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.