swineflutracker.co.uk

An extract of bitter melon “can block breast cancer” reported BBC News. Its website reported on research that suggests that it “turns off signals telling the breast cancer cells to divide, and switched on signals encouraging them to commit suicide”.

The study underlying this news story looked at the effect of an extract of the exotic bitter melon fruit on breast cancer cells that were grown in culture. It found that the extract halted division of the cells and triggered a type of ‘cell suicide’ where the cells make proteins that induce their own death.

However, this was very preliminary research and its direct relevance to humans is very limited without much more research. The research also failed to identify the key ingredients in bitter melon that caused these effects on cells. Overall, this research has provided no evidence to suggest that eating bitter melon or bitter melon extract can prevent or treat breast cancer.

 

Where did the story come from?

This US research was carried out by Dr Ratna Ray and colleagues from Saint Louis University and the University of Hawaii. The study was financially supported by funding from Saint Louis University.
The study was published in the peer-reviewed journal, Cancer Research.

This research was covered well by the BBC, which emphasised the very preliminary nature of this research. The Independent also covered the story concisely but did not specify that this work was done using cultured cells in a laboratory; its statement that “bitter melon extract significantly induced death in breast cancer cells and decreased their growth and spread” could be misinterpreted as referring to the tumour cells of a cancer patient.

 

What kind of research was this?

This was a laboratory study looking at how a concentrated extract of bitter melon affected human breast cancer cells in culture. It also compared how exposure to bitter melon extract (BME) affected non-cancerous human cells.

The researchers report that extract of bitter melon (Momordica charantia) has sugar- and fat-lowering properties.

 

What did the research involve?

The researchers used two types of human breast cancer cell lines, MCF-7 and MDA-MB-231. They also examined a non-cancerous human breast cell line known as HMEC cells.

To prepare the BME the researchers liquidised bitter melons in a household juicer and centrifuged the contents to remove any solids, leaving liquid BME.

The researchers added the extract to the cells in increasing concentrations and measured cell death. They measured cell death by either looking at whether the membrane surrounding the cell was intact, or by looking for markers of a type of programmed cell death called apoptosis. In apoptosis a stimulus will trigger a cell to switch on genes that will cause it to die.

 

What were the basic results?

When cell death was measured by looking at cell membrane integrity, 80% of the MCF-7 and MDA-MB-231 cancer cells had died within 48 hours of treatment with 2 parts BME to 100 parts cell culture medium (the liquid which covers cells in culture and provides their nutrients). At the same BME concentration the non-cancerous HMEC cells did not die, even after five days.

Programmed cell death involves a combination of proteins that can promote or prevent cell death. When exposed to BME the  MCF-7 and MDA-MB-231 cancer cells had raised levels in the protein, catalase, that is produced during programmed cell death. The cancer cells also showed reduced levels of three proteins that prevent programmed cell death (survivin, XIAP and claspin).

Cancer cells divide frequently, causing tumours to grow. The researchers found that cell division was partially halted when treated with BME for 24 hours. The amount of two proteins involved in cell division – cyclin B1 and cyclin D1 – was also lowered.

 

How did the researchers interpret the results?

The researchers suggest that BME inhibits cell growth and causes breast cancer cells to die through programmed cell death. They suggest that BME affects several proteins involved in controlling cell division and cell death, and that these signalling pathways may have a combined effect to induce breast cancer cell death. They further add that BME “can be used as a dietary supplement for prevention of breast cancer”.

 

Conclusion

This was a basic laboratory study that found that putting bitter melon extract on breast cancer cells in culture caused cell death. As this study was conducted on cells in the laboratory there is limited relevance to humans without further research. It does not provide sufficient evidence to suggest that BME supplements or consuming bitter melon can prevent or treat breast cancer.

Cells grown in cell culture can behave very differently to those in the human body. Even in culture, cells’ behaviour can vary depending on the type of nutrient-containing liquid (medium) that they are grown in. A limitation of the present study is that the cancerous and non-cancerous cells were grown in different types of medium, which may have affected their response to the BME.

A further limitation of the study is that it did not isolate which chemical or chemicals in BME caused the effects observed. Much more additional research is needed to assess whether chemicals within bitter melon have any potential in breast cancer drug development or any ability to prevent cancer when ingested.

Links To The Headlines

Extracts of bitter melon ‘can block breast cancer’. BBC News, February 26 2010

Sweet promises from this bitter vegetable. The Independent, February 26 2010

Links To Science

Ray RB, Raychoudhuri A, Steele R and Nerurkar P. Bitter Melon (Momordica charantia) Extract Inhibits Breast Cancer Cell Proliferation by Modulating Cell Cycle Regulatory Genes and Promotes Apoptosis. Cancer Research [Published online first] February 23 2010

“Back pain may be ‘in the mind’” reported The Daily Telegraph, saying that “researchers believe that counselling, or cognitive behavioural therapy [CBT] sessions, work because if you can help people change their thoughts, it will help them to change the way they feel”.

The newspaper report may give some people the wrong impression about these findings. The researchers did not find that back pain may all be in the mind, and did not assess the psychology of pain.

Instead, they compared a one-off advice session given by a nurse or physiotherapist, with this advice session combined with CBT group support sessions. These were designed to solve patients’ difficulties in keeping physically active as a consequence of back pain, and involved finding appropriate exercises that they could do, and ongoing advice and support on physical activities for improving their fitness and quality of life. People in the trial were also instructed in the appropriate use of pain medications.

It found that patients given the extra support sessions had improved physical fitness and quality of life, compared to patients given one-off advice. This indicates that this sort of treatment may provide a simple and relatively cheap way of improving chronic lower back pain.

 

Where did the story come from?

This research was carried out by Professor Sarah E Lamb and colleagues from The University of Warwick and the University of Oxford. The study was funded by The National Institute for Health Research Health Technology Assessment Programme. The study was published in the peer-reviewed medical journal The Lancet.

This research was covered well by BBC News, The Independent and the Daily Mail. The Telegraph incorrectly focused on pain “being all in the mind” and inferred that CBT was targeting the psychology of pain, rather than the psychology of how people manage their pain and their feelings about physical activity.

 

What kind of research was this?

Lower back pain is a common disabling condition in developed countries. Guidance suggests that people with persistent non-specific back pain remain physically active and avoid bed rest. Patients are also advised on how to manage their symptoms and how to use their pain medication appropriately. However, the effect of these lifestyle modifications may be short lived, with pain persisting in the long term.

This randomised controlled trial investigated whether this ‘best practice’ advice was more effective if patients also attended group support sessions and CBT with other people who had lower back pain. Group therapy benefits patients as they can give and receive support from others with similar problems, and treatment can be less expensive than one-on-one care. Here, the researchers wanted to investigate the effectiveness and cost of these interventions.

 

What did the research involve?

The researchers recruited 701 participants from 56 general practices in seven regions across England. Those who took part were identified from consultations with GPs or practice nurses and from searches from patient records.

To be included, participants had to be over 18. They had to have at least moderately troublesome subacute or chronic back pain for a minimum of six weeks and had visited their GP for help with the pain within the past six months. People were excluded if they had a specific or potentially serious cause for their back pain, such as infection, fracture or cancer. The study also excluded people who have severe psychiatric or psychological disorders and those who had tried CBT similar to that used in this study for their back pain.

The participants were randomly assigned to receive advice alone (control) or advice plus CBT. Before being allocated a treatment, a nurse gave them a 15-minute session of active management advice about maintaining physical activity, appropriate drug use and symptom management. The participants were also given The Back Book, which contains information on the management of back pain.

The 233 people in the control group received no further advice. The 468 people in the CBT group attended the Back Skills Training (BeST) programme, consisting of an individual assessment and six group therapy sessions in groups of around eight people. Each session lasted an hour and a half and targeted physical activity and avoidance of activity. This included countering negative thoughts about activity, and advice on different intensity activities and relaxation techniques.

The researchers measured back pain disability using the Roland Morris disability (0-24 points) questionnaire and the modified Von Korff scale (0-100%). In both of these scales, low scores indicate less disability. The participants’ mental and physical health-related quality of life was assessed using the 12-item short-form health survey at 3, 6 and 12 months. These questionnaires were sent out and returned by post.

 

What were the basic results?

The researchers found that 63% of participants in the CBT group attended a sufficient number of sessions to potentially benefit from the therapy. Reasons for not attending the sessions included ill health, work or family problems. Older individuals were more likely to attend the sessions.

Compared with advice alone, advice plus cognitive behavioural intervention was associated with significant benefits in disability. On the Roland Morris score, disability improved by 1.1 points in the control group and by 2.4 points in the intervention group at 12 months. The Von Korff score also showed the CBT group had a greater improvement in disability over 12 months than the control group.
 
When the patients reported how beneficial the treatments had been, 31% of the control group and 59% of the CBT group self-reported recovery at 12 months. Also, more patients in the CBT group were satisfied with their treatment at 12 months. The CBT group also had an improvement in fear avoidance as well as their physical scores, whereas the control group did not.

The total annual costs for each individual were £224.65 in the control group and £421.52 in the CBT group.

 

How did the researchers interpret the results?

The researchers suggest that compared to other treatments such as manipulation, exercise, acupuncture and postural approaches, the benefits of CBT for people with chronic lower back pain were broader and lasted for at least 12 months. They also suggest that when the improvement in quality of life is taken into account, this treatment is cost effective.

 

Conclusion

This well conducted randomised controlled trial found that group CBT was of benefit to people with chronic lower back pain compared with individuals who received one-off advice on how to manage their condition through activity modifications and symptom control.

Although the therapy was effective, the researchers noted that 63% of people attended ‘sufficient’ CBT sessions to potentially benefit and 11% did not attend any of the sessions. Further research would be required to find out how to increase the numbers who attended the sessions. People who received CBT were also unlikely to have been using this intervention in isolation to manage their back pain, as advice was given to them about modifying their activities and pain medications.

It should also be noted that this management strategy would be suitable for chronic ‘nonspecific’ back pain only – that is, pain without an identified medical cause. This type of chronic low back pain is a very common and debilitating condition.

However, there are serious causes of back pain, such as infection, cancer or damage to the spine, that should always be considered and then excluded in a person with persisting or newly developed pain. Likewise, in people who have chronic low back pain without an identified cause, it is always beneficial for health professionals to explore the wider work-related and social or family effects and issues that may be involved with chronic back pain.

This was a randomised controlled trial, this is the best type of study to determine whether a treatment is effective or not. The study was well-carried out and gives good evidence that CBT can be beneficial in aiding patients to manage their chronic back pain effectively, particularly by maintaining appropriate physical activity leading to improvements in their quality of life.

Links To The Headlines

Back pain ‘eased by group therapy sessions’. BBC News, February 26 2010

How talking about your bad back can take the pain away. Daily Mail, February 26 2010

Group therapy ‘can help back pain sufferers’. The Independent, February 26 2010

Back pain may be ‘in the mind’. The Daily Telegraph, February 26 2010

Links To Science

Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. The Lancet 2010; Published online February 26