Lack of sunlight may increase lung cancer risk

US researchers examined data from 111 countries to study the association between latitude, exposure to UVB light ( principal source of vitamin D) and rates of lung cancer.

Analysis of data showed that lung cancer rates were highest in those countries furthest from the equator where exposure to sunlight is lowest and lowest in those nearest. The researchers believed that vitamin D can halt tumor growth by promoting the factors responsible for cell death in the body. They found smoking accounted for up to 85% of all cases of lung cancer but exposure to UVB light in particular had an impact.

Experts warn that exposure to sunlight is the major cause of skin cancer and the link between vitamin D and lung cancer is still unclear. Source : "Could ultraviolet B irradiance and vitamin D be associated with lower incidence rates of lung cancer?" Journal of Epidemiology and Community Health 2008;62:69-74

Women with shorter legs may have higher risk of liver diseases

Almost 4,300 women of 60 - 79 were randomly selected from 23 British towns for an interesting study that investigated the separate associations of leg length and trunk length with levels of four liver enzymes: ALT, GGT, AST and ALP, each of these "reflects a different aspect of potential liver damage". The researchers found that women with shorter legs had higher levels of ALT, GGT and ALP ( an indicator of bone disease) while trunk length was positively associated with ALT and inversely associated with ALP.


They concluded that adult liver function is affected by childhood exposures, such as good nutrition, as reflected in leg length. This may suggest "common childhood influences on liver development and adult risk of diabetes and heart disease."


Source: "The associations between height components (leg and trunk length) and adult levels of liver enzymes" Journal of Epidemiology and Community Health 2008;62:48-53 (abstract only)

How would you manage this patient?

Every month JAMA presents a Clinical Crossroads case with patient's own view, it poses review questions and ask readers to submit their response to how they would care for the patient using evidence from the literature and his/her experience.

"Responses will be selected for posting online based on their quality, including use of the available evidence, weighing the issues, and addressing the patient's concerns." This could be another useful tool for doctors' education.

How would you manage this patient ? "A 39-Year-Old Man With a Skin Infection" JAMA. 2007;298(22)

Image Challenge

The New England Journal of Medicine features medical images every week to provide readers an opportunity to test their diagnostic skills - Image Challenge.

A question with several possible answers is given. You can "check your answer" after you have selected an answer. You can also check "how others chose", it is interesting to see that many people did not get the answers right. It could be a useful educational tool for doctors.

Take this week's Image Challenge.

Pedometer - a perfect gift for motivating physical activity.

A review of 8 randomized controlled trials and 18 observational studies with a total of 2767 participants was carried out to evaluate the association of pedometer use with physical activity and health outcomes, according to an article in JAMA.

The study found that pedometer users in RCTs significantly increased their physical activity by 2491 steps per day more than control participants while those in observational studies 2183 steps per day over baseline. The pedometer users significantly decreased their body mass index by 0.38, the intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg. However, whether these changes are durable over the long term is undetermined.

A pedometer counts steps a person takes and the distance he/she has walked and has become popular as an everyday exercise motivator - a perfect Christmas gift for someone who wants to increase physical activitity and improve health.

Source : "Using Pedometers to Increase Physical Activity and Improve Health - Systematic Review" JAMA. 2007;298(19):2296-2304. (abstract only)

Smoking associated with increased risk of diabetes

According to an article published in the current issue of JAMA , a review of 25 studies involving a total of 1.2 m patients showed that smoking is linked to an increased risk of diabetes.


Analysis of the data indicated that active smokers have a 44% increased risk of developing type 2 diabetes compared with non-smokers. The risk increased with the number of cigarettes smoked, heavy smokers had 61% of increased risk compared with lighter smokers (29%), but the authors said there is a need for further studies to establish whether this association is causal.


Source: "Active Smoking and the Risk of Type 2 Diabetes - A Systematic Review and Meta-analysis" JAMA. 2007;298(22):2654-2664 (abstract only)

Elective caesareans linked to respiratory morbidity

More and more women request a Caesarean section without good medical reasons, a lot of them are completely unaware of the negative impact on their baby.

A large-scale study carried out by Dannish experts involving 34,458 deliveries between 37 and 41 weeks found babies born through elective Caesarean are up to four times more likely to suffer breathing problems compared with those born naturally or by emergency Caesarean. The earlier the Caesarean is carried out, the higher the risk. The researchers advised women not to carry out elective Caesareans before 39 weeks. The report is published by the BMJ.

Source : "Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study" BMJ Online (published 11 December 2007)

Mediterranean diet can lower mortality rate

According to a large scale cohort study of 380,296 people aged 50 - 71 with no history of chronic disease, eating a Mediterranean diet can cut the risk of dying early.

Participants were divided into three groups according to their dietary habits and were then followed-up over a five-year period. The study found that those who followed a Mediterranean diet closely were less likely to die of cancer or heart disease. The authors concluded that their study provided strong evidence that higher conformity with the Mediterranean diet is associated with lower mortality rate.

Source: "Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study" Archives of Internal Medicine. 2007;167(22):2461-2468

Pediatricians' journal reading habits

An interesting article about American pediatricians' reading habits showed that pediatricians read journal articles primarily for current awareness. They chose the formats that were most convenient to them, read quickly and often relied on print journals and personal subscriptions. However they tended to rely on e-resources for research, writing and presentations, most likely provided by the library. The authors said this finding is similar to the results of many studies of physicians.

Summaries of findings :

Amount of reading - Read on average between 145 and 184 articles per year

Age of articles read - 81% of the reading were from the current year

Time spent - On average spent 20 minutes per reading, ie about 49 -61 hrs per year reading articles (other healthcare professionals spent an average of 118 hrs per year reading an average of 322 journal articles )

Purpose of reading - Principal purpose : 50 % for current awareness
Secondary purposes : 30.3 % for treatment, 20% for diagnosis, 18.2% for teaching

Outcomes of reading - Improved a result 43.5%, inspired new thinking 42.2%, helped narrowed the focus 17%

Source & formats of reading - Mostly from personal and print subscriptions for current awareness, but rely on electronic resources provided by the library for research, writing and presentations

Location of reading - Scholarly reading most often at home 50.5%, In office 36.8%, Hospital/clinic only 6.2%

Subscription payment - Personal subscriptions over 5.3 each ( average subscription for scientists and social scientists is under 2 per person).

PubMed use - 71% had used PubMed at some point, about 34 times on average in the past 12 months. As a result of using PubMed, they read between 0 and 1000 articles.

Use of PDA - About half of respondents used a PDA but few used PDAs to download articles .

Source: "Journal reading patterns and preferences of pediatricians" J Medical Library Association 95(1) January 2007 ( free full text)

Tomato ketchup reduces cholesterol levels

21 healthy people with normal cholesterol levels were selected by Finnish scientists for a study and were given a 3- week no tomato products diet followed by a 3-week high tomato diet including 400 ml tomato juice and 30 mg tomato ketchup daily.

The study found that a high dietary intake of tomato products significantly reduced LDL cholesterol levels and increased LDL resistance to oxidation in three weeks. However larger controlled studies are required to establish the clinical benefits in people with elevated cholesterol levels.

Source : "Tomato juice decreases LDL cholesterol levels and increases LDL resistance to oxidation" British Journal of Nutrition (6 December 2007), 98:1251-1258

Honey is better than children's cough medicine

In a US study to compare the effects of a single dose of buckwheat honey or honey-flavored dextromethorphan with no treatment on nocturnal cough and sleep difficulty associated with childhood upper respiratory tract infections, 130 children were randomly assigned to receive buckwheat honey or honey-flavoured dextromethorphan or no treatment before bedtime.

Parents were asked to answer questions about the child's cough and sleep difficulty and compared with the previous night when no treatment was given at all. They rated honey the most favorable relief of symptoms of their child's nocturnal cough and sleep difficulty. The study concluded that honey may be a preferable treatment for children's cough and sleep difficulty.

Source : "Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents" Archives of Pediatrics & Adolescent Medicine. 2007;161(12):1140-1146 ( full text with Athens)

Fever may improve autistic behaviour

A small but interesting study based on 30 children with autism spectrum disorder(ASD) who had a fever found that more than 80% of these children showed fewer autistic behaviour during the fever compared to the children without fever. The behaviour changes involved longer concentration, more talking, improved eye contact and better relations with other people.

The author said that the results of the study are important because they could help the evaluation of the disorder and shed light on future treatment.

Source: "Behaviors Associated With Fever in Children With Autism Spectrum Disorders" Published online November 30, 2007 Pediatrics, in print in the December issue, p. e1386-e1392 (abstract only)

Childhood obesity has lifelong effects

According to 2 studies published in this week's NEJM, children worldwide are gaining excessive weight that causes serious health problems in their adulthood.

The studies found that high body mass index in childhood increases the risk of coronary heart disease in adulthood. The authors said that healthy food and physical activities are the keys to prevent this health problem, but a national strategy involving parents to help these children to maintain an appropraite weight to reduce the future risk of heart disease is urgently needed.

Source:"Childhood Body-Mass Index and the Risk of Coronary Heart Disease in Adulthood" NEJM 357(23):2329-2337 (free full text)


"Adolescent Overweight and Future Adult Coronary Heart Disease" NEJM 357(23):2371-2379
(free full text)

Doctors' behaviour is not consistent to professional standards

More than 1600 physicians took part in a survey that attempted to measure the medical professionalism in accordance with the new physician charter that has been distributed to doctors around the world.

The survey results showed that doctors' behaviour did not reflect the standards they endorsed in some areas. Many respondents failed to report impaired colleagues or serious medical errors and would order unneeded MRI scans if patients demanded the tests. Researchers said that emphasis of patient satisfaction has put doctors in difficult situations.

Source: "Professionalism in Medicine: Results of a National Survey of Physicians" Annals of Internal Medicine. 4 December 2007, 147(11):795-802 (abstract only)

Anti-psychotic drugs can significantly harm dementia patients

Professor Clive Ballard, one of the world's leading experts in dementia, investigated the effects of the anti-psychotic drugs on dementia patients with shocking results.

His study, featured in the BBC Panorama : Please look after Dad, shows that anti-psychotic medication is given to many dementia patients in care homes in the UK costing £80m per year. He said that these drugs have no benefit to dementia patients and can significantly harm them and called for better care for dementia sufferers without relying on these drugs.

An article "Prescription Abuse Seen In U.S. Nursing Homes" in Wall Street Journal (WSJ) reported similar trend in the use of anti-psychotic drugs in nursing homes prescribed by doctors on dementia sufferers whether they are psychotic or not. Health regulators and patient advocates are questioning such practice.

CT scans raise cancer risk

A research article published in this week's NEJM raised serious concerns about the cancer risks associated with CT scans due to its widespread use in America.

CT sacns are increasingly used in America to diagnose medical problems in children as well as adults, they are needlessly exposed to dangerous radiation that raises the risk of cancer.

The authors said that "too many CT studies are being performed in US" and suggested ways to reduce overall radiation dose from CT including reducing dose in individual patients, using other options and reducing the number of prescribed CT studies.

Source : "Computed Tomography — An Increasing Source of Radiation Exposure" NEJM, Volume 357(22):2277-2284 ( free full text)

Prostate cancer patients often receive mismatched therapy

A study conducted at 4 Massachusetts hospitals using questionnaires to survey more than 400 patients found that prostate cancer patients often receive treatment that is contraindicated by pre-existing conditions such as urinary or bowel dysfunction. It also found mismatched treatments were more common than expected.

The authors raised concerns about poor patient-doctor communication that can lead to poor clinical outcomes.

Source: "Treatment 'Mismatch' In Early Prostate Cancer: Do Treatment Choices Take Patient Quality of Life Into Account?" CANCER; Published Online: November 26, 2007 (DOI: 10.1002/cncr.23138); Print Issue Date: January 1, 2008

Can insoles prevent back pain?

There had been a theory that insoles might reduce the impact on spinal discs therefore protecting the back.

According to a new review of 6 studies published in the Cochrane Database of Systematic Reviews 2007, Issue 4, the use of insoles does not prevent back pain. The researchers concluded that "there is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities".

Source: "Insoles for prevention and treatment of back pain" Cochrane Database of Systematic Reviews 2007, Issue 4.

Lung transplants may bring more harm than good to children with CF

According to a new study that looked at lung transplants in children with cystic fibrosis (CF) in US, children rarely benefited from such transplants and there were significant risk of harm associated with the transplant. The lead author said it is important to develop criteria to identify the children who would benefit most from transpalnts.

An editorial in the same issue of the NEJM commented that the report's conclusion was shocking, the transplant rules in the US have chanaged since the study was done and the researchers put together data of children and adult patients who have a different success rate.

Source: "Lung Transplantation and Survival in Children with Cystic Fibrosis". NEJM 2007 357(21): 2143-2152 (abstract only)

Prostate cancer may be missed in obese men

A new study found dcotors may be missing a large number of cancer in obese men because the test for prostate-specific antigen (PSA) is unreliable. It may explain why obese men tend to have more aggressive cancer.

Researchers said doctors must take body weight into account when reading test results for prostate cancer because higher body mass index (BMI) is linked to higher plama volume that can lead to dilution of PSA.

Source: "Obesity-Related Plasma Hemodilution and PSA Concentration Among Men With Prostate Cancer" JAMA. 2007;298(19):2275-2280

Rapid response team reduces death

A children’s hospital in California added a rapid response team (RRT) with experts available 24x7 for hospitalised patients who were not in the intensive care unit. After the implementation of the intervention, there was significant decrease in death and cardiopulmonary arrest rates, according to a new study published in the November 21 issue of JAMA.

However, in an accompanying editorial, the authors said that rigorous and comparable data will need to be collected to determine the best approach for RRTs in pediatrics.


Source: "Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children’s Hospital" JAMA. 2007;298(19):2267-2274 (free full text article)

Arthritis drug withdrawn from market

Prexige, an arthritis drug called COX2 inhibitors, made by Novartis, has been ordered to be withdrawn from the market by drug regulators in Britan after growing international evidence that it has caused severe liver damage - according to the Guardian.

Another drug in the group, Vioxx made by Merk was withdrawn from the market in 2004 after reports of heart problems.

Modest results from obesity drugs

A study that reviewed the results of 30 placebo-controlled trials involving participants with mean BMI 35-36 and took anti-obesity drugs for at least 12 months, found that 3 commonly prescribed drugs - orlistat, sibutramine and rimonabant only achieve modest results in terms of weight loss - under 5% of total body weight.

The researchers said the three drugs had various health benefits but all had adverse effects, in rimonabant is associated with an increase in depression and anxiety.

A separate study in The Lancet found patients who took rimonabant were at increased risk of severe psychiatric events.

Sanofi-Aventis, the French drug maker, has issued press release in response to the BMJ & The Lancet article.

Source : "Long term pharmacotherapy for obesity and overweight: updated meta-analysis" BMJ, doi:10.1136/bmj.39385.413113.25 (published 15 November 2007)

ADHD drugs have no long term benefits

A research referred to in the BBC programme Panorama : What Next for Craig? raised questions about the long -term benefit of the drugs used to treat children with ADHD.

The 3 year Multimodal Treatment study of children with ADHD (MTA) found that ADHD drugs may work well in the short term. By 36 months, there was no apparent improvement in children's behaviour. The study also found the drugs could stunt children's growth.

Source: "3-Year Follow-up of the NIMH MTA Study". Journal of the American Academy of Child & Adolescent Psychiatry. 46(8):989-1002, August 2007.

Healthy diet may cut dementia risk

A study that looked at the diets of more than 8,000 healthy men and women aged over 65 over 4 year period, found that diets rich in fish, omega-3 oils and eating fruit and vegetables daily may decrease the risk of dementia and Alzheimer disease. The study, published in the Journal of Neurology.


Source : "Dietary patterns and risk of dementia -The Three-City cohort study" Neurology 2007;69:1921-1930 (Abstract only)

Long-term Beta Carotene Supplement use may preserve memory

According to a new study that looked at the effects of beta-carotene supplements on the cognitive abilities in nearly 6000 men over an average of 18 years, long term use of beta-carotene supplements may preserve memory and other thinking skills.


However, it was stressed in an accompanying editorial, that other studies into beta-carotene supplements had shown contrasting results. One study has suggested potential harm from taking beta-carotene in pill form.


Source : "A Randomized Trial of Beta Carotene Supplementation and Cognitive Function in Men: The Physicians' Health Study II" Arch Intern Med. 2007;167(20):2184-2190.

Overweight men with prostate cancer have higher risk of dying

A new study that tracked 788 men with prostate cancer also looked at their BMI at the start of the trial and followed up for 8 years. The researchers found that men who are overweight when diagnosed with prostate cancer are twice as likely to die from it. The finding was published in the journal Cancer.


Source : "Obesity and Mortality In Men With Locally Advanced Prostate Cancer: Analysis of RTOG 85-31," Cancer; Published Online: November 12, 2007 (DOI: 10.1002/cncr. 23093); Print Issue Date: December 15, 2007

This is the 3rd post this month about overweight and cancer risk.

Paracetamol as the first line of care for acute low back pain

Australian researchers warn in a study published in The Lancet that diclofenac and/or spinal manipulative therapy do not work for acute lower back pain patients, but paracetamol and keeping active are the best cures.

Source : "Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial" The Lancet, Volume 370, Issue 9599, p 1638-1643.

Pills linked to cervical cancer risk

A Belgian study found that use of oral contraceptives increased the risk of cervical cancer - but the risk fell 10 years after the women stopped taking the pills.

Some experts feared that this study may mislead the public that there is a direct link between cervical cancer and oral contraceptives. They said that the women on the pill may have more sexual activities and therefore more likely to be infected with HPV, but cervical cancer is only caused by HPV. Many doctors said that women should not stop taking them.


Source: "Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies - International Collaboration of Epidemiological Studies of Cervical Cancer" The Lancet, vol 370; 9599, pp 1609-1621

Being overweight does not increase death risk from cancer or heart disease

A new American federal report found that overweight increase the risks of dying from diabetes and kidney disease but not cancer or heart disease. The findings are based on decades of cause-of-death data collected by federal scientists. They also found a protective effect against all other causes of death.

Some dismissed the findings as fundamentally flawed while others saw that the dangers of being fat have been exaggerated. The author said the findings does not mean being overweight is good, but is associated with less mortality than expected.

Source : "Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity" JAMA. 2007;298(17):2028-2037

Tourette syndrome can be treated with deep brain stimulation

A small randomised and double-blinded study of 5 adults with Tourette syndrome (TS) suggests that the tic frequency and severity of some TS patients can be reduced by a technique called deep brain stimulation ( DBS) that has shown success for Parkinson’s and dystonia - sending electric impulses to specific parts of the brain.


Source: "Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome" Journal of Neurosurgery
November 2007 Volume 107, Number 5 DOI: 10.3171/jns.2007.107.5.1004

Cancer fears for overweight women

According to an article published in the BMJ, researchers matched body mass index (BMI) against cancer incidence to identify the risk of being overweight among UK women and found that obesity and overweight raised the risk of developing and dying from a range of cancer.

The study also found that the cancer risk was dependent on a woman's stage in life.


Source: "Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study" BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)

Breast milk and higher IQ - it is in the gene

Two studies of more than 3,000 children in Britain and New Zealand found that breastfeeding raised IQ if the children also had a variant of a gene, called FADS2, found in 90% of people, which helps metabolize the fatty acid efficiently.


Source: "Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism" Proc. Natl. Acad. Sci. (PNAS) November 5, 2007 (subscription required)

Non-prescription painkillers may reduce risk of Parkinson's Disease

A study of 293 patients with Parkinson's Disease found that regular use of some non-prescription drugs known as NSAIDs reduced the risk of developing the disease. The protection persisted for 2 years after the patients stopped taking the drugs.

However, researchers warned that regular use of high dose aspirin and non-aspirin NSAIDs may cause gastrointestinal bleeding and other risks.

Source: "Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease" Neurology 2007; 69: 1836-1842. (Subscription required for f/t)

This blog is one year old - thank you for visiting

I started blogging last October reporting health-related news that have hit the headlines.

One of the reasons that I develop a blog is that news can be posted as they break and readers can access it immediately over the Internet. You might like to read it whenever it suits you by browsing the archives. Anyone can respond to any post, whether writing an informal comment or adding information to it, so a blog could be a useful resource. You can also subscribe to the blog RSS feed, the orange icon with "subscribe", so that you receive the updates as they come in.
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Click on "Comment", write your comment in the "Leave your comment" box.
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Caesarean birth may double morbidity and mortality risk

A new study invovling 97,307 deliveries of babies during the three-month study period in some randomly selected countries has found that women who deliver through non-emergency caesarean birth have double the risk of morbidity and mortality for themselves and the babies as compared to those who go for a vaginal birth.

However, researchers found caesarean delivery prevented foetal deaths in breech born babies.

Source: "Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study" BMJ Online First, doi:10.1136/bmj.39363.706956.55 (published 30 October 2007)

Breaking the waters does not shorten labour

According to a Cochrane systematic review of 14 multicentre, randomised controlled trials involving 4893 women, amniotomy, also called breaking the waters, did not speed delivery.

Amniotomy, artificial rupture of the fetal membranes to induce labor, is one of the most commonly performed procedures to speed contractions, thereby shortening the length of labor. However, the reviewers said that there is little evidence that a shorter labor has benefits for either mother or child and concluded the evidence does not support the routine breaking the waters for women in spontaneous labour.

Source: "Amniotomy for shortening spontaneous labour" - Cochrane Database of Systematic Reviews 2007, Issue 4.

To err is human ...

Two US doctors made a documentary about the impact of medical errors by interviewing patients and families that had been affected by medical error and found that doctors and patients felt the same kind of guilt, fear and isolation after the medical errors occur.

"How can patients, families and clinicians move beyond these feelings and approach closure and forgiveness?" the authors wrote.

Read the free full text article : "Guilty, Afraid, and Alone — Struggling with Medical Error", NEJM 357(17):1682-1683.

Are doctors just playing hunches?

This is an interesting article about evidence-based medicine published by the Time magazine last February.

The author wrote,"The trend in medicine is increasingly to be guided by the data …..All patients would probably benefit if their doctors were abreast of the latest data, but none would benefit from being reduced to one of those statistical points".

Are doctors playing medical hunches?

More women choosing double mastectomies

In a study of 4,969 American women who chose contralateral prophylactic mastectomy (CMP), researchers report that the rate of preventive mastectomy in women with single-breast cancer rose 150% in six years although the actual number of women choosing double mastectomy is relatively small.


The lead author said such aggressive strategy may be unnecessary because the risk of cancer spread to other body sites is higher than the risk of getting cancer in the second breast. He emphasized that women may benefit from treating the known breast cancer first and thinking about other options later after their treatment is completed.

Source: "Increasing Use of Contralateral Prophylactic Mastectomy for Breast Cancer Patients: A Trend Toward More Aggressive Surgical Treatment". Journal of Clinical Oncology , 22 Oct 2007 (ahead of print)

Acupuncture - best therapy for back pain

I learned from a mailing list that there was a large number of queries about a trial published in the journal Archives of Internal Medicine, September 2007.

It was a randomized and blinded trial conducted across 340 practices in Germany involving 1162 adults who had suffered from lower back pain for an average of 8 years. Patients were randomly assigned to one of three treatment groups: verum acupuncture, sham acupuncture or conventional therapy. After 6 months, nearly half of the patients receiving acupuncture treatment showed significant improvements in back pain compared to about one-quarter receiving conventional treatment.


The finding has led to acupuncture being adopted in Germany as a covered benefit for chronic lower back pain treatment under statutory health insurance plans.

Source: "German Acupuncture Trials (GERAC) for Chronic Low Back Pain - Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups , Arch Intern Med. 2007;167:1892-1898 (Sept 27)

Read previous post on "Alternative medicine in the US medical curriculm" and the cut back on using complementary therapies in the UK.

Current evidence does not support aspirin therapy in IVF

Previous studies on the use of aspirin have shown conflicting evidence whether low-dose aspirin is beneficial in IVF.


According to a systematic review of 9 studies in different parts of the world involving more than 1400 women undergoing IVF or ICSI ( intracytoplasmic sperm injection) to treat infertility, currently available evidence does not support the use of aspirin in IVF or ICSI treatment. Further research into this treatment is needed.


Source: "Low-dose aspirin for in vitro fertilisation". Cochrane Database of Systematic Reviews 2007, Issue 4

A bowl of whole-grain breakfast cereal every day can cut the risk of heart failure

A new study comparing cereal intake and the risk of heart failure among more than 21,000 doctors who took part in the Physicians Health Study I found that men who ate whole-grain breakfast cereal regularly were less likely to develop heart failure than those who ate it rarely. The risks of heart failure were highest among those who never ate the cereal.


The researchers concluded that their data "demonstrate that a higher intake of whole grain breakfast cereals is associated with a lower risk of heart failure." The protective effect of whole-grain cereal against heart failure may be due to the beneficial effects of whole grains on heart disease risk factors, such as high blood pressure, heart attack risk, diabetes and obesity.

Source: "Breakfast Cereals and Risk of Heart Failure in the Physicians' Health Study I" Archives of Internal Medicine, Oct 2007; 167: 2080 - 2085 (Subscription required)

Aspirin - men's drug?

Aspirin has been linked to many health benefits, but a study which analysed 23 previously published clinical trials for the effect of aspirin in heart attack prevention, involving more than 113,000 patients found that women may be less responsive to aspirin than men for heart protection.


The researchers believe that gender may be one of the main influences on aspirin's protective powers. One UK expert said the finding is "potentially misleading" and that "taking aspirin in the months and years after a heart attack delivered equal benefits to men and women".


Source: "The influence of gender on the effects of aspirin in preventing myocardial infarction"
BMC Medicine 2007, 5:29 ( This is an open access journal article with full text )

GPs' antibiotic prescription not justified

Most antibiotic prescribing in the UK is in primary care for patients with respiratory tract infections, but guidelines advise against their routine use in patients with upper respiratory tract infections except for chest infections in elderly people.

A BMJ study found that antibiotics reduce the risk of serious complications which is rare after upper respiratory tract infections, but over 4000 courses would have to be needed to prevent one complication. However, only 39 elderly patients would have to be treated with antibiotics for a chest infection to prevent a case of pneumonia.

The study concluded that there is a "clear scope for reductions in antibiotic prescribing for upper respiratory tract infections" and " more research was needed to help doctors differentiate between chest infection and pneumonia"

Read the abstract "Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database" BMJ 2007, October

UK NHS fail on hygiene standards

In the UK, there are growing concerns among patients about C.difficile and MRSA infections following the C.difficile outbreak in Kent that had killed 90 patients between 2004 and 2006.

According to the Healthcare Commission report, 1 in 4 hospital trusts in England are failing to protect patients from deadly superbugs and to meet basic hygiene standards including cleaning hands and instruments.

See also the article "Doctors need a "sea change" in their attitude to C. difficile" BMJ 2007;335:790 (20 October).

MRSA more widespread than thought in US

A team of US researchers carried out a study to find out the incidence of invasive MRSA disease in specific American communities during 2005 and found that MRSA infections are more common than previously thought in the US. It is being found more frequently outside of health care settings and seems to affect certain populations such as the blacks, male and the 65+.


Based on the documented 8,987 cases of of invasive MRSA, the researchers estimated that there were 94,360 cases of invasive MRSA in the US in 2005, resulting in more than 18,000 deaths.


The researchers concluded " invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care. Although in 2005 the majority of invasive disease was related to health care, this may change".


Read the free full text article "Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States" JAMA. 2007;298(15):1763-1771 (Oct 17)

Household cleaning sprays raise asthma risk

A study of more than 3 500 people from 10 European countries found using household cleaning sprays and air fresheners as little as once a week raised the risk of asthma.

Researchers found that cleaning sprays, such as air fresheners, furniture cleaners and glass-cleaners had a particularly strong effect.

Source : "The Use of Household Cleaning Sprays and Adult Asthma: An International Longitudinal Study" Am. J. Respir. Crit. Care Med. 2007; 176(8) : 735-741

Don't smoke around babies

A Bristol research, to be published in the journal Early Human Development, studied the impact of exposure to smoking and its adverse effects both before and after birth.

It found that cot deaths linked to smoking have risen and the risk of death increased with each individual hour the baby was exposed to smoke. The author said "after delivery, the mother can reduce the risk by protecting her baby and not smoking near it".

The Foundation for the Study of Infant Deaths said "If no women smoked in pregnancy, about 60% of cot deaths could be avoided".

Extended benefits of statin therapy

A 15-year Glasgow study showed that patients who had been taking pravastatin for 5 years were still experiencing the benefits 10 years after they stopped taking the drug, with a significant reduced risk of heart attacks and other coronary events.


The extended benefits may be due to the lowering LDL cholesterol by early statin therapy and stabilizing existing plague therefore slowing the progress of coronary heart disease.


Source : "Long-Term Follow-up of the West of Scotland Coronary Prevention Study". NEJM 2007; 357(15):1477-1486 (October 11)

Stressful jobs increase risks of heart disease recurrence

Did you know that job stress was a major predictor of repeated heart attack when compared with other risk afctors such as smoking, alcohol consumption, and high blood pressure?

Previous studies have shown that job strain increases the risk of a first coronary heart disease (CHD) event. According to a new Canadian study of about 980 patients who returned to work after a heart attack, chronic job strain after a first MI was associated with an increased risk of recurrent CHD.

The author said preventive interventions should also take into account the person's work environment and "cardiologists and occupational health services be informed of this finding in order to reduce stressful work for those returning to work after a heart attack".

The ABC News said that workers should learn to manage stress at work to either change their thoughts or to change the situation.

Source: "Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events" JAMA. 2007;298(14):1652-1660

fast treatment of small strokes can prevent major ones

According to a research at Oxford University, fast assessment and treatment of minor strokes or transient ischemic attacks (TIA) can reduce the risk of early recurrent stroke by 80%. Early treatment could help prevent 100,000 strokes each year in Britain, but researchers said "the vast majority of patients in Britain have not been getting treatment for the first few weeks."

The study "Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison" was published in The Lancet (early online publication) October 9, 2007

Another study, "A transient ischemic attack clinic with round-the-clock-assess (SOS-TIA): feasibility and effects" published in The Lancet Neurology, also found that early treatment brought similar results in reducing the risk of a major stroke.

Medical grand rounds and free food

While I was searching for some CME resources for our Foundation Year doctors, I came accross an interesting research article "If you feed them, they will come: A prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center" BMC Medical Education 2007, 7:22


It reports on the results of a prospective study of the effects of providing complimentary food on attendance at medical grand rounds (MGR) and a web-based survey that assessed the attitudes of attendees on the provision of complimentary food at MGRs.


The data suggest that faculty, fellows, and residents are more likely to attend MGR if free food is provided and less likely to attend if free food is not provided.


MGR is a central teaching activity in most departments of medicine at academic medical centers, but attendance by faculty, fellows, and residents appears to be decreasing. The study concludes that providing free food may be an effective strategy for increasing attendance at MGR.


What are your views and experience on the effects of free food on physicians' attendance to MGRs or other educational activities?

Microsoft's personal health records

Microsoft has just released a new "software and service platform" called HealthVault to allow consumers to collect, store and share health information online. It includes free web-based personal health records, Internet search tailored for health queries and a "connecetion center" that can be connected to many devices such as glucose and blood pressure monitors.

Microsoft said the personal information will be stored in a secure database and individuals have complete controls over what information goes in and who sees it. Microsoft HealthVault uses Windows Live ID and a "strong" password to authenticate patients' identity.

Some hospitals, The American Heart Association, Johnson & Johnson LifeScan that sells glucose monitors, are collaborating with Microsoft in this new venture.

Would you choose to use the Microsoft personal health record?

ACE inhibitor may diminish cardiac complications with Marfan Syndrome

A preliminary research of 17 patients suggests that use of the ACE inhibitor perindopril (Aceon), reduced aortic stiffness and dilation in systole and diastole in patients with Marfan Syndrome taking standard beta-blocker therapy.

However the benefits of perindopril in improving cardic risks with Marfan Syndrome need to be established in larger groups and longer term clinical trials because the study was limited by its small size and relatively short duration.

Source: "Effect of Perindopril on Large Artery Stiffness and Aortic Root Diameter in Patients With Marfan Syndrome :A Randomized Controlled Trial" JAMA. 2007;298(13) :1539-1547

Caesarean increases uterine rupture risk

A study of about 300,000 Swedish women found that a caesarean section increases the risk of uterus rupture during a subsequent vaginal delivery.


The study also found neonatal death rate of 51 per 1000, a 60-fold increase in risk. Other risk factors including inducing labour, high maternal age and birthweight significantly increase the risk of uterine rupture.

Read the BJOG release : "Risk Factors For Uterine Rupture And The Neonatal Consequences". BJOG 2007;114:1208-1214.

Early testing for familial cholesterol

According to a BMJ study, based on a review of 13 studies, the researchers suggested that children could be screened at about 15 months of age for familial high cholesterol because the disorder is often inherited.

If children are tested positive for high cholesterol, doctors would screen the parents and drug treatment could begin immediately for the adults.

Full text of the article "Child-parent screening for familial hypercholesterolaemia: screening strategy based on a meta-analysis". BMJ 2007;335(7620):599 is available with an Athens password at the HILO website.

No posts until October

Posts to be resumed in October.

HPV vaccine does not treat HPV

HPV (Human papillomavirus) is a very common virus, some types cause cervical cancer, some cause gential warts. There has been confusion about whether women who have been infected with HPV could benefit from vaccination.

A study of more than 2000 women who already have HPV infection in Costa Rica found that Cervarix, a cervical-cancer vaccines, did not clear the virus from the bodies of the HPV-infected women. The author suggested that the vaccine "should not be used for the purposes of treating prevalent infections" and shoud target young women prior to their sexual debut because the infection happens shortly after sexual initiation.

Read the free article "Effect of Human Papillomavirus 16/18 L1 Viruslike Particle Vaccine Among Young Women With Pre-existing Infection: A Randomized Trial" JAMA. 2007 (7) ;298:743-753. August 15.

Waist size tells heart risk

Several studies have shown waist size is linked with heart attack, stroke and heart disease rsisk. They suggested that a waist circumference of over 35in for a woman, 40in for a man indicates a high risk of developing diabetes and heart disease.

A new US study looked for the early signs of atherosclerosis - narrowing and hardening of the arteries linked to the development of cardiovascular disease, of more than 2700 people with an average age of 45. Using MRI and EBCT scans that specially look for calcium deposits in the heart, they found the smaller a person's waist, the clearer the arteries, regardless of the body weight.

The researchers said the key message is to prevent accumulation of central fat early on in people's lives. "Even a small pot belly puts us at higher risk when compared to a flat tummy."

The report was published in the August 21 issue of Journal of the American College of Cardiology

Verapamil for cluster headache may cause heart problems

Cluster headache is a rare and severe form of headache that is more common in men. A drug, Verapamil, a type of calcium-channel blocker is increasingly used to treat cluster headaches and a range of symptoms including high blood pressure, angina and irregular heart beat.

A new study of 108 patients who had regular electrocardiograms (EKGs) found when high doses of Verapamil were used to prevent cluster headache, 1 in 5 patients developed some form of cardiac irregularity that could progress to serious heart problems.

More than 40% of the participants did not have access to the EKG service or unaware of the need for monitoring their heart. The researchers said that the drug is relatively new for treating cluster headache, therefore healthcare providers may be unaware of the problems. They highlighted the need for frequent EKG monitoring of patients treated with Verapamil for cluster headache.

The study "Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy." is published in the current issue of Neurology 2007 69: 668-675.

Vitamin supplements may not protect your heart

Some previous researches have found viatmin C, E and beta carotene linked to reduced risk of cardiovascular disease, but a new study published in the journal Archives of Internal Medicine casts doubt on these findings.

The latest study involved 8000 women who have a history of cardiovascular disease, randomly assigned to 2 groups : one taking vitamin alone or in combination and one a placebo over 9 years. The results showed that the antioxidants, either alone or in combination had no effect on reducing the risk of heart disease or death in high-risk women.

Some experts suggested that the form of vitamin in over-the-counter dietry supplements may be different from the vitamins found in fruits and vegetables and recommended that lifestyle change with healthy diet and regular exercises is the key to prevent heart disease.

Read the abstract - "A Randomized Factorial Trial of Vitamins C and E and Beta Carotene in the Secondary Prevention of Cardiovascular Events in Women - Results From the Women's Antioxidant Cardiovascular Study " Arch Intern Med. 2007;167 (15):1610-1618. 13-27 August.

Rethink preventive treatments in elderly people

Researchers from the UK and New Zealand said that "preventive treatments in elderly people may simply change the cause of death rather than prolonging life" in the article "Preventive health care in elderly people needs rethinking" in BMJ Online First.


As an example, they said that elderly patients will not necessarily reduce their risk of death caused by cardiovascular disease if they are given statins, their cause of death will most likely be "substituted" for cancer. Doctors are given financial incentives to persuading patients to accept such preventive treatments that are expensive and can be harmful to them.


The authors called for a more sophisticated model to assess preventive treatments in the elderly and concluded that cash may be better spent in relieving suffering through cataract, joint replacement operations and caring for people with dementia.

Doubts over laughing gas safety

A large scale study of 2000 patients undergoing major surgery in hospitals in Australia, UK, Asia and Middle East has raised doubts over the safety of the common anaesthetic known as laughing gas.

Australian researchers found that avoiding using nitrous oxide cut the risk of surgery complications like wound infections, pneumonia, nausea and vomiting. They also found a possible link between nitrous oxide and the risk of heart attacks and concluded that the routine use of nitrous oxide in patients undergoing major surgery should be questioned

The study "Avoidance of Nitrous Oxide for Patients Undergoing Major Surgery: A Randomized Controlled Trial" is published in the current issue of the journal Anesthesiology. 107(2): 221-231,August 2007 ( full text via HILO with Athens password )

Read the RCoA's response.

Hungry hormone and over-eating

British scientists discovered that the hormone Leptin, made by fat cells, is responsible for reducing hunger and increasing the feeling of fullness hunger, it also controls the fondness for food.The findings could lead to new insights into obesity and how to treat the condition.

They studied two teenagers with a rare genetic disorder that do not produce any leptin. They eat excessively and are severely obese. However, when they were treated with leptin, they became more choosey about food, ate less and lost weight.

Their brain activities in response to different food and non-food pictures were recorded using fMRI. The scientists found that the pictures stimulated activity in the area called striatal regions that are associated with pleasant emotions and desires. When the patients were treated with leptin, responses to food pictures in these area were reduced and were activated mostly by foods the patients liked and only when they were hungry.

The researchers said that the findings should "encourage a more sympathetic attitude to people with weight problems" and "will be a key step in the prevention and treatment of obesity". Some experts said such a small study cannot provide conclusive evidence. Read the press release.


The article "Leptin regulates striatal regions and human eating behaviour" is published online in the journal Science, 9 August 2007 (subscription required)

Statin delays artery damage in FH children

According to a randomised, double-blinded, placebo-controlled study in the Netherlands, statin therapy is safe and effective in treating children with familial hypercholesterolemia ( FH ), researchers found that early initiation of statin treatment in FH children as young as 8 delays the early artery damage.

214 children of 8 - 18 were randomised to receive treatment with pravastatin 20 or 40 mg depending on their age or placebo for 2 years.

Follow-up data for 186 children with an average of treatment period of 4.5 years showed that earlier initiation of statin treatment results in a smaller carotid artery intima-media thickness (IMT) at a later age. Furthermore, no serious clinical or laboratory adverse events were reported.

The results showed that the age of statin initiation was a strong, independent predictor for the increased thickening between the intima and media, however, the researchers suggested further clinical trials will be required to determine the optimal age for beginning statin therapy in FH children.

The study "Statin Treatment in Children With Familial Hypercholesterolemia: The Younger, the Better" is published in the journal Circulation. 2007; 116: 664-668

Coffee reduces liver cancer risk

Italian researchers carried out a meta-analysis of 10 published studies on the relation between coffee drinking and risk of hepatocelluar carcinoma, a common type of liver cancer. The studies included participants in Greece, Italy and Japan, some with liver cancer and many without.

They found a 41 % reduction in the risk for liver cancer among coffee drinkers compared with those who never drank coffee. The researchers said that the studies from Europe and Japan showed the same relationship between coffee drinking and reduced liver cancer risk suggested consistency of these results. However, they cautioned that it is difficult to "derive a causal inference on the basis of observational studies alone."

The study "Coffee drinking and hepatocellular carcinoma risk: A meta-analysis" is published in the journal Hepatology, Volume 46, Issue 2 (August 2007), pp 430-435. Read the abstract.

Paediatric SpRs' view of educational supervision

A questionnaire was sent to 129 paediatric SpRs in years 3 -5 in the North Thames region in the UK to find out their views of the educational supervision they receive from consultants. Participation was anonymous to encourage them to express their views and feelings.


There was 67% response rate. Many trainees found little value in the educational supervision, about a third rated the educational supervision they had received "a complete waste of time". Some found that it was little more than a form filling exercise.


When asked how the educational supervision can be improved, the trainees suggested that educational supervisors should learn to listen instead of talking, understand the needs of individual trainees and be encouraging.


Read the free article "Paediatric specialist registrars' views of educational supervision and how it can be improved: a questionnaire study", Journal of the Royal Society of Medicine 2007;100:375-378

Does this child have appendicitis?

Appendicitis is a common cause of pediatric abdominal pain, but the evaluation of abdominal pain in children can be quite difficult because the symptoms are very vague.

According to a new study led by the Johns Hopkins Children's Center, many American children suffer a ruptured appendix, a life-threatening complication because younger children have fewer classic symptoms of nausea, vomiting and pain in the abdomen making it easy to miss the diagnosis.

The researchers reviewed the frequency of the most common symptoms of actual appendicitis in children by analysing 25 studies and identified some of the most telltale signs that will help doctors to narrow down the diagnosis and prompt them to refer the child to a surgeon for evaluation.

These include "rebound" tenderness or pain that occurs after pressure is removed abruptly from the lower right abdomen; abdominal pain that starts around the belly button and migrates down to the right and an elevated white blood cell count. They also suggested that CT scans should be avoided if possible.

The study is published in the July 25 issue of JAMA. 2007;298:438-451. Read the abstract.

Cauliflower and broccoli can cut prostate cancer risk

Almost 32,000 cases of prostate cancer are diagnosed every year in Britian and the risks increase with age.

A new study "Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer" published in the Journal of the National Cancer Institute (JNCI), volume 99, number 15, p.1200-1209, found eating cauliflower and broccoli regularly can almost halve a man's chances of developing prostate cancer. Experts advise the best way to reduce cancer risk is to eat a balanced diet with lots of fruit and vegetables a day. Read the abstract.


The study tracked 29,000 men over a 4-year period, reserachers also monitored their eating habits particularly intake of different vegetables. Read the press release.

UK childhood cancer survival lag behind EU

A study published in the current issue of Lancet Oncology, Volume 8, Number 8, ( subscription required) found that children suffering from cancer in the UK have lower survival rates than their European counterparts. The study highlighted trials on Wilm's tumour - common childhood tumour in Germany.

The authors said that most children in Germany are provided regular check-ups by primary-care paediatricians and increased survival was linked to early diagnosis through routine or incidental examination. They believe children in the UK have been receiving a less thorough treatment .

They called for routine surveillance of children as standard across the UK and said that health visitors needed to be more aware of the symptoms of cancer.

Agenda for change

Agenda for change - the new pay structures rolled out in 2004 in the NHS was intended to improve services for patients by rewarding staff fairly.


The King's Fund found that the agenda for change was rushed and lack of proper implementation after carrying out case studies of 10 NHS Trusts. This means that the intended benefits of the pay reform may never happen and there are few signs it has improved productivity or transformed practice.

The more alcohol you drink, the higher bowel cancer risk

A Cancer Research UK study found that a large glass of wine or a pint of beer a day increases the risk by about 10 %.

The research shows that the more alcohol you drink, the greater your risk of developing bowel cancer. However, the authors said that people can reduce their risk of cancers by cutting down on alcohol. The findings are published in the International Journal of Cancer. (subscription needed)

More than 30,000 new cases of bowel cancer are diagnosed each year in the UK alone. The lifetime risk for bowel cancer is 1 in 20 for men and 1 in 18 for women.

Diabetes drugs double heart failure risk

More than 1.5 million prescriptions for rosiglitazone (Avandia) and pioglitazone (Actos) were issued in England alone last year, but experts warn these 2 commonly used diabetes drugs could double the risk of heart failure, even for those who have never suffered the condition, in a new study in the journal Diabetes Care.

The two drugs are prescribed to millions of patients to treat type 2 diabetes and approved by NICE for use on the NHS. Experts call for a re-evaluation of the benefits and risks of both drugs in view of the concerns on cardiovascular safety.

Drug agencies urge patients not to panic over research findings and should contact their doctors if concerned. Read more ...

Oscar the cat and the dying patients

This Thursday issue of the NEJM publishes an unusual article about the story of Oscar the cat that "has an uncanny ability to predict when residents are about to die", written by Dr. Dosa, a Rhode Island Hospital geriatrician and Brown University professor.


Oscar, the 2-year old cat, was adopted as a kitten and grew up in the advanced dementia unit at a nursing and rehabititation center where Dr Dosa works. After 6 months, the staff noticed that Oscar would make ward rounds, sniffing and observing patients. He seems to have the sense about when patients are about to die and would sit beside them when the time is near.


He has predicted 25 cases by curling next to the patients during their final hours, his presence has alerted staff to contact patients' family about the end-of-life stage and most families are grateful for the warning. However, Oscar's ability of sensing the impending death remains a mystery and no one knows if his behaviour is scientifically significant.


Read the free full text article "A Day in the Life of Oscar the Cat" in NEJM, 2007, July 26, Volume 357:328-329

Obesity is socially contagious

A new study that looked at data collected over 32 years from the Framingham Heart Study, an ongoing cardiovascular study begun in 1948, found that when an individual became obese, the chance that a friend will become obese increased by 57 % even if they were geographically distant.

Researchers said that obesity spread through social ties (see diagram in the article), particularly close friendship. Some experts said the results suggested that people influence one another's behavior and share the ideas about what an acceptable weight is, so it might be more effective to treat obese people in groups than individuals to slow this worldwide epidemic. Read the press release.

The study "The Spread of Obesity in a Large Social Network over 32 Years" is published in NEJM, July 26, Volume 357:370-379. Free full text.

Does high-veggie diet stop cancer return?

According to a study published last week, daily servings of fruits and vegetables does not increase breast cancer survival rates. The current results contradict previous findings that diet made a big difference in reducing breast cancer risk.

Breast cancer survivors were assigned to 2 groups : a control group that followed the FDA nutrition guidelines and an intervention group that was instructed to consume 8 servings of fruits and vegetables, plus 16 ounces of fresh vegetable juice and permitted to eat meat but consume no more than 20% of total calories from fat.

Some cancer experts said that the study was poorly designed and executed: participants self-reported their eating habbits, most did not reach the target of fat reduction and the participants already ate more fruit and vegetables than most Americans before the study started. Some experts said the conclusions were misleading fearing it would discourage breast cancer survivors from pursuing a healthy diet.

The study "Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer" was published in JAMA. 2007;298:289-298. Read the abstract.

Read the press release at ABC News.

Low cholesterol linked to cancer risk

Statins are the world's top-selling drugs in lowering cholesterol to reduce the risk of heart disease, but a new meta-analysis that examined more than 4o,ooo patient records in 23 different trials of statins found that low cholesterol increased cancer risk although the study did not show that the statin drugs themselves caused the cancer.

The reserachers said their findings support taking multiple medications rather than high-dose statins to minimize the side effects and emphasized that patients should continue their statins treatments. The study is published in the July 31, 2007 issue of the Journal of the American College of Cardiology (JACC) 2007, 50:419-420.

In an accompanying editorial, John C. LaRosa said "these current findings provide insufficient evidence that there is any problem with LDL lowering that outweighs its significant benefits on vascular disease." Read the press release.

Soft drinks linked to heart disease

A large scale US study showed that people who drank more than one soda per day had an increased risk of developing heart disease.

The researchers were surprised that it did not matter whether it was regular or diet soda, both were associated with increased risk of developing metabolic syndromes, a group of cardiovascular disease and diabetes risk factors, including a larger waist measurement, high blood pressure, low levels of "good" cholesterol and high levels of sugar in the blood stream.

However, the researchers said that these are just theories, further studies would be needed before recommendations are made about soft drink consumption. Read the press release.

The study "Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and the Metabolic Syndrome in Middle-Aged Adults in the Community" is published online in the journal Circulation 2007, July 23. Read the abstract.

Health literacy linked to mortality risk in elderly

According to a study in the July 23 issue of Archives of Internal Medicine , "Health Literacy and Mortality Among Elderly Persons", David W. Baker et al, elderly patients who could not read physician's instructions or did not understand health information had a higher mortality rate than patients with adequate reading skills. Read the abstract.

The study found that inadequate health literacy was most strongly associated with death from cardiovascular disease and suggested communication with patients in plain language or using pictures or videos to explain complicated ideas can be used to reduce the high mortality rate associated with low health literacy. Read the press release.

Coaching can help patients ask right questions

A new Cochrane review of 33 randomised controlled trials involving more than 8000 patients from 6 countries and in a range of settings and diagnosis found that question checklists and patient coaching were the most common interventions used to help patients address their information needs, coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction.


The review concluded that interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Only interventions immediately before the consultation led to small and statistically significant increases in patient satisfaction. Read more...


"Interventions before consultations for helping patients address their information needs" - Kinnersley et al. Cochrane Library 2007, Issue 3 ( Athens password required for full text article via the HILO website )

Can group thearpy extend life for women with advanced breast cancer?

David Spiegel, Professor of Psychiatry and Behavioural Science at Stanford University School published a paper in The Lancet in 1989 that suggested group psychotherapy for women with metastatic breast cancer prolonged survival. This has led to rapid growth of cancer support groups and debates of the effect of such therapy on cancer patients.

Spiegel and colleagues attempted to replicate the earlier study in a new trial by randomly assigning 125 women with advanced breast cancer into two groups : one that received educational literature and the other received educational literature and weekly group psychotherapy. They found no difference in the overall survival between the two groups, but said that there were psychological benefits in other ways. Read more...

The study "Effects of Supportive-Expressive Group Therapy on Survival of Patients with Metastatic Breast Cancer: A Randomized Prospective Trial" will be published in the September issue of Cancer.

A tiny brain no obstacle to French civil servant

Dr Lionel Feuillet, a neurologist at the Universite de al Mediterranee in Marseille, France, described a rare condition in The Lancet. 2007, vol 370, issue 9583, p.262. "Brain of a white-collar worker".


A man went to a Marseille hospital after he had mild weakness in his left leg. Dr. Feuillet and colleagues learned from his medical history that, as an infant, he had had a shunt inserted into his head to drain away hydrocephalus – water on the brain.

The medical team was shocked by the CT and MRI scans that showed the ventricles, normally tiny chambers that contain the cerebrospinal fluid that cushions the brain, were enlarged massively leaving a thin sheet of brain tissue. Tests showed that, the man, father of two children and works as a civil servant, had an IQ of 75, below the average score but not considered mentally retarded. He manages to live a normal life despite his condition. Read more...

Alternative medicine in US medical curriculum

Washington Post reported in a post "Earning a spot in the curriculum" that a consortium of 38 medical schools including the major ones Harvard, Stanford and Duke is working to integrate complementary and alternative (CAM) into mainstream medical curricula.

Medical students are being taught to ask about the use of CAM tretaments when they take patient history to guard against potential interferance between conventional practices and medicines. Students are encouraged to respect patients' cultural and ethnic backgrounds which may include CAM practices. The most widely embraced therapy is acupuncture.

In the UK, many primary care trusts (PCTs) have refused to pay for homoeopathy and cancelled their contracts after some leading doctors have urged NHS trusts to stop using complementary therapies and to fund only therapies that were backed up by scientific evidence. Read the doctors' open letter to the PCTs.

"When doctors become terrorists"

"Why should doctors not be terrorists?" asked Dr Simon Wessely, a professor of psychiatry at King's College London in a perspective article "When doctors become terrorists" published online on July 16 issue of the NEJM and in print August 16, 2007.

Dr Wessely writes about what has driven doctors to be terrorists in history and people's assumptions about terrorists and doctors. An interesting article that worths reading.

Also from The Times, July 4, 2007, an article "Could a doctor really be a bomber? Well, yes".

CT scan may increase lifetime cancer risk

A 64-slice computed tomography coronary angiography (CTCA) is a type of high-tech scan that is used to evaluate heart disease, but there are little data on its associated cancer risk from the radiation exposure.

A group of researchers conducted a study to estimate the lifetime attributable risk (LAR) of cancer associated with standard radiation exposure from a single heart scan using 64-slice CT coronary angiography. They found that the risk varied widely and were the highest with women in their 20s compared with other adults and concluded that CTCA should be used cautiously, especially in young women, using the lowest effective dose of radiation.

The study "Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography" is published in JAMA. 2007;298(3):317-323 .

Vitamin C does not prevent common cold

Vitamin C is the most widely used supplement against common colds, but a new analysis of 30 studies in the latest issue of The Cochrane Library has found that the doses of 200mg per day had little effect on reducing the length or severity of colds.

However, the Cochrane researchers acknowledge that vitamin C supplements might have health benefits other than keeping adult colds at bay.

GPs earn over £100,000

The NHS data revealed 46% of GPs earned more than £100,000 in 2004-5 in the new contract. It also showed that one in 200 has an income of more than £250,000.


GPs and the government have been criticised for the high income they now earn. Read more..

Taking cancer drugs with food may be more effective

Previously experts have warned of the potential dangers of interactions between food and drugs, but a research published in the Journal of Clinical Oncology showed that taking the breast cancer drug, lapatinib (TYKERB), with food could improve the effectiveness of drugs. This means patients could take lower doses therefore reducing the costs of treating patients.

Researchers call for more research to assess the effects of drug-combinations on patients and warn patients against their own experiments. Read more...

Folic acid enriched flour reduces neural tube defetcs

Dr Philippe De Wals of Universite Laval compared the prevalence of neural tube defects before and after the introduction of folic-acid enriched flours for over 2 million births in Canada between 1993 and 2002 and found that addition of floic acid to flours has led to significant drop in the incidence of neural tube defects in Canada. He said that it is better to integrate folic acid into the food chain than focus on taking vitamin supplements.


The study "Redudction in neural-tube defects after folic acid fortification in Canada" is published in NEJM, July 12, 2007, no.2; 357:135-142. Read more....


Currently only Canada, USA and Chile implement folic acid fortification in flour. Folic acid in the UK is unresolved.

HRT risk for older women - WISDOM trial

A new multicentre, randomised, doubled blind placebo controlled trial was carried out in the UK, Australia and New Zealand to assess the risks and benefits of combined HRT vs placebo or oestrogen alone.

The results are consistent with the findings of the WHI ( US) study, researchers concluded that HRT "increases cardiovascular and thromboembolic risk when started many years after the menopause."


The study is published in the early online issue of BMJ, 11 July 2007. "Main morbidities recorded in the women's international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women". Read the abstract .

The trial was prematurely closed after the WHI publication of the early results of the danger of HRT on older women. Read more...


See also previous post "Estrogen therapy and healthier arteries"

Antibiotics won't prevent urinary tract infections in children

It is estimated that 70,000 to 180,000 children born in a given year will have urinary tract infection (UTI) by the age of 6.

According to a new study in the July 11 issue of the JAMA, "Recurrent urinary tract infection: risk factors and effectiveness of prophylaxis in a primary care cohort", researchers found 611 children had a first UTI and 83 had a recurent UTI, daily antibiotics may not prevent UTI from recuring in children and may increase the risk of drug resistance. A child's age and race may paly a role in the risk of UTI and being resistant to antibiotics.

This is the first large study of children diagnosed with UTI to estimate the effectiveness of antibiotices in a primary care setting. The researchers suggested that it is appropriate for physicians to discuss with parents the risks and unclear benefits of daily antibiotic treatment after a child has had a first UTI. Read the press release at Medical News Today.

Some pediatricians said the findings may change the practice for the better.

Wellcome images

Human cells in culture ( Wellcome images)

Aspirin crystals ( Wellcome images)

Launched on 15 June 2007, "Wellcome images" is a unique collection of clinical, biomedical and historical images provided by the Wellcome Library in London. Online access to these images is free under the Creative Commons Licence that allows users to copy, distribute and display the images for non-commercial purposes provided the source is fully attributed.

Online access to clinical images that are photographs of patients showing signs or symptoms of a disease is restricted to healthcare professionals. Read more....

Selenium supplements may increase diabetes risk

US researchers expected to find selenium improves gluocose metabolism as suggseted by animal studies, but in a new randomized, double-blinded and placebo-controlled study of 1202 patients who were taking part in a clinical trial to assess the effect of selenium supplementation on skin cancer, the researchers were surprised to find that the incidence of type 2 diabetes was significantly higher in the selenium group than in the placebo group.

They concluded that long term use of selenium supplements may increase the risk of developing type 2 diabetes. More significantly, the higher the blood level of selenium, the greater the risk for developing the disease.

This is an important finding for public health because selenium supplements (30 - 200 mg) are used by people throughout the US and the western world. Read more...

The findings will be published in the August issue of Annals of Internal Medicine: 21 August 2007, vol 147, issue4. "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes: A Randomized Trial"

Electronic health records alone do not improve quality of care

A group of Stanford and Harvard researchers assessed the association between electronic health records (EHR) use and the quality of care in a national survey and were suprised to find that EHR use made no difference in 14 of the 17 ambulatory qulaity indicators. They expected better quality from physicians using EHRs.


In 2 quality areas : not prescribing tranquilizers for depression and not ordering routine urinalysis in general medical examinations - doctors using EHRs performed significantly better than those who did not. But in the area of prescribing statins for patients with high cholestrol, physicians using EHRs performed significantly worse than those who did not.

The researchers said sophisticated EHR systems can be a valuable tool for physicians in improving care in outpatient settings, but it is not sufficient to have an EHR system that provides patient data and decision support, physicians have to be willing to act on that input.

The study is published in the July 9 issue of the Archives of Internal Medicine. 2007;167:1400-1405 "Electronic health record use and the quality of ambulatory care in the United States" Read the abstract .

Read the press release.

1.5m misdiagnosed heart disease risk

A BMJ study "Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study" (BMJ Online First) that tracked 1.28 million healthy adults aged 35-74 over a period of 12 years and used GP records from 318 practices found that the traditional score over- estimated cardiovascular disease risk by 35%.
It suggests the current estimates of the number of UK adults at risk of cardiovascular disease are 1.5 million too high.

The study found that white middle-aged men had a lower risk than previously thought and women from poorer backgrounds had a significantly higher risk. It also found that 1 in 3 women, (not 1 in 4 as previously thought ) in their 60s are at risk of heart disease. This has raised the concern of " potentially missing the right people for treatment" and the possibility of over-prescription of statins to many patients who do not need it.

The authors argued that over-predicted estimates of heart disease were derived from the out-dated American model which involves a score based on smoking, blood pressure and cholesterol, along with age and sex, but the the new score used by the BMJ study also takes into account social deprivation, genetic factors and weight, reducing estimates. Read more...

Heart patients unclear when to dial 999

A study shows that many heart patients are not able to tell the difference between angina pain and a heart attack and tend to delay in calling an ambulance when experience chest pain.


In a BMJ "Editorial : Advising patients on dealing with acute chest pain", 335;3-4 ( 6 July 2007), heart experts warn that high-risk patients with heart disease are confused by the varying advice given by different sources on how to use the GTN sprays to relieve their symptoms and when they should call an ambulance. Some high-risk patients may be waiting too long before seeking help as one research showed the average time from onset of symptoms to cardiac rest is 10 minutes.


The authors recommend that high-risk patients need clear guidance on how to distinguish between the symptoms of chest pain and heart attack and wait 5 minutes before calling an ambulance.

A little dark chocolate daily lowers blood pressure

A German study of 44 adults showed that eating a small amount of dark chocolate every day could lower blood pressure without increasing weight or other health risks.

Researchers stressed that although the reduction in blood pressure was small, the effects are clinically noteworthy. They also suggested asking people to consume just 6 g of dark chocolate daily would be much easier than encouraging them to stick to complex diet programs to help them reduce their blood pressure.

The British Heart Foundation warned chocolate is high in fat and calories and is not good for the heart.

The study is published in the July 4 issue of JAMA - "Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide - A Randomized Controlled Trial" JAMA. 2007;298:49-60.

Living with MTAS

This week's BMJ Careers provides a collection of articles focusing on the issue of the current job situation as a result of MMC and MTAS.


The Editor's choice : "living with MTAS" suggests junior doctors should be flexible and consider options and alternative careers.

This week and the next two, the BMJ Careers will feature articles about careers outside the NHS with the hope that junior doctors will be inspired and informed to consider alternative careers. There are some interesting articles :

• Working for the pharmaceutical industry


• Voluntary work is a good idea


• Pastures green - working abroad


• Having the best of both worlds - locuming


• Banking on it - a medical student's experience of working in the City finance sector
• Career decision making in an age of uncertainty

Impact of MTAS on junior doctors' mental health

In a BMJ letter "Mental health of applicants seems to be deteriorating", BMJ 2007;334:1335 (30 June 2007), The Royal College of Psychiatrists reported the preliminary findings of an online survey about the imapct of MMC and MTAS on junior doctors' mental health.

The results showed that there were 790 anonymous responses that indicated increased level of stress and disturbances, most attributing it to MMC/MTAS. The authors said that this requires an urgent response.

A SHO said he doubted the validity of the survey and that doctors and other professionals need resilience and MTAS has reflected that.

Opt-out approach to HIV testing

Many HIV patients are not diagnosed until they have advanced disease.

A group of doctors called for using a routine opt-out testing that would increase the knowledge of HIV infection status and cut infection rate, in the article "Time to move towards opt-out testing for HIV in the UK", BMJ 2007;334:1352-1354 (30 June 2007)

The call was echoed in another article, "Routine testing to reduce late HIV diagnosis in France", BMJ 2007;334:1354- 1356 (30 June 2007)

The "Editorial: reducing the length of time between HIV infection and diagnosis", BMJ 2007;334:1329- 1330 ( 30 June 2007), discussed the specific goal for changes in policy.

Read the report "Standards for HIVClinical Care" produced by the British HIV association (BHIVA)

Needlestick injuries among surgeons in training

Medical News Today reported a survey of nearly 700 surgeons in training at 17 medical centers in the US about previous needlestick injuries. The findings were published in the NEJM, "Needlestick injuries among surgeons in training" Volume 356:2693-2699 , June 28, 2007, Number 26. Read the abstract.

The survey showed that 95% responded, nearly all surgeon residents had had a needlestick injury while in training and more than half of the injuries had involved a high-risk patient, but most failed to report the injuries. Lack of time was the most cited reason for not reporting such injuries.

"A medical student grows and learns"

This is an interesting blog post about the learning experience of a Harvard medical student with the bariatric surgery group in a medical centre : posted by a hospital blog on Tuesday 26 June 2007 :

The student wrote in his journal:

"Like most people, I think that obesity is a lifestyle issue -- it is a reflection of our society with gluttony of unhealthy food and paucity of exercise. And like most people, I feel uneasy about "fixing" obesity by reducing the size of the stomach to give the "artificial" feeling of safety and/or to curb the caloric intake by shortening the length of the digested food transit. Is this an appropriate and responsible medical approach? Is obesity a condition indicating for surgical procedure? What kind of people would allow, or even demand, to have one's body altered in such unnatural ways to escape from obesity?"

"Having spent almost one year with my patient, I am beginning to realize some answers.... ......................" Read more at Running a Hospital.

The student concluded that candid conversations with the patient have taught him to "relinquish assumptions, to empathize and above all, to never forget to listen to my patients so that I can offer them what they really need."

What is your view on this?

Middle aged women have more stroke than men

US researchers found that women aged 45 to 54 were more than twice as likely to have a stroke as men of the same age.

The National Stroke Association (US) poll found that many women could not recognise even one stroke symptom. The F.A.S.T. test helps women detect the stroke symptoms. Read more...

RCOG statement on unassisted childbirth

Royal College of Obstetricians and Gynaecologists (RCOG) issued a statement to warn that the practice of freebirth is new to the UK and little research exists regarding its safety and success

Drug derived from sea squirt shows anti-tumour activity

An article published early online on 21 June 2007 in the The Lancet Oncology "Efficacy of trabectedin (ecteinascidin-743) in advanced pretreated myxoid liposarcomas: a retrospective study" concluded that the drug, trabectedin, derived from sea-squirt shows anti-tumour activity in more than half of patients with advanced pre-treated myxoid liposarcomas, a specific type of cancer associated with chromosomal translocations. Read more.