In Sickness and In Health

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A blog about the latest news and research in clinical medicine.

Helen Jaques
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  • February 23, 2009
  • 08:00 AM
  • 1,014 views

Financial altruism leads to depression

by Helen Jaques in In Sickness and In Health

Do you give cash to people who aren’t your direct family or close friends, including people on the street begging for money? A new study in PLoS One suggests that such charitable behaviour will eventually lead to major depression.

Author Takeo Fujiwara found that financial altruism towards someone other than a family member or close friend [...]... Read more »

  • February 19, 2009
  • 05:30 AM
  • 898 views

Improving communication of medication risks and benefits in direct-to-consumer ads

by Helen Jaques in In Sickness and In Health

A new study published in Annals of Internal Medicine has shown that adding a simple fact box to adverts for prescription drugs considerably improves consumer awareness of the risks and benefits of the medication.  In this study, people who examined an advert with a drug fact box were more likely to choose the most efficacious [...]... Read more »

  • February 12, 2009
  • 11:23 AM
  • 922 views

Researchers identify new prostate cancer marker detectable in urine

by Helen Jaques in In Sickness and In Health

Researchers in the US have found a new marker of the aggressiveness of prostate cancer that is detectable in the urine of men with the malignancy.  Sreekumar et al. discovered that levels of sarcosine, a common amino acid found in many biological tissues, are higher in invasive prostate cancers than in benign cancers and are [...]... Read more »

Arun Sreekumar, Laila M. Poisson, Thekkelnaycke M. Rajendiran, Amjad P. Khan, Qi Cao, Jindan Yu, Bharathi Laxman, Rohit Mehra, Robert J. Lonigro, Yong Li.... (2009) Metabolomic profiles delineate potential role for sarcosine in prostate cancer progression. Nature, 457(7231), 910-914. DOI: 10.1038/nature07762  

  • February 11, 2009
  • 05:43 PM
  • 987 views

Make it a DIET coke break, for the sake of your kidneys

by Helen Jaques in In Sickness and In Health

New research published in PLoS One has shown that drinking two or more fizzy drinks a day can double a woman’s chance of developing signs of kidney disease – but only if she drinks full-sugar sodas.

David A Shoham and colleagues studied data from more than 9,000 individuals in the population-based National Health and Nutrition Examination [...]... Read more »

  • January 26, 2009
  • 06:26 PM
  • 868 views

So you won’t go blind, but you might get prostate cancer

by Helen Jaques in In Sickness and In Health

Although the schoolyard rumours that masturbation causes blindness or hairy palms aren’t true, a new study published in BJU International has found that too much playing solo in your twenties and thirties can increase the risk of prostate cancer.

The study of more than 800 men found that a high level of sexual activity or [...]... Read more »

Polyxeni Dimitropoulou, Artitaya Lophatananon, Douglas Easton, Richard Pocock, David P. Dearnaley, Michelle Guy, Steven Edwards, Lynne O’Brien, Amanda Hall, Rosemary Wilkinson.... (2009) Sexual activity and prostate cancer risk in men diagnosed at a younger age. BJU International, 103(2), 178-185. DOI: 10.1111/j.1464-410X.2008.08030.x  

  • January 25, 2009
  • 09:00 AM
  • 706 views

Spousal abuse increases the risk of miscarriage by 50%

by Helen Jaques in In Sickness and In Health

Domestic violence against women, more specifically violence perpetrated by a partner or spouse, is an important problem worldwide.  A 2005 study by the World Health Organization that assessed 24,000 women in 10 countries found that between 15% and 71% of women had experienced physical or sexual violence, or both, at the hands of their partner.  [...]... Read more »

  • January 13, 2009
  • 06:37 AM
  • 1,019 views

A stressful job doubles the likelihood of stroke - but only for men

by Helen Jaques in In Sickness and In Health

A study published in Annals of Internal Medicine has found that men with a stressful job are twice as likely to have a stroke than are men with less demanding jobs.  Interestingly, there was no correlation between job stress and incidence of stroke among women.

A stroke occurs when the blood supply to the brain is [...]... Read more »

Akizumi Tsutsumi, Kazunori Kayaba, Kazuomi Kario, and Shizukiyo Ishikawa. (2009) Prospective Study on Occupational Stress and Risk of Stroke. Arch Intern Med, 169(1), 56-61. DOI: http://archinte.ama-assn.org/cgi/content/abstract/169/1/56  

  • January 5, 2009
  • 05:56 AM
  • 1,006 views

One in five children with cancer receive wrong chemotherapy doses

by Helen Jaques in In Sickness and In Health

A study of nearly 1,400 adult and pediatric cancer patients published in the Journal of Clinical Oncology has found that 19% of children taking chemotherapy drugs in outpatient clinics or at home were subject to some sort of medication error.  In addition, 7% of adult cancer outpatients also were on the receiving end of chemotherapy [...]... Read more »

K. E. Walsh, K. S. Dodd, K. Seetharaman, D. W. Roblin, L. J. Herrinton, A. Von Worley, G. N. Usmani, D. Baer, & J. H. Gurwitz. (2008) Medication Errors Among Adults and Children With Cancer in the Outpatient Setting. Journal of Clinical Oncology. DOI: 10.1200/JCO.2008.18.6072  

  • December 22, 2008
  • 08:35 AM
  • 970 views

Drinkers don’t take their medications often enough

by Helen Jaques in In Sickness and In Health

A recent study by Bryson et al. has found that moderate to severe alcohol misuse increases the likelihood that patients won’t take their medication properly.

Many patients do not take their medications as often as they should - i.e. on at least 80% of the days they are supposed to.  In fact, a recent study found [...]... Read more »

  • December 12, 2008
  • 01:51 PM
  • 846 views

Are researchers fudging clinical trial statistics?

by Helen Jaques in In Sickness and In Health

Before a clinical trial can commence a protocol - a plan of exactly how a trial will be conducted - will be formulated.  As part of the planning, the individuals undertaking the trial will calculate approximately how many patients need to take part for the results to be meaningful (the ’sample size’) and prespecify which [...]... Read more »

  • November 26, 2008
  • 09:00 AM
  • 795 views

'Two for the price of one' tactic improves outcomes after organ transplantation

by Helen Jaques in In Sickness and In Health

A new study of more than a million transplant recipients has found that rejection rates are lower in patients who receive two organs at once than in those who receive a single organ.The study, published in Annals of Surgery, found that the rejection rates for organs cotransplanted with a donor-specific liver, heart or kidney were significantly lower than those for organs transplanted alone.It has been known for some time that transplanting a liver with another organ such as a kidney or a section of intestine reduces the likelihood of rejection of the primary organ, leading to the suggestion that liver allografts protect other organs from rejection. Combined liver and kidney transplantation is used in patients with hepatorenal syndrome - in which acute kidney failure occurs as a result of liver cirrhosis or fulminant liver failure - or in patients with end-stage renal disease who also have liver damage as a result hepatitis B or C virus infection. Simultaneous intestine and liver transplantation is used in patients with intestinal failure following the removal of a large section of intestine (e.g. because of a tumor) and end-stage liver disease, which may be due to receiving their meals intravenously following intestine removal (total parenteral nutrition).The recent study by Rana et al. has revealed that heart and kidney allografts are also immunoprotective and are themselves protected when transplanted with another organ.The authors searched the United Network for Organ Sharing database – which contains data about every transplant that has taken place in the US since 1986 – and identified all thoracic, kidney, intestine and liver transplant recipients over 18 years old.In patients who simultaneously received heart and kidney transplants from a single deceased donor, the incidences of renal allograft rejection and cardiac allograft rejection at one year were lower than in patients who received either a heart or a kidney allograft alone. In addition, the rate of rejection-free survival at one year was higher in the combined organ recipients. Likewise, compared with patients who received a single organ, rejection of either organ and rejection-free survival were lower and higher, respectively, in individuals who received combined liver and kidney transplants.On the other hand, cotransplantation of intestine or pancreas in patients undergoing kidney or liver transplantation did not lower the risk of rejection or improve rejection-free survival.The authors suggest that combined simultaneous organ transplantation could be used more widely to reduce rejection rates and lower the need for immunosuppression in transplant recipients.------------------------------------------------------------------------------------------------Rana A et al. (2008) The Combined Organ Effect: Protection Against Rejection? Annals of Surgery 248 (5): 871-879 DOI: 10.1097/SLA.0b013e31817fc2b8... Read more »

Abbas Rana, Susanne Robles, Mark J. Russo, Karim J. Halazun, David C. Woodland, Piotr Witkowski, Lloyd E. Ratner, & Mark A. Hardy. (2008) The Combined Organ Effect: Protection Against Rejection?. Annals of Surgery, 248(5), 871-879. DOI: 10.1097/SLA.0b013e31817fc2b8  

  • November 20, 2008
  • 12:00 PM
  • 1,674 views

Chronic kidney disease patients claim to know nothing about their condition

by Helen Jaques in In Sickness and In Health

A study by Finkelstein and colleagues published recently in Kidney International has found that as many of a third of patients with chronic kidney disease (CKD) claim to know nothing about their disease or about their treatment options when their kidneys ultimately fail.CKD encompasses many types of kidney damage and is characterized by the gradual loss of renal function, often with few symptoms bar raised blood pressure and nonspecific signs such as fatigue and reduced appetite. CKD is graded on a 5-point scale, with stage 1 being slightly diminished kidney function and stage 5 being established kidney failure. Despite treatment many cases progress, in some instances to the point of kidney failure, otherwise known as end-stage renal disease. Once a patient reaches end-stage renal disease, they have to regularly undergo life-saving treatment that mimics the roles performed by their now defunct kidneys. Some such treatments include dialysis and kidney transplantation.In the study by Finkelstein et al., 676 patients with stage 3–5 CKD who had been receiving nephrology care for about 5 years completed a questionnaire to assess their knowledge of CKD and of renal replacement therapies. Only 23% of patients reported having a great deal or extensive knowledge about their CKD and 35% reported having very limited or no knowledge. When questioned about their knowledge of renal replacement therapy, 35% of patients reported knowing nothing about any end-stage renal disease treatment modality.Various studies have shown that decent education about CKD can delay the onset renal failure, increase the likelihood of the patient choosing a less costly home-based therapy rather than elaborate hospital-based dialysis, and improve outcomes of patients after the start of dialysis.The findings of the Finkelstein et al. study indicate that despite receiving specialized kidney care for several years, many patients with CKD feel they have little knowledge of their disease and are, therefore, ill equipped to make treatment decisions. In an editorial accompanying the research, Chester Fox and Linda Kohn of University at Buffalo, New York, suggest that, "A multidisciplinary team - including dieticians, social workers, nurse educators, and pharmacists - and access to transplant surgeons are necessary to improve patient knowledge and understanding about progression of CKD and treatment options."Finkelstein FO et al. (2008). Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies Kidney International 74 (9): 1178-1184 DOI: 10.1038/ki.2008.376------------------------------------------------------------------------------------------------------------------Another recent study, this time published in Archives of Internal Medicine, measured whether the introduction of early detection guidelines had improved the number of patients with CKD who were aware that they had the disease. The authors specifically asked 2,992 patients with stage 1-4 CKD whether or not they had been told that they had weak or failing kidneys. Between 1999 and 2004, awareness improved only in patients with stage 3 CKD. Patients with risk factors for CKD such as diabetes or hypertension were most likely to be aware of their disease.... Read more »

Fredric O Finkelstein, Kenneth Story, Catherine Firanek, Paul Barre, Tomoko Takano, Steven Soroka, Salim Mujais, Kathleen Rodd, & David Mendelssohn. (2008) Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies. Kidney International, 74(9), 1178-1184. DOI: 10.1038/ki.2008.376  

  • November 17, 2008
  • 08:30 AM
  • 2,467 views

Testosterone skin patches improve sex drive in postmenopausal women

by Helen Jaques in In Sickness and In Health

A considerable proportion of women - between 25% and 53% in fact - suffer from sexual problems, with libido taking a nosedive after the menopause as estrogen levels drop. Although low libido isn't a health problem per se, it has been shown to have a negative effect on sexual relationships and overall wellbeing.It has been known for several years that testosterone, administered as a skin patch, improves sexual function in postmenopausal women. Previous studies on sex drive in women have only looked at the effects of testosterone in females also taking estrogen therapy, as testosterone is thought to be ineffective without concurrent estrogen administration. Long-term estrogen therapy is, however, associated an increased risk of cardiovascular disease.A recent study by Davis et al. has now shown that testosterone patches can improve libido in postmenopausal women taking no other hormone therapy. Sponsored by Procter & Gamble, the study found that use of the company's Intrinsa testosterone patches doubled the number of satisfying sexual episodes a month in women with low libido.The study - conducted at 65 centers in the US, Canada, Australia, the UK and Sweden - enrolled 814 women who had undergone natural or surgical (e.g. through hysterectomy) menopause and who were concerned about decreases in their levels of desire and sexual activity. These women were randomly assigned to receive daily placebo, 150 micrograms of testosterone a day or 300 micrograms of testosterone a day, which was administered via patches applied to the abdomen.After 24 weeks of treatment, the increase in the number satisfying sexual episodes per month was greater in women receiving 300 micrograms of testosterone a day than in women receiving placebo (an increase of 2.1 episodes vs 0.7 episodes). The increase seen in women receiving 150 micrograms of testosterone a day, however, was not markedly greater than that in women on placebo (an increase of 1.2 vs 0.7 episodes). Both testosterone therapy groups showed a greater increase in sexual desire than the placebo group and a more notable decrease in libido-related personal distress.The number of reported side effects throughout the 52-week study period was similar in all three groups, although there was a higher incidence of unwanted hair growth in the women receiving 300 micrograms of testosterone a day. Four women receiving testosterone were diagnosed with breast cancer compared with none in the placebo group, but at least one case was thought to have developed before the initiation of testosterone therapy and the other cases were put down to chance.Speaking to CNN, Dr Sheryl Kingsberg, one of the coauthors of the study, said, "Although the change in activity is modest, that's something that is appropriate and I think most women would be more than happy with it. They wanted to return to the level of desire they had in their premenopausal years, and that's what they got."-------------------------------------------------------------------------------------------------Davis SR et al. for the APHRODITE Study Team (2008). Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen N Engl J Med 359 (19): 2005-2017 PMID: 18987368... Read more »

Davis SR et al. for the APHRODITE Study Team. (2008) Testosterone for Low Libido in Postmenopausal Women Not Taking Estrogen. N Engl J Med, 359(19), 2005-2017. DOI: 18987368  

  • November 12, 2008
  • 05:53 PM
  • 1,960 views

Cardiologists circumspect on stellar JUPITER results

by Helen Jaques in In Sickness and In Health

The publication this week in New England Journal of Medicine of the JUPITER trial - which found that the statin rosuvastatin reduces the risk of heart attack and other cardiovascular events in people with normal cholesterol levels - has cause quite a stir. The likes of the BBC and the Daily Mail squealed that statins should be prescribed to all healthy adults, but what did the study actually look at, and what do doctors think of the findings?In patients with raised cholesterol levels, treatment with statins reduces the risk of cardiovascular events such as heart attack and stroke; however, nearly half of all first cardiovascular events occur in people whose cholesterol levels are below current thresholds for pharmacological therapy. The JUPITER trial investigated the benefits of treatment with rosuvastatin (also known as crestor) in 17,802 patients over 50 years of age who had normal blood levels of low density lipoprotein (LDL) cholesterol ('bad' cholesterol), but elevated levels of another marker of heart disease called C-reactive protein (CRP).Compared with a placebo, statin treatment reduced the levels of both LDL cholesterol and CRP by considerable amounts (50% and 37%, respectively), and also almost halved the likelihood of a major cardiovascular event such as a heart attack or stroke. When the results were broken down, it was found that the risk specifically of heart attack was reduced by 54% and the risk of fatal or nonfatal stroke decreased by 48%.CRP levels are not usually measured in people at risk of heart disease, yet statin treatment had a remarkable effect in people who were otherwise apparently healthy but had elevated levels of this marker. Doctors are now been asking whether measurement of CRP levels should be undertaken in all people at risk of heart disease, and whether statins should be prescribed as a preventative measure to a wider range of people, regardless of whether their cholesterol levels indicate that they should receive such treatment.In an editorial in the same issue of New England Journal of Medicine, Mark A Hlatky from Stanford University School of Medicine in California goes through the trial with a fine tooth comb to decide whether or not doctors should change how they prescribe statins.He notes that "JUPITER was a trial of statin therapy, not high-sensitivity CRP testing", and opines that "the evidence still favors [a] selective strategy for measuring high-sensitivity C-reactive protein, not routine measurement". Dr Hlatky also points out that the trial was only 2 years long, so could not assess the effects of long-term statin treatment, and that the cost of rosuvastatin is much higher than that of generic statins, so the benefits of broader prescription of rosuvastatin treatment need to be weighed up against these factors.You don't have to just take Dr Hlatky's word though. New England Journal of Medicine are hosting an online Clinical Directions poll to find out directly from doctors whether they are likely to change how they practice on the basis of the JUPITER results.So far over 1,500 doctors and medical professionals have voted in the poll, and only 53% believe that the approach to laboratory screening and therapeutic use of statins in apparently healthy adults should be changed. The comments on the poll are just as cautious - Greg Rice of Libby, Montana says "Certainly what this study clearly shows most is that there is a large cohort of high risk patients we are missing. However, simply giving them a statin is not a very cost effective way to reduce the risk of coronary disease", whereas Timur Timurkaynak of Ankara, Turkey states "I really wonder what have we learned from jupiter trial that we don't know before".So it seems that the jury is going to being deliberating for some time as to whether apparently healthy people should have their CRP levels measured and should receive statins. The JUPITER trial seems to have thrown up more questions than it has answered, and it is clear that more research is needed before statins start getting dished out willy nilly.Nature News has a good run down of the JUPITER study and whether you should be heading straight to your doctor for preventative statin treatment------------------------------------------------------------------------------------------------------------------Ridker PM et al. (2008). Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein New England Journal of Medicine DOI: 10.1056/NEJMoa0807646... Read more »

P. M Ridker, E. Danielson, F. A.H. Fonseca, J. Genest, A. M. Gotto, J. J.P. Kastelein, W. Koenig, P. Libby, A. J. Lorenzatti, J. G. MacFadyen.... (2008) Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. New England Journal of Medicine. DOI: 10.1056/NEJMoa0807646  

  • November 5, 2008
  • 02:20 PM
  • 1,030 views

Consumption of caffeine during pregnancy increases the risk of having an underweight baby

by Helen Jaques in In Sickness and In Health

Caffeine has been proposed to have all sorts of effects on health, both good and bad. Just in the last few months, it has been reported that caffeine can help repair damaged blood vessels, protect against cataract formation, and even shrink women's breasts.Now new research published in the British Medical Journal has found that consuming caffeine during pregnancy can increase the risk of giving birth to low-birth-weight baby. Underweight babies are more likely to be delivered early or by cesarean section, and are at a higher risk of having neurological disabilities.The authors of this study devised a questionnaire on habitual caffeine intake that was administered before conception and twice during pregnancy in 2,635 women. They then looked at information on pregnancy complications and delivery details in the electronic databases of the two large UK maternity hospitals in which the study was conducted.The mean caffeine intake during pregnancy in these women was 159mg a day - equivalent to approximately a cup and a half of filter coffee, three cups of tea, or about three cans of cola drink. Approximately 62% of the total caffeine ingested was in the form of tea, 14% was in coffee, 12% in cola drinks and 8% in chocolate.Compared with women who consumed less than 100mg of caffeine a day, the risk of having a low-birth-weight baby was 20% higher in those who consumed 100-199mg per day and 50% higher in those who consumed 200-299mg per day. The size of the reduction in birth weight increased as caffeine intake increased.Importantly, the magnitude of the association between caffeine consumption and baby size was similar to that seen between alcohol consumption and birth weight, i.e. caffeine consumption increased the risk of having a low-birth weight baby as much as alcohol consumption did.The Food Standards Agency in the UK has now changed it's recommendations on caffeine intake during pregnancy on the basis of this research, lowing the limit from 300mg a day to 200mg a day.------------------------------------------------------------------------------------------------------------------CARE Study Group (2008). Maternal caffeine intake during pregnancy and risk of fetal growth restriction: a large prospective observational study BMJ, 337 DOI: 10.1136/bmj.a2332... Read more »

  • October 23, 2008
  • 05:00 AM
  • 1,025 views

Attitude has no effect on survival in women with breast cancer

by Helen Jaques in In Sickness and In Health

Many patients with cancer feel that their attitude towards the 'fight' is an important part of beating the disease, but maintaining a positive perspective is pretty tough in the face of a life-threatening malignancy.A large, population-based study published in the Journal of Clinical Oncology has now found that psychosocial factors such as fighting spirit and fatalism have no effect on survival in patients with breast cancer. The authors Phillips et al. emphasize that their results could allay the concerns of anxious women who believe that their mental attitude towards breast cancer will affect their likelihood of survival, and could in fact lift the burden of responsibility such women may feel.Phillips et al. studied 708 Australian women diagnosed with nonmetastatic breast cancer before the age of 60 (average age 40 years old). At study entry approximately 11 months after diagnosis, all women completed an array of psychosocial tests that were designed to assess factors such as anxiety and depression, coping style, and social support. These women were then followed up for an average of 8.2 years.In total, 33% of women experienced distant recurrence of their cancer and 24% died during follow-up. Once the patient data had been adjusted to take into account other factors that affect chances of recovery, such as tumour size, no associations could be found between psychosocial factors and either distant disease-free survival or overall survival.The authors conclude that their study does not support the controversial theory that psychosocial factors influence survival after breast cancer. They state, "This should be reassuring for women, particularly those who experience substantial levels of psychosocial distress after their diagnosis."It is important to note, however, that therapies that aim to reduce psychosocial stress in women with breast cancer should not be discounted, as such interventions do seem to improve quality of life.------------------------------------------------------------------------------------------------------------------K.-A. Phillips, R. H. Osborne, G. G. Giles, G. S. Dite, C. Apicella, J. L. Hopper, R. L. Milne (2008). Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study. Journal of Clinical Oncology 26 (28): 4666-4671 DOI: 10.1200/JCO.2007.14.8718... Read more »

K.-A. Phillips, R. H. Osborne, G. G. Giles, G. S. Dite, C. Apicella, J. L. Hopper, & R. L. Milne. (2008) Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study. Journal of Clinical Oncology, 26(28), 4666-4671. DOI: 10.1200/JCO.2007.14.8718  

  • October 10, 2008
  • 01:41 PM
  • 1,857 views

Skin test to detect Parkinson's disease

by Helen Jaques in In Sickness and In Health

A recent study published in the Journal of Neuropathology & Experimental Neurology has shown that neural signs of Parkinson's disease can be identified by taking a simple skin sample.Parkinson’s disease is a progressive neurodegenerative disease that affects about 1 in every 500 people in the UK. There is no biochemical test to definitively diagnose Parkinson's disease; diagnoses are instead made on the basis of various clinical assessments. Parkinson's disease is, however, characterized by the presence of Lewy bodies (LBs) - tiny protein deposits in nervous tissue.LBs can only be identified from a tissue sample, which is then stained and examined under a microscope (see right). These proteins tend to accumulate in the central nervous system and in the sympathetic ganglia, nervous tissue that runs like train tracks down either side of the spine - places that are nearly impossible to get biopsy samples.In this study, the authors looked for LBs in various tissues in 279 patients undergoing autopsy. A total of 85 patients had evidence of LBs in their central nervous system, so were diagnosed as having had a LB disease (LBD) - Parkinson's with or without dementia, dementia with LBs or LB-related progressive autonomic failure.The authors then examined skin biopsy samples taken the patients with proven LBD and found that 20 (23.5%) patients showed LB pathology in the cutaneous nerves of skin samples. None of the 194 individuals who did not have LBD showed evidence of LBs in skin samples; therefore, the skin test didn’t mistakenly identify any patients as having LBD.More specifically, LBs were found in the skin of 70% of patients who had Parkinson’s disease with dementia and in 40.4% of those who had dementia with LBs. On the other hand, LB pathology was found in the skin of only 20% of patients who had subclinical LBD, i.e. patients who would have had few symptoms of LBD but not enough signs to meet all the criteria for a diagnosis. This skin biopsy test might not, therefore, be a useful test for early diagnosis in individuals suspected of having LBD.When the authors looked at the clinical records of the patients that they had autopsied, they found that LBD patients who had evidence of LB pathology in their skin were more likely to have been bedridden and unable to walk independently before they died than were those patients with LBD who did not have cutaneous LB pathology (PP=0.065, respectively). This finding suggests that skin biopsy testing could be used to predict which patients’ physical functioning might be affected most seriously by their disease, and physiotherapy could be prescribed accordingly.Ikemura et al.’s study is the first to find evidence of LB pathology in the skin of patients with LBD; however, their results do not support the use of skin biopsy as an early diagnostic test. Testing for LBs in the skin could be used to confirm the diagnosis in a patient with clinical Parkinson’s disease or dementia with LBs and to predict the effect the disease might have on their physical functioning, both of which could help clinicians tailor treatment.------------------------------------------------------------------------------------------------------------------Ikemura M, Saito Y, Sengoku R, Sakiyama Y, Hatsuta H, Kanemaru K, Sawabe M, Arai T, Ito G, Iwatsubo T, Fukayama M, Murayama S (2008). Lewy Body Pathology Involves Cutaneous Nerves. J Neuropathol Exp Neurol, 67 (10), 945-953 PMID: 18800013... Read more »

Ikemura M, Saito Y, Sengoku R, Sakiyama Y, Hatsuta H, Kanemaru K, Sawabe M, Arai T, Ito G, Iwatsubo T.... (2008) Lewy Body Pathology Involves Cutaneous Nerves. . J Neuropathol Exp Neurol, 67(10), 945-953. DOI: 18800013  

  • October 1, 2008
  • 05:21 PM
  • 2,167 views

Irresponsible reporting of clinical trials by the news media

by Helen Jaques in In Sickness and In Health

It is important for journalists to highlight any potential bias in medical research so that patients and physicians alike can judge how valid clinical trial findings are. Today the Journal of the American Medical Association published a study showing that almost half of news stories on clinical trials fail to report the funding source of the trial. In addition, two-thirds of news articles refer to study medications by their brand names instead of by their generic names.The authors Hochman et al. reviewed papers published between 1st April 2004 and 30th April 2008 in the top five medical journals (New England Journal of Medicine, JAMA, the Lancet, Annals of Internal Medicine and Archives of Internal Medicine) to find pharmaceutical-company-funded studies that evaluated the efficacy or safety of medications. They then searched 45 major US newspapers (for example New York Times and USA Today) and 7 US-based primary news websites (including ABC News, CNN and MSNBC) for news stories that reported these clinical trials.A total of 358 company-funded clinical trials were identified, and 117 of these yielded 306 distinct news stories. Of the 306 news stories, 42% did not report the funding source of the clinical study. A total of 277 of these news articles were about medications that had both brand names and generic names, but 67% of stories used brand names in at least half of the references to the medication and 38% used only brand names.By using a brand name in news articles instead of a generic name, journalists are inadvertently favouring one pharmaceutical company over another. For example, the cholesterol lowering drug atorvastatin (generic name) is manufactured by several different pharmaceutical companies who all give it a different brand name - Pfizer call it Lipitor, whereas Merck until recently marketed a version called Zocor. Drugs are often referred to by their brand name because these titles tend to be better known - you've probably heard of paracetamol but not of acetaminophen; fair enough, maybe, but this practice still represents biased reporting.Hochman et al. also surveyed 94 newspaper editors to find out whether these individuals thought that their publication accurately reported clinical trials. Interestingly, 88% of editors stated that their newspaper often or always reported reported company funding in articles about medical research, and 77% said that their publication often or always referred to medications by their generic names.It seems that news outlets think they are reporting funding sources in medical articles when actually they're not. Academic journals have strict policies for disclosing funding and potential conflicts of interest, so why don't newspapers follow suit?---------------------------------------------------------------------------------------------------------------------M. Hochman, S. Hochman, D. Bor, D. McCormick (2008). News Media Coverage of Medication Research: Reporting Pharmaceutical Company Funding and Use of Generic Medication Names JAMA: The Journal of the American Medical Association, 300 (13), 1544-1550 DOI: 10.1001/jama.300.13.1544... Read more »

  • September 16, 2008
  • 07:17 PM
  • 1,287 views

Do common pain medications mask signs of prostate cancer?

by Helen Jaques in In Sickness and In Health

A study recently published in the journal Cancer has suggested that common painkillers such as paracetamol and aspirin might affect blood levels of a marker commonly used to diagnose prostate cancer.In this study, Singer et al. examined levels of prostate specific antigen (PSA) in the bloodstream of 1,319 men aged over 40 years. PSA is a protein produced in the prostate gland. Blood levels of PSA will be minuscule in healthy men, but raised levels often indicate the presence of prostate cancer. If a simple blood test detects serum levels of PSA higher than a specific threshold (4 ng/ml to be exact), your doctor will be booking you in for a digital rectal examination with a prostate cancer specialist faster than you can say "He wants to stick his finger where?!"In addition, study participants were asked how often they took analgesic drugs classed as non-steroidal anti-inflammatory drugs (NSAIDs) - common types being aspirin and ibuprofen - or the drug acetaminophen, which you'll probably be familiar with as paracetamol. NSAIDs and acetaminophen act as painkillers by reducing inflammation. Given that inflammation in the prostate has been implicated in the development of prostate cancer, the authors of this study wanted to find out whether NSAIDs or acetaminophen affected the risk of prostate cancer in men who took these drugs.The results of this study showed that serum levels of PSA in men who took NSAIDs or acetaminophen "nearly every day" were considerably lower than levels in men who did not take either drug. Seeing as this study didn't then follow these men for several years to find out whether there were fewer instances of prostate cancer in the men who took these analgesics than in those who didn't, it is not clear whether this decrease in PSA levels means that the drugs reduce the risk of cancer. In fact, it it possible that NSAIDs and acetaminophen may reduce serum levels of PSA despite suspicious goings on in the prostate and thus cause doctors to miss cases of prostate cancer, which would otherwise be flagged by raised PSA levels.So what are the implications of the study? Should men chew down aspirin every day to prevent prostate cancer, or would they make detection of the malignancy more difficult for their doctor by doing so? Dr Eric Singer, one of the authors of this study, told Reuters news, "If you're a guy who's close to the upper limit of normal [in PSA levels] or would have been over the upper limit and now you're under it because of [these drugs], that could certainly change whether or not you would be referred for a biopsy [to check for a tumor]". He also emphasizes that these findings are preliminary and shouldn't prompt men to change their behaviour.----------------------------------------------------------------------------------------Eric A. Singer, Ganesh S. Palapattu, Edwin van Wijngaarden (2008). Prostate-specific antigen levels in relation to consumption of nonsteroidal anti-inflammatory drugs and acetaminophen Cancer DOI: 10.1002/cncr.23806... Read more »

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