Blackberry Users Learning Painful Lesson
Oct 21, 2005
By ALICIA CHANG
 
LOS ANGELES (AP) - Chris Claypool was addicted to his BlackBerry wireless handheld. Like many users, he never thought twice about pecking away at lightning speed, replying to a wave of e-mails from clients around the globe. Last year, the 37-year-old agricultural sales director from Post Falls, Idaho, noticed a throbbing sensation in this thumbs whenever he typed.

He switched to tapping with his index finger, then his middle digit and finally his pinky. But his thumbs pained him to the point where he can't even press the buttons on his TV remote control.

After months of aching, Claypool took a break. Now he only uses his BlackBerry to send short messages - typing with the tip of a pencil eraser whenever his thumbs get sore.

"It affects business because I can't whack away on my BlackBerry like I used to," he said. "It's just too painful."

Repetitive motion injuries, which have long afflicted desktop and laptop computer users, are invading the mobile handheld world.

There's even an informal name for the malady - "BlackBerry Thumb" - a catch-all phrase that describes a repetitive stress injury of the thumb as a result of overusing small gadget keypads.

Business executives and tech-savvy consumers are increasingly using BlackBerries, Treos, Sidekicks and other devices with miniature keyboards designed for thumb-tapping to stay connected while on the go.

And that has some ergonomic and hand experts worried about injuries from overexertion.

"If you're trying to type 'War and Peace' with your thumbs, then you're going to have a problem," warned Alan Hedge, director of the Human Factors and Ergonomics Laboratory at Cornell University in Ithaca, N.Y.

No national statistics exist on how many people suffer from this type of thumb ailment, but some doctors say they are seeing an upswing in related cases, said Dr. Stuart Hirsch, an orthopedist at St. Joseph's Hospital and Medical Center in Paterson, N.J.

"It's mostly the road warrior who prefers to answer e-mails on a thumb keyboard," said Hirsch. "If all you did was just answer with a simple yes and no, it would not be a dilemma."

For as long as video gamers have been blasting aliens, so-called "Gamer's Thumb" has been a sore spot for them, as well. With tens of millions of portable video game machines on the market, lots of young hands risk digit abuse.

Games for such devices generally include some type of printed warning about injury risks from prolonged playing.

Earlier this year, the American Society of Hand Therapists issued a consumer alert, warning users of small electronic gadgets that heavy thumb use could lead to painful swelling of the sheath around the tendons in the thumb.

The group recommended taking frequent breaks during e-mailing and resting one's arms on a pillow for support.

A booklet that ships with the Nintendo DS handheld system advises a 10 to 15 minute break for each hour of play, and a break of at least several hours if gamers experience wrist or hand soreness.

"People tend to use just one finger over and over again and it's that repetitive use with one digit that could lead to problems," said Stacey Doyon, vice president of the American Society of Hand Therapists and a registered occupational therapist in Portland, Maine.

The BlackBerry, which debuted in 1999, employs a full QWERTY keypad for thumb typing to automatically send and receive e-mail. About 2.5 million people currently use Blackberries, more than double from a year ago.

An executive for Research In Motion Ltd., which makes the BlackBerry, said the company considers ergonomic factors when designing its keyboards.

"Of course, any product can be overused ... so people should listen to their own bodies and adjust their routine if necessary. But I would caution against confusing rare examples of overuse with the typical experience," Mark Guibert, vice president of marketing, wrote in an e-mail.

Musculoskeletal disorders, which include repetitive strain injuries, accounted for a third of all workplace injuries and illnesses reported in 2003 - the latest data available, according to the U.S. Bureau of Labor Statistics.

Specialists say the thumb - considered by many as an island because it is set apart from the other fingers - is among the least dexterous digit and is not meant to be rigorously worked out.

For people who insist on typing more than a sentence with their thumbs, external keyboards that connect to the gadgets may be a less painful alternative, said Dr. Jennifer Weiss, assistant professor of orthopedics at the University of Southern California in Los Angeles.

Treatment for BlackBerry thumb may include wearing a splint and applying ice to the affected area. If the pain persists, doctors may opt to inject the thumb area with a cortisone shot. Surgery may be required as a last resort.

John Orminski, a 44-year-old information technology manager from Pontiac, Mich., went to a doctor in the spring after feeling a strain in his right thumb.

On any given day, Orminski uses his thumb repeatedly to punch clients' telephone numbers, scroll through his address book and update his calendar on his BlackBerry.

Orminski already suffers from golfer's elbow - a form of tendinitis - from playing the sport. But unlike his elbow pain, which occurs in spurts, Orminski's thumb woes tend to flare up more often.

He recently started physical therapy for this thumb - receiving electrical stimulation and massage to relax the muscles.

"It can get sore and tender, but I'm learning to live with it."

American Society of Hand Therapists:

Reach in Motion

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MAMMOGRAPHY – THE HIDDEN DOWNSIDE, PART III

False Negatives

Mammograms can and do sometimes miss cancers entirely. A woman may have a normal mammogram at one screening but still develop a so-called ‘interval cancer' before her next examination. As we have seen in our previous newsletters, this kind of cancer tends to be the most deadly. The ‘false negative' rate – that is, the rate at which mammography gives a clean bill of health to those who in reality do have cancer, has been estimated to be somewhere between 10 and 15 percent (Welch 2004).


The Problem of DCIS

Meanwhile, the number of cases of premalignant, non-invasive lesions such as ductal carcinoma in situ (DCIS) being diagnosed by mammography has increased by 900 percent in the US over the past 20 years. It has now reached the point where almost 20 percent of all breast cancer diagnoses involve DCIS.

Some people interpret this as a good thing, i.e., a sign that cancer is being caught in its earliest stages. Treated early or late, DCIS has a low mortality rate (around 1 percent). Precisely what percentage of these latent, precancerous lesions might eventually progress to become truly invasive is unknown, although it has been estimated that almost 50 percent of all ‘in situ' cancers will never progress and would be better left undetected and therefore untreated (Handler 2003).

Perhaps one day in the future there will be a way of distinguishing between those women whose DCIS poses an imminent threat of invasiveness and those whose lesions are harmless, so that treatment can be directed only towards those who truly need it. Currently, though, such a test does not exist.

Undoubtedly mammography is having the effect of labeling a substantial number of women as having breast cancer, and channeling them towards aggressive treatment, when in fact they have a pseudodisease – i.e., a benign condition that poses no threat to life.

In one large-scale Canadian study of screening mammography it was found that DCIS was diagnosed in more than double the number of women who were given mammography than in those given careful clinical breast examinations (CBE) by qualified providers (i.e., 71 such women in the mammography group compared with 29 in the breast examination group). Another large Canadian study found that 71 mammography patients were given a diagnosis of DCIS compared with only 16 in the breast examination group. Meanwhile, a careful analysis of the outcomes of both these studies concluded that mortality rates from breast cancer were unaffected by screening mammography: the women in these studies experienced no survival benefit whatsoever from mammography even after 10 years of follow up (Miller 2000).


Radiation and Other Hazards

Another important factor that is largely ignored by the medical profession and the media is the radiation danger inherent in screening mammography, particularly to younger women (i.e., women in the premenopausal age range of 40-50 years). Breast tissue is highly sensitive to radiation: an annual exposure to 1 cGy, or centigray (the dosage involved in taking a standard mammogram) increases the risk of cancer by 1 percent, and over a 10-year period of annual mammography screening this could augment a woman's cancer risk by 10 percent. The risk may be even greater – up to a 20 percent increased risk - for those women who carry certain genetic mutations (Swift 1994).

In addition, annual mammography exposes the breast tissue to repeated doses of low-energy X rays. Contrary to what one might expect, low-energy X rays are actually more damaging to DNA than their high-energy counterparts, according to a study performed at Columbia University's Center for Radiological Research (Brenner 2002).

For younger women in particular, whose breasts are denser and who have a longer projected lifespan ahead of them than postmenopausal women, the additional exposure to X-rays posed by annual mammography beginning at the recommended age of 40 could pose a significantly increased risk of cancer. The Columbia University article concluded:

"There is evidence that low energy X rays as used in mammographic screening produce an increased biological risk per unit dose relative to higher energy photons. At low doses, the increased risk appears to be of a factor of 2….For older women, the benefit is still likely to outweigh the radiation risk. For women less than 50 years of age, however, this increase in the estimated radiation risk might indicate a somewhat later age than currently suggested, by about 5-10 years, at which to recommend commencement of routine breast screening" (Brenner 2002).

This paper is significant – and unusual - in that it both acknowledges the risks involved in repeated radiation exposure to the breast through mammography and urges a re-examination of current recommendations concerning the appropriate age to begin regular screening. Most discussions of mammography are not as frank.

Another hidden hazard in mammography is the physical compression of the breasts that is necessary to obtain a readable radiographic image. This physical compression can result in the rupture of small blood and lymphatic vessels, which, if they are in close proximity to a tumor – even a tiny tumor – may result in the release of malignant cells into the general circulation (Rosser 2000).


The Mammography Paradox

That mammography is not as effective in saving lives as its promoters have insistently claimed is bad enough, but more alarming by far is the little-publicized fact that in women aged 40-49, mammography is actually associated with an increased, rather than a decreased, risk of death- a phenomenon known to researchers as the "mammography paradox."

Yes, you read that right: mammography in younger women (ages 40-49) may actually accelerate, rather than reduce, breast cancer mortality.

This increased death rate from breast cancer in younger women who undergo screening mammography has been documented consistently in screening trials across different countries, settings and populations. It is a fact known to many researchers in the field, yet it remains largely unknown to the general public – and it certainly not a danger of which women are routinely made aware by their healthcare providers.

One critic of exclusive reliance on screening mammography is Cornelia J. Baines, MD., of the University of Toronto. Dr. Baines is hardly an outsider to the field. She is deputy director of the prestigious Canadian National Breast Screening Study, and the author of 70 PubMed-listed journal articles. She has also written an important paper that is frank in its discussion of this issue. In this paper, aptly titled "Mammography screening – Are women really giving informed consent?" Dr. Baines says: "Many women remain unaware of the extent to which efforts to achieve breast cancer control through mammography screening may be doing harm as well as good. An unacknowledged harm is that for up to 11 years after the initiation of breast cancer screening in women aged 40-49 years, screened women face a higher death rate from breast cancer than unscreened control women, although that is contrary to what one would expect" (Baines 2003).

How could this happen? How can it be that instead of saving their lives, earlier detection might actually result in a greater likelihood of death in these women?

Conclusion Next week!


--Ralph W. Moss, Ph.D.