Rising blood levels of PSA (prostate-specific antigen) is used to diagnose prostate cancer, but there is conflicting evidence that statins ( cholesterol-lowering drug) may be associated with a reduced risk of prostate cancer.
Researchers at Duke University studied changes in PSA levels in 1,214 men who were prescribed statins and found PSA level drops slightly in men who lower their cholestrol with statin drugs. They said that the reduction could mean that statins may affect prostate biology or statins may lower their PSA levels without lowering the risk of prostate cancer, making the disease more difficult to diagnose.
Critics said further research is needed and men who currently take Statins should not be worried by these findings. In the UK, PSA testing is not rountinely carried out.
Source: Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ. The Influence of Statin Medications on Prostate-specific Antigen Levels. Journal of the National Cancer Institute 2008; Advance Access published online on October 28, 2008
Thursday, October 30, 2008
HRT can increase joint problems
A study funded by Cancer Research UK, the NHS Breast Screening Program and the Medical Research Council followed 1.3 million women for an average of 6.1 years and collected information on reproductive history, use of hormonal therapies, other medical history and lifestyle.
Researchers found that women using HRT are more likely to need a knee replacement due to arthritis than women who have never used HRT. There is also increased risk of hip replacement. The researchers conclude that ‘hormonal and reproductive factors increase the risk of hip and knee replacement, more so for the knee than for the hip. The reasons for this are unclear.’
Critics say that there are limitations of its data collection method and the findings conflict with those of previous studies.
Source: Liu B, Balkwill A, Cooper C et al. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. Annals of Rheumatic Diseases 2008; Oct 28 ( via press release)
Researchers found that women using HRT are more likely to need a knee replacement due to arthritis than women who have never used HRT. There is also increased risk of hip replacement. The researchers conclude that ‘hormonal and reproductive factors increase the risk of hip and knee replacement, more so for the knee than for the hip. The reasons for this are unclear.’
Critics say that there are limitations of its data collection method and the findings conflict with those of previous studies.
Source: Liu B, Balkwill A, Cooper C et al. Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women. Annals of Rheumatic Diseases 2008; Oct 28 ( via press release)
Wednesday, October 29, 2008
New diet pill doubles weight loss
A phase II trial ( funded by Neurosearch, a pharmaceutical company in Denmark and other sources) in which 203 obese patients were randomised to receive three different daily doses of tesofensine ( a new diet drug) or placebo pills found that those who received tesofensine lost more weight than those received placebo.
Dieting patients on the highest doses lost up to 12.8kg (28.2lbs) in six months, roughly twice the level achieved by best weight loss drugs already used in Europe. However, side effects have been experienced by these patients.
Critics said more trials are needed and the efficacy and safety of the drug need confirmation in larger phrase III trials. ( Note: The maker of tesofensine, Neurosearch, is seeking approval for the drug in the US and Europe).
Source: Astrup A, Madsbad S, Breum L, et al. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. The Lancet. Early Online Publication, 23 October
Dieting patients on the highest doses lost up to 12.8kg (28.2lbs) in six months, roughly twice the level achieved by best weight loss drugs already used in Europe. However, side effects have been experienced by these patients.
Critics said more trials are needed and the efficacy and safety of the drug need confirmation in larger phrase III trials. ( Note: The maker of tesofensine, Neurosearch, is seeking approval for the drug in the US and Europe).
Source: Astrup A, Madsbad S, Breum L, et al. Effect of tesofensine on bodyweight loss, body composition, and quality of life in obese patients: a randomised, double-blind, placebo-controlled trial. The Lancet. Early Online Publication, 23 October
Leukaemia drug halts MS
Researchers compared alemtuzumab (a drug to treat leukaemias or blood cell cancers) in treating MS with interferon beta-1a (a drug that is already used to treat the condition) and found that it halted and reversed the effects of the disease. However, there were some serious side effects in a few patients.
334 patients with early symptoms of MS were recruited from 49 centres across Europe and the US between December 2002 and July 2004 and randomised to receive interferon beta-1a or alemtuzumab at a dose of either 12mg or 24mg. Researchers found that those who took alemtuzumab had a reduction in disability (71%) and reduction in the risk of relapse (74%) compared with beta-interferon.
Critics said that it is not known if the drug would be beneficial for more advanced MS and the result of restoration of brain tissue will need confirmation in larger phase 3 trials.
Source: The CAMMS223 Trial Investigators. Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis. NEJM 2008; 359: 1786-1801
334 patients with early symptoms of MS were recruited from 49 centres across Europe and the US between December 2002 and July 2004 and randomised to receive interferon beta-1a or alemtuzumab at a dose of either 12mg or 24mg. Researchers found that those who took alemtuzumab had a reduction in disability (71%) and reduction in the risk of relapse (74%) compared with beta-interferon.
Critics said that it is not known if the drug would be beneficial for more advanced MS and the result of restoration of brain tissue will need confirmation in larger phase 3 trials.
Source: The CAMMS223 Trial Investigators. Alemtuzumab vs. Interferon Beta-1a in Early Multiple Sclerosis. NEJM 2008; 359: 1786-1801
Tuesday, October 28, 2008
Doctors often prescribe placebo treatments
The use of placebos is controversial, researchers at the NIH ( National Institute of Health) surveyed 1200 internists and rheumatologists to examine the doctors' attitudes towards and the use of placebo treatments in the US.
679 physicians returned the survey questionnaires, half said they prescribed placebo treatments on a regular basis, 62% believed the practice ethically acceptable and were happy to recommend or prescribe placebo treatments. 68% of those prescribe placebo drugs said that they describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condidtion", only a small number of physicians inform patients of the placebo treatment.
The most commonly prescribed placebo treatments were painkillers (41%) or vitamins (38%), some prescribed antibiotics (13%) and sedatives (13%), a few using sugar pills.
The authors concluded that precribing painkillers or vitamins to promote positive expections may not raise serious concerns but prescribing antibiotics and sedatives when they are not clearly indicated could have adverse effects for patients and public health.
Some doctors said the survey is misleading and the conclusions need disputed.
Source: "Prescribing "placebo treatments": results of national survey of US internists and rheumatologists" BMJ 2008;337:a1938 ( f/t via Athens)
679 physicians returned the survey questionnaires, half said they prescribed placebo treatments on a regular basis, 62% believed the practice ethically acceptable and were happy to recommend or prescribe placebo treatments. 68% of those prescribe placebo drugs said that they describe the placebo treatments to patients as "a potentially beneficial medicine or treatment not typically used for their condidtion", only a small number of physicians inform patients of the placebo treatment.
The most commonly prescribed placebo treatments were painkillers (41%) or vitamins (38%), some prescribed antibiotics (13%) and sedatives (13%), a few using sugar pills.
The authors concluded that precribing painkillers or vitamins to promote positive expections may not raise serious concerns but prescribing antibiotics and sedatives when they are not clearly indicated could have adverse effects for patients and public health.
Some doctors said the survey is misleading and the conclusions need disputed.
Source: "Prescribing "placebo treatments": results of national survey of US internists and rheumatologists" BMJ 2008;337:a1938 ( f/t via Athens)
Friday, October 24, 2008
JAMA editoral argues against preemption
JAMA published an editorial in the October issue in urging the US Supreme Court not to endorse preemption and argues for patients' right to sue drugmakers in state court for harms caused by defective drugs that were approved by FDA.
The editorial states that " ......if the court rules in favors of Wyeth, endorsing preemption, patients will lose an irreplaceable method for seeking remedies for injuries resulting from pharmaceutical agents that were approved by FDA."
American legislation states that federal regulation preempts state law - this means that patients have no legal right to sue drugmakers in state court for injuries caused by FDA-approved drugs.
Source: Catherine D. DeAngelis, Phil B. Fontanarosa Prescription Drugs, Products Liability, and Preemption of Tort Litigation JAMA 2008;300(16) :1939-1941 ( f/t via Athens)
The editorial states that " ......if the court rules in favors of Wyeth, endorsing preemption, patients will lose an irreplaceable method for seeking remedies for injuries resulting from pharmaceutical agents that were approved by FDA."
American legislation states that federal regulation preempts state law - this means that patients have no legal right to sue drugmakers in state court for injuries caused by FDA-approved drugs.
Source: Catherine D. DeAngelis, Phil B. Fontanarosa Prescription Drugs, Products Liability, and Preemption of Tort Litigation JAMA 2008;300(16) :1939-1941 ( f/t via Athens)
Top tips for good surgical sign-out practice
In America, 80-hour workweek was recently adopted to reform medical care and resident education with the benefits of reducing fatigue among physicians and reducing medical errors. The change of work hours also brings new challenge of the continuity of care as residents have to depend more on colleagues to assume the care of patients at different times.
Surveys show that there is no standardised sign-out process and transitions of care among residents as policies and procedures for sign-out practices vary widely among institutions, services and individuals.
The surgical interns at The Johns' Hopkins Hospital carried out a review of current literature on this topic and develop a list for safe and effective sign-outs based on their personal experiences.
Source: "The Top 10 List for a Safe and Effective Sign-out" Archives of Surgery. 2008;143(10):1008-1010
Surveys show that there is no standardised sign-out process and transitions of care among residents as policies and procedures for sign-out practices vary widely among institutions, services and individuals.
The surgical interns at The Johns' Hopkins Hospital carried out a review of current literature on this topic and develop a list for safe and effective sign-outs based on their personal experiences.
Source: "The Top 10 List for a Safe and Effective Sign-out" Archives of Surgery. 2008;143(10):1008-1010
Doubts over aspirin use in diabetes
UK guidelines recommend a daily dose of aspirin as a "preventive" treatment in the diabetics as they are at a much higher risk of cardiovascular disease. However, a study published in the BMJ found no benefit from either aspirin or antioxodants in preventing heart attacks. It also increases the risk of internal bleeding.
The study invloved 1,276 adult patients with diabetes mellitus from 16 diabetic clinics in Scotland between November 1997 and July 2001. Participants were randomly assigned in four groups to receive the aspirin tablet + antioxidant capsule, or aspirin tablet + placebo capsule, or placebo tablet + antioxidant capsule or both a placebo tablet and a placebo capsule.
The findings show that in adults with diabetes and no symptoms of cardiovascular disease, there was no evidence that aspirin or antioxidants use prevented heart attacks, strokes, amputations or death. However, the drug was beneficial in people who already have a history of heart attack or stroke.
Experts said the study was "extremely important" because it confirms the concerns of aspirin use by the general population and it is worth revisiting the guidelines.
Source: Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; Published 16 October ( f/t via Athens)
The study invloved 1,276 adult patients with diabetes mellitus from 16 diabetic clinics in Scotland between November 1997 and July 2001. Participants were randomly assigned in four groups to receive the aspirin tablet + antioxidant capsule, or aspirin tablet + placebo capsule, or placebo tablet + antioxidant capsule or both a placebo tablet and a placebo capsule.
The findings show that in adults with diabetes and no symptoms of cardiovascular disease, there was no evidence that aspirin or antioxidants use prevented heart attacks, strokes, amputations or death. However, the drug was beneficial in people who already have a history of heart attack or stroke.
Experts said the study was "extremely important" because it confirms the concerns of aspirin use by the general population and it is worth revisiting the guidelines.
Source: Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; Published 16 October ( f/t via Athens)
Vitamin B supplement does not slow Alzheimer's disease
Reserachers thought that vitamin B may slow Alzheimer's disease because it can lower the levels of homocysteine, an amino acid linked to brain cell damage. A new research published in JAMA has demonstrated that vitamin B supplements made very little difference to the decline of mental functions, contrary to what previous studies have suggested
340 patients with mild to moderate Alzheimer's disease were randomised to receive either a combination of vitamin B supplements or a placebo for 18 months. Researchers found no significant difference in reduction of cognitive ability between the groups and concluded that this is not a useful treatment of Alzheimer's disease.
Source: Aisen PS, Schneider LS, Sano M et al. High-Dose B Vitamin Supplementation and Cognitive Decline in Alzheimer Disease: A Randomized Controlled Trial. JAMA 2008; 300(15): 1774-1783 ( f/t via Athens)
340 patients with mild to moderate Alzheimer's disease were randomised to receive either a combination of vitamin B supplements or a placebo for 18 months. Researchers found no significant difference in reduction of cognitive ability between the groups and concluded that this is not a useful treatment of Alzheimer's disease.
Source: Aisen PS, Schneider LS, Sano M et al. High-Dose B Vitamin Supplementation and Cognitive Decline in Alzheimer Disease: A Randomized Controlled Trial. JAMA 2008; 300(15): 1774-1783 ( f/t via Athens)
Lancet study confirms Vioxx risk
Vioxx, a pain killer, was withdrawn from the market in 2004 after the APPROVe trial showed that it doubled the risk of heart attacks.
In a new study published in The Lancet, researchers contacted 84% of the people who took part in the original trial and confirmed the findings of previous study. They also found that a year after stopping the treatment, participants still had increased risk of heart attack, stroke or death comapred with those in the placebo group. The researchers raised the concern that long term use of of all non-aspirin NSAIDs may have a similar effect and suggested doctors to weigh up the benefits of these drugs in individual patients.
The drugmaker, Merck, issued a statement :"....this post-hoc analysis using limited data from a prematurely terminated study needs to be interpreted very cautiously......".
Source: Baron JA, Sandler RS, Bresalier RS et al. Cardiovascular events associated with rofecoxib: final analysis of the APPROVe trial. The Lancet 2008; Oct 14 [Early online publication]
In a new study published in The Lancet, researchers contacted 84% of the people who took part in the original trial and confirmed the findings of previous study. They also found that a year after stopping the treatment, participants still had increased risk of heart attack, stroke or death comapred with those in the placebo group. The researchers raised the concern that long term use of of all non-aspirin NSAIDs may have a similar effect and suggested doctors to weigh up the benefits of these drugs in individual patients.
The drugmaker, Merck, issued a statement :"....this post-hoc analysis using limited data from a prematurely terminated study needs to be interpreted very cautiously......".
Source: Baron JA, Sandler RS, Bresalier RS et al. Cardiovascular events associated with rofecoxib: final analysis of the APPROVe trial. The Lancet 2008; Oct 14 [Early online publication]
Friday, October 17, 2008
Counselling to hospitalised smokers
Researchers analysed the results of 33 trials of smoking cessation interventions in 9 countries from 1999 to 2007 to see what kind of hospital- based smoking cessation programmes works.
They found that smoking counselling that began during hospitalization and included supportive contacts for more than 1 month after discharge increased smoking cessation rates at 6 to 12 months, no benefit was found for interventions with less postdischarge contact.
The lead author concluded that "offering smoking cessation counseling to all hospitalized smokers is effective as long as supportive contacts continue for more than 1 month after discharge".
Source: "Smoking Cessation Interventions for Hospitalized Smokers - A Systematic Review" Archives of Internal Medicine. 2008;168(18):1950-1960 (f/t via Athens)
They found that smoking counselling that began during hospitalization and included supportive contacts for more than 1 month after discharge increased smoking cessation rates at 6 to 12 months, no benefit was found for interventions with less postdischarge contact.
The lead author concluded that "offering smoking cessation counseling to all hospitalized smokers is effective as long as supportive contacts continue for more than 1 month after discharge".
Source: "Smoking Cessation Interventions for Hospitalized Smokers - A Systematic Review" Archives of Internal Medicine. 2008;168(18):1950-1960 (f/t via Athens)
Friday, October 10, 2008
Is honey better at healing wounds than standard treatments used in the NHS ?
The Cochrane Library publishes a systematic review that aimed to determine whether honey increases the rate of healing in acute wounds and chronic wounds.
Researchers identified 19 RCTs or quasi randomised trials involving more than 2,500 patients with various wounds and found that in the trials of partial thickness burns, honey reduced healing time to healing by 4.68 days compared with some conventional dressings. However the researchers said this finding should be treated with caution.
In chronic wounds, they found that honey dressings used under compression bandaging did not increase healing in venous leg ulcers significantly, but researchers said there is insufficient evidence to guide clinical practice in other areas.
Source: Jull AB, Rodgers A, Walker N. "Honey as a topical treatment for wounds (Review)." Cochrane Database Systematic Review 2008; Issue 4 ( f/t via Athens)
Researchers identified 19 RCTs or quasi randomised trials involving more than 2,500 patients with various wounds and found that in the trials of partial thickness burns, honey reduced healing time to healing by 4.68 days compared with some conventional dressings. However the researchers said this finding should be treated with caution.
In chronic wounds, they found that honey dressings used under compression bandaging did not increase healing in venous leg ulcers significantly, but researchers said there is insufficient evidence to guide clinical practice in other areas.
Source: Jull AB, Rodgers A, Walker N. "Honey as a topical treatment for wounds (Review)." Cochrane Database Systematic Review 2008; Issue 4 ( f/t via Athens)
Painkillers reduces breast cancer risk
Researchers carried out a meta-analysis of 38 relevant studies carried out in 5 different countries and involving 2.7 million women to examine the association between NSAID use and breast cancer.
The combining results from all 38 studies show that the use of NSAIDs was associated with a 12% reduction in risk of breast cancer. Analysis of all studies examining aspirin use only found a 13% reduction in the risk while the ibuprofen analysis found a 21% reduction in the risk of breast cancer. The authors conclude that there was an overall decreased risk of breast cancer with NSAID use.
Critics say that the use of aspirin and ibuprofen is not without risk in themselves and warn that long-term use of these painkillers would have serious side effects.
Source: Takkouche B, Regueira-Méndez C, Etminan M. Breast Cancer and Use of Nonsteroidal Anti-inflammatory Drugs: A Meta-analysis. Journal of the National Cancer Institute 2008; Oct 7 [Epub ahead of print]
The combining results from all 38 studies show that the use of NSAIDs was associated with a 12% reduction in risk of breast cancer. Analysis of all studies examining aspirin use only found a 13% reduction in the risk while the ibuprofen analysis found a 21% reduction in the risk of breast cancer. The authors conclude that there was an overall decreased risk of breast cancer with NSAID use.
Critics say that the use of aspirin and ibuprofen is not without risk in themselves and warn that long-term use of these painkillers would have serious side effects.
Source: Takkouche B, Regueira-Méndez C, Etminan M. Breast Cancer and Use of Nonsteroidal Anti-inflammatory Drugs: A Meta-analysis. Journal of the National Cancer Institute 2008; Oct 7 [Epub ahead of print]
Wednesday, October 08, 2008
Absence from work links to death
UCL researchers studied the sickness records of 6500 employees in 20 Whitehall departments between 1985 and 1988 and comapred with mortality up until 2004.
Researchers found that employees who had extended periods of sick leave had 66% higher risk of early death. They were surprised to find that those who had long absence from work due to psychiatric reasons were twice as likely to die from cancer as the healthy colleagues. The study leader said " it would be useful for this information to be collected because we could identify groups with high risk of serious health problems".
Critics say the recorded reasons of sickness mat not cover the actual causes.
Source: Head J, Ferrie JE, , Alexanderson K, et al. "Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study." BMJ 2008; Oct 3 [Epub ahead of print]
Researchers found that employees who had extended periods of sick leave had 66% higher risk of early death. They were surprised to find that those who had long absence from work due to psychiatric reasons were twice as likely to die from cancer as the healthy colleagues. The study leader said " it would be useful for this information to be collected because we could identify groups with high risk of serious health problems".
Critics say the recorded reasons of sickness mat not cover the actual causes.
Source: Head J, Ferrie JE, , Alexanderson K, et al. "Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study." BMJ 2008; Oct 3 [Epub ahead of print]
Free drug samples to children
Researchers analysed the data on more than 10,000 US children under 18 years old from a 2004 national survey that included questions on receipt of free drug samples.
They found that 1 in 10 children who take prescription medications received free samples and 1 in 20 children overall got free samples. The study showed that wealthy and insured American children who had access to medical care and saw doctors in private offices rather than in hospitals or clinics were more likely to get free drug samples although drug companies argue that free samples help uninsured and low-income people get the medications they need.
The author said that most free samples were new and expensive drugs, in her previous study on free samples for adults, Vioxx topped the list but was later withdrawn from the market due to dangerous side effects. She concluded that "Poor and uninsured children are not the main recipients of free drug samples. Free samples do not target the neediest children selectively and they have significant safety considerations."
Source: "Free Drug Samples in the United States: Characteristics of Pediatric Recipients and Safety Concerns" ( Published online October 1, 2008) Pediatrics Vol. 122 No. 4 October 2008, pp. 736-742
They found that 1 in 10 children who take prescription medications received free samples and 1 in 20 children overall got free samples. The study showed that wealthy and insured American children who had access to medical care and saw doctors in private offices rather than in hospitals or clinics were more likely to get free drug samples although drug companies argue that free samples help uninsured and low-income people get the medications they need.
The author said that most free samples were new and expensive drugs, in her previous study on free samples for adults, Vioxx topped the list but was later withdrawn from the market due to dangerous side effects. She concluded that "Poor and uninsured children are not the main recipients of free drug samples. Free samples do not target the neediest children selectively and they have significant safety considerations."
Source: "Free Drug Samples in the United States: Characteristics of Pediatric Recipients and Safety Concerns" ( Published online October 1, 2008) Pediatrics Vol. 122 No. 4 October 2008, pp. 736-742
Does common cold cause asthma?
US researchers studied more than 250 newborns at high risk for asthma and followed them from birth to 6 years old to investigate the relationship between specific childhood illnesses and early development of asthma. Samples of mucus from their nose and throat were taken and analysed and they were tested for specific viruses during wheezing illnesses.
Researchers found that nearly 90% of the children wheezing with common cold virus, rhinovirus (RV) at age 3 subsequently developed asthma at age 6. The lead author wrote in the Americam Journal of Respiratory and Critical Care Medicine that rhinovirus which causes wheezing in childhood was the most significant predictor of the subsequent development of asthma at age six.
Critics say that athough the study demontrated an association between wheezing during childhood colds and later asthma, it does not mean that cold is the casue of asthma. Asthma is a very difficult condition to diagnose but asthma at age six does not necessarily mean that the it will persist into later childhood.
Source: "Jackson DJ, Gangnon RE, Evans MD, et al. Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High-Risk Children." Am J Respir Crit Care Med 2008: 178; 667–672 ( abstract only)
Researchers found that nearly 90% of the children wheezing with common cold virus, rhinovirus (RV) at age 3 subsequently developed asthma at age 6. The lead author wrote in the Americam Journal of Respiratory and Critical Care Medicine that rhinovirus which causes wheezing in childhood was the most significant predictor of the subsequent development of asthma at age six.
Critics say that athough the study demontrated an association between wheezing during childhood colds and later asthma, it does not mean that cold is the casue of asthma. Asthma is a very difficult condition to diagnose but asthma at age six does not necessarily mean that the it will persist into later childhood.
Source: "Jackson DJ, Gangnon RE, Evans MD, et al. Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High-Risk Children." Am J Respir Crit Care Med 2008: 178; 667–672 ( abstract only)
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