Newsweek August 27, 2008
…Like Meiser and, more recently, actress Christina Applegate, a small but growing number of women with cancer in only one breast are opting to get their healthy breast removed too. In a study published in the Journal of Clinical Oncology last October, researchers found that the rate of bilateral mastectomies among women with cancer in only one breast more than doubled from 1998 to 2003, from 1.8 percent to 4.8 percent. “The main motivation is fear,” says Stephen Sener, a doctor and former president of the American Cancer Society. “Some women say, ‘I can’t live with the anxiety of having this happen again.'”…
…Some women simply overestimate the risk of getting cancer in the opposite breast. The typical patient has about .5 percent to .75 percent risk per year of developing a new cancer in the healthy breast, which works out to a 20 to 30 percent chance of developing a new cancer by age 80 if she is treated and diagnosed at age 40, says Seema Khan, co-leader of the breast cancer program at the Robert H. Lurie Comprehensive Cancer Center at NORTHWESTERN University.
The rise in prophylactic mastectomies also disturbs some breast-cancer awareness advocates. “It’s just terrible that that’s the position women are in after spending billions of dollars on research and on awareness and on building cancer centers and treatment centers around the country, and that’s still the choice we give women—cut off healthy breasts,” says breast-cancer survivor Fran Visco, president of the National Breast Cancer Coalition.
And experts say women facing the choice of prophylactic mastectomy and reconstruction should remember that reconstructed breasts are very different from natural breasts. While modern implants may look more natural, the process can be arduous. In the end, “it gives you a mound on the chest wall,” says Khan. “Without clothes, it doesn’t really look like a breast, it doesn’t feel like a breast, and it certainly doesn’t have much of the sensation of the breast.”
Maybe you think nutritionists flip flop as often as political candidates seem to do. Eggs are bad, no eggs are OK. Switch to margarine, no go back to butter. Drink eight glasses of water each day, no never mind.
What appears to be conflicting news about nutrition is due to the ever-evolving nature of science, said Linda Van Horn, a professor of preventive medicine and nutrition researcher at NORTHWESTERN University.
New discoveries about the composition of foods are often behind these seeming nutrition flip-flops, said Van Horn, who serves as editor of the Journal of the American Dietetic Association and is charged daily with the task of translating emerging science….
Forum Details Enormous Cost of Caring for Illinois Babies Exposed to Alcohol
Chicago Tribune August 27, 2008
The cost of caring for the almost 1,800 babies born in Illinois each year who are damaged by exposure to alcohol in the womb is enormous over their lifetimes, which can include medical treatment and incarceration….
…In an earlier era, sipping an occasional martini while pregnant was not only acceptable but fashionable.
But that all changed after 1981, when the surgeon general warned women about drinking. Alcohol freely crosses the placenta, “so however intoxicated Mom is, the kid feels the same way,” said Dr. Catherine Stika, associate professor of obstetrics and gynecology at NORTHWESTERN University’s Feinberg School of Medicine.
Cancer Test for Women Raises Hope, and Concern
The New York Times August 26, 2008
A new blood test aimed at detecting ovarian cancer at an early, still treatable stage is stirring hopes among women and their physicians. But the Food and Drug Administration and some experts say the test has not been proved to work.
The test, called OvaSure, was developed at Yale and has been offered since late June by LabCorp, one of the nation’s largest clinical laboratory companies.
The need for such a test is immense. When ovarian cancer is detected at its earliest stage, when it is still confined to the ovaries, more than 90 percent of women will live at least five years, according to the American Cancer Society.But only about 20 percent of cases are detected that early. If the cancer is detected in its latest stages, after it has spread, only about 30 percent of women survive five years….
But Dr. Julian C. Schink, director of gynecologic oncology at NORTHWESTERN University, said it would be ”playing Russian roulette” to put off ovary surgery unless OvaSure detected cancer. ”We just don’t have any data to show this test will turn positive before the disease turns metastatic,” he said….
The Wrong Call on Prostate Cancer Screening
The Washington Post August 26, 2008
Numerous media reports followed a federal task force’s announcement this month that there is insufficient medical evidence to assess the risks and benefits of prostate cancer screening in men younger than 75 and that doctors should stop testing men over age 75 [” U.S. Panel Questions Prostate Screening; ‘Dramatic’ Risks for Older Men Cited,” front page, Aug. 5].
It’s important to note that consideration was not given to the overwhelming body of emerging evidence that screening with PSA tests and digital rectal exams saves lives. Rates of death from prostate cancer and rates of diagnosis at advanced stages have decreased markedly since testing became widespread. As a physician and a researcher specializing in prostate cancer, I worry that this recommendation will result in delays in potentially lifesaving treatment and possibly the unnecessary loss of life….
William J. Catalona is medical director of the Clinical Prostate Cancer Program at the Robert H. Lurie Comprehensive Cancer Center at NORTHWESTERN University’s Feinberg School of Medicine. He receives research support and honorariums for speaking from Beckman Coulter Inc., a manufacturer of PSA tests.
With new “extended cycle” and “continuous” oral contraceptives on the market, women today can choose to have monthly withdrawal bleeding just four times a year—or not at all. To many American women of childbearing age, these options have tremendous appeal. In fact, more than two-thirds of women said they are interested in suppressing monthly bleeding, according to national survey results presented at an Association of Reproductive Health Professionals (ARHP) reproductive health conference.
“In the last 10 years, there really has been almost a revolutionary change in the opinions and the views of women regarding menstruation,” observed Dr. Lee P. Shulman, professor and chief of reproductive genetics in the Department of Obstetrics and Gynecology at NORTHWESTERN University’s Feinberg School of Medicine in Chicago.
“It’s not just the more mature reproductive women desiring fewer withdrawal bleeds,” said Shulman, immediate past chair of the ARHP. “Now that’s becoming a more common desire among even younger women seeking hormonal contraception.”…
Good Health, More Wealth
Chicago Tribune August 24, 2008
…Preventive care. Even with insurance, many treatments don’t come cheap. So doing whatever you can to minimize the need for care could make a big difference to not only your health but also your savings.
There are a variety of preventive strategies for staying healthy: eating right, exercising, doing appropriate screenings, flossing your teeth and getting enough shut-eye, among others. The merits of each are endlessly debated, and their effectiveness subject to genetic makeup and luck….
…Not all of the advice requires sacrifice or an upfront cost.
Linda Van Horn, acting chair of the Department of Preventive Medicine at NORTHWESTERN University’s Feinberg School of Medicine, said: “I have also heard that laughing is a good thing. It costs nothing but makes everything seem more tolerable.”
“As a general thing, I think it’s very important to never lie, to tell the truth,” Laurie Zoloth, a professor of medical humanities and bioethics at NORTHWESTERN University’s Feinberg School of Medicine, said when I called and posed the predicament.
Zoloth said people should be allowed to confront reality. “Is your mother a religious person?” she asked. If so, she said, maybe she would have wanted to start praying immediately for her sister. Even if she herself weren’t well, it might help her to feel she could do something for someone else.
Delivering the terrible truth, Zoloth said, had to be weighed against the risks of hiding it.
When my mother eventually found out, would she be left wondering if she could count on the people she loves to tell her the truth? Would she be left feeling diminished, thinking, “Did you think I couldn’t handle it? Did you think I couldn’t help?”
Rules are always open to exception, and Zoloth agreed that I had to take into account my mother’s situation, my relationship with my mother and her relationship with her sister.
Then she told two stories.
One was about her grandmother, whose son had died unexpectedly. Afraid it would upset a woman so old and frail, no one told her.
“What was really upsetting to her,” Zoloth said, “was she was ill and her son didn’t come visit her.”
Zoloth’s second story was about herself. Her husband had gotten a cancer diagnosis about the time her elderly parents, in California, were going through difficulties of their own. Despite her belief in truth, and that withholding is a form of lie, she delayed telling them about her husband.
A couple of days ago, just before I called Zoloth, my quandary was solved. When my aunt got out of the hospital, she called my mother. That felt right to me. Sister to sister. And yet it still feels slightly wrong that for a week I knew something so important to my mother and didn’t share it. In that kind of situation, Zoloth said, it’s important to address what happened.
“You say, ‘I love you so much. I tried so hard to make the world good for you. I’m so sorry I had to withhold information.’ Then you have to reset to zero with the promise to tell the truth.”…
Specialty Care Advised for Gestational Trophoblastic Neoplasia Failing Monotherapy
Reuters August 19, 2008
Women with high-risk gestational trophoblastic neoplasia, as well as those who fail initial single-agent therapy, should be referred to a specialized trophoblastic disease center to maximize the chance for cure, physicians at NORTHWESTERN University in Chicago recommend.
Gestational trophoblastic neoplasia is one of the most curable of all human tumors, Dr. John R. Lurain and colleagues note in the August issue of Obstetrics & Gynecology. However, inadequate treatment of metastatic disease can reduce survival to less than 20%. Dr. Lurain’s group reviewed records of 408 patients with choriocarcinoma and invasive mole (excluding placental-site tumor) treated at NORTHWESTERN’s John I. Brewer Trophoblastic Disease Center during two periods, 1962-1978 and 1979-2006.:
…”The presence of these characteristics suggests provision of aggressive multiagent chemotherapy, often combined with surgery and brain radiation, to maximize the chance for cure,” Dr. Lurain and his associates advise….
Impotence Drug Treats Prostate Enlargement: Study
Reuters August 19, 2008
Impotence drugs may be able to help reduce the symptoms caused by enlarged prostates, such as trouble urinating, U.S. researchers reported on Tuesday….
…Researchers at the University of Texas Southwestern Medical Center at Dallas, NORTHWESTERN University in Chicago and Lilly Research Laboratories tested more than 1,000 men with enlarged prostates—a condition known as benign prostatic hyperplasia or BPH.
Some got various doses of Cialis, known generically as tadalafil, while some got a placebo. Those who got Cialis were more likely to report their symptoms had improved, and a relatively low dose of 5 mg a day did the trick, reported the researchers, led by UTSW’s Dr. Claus Roehrborn….
Cell Phone Frenzy: Are All Those Radio Waves Bad for You? The Answer isn’t Clear
RedEye (Chicago Tribune) August 19, 2008
…The National Cancer Institute says studies have not shown any consistent link between cell phone use and cancer, but acknowledge additional research is needed. The American Cancer Society shares that opinion, as does the U.S. Food and Drug Administration, which also points out there’s no proof cell phones are completely safe either. International studies and analyses of those studies have had conflicting results.
But a media frenzy fueled the debate last month when Dr. Ronald Herberman, director of the University of Pittsburgh Cancer Institute, issued a warning to his faculty and staff to limit cell phone use because of a possible cancer risk….
…Dr. Sean Grimm, assistant professor of neurology at the Robert H. Lurie Comprehensive Cancer Center of NORTHWESTERN University, said there’s no convincing link between cancer and cell phone use.
“I wouldn’t tell my patients that they shouldn’t use cell phones. Right now, there’s no clear evidence,” he said….
‘Beetle Juice,’ Pesticides and Tough SEALs
Chicago Tribune August 17, 2008
Molluscum contagiosum is a harmless viral skin infection that you don’t hear much about until the small, pinkish growths suddenly appear on your child’s face, arms and legs….
Usually, there’s no need to treat it. The lesions, which can be itchy, may last between two weeks and four years—the average is two years—but they eventually go away on their own. Still, the CDC suggests covering all visible bumps with watertight bandages before letting a child swim, and avoiding direct contact sports such as wrestling.
You can also try “beetle juice” or cantharidine, under a doctor’s supervision, said Dr. Amy Paller, chair of the dermatology department at Northwestern University’s Feinberg School of Medicine. “It’s as effective as anything except perhaps scraping each one individually, which is bloody and can be painful,” she said….
Genetic Cause of Colorectal Cancer Found
UPI August 14, 2008
U.S. medical scientists say they’ve discovered a genetic trait that is likely the most common cause of colorectal cancer that’s been found. Researchers at NORTHWESTERN University’s Feinberg School of Medicine and colleagues say the genetic trait they discovered is present in 10 percent to 20 percent of patients with colorectal cancer. That, the scientists said, strongly suggests the trait is a major contributor to, and likely the most common cause of, colorectal cancer.
If a person inherits the trait—which is dominant and clusters in families—the scientists found the lifetime risk of developing colorectal cancer is 50 percent, compared with 6 percent for the general population.
“The reasonable expectation is this finding will save some lives,” said Dr. Boris Pasche, lead author of the study. “We will be able to identify a larger number of individuals that are at risk of colorectal cancer and, in the long term, maybe decrease the cases of colorectal cancer and of people dying from it….”
This story was carried on the following news outlets:
Crucial genetic factor in colorectal cancer found
Reuters August 14, 2008
Gene ‘clue’ to colorectal cancer
BBC News August 14, 2008
“The Lou Dobbs Radio Show” (Syndicated) August 14, 2008
Reference to research by Dr. Boris Pasche, director of the Cancer Genetics Program, regarding the genetic cause of colorectal cancer.
WBZ-AM (Boston), KYW-AM (Philadelphia), WBT-AM (Charlotte), KNX-AM (Los Angeles), WCBS-AM (New York), WCCO-AM (Minneapolis), KDKA-AM (Pittsburgh), KNBC-TV (Los Angeles), KCBS-AM (San Francisco), WGAL- TV (Harrisburg), WTOP-AM (Washington), KMOX-AM (St. Louis), KRLD-AM (Dallas), WHNZ-AM (Tampa). Aug. 14. Reference to research by Dr. Boris Pasche, director of the Cancer Genetics Program, regarding the genetic cause of colorectal cancer.
WGN-TV Aug. 15. Boris Pasche, MD, associate professor of medicine, comments on his research on the genetic cause of colon cancer.
Crucial genetic factor in colorectal cancer found
National Post (Reuters) August 14, 2008
Colorectal Cancer Gene Mutation Found
WebMD August 14, 2008
Scientists Identify Genetic Contributor to Colorectal Cancer Risk
American Cancer Society News Center
Dopamine Pathways Said to Control Conduct
UPI August 12, 2008
U.S. scientists say they’ve found some human behavior is controlled by balanced activation of two pathways in the brain using the neurotransmitter dopamine. Professor James Surmeier and colleagues at NORTHWESTERN University say their discovery helps explain Parkinson’s disease and drug addiction.
Dopamine “shapes the two main circuits of the brain that control how we choose to act…,” said Surmeier, adding both circuits are in the brain’s striatum, a region critical for translating thoughts into action. One circuit activates conduct while the other inhibits it. In drug addiction, Surmeier explained that “dopamine released by drugs leads to abnormal strengthening of the cortical synapses driving the striatal ‘go’circuits, while weakening synapses at opposing ‘stop’ circuits.” The result is the compulsive conduct seen in addiction….
America’s Unhealthiest Grocery Shoppers
Forbes August 12, 2008
While we all indulge every now and then, new data show that shoppers in certain portions of the country are more prone to regularly buying unhealthy items at the grocery store than others, due in part to a mix of regional, community and familial influences…
…People are also more influenced by the dietary choices of friends and family than they realize, says Dr. Robert Kushner, weight-management expert and professor of medicine at NORTHWESTERN University’s Feinberg School of Medicine. Research out of Harvard Medical School and the University of California San Diego published in the New England Journal of Medicine last year showed that obesity and thinness are socially contagious, with friends, siblings, spouses and neighbors affecting each others’ eating habits and physical activity levels. In other words, if your friends tend to skip the gym and go out for ice cream, you’re likely to as well.
There are socio-economic factors at work too. If you live in a community full of convenience stores and restaurants that sell food in wrappers, it’s probably affecting your diet on the whole, including the choices you make in the grocery store, Kushner says….
Studies Refine Obesity’s Risk for Heart Troubles
U.S. News & World Report August 11, 2008
Some obese people don’t seem to be at increased risk for heart disease, while some normal-weight people have a number of heart disease risk factors, according to two studies….
…”Both reports emphasize the benign nature of fat accumulation outside the abdomen,” Dr. Lewis Landsberg, of the NORTHWESTERN University Comprehensive Center on Obesity in Chicago, wrote in an accompanying editorial.
“In both studies, the detrimental effect of visceral fat accumulation and its surrogate, waist circumference, were clearly demonstrated, confirming older studies showing that waist circumference is a risk factor even in normal-weight individuals,” he said.
The studies show it’s important to calculate body mass index and measure waist circumference when assessing cardiovascular risk in overweight and obese patients, Landsberg noted.
This story was carried on the following news outlets:
Some Obese People are, in Fact, Healthy
Los Angeles Times (Associated Press) August 11, 2008
Extra Pounds Don’t Always Increase Risk to Heart, Study Says
Bloomberg August 12, 2008
Study: Half of overweight adults may be heart-healthy, defying conventional wisdom
Chicago Tribune (AP) August 12, 2008
Debate Flares: Can Obese Patients Be Healthy?
American Medical News September 1, 2008
Extended Ambulatory pH Study Tracks Proton Pump Inhibitor Effects
Reuters August 7, 2008
Four-day esophageal pH recording using a wireless capsule in patients with suspected gastroesophageal reflux disease (GERD) allows monitoring periods with and without use of proton pump inhibitors (PPIs), according to Chicago-based re-searchers.
“Controversy exists as to whether pH monitoring should be done while patients are off or on acid suppression with PPIs,” senior investigator Dr. Ikuo Hirano told Reuters Health. “Our study was designed to take advantage of a newer pH monitoring system using wireless technology that allows for 96-hour rather than conventional 24-hour recording periods.”
In the July issue of the American Journal of Gastroenterology, Dr. Hirano and colleagues at NORTHWESTERN University’s Feinberg School of Medicine report their study using this approach to monitor 60 patients. On the first 2 days they did not receive PPI therapy but on days 3 and 4, they were given rabeprazole or ome-prazole/sodium bicarbonate….
The Nose, an Emotional Time Machine
The New York Times August 5, 2008
…We’ve all heard about the mysterious powers of smell and its importance in love, friendship and food. Yet a simple game like What’s My Bean, and our consistent surprise at the impact of shutting down our smell circuits, shows that we don’t really grasp just how deep the nose goes.
At the International Symposium on Olfaction and Taste held in San Francisco late last month, Dr. Herz and other researchers discussed the many ways our sense of smell stands alone. Olfaction is an ancient sense, the key by which our earliest forebears learned to approach or slink off. Yet the right aroma can evoke such vivid, whole body sensations that we feel life’s permanent newness, the grounding of now.
On the one hand, said Jay A. Gottfried of NORTHWESTERN University, olfaction is our slow sense, for it depends on messages carried not at the speed of light or of sound, but at the far statelier pace of a bypassing breeze, a pocket of air enriched with the sort of small, volatile molecules that our nasal-based odor receptors can read. Yet olfaction is our quickest sense….
U.S. Panel Questions Prostate Screening; ‘Dramatic’ Risks For Older Men Cited
The Washington Post August 5, 2008
The blood test that millions of men undergo each year to check for prostate cancer leads to so much unnecessary anxiety, surgery and complications that doctors should stop testing elderly men, and it remains unclear whether the screening is worthwhile for younger men, a federal task force concluded yesterday….
…The guidelines address perhaps the most important and contentious issue in men’s health, and were praised by officials at several leading medical groups, including the National Cancer Institute and the American Cancer Society. But they drew strong criticism from others who are convinced that routine screening is necessary.
“I think they’re really missing the boat,” said William J. Catalona, a professor of urology at NORTHWESTERN University. “It’s a disservice to patients. A lot of men die from prostate cancer, and there’s just an overwhelming amount of evidence that screening saves lives.”…
This story was carried on the following news outlets:
Prostate Screening May be Unnecessary for Older Men, Panel Says
Chicago Tribune August 4, 2008
Many Immigrant Children Even Less Active Than U.S.-born Children, Study of Nearly 70,000 Says
The Associated Press (Chicago Tribune) August 4, 2008
Many immigrant children get even less vigorous exercise than their U.S.-born counterparts, the largest study of its kind suggests. Plenty of earlier evidence shows that U.S. children are pretty inactive. The new study of nearly 70,000 children simply found even lower levels of activity among immigrants….
…Singh said the results among Hispanics were particularly striking: nearly 23 percent of children in families where both parents were born in Spanish-speaking countries got no vigorous physical activity. Also, two-thirds of them didn’t participate in organized sports.
Moreover, among Hispanics, U.S.-born children with foreign-born parents were less active than kids whose parents were both born in the United States. By contrast, among blacks and Asians, U.S.-born children with U.S.-born parents were less active than kids with at least one foreign-born parent.
Dr. Mita Sanghavi Goel of NORTHWESTERN University said the results in Hispanics are troubling because of high rates of obesity and diabetes—both related to inactivity—among Hispanics, the nation’s largest immigrant group. “That just highlights how important it is to intervene early and set healthy lifestyle patterns early on,” Goel said….
Survive Cancer, Have Baby
Newsweek August 4, 2008
The emerging field of oncofertility offers hope to patients who worried that they couldn’t conceive.
…Welcome to the burgeoning world of oncofertility.
As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties oncology and assisted reproduction to come together. “The narrative of cancer is no longer that it’s a death sentence; it’s a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle,” says Teresa Woodruff of NORTHWESTERN University’s Feinberg School of Medicine, who last fall received a first-of-its- kind $21 million NIH grant to develop ways of protecting cancer patients’ reproductive health.
Of the 125,000 people under the age of 45 who are diagnosed with cancer each year, roughly half will receive treatments that will affect their fertility. The cancers that most commonly strike the young leukemias, lymphomas and breast cancers require some of the most toxic forms of chemotherapy, which target rapidly growing and fragile cells like hair follicles, sperm and eggs….
…Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility….
This story was carried on the following news outlets:
Doctors Give Cancer Patients More Options to Preserve Fertility
The Kansas City Star July 31
Cancer Patients Getting More Options to Preserve Fertility
Monterey County Herald (Calif.) July 26, 2008
Beijing’s Olympic Smog: How Bad Will It Be?
Business Week August 4, 2008
China’s blue-sky blues aren’t going away even with factory closings and restricted driving. The region’s climate is part of the problem. A week before the start of the Olympics, Beijing’s smog still threatens the Games. The effects of the polluted air are worrying to many Olympic athletes, some of whom have attempted to limit time spent in Beijing.
National teams from the U.S., Britain, France, and Germany, to name just a few, have been doing their pre-Olympics training in Japan (BusinessWeek.com, 2/12/08) rather than take their chances in China. Australia’s Olympic committee is giving athletes concerned about the smog’s impact on their health the O.K. to withdraw from events. Record-holding Ethiopian distance runner Haile Gebrselassie, who has asthma, has pulled out of the marathon, citing bad air….
…Athletes aren’t the only ones at risk. Spectators may also be hurt by breathing dirty air, say Dr. Gokhan Mutlu and Dr. Scott Budinger at NORTHWESTERN University’s Feinberg School of Medicine. They published research last year showing that pollution can trigger heart attacks and strokes in at-risk people by making the blood thicker.
How It Feels: Multiple Sclerosis
Chicago Tribune August 3, 2008
…She again saw the neurologist and had another MRI, which showed that she had MS. “I was devastated….All I knew about MS was the neighbor down the street when I was little, who [had MS and]went quickly from crutches to a wheelchair.”
That’s unfortunately a common but not necessarily accurate perception nowadays, said Bruce Cohen, MD, professor of neurology at NORTHWESTERN University’s Feinberg School of Medicine. “People’s picture of the disease is skewed; they make the assumption that people with MS end up in a wheelchair, but that’s simply not true.”…
…No one knows what causes MS, said Cohen, but evidence is mounting toward some combination of genetics and environmental influences. MS treatment has dramatically changed over the past 15 years, said Cohen. “An increasing number of treatments have been shown to be effective in the early stages. Arguably there’s evidence that by using [these treatments]early, we maybe changing the natural history of the disease long term.” Cohen is also hopeful about new therapies being developed to target aspects of the immune system and to protect nerve fibers from damage….
Cops and the Mentally Ill
Newsweek July 31, 2008
…From coast to coast, mentally ill people, without reliable access to the costly on-demand care they need, are left to fend for themselves. In the aftermath of the movement in the 1970s to close large mental asylums, many of today’s mentally ill are left to their own devices; they are often homeless and without full-time advocates. With government unable or unwilling to properly serve this population, the criminal-justice system is left to pick up the slack.
Contrary to what many assume, the mentally ill are most often the victimized, not the victimizers. A 2005 study by researchers at the Feinberg School of Medicine at NORTHWESTERN University suggested that persons with serious mental illnesses are 11 times more likely than the general population to be victims of violent crime, with perhaps as many as 1 million crimes committed against those with serious mental-health issues each year….
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