(This strikes close to home: I don't know what wigs out me and my siblings more, the fact that my mother's walker is so rarely used or the way she operates it when she takes it out for its monthly spin, her back leaned wayyyy over, arms outstretched, the walker just a distant blur in front of her.)

In response to these numbers, the American Physical Therapy Assn. has put out a reminder that it makes sense to consult a physical therapist so that appropriate walking aids are selected and people are taught how to use them properly. (This tip is a tad self-serving, perhaps, but also seems very sensible.)

Some tips from the association's release:

• The walker or cane should be about the height of your wrists when your arms are at your sides.
• When using a walker, your arms should be slightly bent when holding on, but you shouldn't have to bend forward at the waist to reach it.
• Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn through.

-- Rosie Mestel

Even when researchers adjusted for factors such as income, education, age and severity of illness, they found that African Americans were more likely to die from breast, ovarian and prostate cancer than were whites. That's the conclusion of a study to be published July 15 in the Journal of the National Cancer Institute. (The link will take you to the abstract. Unfortunately, you have to pay to read the whole report.)

“A lot of factors that have been used to explain population statistics that surround socioeconomic disparities and access to care are not present here,” says study coauthor Dr. Kathy Albain of Loyola University Health System in Maywood, Ill., in a telephone interview.

Now, the question left is why.

The fact that the disparity was found only in sex-specific cancers suggests a racial difference in hormonal environment or in genes that control the metabolism of drugs, toxins and hormones, Albain says.

But the study (which looked at cancer outcomes in nearly 20,000 adults) has certain limitations. For that reason, other researchers still question if these conclusions about genetic differences can be drawn yet. For example, differences in survival could be related to disparities in the quality of the two populations' overall health or their tendency to adhere to the cancer therapies they received.

Albain adds that although the gene patterns reducing cancer survival may be more common in blacks, not all African Americans will carry them. And some white people will. Once the important genetic patterns are identified, "We can then alter treatment regardless of the race that has the pattern.... It could be a win-win for all patients of all races.”

Read an article by the Chicago Tribune for more information about the study and what scientists think of it.

-- Shara Yurkiewicz

Two recent studies present new takes on ACL surgery and recovery.

NFL players who underwent ACL surgery had longer careers than their peers who had meniscus repairs, or who underwent both procedures. Researchers analyzed a database of NFL player injuries from 1987 to 2000 and found 54 who had had meniscus repairs, 29 with a history of ACL reconstruction, and 11 with a history of both. They were matched with a control group with no prior surgeries and matched by position, year drafted, round drafted and other injury history. ACL surgery alone didn't substantially shorten the careers of the players, either by year or game number. However, the careers of those who had had meniscus repairs shrunk were about 1.5 years shorter, or 23 games. And players who had both procedures had careers cut by almost two years, on average, and 32 games.

"A combination of ACL reconstruction and meniscectomy may be more detrimental to an athlete's durability than either surgery alone," said lead author Dr. Robert Brophy of the Washington University School of Medicine, in a news release. "With further research, we will be able to better understand how these injuries and surgeries impact an athlete's career and what can be done to improve long-term outcomes."

ACL surgery in young athletes is becoming more common. But some health experts (and parents) worry that such surgery could carry risks because bones haven't finished growing. But a new study suggests that delaying surgery might have even worse consequences. Researchers examined records of 70 children 14 and younger who had ACL reconstruction surgery between 1991 and 2005. A little less than half (29) who put off treatment for more than 12 weeks had four times as many medial meniscus tears, 11 times as many lateral compartment chondral injuries, and three times as many patellotrochlear injuries. They also had more instability in their knees.

Both studies were presented this week at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.

-- Jeannine Stein

Photo: US Presswire

New research suggests why mouse stem cells are so easy to grow, and that may lead to advances in growing embryonic stem cells from other animals.

The study, published this week in the journal Science Express, found that activation of what's called the TDH gene in mouse embryonic stem cells results in their ability to grow successfully. The study showed that the cultures scientists use for the embryonic mouse stem cells is important to keep the TDH gene actively expressed.

"Scientists added this and that until they got the right 'soup,' " Steven McKnight, the lead author of the study and chairman of biochemistry at UT Southwestern Medical Center, said in a news release. "You would think the 'mouse soup' would then work for all species, but it doesn't. Researchers have been trying for 20 years to get the right formula for maintaining embryonic stem cells from other species. With few exceptions, however, they still haven't gotten it right."

Because of gene mutations, human embryonic stem cells do not produce the TDH enzyme that is crucial to the mouse cell growth. It may be possible to repair the mutated human TDH gene and replace it into human embryonic stem cells to trigger better growth.

"I don't know whether this will work or not -- it's highly speculative," McKnight said. "But if so, it would be profound."

-- Shari Roan

Photo courtesy of Advanced Cell Technology Inc.

Government data show that American adults eat an average of almost 500 more calories per day now than we did 30 years ago. And that’s not just because we’ve lost our willpower, according to Susan Roberts, director of the Energy Metabolism Laboratory at the USDA Human Nutrition Research Center on Aging at Tufts University.

“The environment kind of forces us to eat more,” she explained. “We have all kinds of metabolic responses to the environment that make us more hungry.”

TV commercials, large portion sizes and the mind-numbing array of food choices available from grocery stores and restaurants trigger a cascade of biological events that encourage overeating.

“When you see or smell food, you have an insulin surge, which drops your blood glucose,” she said. “Your stomach relaxes, so it gets bigger and you need more food just to feel full.”

What can be done about it? As usual, there are calls for limiting food advertising aimed at kids or banning calorie-laden drinks like soda and juice. But Roberts had a clever idea I’d never heard before.

In a meeting with the Congressional Biomedical Research Caucus in February, she suggested that lawmakers regulate portion sizes in restaurants in the same way they handle car emissions with the auto industry.

“The emissions control standards are not legislating what any particular car has to have for gas mileage, but they say that on average, cars have to do this,” she said. “We can say to restaurants, ‘You can serve anything you like, but on average 50% of your sales have to come from reasonable portions.’ Then we can let restaurants figure out how to do it.”

-- Karen Kaplan

Photo: Doesn't this picture make you crave French fries? Credit: Shizuo Kambayashi/AP

The survey, presented this week at the academy's annual meeting, involved 500 dentists. The dentists also suggested that aging, dehydration and salivary gland disease were causes of the disorder. Dry mouth is also known as xerostomia. It's caused by a decrease in salivary gland function and affects about 1 in 4 Americans. If left untreated, dry mouth can contribute to tooth decay.

"The number of xerostomia cases has increased greatly over time because people are taking more and more medications," said Cindy Kleiman, a dentist and expert on dry mouth, in a news release.

About 400 prescription medications are linked to dry mouth, including many antidepressants, painkillers, diuretics, antihistamines, tranquilizers and anti-hypertensives. Dry mouth can also be a symptom of a variety of diseases and medical disorders. People with dry mouth should discuss their symptoms with a dentist, according to experts.

The Academy of General Dentistry recommends these suggestions to alleviate dry mouth:

• Brush and floss twice a day
• Chew sugarless gum or suck on non-citrus flavored or sour sugarless candy
• Drink plenty of water
• Brush with a fluoride toothpaste to protect your teeth
• Use over-the-counter saliva substitutes
• Avoid alcohol and caffeine
• Avoid smoking
• Avoid overly salty foods
• Avoid citrus juices
• Avoid dry foods
• Breathe through your nose instead of your mouth as often as possible
• Use moisturizer regularly on your lips
• Sleep with a humidifier in your room to add moisture to the air
• Visit your dentist regularly

-- Shari Roan

Photo credit: 3D4medical.com

The word was termed some years ago by Colorado physician and alternative medicine expert Dr. Steven Bratman to define an obession with healthy eating. Here's a quick overview from Psychology Today and another from Suite101.com. The condition isn't an officially recognized disorder, and the term doesn't appear to have gained much traction in pop culture, much less the medical field. 

Here's an excerpt from Bratman's original essay on the topic, published in Yoga Journal in 1997:

Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic's day.

He and co-author Steven Knight wrote a book about the condition in 2001: "Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating."

A WebMD story, "Orthorexia: Good Diets Gone Bad," which features Bratman prominently, offers a bit more context. And a nice tip sheet from the Palo Alto Medical Foundation explains how to recognize the symptoms in teens.

For those who want their explainers video-style, here's one person's YouTube video introduction to the topic.

And the original essay, whether you agree that the condition is real or simply another form of obsessiveness, anorexia or something else entirely, is intriguing. Here's more:

The act of eating pure food begins to carry pseudospiritual connotations. As orthorexia progresses, a day filled with sprouts, umeboshi plums, and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless. When an orthorexic slips up (which may involve anything from devouring a single raisin to consuming a gallon of Haagen Dazs ice cream and a large pizza), he experiences a fall from grace and must perform numerous acts of penitence. These usually involve ever-stricter diets and fasts.

And about those headlines from the week: The obesity epidemic: Pounds and dollars rise together; Obesity hitting California's economy in a big way, study finds; Permanent diet may equal longer life.

There's a medium here somewhere.

-- Tami Dennis

Photo: Ken Hively / Los Angeles Times

The FDA made the announcement today, and production at the plant is reportedly ramping back up. Here's a new AP story and a slightly fuller one from ABC News, the second of which brings a third strain of E. coli into the picture.

And perhaps more relevant considering the scarcity of facts, the list of recalled products, the Food and Drug Administration's basic page on the topic, plus one from the federal Centers for Disease Control and Prevention.

But if you're wondering how the investigators ended up pointing the finger at cookie dough in the first place, here's an informative blog post from a CDC officer investigating this outbreak. She writes: "There are no short cuts. We talk to the patients, we look at the combined information, and we generate hypotheses about the cause. Then we can refine our questions and go back to the patients again to see which hypothesis holds true." 

And, as a bonus, here's Michael Jacobson, executive director of the nutrition watchdog Center for Science in the Public Interest, expressing outrage over Nestle's alleged recalcitrance in cooperating with the FDA during inspections at the plant in question.

And in other food safety news this week: "Administration moves to bolster food safety net."

None of which explains the source of the E. coli blamed in the outbreak.

-- Tami Dennis

Photo: Some people actually eat cookie dough without cooking it first.

Credit: Justin Sullivan / Getty Images

Wait -- should you be doing that? Such reckless sand play, scientists have found, puts people at risk for subsequent stomach cramping and diarrhea courtesy of fecal bacteria on the shore. Safer to walk along the beach or (gulp) go in the water.

In a survey of 27,000 visitors to ocean and freshwater beaches, 13% of those who said they'd dug in sand during a visit to a beach reported gastrointestinal problems when interviewed 10 to 12 days later.

As for those who allowed themselves to be buried in sand, their rate was even higher: 23%. So think about that the next time you decide to go have some fun like that.

The study, by scientists at the University of North Carolina at Chapel Hill and the Environmental Protection Agency, was published in the American Journal of Epidemiology.

-- Rosie Mestel

Photo credit: Genaro Molina / Los Angeles Times

The reason? Possible salmonella contamination.

No illnesses have been linked to any of the products, which aren't sold directly to consumers but to companies with which the cooperative does business.

But because dry milk lasts a while, one of its main selling points after all, some could conceivably be in your cabinet.

Here's the news release from the company and the announcement on the FDA's website.

Bought any Turkey Gravy Mix from Gold Medal?

Popcorn Seasoning Movie Theater Butter Flavored from Kroger?

Hearty Traditions Maple & Brown Sugar Instant Oatmeal from Malt-O-Meal?

International Drinking Cocoa, Madagascar Vanilla, from Land O Lakes?
 
Nonfat dry milk products sold by Meijer and Giant, among others?

Or one of many products offered by Max Muscle Sports Nutrition?

It might be on the list. Even if not, you might want to check back. The number of products seems to be growing -- as such lists do.

-- Tami Dennis

Smokers, and the physicians who advise them, have always been wary of suggesting the use of patch and cigarettes together for fear that the two-fisted approach would cause nicotine overdoses. And the labels of nicotine patches reflect that concern, warning would-be quitters not to use both at once.

But researchers at Duke University's Center for Nicotine and Smoking Cessation Research found that smokers who wore the smoking-cessation aid before they smoked were more likely to decrease the number of cigarettes they smoked in the two-week period before their official quit date. That's probably because the patch was satisfying some of their desire for nicotine, they surmised. When the time came to quit, it would seem that some had already dialed down their need to light up and puff.

In all, 22% of those who wore the patch for two weeks before quitting abstained continuously from cigarettes for 10 weeks. Only 11% of those who wore a fake patch -- the placebo -- abstained for that long.

One interesting parallel: The smoking-cessation drug Chantix is also to be started two weeks before a person's quit date. But Chantix is thought to suppress the urge to smoke not by replacing cigarettes' nicotine, but by blocking the brain's reward-seeking pathways, thus blunting the craving to smoke and the pleasure in doing so. 

Quitting is hard; and it's probably particularly hardfor the same reason that these two pre-quitting treatments probably help: because in addition to a smoker's physical need for nicotine, there is also the relaxing, pleasurable, familiar routine of breaking for a cigarette, staring into the cloud of blue smoke you've created and, for a brief spell, just floating in the sensation of relief. If that hypnotic spell can be eased -- or even broken -- before their quit date, maybe quitters will have one big battle, not two, to fight.

By the way, the FDA recently ordered warnings on Chantix cautioning those who take it to look out for signs of odd behavior or thinking: unusual aggression, irritability, sadness or suicidal behavior. Nicotine patches, so far, have been free of such concerns.

Finally, a disclosure by the Duke study's lead author, Jed Rose: Rose is one of the inventors of the nicotine patch, and has received royalties in the past on their sales. Also, the research was conducted under a grant from the tobacco giant Phillip Morris USA. Don't say we didn't tell you.

-- Melissa Healy 

But with obesity starting younger and younger, health experts realize that weight loss efforts and lifestyle changes for children and teens must start sooner, and need to be tailored to that age group to be effective. That's why researchers from the Miriam Hospital and the Warren Alpert Medical School of Brown University are starting the Adolescent Weight Control Registry, led by Rena Wing, director of the Weight Control and Diabetes Research Center at the Miriam Hospital, and Elissa Jelalian, associate professor of psychiatry and human behavior at Brown Medical School.

"We're doing it with the idea that we could develop better interventions for teens," says Jelalian. "We would also like to track kids over time to see how they do through transitions, such as from school to independence."

Through questionnaires and surveys, adult registry founders Wing and James O. Hill, director of the Center for Human Nutrition, have discovered similarities among successful losers, such as being faithful to regular exercise and diligent about portion control.

But teens lose weight differently from adults, Jelalian says, for many reasons: Teens and parents can initiate efforts; teens are learning to navigate through peer pressure and social situations; they don't always have access to gyms or fitness classes; and they're not always in control of what's served at meals.

The study is currently seeking participants ages 14 to 20 from around the country. Requirements are less stringent than for adults -- teens must have kept off at least 10 pounds for a year or more, and fulfill other conditions.

"I think when you get down to diet and activity," says Jelalian, "inevitably these kids will have somehow cut back on eating and upped their activity. But I think there are lots of ways of getting to that point."

-- Jeannine Stein

Photo credit: M. Spencer Green / Associated Press

Researchers at the University of North Carolina reached this conclusion after a series of studies that required 86 participants to submit daily "emotion reports" that gauged their emotional status in detail over the course of the day. The study showed that happy people do not need to be Pollyannas or deny the upsetting parts of life. But these people have the ability to put greater stock in small, happy moments. Savoring these blips of pleasure in everyday life, the study found, elevates one's mood overall and leads to more resilience against negative events.

"This study shows that if happiness is something you want out of life, then focusing daily on the small moments and cultivating positive emotions is the way to go," said Barbara Fredrickson, the lead author of the study, in a news release. "Those small moments let positive emotions blossom, and that helps us become more open. That openness then helps us build resources that can help us rebound better from adversity and stress, ward off depression and continue to grow."

The key to focusing on micro-moments, Fredrickson said, is to set aside worries about the big picture.

"A lot of times we get so wrapped up in thinking about the future and the past that we are blind to the goodness we are steeped in already, whether it's the beauty outside the window or the kind things that people are doing for you. The better approach is to be open and flexible, to be appreciative of whatever good you do find in your daily circumstances, rather than focusing on the bigger questions, such as 'Will I be happy if I move to California?' or 'Will I be happy if I get married?' "

The study, published in the current issue of the journal Emotion, was co-authored by researchers at UC San Francisco, the University of Michigan,University of Pittsburgh and Cornell University. Fredrickson has written a book on her research titled, "Positivity: Groundbreaking Research Reveals How to Embrace the Hidden Strength of Positive Emotions, Overcome Negativity and Thrive," (Crown Publishing, 2009).

Here's a link to a video of Fredrickson discussing the research.

-- Shari Roan

Photo credit: Los Angeles Times

For one thing, this suppression does tend to increase the risk of disease. An undesirable side effect by anyone's standards.

Rapamycin, an antibiotic commonly given to prevent rejection of organ transplants, was given to old mice in a recent study and, yes, the animals lived longer. Lifespan was increased up to 14% for female rodents (not to belabor the point, but it's worth repeating that the study was on, yes, rodents) and up to 9% for male rodents. *

Now, more on rapamycin.

The National Cancer Institute defines it as: "An antibiotic that blocks a protein involved in cell division and inhibits the growth and function of certain T cells of the immune system involved in the body's rejection of foreign tissues and organs. It is a type of immunosuppressant and a type of serine/threonine kinase inhibitor. Rapamycin is now called sirolimus." 

More on sirolimus from rxlist.com, which points out that the drug can increase the risk of certain types of cancer -- lymphoma and skin cancer, for example.

Here's a summary of the new research, published Wednesday in the journal Nature. It states: "Rapamycin may extend lifespan by postponing death from cancer, by retarding mechanisms of ageing, or both."

That's heady stuff. Here's a bit more context, in a more accessible version, from nature.com. And a blog post from the site pointing out just where the word "mice" first appeared in various media reports.

As a Forbes story clarifies, the significance here is actually what the research tells us about the biology of aging. There's a long way to go between one finding about a signaling pathway in the body and practical effects in people. A very long way.

But, of course, that doesn't mean you shouldn't try to get this antibiotic and take it as an insurance policy. Mega doses, naturally, just to be on the safe side. 

-- Tami Dennis

* An earlier version of this story said the mice were all of the same type. Not so, as Mr. Miller (see comment below) was kind enough to point out.

What if I told you it would dramatically reduce your odds of getting cancer, heart disease and diabetes?

Perhaps more folks will start considering the trade-off between a long life and an enjoyable life after reading a study released today by the journal Science.

Researchers in Wisconsin have been feeding 38 rhesus monkeys a restricted diet that contains 30% fewer calories than standard monkey chow for as long as 20 years. Those calorically restricted monkeys had half the risk of developing cardiovascular disease or cancer compared with the 38 control monkeys on the normal diet.

What’s more, none of the low-cal animals developed Type 2 diabetes. That compares to five diabetic monkeys and another 11 that were pre-diabetic in the control group.

Overall, the researchers found that monkeys on the regular diet were three times as likely to die of age-related causes during the study than the ones on caloric restriction. An article about the study appears in Science News.

Researchers said that, because monkeys are close relatives of humans, it’s quite likely that humans could live longer and healthier lives by paring back their calories too. But with two-thirds of the country classified as overweight or obese, it hardly seems like a trend that will take off.

-- Karen Kaplan

Photo: Canto, 27 (right), is on a restricted diet, and Owen, 29, is not. Canto looks younger, but is he happier? Credit: University of Wisconsin

A vaccine against anthrax is available and is given to laboratory workers and some soldiers, but its use has been controversial because of the high incidence of side effects. The new research provides "an important addition to the existing arsenal" against anthrax, Dr. Gary G. Nable, director of vaccine research at the National Institute of Allergy and Infectious Diseases wrote in an editorial in the same issue of the journal.

The antibody, called ABthrax,  was developed by Human Genome Sciences of Rockville, Md., under a contract from the government's Biomedical Advanced Research and Development Authority following the 2001 attacks in which anthrax-containing letters were sent to journalists and politicians, killing five people. The company has already delivered 20,000 doses of the drug to the U.S. Strategic National Stockpile for emergency use.

In one experiment, monkeys got a single dose of ABthrax or a placebo two days before receiving a lethal dose of anthrax. Those receiving a placebo all died within six days, while nine of the 10 receiving the highest dose survived. In a similar experiment, monkeys were given the drug after inhaling a powder of anthrax 200 times the lethal dose. Nine of 14 monkeys receiving the highest dose survived. Similar results were obtained with rabbits.

The drug cannot ethically be tested against anthrax in humans, but studies in 333 healthy people showed that it produced no adverse side effects. The company has applied to the Food and Drug Administration for approval under a rule that lets animal studies substitute for human ones in cases where human testing is not feasible.

-- Thomas H. Maugh II

Not in all cases, according to a recent Cochrane Library study, which reviewed previous studies comparing muscle pain relief via rubefacients -- topical rubs that cause skin redness by dilating the capillaries and increasing blood flow -- to topical nonsteroidal anti-inflammatory drugs. Here, in part, is what the BBC had to say about it:

"They looked at 16 studies involving nearly 1,300 patients using creams containing salicylate -- a close drug relative of aspirin.

"Results from four of the studies showed topical salicylates performed better than dummy (placebo) creams against acute pain, but when lower quality studies were excluded, the results were not statistically significant.

"Again, when used for chronic conditions, salicylates performed better than placebos.

"But only one in six patients with chronic pain from conditions like osteoarthritis benefited substantially from using the muscle rubs compared with one in three using non-steroidal anti-inflammatory painkiller gels like ibuprofen or diclofenac."

The review concluded that more research -- specifically large, good-quality clinical trials -- is needed to determine the effectiveness of muscle rubs.

Considering how many athletes and exercisers (including weekend warriors) use these rubs, the study's conclusion is worth considering. But keep in mind that topical NSAIDs are not without their side effects, such as gastrointestinal problems, although some studies show they have fewer complications than oral NSAIDs.

-- Jeannine Stein

Photo credit: Charles Bush

In 2001, expenditures for obese Americans totaled $167 billion compared with $303 billion in 2006. Costs for adults who were overweight rose 36% during that time period while costs for normal-weight adults increased 25%.

Healthcare expenditures for obese Americans accounted for 35% of all costs in 2006, the report noted. During the years of 2001 to 2006, the number of obese Americans increased from 48 million to 59 million people. Obese people are much more likely to suffer from several chronic health conditions.

One hopes the figures, which were compiled by the Agency for Healthcare Research and Quality, will come to the attention of lawmakers and other authorities discussing healthcare reform. Perhaps the top goal of healthcare reform should be preventing obesity, and the myriad of health problems it causes, in our children.

-- Shari Roan

Illustration credit: Michelle Chang / For The Times

If you're waiting with bated breath for all those new healthful-food-scoring schemes to hit the grocery stores, you may be interested in a chart of existing and upcoming rating systems compiled by the Fooducate blog. It's a pretty useful resource.

The situation is, as the blog terms it, a veritable "tower of Babel."

(By the way, if all the fields of the chart don't show up when you click on the link, copying and pasting the content into a blank document seems to do the trick, for reasons that I do not understand.)

-- Rosie Mestel

Photo: Karen Tapia / Los Angeles Times

More men -- and, again, their doctors (who are paid by procedure, not by performance) -- need to ask themselves whether less might ultimately provide more. That's the suggestion posed by a smart, making-the-big-picture-personal piece in today's New York Times.

For writer David Leonhardt, the true test of health reform can be summed up with our medical and insurance systems' approach to prostate cancer, specifically the common, slow-growing kind. It's the kind that can often be monitored with what is known as watchful waiting without the risk of side effects that comes with radiation and surgery.

He writes:

But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.

And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.

If you doubt that similar-benefits contention and want an in-depth look at how the treatments compare, there's this report: "Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer" from the Agency for Healthcare Research and Quality.

The report, released last year, concludes:

Published evidence indicates that no one therapy can be considered preferred for localized
prostate cancer due to limitations in quality of the body of comparative effectiveness evidence. All treatment options result in adverse effects (primarily urinary, bowel, and sexual) though the severity and frequency may vary between treatments and according to the provider/hospital. Even if differences in therapeutic efficacy exist, differences in AEs [adverse effects], convenience, and costs are likely to be important factors in individual patient decision making. Despite this uncertainty, patient-reported satisfaction with any individual therapy received is high.

Leonhardt is right. This one example highlights the seemingly large and intractable problems of rising healthcare costs (proton radiation therapy isn't cheap) and getting the most effective healthcare for our national dollars.

And, come decision-making time, if less-expensive treatments are as effective as more high-tech ones,  perhaps it's time to question some of the recommendations for expensive treatment and screenings.

-- Tami Dennis

Illustration: Wes Bausmith / Los Angeles Times