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Marc Garnick, M.D., Harvard Medical School

New discovery helps doctors accurately predict which patients will be helped by certain drugs

Harvard Medical School, March 20, 2009, by Marc Garnick MD — Personalized medicine—where doctors tailor treatment of a disease to characteristics of an individual person and unique features of his or her disease —is becoming a reality for colon cancer patients. Some recent discoveries offer incredible new insights that may help physicians better select treatments for specific patients.

One way scientists study personalized medicine is to look at the specific and unique abnormalities in a patient’s cancer cells. While two people may have the same type of cancer, certain genetic aspects of their tumor cells may be different. Treatments are then designed to work off of these differences. For example, let’s assume that a specific chemical reaction is needed for a specific person’s cancer cell to grow. If we can make a drug that interferes with that chemical reaction, there is a good chance that we can interfere with the cancer cell’s growth—and potentially improve the patient’s cancer.

There are many different ways that colon cancer can be stimulated to grow. On the surface of colon cancer cells are substances called receptors—things that look like mini locks. Our blood contains some chemicals (called growth factors) that can interact with these receptors—sort of like keys that fit into the locks. When a receptor and its matching growth factor come together, the cancer gets turned on, and this sets in motion a series of chemical reactions that allow it to grow and do all the bad things that cancer cells do.

One specific class of drug—called growth factor blockers—can interfere with this lock and key interaction, and thereby interfere with the signals that allow the colon cancer cells to grow. Several recently completed clinical studies have shown that about 40% to 50% of patients with colon cancer respond well to these drugs. But the big news came when researches looked more carefully at the cancers and tried to distinguish if there were any differences in the chemical make up of the cancer cells (so called molecular characteristics) that responded positively to the treatment versus the ones that didn’t. And what they discovered is profound.

There is a substance in all of the body’s cells—including cancer cells—called Kras. Cancers that responded well to growth factor blockers had a form of Kras that looked pretty much like Kras of normal cells. In the cancer cells that did not respond well, the Kras was altered and mutated and unlike that found naturally.

It turns out that a normal form of Kras is needed for the growth factor blocker to stop the growth of colon cancer. If Kras is mutated, the growth factor blocker simply does not work. There are ways to test people to see if their cancer cells have a normal or abnormal form of Kras, so we can now predict if a growth factor blocker would work based upon this test.

Why is this discovery so important? There are several reasons:

· First, growth factor blockers have a spectrum of side effects such as skin reactions, abdominal pain, infusion reactions, diarrhea, and scarring of the lungs.

So your doctor would not want to prescribe the drug if there was little likelihood of it working.

· Second, greater hope can be offered to patients if they have a normal form of Kras and are given the drug.

· Third, these drugs are expensive. There would be no reason to prescribe an expensive drug to a patient whose cancer has an abnormal form of Kras, where the probability of it working is small to non-existent. National cancer organizations have recommended that insurers require Kras testing, so that insurers can decrease unnecessary spending on these drugs in people for whom they will not work.

I predict that in the very near future, additional research on the specific molecular characteristics and chemical processes of tumor cells will be discovered in other types of cancers. This will lead to the development of specific drugs that interfere with these reactions. Further research will then be directed into getting a better understanding of the differences in those patients whose cancers respond favorably and those that do not. Already, this is happening in patients who have a specific type of non-small cell lung cancer. No doubt, it will be applied to other cancers soon.

Marc Garnick, M.D., is an internationally renowned expert in medical oncology and urologic cancer, with a special emphasis on prostate cancer. He is a Clinical Professor of Medicine at Harvard Medical School and maintains an active oncology practice at Beth Israel Deaconess Medical Center. Dr. Garnick serves as Editor in Chief of Perspectives on Prostate Diseases, a quarterly report from Harvard Health Publications.

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Nutritional Supplements and Cancer Risk—Act (and think) Conservatively

Harvard Medical School, by Marc Garnick MD — My patients (both with and without prostate cancer) have an insatiable desire for information regarding foods, vitamins, nutritional supplements, and other non-prescription “stuff” that they can add to their daily diets to help improve the odds of them beating or avoiding prostate cancer. At a recent community outreach program that highlighted new advances in cancer, the vast majority of the questions from the audience dealt with food, nutritional supplements, and vitamins. Intelligent answers to these questions require balance and an understanding that not all the answers are in yet. So what advice can be offered in the meantime?

Selenium and Vitamin E

I was dismayed and disappointed by the recent announcement that two widely used supplements―selenium and vitamin E―which had been touted to reduce the risk of prostate cancer showed no such effect. In fact, there is even the possibility that they increase the risk of prostate cancer and diabetes. A large, government-sponsored study found these results.

This study should not only impact your decisions about selenium and vitamin E, it should also increase your skepticism of other, yet unproven, remedies that are widely used. Let’s take a look at some of them.

What Supplements and Foods are Thought to Reduce Prostate Cancer Risk?

A recent roundtable of Harvard experts was convened to categorize substances that reduce prostate cancer risk or increase the risk. Among substances that were thought to reduce risk were selenium and vitamin E―though we now know that not to be the case. Others on the list were:

· Fish, with the theory being that omega 3-fatty acid, a substance present in certain fatty fishes, may block the development of certain types of cancer.

· Cooked tomatoes, which contain a substance called lycopene that has anti-oxidant properties.

What Needs More Study?

Substances that have been thought to have some protective effect on prostate cancer development, but which have not been subject to many rigorous scientific studies, include:

· Members of the beta carotene family (carotenoids), melatonin and pomegranate juice. All of these are thought to have anti-oxidant properties.

· Soy and vitamin D, which have been able to block or stop the growth of cancer cells in laboratory situations and have gained popularity as food supplements.

What Increases Risk?

On the opposite side of the equation are substances that can actually increase the risk of prostate cancer. These include:

· Ingesting high levels of calcium (greater than 1,500 mg per day)

· Eating red meat

· Zinc supplements.

My Advice on Prostate Cancer and diet, supplements

On a practical level, I advise my patients not to ingest more than 1,000 mg of dietary calcium per day, and to avoid red meat or decrease the amount of red meat to once a month.

The specific advice related to the other substances listed above is still in a state of flux. In my opinion, encouraging people to eat fish high in omega 3-fatty acids makes sense because anti-oxidants are thought to provide a host of benefits, including, perhaps, reducing the risk of cancer. Keep in mind that pomegranate juice has quite a lot of calories, so people who are watching their weight need to take this into consideration. If you are a believer in lycopene ingestion, get it from cooking tomatoes with a little bit of oil; the bottled variety that you can buy for the nutritional supplement stores is unlikely to work since very little of that form of lycopene is absorbed into the blood stream.

The sobering news from the selenium and vitamin E study again bears emphasizing. While we thought that taking these substances was promoting enhanced prostate health, that turned out not to be true. We simply had not yet performed the necessary studies to make definitive conclusions.

When the newspaper reports a new finding about some substance that has a positive effect on cancer, please react with caution. While the claim may indeed have some merit, the benefit is likely to be modest at best and the substance may not be as effective as other tried and true things such as a good, healthy diet and exercise.

When my patients want additional information about supplements, I generally refer them to one of several websites. These include the National Cancer Institute’s Office of Cancer Complementary and Alternative Medicine www.cancer.gov/cam and the National Institutes of Health website on Complementary and Alternative Medicine, www.nccam.nih.gov

The Washington Post, March 24, 2009, by Ranit Mishori MD — When George Taler meets with a patient, he does all the usual things: He measures blood pressure, listens to the heart and lungs, takes a look in the mouth and ears, and updates the medical chart. But then he does something unusual: He checks out medicine containers in the bathroom, food in the refrigerator and the general condition of the patient’s environment.

Taler, a physician at Washington Hospital Center, does house calls.

He is part of a small but growing tribe of doctors, nurses, physician assistants and nurse practitioners who are reviving this once-common practice for keeping Americans healthy and in touch with their doctors. Having virtually disappeared from medical practice by the 1980s, the house call has been making somewhat of a comeback, thanks primarily to Medicare changes that make house calls more easily billable. Advocates say revival of the house call could help reduce health-care costs substantially and enhance quality of care for many elderly and chronically ill patients.

For generations, the home visit was an institution, something a doctor, black bag in hand, just did. In 1930, house calls made up about 40 percent of physician encounters with patients in the United States, according to a recent article in the journal Clinics in Geriatric Medicine.

By 1950, that number had dropped to 10 percent. And by 1980, home visits accounted for a mere 1 percent.

Why did the house call fade away? In part, technology was to blame. As new diagnostic tools and advanced treatments became available in hospitals and clinics, that’s where people wanted to go. As the article in Clinics puts it, both doctors and patients came to associate ” ‘good medicine’ with hospitals and clinics. House calls became old fashioned.”

Financial incentives also worked against house calls, according to the article. More doctors chose specialized fields that relied on the technology of hospitals, while those who chose primary care could see easily twice as many patients in offices and clinics as they could traveling from home to home.

And then there’s the fact that private insurance has rarely fully covered such visits. (A few “concierge” medical practices will perform house calls for those patients willing to pay a substantial annual fee, or a trip fee, that is not covered by insurance.)

Similar constraints and disincentives have not been at work in other countries, including Canada, Denmark, France and the Netherlands, where home visits have continued to be a part of medical practice.

According to the Clinics article, in Britain, which has a strong tradition of primary care medicine and a national system of subsidized health care, doctors make 10 times as many house calls per 1,000 patients each year as do U.S. doctors.

In 1998, Medicare modified its billing procedures, making it easier for practitioners to receive payment for home visits to the elderly and chronically ill and increasing payments by 50 percent. Since then, Medicare statistics show a large bump in physician house calls, from 1.5 million in 2000 to almost 2.2 million in 2007.

Although house calls still account for fewer than 1 percent of all outpatient visits, “there is certainly a growing interest,” says Constance Row, executive director of the American Academy of Home Care Physicians. According to the Clinics article, “increasing numbers of physicians have chosen full-time house call practice as their preferred professional role.” Row backs efforts to increase the use of house calls as a “win-win situation for everyone. It is one of those things that patients want, that their families and caregivers want and also something that would actually save money.”

Ironically, although technology undermined the old practice of house calls, technology has now made the house call a reasonable alternative to office or hospital visits for certain patients. Doctors still rely on the black bag basics (stethoscope, otoscope, blood pressure cuff, blood-drawing equipment), but now they also come equipped with laptops with electronic medical records and wireless capabilities, portable EKG machines, even bedside X-ray and ultrasound devices that were once found only at a hospital, according to Ernest Brown of Unity Health Care, which mainly serves poor people in the District.

Point-of-care testing (where blood, urine and other tests are done at the bedside, with results available in minutes) has become so easy that home-care practitioners can operate very efficiently, with “very little overhead, in some cases working exclusively out of your own car,” said Brown, a family physician who does house calls.

For Eleanor Moss, 81, having a doctor who performs house calls has been a blessing. A District native, she suffers from several chronic conditions, including multiple sclerosis, which makes it hard for her to move around, let alone leave her apartment near Howard University to see doctors. She can zip around her small home in a motorized scooter she controls with a joystick, but going much beyond that is onerous and “just wears me out . . . getting my clothes on and whatnot . . . everything,” she says.

She seems delighted when Taler, co-director of Washington Hospital Center’s medical house call program, shows up on a recent day, black bag in hand. His visits, she says, “save me. . . . I’m telling you . . . it really saves me.”

Indeed, it is people like Moss — elderly, with multiple conditions and limited mobility — who represent the biggest clientele for house calls. They are what Row calls the “home-limited elderly,” people who don’t see a doctor routinely because getting out is so difficult. This “forgotten population,” Row says, is “getting much lower-quality care than they should have.”

When something goes wrong, they end up in emergency rooms or hospitalized, being treated in a crisis rather than routinely with an eye toward prevention. According to the Clinics article, studies have suggested that house calls may keep people in their homes longer and reduce mortality, particularly in the frail elderly population. That is probably due in part to physicians’ being able to identify new or worsening medical problems that, left untreated, could contribute to further disability and even death.

There may also be some significant cost savings. Although homebound patients represent only 5 percent of the Medicare population, they consume more than 43 percent of the budget, according to a congressional analysis. An ER visit can be more than 10 times the cost of a typical house call, which Row pegs at $100 to $150.

But in one of those strange twists of how America pays for health care, the cost-saving benefit of house calls might actually hurt the medical centers that provide them. Institutions such as Washington Hospital Center, which sponsors and financially supports Taler’s large house call program, depend on revenue from ER visits and hospital admissions. An analysis by Taler and his colleagues found that seeing patients at home results in a 60 percent savings to the health-care system in general, but the reduction in ER visits and hospital admissions means less money for the hospital and its programs, including Taler’s.

“A failure of health-care policy” is what he calls the conundrum.

Still, Taler’s service is growing and includes 600 patients — tended to by four doctors, three nurse practitioners, three social workers, one office nurse and four support staffers — in what he fondly calls “the largest nursing home without walls in the District.” It is a 24-7 operation, able to take calls and arrange short-notice visits even outside regular business hours. “These are our friends, and we don’t want to abandon them to an emergency department,” Taler says.

Taler, who acknowledges that he is a “zealot” for house calls, argues for what he calls “slow medicine”: an unhurried encounter in the patient’s known and non-threatening environment, also known as home. Departing Moss’s home the other day, he summed it up emphatically, and a little wistfully: “That’s what I went into medicine for.”

Or as Ernest Brown puts it, by doing house calls he is not only given the opportunity to be a good doctor, but he also gets to play the part of “psychiatrist, social worker, advocate and, in some cases, ‘family.’ I give a lot — and get even more in return.”

Ranit Mishori is a family physician and faculty member in the Department of Family Medicine at Georgetown University School of Medicine.

WashingtonPost.com, March 24, 2009, by Francesca Lunzer Kritz — Call it the United Nations of foodstuff. A U.S. Department of Agriculture regulation that became final last week requires country-of-origin labeling (known as COOL) on many fresh foods, including cuts of meat, poultry, lamb and pork, fruits and vegetables, and some nuts. (Labeling of fish and shellfish began two years ago, and packaged food has long required labeling.)

Knowing the country of origin is helpful in the event of a contamination outbreak or recall, says Agriculture Secretary Tom Vilsack. If an outbreak in, say, tomatoes from Chile is announced, the labels can help consumers choose tomatoes from another country.

Not all foods you might think of as fresh must be labeled; for example, fruit salad is considered processed — as are frozen mixed vegetables — and thus not subject to the labeling rules. But Vilsack has said that if manufacturers don’t voluntarily label such products, he may move to require it. Consumer Reports offers a chart of what is and is not labeled. Go to http://www.consumersunion.organd type “COOLTOOL” in the search engine.

Meanwhile, the Center for Science in the Public Interest, a nonprofit advocacy group, is trying to advance an idea that would give specific consumers quick information about items that have been recalled.

Earlier this year, CSPI asked 50 supermarket chains to use information from their loyalty clubs (such as Giant’s Bonus Club card) to contact consumers who had purchased a recalled product. CSPI has yet to hear back from any chain, says Sarah Kelley, a staff attorney for the group, but Giant and Costco have used such information to contact consumers about the ongoing recall linked to peanuts contaminated with salmonella.

Kelly says that while “some consumers may think that is an invasion of their privacy, giving up a bit of privacy in exchange for quick information about a health scare is well worth the trade-off.”

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The FDA approved nonprescription sale of the morning-after pill but limited use to women 18 and older.
(Barr Pharmaceuticals Via Bloomberg News)

Judge Says Politics Influenced Policy on the Contraceptive

The Washington Post, March 24, 2009, by Rob Stein — A federal judge ordered the Food and Drug Administration yesterday to reconsider its 2006 decision to deny girls younger than 18 access to the morning-after pill Plan B without a prescription.

U.S. District Judge Edward R. Korman in New York instructed the agency to make Plan B available to 17-year-olds within 30 days and to review whether to make the emergency contraceptive available to all ages without a doctor’s order.

In his 52-page decision, Korman repeatedly criticized the FDA’s handling of the issue, agreeing with allegations in a lawsuit that the decision was “arbitrary and capricious” and influenced by “political and ideological” considerations imposed by the Bush administration.

“These political considerations, delays and implausible justifications for decision-making are not the only evidence of a lack of good faith and reasoned agency decision-making,” he wrote. “Indeed, the record is clear that the FDA’s course of conduct regarding Plan B departed in significant ways from the agency’s normal procedures regarding similar applications to switch a drug from prescription to non-prescription use.”

FDA lawyers are reviewing the decision, said Rita Chappelle, an agency spokeswoman, who declined to comment further.

Critics of the FDA’s decision hailed the ruling.

“We’re very excited,” said Suzanne Novak, a senior staff lawyer for the Center for Reproductive Rights, which filed the lawsuit. “The message is clear: The FDA has to put science first and leave politics at the door.”

Opponents of Plan B condemned the judge’s order.

“This ruling puts politics above women’s health, and intrudes into parents’ ability to protect their minor daughters,” said Wendy Wright of the group Concerned Women for America. She also questioned the drug’s effectiveness.

“Making the morning-after pill easy to get has not resulted in fewer pregnancies or abortions, as advocates promised it would,” Wright said. “Pregnancy counselors report more young women relying on it as a regular form of birth control — even though the drug has not been tested to discover what happens when it is used multiple times.”

Plan B consists of higher doses of a hormone found in many standard birth-control pills. Taken within 72 hours of unprotected sex, it has been shown to be highly effective at preventing pregnancy.

With strong support from women’s health groups and family planning advocates, Barr Pharmaceuticals, which makes Plan B, asked the FDA in 2003 to allow the drug to be sold without a prescription so women would not have to obtain a doctor’s order to get it.

Conservative Congress members and advocacy groups opposed the request. They questioned the drug’s safety and argued that wider availability could encourage sexual activity and make it easier for men to have sex with underage girls. They also maintain that Plan B can cause the equivalent of an abortion.

The FDA delayed its decision for three years despite endorsements of nonprescription sales by its outside advisers and internal reviewers, leading to intense criticism that the agency was allowing politics to influence the decision.

When the agency eventually approved nonprescription sale in August 2006, proponents were disappointed that the drug was limited to women age 18 and older. The FDA said that there was too little safety data to approve the drug for teenagers younger than 18 and that pharmacists would be unable to enforce the age cutoff. The requirement also meant that women must show proof of their age when buying the drug, which made it more difficult for some women, such as illegal immigrants.

In his ruling, Korman detailed repeated interference by “political actors” in the agency’s handling of Plan B, including the long delay in approving the drug and the ultimate decision to act only after some senators tried to apply pressure by blocking confirmation of acting FDA commissioners. The agency’s justification for its final decision “lacks all credibility,” Korman said.

“The court has vindicated our claim that the Bush administration’s FDA was playing political games with women’s health,” said Nancy Northup, president of the Center for Reproductive Rights. “The judge’s opinion makes clear that the FDA should have put medical science first and left politics at the lab door.”

Susan F. Wood of George Washington University, who resigned from the FDA because of the agency’s delays, noted that several officials involved in the decision are either still at the agency or in other key government positions, including Janet Woodcock, who heads the FDA’s drug approval office, and Steven Galson, now acting surgeon general and assistant secretary of health. But Wood and others said they are confident that the new leadership at the agency will make Plan B widely available after reviewing the case.

“I think FDA is now in a position where it can make a fair decision because of the change in leadership and the commitment by everyone involved to make science-based decisions,” Wood said. “This is a chance for the agency to demonstrate it is back on track.”

President Obama recently announced plans to name former New York City health commissioner Margaret A. Hamburg as FDA commissioner and Baltimore Health Commissioner Joshua M. Sharfstein as her deputy. He also issued an order he said was designed to insulate scientific decisions throughout the government from political influence.

Plan B remains the focus of intense debate, particularly over whether pharmacists who oppose its use on moral grounds should be required to sell it.

Harvard Medical School, March 24, 2009 — Want to improve your health? Start by focusing on the things that bring you happiness. There is some scientific evidence that positive emotions can help make your life longer and healthier. But to produce good health, positive emotions may need to be long term. In other words, thinking positive thoughts for a month when you already have heart disease won’t cure the disease. But lowering your stress levels over a period of years with a positive outlook and relaxation techniques could reduce your risk of heart problems.

Pathways to happiness

In an early phase of positive psychology research, University of Pennsylvania psychologist Martin Seligman and Christopher Peterson of the University of Michigan chose three pathways to examine:

· Feeling good. Seeking pleasurable emotions and sensations, from the hedonistic model of happiness put forth by Epicurus, which focused on reaching happiness by maximizing pleasure and minimizing pain.

· Engaging fully. Pursuing activities that engage you fully, from the influential research by Mihaly Csikszentmihalyi. For decades, Csikszentmihalyi explored people’s satisfaction in their everyday activities, finding that people report the greatest satisfaction when they are totally immersed in and concentrating on what they are doing—he dubbed this state of intense absorption “flow.”

· Doing good. Searching for meaning outside yourself, tracing back to Aristotle’s notion of eudemonia, which emphasized knowing your true self and acting in accordance with your virtues.

Through focus groups and testing hundreds of volunteers, they found that each of these pathways individually contributes to life satisfaction.

Things that won’t make you happy

People tend to be poor judges of what will make them happy. While most people say they want to be happy, they often believe in myths or carry assumptions that actually get in the way. Here are some widely held myths about what will bring happiness:

Money and material things. The question of whether money can buy happiness has, for more than 30 years, been addressed by the “Easterlin paradox,” a concept developed by economist Richard Easterlin. His research showed that people in poor countries are happier when their basic necessities are covered. But any money beyond that doesn’t make much difference in happiness level. This idea has been challenged periodically, as in 2008 when two University of Pennsylvania researchers analyzed Gallup poll data from around the world. They showed, in contrast to Easterlin’s work, that people in wealthier countries are happier in general. The two studies were not directly comparable in method, however. And Easterlin points out that the new study may be flawed by cultural bias, as people from different countries may have different ways of answering questions about wealth and happiness.

Youth. Being young and physically attractive has little or no bearing on happiness. In a study published by Richard Easterlin in 2006 in the Journal of Economic Psychology, not only did being young fail to contribute to happiness, but adults grew steadily happier as they moved into and through middle age. After that, happiness levels began to decline slowly as health problems and other life problems emerged.

Children. Children can be a tremendous source of joy and fulfillment, but their day-to-day care is quite demanding and can increase stress, financial pressures, and marital strife. When ranking their happiness during daily activities, mothers report being more happy eating, exercising, shopping, napping, or watching TV than when spending time with their children. In several studies, marital satisfaction declines after the first child is born and only recovers after the last child leaves home. Personal relationships of all types are important, however. In studies, being married, having more friends, and having sexual intercourse more often are all moderately or strongly associated with happiness.

How do you know if you’re in flow?

You lose awareness of time. You aren’t watching the clock, and hours can pass like minutes. As filmmaker George Lucas puts it, talent is “a combination of something you love a great deal and something you can lose yourself in—something that you can start at 9 o’clock, look up from your work and it’s 10 o’clock at night … .”

You aren’t thinking about yourself. You aren’t focused on your comfort, and you aren’t wondering how you look or how your actions will be perceived by others. Your awareness of yourself is only in relation to the activity itself, such as your fingers on a piano keyboard, or the way you position a knife to cut vegetables, or the balance of your body parts as you ski or surf.

You aren’t interrupted by extraneous thoughts. You aren’t thinking about such mundane matters as your shopping list or what to wear tomorrow.

You are active. Flow activities aren’t passive, and you have some control over what you are doing.

You work effortlessly. Flow activities require effort (usually more effort than involved in typical daily experience). Although you may be working harder than usual, at flow moments everything is “clicking” and feels almost effortless.

FEATURED CONTENT: Using the positive in your life

· Finding and using your inner character strengths

· Putting mindfulness to use toward well-being

· Developing gratitude

· Savoring pleasure

· Becoming more engaged through “flow”

· Coping with stress when times are tough

· Forming positive relationships and communities

Reprinted from Positive Psychology: Harnessing the power of happiness, personal strength, and mindfulness, a Special Health Report from Harvard Medical School, © 2009 by Harvard University. All rights reserved.

Food, water and energy shortages will unleash public unrest and international conflict, Professor John Beddington will tell a conference tomorrow

Ian Sample, science correspondent
guardian.co.uk, Wednesday 18 March 2009

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Food and water shortages as a result of climate change and growing populations are likely to trigger mass migration and unrest. Photograph: AFP/Getty

A “perfect storm” of food shortages, scarce water and insufficient energy resources threaten to unleash public unrest, cross-border conflicts and mass migration as people flee from the worst-affected regions, the UK government’s chief scientist will warn tomorrow.

In a major speech to environmental groups and politicians, Professor John Beddington, who took up the position of chief scientific adviser last year, will say that the world is heading for major upheavals which are due to come to a head in 2030.

He will tell the government’s Sustainable Development UK conference in Westminster that the growing population and success in alleviating poverty in developing countries will trigger a surge in demand for food, water and energy over the next two decades, at a time when governments must also make major progress in combating climate change.

“We head into a perfect storm in 2030, because all of these things are operating on the same time frame,” Beddington told the Guardian.

“If we don’t address this, we can expect major destabilisation, an increase in rioting and potentially significant problems with international migration, as people move out to avoid food and water shortages,” he added.

Food prices for major crops such as wheat and maize have recently settled after a sharp rise last year when production failed to keep up with demand. But according to Beddington, global food reserves are so low – at 14% of annual consumption – a major drought or flood could see prices rapidly escalate again. The majority of the food reserve is grain that is in transit between shipping ports, he said.

“Our food reserves are at a 50-year low, but by 2030 we need to be producing 50% more food. At the same time, we will need 50% more energy, and 30% more fresh water.

“There are dramatic problems out there, particularly with water and food, but energy also, and they are all intimately connected,” Beddington said. “You can’t think about dealing with one without considering the others. We must deal with all of these together.”

Before taking over from Sir David King as chief scientist last year, Beddington was professor of applied population biology at Imperial College London. He is an expert on the sustainable use of renewable resources.

In Britain, a global food shortage would drive up import costs and make food more expensive. Some parts of the country are predicted to become less able to grow crops as higher temperatures become the norm. Most climate models suggest the south-east of England will be especially vulnerable to water shortages, particularly in the summer.

The speech will add to pressure on governments following last week’s climate change conference in Copenhagen, where scientists warned that the impact of global warming has been substantially underestimated by the UN’s Intergovernmental Panel on Climate Change. The latest research suggests that sea level rises, glacier melting and the risk of forest fires are at, or beyond, what was considered the worst case scenario in 2007.

Beddington said that shifts in the climate will see northern Europe and other high-latitude regions become key centres for food production. Other more traditional farming nations will have to develop more advanced pesticides or more hardy crops to boost yields, he said. In some countries, almost half of all crops are lost to pests and disease before they are harvested. Substantial amounts of food are lost after haversting, too, because of insufficient storage facilities.

Beddington said a major technological push is needed to develop renewable energy supplies, boost crop yields and better utilise existing water supplies.

Looming water shortages in China have prompted officials to build 59 new reservoirs to catch meltwater from mountain glaciers, which will be circulated into the water supply.

Beddington will use the speech to urge Europe to involve independent scientists more directly in its policy making, using recent appointments by President Barack Obama in the US as an example of how senior scientists have been brought into the political fold. Shortly after taking office, Obama announced what many see as a “dream team” of scientists, including two Nobel laureates, to advise on science, energy and the environment.