The blind can see after gene therapy

Multiple newspapers have reported a small trial of a revolutionary new gene therapy that has cured a form of inherited blindness within days.

Three young adult volunteers who had LCA, a particular form of blindness, and had severe vision loss since childhood were recruited. The researchers used a technique whereby the DNA of the virus AAV was removed and then replaced with DNA containing the desired gene (RPE65 in this case). The virus carrying the RPE65 gene was then injected into the retina of one eye in each of the volunteers.

The researchers found that all three volunteers had an improvement in their vision 30 days after the injection, with two volunteers reporting improvements as early as 7 - 10 days after the treatment.

Critics say it is important to note that this particular gene therapy would only work for this type of LCA, more "studies are needed to fully understand the process and its longer-term effects and safety before it can be used more widely".

Source: "Human gene therapy for RPE65 isomerase deficiency activates the retinoid cycle of vision but with slow rod kinetics". PNAS USA 2008; Sep 22 [Epub ahead of print]

Does regular use of paracetamol cause asthma?

The findings of a multi-centre study involving 1,028 participants across Europe suggested that using paracetamol at least once a week increases the risk of asthma.

Half of the participants were recruited as cases of self-reported diagnosis of asthma and half were healthy volunteers with no diagnosis of asthma as control. They found that cases were about 2.5 - 2.9 times more likely to have taken paracetamol regularly than controls but they did not find any association between use of other painkillers and asthma. The researchers said "there is now a need to carry out suitable intervention studies to determine whether the link is causal".

Critics say there are problems with this study - eg a case-control study cannot prove causation and cannot rule out that asthma causes people to take more painkillers. It was suggested that a randomised controlled study of healthy participants to paracetamol or not will produce more conclusive results.

Source: "The relation between paracetamol use and asthma: a GA2LEN European case-control study". European Respiratory Journal 2008; Published online before print June 25

Colonoscopy vs CT scan

In a study of 2600 asymptomatic adults at 15 study centres, CT colonographic screening identified 90% of medium and large of adenomas detected by colonoscopy. The findings published in NEJM suggest that people who do not want a colonscopy could opt for a CT scan, reported The Wall Street Journal.

CT colonography is a noninvasive option in screening for colorectal cancer, it can show other problems that may need followed. Critics say there is a third test called fecal occult blood testing (FOBT) that has been shown to reduce death from colon cancer, but there is insufficient evidence to say which is the best.

Source: "Accuracy of CT Colonography for Detection of Large Adenomas and Cancers" NEJM 2008 Volume 359(12):1207-1217 (abstract only)

Improving your chances of getting the dream job

Want that job? Follow these tips published by the BMJ Careers.


The author writes " it’s not all about luck , there are concrete ways to improve your chances" of getting your dream job.

1). Medical CV writing skills
Tips on how to stand out from the crowd by focusing on the evidence with examples showing full range of skills that the prospective employers are looking for etc

2). Interview skills
Tips on knowing the questions, preparing your answers and questions to strengthen your interview and impress the interviewing panel etc

3). Presentation skills: 4 P's - plan, prepare, phrase, and project
Tips on how to deal with common difficult situations - interruptions, audience looks bored, audience not listening and talking, questions you can’t answer etc

4). Networking skills - more than just self promotion
Benefits of networking and how to approach it.

Food packaging chemical links to diabetes and heart disease

Multiple newspapers reported a study published in JAMA that found higher level of bisphenol A (BPA), a chemical widely used in food and drink packaging, in adults' urine increased the risk of heart disease and diabetes.

Researchers looked at the data of a survey that assessed the health and diet of the general US population invloving 1455 adults aged 18 - 74 to investigate associations between BPA concentrations in urine and adult health status.

Critics say that this is the first cross-sectional study on this subject, it can only show the relationships between exposure and risk but it cannot prove BPA cause these chronic diseases. Further research will be needed to confirm these findings.

Source: Lang IA, Galloway TS, Scarlett A, et al. Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults. JAMA 2008; 300(11):1303-1310

Fewer surgical mistakes after shorter hours for residents

Concern has been raised about the effects of restricted work hours on patient care and surgical training among the medical community in the US. A study published in the Archives of Surgery this week found that surgical compliactions have fallen after the restrictions on work hours introduced in a large teaching hospital in California.

Researchers studied the medical records of 2470 patients who had laparoscopic gallbladder surgery. Half of the operation were performed before the 80-hour restriction on the surgical residents and the other half were after the change in hours. They found that after the shorter weeks, fewer patients had bile duct injuries, a common problem frequenetly caused by technical error. The author said the study is "the first that has shown there is improvement in outcomes in this new era" although it is unclear why the complication rates decreased.

Source: "Decreased Bile Duct Injury Rate During Laparoscopic Cholecystectomy in the Era of the 80-Hour Resident Workweek" Arch Surg. 2008;143(9):847-851.

Mediterranian diet protects against all major diseases

The BMJ published a large scale systematic review and meta-analysis which statistically combined the results of 12 separate studies with over 1.5 million people. The results show that those who follow strictly this style of diet are more likely to live longer, and less likely to die from major diseases such as heart disease, stroke or cancer etc.

The researchers said the results seem “clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of major chronic diseases.” However they point out that it is important to estimate the effects of the dietary pattern as a whole rather than the individual components of the diet.

Source: "Adherence to Mediterranean diet and health status: meta-analysis." BMJ 2008; 337:a1344 ( published online)

Knee surgery had no benefit for osteoarthritis

Two studies raising doubts about the effectiveness of knee surgery were published in the New England Journal of Medicine (NEJM).


About 200 patients with moderate-to-severe osteoarthritis of the knee were randomly assigned to receive either surgery, drugs and physical therapy ( as treatment group with arthoscopic surgery ) or drugs and physical therapy alone ( as control group ). (1)


At the end of the study, researchers found that patients in the treatment group had slightly less pain than those in the control group after 3 months, but no significant differences between the two groups after 2 years. Researchers concluded that “arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy”. A previous study published in 2003 had similar results.

Another study in the same journal found that MRI scan of middle-age and older people show that meniscal tears in the knee are more common in this age group than previously thought and often without pain or stiffness. The author said "Clinicians who order MRI of the knee should take into account the high prevalence of incidental tears when interpreting the results and planning therapy". (2)


Source 1 :"A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee." NEJM 2008; 359(11):1097-1107 ( abstract only)


Source 2: "Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons Volume" NEJM 2008. 359(11) :1108-1115 ( abstract only)

Less US medical students choose to work in primary care

The Wall Street Journal published an interesting article about more and more US medical graduates choose their careers in specialties over primary care. It has attracted a large number of comments.

The article is based on two studies published in this week's JAMA. A research letter in the journal suggests that higher pay in specialties is a reason for the career choose.

A survey, published in the same journal, involving 1177 fourth-year medical students at 11 US medical schools in 2007, found that only 2% planned to work in primary care internal medicine. A similar survey in 1990 found 9%. The decline has raised worries about shortage of primary care physicians in the US.

Paper work, increasing demands of the chronically ill, the elderly and people with complex diseases and students' concerns about the primary care system, insurance pays, lawsuits, debts, the need to see large number of patients daily to break even also contibute to the primary care gap. Some primary care physicians feel that specialty doctors get more respect and chance of practice medicine.

Source: Research letter - "Future Salary and US Residency Fill Rate Revisited" JAMA. 2008;300(10):1131-1132 ( f/t via Athens )

Source: "Factors Associated With Medical Students' Career Choices Regarding Internal Medicine" . JAMA. 2008;300(10):1154-1164 ( f/t via Athens )

Vitamin B12 may prevent brain shrinkage

A study, led by scientists at Oxford University, involving 107 healthy elderly found that those with lower vitamin B12 levels in their blood were six times more likely to experience brain shrinkage compared with those who had higher levels of the vitamin.


Particpants were given annual scans of their brain volume, blood tests to assess the vitamin B12 levels as well as physical examinations for up to five years. The researcher said "this study suggests that simply adjusting our diets to consume more vitamin B12 through eating meat, fish, fortified cereals or milk may be something we can easily adjust to prevent brain shrinkage and so perhaps save our memory."


However, "more information is needed before recommending that people take vitamin B12 supplements to guard against the loss of brain volume and possibly prevent declines in thinking and memory", the author concluded.



Source: "Vitamin B12 status and rate of brain volume loss in community-dwelling elderly". Neurology 2008; 71:826–832

Fresh research rule out MMR-autism link

Despite a growing amount of evidence that MMR vaccine is safe, many parents are still concerned that MMR causes autism. A few newspapers reported a new study that replicates the methods of the original study conducted in 1998 by Dr Andrew Wakefield that sparked the controversy of a link between autism and the MMR vaccine.

The new study compared children with gastrointestinal disturbances who also had autism with a control group without autism to see if there was evidence of meales virus RNA in the bowel of children with autism who also have gastrointestinal disturbances. The reserachers said their results did not support the association of autism with persistent measles in the bowel or with MMR vaccination.

Critics say that although this is a stronger study than the Wakefield's with a control group and more cases, it is still small and the findings may still be due to chance. However, this study provides evidence that disproves the MMR-autism link.

Source: " Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study." PLoS ONE 2008; 3(9):e3140

Hospital doctors' memory sticks threaten data security

Two doctors surveyed their colleagues at a teaching hospital in London and found that 92 out of 105 held unsecured memory sticks, 79 held confidential patient information but only 5 were password protected. The authors said this is a clear breach of data security, reported the BBC.

They claim that the findings reflect the lack of security across UK hospitals and beyond.

Although hospitals issue doctors with chip-and-pin cards to access NHS databases and patient records, many doctors increasingly rely on their own memory sticks to store patients data tradidtionally written in doctors' notebooks.

The DH said "any breach of patient security is unacceptable…...The NHS locally has legal responsibility to comply with data protection rules." The survey is published in today's Health Service Journal.

Vytorin's cancer saga

The New England Journal of Medicine published an editorial yesterday on its website rising the doubts of the safety of the drug Vytorin and its cancer link. It concludes that “physicians and patients are unfortunately left for now with uncertainty about the efficacy and safety of the drug”.

Vytorin is a combination of 2 drugs : a statin called simvastatin and ezetimibe, a new drug for lowering cholesterol . Vytorin is one of the best-selling drugs in the world and heavily prescribed by doctors although there is little evidence that ezetimibe offers the same benefits as stains.


The SEAS trials of Vytorin, conducted by reserachers in Norway found that Vytorin lowered the average levels of “bad” LDL cholesterol but not the aortic valve disease. It also found unexpectedly more cancer cases among patients taking Vytorin than the placebo.


This has prompted the analysis of the ezetimibe trials by Oxford researchers. When the results from all trials were combined, they did not find an increased incidence of cancer and they concluded that there is "no credible evidence of any side effect of ezetimibe on cancer risk". However, they suggest that “follow-up of longer duration will permit the balance of risks and benefits to be determined more reliably.”

Source: Both articles are published online on Sept 2 at the NEJM website ( will appear in Sept 25 issue of the journal)