By A. Nasib. Bethany College, Scotts Valley, CA.

Inverse relationships have been reported between Dietary Fiber intake and risk of colon cancer in some case-control studies (Bidoli et al generic apcalis sx 20mg overnight delivery erectile dysfunction vacuum pump medicare. A critical review of 37 observational epide- miological studies and a meta-analysis of 23 case-control studies showed that the majority suggest that Dietary Fiber is protective against colon cancer quality apcalis sx 20mg erectile dysfunction age 27, with an odds ratio of 0. Furthermore, a meta-analysis of case-control studies demonstrated a combined relative risk of 0. Lanza (1990) reviewed 48 epidemiological studies on the relationship between diets containing Total Fiber and colon cancer and found that 38 reported an inverse relationship, 7 reported no association, and 3 reported a direct association. In the Netherlands, Dietary Fiber intake was reported to be inversely related to total cancer deaths, as the 10-year cancer death rate was approximately threefold higher in individuals with low fiber intake compared with high fiber intake (Kromhout et al. Intervention Studies There have been a number of small clinical interventions addressing various surrogate markers for colon cancer, primarily changes in rectal cell proliferation and polyp recurrence. Generally, the small intervention trials have shown either no effect of fiber on the marker of choice or a very small effect. There was no overall decrease in rectal cell proliferation as a result of fiber supple- mentation unless the groups were divided into those with initially high and those with initially normal labeling indices. With this statistical division, there was a significant decrease in cell proliferation as a result of the fiber supplementation in six of the eight patients with initially high labeling indices and three of the eight patients with initially low indices, which suggests that wheat-bran fiber is protective against colon cancer. In a sepa- rate trial from the same group, supplemental dietary wheat-bran fiber (2. Additionally, two randomized, placebo-controlled trials found no significant reduction in the incidence of colon tumor indicators among subjects who supplemented their diet with wheat bran or consumed high fiber diets (MacLennan et al. Recently, findings from three major trials on fiber and colonic polyp recurrence were reported (Alberts et al. All were well-designed, well-executed trials in indi- viduals who previously had polyps removed. The Polyp Prevention Trial, which incorporated eight clinical centers, included an intervention that consisted of a diet that was low in fat, high in fiber, and high in fruits and vegetables (Dietary Fiber) (Schatzkin et al. There was no difference in polyp recurrence between the intervention and control groups. Again, there was no differ- ence between the control group and the intervention group in terms of polyp recurrence. The adjusted odds ratio for the psyllium fiber intervention on polyp recurrence was 1. Potential Mechanisms Many hypotheses have been proposed as to how fiber might protect against colon cancer development; these hypotheses have been tested primarily in animal models. The hypotheses include the dilution of car- cinogens, procarcinogens, and tumor promoters in a bulky stool; a more rapid rate of transit through the colon with high fiber diets; a reduction in the ratio of secondary bile acids to primary bile acids by acidifying colonic contents; the production of butyrate from the fermentation of dietary fiber by the colonic microflora; and the reduction of ammonia, which is known to be toxic to cells (Harris and Ferguson, 1993; Jacobs, 1986; Klurfeld, 1992; Van Munster and Nagengast, 1993; Visek, 1978). Unfortunately, most of the epidemiological and even the clinical intervention trials did not measure functional aspects of potential mechanisms by which fiber may be protective, and they did not attempt to relate aspects of colon physiology such as fecal weight or transit time to a protective effect against tumor development. Cummings and colleagues (1992) suggest that a daily fecal weight greater than 150 g is protective against colon cancer. In a study by Birkett and coworkers (1997), it was necessary to achieve a stool weight of 150 g to improve fecal markers for colon cancer, including fecal bulk, primary to secondary bile acid ratios, fecal pH, ammonia, and transit time. Dietary Fiber intake was 18 ± 8 g in the less than 150-g fecal-weight group and 28 ± 9 g in the greater than 150-g group (p < 0. Dietary Fiber Intake and Colonic Adenomas People with colonic adenomas are at elevated risk of developing colon cancer (Lev, 1990). Several epidemiological studies have reported that high Dietary Fiber and low fat intakes are associated with a lower incidence of colonic adenomas (Giovannucci et al. For example, Giovannucci and coworkers (1992) studied a population of 7,284 men from the Health Professionals Follow-up Study and found a significant negative relationship between Dietary Fiber intake and colonic adenomas. The inverse relationship with Dietary Fiber persisted when they adjusted for other nutrients commonly found in fruits and vegetables. The overall median dietary intake of Dietary Fiber in this population was 21 g/d, with a median intake of 13 g/d for the lowest quintile and 34 g/d for the highest quintile. Possible Reasons for the Lack of a Protective Effect of Dietary Fiber in Some Trials There is considerable debate and speculation as to why clinical inter- vention trials on the relationship between fiber intake and colon cancer have not shown the expected beneficial effect of fiber. Some of the recent prospective studies, such as the Nurses’ Health Study (Fuchs et al. As noted above, the Health Professionals Follow-up Study showed a protective effect of Dietary Fiber from the diet against colonic adenomas (Giovannucci et al. However, when the same cohort was later investigated for the relationship between intake of Dietary Fiber and colon carcinoma, no relationship was found (Giovannucci et al. A partial explanation for the difference is due to differences in ways that the data were analyzed based on informa- tion that was known at the time of analysis. A similar situation was found in the Nurses’ Health Study cohort, which initially found that the combination of high Dietary Fiber and low saturated or animal fat intake was associated with a reduced risk of adenomas (Willett et al. Again, at follow-up in the same cohort, no relation- ship was found between Dietary Fiber intake and colon cancer incidence (Fuchs et al.

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In one typical study buy apcalis sx 20mg fast delivery erectile dysfunction for young men, police officers shown black and white photographs of male university students and employees thought more of the black than white faces looked criminal cheap apcalis sx 20mg with mastercard erectile dysfunction medication free samples; the more stereotypically black the face was, the more likely the officers thought the person looked criminal (Eberhardt et al. Unconscious notions and attitudes are most likely to influence criminal justice decisions that have to be made in the face of uncertainty and inadequate information or in ambiguous or borderline cases. To recognize the influence of race on social psychology, unconscious cognitive habits, and “perceptual shorthand” (Hawkins 1981, p. Race helps explain the development and persistence of harsh drug laws and policies. White Americans tend to support harsher punishments more than do blacks, a predilection that has strong roots in racial hostilities, tensions, and resentments (Tonry 2011, p. Researchers have found that whites with racial resentments toward blacks are far more likely to support punitive anticrime policies and that whites are twice as likely as blacks to prefer punishment over social welfare programs to reduce crime (Unnever, Cullen, and Johnson 2008). Even assuming public officials who championed the war on drugs decades ago operated from the best of motives or were simply remarkably ignorant about the likely effects of their decisions, good intentions or ignorance can be no excuse today. No reasonable public official can believe it is a good thing for black America to have in its midst a large caste of second-class citizens—banished into prisons and then branded for life with a criminal record. The persistence of drug policies that disproportionately burden black Americans reflects factors similar to those that led to the adoption of harsh penal policies initially: punitive attitudes toward crime, fear of “the other,” misinformation about drugs and their effects, the belief that using drugs is immoral and wrong, and the lack of instinctive sympathy for members of poor minority communities. At a structural level, the drug war—as part of the criminal justice system—retains its historic function of perpetuating and reinforcing racial inequalities in the distribution of political, social, and economic power and privileges in the United States. White Americans have long used the criminal justice system to advance their interests over those of blacks; the difference today is that they may no longer be doing so consciously. Over a decade ago, observers of drug criminalization in the United States began labeling its impact on black Americans as the “new Jim Crow,” recognizing that drug law enforcement has the effect of maintaining racial hierarchies that benefit whites and disadvantage blacks. In her best-selling book, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, Alexander (2010) contends that criminal justice policies and the collateral consequences to a criminal conviction today are—like slavery and Jim Crow in earlier times—a system of legalized discrimination that maintains a racial caste system in America: “today it is perfectly legal to discriminate against criminals in nearly all the ways that it was once legal to discriminate against African Americans…. As a criminal, you have scarcely more rights and arguably less respect, than a black man living in Alabama at the height of Jim Crow. She argues convincingly that drug policies have been and remain inextricably connected to white efforts to maintain their dominant position in the country’s social hierarchy. As Tonry says, “the argument is not that a self-perpetuating cabal of racist whites consciously acts to favor white interests, but that deeper social forces collude, almost as if directed by an invisible hand, to formulate laws, politics, and social practices that serve the interests of white Americans” (Tonry 2011, p. What will it take to change a quarter of a century of drug policies and practices that disproportionately and unjustifiably harm blacks? What will it take for Americans to condemn racial disparities in the war on drugs with the same fervor and moral outrage that they came to condemn the “old” Jim Crow? One part of the answer has to be public recognition that racial discrimination can exist absent from “racist” actors. The norm of racial equality has become descriptive and injunctive, endorsed by nearly every American. Subscriber: Univ of Minnesota - Twin Cities; date: 23 October 2013 Race and Drugs loathe to recognize or acknowledge structural racism because that would raise questions about their commitment to racial equality—and their willingness to give up the privileges of being white. White discomfort with even the very notion of structural inequality no doubt also is strengthened by conservative American political and moral cultures that stress individual responsibility. Implicit racial bias, racial self- interest, and conservative values combine to make it easy for whites to believe that black incarceration is a reflection of choices blacks have made and penal consequences they have merited. Whites rationalize or avoid seeing the inequities inherent in the war on drugs, assuming or persuading themselves “that the problem is not in the policies they and people like them set and enforce, but in social forces over which they have no control or in the irresponsibility of individual offenders” (Tonry 2011, p. The “myth of a colorblind criminal justice system” is widely influential in the United States because the language of police, judges, prosecutors, and public officials has been wiped clean of explicit racial bias (Roberts 1997, p. United States courts, unfortunately, have made it easier for white Americans to ignore racial disparities in twenty-first century America. Under current constitutional jurisprudence, facially race-neutral governmental policies do not violate the constitutional guarantee of equal protection unless there is both discriminatory impact and discriminatory intent. Supreme Court has decided that every lawsuit involving claims of racial discrimination directed at facially race-neutral rules would be conducted as a search for a “bigoted decision-maker”…. If such actors cannot be found—and the standards for finding them are tough indeed—then there has been no violation of the equal protection clause. In contrast, international human rights law prohibits racial discrimination unaccompanied by racist intent (Fellner 2009). Obviously, laws that make explicit distinctions on the basis of race (other than affirmative action policies) constitute prohibited discrimination. But so do race-neutral laws or law enforcement6 practices that create unwarranted racial disparities, even if they were not enacted or implemented by culpable actors who intentionally sought to harm members of a particular race (United Nations Committee on the Elimination of Racial Discrimination 2005; Zerrougui 2005). It has recommended that the United States “take all necessary steps to guarantee the right of everyone to equal treatment before tribunals and all other organs administering justice, including further studies to determine the nature and scope of the problem, and the implementation of national strategies or plans of action aimed at the elimination of structural racial discrimination” (United Nations Committee on Elimination of Racial Discrimination 2008, paragraph 20). Laws or practices that harm particular racial groups must be eliminated unless they “are objectively justified by a legitimate aim and the means of achieving that aim are appropriate and necessary” (United Nations Committee on the Elimination of Racial Discrimination 2008, paragraph 10). The operational and political convenience of making arrests in low-income minority neighborhoods rather than white middle-class ones may be an explanation but certainly not a justification. Even assuming the legitimacy of the goal of protecting minority neighborhoods from addiction and drug gang violence, the means chosen to achieve that goal—massive arrests of low-level offenders and high rates of incarceration—are hardly a proportionate or necessary response.

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