More resources needed to improve ‘grossly inadequate’ health services for skin disorders in Hong Kong, dermatologist warns

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To veteran dermatologist Tommy Luk Nai-ming, a 23-year-old Hong Kong woman’s suicide note last month saying her eczema left her feeling she would be better “dead than alive” underscored how distressing skin disorders could be.

“Skin diseases can lead to many psychological problems,” said Luk, who retired in 2015 after spending more than 20 years treating skin conditions in Hong Kong’s government hospitals and clinics.

It was not known if the woman – whose parents were also found dead with stab wounds in their home – received treatment from the public sector.

But to Luk, it was a stark reminder of the need for more resources to develop public dermatology services, which he described as “grossly inadequate”.

To give the poor and elderly a “helping hand”, the 64-year-old provides free consultations and runs the non-profit Hong Kong Dermatology Foundation to raise awareness of skin conditions.

Luk, a former senior medical officer with the Department of Health, proposed restructuring the department’s Social Hygiene Service, under which dermatology services and treatment of sexually transmitted diseases are lumped together.

This is common in some countries but other developed economies, such as Britain, have made dermatology a separate medical service.

Doing the same in Hong Kong would mean the specialty received targeted resources and this would improve treatment options for disorders, Luk said.

“The department has placed a higher priority on sexually transmitted diseases … as they are infectious diseases,” he said, agreeing that curbing the spread of such diseases was critical.

But he stressed that proper treatment of skin diseases, which might be misunderstood by some people as being for cosmetic purposes only, was equally important for patients’ well-being.

Twice a week the foundation’s clinic in Yau Ma Tei, Luk offers free skin consultations to underprivileged patients referred from partnering non-governmental organisations, including those serving the elderly or people with intellectual disabilities.

More than 440 patients have benefited since the free service started in 2016.

Luk said there had not been much progress in treating skin diseases in the public sector; for instance, the options were roughly the same now as about 20 years ago. Yet there are more than 2,000 skin diseases and, globally, there have been advances in how they are understood and treated, he added.

Last year, more than 236,000 patient attendances were recorded at clinics under the Social Hygiene Service unit for skin problems while the number was over 86,000 for sexually transmitted diseases.

Only about 30 doctors work in the unit but they do not treat HIV/Aids patients who are handled by the department’s Special Preventive Programme.

A patient could wait more than three years to see a doctor.

Meanwhile, only two public hospitals – Prince of Wales and Queen Mary – have their own dermatologists working there.

Dr Leung Sze-kee, president of the Hong Kong College of Dermatologists, said ideally the two services should be separated in the long run, but the unit needed more doctors first.

“There would be even less manpower for dermatology if the current two services were separated in the public sector,” Leung said.

Private dermatologist Dr Kingsley Chan Hau-ngai said a public-private partnership scheme could be introduced to provide public patients with better access to skin services.

The department said it planned to increase the number of doctors in the Social Hygiene Service unit this year to improve treatment for those with severe psoriasis and other serious skin diseases. However, it had no plans to split the dermatology and sexually transmitted disease services.

The Food and Health Bureau said it would continue to monitor the service’s manpower and enhance its provision as appropriate. The Hospital Authority said it would work closely with the department to explore the strengthening of specialist training in dermatology and service provision in public hospitals.


Turmeric tea for weight loss? You have more options in ginger, lemon and green tea

Best tea for weight loss: The benefits of green tea, say fitness experts, are many. It helps decrease inflammation, improves skin and decrease growth of cancer cells in the body.

The aroma of tea brewing over a burner is the perfect sight in the monsoons. And what’s better is the fact that you can lose weight while sipping on some hot chai. Though our milky chai has not been associated with weight loss, the newer varieties available in the market promise instant weight loss. In fact nutritionist Rujuta Diwekar encourages her clients to drink milky chai for its many benefits. Many fitness experts count turmeric tea, ginger, lemon and green tea among the best tea for weight loss.

Green tea, which has been immensely popular in the past decade, has anti-cancer properties apart from weight loss. It speeds up the metabolism process by directly acting at the cellular level and thereby helping the fat burn rate in the body. White tea, which is a purer form of tea, inhibits the production of fat cells and also helps in weight loss,” says Harish Mohan, founder SipWise, a beverage brand.

Here’s a list of some other teas to try for weight loss

Turmeric tea

Turmeric tea accelerates digestion, increases metabolism and promotes weight loss. Turmeric has a bioactive compound called curcuminoids – curcumin, which has many powerful medicinal healing properties. “The curcumin in turmeric suppresses the growth of fat tissues and helps reduce weight. Eating mindfully and drinking turmeric tea regularly could help restrict increase in fat cells,” says Payal Kothari, integrative nutritionist and life coach.

Green tea

Being a storehouse of many antioxidant compounds, it’s easy to assume that green tea is one of the healthiest beverages. This tea helps decrease inflammation, improves skin and decrease growth of cancer cells. “This is a calorie-free drink and something that most weight-watchers swear by. Green tea contains catechins, antioxidants that help suppress the production of free radicals in the body. It has also been shown to activate the body’s thermogenic fat-burning activity,” explains Delhi-based Sujata Sharma, who is a diabetes educator for the BeatO app.

Matcha tea

For the uninitiated, matcha is a finely ground green tea. In ancient Japan, monks primarily consumed it as a beverage of choice. Now, it can either be dissolved in milk or water to add to its versatility — and also for its health benefits. “This green tea leaf powder is high in chlorophyll levels which promotes cell regeneration, detoxes and reboots the body keeping it healthy and inflammation free,” says Kothari. Apart from the health benefits like improving moods, memory and concentration, helping you relax, aiding in weight loss, matcha has taken a diverse transformation into the culinary world with chefs adding it to desserts, smoothies among other things.

Ginger, lemon, mint herbal tea

“If consumed on a daily basis, this concoction acts as a great immunity booster with its anti-bacterial, antioxidant and anti-inflammatory properties, ideal for all ages,” says Kothari. Just a cup of this healing tea can help detoxify and makes the body alkaline. It is easier to lose weight when the body is in alkaline mode.


Chronotherapy Could Make Cancer Treatments More Effective, Here’s How

Chronotherapy Could Make Cancer Treatments More Effective, Here

Chi Van Dang generally declines to discuss the science that made him famous. A leading authority on cancer metabolism, he routinely is asked to speak about how tumors reprogram biochemical pathways to help them slurp up nutrients and how disrupting these noxious adaptations could be a powerful approach to treating cancer. Instead of doing so, Dang uses his soapbox at every research meeting, lecture and blue-ribbon panel to advocate for something else: a simple yet radical tweak to how oncologists administer cancer drugs.

The approach, known as chronotherapy, involves timing delivery of drugs to minimize side effects while maximizing effectiveness. The idea is to synchronize therapy with the body’s natural 24-hour rhythms — the circadian clock — and striking when cancer cells are most vulnerable or when healthy cells are least sensitive to toxicity (or, ideally, both).

Dang didn’t set out to become an ambassador for this field. But as scientific director of the Ludwig Institute for Cancer Research, a nonprofit that funds cancer labs worldwide, and chair of the board of scientific advisers at the National Cancer Institute, he finds himself in a powerful position to reshape the research agenda — and he believes chronotherapy’s time has come.

It is not an entirely new concept. Some trials in the 1980s and 1990s showed dramatic reductions in toxicities and extended survival times among cancer patients who were treated in a clock-optimized fashion. But mostly “it’s just always been on the fringe,” says Dang. “There weren’t that many card-carrying cancer biologists like me getting into it.”

Until now.

Researchers are finding new ways to administer old drugs and they are devising clever tactics for rewiring aberrant clocks. They are transforming a strategy long dismissed as complementary or alternative medicine into rigorous science. Last year, the NCI — the largest funder of cancer research in the world — put out a call for grant applications from scientists seeking to understand how circadian processes affect tumor development and the responses of patients to therapy.

“It’s capturing people’s interest,” Dang says.

A slender and bespectacled 63-year-old with the confident and unhurried voice of a seasoned physician, Dang cites his father — Chieu Van Dang, Vietnam’s first neurosurgeon and a former dean of the University of Saigon School of Medicine — as a role model. His father’s death from liver cancer in 2004 remains an inspiration to develop better treatments.

Family also was a driving factor behind a career move that prompted Dang’s embrace of circadian biology. He had spent nearly 25 years at Johns Hopkins University, rising to vice dean for research of the medical school; he figured he’d never leave. But in 2011, after his older brother Bob died of cancer, Dang said he thought, “I need to do more.”

So when the University of Pennsylvania approached him that year with an offer to become director of its cancer center, he jumped.

Penn also is home to one of the nation’s largest groups of chronobiology researchers, and Dang found himself chatting and collaborating with clock researchers across the campus. It prompted an epiphany: If cancer is a disease of runaway cell growth and if circadian rhythms keep cell cycles in check, then disrupting the internal clock must be, as Dang puts it, a “missing link” of tumor development and growth.

The circadian clock is a complex biological circuit that controls daily rhythms of sleep, eating, body temperature and more. There is a master clock that sits in the brain, secondary clocks in other organs and clocks in each cell, controlled by a network of genes and proteins that oscillate their activity levels in periodic cycles.

When these clocks are in sync, the body operates properly. But when clock genes are mutated or thrown off by jet lag, these systems can get out of whack, which can create conditions for tumors to grow and spread.

Early hints that disrupted clocks could lead to cancer came in 2001, when two teams of epidemiologists concluded that women who regularly worked night shifts had increased chances of developing breast cancer. Later studies established links between graveyard shifts and cancers of the colon, prostate and endometrium — which prompted the World Health Organization’s International Agency for Research on Cancer in 2007 to designate night-shift work involving circadian disruption as a probable carcinogen.

Researchers now generally believe that nocturnal light, which decreases the body’s natural production of the clock-regulating hormone melatonin, explains such a link. This suggests that melatonin pills or modulating ambient lighting could help mitigate risk among shift workers.

But, says Steven Hill, a circadian cancer researcher at Tulane University, “there are no published studies or active interventional studies” to back that up.

In part, that’s because prevention trials of this kind would be hugely expensive and lengthy — and also because many researchers are instead focused on treatment strategies for people who already have a cancer diagnosis. Earlier this year, for example, a team at the Salk Institute for Biological Studies in La Jolla, California, described two novel drugs that target key clock components and kill several types of cancer cells in a laboratory dish while also slowing the growth of brain tumors in mice.

By reawakening circadian clocks in cancer cells, the drugs seemed to block biological functions that tumors rely upon.

Dang’s own research has focused mainly on showing how a notorious cancer gene named MYC suppresses genes at the core of the mammalian clock. This suppression pushes cells into aberrant, perpetual activity that drives tumor progression. Last year, researchers at Texas Children’s Cancer Center reported that a drug that indirectly stimulates one of these clock genes, BMAL1, could help blunt the growth of neuroblastoma, a cancer of nerve tissue, in cell cultures and mice.

Dang also has recently studied a class of anti-tumor drugs that failed in clinical testing 10 to 20 years ago. They all caused such low platelet counts that they never progressed past early trials.

Now, in mouse experiments, Dang’s team has found that timing is key. Drugs given at 10 a.m. or 6 p.m. both caused tumor regression, but only the 6 p.m. treatment caused low platelet counts. Perhaps, he says, patients in those early trials were given the drugs at the wrong time.

Another drug that doctors may be administering suboptimally is streptozocin, used to treat a rare form of pancreatic cancer. A 2017 mouse study showed that timing streptozocin administration minimized drug toxicity. And although research results in mice often don’t translate to people, the scientists behind this finding hope to test this schedule in patients.

Other data suggest that resetting clocks in tumors could mitigate cancer side effects such as low blood-cell counts and perhaps cachexia, a devastating loss of body weight and strength that often afflicts people in the final stages of cancer.

At the moment, only one chronotherapy clinical trial is running in the United States. It’s happening at the Washington University School of Medicine in St. Louis, where neuro-oncologist Jian Campian and colleagues over the past two years have treated 30 brain cancer patients with the chemotherapy drug temozolomide at 8 a.m. or 8 p.m.

So far, Campian said, it looks as if the drug’s side effects are far worse when people take it in the morning, though it’s too early to say anything conclusive.

A sticking point for timed treatment is that people differ. We all have “chronotypes” that determine whether we are morning or evening people, and that will probably affect responses to cancer drugs, notes Campian’s collaborator Erik Herzog. Ideally, treatment timings would be finely tuned to patients — “the ultimate personalized medicine,” Herzog says.

But precisely and noninvasively measuring people’s clocks, or the clock of their tumors, is no small task. “We still need to identify better biomarkers to personalize chronotherapy,” says Francis Lévi, a chronotherapy researcher at the University of Warwick in Britain.

For now, most human data comes from anecdotal reports such as those of Joe Kuna, who was diagnosed with metastatic colon cancer in 2014 and given two to five years to live. Four years on, the 61-year-old has survived a tennis-ball-size tumor in his colon and 15 lesions in his liver. Kuna, who runs a bowling alley in Johnsburg, Illinois, opted to undergo chronotherapy at the nearby Block Center for Integrative Cancer Treatment in Skokie.

For almost two years, Kuna would arrive at the center every other Tuesday, usually between 1 p.m. and 3:30 p.m., for his dose of oxaliplatin. Oncologist Keith Block, medical director of the clinic, said oxaliplatin seems to work best in the afternoon.

Kuna would sit in a cubicle and eat his tuna fish sandwich while the intravenous medication dripped into his veins through a port.

Another drug in Kuna’s chemotherapeutic cocktail, fluorouracil, is considered more of a nighttime agent — so Kuna took home a pump that was programmed to kick in at 10 p.m.

“I truly believe it’s why I’m still here,” Kuna said of this treatment and the diet and supplement regimen he followed. Although a scan in January revealed two new cancerous spots in his liver, Kuna is confident that, with surgery and more chronotherapy, he could be cancer-free once more. Doctors removed the new tumors on April 26.

Still, there’s no proof that Kuna’s treatment made a difference. The other patients he befriended at the Block Center are not alive today.

Most chronotherapy strategies are based on a limited understanding of clock biology — which frustrates Dang, who has yet to test any of his ideas surrounding drug timing in patients.

“We really want to provide the mechanistic basis of why you treat at a certain time of day, and not just rely on trial and error,” he said.

But perhaps, just as a small career move reshaped his own research, “it could be,” he said, “that simple adjustments make a big difference for patients.”