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EDITOR'S CHOICE: Kamran Abbasi Champions and betrayers of public health BMJ 2003; 327: 0-f [Full text]

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Primary Task of WHO: learning and teaching the Pre-Metabolic Syndrome.

Sergio Stagnaro   (29 August 2003)

Fleming is still the champion of public health - 75 years later.

Friedrich Flachsbart   (3 September 2003)

Primary Task of WHO: learning and teaching the Pre-Metabolic Syndrome. 29 August 2003
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genoa) Italy. Send response to journal: Re: Primary Task of WHO: learning and teaching the Pre-Metabolic Syndrome.	WHO's election, fortunately, is over. Now, its members have to think that insulin resistance is associated with both breast cancer, with worse outcome(1), and colorectal (2) and prostate cancers (3). Thus, Dr. Reaven states rightfully: "what began as a relatively narrow cardiovascular issue...has broad implications." In 1988, Dr. Reaven initially suggested the link between what was then termed "Syndrome X" and coronary heart disease (CHD) via insulin resistance, hyperinsulinemia, hypertension, high plasma triglyceride levels, and low plasma HDL cholesterol, with varying degrees of glucose intolerance. Frank diabetes, impaired fasting glucose, and impaired glucose tolerance may be present, but half of the persons with such as syndrome have normal glucose tolerance (4). All around the world, many authors underline the pivotal role of metabolic syndrome in the onset of both cancer and type 2 diabetes (2, 5, 6). However, we must admit that not all patients with metabolic syndrome are, or will be, affected by type 2 diabetes and/or cancer. Biophysical Semeiotics and Clinical Microangiology (HONCode site 233736, http://digilander.libero.it/semeioticabiofisica, and http://digilander.libero.it/microangiologia) enlighten the above-mentioned link, from patho-physiological view-point. Really, on the base of an inherited mitochondrial cytopatology, I named Congenital Acidosic Enzyme- Metabolic Hystangiopathy (7, 8, 9) (CAEMH) (http://digilander.libero.it/semeioticabiofisica/Documenti/Eng/istangiopatia%20cong.acidos.enzimo) , there are a lot of biophysical-semeiotic constitutions (http://digilander.libero.it/semeioticabiofisica/constitutions.htm), conditio sine qua non of the most common and severe human diseases, including type 2 diabetes and malignancies. The transition from these gene-dependent conditions to well-defined diseases, necessarily passes through a lot of stages, first of all, the “pre-metabolic syndrome”, real forerunner of all other disorders, and, thus, locus of primary prevention (http://bmj.com/cgi/eletters/327/7409/266#35204), I have largely illustrated in a previous article (URL: http://digilander.libero.it/microangiologia/Documenti/Eng/Pre- metabolic%20syndrome%20engl.doc). In conclusion, only individuals affected by well-defined biophysical-semeiotic constitutions, e.g., “diabetic AND dyslipidemic”, oncological, a.s.o., if particularly intense, can suffer from type 2 diabetes and, respectively, from cancer (Oncological Terrain: URL http://digilander.libero.it/semeioticabiofisica/oncological.htm). In conclusion, the “pre-metabolic syndrome” is the first abnormal biological event, lasting years or decades, as the forerunner of metabolic syndrome and, then, of the most common human diseases. References 1. Goodwin PJ, Ennis M, Pritchard KI, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol. 2002;20:42-51. Abstract 2. Kaaks R, Toniolo P, Akhmedkhanov A, et al. Serum C-peptide, insulin- like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst. 2000;92:1592-1600. Abstract 3. Hsing AW, Chua S Jr, Gao YT, et al. Prostate cancer risk and serum levels of insulin and leptin: a population-based study. J Natl Cancer Inst. 2001;93:783-789. Abstract 4. Reaven G. Insulin resistance: Why is it important? What is the link between it and cardiovascular disease? How can you recognize it? Program of the American Association of Clinical Endocrinologists 12th Annual Meeting and Clinical Congress; May 14-18, 2003; San Diego, California. 5. Sinagra D et al. Metabolic syndrome and breast cancer risk. Eur Rev Med Pharmacol Sci. 2002; 6: 55-59. 6. Boissonneult GA et al. Dietary fat and neoplasia. The role of net energy in enhancement of carcinogenesis: effect of fat and calories on the immune system. Adv Exp Med Biol 1996; 206: 85-98. 7. Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz. Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28 Settembre-1 Ottobre, Bellagio, 1983. 8) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. X Congr. Naz. Soc. It. di Microangiologia e Microcircolazione. Atti, 61. 6-7 Novembre, Siena, 1981. 9) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una Patologia Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144, 423,1993. (Infotrieve). Competing interests:   None declared
Fleming is still the champion of public health - 75 years later. 3 September 2003
Friedrich Flachsbart, General medicine 37085 Göttingen Send response to journal: Re: Fleming is still the champion of public health - 75 years later.	Dear Sir, Respiratory infections, rheumatic heart disease and post-streptococcal-glomerulonephritis are still the main killer of men. 75 years ago, September 3, 1928, Fleming changed the world. Now we are able to resist. Penicillin. Sincerely Yours Friedrich Flachsbart Competing interests:   None declared