Earth Perhaps Not Such a Benevolent Mother After All

Most of us think of Earth as a nurturing place, with a natural equilibrium where life thrives and flourishes.

Some refer to that idea as the Gaia hypothesis, named for the ancient Greek goddess of Earth. The Gaia hypothesis suggests that the planet behaves as a kind of giant organism, with its complex systems finely tuned to compensate when one system gets out of kilter.

But Peter Ward, a University of Washington paleontologist, says that it is the Gaia view that is out of kilter. Ward has looked closely at conditions that existed during numerous mass extinction events in Earth's history to draw the conclusion that the Earth maybe isn't such a hospitable, harmonious nurturing mother after all.

In a new book, he suggests the planet ultimately is inhospitable to life, and that life itself might be the primary reason. Rather than Gaia, he invokes the darker Medea from Greek mythology.

"The Medea hypothesis says life is already shutting down Earth as a habitable planet. Not just the diversity of life, but the actual biomass," Ward said. "Life keeps evolving, and there are unintended, often negative, consequences."

"The Medea Hypothesis: Is Life on Earth Ultimately Self-Destructive?" was published in April by Princeton University Press. In the 208-page book, Ward argues that humans have to use engineering to manage their environment or face potential extinction if the Earth is left to manage itself.

"The engineering I'm talking about is not girders and sky shields. It's engineering microbes to take over food production and energy production," he said.

Microbes have undergone evolution, a sort of natural engineering, throughout Earth's history, he said, and humans have the ability to guide such changes to clean the environment, for example, or regulate carbon dioxide in the atmosphere.

Like Gaia, Medea is a mythological character, though she is decidedly much darker in nature. Medea was married to Jason at the time he pursued the Golden Fleece but, according to legend, he left her and in revenge she killed their two children.

Ward, a UW professor of biology and of Earth and space sciences, says numerous mass extinctions show that our planet behaves in somewhat the same way. For example:

**The evolution of oxygen-producing organisms twice plunged Earth into ice ages as carbon dioxide, crucial for photosynthesis, was stripped from the atmosphere.

**The evolution of the first true animals caused extinction of most stromatolites, layers of microbes living in sediment in the oceans' intertidal zones. The result was somewhat more complex life forms, but a vastly smaller volume of living matter.

**The evolution of the first forests 400 million years ago is considered one of the great events in Earth history. But tree roots pushed into subsurface rocks, exposing them to increased weathering. The weathered elements again stripped carbon dioxide from the atmosphere and plunged the Earth into a 90 million-year ice age.

"The irony is that we have way too much carbon dioxide right now, but we should stash it in a bank because we're going to need it," Ward said. "The end of life as we know it is when we reach just 10 parts per million of carbon dioxide in the atmosphere."

Currently, carbon dioxide is at 380 parts per million and rising, creating a greenhouse effect that most climate scientists say will greatly increase temperatures around the world, with some severe consequences. For example, with the melting of mountain and polar ice sheets, the world's most-productive agricultural land will be submerged and humans will struggle to find food, Ward said.

He noted that throughout Earth's history, carbon has been stripped from the atmosphere and stored in trees, rocks, even the oceans. He said those processes will continue until atmospheric carbon dioxide drops to 10 parts per million, a point at which no plants can live. Once plants are gone, within 20 million years the oxygen will plummet to 1 percent of the total atmosphere and life as we know it will end.

"Then you've gotten to a point where it will be forever impossible to get diversity of life back. It will be forever impossible to regain an oxygen-rich atmosphere. That's not Gaia. It's the opposite of Gaia," he said.

He notes that of 15 mass extinction events in Earth's history, only the one 65 million years ago that brought an end to the age of dinosaurs was likely caused by a comet or asteroid crashing into the planet's surface. The others all resulted from Earth's own processes.

"There's no Gaia. There's just this dumb, blind life. It tries out all kinds of new things that are good for new kinds of life but are detrimental to everything else that exists. The innovations lead to disaster," Ward said.

He added that, contrary to recently popular beliefs, the planet likely would not somehow "heal itself" if all humans were suddenly removed. Instead, he said, humans are the key to saving the planet and, in the end, are perhaps the only true Gaian force.

"We're not renting. We're the owners, but there can be a cost to the rest of nature of our ownership," Ward said. "There is an easy fix – the only fix is intelligence. Knowing that there is a problem is what will get us out of it. We're the only ones who can put our hands on the controls."

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Weird Science News: Rachel Maddow Describes Fire Ant Research in Texas

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Your Brain On--and Off--Caffeine

Ever miss your daily cup of coffee and subsequently get a pounding headache? According to reports from consumers of coffee and other caffeinated products, caffeine withdrawal is often characterized by a headache, fatigue, feeling less alert, less energetic and experiencing difficulty concentrating. Researchers from the University of Vermont College of Medicine and Johns Hopkins School of Medicine sought to investigate the biological mechanisms of caffeine withdrawal in a paper published recently in the online edition of the scientific journal Psychopharmacology. They looked at brain electrical activity and blood flow during caffeine withdrawal to examine what was taking place physiologically during acute caffeine abstinence, including the likely mechanism underlying the common "caffeine withdrawal headache."

The group examined caffeine's effects in a double-blind study, which involved the administration of caffeine and placebo capsules. Each participant's response to the caffeine or placebo was measured using three different measures -- brain electrical activity via electroencephalogram (EEG); blood flow velocity in the brain via ultrasound; and participants' self-reports of subjective effects via questionnaires. The team demonstrated that stopping daily caffeine consumption produces changes in cerebral blood flow velocity and quantitative EEG that are likely related to the classic caffeine withdrawal symptoms of headache, drowsiness and decreased alertness. More specifically, acute caffeine abstinence increased brain blood flow, an effect that may account for commonly reported withdrawal headaches. Acute caffeine abstinence also produced changes in EEG (increased theta rhythm) that has previously been linked to the common withdrawal symptom of fatigue. Consistent with this, volunteers reported increases in measures of "tired," "fatigue," "sluggish" and "weary." Overall, these findings provide the most rigorous demonstration to date of physiological effects of caffeine withdrawal.

The researchers also discovered a provocative and somewhat unexpected finding -- that there were no net benefits associated with chronic caffeine administration.
"In addition to looking at caffeine withdrawal, this rigorous design also permitted comparison of chronic caffeine maintenance with chronic placebo maintenance, which provides unique information about the extent to which there are net beneficial effects of daily caffeine administration," said Stacey Sigmon, Ph.D., research associate professor of psychiatry at the University of Vermont and first author on the study. "In contrast to what most of us coffee lovers would think, our study showed no difference between when the participant was maintained on chronic placebo and when the participant was stabilized on chronic caffeine administration. What this means is that consuming caffeine regularly does not appear to produce any net beneficial effects, based on the measures we examined."

Co-authors on the study, which was a collaboration between Sigmon and Roland Griffiths, Ph.D., at the Johns Hopkins University School of Medicine, include Griffiths, as well as Ronald Herning, Warren Better and Jean Cadet of the National Institute on Drug Abuse's Molecular Neuropsychiatry section.

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Autism Linked to Being Firstborn, Breech or Moms 35 and Older Giving Birth

Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, University of Utah School of Medicine researchers have reported in a new study with Utah children.

In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder (ASD), compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found.insert beginning span tag hereAlthough they didn't identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first.

"The results of this study give us an opportunity to look more closely at these risk factors for children across the autism spectrum, and not only those diagnosed with autism," said first author Deborah A. Bilder, M.D., assistant professor of psychiatry. "This shows that further investigation of the influence of prenatal factors is warranted."

Autism is a complex brain disorder that impairs social, communicative, and behavioral development and often is characterized by extreme behavior.

Bilder and her colleagues in the U medical school's department of psychiatry and the Utah Department of Health examined the birth records of Utah children who had been identified as having an autism spectrum disorder in a 2002 epidemiological study by the U.S. Centers for Disease Control and Prevention (CDC). That study looked at 8-year-old children in Utah's three most populous counties--Salt Lake, Davis, and Utah--and used nationally accepted criteria for an ASD classification. The researchers compared birth records for children identified with an ASD with unaffected children born in those three counties in 1994. Of that group, 196 were identified with an ASD. Birth certificates were available for 132 of those children, and the researchers examined those records for possible prenatal, perinatal, and neonatal risk factors related to ASD.

Their investigation showed that the mother's age when giving birth (older than 34), breech presentation, and being firstborn were significant risk factors for the development of an ASD. The researchers also identified a small but significant relationship between the increased duration of education among mothers of those children.

Further investigation would be needed to understand how these three risk factors may relate to ASD. But a possible explanation for the correlation of firstborn children might be that parents are reluctant to have a second child if the first is diagnosed with ASD. A possible interpretation of increased risk associated with advanced maternal age is that changes in genes occurring over time may contribute to autism spectrum disorders. The association found between breech presentation and ASD most likely indicates a shared cause, such as neuromuscular dysfunction. The vast majority of children born breech, however, are healthy.

This study follows several from the University in recent years, which found that Utah has one of the highest autism spectrum disorder rates in the country (one in 133 Utah children has the disorder), helped indentify a gene that may predispose people to autism, and showed that Utah adults with autism have a better quality of life than those in other studies.

For the next step in their research, Bilder and her colleagues want to repeat this study, using a larger population of Utah 8-year-olds from subsequent birth years, to see if it replicates the results of the current study. They also may study the subset of children with breech presentation to determine whether they haven a genetic vulnerability that put them at increased risk for developing an autism spectrum disorder.

The study's other authors are Judith P. Zimmerman, Ph.D., research assistant professor of psychiatry; Judith Miller, Ph.D., associate professor of psychiatry; and William M. McMahon, M.D., chairman of the Department of Psychiatry.

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Lack of Food Variety Puts Kids with Autism at Risk for Poor Nutrition

The strong preference kids with autism have for certain foods places them at risk for nutritional deficiencies because their diets lack sufficient variety, according to research presented at this year's Pediatric Academic Societies meeting in Baltimore.

Researchers said screening children for the amount of variety of food in their diets may be a good clinical marker to predict which children might be at risk for nutrition problems. Kids with low food variety scores who are at risk could then be referred to dieticians or therapists to help them expand food choices and improve nutrition, said Michelle Zimmer, M.D., lead investigator and a pediatrician in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's.insert beginning span tag hereThe study is one of two presented by Dr. Zimmer and colleagues this year at PAS that deal with autism, the second one showing that the red blood cells of children with autism have low levels of a fatty acid linked to cognitive function. This finding, the researchers report, warrants further research into how the low fatty acid levels may trigger biochemical changes in the brain linked to autism.

The team found that levels of docosahexanoic acid and total omega-3 fatty acids were significantly lower in the red blood cells of autistic children than in normally developing children. Omega-3 fatty acids are nutritionally important substances considered vital to the normal development of children.

Evidence of abnormal fatty acid metabolism in children with autism runs counter to at least one previous study that suggested no difference between normally developing and autistic children. The different results between studies may be explained by the current research focusing on an older group of children, Dr. Zimmer said.

"The fatty acid docosahexanoic is linked to other mental health issues, and this raises questions about whether there are functional issues in neural cells involving a deficiency of essential fatty acids," said Dr. Zimmer. "The main point of the study is we cannot rule that fatty acids are part of the story of what is going on with kids who have autism."

Dr. Zimmer said its possible older children with autism have had more time to use up their bodies' stores of omega-3 fatty acids and are unable to replenish those stores. The 21 children with autism in this study were between the ages of 3 and 18 years, as were the 20 age-matched normally developing children and 10 if their siblings who served as control subjects.

The research team is conducting a larger study with more children to verify its PAS findings. Dr. Zimmer said another study is also under design to give essential omega-3 fatty acids, such as docosahexanonic acid, to children with autism to see what impact it has on brain chemistry and/or the disorder.

Increasing foods rich in omega-3 fatty acids in the diets of autistic children has been suggested by some researchers as potentially beneficial, Dr. Zimmer said. Although doing so would not have a negative impact on the children, until studies are conducted it isn't known what affect, if any, it might have, she added. Also, given the findings of the previous study on the lack of food variety among kids with autism, augmenting their diets could be challenging.

Most of the 19 autistic children in the food study had much lower food variety scores in their diets than typically developing children. A majority of the children with autism also suffered from nutritional deficiencies. The researchers concluded children with autism and low food variety scores are at risk for mild and serious nutritional deficiencies.

Researchers participating in studies were from the division of Developmental and Behavioral Pediatrics and division of Neurology at Cincinnati Children's. Researchers from the department of Pathology at the University of Cincinnati participated in the study on food variety.

The PAS meeting is the largest international meeting focused on research in child health. It is sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

Cincinnati Children's Hospital Medical Center is one of America's top three children's hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children's hospitals in the U.S., Cincinnati Children's is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health. For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize (r) for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes. Additional information can be found at www.cincinnatichildrens.org.

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Popular Diabetes Treatment Could Trigger Pancreatitis, Pancreatic Cancer

A drug widely used to treat Type 2 diabetes may have unintended effects on the pancreas that could lead to a form of low-grade pancreatitis in some patients and a greater risk of pancreatic cancer in long-term users, UCLA researchers have found.

In a study published in the online edition of the journal Diabetes, researchers from the Larry L. Hillblom Islet Research Center at UCLA found that sitagliptin, sold in pill form as Januvia, caused abnormalities in the pancreas that are recognized as risk factors for pancreatitis and, with time, pancreatic cancer in humans. Januvia is marketed by Merck & Co. Inc. Sitagliptin is a member of a new class of drugs that enhance the actions of the gut hormone known as glucagon-like peptide 1 (GLP-1), which has been shown to be effective in lowering blood sugar in people with Type 2 diabetes. The study is available at http://diabetes.diabetesjournals.org/cgi/content/abstract/db09-0058v1. "Type 2 diabetes is a lifelong disease -- people often take the same drugs for many years, so any adverse effect that could over time increase the risk for pancreatic cancer would be a concern," said Dr. Peter Butler, director of the Hillblom Center and the study's lead investigator. "A concern here is that the unwanted effects of this drug on the pancreas would likely not be detected in humans unless the pancreas was removed and examined."

An observed connection between Byetta, a drug used to treat Type 2 diabetes that is related to Januvia in its intended actions, and pancreatitis has already been reported, prompting a Food and Drug Administration warning. Amylin Corp., which markets Byetta, has suggested that since there is no known mechanism linking the cases of pancreatitis with Byetta, the association might be chance. The UCLA study suggests that there may indeed be a link between drugs that enhance the actions of GLP-1 and pancreatitis -- by increasing the rate of formation of cells that line the pancreatic ducts.

In the study, researchers used human IAPP transgenic (HIP) rats to test both sitagliptin and metformin; metformin, a member of an older, different class of diabetes drugs in use since the 1950s, has recently been found to have anti-tumor properties. The researchers sought to determine how the drugs, both singly and in combination, affected islet disease progression in the pancreas -- particularly how they affected beta cells in the pancreas's Islets of Langerhans. Beta cells are responsible for releasing insulin in people with normal metabolism, but they don't produce insulin in sufficient amounts in diabetes patients. HIP rats approximate both the islets and metabolism of people with Type 2 diabetes. The drugs were tested in 40 rats for 12 weeks.

The researchers found that the two drugs in combination had a synergistic effect that helped preserve beta cells, improved their function and enhanced insulin sensitivity in the test rats. With the sitagliptin alone, however, the rats had abnormally high rates of cell production in their pancreatic ducts; a few developed an abnormality known as ductal metaplasia, and one developed pancreatitis.

But the metformin, trade name Glucophage, seems to counteract sitagliptin's adverse effect.

"The apparent protection against the unwanted actions of sitagliptin in the exocrine pancreas are intriguing and may offer a potential way of using the GLP-1 class of drugs safely," Butler said. "The protective effect may have been either by the actions of metformin to decrease blood glucose values or its recently appreciated properties as a tumor suppressive agent."

Butler noted that the present study was undertaken in rats and that it is possible the adverse effects observed would not occur in humans.

"Given these findings, it is probably sensible to use the GLP-1 class of drugs only with metformin until other data is forthcoming," he said.

The National Institutes of Health, the Larry Hillblom Foundation and the Merck Research Foundation funded this study.

In addition to Butler, researchers included Aleksey V. Matveyenko, Heather I. Cox, Artemis Moshtaghian, Tatyana Gurlo, Ryan Galasso and Alexandra E. Butler, all of the Hillblom Center, and Sarah Dry of the department of pathology and laboratory medicine at the David Geffen School of Medicine at UCLA.

The Larry L. Hillblom Islet Research Center at UCLA, established in 2004, is the first center dedicated to the study of the Islets of Langerhans, which include the insulin-producing cells in the pancreas. An understanding of the causes of islet cell destruction is key to finding a cure for diabetes. The center's faculty members, recruited from around the world, provide leadership in the worldwide fight against the disease. The center is funded by a grant from the Larry Hillblom Foundation, which supports medical research in the state of California.

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Biofuel Production: a Drink-Or-Drive Issue?

Federal requirements to increase the production of ethanol has developed into a "drink-or-drive issue" in the Midwest as a result of biofuel production's impact on water supplies and water quality, says an environmental engineering researcher at Missouri University of Science and Technology in the latest issue of the journal Environmental Science & Technology.

In an analysis of the water required to produce ethanol from various crops, Dr. Joel G. Burken, a professor of environmental engineering at Missouri S&T, and colleagues from Rice University and Clarkson University find that ethanol could become a costly proposition in terms of "gallons per mile" and other water quality issues. They describe the Midwest's water needs and impacts as the 'water footprint' in their cover feature for the May 1 issue of Environmental Science & Technology. The researchers report that ethanol derived from corn grown in Nebraska, for example, would require 50 gallons of water per mile driven, when all the water needed in irrigation of crops and processing into ethanol is considered. Fuel derived from irrigated sorghum grown in that state would require even more water to produce - as much as 115 gallons per mile.

Moreover, increasing production of biofuels from row crops will likely result in more water pollution due to soil erosion and the increased use of pesticides to grow enough crops to meet federal mandates for more ethanol, the researchers say. The mandated production using the current technology has driven the use of ethanol production from corn and biodiesel from soybeans as these are the currently available technologies.

In their Environmental Science & Technology article, the researchers suggest that federal regulators take a closer look at how a push for bioenergy will affect water resources.

"Developing a sustainable national biofuels program requires careful consideration of logistical concerns ... and of unintended environmental impacts," write Burken and his co-authors, Rosa Dominguez-Faus and Dr. Pedro J. Alvarez of Rice University and Dr. Susan E. Powers of Clarkson University, in their article, "The Water Footprint of Biofuels: A Drink or Drive Issue?" The article is online at http://pubs.acs.org/doi/abs/10.1021/es802162x.

To arrive at their gallons-per-mile figures, the researchers first looked at the amount of water required to produce a single gallon of ethanol. In Nebraska, for example, it takes 800 gallons of water - from crop irrigation through final processing into ethanol - to create a single gallon of the corn-derived transportation fuel. Divide that by an average mileage of 16 miles per gallon (or two-thirds the average for gasoline-powered cars, a standard average for ethanol-powered vehicles), and the result is 50 gallons of water per mile.

While previous studies have examined biofuel production's impact on air quality, land use and net energy value, "the effect of increased biofuel production on water security has not been subjected to the same scrutiny," the researchers write. The main focus of previous studies looked at environmental trade-offs to fossil-fuel usage and not other aspects of biofuel production, according to the researchers.

"The overall water footprint associated with biofuels must recognize the impact of increased agricultural activity on water quality as well as water consumption," they write. With the federal Energy Independence and Security Act (EISA) of 2007 calling for a dramatic ramp-up in ethanol production by 2015, Burken and his colleagues foresee additional water quality problems due to "increased agricultural activity such as tilling more land for row crops and higher fertilizer and agrichemical application."

The Energy Independence and Security Act requires the United States to produce 15 billion gallons of corn-derived ethanol annually by 2015 and 16 billion gallons of fuel from cellulosic crops, such as switchgrass, by 2016. The researchers note that 44 percent of all the corn produced in the United States from 2007 would be required for ethanol production to meet the 2015 goal.

"The decision to mandate ethanol production may look great initially as we all like the concept of biofuels," Burken says, "but really our difficult energy position and reliance on foreign oil is the result of our lack of an energy policy and investing a decade ago in biofuel technologies. Biofuel production is part of our energy future, but it needs to be considered as part of a portfolio of energy sources and technologies."

While it's unlikely the EISA will be repealed, Burken hopes lawmakers and regulators at the state and federal levels "consider a life-cycle analysis before implementing future mandates" for energy sources. Lawmakers and regulators need to consider all of the economic and environmental trade-offs - not just reducing greenhouse gas emissions, for instance. "Otherwise, we may be thinking we're addressing one environmental issue while in fact sacrificing another," Burken says.

Burken and his colleagues suggest that "drought-tolerant, high-yield plants grown on little irrigation water" would have less impact on water resources. One such crop, Burken says, is miscanthus, a fast-growing perennial grass that "grows so dense you can't walk through it and grows about 9-10 feet a year." Currently, however, no technology is available to convert the cellulosic biomass and produce it in large quantities. Once alternative biofuel production crops and processes are developed, selecting the best crop for individual settings will help to optimize biofuel production and minimize the environmental impacts of the production, Burken says.

"Developing the crops and distribution of crop production took about 100 years to get to where it was a few years ago," Burken says. "Redeveloping this production with the goal of biofuel production will take time and effort of farmers and engineers. While miscanthus may or may not be a part of our biofuels future, we at least need a little time and investment to develop the best solutions for our future."

Quoting Texas oilman T. Boone Pickens, whom Burken met on April 22 during the Missouri Energy Summit, Burken says, "The best time to plant a tree was 20 years ago, but the next best time if you didn't is today."

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Study Predicts Dramatic Growth in Cancer Rates Among U.S. Elderly, Minorities

Over the next 20 years, the number of new cancer cases diagnosed annually in the United States will increase by 45 percent, from 1.6 million in 2010 to 2.3 million in 2030, with a dramatic spike in incidence predicted in the elderly and minority populations, according to research from The University of Texas M. D. Anderson Cancer Center.

The study, published online today in Journal of Clinical Oncology, is the first to determine such specific long-term cancer incidence projections. It predicts a 67 percent increase in the number of adults age-65-or-older diagnosed with cancer, from 1 million in 2010 to 1.6 million in 2030. In non-white individuals over the same 20-year span, the incidence is expected to increase by 100 percent, from 330,000 to 660,000. According to Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology, the study underscores cancer's growing stress on the U.S. health care system.

"In 2030, 70 percent of all cancers will be diagnosed in the elderly and 28 percent in minorities, and the number of older adults diagnosed with cancer will be the same as the total number of Americans diagnosed with cancer in 2010," said Smith, the study's senior author. "Also alarming is that a number of the types of cancers that are expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates."

Unless specific prevention and/or treatment strategies are discovered, cancer death rates also will increase dramatically, said Smith, who is currently on active military duty and is stationed at Lackland Air Force Base.

To conduct their research, Smith and his team accessed the United States Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, the premier population-based cancer registry representing 26 percent of the country's population. Cancer incidence rates were calculated by multiplying the age, sex, race and origin-specific population projections by the age, sex, race and origin-specific cancer incidence rates.

The researchers found that from 2010 to 2030, the population is expected to grow by 19 percent (from 305 to 365 million). The total number of cancer cases will increase by 45 percent (from 1.6 to 2.3 million), with a 67 percent increase in cancer incidence in older Americans (1 to 1.6 million), compared to an 11 percent increase in those under the age of 65 (.63 to .67 million).

With respect to race, a 100 percent increase in cancer is expected for minorities (.33 to .66 million); in contrast, in white Americans, a 31 percent increase is anticipated (1.3 to 1.7 million). The rates of cancer in blacks, American Indian-Alaska Native, multi-racial, Asian-Pacific Islanders and Hispanics will increase by 64 percent, 76 percent, 101 percent, 132 percent and 142 percent, respectively.

Regarding disease-specific findings, Smith and his team found that the leading cancer sites are expected to remain constant - breast, prostate, colon and lung. However, cancer sites with the greatest increase in incidence expected are: stomach (67 percent); liver (59 percent); myeloma (57 percent); pancreas (55 percent); and bladder (54 percent).

Given these statistics, the role of screening and prevention strategies becomes all the more vital and should be strongly encouraged, said Smith. In the study, Smith and his team site: vaccinations for hepatitis B and HPV; the chemoprevention agents tamoxifen and raloxifene; interventions for tobacco and alcohol; and removal of pre-malignant lesions, such as colon polyps.

These findings also highlight two issues that must be addressed simultaneously: clinical trial participation and the increasing cost of cancer care. Historically, both older adults and minorities have been under-represented in such studies, and, therefore, vulnerable to sub-optimal cancer treatment. Simultaneously, over the past decade in particular, the cost of cancer care is growing at a rate that's not sustainable.

"The fact that these two groups have been under-represented in clinical research participation, yet their incidence of cancer is growing so rapidly, reflects the need for therapeutic trials to be more inclusive and address issues that are particularly relevant to both populations," said Smith. "In addition, as we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients. These are two issues that oncologists need to be much more concerned about and attuned to."

Another issue that needs to be addressed is the shortage of health care professionals predicted. For example, according to a workforce assessment by American Society for Clinical Oncology (ASCO), the shortage of medical oncologists will impact the health care system by 2020. Smith said ASCO and other professional medical organizations beyond oncology are aware of the problem, and are actively engaged in efforts to try and grow the number of physicians, as well as encourage the careers of nurse practitioners and physician assistants who are part of the continuum of care, to best accommodate the increase in demand forecasted.

"There's no doubt the increasing incidence of cancer is a very important societal issue. There will not be one solution to this problem, but many different issues that need to be addressed to prepare for these changes," said Smith. "I'm afraid if we don't come to grips with this as a society, health care may be the next bubble to burst."

In addition to Smith, other M. D. Anderson authors on the study include: Thomas Buchholz, M.D., professor and chair of the Department of Radiation Oncology and the study's senior author; Gabriel Hortobagyi, M.D., professor and chair of the Department of Breast Medical Oncology; and Grace Smith, M.D., Ph.D., assistant professor in the Department of Radiation Oncology. Arti Hurria, M.D., post-doctoral fellow in the Department of Medical Oncology, City of Hope Cancer Center, also is a contributing author on the study.

About M. D. Anderson
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News & World Report.

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Obesity, Diabetes Interfere With Work Productivity

Obese workers with type 2 diabetes report less productivity on the job than their normal-weight co-workers, according to a new study of 7,338 working adults.

"We obtained information directly from individuals on how effective they were at the workplace to provide their perspective of the impact of diabetes and obesity on patients' lives," said study co-author Kathleen Fox, Ph.D. In a survey of adults with or at risk for diabetes, participants answered questions about missed work time, reduced on-the-job effectiveness and impairment in daily activities.

The analysis, which appears in the May/June issue of the American Journal of Health Promotion, found that being obese and having diabetes predicted on-the-job problems with productivity.

Obese people with type 2 diabetes experienced the most work impairment, losing 11 percent to 15 percent of work time -- about 5.9 hours per week -- because of health problems that affected productivity on the job, said Fox, president of Strategic Healthcare Solutions, LLC.

In comparison, normal-weight participants at low risk for diabetes reported losing only 9 percent of work time -- about 3.6 hours per week -- due to health problems.

Obese workers with type 2 diabetes also experienced the most problems off the job, reporting impairment during 20 percent to 34 percent of their daily activities, like shopping, exercising and childcare.

The study supports previously published research that "the heavier people are, the more lost productivity at work," said Anne Wolf, an instructor at the University of Virginia School of Medicine who specializes in researching the economic impact of obesity.

What differed was that researchers found an independent effect of diabetes on productivity, Wolf said.

"From an employer's perspective, this study provides evidence that workplace wellness programs that include weight loss and weight management would be beneficial for obese employees with or at risk for diabetes," Fox said.

"Employers who spend money in a lifestyle intervention will find their investment returned to them in the form of increased productivity and reduced absenteeism," Wolf agreed.

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