Most people don’t realize that over 30,000 people are purposely shot to death each year in the U.S. Moreover, rates of firearm-related violent crimes continue to climb, having increased by 26% since 2008. To gain perspective on these numbers, firearm deaths have now reached a yearly rate that equals that of automobile fatalities. What we can do to stem such violence is urgent but hampered severely by the rabid supporters of the second amendment and, of course, the gun lobby. Some clarification recently has been shed on this problem by a study appearing in the prestigious medical journal, the AMA sponsored Archives of Internal Medicine. These authors explored the question whether more restrictive firearm laws in a given state are associated with fewer shooting deaths. To answer this question, using sophisticated statistical methods, they measured the association between the rate of shooting deaths in a state-by-state rating (divided into quarters) of strength of legislation designed to limit sale and use of firearms. Their results were very illuminating: Those states with the fewest firearm regulations, as exemplified by Utah and Louisiana (0-2 laws), suffered the highest rate of firearm fatalities, which included both homicides and suicides. The states with the strictest pattern of regulation, as exemplified by Hawaii and Massachusetts (9-24 laws) experienced the lowest fatality rates. Indiana, my home State, fell into the second lowest category for regulation and, as expected, fell into the second highest incidence of firearm deaths.

    These authors freely admitted that finding an association between two factors—gun laws and mortality—does not prove that these two are causally related. But it sure raises important thoughts about what we as a society can do about this problem. Further research is obviously needed, but it is quite likely that more restrictive gun laws can save lives.

The experience in Australia adds strong support to this argument: In response to a mass shooting of 20 people by an assault weapon in 1996, the state enacted a comprehensive set of firearm law reforms. Among others, the regulations included a ban on civilian ownership of semiautomatic long guns and pump action shotguns. Financed by a small tax levy on all workers, this law was combined with a buyback program of those guns already in circulation. This included a prohibition of mail or internet gun sales with required registration of all firearms continuing to be legally held. Since then, there have been no mass shootings and an accelerated decline in total gun-related deaths.   

    Another study appearing in a major medical journal has added even more weight to these conclusions. In a study that included 27 different countries around the world, researchers found that there was a strong correlation between gun ownership rates and firearm-related deaths. Those countries with the highest rates of gun ownership, e.g. the U.S.A. (88.8 per 100 inhabitants) suffered the highest firearm-related deaths, whereas those with the lowest rates of such possession, i.e., Japan and the U.K. (0.6 and 6.2 per 100) enjoyed the lowest rate of such deaths. Interestingly these same researchers found a poor correlation between mental illness and firearm deaths. 

    Another proposed remedy, i.e. more aggressive attempts to identify, treat and constrain the huge numbers of those who are mentally ill, is an exercise doomed to failure.

Moreover, the limited relationship between mental illness and firearm deaths, as noted above, implies that trying to find and treat those suffering from mental illness would do little to reduce the number of gun-related fatalities. Hall and Friedman provided further confirmation of this concept (Mayo Clinic journal, November, 2013), by concluding that proper identification the small proportion of the mentally ill individuals capable of homicide prior to an actual act of violence is extremely difficult, if not impossible.

     Widespread arming of teachers and/or police officers is equally ridiculous, especially since it would increase chances for erroneous shootings in the absence of any expected benefits.

    With such limited options available, what are we left with? Although we need not scrap the second amendment, those who hold legislative power should seriously consider stronger laws restricting guns, while, at the same time, sponsoring and performing more comprehensive research on this urgent problem. If we value life, we cannot afford to wait!      

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    We have long known that regular exercise can prevent cardiovascular disease. For the past 20 years, however, evidence has been accumulating that such exercise can prevent some cancers, especially those involving the colon and breast. The list of potentially preventable cancer types has been growing, with evidence now suggesting that the prevention may also include cancers of the lung, uterus, and prostate gland.

    Regarding cancer in men, prostate cancer is the most prevalent form, being diagnosed in approximately 223,000 men yearly, but fatalities are relatively low, at 29,000.

    Lung cancer is found in about 110,000 yearly, and causes death in 88,000

    Colorectal cancers are diagnosed in 72,700 men, and fatal in 27,000.

   In women, a whopping 230,480 new cases of invasive breast cancer are being diagnosed yearly in the U.S. A total of 39,500 are expected to die from this disorder.


                             THE ROLE OF EXERCISE

   In 2003, a paper in the journal Medicine & Science in Sports & Exercise reported that more than a hundred population (epidemiologic) studies on the role of physical activity and cancer prevention have been published. The authors noted that:

    “The data are clear in showing that physically active men and women have about a 30-40 percent reduction in the risk of developing colon cancer, compared with inactive persons … With regard to breast cancer, there is reasonably clear evidence that physically active women have about a 20-30 percent reduction in risk, compared with inactive women. It also appears that 30-60 min/day of moderate- to vigorous-intensity physical activity is needed to decrease the risk of breast cancer, and that there is likely a dose-response relation.”

    These studies were collected mainly by questionnaires about exercise regularity and subsequent development of cancers. Although this type of information is convincing, we now have even more conclusive results derived from careful assessment of physical fitness and development of cancer, at least in men.

    According to a 20-year, prospective study of more than 17,000 men at the Cooper Institute in Dallas, Texas, measured levels of cardiorespiratory fitness appear to be as predictive of cancer risk and survival as they are of heart disease risk and survival.

   Their data showed that the risks of lung and colorectal cancer were reduced 68% and 38%, respectively, in men with the highest level of cardiorespiratory fitness, compared with those who were the least fit.

    Although cardiorespiratory fitness did not significantly reduce prostate cancer incidence, the risk of dying was significantly lower among men with prostate, lung, or colorectal cancer if they were more fit in middle age.

   Although prior studies have shown that being physically active is protective against cancer, this study is unique because it looked at a very specific marker – cardiorespiratory fitness as measured by maximal exercise tolerance testing.

What was unexpected was that evidence of fitness not only predicts prevention of cancer but also even mortality after cancer has already been diagnosed.

    Thus quantitative measurements of fitness might be compared with measuring your cholesterol, providing us with a very specific number to target. Merely asking someone about his/her physical activity doesn’t provide that information.

     The 17,049 men in the study underwent exercise tolerance testing with a treadmill or bicycle and risk factor assessment at an average age of 50 years as part of a long term study. Metabolic equivalents (METs) were used to record the men’s cardiorespiratory fitness (CRF) and to place them into five CRF quintiles. Lung, colorectal and prostate cancers were assessed using Medicare claims data at Medicare age, and cause-specific mortality was determined after cancer diagnosis.

    Over the 20 years of follow-up, 2,885 men had been diagnosed with prostate, lung, or colorectal cancer, and of these, 769 died. .

    Compared with men in the lowest CRF fitness quintile, hazard ratios for developing lung and colorectal cancer men in the highest fitness group were 68% lower for lung cancer and 32% lower for colorectal cancer, after researchers adjusted for such risk factors as smoking, body mass index, and age.

    In men who had already developed all these cancers, mortality also declined across the higher the fitness groups.

   Even a single MET increase in fitness reduced the risk of dying from cancer and cardiovascular disease by 14% and 23%, respectively.

   Another striking finding is that even if men aren’t obese, they still have an increased risk of cancer if they aren’t fit, suggesting that everyone can benefit from improving their fitness. The findings also suggest that, ideally, individuals should be advised that they need to achieve a certain fitness level, and not just be told that they need to exercise

   The study did not evaluate whether a particular type of exercise contributed more consistently to cardiovascular fitness, but in general, activities performed at high intensity, regardless of type, are the best way to improve fitness.

    Additional research is needed to determine fitness and cancer risk in women, fitness and risk of all major site-specific cancers and the necessary change in fitness to prevent cancer.

   In the meantime, plenty of exercise is fit for all!

Cancer Fitness



6R27SJPMJJ99               What is hypertension?

Hypertension is blood pressure that persistently stays higher than normal. Blood pressure is the force of blood against artery walls as the heart pumps blood through the body. Blood pressure can be unhealthy if it exceeds 140/90. (140 refers to the highest level reached with each heartbeat, and the 90, the low between these beats.) The higher your blood pressure, the greater the health risks. If you think that’s not your problem, think again, for this condition affects at least one third of our adult population!

High blood pressure can be controlled or prevented if you take these steps:

  • Maintain a healthy weight.
  • Be physically active.
  • Follow a healthy eating plan, which includes foods that do not contain a lot of salt (sodium}, often referred to as the DASH diet..
  • Do not drink a lot of alcohol.

Diet affects high blood pressure. “DASH” stands for “dietary approaches to stop hypertension.” Following the DASH diet and reducing the amount of sodium in your diet will help lower your blood pressure. If pressure is presently normal, this diet will also help prevent high blood pressure, which, as noted, is extremely common.

What is the DASH diet?

The DASH diet is a diet that is low in saturated and trans fat, cholesterol, and total fat. It is rich in fruits, vegetables, and low-fat dairy foods. The DASH diet also includes whole-grain products, fish, poultry, and nuts. It encourages fewer servings of red meat, sweets, and sugar-containing beverages. It is rich in magnesium, potassium, and calcium, as well as protein and fiber.

How do I get started on the DASH diet?

The DASH diet requires no special foods and has no hard-to-follow recipes. Start by seeing how DASH compares with your current eating habits.

The DASH eating plan illustrated below is based on a diet of 2,000 calories a day. Your healthcare provider or a dietitian can help you determine how many calories a day you need. Most adults need somewhere between 1600 and 2800 calories a day, which varies according to physical activity. Serving sizes for different foods vary from 1/2 cup to 1 and 1/4 cups. Check product nutrition labels for serving sizes and the number of calories per serving.

Make changes gradually. Here are some suggestions that might help:

  • If you now eat fewer than 1 or 2 servings of vegetables a day, add a serving at lunch and another at dinner.
  • Puree vegetables and add them into soups, stews, and sauces.
  • If you have not been eating fruit regularly, or have only juice at breakfast, add a serving to your meals or have it as a snack.
  • Drink milk or water with lunch or dinner instead of soda, sugar-sweetened tea, or alcohol. Choose low-fat (1%) or fat-free (nonfat) dairy products so that you are eating fewer calories and less saturated and trans fat, total fat, and cholesterol.
  • Read food labels on margarines and salad dressings to choose products lowest in fat and sodium.
  • If you now eat large portions of meat, slowly cut back—by a half or a third at each meal. Limit meat to 6 ounces a day (two 3-ounce servings). Three to 4 ounces is about the size of a deck of cards.
  • Have 2 or more meatless meals each week. Increase servings of vegetables, rice, pasta, and beans in all meals. Try casseroles, pasta, and stir-fry dishes, which have less meat and more vegetables, grains, and beans.
  • Use fruits canned in their own juice. Fresh fruits require little or no preparation. Dried fruits are a good choice to carry with you or to have ready in the car.
  • Try these snacks ideas: unsalted pretzels or nuts mixed with raisins, graham crackers, low-fat and fat-free yogurt or frozen yogurt, popcorn with no salt or butter added, and raw vegetables.
  • Choose whole-grain foods to get more nutrients, including minerals and fiber. For example, choose whole-wheat bread, whole-grain cereals, or brown rice. Although whole grains are a healthy choice, large portions can lead to weight gain. A portion of grain is 1/2 to 1 cup. A cup of food is about the same size as your fist.
  • Use fresh, frozen, or no-salt-added canned vegetables.

·        Remember to also reduce the salt and sodium in your diet. Try to have no more than 2300 milligrams (mg) of sodium per day, with a goal of further reducing the sodium to 1500 mg per day. Two thirds of a teaspoon of table salt equals about 1500 mg of sodium. However, even if you can’t achieve these goals, recent research shows that even modest reductions in salt intake can produce lesser, but beneficial, reductions in blood pressure.

Some important ways to reduce sodium are the following:

  • Eat food products with reduced-sodium or no salt added. In general, canned soups contain far too much sodium.
  • Use less salt when you prepare foods and do not add salt to your food at the table.
  • Read food labels. Aim for foods that contain less than 5% of the daily value of sodium
  • Watch out for sodium hidden in canned sauces, instant soups, salad dressings, frozen dinners and packaged foods in general.
  • Avoid large portions of baked goods, such as pancakes and biscuits, which are extremely high in sodium due to the baking soda content.
  • When eating at restaurants or grocery shopping, choose low sodium alternatives.

The DASH eating plan is not designed for weight loss. But it contains many lower-calorie foods, such as fruits and vegetables. You can make it lower in calories by replacing high-calorie foods with more fruits and vegetables. Some ideas to increase fruits and vegetables and decrease calories include:

  • Eat a medium apple instead of 4 shortbread cookies. You’ll save 80 calories.
  • Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds. You’ll save 230 calories.
  • Have a hamburger that’s 3 ounces instead of 6 ounces. Add a 1/2 cup serving of carrots and a 1/2 cup serving of spinach. You’ll save more than 200 calories.
  • Instead of 5 ounces of chicken, have a stir fry with 2 ounces of chicken and 1 and 1/2 cups of raw vegetables. Use just a small amount of vegetable oil. You’ll save 50 calories.
  • Have a 1/2 cup serving of low-fat frozen yogurt instead of a 1-and-1/2-ounce chocolate bar. You’ll save about 110 calories.
  • Use low-fat or fat-free condiments, such as fat-free salad dressings.
  • Eat smaller portions. Cut back gradually.
  • Use food labels to compare fat and calorie content in packaged foods. Items marked low fat or fat free may be lower in fat but not lower in calories than their regular versions.
  • Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks.
  • Drink water or club soda instead of cola or other soda drinks.

For more information, see the Guide to Lowering your Blood Pressure with DASH at: