response to the confusing way that the health message has been communicated to us. When it comes to processed meat, we have been misled not just by wild exaggerations of the food industry but by the caution of science.

      On the WHO website, the harmfulness of nitrite-treated meats is explained so opaquely you could miss it altogether. In the middle of a paragraph on what makes red meat and processed meat increase the risk of cancer, it says: For instance, carcinogenic chemicals that form during meat processing include N-nitroso compounds. What this means, in plain English, is that nitrites make bacon more carcinogenic. But instead of spelling this out, the WHO moves swiftly on to the question of how both red and processed meats might cause cancer, after adding that it is not yet fully understood how cancer risk is increased.

      The
      The typical British sausages does not fall into the processed meat category. Photograph: Julian Smith/AAP

      This caution has kept us as consumers unnecessarily in the dark. Consider sausages. For years, I believed that the unhealthiest part in a cooked English breakfast was the sausage, rather than the bacon. Before I started to research this article, Id have sworn that sausages fell squarely into the processed meat category. They are wrongly listed as such on the NHS website.

      But the average British sausage as opposed to a hard sausage like a French saucisson is not cured, being made of nothing but fresh meat, breadcrumbs, herbs, salt and E223, a preservative that is non-carcinogenic. After much questioning, two expert spokespeople for the US National Cancer Institute confirmed to me that one might consider fresh sausages to be red meat and not processed meat, and thus only a probable carcinogen. (To me, the fact that most sausages are not processed meat was deeply cheering, and set me dancing around the kitchen with glee thinking about toad in the hole.)

      In general, if you ask a cancer scientist to distinguish between the risks of eating different types of meat, they become understandably cagey. The two experts at the National Cancer Institute told me that meats containing nitrites and nitrates have consistently been associated with increased risk of colon cancer in human studies. But they added that it is difficult to separate nitrosamines from other possible carcinogens that may be present in processed meats like bacon. These other suspects include haem iron a substance that is abundant in all red meat, processed or not and heterocyclic amines: chemicals that form in meat during cooking. A piece of crispy, overcooked bacon will contain multiple carcinogens, and not all are due to the nitrates.

      The problem with this reasoning, as I see it, is that it cant account for why processed meat is so much more closely linked to cancer than cooked red meat. For that, there remains no plausible explanation except for nitrates and nitrites. But looking for clear confirmation of this in the data is tricky, given that humans do not eat in labs under clinical observation.

      Most of what we know about processed meat and cancer in humans comes from epidemiology the study of disease across whole populations. But epidemiologists do not ask the kind of detailed questions about food that the people who eat that food may like answers to. The epidemiological data based on surveys of what people eat is now devastatingly clear that diets high in processed meats lead to a higher incidence of cancer. But it cant tell us how or why or which meats are the best or worst. As Corinna Hawkes of City University comments, The researchers dont ask you if you are eating artisanal charcuterie from the local Italian deli or the cheapest hotdogs on the planet.

      I would love to see data comparing the cancer risk of eating nitrate-free Parma ham with that of traditional bacon, but no epidemiologist has yet done such a study. The closest anyone has come was a French study from 2015, which found that consumption of nitrosylated haem iron as found in processed meats had a more direct association with colon cancer than the haem iron that is present in fresh red meat.

      It may be possible that epidemiologists have not asked people more detailed questions about what kind of processed meats they eat because they assume there is no mass-market alternative to bacon made without nitrates or nitrites. But this is about to change.


      The technology now exists to make the pink meats we love in a less damaging form, which raises the question of why the old kind is still so freely sold. Ever since the war on nitrates of the 1970s, US consumers have been more savvy about nitrates than those in Europe, and there is a lot of nitrate-free bacon on the market. The trouble, as Jill Pell remarks, is that most of the bacon labelled as nitrate-free in the US isnt nitrate-free. Its made with nitrates taken from celery extract, which may be natural, but produces exactly the same N-nitroso compounds in the meat. Under EU regulation, this bacon would not be allowed to be labelled nitrate-free.

      Its the worst con Ive ever seen in my entire life, says Denis Lynn, the chair of Finnebrogue Artisan, a Northern Irish company that makes sausages for many UK supermarkets, including Marks & Spencer. For years, Lynn had been hoping to diversify into bacon and ham but, he says, I wasnt going to do it until we found a way to do it without nitrates.

      When Lynn heard about a new process, developed in Spain, for making perfectly pink, nitrate-free bacon, he assumed it was another blind alley. In 2009, Juan de Dios Hernandez Canovas, a food scientist and the head of the food tech company Prosur, found that if he added certain fruit extracts to fresh pork, it stayed pink for a surprisingly long time.

      In January 2018, Finnebrogue used this technology to launch genuinely nitrate-free bacon and ham in the UK. It is sold in Sainsburys and Waitrose as Naked Bacon and Naked Ham, and in M&S as nitrate-free bacon. Kirsty Adams, who oversaw its launch at M&S, explains that its not really cured. Its more like a fresh salted pork injected with a fruit and vegetable extract, and is more perishable than an old-fashioned flitch of bacon but that doesnt matter, given that it is kept in a fridge. Because it is quick to produce, this is much more economically viable to make than some of the other nitrate-free options, such as slow-cured Parma ham. The bacon currently sells in Waitrose for 3 a pack, which is not the cheapest, but not prohibitive either.

      I tried some of the Finnebrogue nitrate-free bacon from M&S. The back bacon tasted pleasant and mild, with a slight fruitiness. It didnt have the toothsome texture or smoky depth of a rasher of butchers dry-cured bacon, but Id happily buy it again as an alternative to nitro-meat. None of my family noticed the difference in a spaghetti amatriciana.

      Nitrate-free bacon still sounds a bit fancy and niche, but there shouldnt be anything niche about the desire to eat food that doesnt raise your risk of cancer. Lynn says that when he first approached Prosur about the fruit extract, he asked how much they had sold to the other big bacon manufacturers during the two years they had been offering it in the UK. The answer was none. None of the big guys wanted to take it, claims Lynn. They said: It will make our other processed meats look dodgy.

      But it also remains to be seen how much consumer demand there will be for nitrate-free bacon. For all the noise about bacon and cancer, it isnt easy to disentangle at a personal level just what kind of risk we are at when we eat a bacon sandwich. OK, so 34,000 people may die each year because of processed meat in their diet, but the odds are that it wont be you. I asked a series of cancer scientists whether they personally ate processed meat, and they all gave slightly different answers. Jill Pell said she was mostly vegetarian and ate processed meats very rarely. But when I asked Fabrice Pierre, a French expert on colon cancer and meat, if he eats ham, he replied: Yes, of course. But with vegetables at the same meal. (Pierres research at the Toxalim lab has shown him that some of the carcinogenic effects of ham can be offset by eating vegetables.)

      Our endless doubt and confusion about what we should be eating have been a gift to the bacon industry. The cover-up about the harm of meat cured with nitrate has been helped along by the scepticism many of us feel about all diet advice. At the height of the great bacon scare of 2015, lots of intelligent voices were saying that it was safe to ignore the new classification of processed meats as carcinogenic, because you cant trust anything these nutritionists say. Meanwhile, millions of consumers of ham and bacon, many of them children, are left unprotected. Perhaps the most extraordinary thing about this controversy is how little public outrage it has generated. Despite everything, most of us still treat bacon as a dear old friend.

      In an ideal world, we would all we eating diets lower in meat, processed or otherwise, for the sake of sustainability and animal welfare as much as health. But in the world we actually live in, processed meats are still a normal, staple protein for millions of people who cant afford to swap a value pack of frying bacon for a few slivers of Prosciutto di Parma. Around half of all meat eaten in developed countries is now processed, according to researcher John Kearney, making it a far more universal habit than smoking.

      The real victims in all this are not people like me who enjoy the occasional bacon-on-sourdough in a hipster cafe. The people who will be worst affected are those many on low incomes for whom the cancer risk from bacon is compounded by other risk factors such as eating low-fibre diets with few vegetables or wholegrains. In his book, Coudray points out that in coming years, millions more poor consumers will be affected by preventable colon cancer, as westernised processed meats conquer the developing world.

      Last month, Michele Rivasi, a French MEP, launched a campaign in collaboration with Coudray demanding a ban of nitrites from all meat products across Europe. Given how vigorously the bacon industry has fought its corner thus far, a total ban on nitrites looks unlikely.

      But there are other things that could be done about the risk of nitrites in bacon, short of an absolute veto. Better information would be a start. As Corinna Hawkes points out, it is surprising that there hasnt been more of an effort from government to inform people about the risks of eating ham and bacon, perhaps through warning labels on processed meats. But where is the British politician brave enough to cast doubt on bacon?

      Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read weekly email here.

      Read more: https://www.theguardian.com/news/2018/mar/01/bacon-cancer-processed-meats-nitrates-nitrites-sausages

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