A few newspapers reported a study that has found regular use of ibuprofen, aspirin and other painkillers known as NSAIDs reduces the risk of developing the Alzheimer's disease. Doctors warn that people should not take over-the-counter pain remedies to ward off dementia as there are side effects. The finding is based on a review of six studies involved almost 14,000 people.
Researchers concluded that NSAID use reduced the risk of Alzheimer’s disease. However, they did not find that a sub-group of NSAIDs, known as the SALAs, more effective than other non-SALAs in preventing the disease. This suggests that all conventional NSAIDs have a similar protective effect in humans.
Critics say this was a review of selected studies and that the risk from bleeding need to be considered against any benefits.
Source: "No advantage of A 42-lowering NSAIDs for prevention of Alzheimer dementia in six pooled cohort studies." Neurology 2008; May 28 [Epub ahead of print]
Friday, May 30, 2008
Anti-hypertension drug types do not influence outcome
Previous studies suggest that the effects of anti-hypertensive drugs might be smaller among elderly people and some guidelines recommend specific types of blood pressure lowering treatment for particular age groups.
According to the BMJ, a new meta-analyses of 31 trials with more than 190,000 participants "showed no clear difference between age groups in the effects of lowering blood pressure or any difference between the effects of the drug classes on major cardiovascular events, .... also showed no difference in effects between the two age groups for the outcome of major cardiovascular events".
Source: "Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials -Blood Pressure Lowering Treatment Trialists’ Collaboration" BMJ 2008;336:1121-1123 ( free f/t)
According to the BMJ, a new meta-analyses of 31 trials with more than 190,000 participants "showed no clear difference between age groups in the effects of lowering blood pressure or any difference between the effects of the drug classes on major cardiovascular events, .... also showed no difference in effects between the two age groups for the outcome of major cardiovascular events".
Source: "Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials -Blood Pressure Lowering Treatment Trialists’ Collaboration" BMJ 2008;336:1121-1123 ( free f/t)
Thursday, May 29, 2008
Regular exercises reduce cancer death risk in men
Newspapers reported on a prospective cohort study of more than 40,000 Swedish men that found those who exercised moderately for at least 60 minutes a day reduced their risk of cancer, also in men who have cancer, 30 minutes a day of moderate exercise improved their chances of survival by 33%.
The researchers said the findings ‘may have major public health implications in the prevention and treatment of malignancies’ but the results require confirmation.
Critics say the study did not take into account the effect of diet that can influence their risk of cancer and it is possible that the men who exercised more also had healthier diets.
Source: "Association of physical activity with cancer incidence, mortality, and survival: a population-based study of men" British Journal of Cancer (2008) 98, 1864-1869.
The researchers said the findings ‘may have major public health implications in the prevention and treatment of malignancies’ but the results require confirmation.
Critics say the study did not take into account the effect of diet that can influence their risk of cancer and it is possible that the men who exercised more also had healthier diets.
Source: "Association of physical activity with cancer incidence, mortality, and survival: a population-based study of men" British Journal of Cancer (2008) 98, 1864-1869.
Gum disease link to cancer risk
The BBC reports - Men with a history of periodontal (gum) disease were 14% more likely to develop cancer than those without. This is based on a prospective cohort study that analysed data for more than 48,000 male health professionals who had not had cancer prior to 1986 and who responded to questionnaires about periodontal disease.
Researchers concluded that "periodontal disease is associated with a small, but significant, increase in overall cancer risk" and that this increase in risk exists in men who had never smoked, but they said that "any recommendations for prevention of cancer based on these findings are premature" and further studies are needed to clarify whether periodontal disease itself causes the increase in cancer or whether it indicates some other factors.
Critics say the study included only male professionals, the results may not apply to other groups of people.
Source: "Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study." Lancet Oncology 2008; May 6 [Epub ahead of print]
Researchers concluded that "periodontal disease is associated with a small, but significant, increase in overall cancer risk" and that this increase in risk exists in men who had never smoked, but they said that "any recommendations for prevention of cancer based on these findings are premature" and further studies are needed to clarify whether periodontal disease itself causes the increase in cancer or whether it indicates some other factors.
Critics say the study included only male professionals, the results may not apply to other groups of people.
Source: "Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study." Lancet Oncology 2008; May 6 [Epub ahead of print]
Wednesday, May 28, 2008
Music's healing and sedative effects in ICU patients
An interesting article from the New York Times.
Dr C Conrad, a senior surgical resident at Harvard with a doctorate in music philosophy, and colleagues carried out a simple study involving 10 ICU patients. Just after the sedation was lifted, 5 were given gentle piano music for 1 hour while 5 heard nothing.
They found that those patients listening to music showed reduced BP and heart rate, less need for pain medication and 20% drop in epinephrine and interleukin-6 ( 2 important stress hormones). They also had a 50% increase in pituitary growth hormone.
Previous research has shown growth hormone generally rises with stress and falls with relaxation, Dr Conrad argued that the growth hormone may reduce the levels of stress hormones that produce inflammation that in turn causes pain and raises BP and heart rate.
Experts said the study suggests a rise in growth hormone may dampen inflammation and stress responses although they did not buy in the proposed mechanism.
Source: "Overture for growth hormone: requiem for interleukin-6?" Critical Care Medicine. 2007 Dec;35(12):2709-13 ( f/t via Athens)
Dr C Conrad, a senior surgical resident at Harvard with a doctorate in music philosophy, and colleagues carried out a simple study involving 10 ICU patients. Just after the sedation was lifted, 5 were given gentle piano music for 1 hour while 5 heard nothing.
They found that those patients listening to music showed reduced BP and heart rate, less need for pain medication and 20% drop in epinephrine and interleukin-6 ( 2 important stress hormones). They also had a 50% increase in pituitary growth hormone.
Previous research has shown growth hormone generally rises with stress and falls with relaxation, Dr Conrad argued that the growth hormone may reduce the levels of stress hormones that produce inflammation that in turn causes pain and raises BP and heart rate.
Experts said the study suggests a rise in growth hormone may dampen inflammation and stress responses although they did not buy in the proposed mechanism.
Source: "Overture for growth hormone: requiem for interleukin-6?" Critical Care Medicine. 2007 Dec;35(12):2709-13 ( f/t via Athens)
Flavanol-containing cocoa improves diabetics blood flow
A small study funded by Mars Inc. (who also provided the cocoa drinks used in the study) found that three mugs of specially formulated cocoa (containing high levels of flavanols, a type of antioxidant ) a day for a month improved blood flow through the arteries by 30% in diabetics.
They used FMD ( flow-mediated dilation) in the brachial artery (artery in the upper arm) to measure cardiovascular risk - lower FMD has been linked to a greater risk of cardiovascular enents. Researchers concluded that "diets rich in flavanols reverse vascular dysfunction in diabetes" and that cocoa could be used as a treatment to reduce the risk of cardiovascular disease.
Critics warn diabetics should not start eating chocolate to try to reduce their cardiovascular risk because of the high levels of fat and sugar involved, they should eat more fruit and vegetables that also have high levels of the antioxidants.
Source: "Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients - A Double-Masked, Randomized, Controlled Trial" J American College of Cardiology, 2008; 51:2141-2149
They used FMD ( flow-mediated dilation) in the brachial artery (artery in the upper arm) to measure cardiovascular risk - lower FMD has been linked to a greater risk of cardiovascular enents. Researchers concluded that "diets rich in flavanols reverse vascular dysfunction in diabetes" and that cocoa could be used as a treatment to reduce the risk of cardiovascular disease.
Critics warn diabetics should not start eating chocolate to try to reduce their cardiovascular risk because of the high levels of fat and sugar involved, they should eat more fruit and vegetables that also have high levels of the antioxidants.
Source: "Sustained Benefits in Vascular Function Through Flavanol-Containing Cocoa in Medicated Diabetic Patients - A Double-Masked, Randomized, Controlled Trial" J American College of Cardiology, 2008; 51:2141-2149
HRT pills double risk of blood clots
Researchers in France and Glasgow carried out a systematic review and meta-analysis on some studies looking at the risk of venous thromboembolism in women taking hormone replacement therapy HRT) - the BBC reported.
They concluded that "current use of oral oestrogen increases the risk of venous thromboembolism by twofold to threefold" and they said that HRT patch may be safer but further research is needed.
The critics say this new study provides valuable evidence about the size of the risks and gives some idea of the difference between patches and pills, but women should not assume that it is unsafe to take HRT pills or patches are safe.
Source: "Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis" BMJ, published 20 May 2008. Ahead of print ( f/t via Athens)
They concluded that "current use of oral oestrogen increases the risk of venous thromboembolism by twofold to threefold" and they said that HRT patch may be safer but further research is needed.
The critics say this new study provides valuable evidence about the size of the risks and gives some idea of the difference between patches and pills, but women should not assume that it is unsafe to take HRT pills or patches are safe.
Source: "Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis" BMJ, published 20 May 2008. Ahead of print ( f/t via Athens)
Biological washing powders do not cause skin irritation
News sources reported that British researchers examined 44 papers about whether enzymes added to detergent washing powders can cause skin reactions and concluded that "biological detergents do not cause skin irritation. They advised that doctors should look beyond laundry detergents for the true cause of eczema, rashes and itches.
Critics said this seems a good advice but the readers should be aware of some of the limitations of this study - the researchers have not described their searching methods, it is not clear if all relevant papers have been looked at, they may fail to detect some publications which could influence their conclusion. The researchers have declared their consultancy fees from Unilever.
Source: "Enzymes, detergents and skin: facts and fantasies" British Journal of Dermatology 158(6): 1177-1181, June 2008
Critics said this seems a good advice but the readers should be aware of some of the limitations of this study - the researchers have not described their searching methods, it is not clear if all relevant papers have been looked at, they may fail to detect some publications which could influence their conclusion. The researchers have declared their consultancy fees from Unilever.
Source: "Enzymes, detergents and skin: facts and fantasies" British Journal of Dermatology 158(6): 1177-1181, June 2008
Friday, May 23, 2008
Rosehip for osteoarthritis pain reduction
Researchers conducted a meta-analysis of randomised controlled trials into the use of Rosa canina hip powder treatment compared with placebo for osteoarthritis, reported a newspaper.
They combined and analysed the results from these studies and found that use of Rosa canina reduced pain to about a third compared to the placebo group. People taking the powder were also less likely to use "rescue" medication, ie painkillers.
Critics say the study provides good evidence that rosehip reduces pain associated with osteoarthritis, however it was not set up to determine whether rosehip was better than current treatments.
Source: "Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials" Osteoarthritis and Cartilage April 2008 Ahead of print
They combined and analysed the results from these studies and found that use of Rosa canina reduced pain to about a third compared to the placebo group. People taking the powder were also less likely to use "rescue" medication, ie painkillers.
Critics say the study provides good evidence that rosehip reduces pain associated with osteoarthritis, however it was not set up to determine whether rosehip was better than current treatments.
Source: "Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials" Osteoarthritis and Cartilage April 2008 Ahead of print
Unpublished data on herceptin
The Guardian reported a study carried out by New Zealand researchers that investigate whether it is better to use herceptin, a breast cancer drug, alongside the chemotherapy or after it, ie sequential use.
They found that the data of the sequential use of herceptin were not published while data from the women given herceptin alongside their chemotherapy and women in the control group have been fully published in a peer-review journal. When they combined all these results, they found that the effect of herceptin was a third less effective than previously thought.
They concluded that not including these data in the overall assessment of the sequential use of herceptin has led to the treatment recommendation of the drug - a case of publication bias in which drug companies publish only trial results that are favourable.
Source: "Trastuzumab: possible publication bias". Lancet 2008; 371:1646-1648 ( free f/t via Athens)
They found that the data of the sequential use of herceptin were not published while data from the women given herceptin alongside their chemotherapy and women in the control group have been fully published in a peer-review journal. When they combined all these results, they found that the effect of herceptin was a third less effective than previously thought.
They concluded that not including these data in the overall assessment of the sequential use of herceptin has led to the treatment recommendation of the drug - a case of publication bias in which drug companies publish only trial results that are favourable.
Source: "Trastuzumab: possible publication bias". Lancet 2008; 371:1646-1648 ( free f/t via Athens)
"Overconfidence as a cause of diagnostic error in medicine"
The May issue of the American Journal of Medicine is dedicated to the understanding and addressing the sensitive issue of diagnostic error. The authors of this particular article conducted an extensive literature review ( with more than 200 references) on the incidence and impact of diagnostic error and examined the possibility that overconfidence contributes to diagnostic error.
The authors noted that the rate of diagnostic error is as high as 15%, "when directly questioned, many clinicians acknowledge that diagnostic errors exist but believe the rate is very low and that any errors are made by others who are less skillful or less careful". The authrs said this reflects overconfidence and complacency that leads to the failure to recognise one's own error.
In the great majority of cases, most diagnosis are correct, but the authors said that very often diagnostic errors are cognitive in nature and arise from those cases that physicians perceive as routine and unchallenging. They failed to recognise the shortcomings that derive from heuristic thinking.
The authors found that many physicians underutilized diagnostic decision-making tools, eg guidelines, and that feedback regarding their errors is also lacking, together with the overconfidence, these have contributed to the high misdiagnosis rates.
Based on the belief that physicians overall are dedicated and well-intentioned, if they were more aware of these factors and their own predisposition to error, they would take steps to reduce their errors, the authors suggest that strategies to address the problem should focus on "improving the physician's calibration between their perception of the case and the actual case".
The authors suggest two approaches to reduce diagnostic error :
1). Improving physician's cognition needs and focusing on making them better thinkers, less subject to biases, and more aware of what they know and do not know.
2). Changing the healthcare environment so that the data on patients, potential diagnoses and any additional information are more accurate and accessible.
Source:"Overconfidence as a Cause of Diagnostic Error in Medicine" American Journal of Medicine 2008;121(5), supplement, S2-S23 (Free f/t)
The authors noted that the rate of diagnostic error is as high as 15%, "when directly questioned, many clinicians acknowledge that diagnostic errors exist but believe the rate is very low and that any errors are made by others who are less skillful or less careful". The authrs said this reflects overconfidence and complacency that leads to the failure to recognise one's own error.
In the great majority of cases, most diagnosis are correct, but the authors said that very often diagnostic errors are cognitive in nature and arise from those cases that physicians perceive as routine and unchallenging. They failed to recognise the shortcomings that derive from heuristic thinking.
The authors found that many physicians underutilized diagnostic decision-making tools, eg guidelines, and that feedback regarding their errors is also lacking, together with the overconfidence, these have contributed to the high misdiagnosis rates.
Based on the belief that physicians overall are dedicated and well-intentioned, if they were more aware of these factors and their own predisposition to error, they would take steps to reduce their errors, the authors suggest that strategies to address the problem should focus on "improving the physician's calibration between their perception of the case and the actual case".
The authors suggest two approaches to reduce diagnostic error :
1). Improving physician's cognition needs and focusing on making them better thinkers, less subject to biases, and more aware of what they know and do not know.
2). Changing the healthcare environment so that the data on patients, potential diagnoses and any additional information are more accurate and accessible.
Source:"Overconfidence as a Cause of Diagnostic Error in Medicine" American Journal of Medicine 2008;121(5), supplement, S2-S23 (Free f/t)
Monday, May 19, 2008
Beta blockers cost more lives than they saved
For many years, beta blockers have been given routinely to patients undergoing surgery to reduce the risk of heart attcks after operations, but a new study, published in The Lancet, of more than 8000 patients in 23 countries who had surgery has found that those given the drugs double their risk of stroke and a third more likely to die within a month of surgery, the BBC reported.
The lead researcher said although beta blockers had benefits in lowering heart attacks, they were outweighed bythe increase of stroke and death. The study claimed that about 800,000 would have died as a result of doctors giving out the drugs without considering the side effects.
Source: "POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial". Lancet 2008. DOI: 10.1016/S0140-6736(08) 60601-7. Ahead of print.
The lead researcher said although beta blockers had benefits in lowering heart attacks, they were outweighed bythe increase of stroke and death. The study claimed that about 800,000 would have died as a result of doctors giving out the drugs without considering the side effects.
Source: "POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial". Lancet 2008. DOI: 10.1016/S0140-6736(08) 60601-7. Ahead of print.
Breastfeeding may protect women against arthritis
According to a new study in the Annals of the Rheumatic Diseases that compared 136 women with rheumatoid arthritis to 544 without the condition, women who had breastfed for 13 months or more were half as likely to develop the disease as those who had never breastfed. The study also found that taking oral contraceptives did not have the same effect.
Experts said previous studies showed that "breastfeeding was a risk factor for developing rheumatoid arthritis in a small group of women soon after giving birth to their first child."
Source: "Breast-feeding, but not oral contraceptives, is associated with a reduced risk of rheumatoid arthritis" Annals of Rheumatic Diseases. Published Online First: 13 May 2008. doi:10.1136/ard.2007.084707 (f/t via Athens)
Experts said previous studies showed that "breastfeeding was a risk factor for developing rheumatoid arthritis in a small group of women soon after giving birth to their first child."
Source: "Breast-feeding, but not oral contraceptives, is associated with a reduced risk of rheumatoid arthritis" Annals of Rheumatic Diseases. Published Online First: 13 May 2008. doi:10.1136/ard.2007.084707 (f/t via Athens)
Mind your manners
An assistant professor of psychiatry at Harvard Medical School said that medical education and postgraduate training should place more emphasis on teaching doctors good behavior that would enhance their relationship with patients. He said when dcotors deal with patients in a polite manner, patients have a satisfying experience.
Source:"Etiquette-Based Medicine" New England J of Medicine, 2008, 358(19):1988-1989 ( free f/t)
Source:"Etiquette-Based Medicine" New England J of Medicine, 2008, 358(19):1988-1989 ( free f/t)
Thursday, May 15, 2008
Obesity increases dementia risk
Multiple news sources reported a systematic review of 10 published studies in 5 different countries that found obesity increases the risk of dementia in general by 42% and Alzheimer's by 80%. Researchers also found that people who are underweight have an elevated risk of dementia and its subtype. The study also included a meta-analysis of 7 stuides with at least 5 years followed up.
The senior author said that preventing obesity at a younger age could reduce the number of dementia patients in the US.
Source: "Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis". Obesity Reviews 9(3):204-218, May 2008
breastfed babies are smarter
Several newspapers reported on a study that found prolonged and exclusive breastfeeding makes kids smarter.
This is a large randomised trial involving more than 17,000 babies to see if a breastfeeding programme of promoting the duration and exclusive breastfeeding has an effect on childhood intelligence. The babies were followed up to 6 years. The decision of breastfeeding was the women's own choice.
The study found that children from the breastfeeding promotion group scored significantly higher than the controls on scores of vocabulary, similarities and verbal IQ.
Source: "Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial" Archives of General Psychiatry. 2008;65(5):578-584. (f/t via Athens)
This is a large randomised trial involving more than 17,000 babies to see if a breastfeeding programme of promoting the duration and exclusive breastfeeding has an effect on childhood intelligence. The babies were followed up to 6 years. The decision of breastfeeding was the women's own choice.
The study found that children from the breastfeeding promotion group scored significantly higher than the controls on scores of vocabulary, similarities and verbal IQ.
Source: "Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial" Archives of General Psychiatry. 2008;65(5):578-584. (f/t via Athens)
Aspirin daily reduces breast cancer risk
News sources reported a new study that found women who took aspirin, known as non-steroidal anti-inflammatory drugs (NSAIDs) daily were 16% less likely to develop breast cancer.
Researchers studied the questionnaire responses from a previous study conducted in 2003 and used the answers to relate the use of NSAIDs to the chance of developing breast cancer. They concluded that "breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in oestrogen-receptor (ER)-positive breast cancer." However they suggested further research is required as other studies have shown conflicting results.
Source: "Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health–AARP Diet and Health Study" Breast Cancer Research 2008, 10:R38doi:10.1186/bcr2089 ( free f/t)
Researchers studied the questionnaire responses from a previous study conducted in 2003 and used the answers to relate the use of NSAIDs to the chance of developing breast cancer. They concluded that "breast cancer risk was not significantly associated with NSAID use, but daily aspirin use was associated with a modest reduction in oestrogen-receptor (ER)-positive breast cancer." However they suggested further research is required as other studies have shown conflicting results.
Source: "Nonsteroidal anti-inflammatory drugs and breast cancer risk in the National Institutes of Health–AARP Diet and Health Study" Breast Cancer Research 2008, 10:R38doi:10.1186/bcr2089 ( free f/t)
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