The Lancet issued a press release on Tuesday 2 February 2010 following the GMC's decision on the paper by Wakefield et al in 1998 stating that several elements of the paper are incorrect. "In particular, the claims in the original papaer that children were consecutively referred and that investigations were approved by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record."
The study, published in The Lancet, claimed 8 of the 12 children showed signs of autism within days of receiving the MMR vaccine. The lead author, Andrew Wakefield, suggested that there might be a link between the vacciantion and autism. Although it was a very small study with only 12 children, the findings had caused a massive drop in the uptake of the MMR vaccine and sparked panic over the MMR vaccine around the world.
In the same issue of The Lancet, a commentary " Vaccine adverse events: causal or incidental?" written by 2 American vaccine specialists was also published. They pointed out that Wakefield's paper lacked epidemiological evidence to support the causal association with MMR vaccine and warned that such claim would cause confusion and fear among the media and the public. Unfortunately their message was not picked up by the media and the general public had little access to research articles.
The GMC found that Wakefield had no ethical approval nor relevant qualifications to carry out the tests on children. He also failed to declare that he had received money from a law firm representing the parents to carry out the research. Questions were raised on how Wakefield's research was scrutinised by the Royal Free and UCL Medical School where he worked at the time. A subsequent investigation by The Royal Free Hospital in 2004 reported that Wakefield's work on children was "appropriate". However, The Lancet issued a partial retraction of the interpretation from 10 of the 12 authors except Wakefield and one other author. See "The lessons of MMR" The Lancet, 363, 6 March 2004, pp 747–749 ( full text via Athens)
Some critics say the Lancet retraction is a bit too late while others say that the retraction will not change the situation as the MMR-autism debate continues.
See also: "The Lancet retracts controversial MMR research paper". Independent ,2 February 2010
Thursday, January 21, 2010
Concerns raised on high prescription errors in children
A study, carried out in 2005 by the Univeristy of London involving a children's hospital, 3 general teaching hospital and 1 non-teaching hospital in London, looked at prescription errors given to children in hospital. The study was published in Archives of Disease in Childhood.
During the study, pharmacists found 391 prescription errors and 429 administration errors in the 3000 prescriptions they exmined over a 2-week period. Errors included incomplete prescriptions, wrong dose, how the drugs should be prepared or how they should given to the patients. One mistake was picked up by the nurse, on 5 occasions, the researchers intervened to prevent the patient suffering the harm.
The researchers believe that their findings show a general picture across Britain and still stand today. The author said prescribing for children is very difficult because most drugs are formualted for adults, doctors have to calculate the dose for children. Much more needs to be done to improve prescribing to children.
They call for better education for doctors on prescription skills and electronic prescribing to be introduced in hospitals. See also post on GMC study on prescription errors in hospitals.
Source: "Minimising medication errors in children”Archives of Disease in Childhood 2009 ;94:161-164
During the study, pharmacists found 391 prescription errors and 429 administration errors in the 3000 prescriptions they exmined over a 2-week period. Errors included incomplete prescriptions, wrong dose, how the drugs should be prepared or how they should given to the patients. One mistake was picked up by the nurse, on 5 occasions, the researchers intervened to prevent the patient suffering the harm.
The researchers believe that their findings show a general picture across Britain and still stand today. The author said prescribing for children is very difficult because most drugs are formualted for adults, doctors have to calculate the dose for children. Much more needs to be done to improve prescribing to children.
They call for better education for doctors on prescription skills and electronic prescribing to be introduced in hospitals. See also post on GMC study on prescription errors in hospitals.
Source: "Minimising medication errors in children”Archives of Disease in Childhood 2009 ;94:161-164
Too much TV viewing shortens lives
Nearly 9,000 Australian adults, divided into 3 groups, were tracked for roughly six and a half years by researchers: those who watched TV less than 2 hours per day, between 2 and 4 hours, and more than 4 hours.
Researchers found that those who watched TV more than 4 hrs had a 46% higher risk of death from all causes and an 80% higher risk of cardiovascular death, each hour watching the TV per day increased the risk of death from cardiovascular disease by 18% and the risk of cancer death by 9%. The study was published online in Circualtion.
Researchers found a strong connection between TV hours and death from cardiovascular disease not only in overweight and obese people, but also among those who had a healthy weight. The lead author said "sitting for long periods has unhealthy influence on blood sugar and blood fats".
Source: Television Viewing Time and Mortality. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. Published online before print January 11, 2010
Researchers found that those who watched TV more than 4 hrs had a 46% higher risk of death from all causes and an 80% higher risk of cardiovascular death, each hour watching the TV per day increased the risk of death from cardiovascular disease by 18% and the risk of cancer death by 9%. The study was published online in Circualtion.
Researchers found a strong connection between TV hours and death from cardiovascular disease not only in overweight and obese people, but also among those who had a healthy weight. The lead author said "sitting for long periods has unhealthy influence on blood sugar and blood fats".
Source: Television Viewing Time and Mortality. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. Published online before print January 11, 2010
Monday, January 18, 2010
Higher antibiotic doses to bigger people
Two doctors said in The Lancet Viewpoint, although drug treatments are tailored for individual patients, most dosing regimens, do not take patient's body size into consideration.
They argued that with increasing level of obesity worldwide, the standard dose of antibiotics for all adults is outdated because it may not be strong enough to clear the infection in taller and larger adults and resistance may be developed. Likewise, smaller patients may get too much drug, and suffer greater side-effects as a result.
They said that a patient's bodyweight should be taken into account when calculating their dose of antibiotics to achieve effectivenesss and safety.
Critics say that this review is based on authors' views and experience and is a valuable discussion. Changes to current prescribing would be costly and complicated, therfore further research and follow-up of previous study data would be needed.
Source:
"Adjustment of dosing of antimicrobial agents for bodyweight in adults". The Lancet, 375(9710):248-251
Editorial: "Prescribing medicines: size matters". The Lancet 2010; 375(9710): 172
They argued that with increasing level of obesity worldwide, the standard dose of antibiotics for all adults is outdated because it may not be strong enough to clear the infection in taller and larger adults and resistance may be developed. Likewise, smaller patients may get too much drug, and suffer greater side-effects as a result.
They said that a patient's bodyweight should be taken into account when calculating their dose of antibiotics to achieve effectivenesss and safety.
Critics say that this review is based on authors' views and experience and is a valuable discussion. Changes to current prescribing would be costly and complicated, therfore further research and follow-up of previous study data would be needed.
Source:
"Adjustment of dosing of antimicrobial agents for bodyweight in adults". The Lancet, 375(9710):248-251
Editorial: "Prescribing medicines: size matters". The Lancet 2010; 375(9710): 172
Friday, January 15, 2010
Breast cancer screening controversy
The US Preventive Services Task Force (USPSTF) has issued new guidelines calling for women to change from annual screening at age 40 to biennial mammograms at 50.
The new guidelines aimed at reducing unnecessary treatment but have caused public uproar and confusion. Radiologists say the USPSTF recommendations were "unfounded" and put forward their own guidelines in the January issue of the Journal of the American College of Radiology.
However, the USPSTF continues to recommend biennial mammograms and says that individuals should take into account one's values regarding specific benefits and harms when deciding when to start the screening.
Source: "Screening for breast cancer: U. S. Preventive Services Task Force recommendation statement" Ann Intern Med 2009; 151: 716-26.
The new guidelines aimed at reducing unnecessary treatment but have caused public uproar and confusion. Radiologists say the USPSTF recommendations were "unfounded" and put forward their own guidelines in the January issue of the Journal of the American College of Radiology.
However, the USPSTF continues to recommend biennial mammograms and says that individuals should take into account one's values regarding specific benefits and harms when deciding when to start the screening.
Source: "Screening for breast cancer: U. S. Preventive Services Task Force recommendation statement" Ann Intern Med 2009; 151: 716-26.
Thursday, January 14, 2010
Blood pressure drugs could reduce the risk of dementia
American researchers investigated the incidence of dementia in 800,000 people aged 65 or over with cardiovascular disease, mostly male. The patients were divided into 3 groups according to the type of blood pressure drugs they were taking : ARBs, lisinopril or other cardiovascular drugs.
The researchers found that ARBs were associated with reduced risk of developing dementia when compared with the other 2 types of drugs. ARBs had additional effects when combined with another type of high BP drug. Those with existing dementia who took both drugs were less likely to die early or be admitted to a nursing home. The study concluded that ARBs could reduce the risk of developing Alzheimer's disease or dementia.
Citics say that there are limitations which may have affected the results: the subjects were not randomly assigned a treatment, each group of people might have different diseases such as diabetes or cardiovascular disease and the follow-up period was too short for a condition such as dementia. Further work is needed to include both male and female.
Source: N-C Li, Lee A, Whitmer RA, et al. "Use of angiotensin receptor blockers and risk of dementia in a predominantly male population: prospective cohort analysis". BMJ 2010; 340: b5465
Choose C-sections only when there is a medical reason
According to a survey by the World Health Organization(WHO) published online in The Lancet, women who had caesarean sections without a medical reason were 10 times more likely to be admitted to intensive care, required blood transfusions or encountered complications.
The WHO study reviewed nearly 110,000 births in 9 Asian countries in 2007-08 and found that about 27% of the births were done by C-sections, 2/3 of the hospitals surveyed make more money if C-sections were carried out. The authors warned that C-sections should be opted for only when there is a medical indication to improve the outcome.
In the UK, nearly a quarter of births are carried out by C-sections despite the evidence against it.
Source: "Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007—08" The Lancet, Early Online Publication, 12 January 2010 ( f/t via Athens)
The WHO study reviewed nearly 110,000 births in 9 Asian countries in 2007-08 and found that about 27% of the births were done by C-sections, 2/3 of the hospitals surveyed make more money if C-sections were carried out. The authors warned that C-sections should be opted for only when there is a medical indication to improve the outcome.
In the UK, nearly a quarter of births are carried out by C-sections despite the evidence against it.
Source: "Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007—08" The Lancet, Early Online Publication, 12 January 2010 ( f/t via Athens)
Tuesday, January 12, 2010
Why so few heart attack survivors take advantage of rehab?
A new reserach published in Circualtion has found, as in many other studies, that cardiac rehab improves the survival rate of heart attack survivors.
The study tracked more than 30,000 Medicare patients aged over 65 for 4 years and found that
those who completed 36 sessions of rehab had a risk reduction of 47% in death and 31% in heart attack than those who had fewer sessions. However only 18% attended all 36 sessions and drop-out rate was high.
Other studies have shown that patients who attended even a few sessions improved their survival rate significantly, but most heart attack survivors did not go to rehab and those who went did not stick to it. Why don't patients take advantage of it?
Some cardiologists say that successful rehab required strong self-discipline and perserverance as well as respect in the medical community supported by adequate resources. A study published in 2007 in Circualtion found that cardiac rehab was provided to about 14% of patients hospitalised for heart attacks and 31% who had bypass surgery.
Source: Bradley G. Hammill “Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries” Circulation. 2010;121:63-70 ( f/t via Athens)
The study tracked more than 30,000 Medicare patients aged over 65 for 4 years and found that
those who completed 36 sessions of rehab had a risk reduction of 47% in death and 31% in heart attack than those who had fewer sessions. However only 18% attended all 36 sessions and drop-out rate was high.
Other studies have shown that patients who attended even a few sessions improved their survival rate significantly, but most heart attack survivors did not go to rehab and those who went did not stick to it. Why don't patients take advantage of it?
Some cardiologists say that successful rehab required strong self-discipline and perserverance as well as respect in the medical community supported by adequate resources. A study published in 2007 in Circualtion found that cardiac rehab was provided to about 14% of patients hospitalised for heart attacks and 31% who had bypass surgery.
Source: Bradley G. Hammill “Relationship Between Cardiac Rehabilitation and Long-Term Risks of Death and Myocardial Infarction Among Elderly Medicare Beneficiaries” Circulation. 2010;121:63-70 ( f/t via Athens)
Mozart's music may help premature babies gain weight
A group of Israeli doctors from the Tel Aviv University medical centre carried out a small study involving 20 healthy premature babies to look at the effects of music on short-term metabolic efficiency. The study was published in Pediatrics.
The babies were randomly assigned to either exposure to Mozart's music for 30 minutes or no music, then alternative treatment was given the next day. The researchers measured the babies' resting energy expenditure (REE) during the exposure period and comapred the way the babies responded to the music with their metabolism during music-free period. The study did not measure the changes in weight.
The study found that exposure to Mozart's music for 30 minutes reduced the babies' REE, although the mechanism was unclear, it appeared that the music has relaxed the babies and this effect might increase the babies' weight gain. However the researchers were cautious about the clincal implications of their findings and said that more research is needed.
Other research has found the "Mozart effect" has improved the IQ in college students, lowered heart rates, stress level etc, later studies challenged these findings.
Source: Lubetzky R, Mimouni FB, Dollberg S et al. Effect of Music by Mozart on Energy Expenditure in Growing Preterm Infants. Pediatrics Vol. 125 No. 1 January 2010
The babies were randomly assigned to either exposure to Mozart's music for 30 minutes or no music, then alternative treatment was given the next day. The researchers measured the babies' resting energy expenditure (REE) during the exposure period and comapred the way the babies responded to the music with their metabolism during music-free period. The study did not measure the changes in weight.
The study found that exposure to Mozart's music for 30 minutes reduced the babies' REE, although the mechanism was unclear, it appeared that the music has relaxed the babies and this effect might increase the babies' weight gain. However the researchers were cautious about the clincal implications of their findings and said that more research is needed.
Other research has found the "Mozart effect" has improved the IQ in college students, lowered heart rates, stress level etc, later studies challenged these findings.
Source: Lubetzky R, Mimouni FB, Dollberg S et al. Effect of Music by Mozart on Energy Expenditure in Growing Preterm Infants. Pediatrics Vol. 125 No. 1 January 2010
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