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Indonesia: Warning issued over ‘dragon’s breath’ viral video trend

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CNN
 — 

Indonesia is warning people against consuming liquid nitrogen after more than 20 children were harmed eating a street snack known as “dragon’s breath” that’s at the center of a dangerous new viral video trend.

The children suffered burns to their skin, severe stomach pains and food poisoning after consuming the colorful candies, according to Indonesia’s Ministry of Health, which is urging parents, teachers and local health authorities to be vigilant.

The candies are dipped in liquid nitrogen to create a vapor effect when eaten. They are popular with children, dozens of whom have uploaded clips to short-form video app TikTok showing them blowing the fumes out of their mouths, noses and ears. One video showing the preparation of the snack by a street vendor has been viewed close to 10 million times.

Around 25 children have been hurt consuming the candies, including two who were hospitalized, said the ministry’s director general Maxi Rein Rondonuwu. No deaths have been reported.

Using liquid nitrogen in food preparation is not illegal. Top chefs often use the vapors to create theatrical effects when serving dishes. It is clear, colorless and odorless, and commonly used in medical settings and as an ingredient to freeze food.

However, when not used properly, it can be hazardous.

”Liquid nitrogen is not only dangerous when consumed, it can cause severe breathing difficulties from nitrogen fumes that are inhaled over a long time,” Maxi said.

The first case was reported in July 2022, according to the ministry, when a child from a village in the Ponorogo Regency in East Java suffered cold burns on his skin after eating the snack.

More cases were reported in November and December, including a 4-year-old boy who was admitted to hospital in the capital Jakarta with severe stomach pain.

“Schools must educate children in the community about the dangers of liquid nitrogen in food (to) prevent more cases of severe food poisoning,” Maxi said.

– Source:
HLN
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New liquid nitrogen cereal sparks controversy

In 2018, the US Food and Drug Administration (FDA) issued safety alerts warning that serious injury could result from eating foods like ice cream, cereal or cocktails prepared with liquid nitrogen.

“Injuries have occurred from handling or eating products prepared by adding liquid nitrogen immediately before consumption, even after the liquid nitrogen has fully evaporated due to the extremely low temperature of the food,” the FDA said.

“This is a hazardous chemical compound,” said Clarence Yeo, a Singapore-based doctor. “It irritates the stomach and can cause burns in the mouth and esophagus. Children would be especially sensitive to (its effects) if it is eaten in large amounts.”

Yeo warned he “wouldn’t advise anyone to eat it.”

“You could end up in hospital and the worst case scenario could be organ damage,” he said.

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Health

Some people may be able to stretch out the time between colonoscopies, study suggests

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CNN
 — 

A new study raises the question whether some people can wait longer than the recommended 10years to repeat a colonoscopy after a negative initial screening for colorectal cancer.

The study, published in JAMA Internal Medicine, looked at 120,000 people 65 and older in Germany from 2013 to 2019 who had a colonoscopy 10 or more years after an initial negative screening, and it compared them with all colonoscopy screenings conducted on people 65 or older in that time period – most of whom were being screened for the first time.

It found the presence of precancerous or cancerous growths was 40% to 50% lower among the repeat screeners, finding advanced growths or cancers in only 4% to 5% of women and 5% to 7% of men 10 or more years after a negative colonoscopy.

The researchers also evaluated whether the number of abnormal growths differed between men and women, finding the prevalence 40% higher in men.

When looking by age, detection rates were highest among individuals 75 years or older.

The authors conclude that the current 10-year screening intervals for colonoscopies are safe, and they also suggest that extending the intervals may be warranted in some instances, especially for females and younger people without gastrointestinal symptoms.

“For instance, women at younger screening ages with no finding at index colonoscopy could possibly be screened at prolonged intervals or, alternatively, be offered less invasive methods, such as stool tests, while maintaining the 10-year interval for men and women at older ages,” the study authors wrote.

Colorectal cancer is the second leading cause of cancer deaths in the United States. It is also one of the most preventable cancers with effective screening tests like colonoscopies that can detect early disease.

Death rates from colorectal cancer have decreased over recent decades, largely due to colonoscopies.

Current guidelines recommend screening for colorectal cancer in all adults 45 to 75 years old. The recommendations were recently changed to start screening at 45 instead of 50 years of age in response to more cancer being diagnosed at younger ages. If the screening is negative, patients don’t need another one for 10 years.

Dr. Douglas Owens, a health policy professor at Stanford University and a former chair of the US Preventive Services Task Force, which makes US cancer screening recommendations, said there is promise to the findings.

“(Colorectal cancer) is not like other cancers where there are big harms from over screening potentially. Here they are small, but they’re not zero, and it comes from the colonoscopy. So, if you could get the same benefit at a lower number of colonoscopies, that would be a win,” Owens said.

Owens would like to see more research on extending the screening intervals, as would Dr. Robert Bresalier, a professor of gastrointestinal oncology at MD Anderson Cancer Center.

“There’s good evidence that screening colonoscopy in asymptomatic individuals at 10-year intervals is effective and cost effective. And I think I’m not ready to change. I would not be ready to change practice in terms of extending the interval based on the study, but it is comforting and provides additional data to strengthen the concept of adhering to these guidelines,” Bresalier said. “The overall message from this study is we can feel comfortable with the current guidelines.”

The study authors note the study’s finding don’t extend to individuals who might need to undergo a colonoscopy at earlier intervals to assess symptoms they might be having, such as rectal bleeding, or individuals who are at higher risk of colorectal cancer. They say generalizing their findings should be done cautiously.

Experts maintain that colonoscopies are one of the most important preventive services and for all eligible groups to get tested.

“(This study) supports the importance of screening for colon cancer and that there are many ways, many effective ways to do that,” Owens said.

Although colonoscopy is considered the gold standard for colon cancer screening, there are alternatives. Other screening options include annual fecal occult blood tests which look for blood in the stool.

“The main thing is to get screened. It doesn’t matter if you use a stool test or you get a colonoscopy, pick one. Pick whichever one suits your preferences, but do it,” Owens said.

More than a quarter of eligible Americans don’t get screened for colorectal cancer, and public health advocates urge Americans to get screened.

“Right now, the biggest impact we can have – and relevant to this discussion — is screening. So if you haven’t been screened and you’re in that age relevant group, you should get screened. And that clearly has a larger impact, and the biggest impact we can do right now in terms of influencing death of colorectal cancer,” Bresalier said.

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Entertainment

How to screen for colon cancer

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CNN
 — 

Colon cancer has claimed another life. Emmy Award and Golden Globe winner Kirstie Alley, best known for her roles in the television sitcoms “Cheers” and “Veronica’s Closet,” died Monday at age 71 after battling cancer that was “recently discovered,” according to a family statement.

A representative for Alley confirmed to CNN via email on Tuesday that she had been diagnosed with colon cancer prior to her death.

Colorectal cancer, which includes colon and rectal cancers, is the second most common cause of death from cancer in 2022, outranked only by lung and bronchus cancer, according to the National Cancer Institute Surveillance, Epidemiology and End Results Program.

Regular checkups are the best way to keep colon cancer at bay, according to the US Preventive Services Task Force. The task force lowered the age to begin screening for colon and rectal cancer to 45 last year after a worrisome spike in cases of colorectal cancer in people younger than 50.

The new recommendations apply to everyone ages 45 to 75, including people with no symptoms, no prior diagnosis, no family history of colon or rectal disease, and no personal history of polyps, which are all key risk factors. Polyps are bumps or tiny mushroom-like stalks that grow inside the colon or rectum.

If these growths are not found and removed, they can turn cancerous.

Adults ages 76 to 85 years can also be screened, depending on their overall health, prior screening history and personal preferences, the task force said.

Colorectal cancer screening can occur in several ways, including simple mail-in tests that look for blood or cancer cells in a sample of stool collected by the patient. However, all stool tests can have false-positive test results, which would likely require a more invasive test to rule out cancer, according to the American Cancer Society.

Stool tests: While a stool test is the least invasive option, it does have to be done at least once a year, the society said. No anti-inflammatory pain relievers can be taken for seven days prior to a stool test, while red meats such as beef, lamb or liver and any citrus or vitamin C supplements should be avoided for at least three days.

If the test finds something of concern, “you will still need a colonoscopy to see if you have cancer,” according to ACS. However, hidden bleeding in the stool does not automatically signal cancer, as ulcers, hemorrhoids and other conditions can also cause rectal bleeding.

DNA stool test: A DNA stool test is another option, the society said. Because colorectal cancer cells can have DNA mutations, the test can screen for those genetic abnormalities. This test only needs to be done once every three years, but an entire stool sample must be collected and mailed.

Patients may have insurance coverage issues because the test is fairly new, ACS said. Again, if anything suspicious is found, a colonoscopy will still be required.

For all of the following tests, the colon must be clean and free of stool matter, which requires at-home bowel prep. Ways to empty the bowels include pills, drinking a laxative solution or the use of an enema the night before the procedure.

This process has become much easier over the years with the advent of new kits that don’t require as much liquid laxative, so talk to your doctor about your options, ACS suggested.

Colonoscopy: One of the most widely used tests, this procedure allows a doctor access to the entire length of the colon and rectum with a colonoscope, a “flexible, lighted tube about the thickness of a finger with a small video camera on the end,” ACS said.

Typically, the patient is under light sedation during the whole procedure, waking up with no knowledge of the process. Watching on video in real time as the scope moves through the intestine, the doctor can stop and insert small instruments into the scope to take a sample or even remove any suspicious polyps.

Virtual colonscopy: This test uses computer programs that take X-rays and a computed tomography (CT) scan to make three-dimensional pictures of the inside of the colon and rectum.

The test does not require sedation. However, it does require the same bowel prep as a regular colonoscopy. After the patient drinks a contrast dye, a small, flexible tube will be inserted into the rectum, followed by pumped air expand the rectum and colon for better pictures.

As with all CT scans, this procedure exposes the patient to a small amount of radiation and can cause cramping until the air exits the body, the society said. If a suspicious mass is detected, a colonoscopy will still be needed to remove the mass.

Flexible sigmoidoscopy: This test inserts the same flexible camera tube into the lower part of the colon. However, because the tube is only 2 feet (60 centimeters) long, this test only allows the doctor to examine the entire rectum and less than half of the colon — any polpys in the upper colon will be missed. This test is not often used in the United States, the society said.

Many people avoid a colonoscopy, partly due to the preparation, so as a way of encouraging people to get screened, former “Today” host Katie Couric broadcast her entire procedure in 2000 — from prep the night before to a mildly sedated Couric watching the procedure as it unfolded.

“I have a pretty little colon,” Couric said with a sleepy chuckle as she watched the video projection from the scope inside her colon. “You didn’t put the scope in yet, did you?” asked Couric, whose husband, Jay Monahan, had died from colon cancer at age 42 in 1998.

“Yes! We’re doing the examination. We’re almost done,” said her physician, the late Dr. Kenneth Forde, who taught for nearly 40 years at Vagelos College of Physicians and Surgeons at Columbia University in New York City.

More recently, actors Ryan Reynolds and Rob McElhenney videotaped parts of their colonoscopies to raise public awareness after Reynolds lost a bet.

“Rob and I both, we turned 45 this year,” Reynolds said in the video. “And you know, part of being this age is getting a colonoscopy. It’s a simple step that could literally — and I mean, literally — save your life.”

Doctors found both actors had polyps that were removed during the screening.

“It’s not every day that you can raise awareness about something that will most definitely save lives. That’s enough motivation for me to let you in on a camera being shoved up my a–,” Reynolds said.

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Business

In wake of baby formula crisis, critical report recommends major food safety changes at FDA

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CNN
 — 

To help prevent outbreaks of food-related illness and problems like the formula shortage that left many parents in the US without adequate access to food for their babies, the US Food and Drug Administration needs a clearer mission and a different kind of leadership, and it has to act with more urgency, according to a highly critical new report.

After the agency faced serious criticism for its handling of the formula shortage, FDA Commissioner Dr. Robert Califf commissioned the review of the Human Foods Program in July from the Reagan-Udall Foundation, an independent group of experts.

The need for a review was considered so urgent that Califf asked the group to submit the report in 60 business days – lightning speed for government-focused reports. It was submitted to the FDA on Tuesday.

About 48 million Americans get some kind of foodborne illness every year, according to the US Centers for Disease Control and Prevention. Of those, 128,000 are hospitalized, and 3,000 die. Produce alone in 2019 was responsible for 46% of foodborne illness outbreaks, according to the US Department of Agriculture.

The FDA oversees the safety of 78% of the US human food supply.

It enforces food safety regulations, works with local governments on food safety information, promotes dietary guidelines, and develops food safety information and education, as well as overseeing nutrition labels on most food and being responsible for promoting good nutrition practices to the US public.

The US food supply is generally recognized as safe, the Reagan-Udall Foundation’s report said, but the FDA needs to be much more proactive in dealing with foodborne pathogens in order to protect Americans.

“An approach that is primarily focused on identifying and reacting to acute outbreaks of foodborne illness and death is unacceptable,” the report says.

Americans’ nutrition can also improve, the report says. Most people don’t follow the US dietary recommendations, and more than a million die of diseases that can be linked to diet such as heart disease, type 2 diabetes and cancer each year, according to the FDA

“Relying solely on food labeling and consumer education to drive the needed changes in the food supply is also an unacceptable strategy for reducing diet-related chronic diseases,” the new report says.

The report suggests that the agency needs major reform in order to do a better job managing food in the US. Some of the proposed changes would require congressional approval.

The report has several suggestions for ways to reach these goals. One would create a separate Center for Nutrition within the US Department of Health and Human Services. Another would have the FDA develop a strategy to increase funding for the Human Foods Program, with help from Congress. The agency could also connect its technology systems so they better communicate with each other.

The FDA could seek to amend the Federal Food, Drug, and Cosmetic Act to allow the disclosure of more information to local agencies. Or it could get regulatory authority to request records from food manufacturers in advance or in lieu of inspection.

The report recommends that the FDA explore applying its authority to require infant formula manufacturers, for instance, to keep microbiological testing records that are available on request so there is real-time disclosure of results.

It also suggests that the FDA use its mandatory recall authority more often and that there should be a process by which accommodations are made for products that are considered life-sustaining, like formula. At the moment, food recalls are usually voluntarily initiated by a manufacturer or food distributor.

The report also notes that the food program is run under the leadership of several managers. This “lack of a single, clearly identified person” to lead the program has led to a culture of “constant turmoil” and “indecisiveness and inaction” that has created “disincentives for collaboration,” according to the report.

That turmoil was partly to blame for the agency’s problematic handling of the formula shortage, the report says.

Experts have said the agency failed to act quickly enough on sanitation complaints at an Abbott Nutrition formula manufacturing facility in Michigan, and because of a lack of communication across departments, it didn’t circumvent what became a massive shortage of formula after the plant shut down.

“A review of events indicates that lack of communication and engagement across the Agency accounted, in part, for missteps,” the new report says. “There was little motivation, and apparently no requirement, to share information and interact across the Agency to facilitate critical thinking and proactive decision-making.

“This is especially problematic in a crisis, where decisions should be made quickly and be vetted properly.”

The report suggests that the FDA create a new structure with clear roles and leaders. It also encourages development of a culture that is more transparent, that acts quickly and collaborates.

“The current culture of the FDA Human Foods Program is inhibiting its ability to effectively accomplish this goal” of protecting public health,” the report says.

Califf said Tuesday that the agency has not had the opportunity to review the report in depth but that the report provides “significant observations” and options to consider.

“The work of these independent evaluators will help to inform a new vision for the FDA Human Foods Program,” Califf said in a news release.

Some critics have suggested that food safety takes a back seat to the FDA’s regulations of drugs and medical devices. Califf acknowledged that food policy was important to the agency, citing the decline in life expectancy in the US largely due to chronic diseases that can be improved with good nutrition.

“The Human Foods Program is a top priority for the agency. America’s food supply is as safe as it’s ever been,” he said. “That said, over the past several years, the program has been stressed by the increasing diversity and complexity of the nation’s food systems and supply chain, the ongoing impacts associated with climate change and rapid advances in the science underlying many of the foods we eat today.”

The FDA will inform the public about how it is moving forward on the panel’s suggestions by the end of January and will provide additional updates at the end of February, including on any structural or procedural changes it will make, Califf said.

He said he’s putting together a group of leaders at the FDA that will advise him on how to “operationalize these findings,” and he expects these leaders to be “bold and focused on the transformative opportunities ahead for the FDA’s food program.”

In April, a coalition of 30 organizations that represent industry, local regulators and consumers sent a letter to the FDA asking for the creation of a deputy commissioner for foods with direct line authority over all the agency’s food components.

One of the organizations, Consumer Reports, has called for months for more accountability and focused leadership from the FDA.

“We need strengthened leadership and accountability at the FDA to implement a culture of prevention, respond more quickly to problems as they arise, and take timely action on proposed food safety rules and initiatives,” Brian Ronholm, Consumer Reports’ director of food policy, said Tuesday.

Ronholm called the new report a “very encouraging first step.”

“We cannot afford to tolerate the status quo and let this moment go by without adopting fundamental changes to improve the FDA’s ability to protect the public and ensure our food is safe,” he said in a statement.

The Consumer Brands Association, a trade association for food manufacturers that also signed the April letter, said Tuesday that the lack of a single leader on food policy leads to “a lot of inefficiencies.”

“A siloed approach across FDA makes it harder for industry to engage,” said Sarah Gallo, the organization’s vice president for product policy. “It is just really complicated when you don’t have somebody looking over the different parts of the agency that have some form of jurisdiction over all those things.

“We can’t ignore what happened with the formula crisis,” Gallo added, a tangible example of what can happen when the FDA is not functioning at its best.

Roberta Wagner, vice president of regulatory and technical affairs for the Consumer Brands Association, agreed that if there were one person in charge, they could make sure the inspection and policy parts of the FDA would work together.

Wagner added that the food industry has embraced a more prevention-oriented kind of philosophy when it comes to safety. “Quite frankly, the problem is, FDA’s inspection force has not modernized itself or its approaches to basically mirror that prevention-oriented system and philosophy,” Wagner said.

The FDA food division has its work cut out for it, though, added Wagner, who worked with the agency in several capacities before joining the association.

“Think about it: The FDA has to keep up with hundreds of thousands of farms and facilities,” she said. “If you have these siloed operations, you’re not having these really critical conversations about where we should be and what should we be doing out there.

“We all want an FDA with a strong foods program. We want consumers not to worry about what they’re eating or whether they’re going to be able to get that certain needed food product,” Wagner added.

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