Most recent articles are listed first within a Section (TMT reviews are included back to January, 2006 and are available in archives for earlier years). The Sections below in order are:

Click on the blue title above for any Section to go to that Section.  Clicking on the blue title for an Item within a Section will take you to a new web page with the original article (if this is still available at the original website). To search, do Ctrl+F (hit the "F" key while holding down the "Control" or "Ctrl" key) and type in the search word or phrase (e.g., "heart").

NOTE September 1, 2007: Because of the great success of our pain questionnaires (http://masterdocs.com/pain.htm - over 3,500 responders to date) and the activity of our collaborations with several academic units, we are temporarily suspending regular postings on this medical news web page,

Why we publish our Medical News: We give you the latest medical news without the hype. Our focus is "patient empowerment" -- free medical questionnaires for common symptoms and medical conditions, and unbiased, up-to-date medical news that can be understood by the public as well as physicians. We flag three of the commonest errors in interpreting clinical studies - not prespecifying a primary study endpoint, overinterpreting observational studies, and overinterpreting subgroup analyses. We normally email the first author of an article reviewed for comment and appropriate revision of our review.

 Remember to check out our free Chronic Pain Questionnaires and other Medical Questionnaires.

Latest Entries (Sections in parentheses):

July 26, 2007: Adverse cardiovascular effects with rofecoxib (Vioxx) versus placebo in patients with colorectal cancer (Heart Disease & Stroke).

July 16, 2007: Older oral hypoglycemic (metformin) gives equivalent blood sugar control in Type II diabetes, lowers LDL cholesterol, and does not increase weight (Other Chronic Disease).

July 12, 2007: As implemented, Electronic Health Records were not associated with better quality ambulatory care (Computers in Medicine).

June 29, 2007: Second-hand smoke increases levels of tobacco-specific carcinogens (Other Chronic Disease).

June 11, 2007: Randomized study suggests weight loss is greater with a reduced fat diet if more fruits and vegetables are eaten (Diet & Exercise).

June 5, 2007: Randomized acupuncture trial suggests blood pressure reduction (Heart Disease & Stroke). Out of hospital cooling of patients with cardiac arrest feasible and safe. Larger studies should be done. (Heart Disease & Stroke).

May 21, 2007: Meta-analysis suggests heart hazard with rosiglitazone (Avandia) but manufacturer's data should be released (Heart Disease & Stroke).

May 18, 2007: HPV vaccine could prevent cancer of cervix, vulva, vagina, mouth and throat (Cancer).

May 9, 2007: Senate votes new powers to FDA on drug safety (Administrative&Political).

May 2, 2007: Depressed patients may need both antidepressants and treatment for insomnia (Neurological/Psychological).

April 14, 2007: Active, electronic post-marketing drug safety surveillance system advocated by former FDA Commissioner (Computers in Medicine).

April 4, 2007: Combination of sumatriptan and naproxen useful for acute treatment of migraine (Pain).

March 27, 2007: Increasing HDL cholesterol with torcetrapib did not affect the primary endpoint (percent atheroma volume) in the ILLUSTRATE study (Heart Disease & Stroke).

March 17, 2007: Cardiac-only resuscitation by bystanders may be best for out-of-hospital cardiac arrest (Heart Disease & Stroke).

March 15, 2007: Poor warfarin compliance associated with poor INR control, and more stroke, heart attack, major bleeding, and mortality. Many high risk patients are not prescribed warfarin (Heart Disease & Stroke). Weekend hospital admission for heart attack associated with higher mortality (Heart Disease & Stroke).

March 6, 2007: Randomized study suggests slightly more weight loss with Atkins diet (Diet & Exercise).

March 5, 2007: Ibuprofen best pain killer for kids with acute traumatic musculoskeletal injuries (Pain).

March 3, 2007: Happy countries may have less high blood pressure (Neurological & Psychological).

March 1, 2007: Pain killers including acetaminophen and aspirin associated with higher risk of high blood pressure (Heart Disease & Stroke). Improvement in oral health may reduce cardiovascular risk (Heart Disease & Stroke).

FEBRUARY 2007:  US Government privacy standards for electronic health data in "early stages". TMT privacy standards fully implemented. (Computers in Medicine). Heart disease rate varies from state to state (Heart Disease & Stroke). Controlled study shows low-dose morphine can improve refractory cough (Other Chronic Disease). Weekly motivational counseling improves mood after stroke (Heart Disease & Stroke). Nasal spray better than flu shots for small children (Miscellaneous). New method more accurate for identifying cardiovascular risk in women (Heart Disease & Stroke). High dose atorvastatin (Lipitor) reduces heart failure hospitalizations (Heart Disease & Stroke). Religious people with advanced cancer get inadequate spiritual support and want aggressive measures to extend life (Cancer). Randomized trial suggests that 3 months of psychoanalysis helps patients with panic disorder (Neurological & Psychological). In preliminary study, Down's Syndrome was identified by fetal DNA test on maternal blood (Miscellaneous). Lessen burden of bereavement by spending more time with family members and giving them a bereavement brochure (Neurological & Psychological).

JANUARY 2007:  FDA announces new initiatives to assess safety of marketed drugs (Administrative & Political). ABCD2 score predicts 2-day risk of progression of TIA to stroke (Heart Disease & Stroke). Financial incentives improve hospital performance (Administrative & Political). Observational study suggests that trans fats may increase infertility but additional evaluation is required (Diet & Exercise). In observational study, dense breast tissue increased risk of breast cancer and increased difficulty of diagnosis (Cancer). Cancer deaths are down. Cancer pain is treatable. (Cancer). Arthritis and related conditions cost over $500 per year per American adult (Pain). Black tea with no milk increases ability of arteries to relax, but adding milk prevents this effect (Diet & Exercise). Food industry-funded studies of soft drinks, juice or milk tend to favor the commercial interests of the funder (Diet & Exercise). Drug prices higher in Medicare private plans than in VA system (Administrative & Political). Starbucks removing trans fats from its pastries (Diet & Exercise). Therapy with ACE inhibitors, angiotensin receptor blockers or beta-blockers associated with better outcome following hospital discharge for heart failure (Heart Disease & Stroke). Pergolide (Permax) and cabergoline (Dostinex) associated with heart valve abnormalities in Parkinson's disease patients (Heart Disease & Stroke).

DECEMBER 2006:  Evidence-based procedures reduce catheter-related blood stream infections in ICUs (Miscellaneous). Observational study suggests that proton pump inhibitors increase hip fracture risk (Other Chronic Diseases). Cognitive training helps mental function in the elderly (Neurological & Psychological). Randomized study suggests reduced fat in diet reduces breast cancer recurrence (Cancer). Breast cancer rate dropped 7% in 2003, possibly because of less female hormone therapy (Cancer). Pain gene variants can increase or eliminate pain (Pain). Observational study suggests that surgery or radiation for localized prostate cancer improves survival in elderly men (Cancer). More prolonged antiplatelet therapy recommended by some experts for patients with drug-eluting stents (Heart Disease & Stroke). More on torcetrapib: conflicting studies of relationship between CETP levels and heart disease (Heart Disease & Stroke). Physicians may defer to computer in diagnosis (Computers in Medicine). Some more possible explanations for torcetrapib safety problems (Heart Disease & Stroke). Possible explanations for torcetrapib safety problems (Heart Disease & Stroke). FDA clarifies DSMB monitoring in Pfizer's ILLUMINATE torcetrapib trial (Heart Disease & Stroke). Pfizer halts all torcetrapib trials because of increase in mortality and cardiovascular events (Heart Disease & Stroke).

NOVEMBER 2006:  Moderate alcohol consumption may reduce risk of heart failure by reducing the risk of coronary disease (Heart Disease & Stroke). Most back & sciatica patients who don't require urgent surgery improve with either medical or surgical therapy. You can always get surgery later. (Pain). Identifying serious adverse drug effects: Drug companies, Investigators, Advisory Committees, and the FDA (Administrative & Political). Naproxen increases risk of cardiovascular events in Alzheimer's trial (Heart Disease & Stroke). With resveratrol, mice can run twice as long on a treadmill (Diet & Exercise). Pain relief in fibromyalgia reported with pregabelin (Lyrica) in 6-month double-blind study (Pain). Americans are living longer but have more long-term pain (Pain). Medication blister packs and education improve medication compliance in the elderly by 36%, with lower BP & cholesterol (Miscellaneous). Stable patients after acute phase of heart attack don't need angioplasty and stent (Heart Disease & Stroke). Etoricoxib (Arcoxia) similar to diclofenac in risk of heart attack, stroke & death but causes more high blood pressure and heart failure (Heart Disease & Stroke). Heart attack patients get angioplasty too late (Heart Disease & Stroke). Diet with low carbohydrate and vegetable sources of fat and protein may reduce coronary risk (Diet & Exercise). Warts and all – trial of the tape (Miscellaneous). Primary care in US lags other developed countries in clinical information systems and quality and efficiency incentives (Computers in Medicine). Poor people in wealthy neighborhoods have higher death rate than poor people in poor neighborhoods (Administrative & Political). Open study suggests that one-year of therapy with a heart assist device combined with drug therapy can reverse severe heart failure (Heart Disease & Stroke). Restraining good hand improves movement of affected arm after stroke (Heart Disease & Stroke). Chronic constipation associated with higher mortality (Other Chronic Disease). Physically active people have less macular degeneration (Other Chronic Disease). Higher PSA velocity 10-15 years before prostate cancer diagnosis may be associated with higher prostate cancer mortality (Cancer). Study in mice shows that resveratrol, found in red wine, offsets bad effects of high calorie diet and extends lifespan (Diet & Exercise).

OCTOBER 2006:  Unblinded randomized study suggests acupuncture is effective in patients with osteoarthritis (Pain). Pneumococcal vaccine appears effective with each of various vaccination schedules (Miscellaneous). 80% of US Internet users have searched on-line for health information (Computers in Medicine). Are flu shots as effective as claimed? (Miscellaneous). CT screening detects early lung cancer (Cancer). CDC recommends routine Zostavax shingles vaccine for those 60 and over (Miscellaneous). Observational study associates higher vegetable consumption with better cognitive function in elderly (Neurological & Psychological). Observational study in healthy men shows correlation between alcohol consumption and reduced risk of heart attack (Diet & Exercise). Less than 10% of US doctors use full-fledged electronic health records for outpatients (Computers in Medicine). NIH doctors criticize Eli Lilly's promotion of sepsis drug (Administrative & Political). Noise-cancelling headphones might prevent hearing loss in noisy subway (Miscellaneous). Over 700,000 adverse drug events yearly require treatment in US Emergency Rooms, with over 100,000 hospitalizations. Elderly at higher risk. (Administrative & Political). Mortality in Medicare patients depends on the hospital (Administrative & Political). FDA approves Aricept for severe Alzheimer's Disease (Neurological & Psychological). Does daily weighing help maintain weight loss? (Diet & Exercise). Symptoms suggesting stroke occur in 18% of older people without a stroke diagnosis (Heart Disease & Stroke). Industry-sponsored meta-analyses are of poorer quality and conclusions are more favorable to the experimental drug (Miscellaneous). Get your 'flu shot - it could save your life (Miscellaneous). NIH clinical trial will compare $20-100/month drug with $2000/month drug in macular degeneration (Other Chronic Disease).Smarter breast-feeding mothers mean smarter breast-fed children  (Diet & Exercise).

SEPTEMBER 2006: Bayer did not tell FDA about preliminary safety data from Trasylol observational study (Heart Disease & Stroke). IOM report recommends more funding/staffing/enforcement tools for FDA and more emphasis on safety of marketed drugs (Administrative & Political). Test for H. Pylori before starting NSAIDs in high GI risk patients (Pain). It's OK to eat canned or frozen spinach (Diet & Exercise). Prescribing errors for seniors almost 7 times as likely as with younger patients (Administrative & Political). Meta-analyses confirm Vioxx cardiovascular toxicity but raise other questions (Heart Disease & Stroke). US divided into "Eight Americas" on basis of longevity (Administrative & Political). Difficulty understanding patient pamphlets and prescription labels is common and associated with poor health (Administrative & Political). Don't take ibuprofen less than 8 hours before or less than 30 minutes after aspirin taken for cardioprotection (Heart Disease & Stroke). Report claims Norvasc reduces risk of diabetes (Other Chronic Disease). High dose Lipitor reported to reduce heart attack risk more than medium dose Zocor (Heart Disease & Stroke). Subgroup analysis of TNT trial shows that high risk patients with coronary disease and metabolic syndrome do well on high dose (80mg) Lipitor (Heart Disease & Stroke).

AUGUST 2006: APC and PreSAP double-blind trials show that celecoxib (Celebrex) at dosage of 400 mg/day or greater reduces risk of colorectal adenomas but increases cardiovascular risk (Heart Disease & Stroke). Observational study suggests that NSAIDs may protect against development of prostate cancer only in men with the gene type associated with higher LTA levels (Cancer). Observational study suggests that NSAIDs reduce BPH risk (symptoms, prostate size, urinary flow & PSA) (Other Chronic Disease). FDA Drug/Device Advisory Committees recommend approval in 8 of 10 cases and FDA usually follows the recommendation (Administrative & Political). Could stem cells be harvested from embryos without damaging the developing embryo? (Miscellaneous). Being overweight at age 50 increases risk of death, particularly in women. Waist/hip ratio may be a better measure than BMI (Diet & Exercise). 'ReNu with MoistureLoc" is 13 times as likely to cause fungus infection in contact eye wearers (Miscellaneous). Large observational study in 52 countries shows heart attack risk with all forms of tobacco, including second-hand smoke (Heart Disease & Stroke). Computerized feedback increases short-term weight loss (Diet & Exercise). In randomized trials both COX-2 inhibitors and traditional NSAIDs increase vascular risk (Heart Disease & Stroke). Observational study suggests that aspirin may mitigate the increased cardiovascular risk with NSAIDs (Heart Disease & Stroke). High-dose Lipitor reduces risk of recurrent stroke even in people without known coronary disease (Heart Disease & Stroke). Observational study suggests all NSAIDs (Cox-2-selective and non-Cox-2-selective) modestly increase heart attack risk (Heart Disease & Stroke).

JULY 2006: Faster aging in poor people may be related to shortened telomeres (Miscellaneous). Medication errors injure 1.5 million in US/year. Patients can protect themselves. Electronic prescribing can help. (Miscellaneous). FDA approves once-a-day 3-drug combination tablet for HIV treatment (Miscellaneous). Increased energy expenditure associated with reduced mortality in high-functioning older adults (Diet & Exercise). Gene effects markedly different between males and females (Miscellaneous). Most heart attacks might be prevented by a healthy lifestyle (Heart Disease & Stroke).

JUNE 2006: New England Journal of Medicine issues "correction" on Vioxx APPROVe trial (Heart Disease & Stroke). Observational study suggests mortality risk is increased with short duration NSAID therapy in patients with previous heart attack (Heart Disease & Stroke). Fibromyalgia symptoms respond to acupuncture in controlled trial (Pain). Media stories on medical reports at scientific meetings are misleading (Administrative & Political).

MAY 2006: Dr. Scott Evans of the Harvard School of Public Health, has provided us with a Review of the issue of changing clinical trial endpoints after a trial has begun, an issue posted in our Miscellaneous section on March 26, 2006 (Miscellaneous). Please send any comments to info@masterdocs.com and we will forward them to Dr. Evans. Data from Merck report suggest fairly constant cardiovascular risk (0.2% of patients/6 months) during most of Vioxx therapy and in 1-year following therapy, with higher risk in last 6 months of 3-year Vioxx period (Heart Disease & Stroke). New analysis suggests greater, earlier and more persistent increase in cardiovascular risk with rofecoxib (Vioxx) (Heart Disease & Stroke). Node-positive breast cancer women who have more HER2 receptor activity do better with epirubicin as part of a triple therapy regimen (Cancer). Cardiovascular clinical trials report more positive results if they are industry-funded  (Miscellaneous). 21% of office-based prescriptions are off-label, usually without scientific support. Could compromise patient safety and waste medications. (Miscellaneous). Fusarium eye infections cause worldwide withdrawal of MoistureLoc. Topping up storage case or leaving bottle cap open could increase risk. (Miscellaneous). Academic researchers suggest Merck should continue to follow APPROVe study patients for long-term heart damage from Vioxx (Heart Disease & Stroke). New Merck analysis suggests increased stroke risk with rofecoxib (Vioxx); increased cardiovascular risk may persist to some extent after stopping Vioxx (Heart Disease & Stroke). New Analysis suggests that paroxetine (Paxil) may increase risk of suicide attempts in young adults (Neurological & Psychological). FDA approves varenicline (Chantix) for smoking cessation (Miscellaneous). Despite higher healthcare spending, US lags in use of health information technology (Computers in Medicine). Observational study of breast cancer in post-hysterectomy women supports safety of estrogen therapy for about 10-20 years, but breast cancer risk might increase with longer duration of estrogen therapy (Cancer). Clinical trial design in the post-Vioxx world (Administrative & Political). New prostate cancer gene may cause 8% of prostate cancers in men of European stock and 16% of those in African American men (Cancer). Update on fungus infections of eye in soft contact lens wearers (Miscellaneous). New observational study suggests increased heart attack risk during first 2 weeks of rofecoxib (Vioxx) treatment (Heart Disease & Stroke). Naltrexone (Revia) and combined behavioral intervention are effective in alcohol dependence (Neurological & Psychological). Despite less healthcare expenditure, the English are healthier than Americans (Miscellaneous). CCHIT Certification process issued for Electronic Health Records (Computers in Medicine).

APRIL 2006: JAMA article examines industry financial ties and voting patterns at FDA Advisory Committee meetings (Administrative & Political). A stroke in certain sections of the brain can also damage the heart (Neurological & Psychological). Everyone agrees we need electronic medical records. So why are we not doing it? (Computers in Medicine). Planning for pregnancy - CDC recommendations (Miscellaneous). Treasury Secretary: “The typical doctor’s office has less information technology in it than the corner drug store” (Computers in Medicine). The Challenge of Subgroup Analyses - Reporting without Distorting (Miscellaneous). Compression stockings during air travel reduce leg thrombosis, leg discomfort and swelling (Miscellaneous). Review supports routine use of antibiotics in COPD exacerbations (Other Chronic Disease). Observational study suggests Mediterranean Diet may reduce risk of Alzheimer's disease (Neurological & Psychological). New observational study suggests heart risk with COX-2 NSAIDs (Heart Disease & Stroke). Trans fats associated with coronary heart disease and sudden cardiac death (Diet & Exercise). No increase in breast cancer risk with estrogen alone (Cancer). Chemotherapy most useful in the 30% of women with ER-negative breast cancers (Cancer). Coronary patients should get ACE inhibitors (Heart Disease & Stroke). Brain Training for the Aging Brain (Neurological/Psychological). 2) Prevent Jet Lag using British Airways Jet Lag Advisor (Miscellaneous). Observational study suggests early removal of ovaries may be associated with increased risk of Alzheimer's (Neurological/Psychological). In a small controlled trial, two longevity markers (insulin & temperature) fell with 6-months calorie restriction; larger, longer studies needed to assess aging/longevity (Diet & Exercise). Study shows donepezil (Aricept) improves cognition and activities of daily living in severe Alzheimer's (Neurological/Psychological). High dose Celebrex reduces risk of new colon polyps but increases cardiovascular risk in patients with previous colon polyps (Cancer). Observational study finds less breast cancer with use of COX-2 inhibitors (Cancer)

MARCH 2006: Intercessory prayer did not reduce cardiac complications after bypass surgery; patients who knew they were receiving intercessory prayer had higher complication rate (Heart Disease & Stroke). Bird flu vaccine may protect 55-60% of those people vaccinated. FDA approves flu drug that protects against seasonal flu and bird flu (Miscellaneous). MRI study shows that highly intelligent children have more dynamically changing brains and reach peak thickness of the cerebral cortex at a later age (Neurological/Psychological). Omega 3 fats (found in fish oils and some plants) do not have a clear effect on mortality, heart disease, or cancer (Diet/Exercise). Can clinical trial endpoints be added after the clinical trial begins? (Miscellaneous). Open-label studies suggest that adding or switching antidepressants may help citalopram (Celexa) non-responders (Neurological/Psychological). Stimulants may cause hallucinations in 2-5% of children taking these drugs (Neurological/Psychological). Bird flu virus stays deep in the lungs, preventing human transmission by coughing or sneezing (Miscellaneous). Three full papers for studies already reviewed by TMT (March 14 & 15, 2006) are now available for download at no charge. These studies are: "Very High-Intensity Statin Therapy and Regression of Coronary Atherosclerosis", "Fondaparinux in Patients With Acute Myocardial Infarction" and "Abciximab in Patients With Acute Coronary Syndromes Undergoing PCI After Clopidogrel Pretreatment". Inaccuracies and stigmatizing language are common in neurology coverage by US newspapers (Neurological/Psychological). Seattle Heart Failure model predicts life expectancy and effects of different therapies (Heart Disease/Stroke). Breast asymmetry may be associated with increased risk of breast cancer (Cancer). Two separate H5N1 bird flu strains have evolved, but not yet a strain allowing human-to-human transmission (Miscellaneous). Study suggests that donepezil (Aricept) could be associated with increased death rate (Neurological/Psychological). Maintenance therapy with antidepressant drug helps after drug-assisted recovery from major depression in old age  (Neurological/Psychological). Only 55% of Americans receive quality health care. Use of electronic medical records could improve population-wide quality of care (Administrative/Political). Developmental drug torcetrapib raises HDL cholesterol but also raises blood pressure (Heart Disease & Stroke). Drug-eluting stent better for coronary restenosis of bare-metal stent than radiation (Heart Disease & Stroke). Fondaparinux (Arixtra) may reduce death and repeat heart attack in STEMI heart attacks (Heart Disease & Stroke). Candesartan treatment of pre-hypertension lowers blood pressure, but effect largely disappears on stopping therapy (Heart Disease & Stroke). Adding abciximab to clopidogrel reduces coronary events in acute coronary syndrome (Heart Disease & Stroke). Surgical trial to evaluate effect of closure of patent foramen ovale on migraine headaches (Heart Disease & Stroke). High dose Crestor may cause regression of coronary atherosclerosis (Heart Disease & Stroke). High dosage or frequent use of acetaminophen and non-selective NSAIDs may increase cardiovascular risk (Heart Disease & Stroke). Salt & water blood filter more effective than diuretics in severe heart failure (Heart Disease & Stroke). High dose Lipitor may improve kidney function in coronary disease patients (Other Chronic Disease). No cardiovascular benefit with Vitamin B (folic acid, B6, B12) in two large trials (Heart Disease & Stroke). 2) Adding Plavix to aspirin may increase risk in patients without established heart disease (Heart Disease & Stroke). Three of four older Americans skip colon cancer screening (Cancer). Withdrawn MS drug might return to market (Neurological/Psychological). "Caffeine Gene" may (or may not) indicate increased risk of heart attack (Heart Disease & Stroke). Restraining good arm may give some recovery of affected arm after stroke (Neurological/Psychological). Clinical trial result causes emphysema patients to say "no" to lung surgery (Other Chronic Disease). New publications show multiple sclerosis drug previously withdrawn from market is effective (Neurological/Psychological). New analysis of Celebrex cardiovascular safety adds little (Heart Disease & Stroke).

FEBRUARY 2006: You're never too old to exercise (Diet & Exercise). Before undergoing knee cartilage surgery, make sure the symptoms come from the cartilage damage (Pain). Optimistic people have lower cardiovascular death rates (Neurological/Psychological). Virus found in prostate cancers (Cancer). The GAIT study in osteoarthritis of the knee showed no clear benefit from glucosamine and chondroitin, but Celebrex was effective (Pain). The SUCCESS-I study showed less GI complications with Celebrex than with non-COX-2-selective NSAIDs (Pain). A study in rheumatoid arthritis reported that chronic inflammation is "probably a driving force for premature atherosclerosis" (Pain). Misdiagnosis occurs in 20% of fatal illnesses (Miscellaneous). Only 1/4 of US hospitals have electronic medical records (Computers in Medicine). AMA & Congress agree on new standards of healthcare quality (Administrative/Political). Lack of flu shots in healthcare workers increases patient risk (Miscellaneous). Poverty is associated with poor health & increased mortality (Miscellaneous). In a British study, women consulted their doctor for headache 2.6 times as often as men (Pain). No clear benefit of calcium+vitamin D on risk of fracture or colon cancer in postmenopausal women, but dosage, duration and concomitant therapy may have obscured benefit (Diet & Exercise).  FDA relabeling of whole grain foods may encourage people to take recommended daily amounts of whole grain foods ( 3 slices of bread, 3 cups of breakfast cereal, or 1 1/2 cups of cooked rice or pasta) (Diet & Exercise). For older couples, if one of the partners is hospitalized for a debilitating illness, the non-hospitalized partner is at increased risk for death (Miscellaneous). Over 80% accuracy of prognostic index for 4-year mortality in older adults (Miscellaneous). Many heart attacks go undetected (Heart Disease & Stroke).

1. DIET & EXERCISE

Randomized study suggests weight loss is greater with a reduced fat diet if more fruits and vegetables are eaten

Randomized study suggests slightly more weight loss with Atkins diet

Observational study suggests that trans fats may increase infertility but additional evaluation is required

Black tea with no milk increases ability of arteries to relax, but adding milk prevents this effect

Food industry-funded studies of soft drinks, juice or milk tend to favor the commercial interests of the funder

Starbucks removing trans fats from its pastries

With resveratrol, mice can run twice as long on a treadmill

November 17, 2006: A recent study (see TMT review of November 1 below) reported that resveratrol (RSV) prolonged life span in mice. Now a new study has reported that RSV treated mice can run twice as long on a treadmill, and were protected against diet-induced-obesity and insulin resistance. These effects "were associated with an induction of genes for oxidative phosphorylation and mitochondrial biogenesis and were largely explained by an RSV-mediated decrease in PGC-1α acetylation and an increase in PGC-1α activity. this mechanism is consistent with RSV being a known activator of the protein deacetylase, SIRT1...".

Diet with low carbohydrate and vegetable sources of fat and protein may reduce coronary risk

November 8, 2006: A 20-year observational study in over 80,000 women in the Nurses' Health Study suggests that a low carbohydrate diet in which fat and protein come from vegetables is associated with a 30% reduction in adjusted risk of coronary heart disease. Observational studies cannot establish causality but can suggest the need for further study.

Study in mice shows that resveratrol, found in red wine, offsets bad effects of high calorie diet and extends lifespan

November 1, 2006: Resveratrol, a natural, small-molecule substance found in red wine, is known to extend lifespan in several non-mammalian species. A new study published in Nature confirms this finding in middle-aged mammals (mice) exposed to a high-calorie diet. Compared with a control group, mice receiving resveratrol lived longer and offset the adverse effects on blood glucose, insulin and the liver that occurred in the mice not receiving resveratrol. The National Institute of Aging's Dr. Richard Hodes advised people to wait for the results of safety testing of the high doses of resveratrol used in the mouse study. Dr. Ronald Kahn, president of the Joslin Diabetes Center in Boston, advised "Have another glass of pinot noir — that's as far as I'd take it right now."

Observational study in healthy men shows correlation between alcohol consumption and reduced risk of heart attack

October 24, 2006: In an observational study, a cohort of almost 9,000 men free of major illness and with favorable lifestyles for cardiovascular health were followed for 16 years. Compared with men who abstained from alcohol, a lower risk of heart attack was seen in those who took alcohol: 2%, 41%, 62% and 14% with alcohol consumption of 0.1 to 4.9 g/d, 5.0 to 14.9 g/d, 15.0 to 29.9 g/d (about 2 drinks a day), and 30.0 g/d or more, respectively. The authors conclude "Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk" for heart attack. Observational studies cannot establish causality but can suggest the need for further study.

Does daily weighing help maintain weight loss?

October 12, 2006: A paper in the New England Journal of Medicine examined various ways of maintaining weight loss in a group of people who had lost at least 10% of body weight through dieting. Participants were randomly assigned to a control group (105 people who received quarterly newsletters), face-to-face intervention (105 who regularly met with study staff and received a scale for daily weight measurement) and Internet-based intervention (104 who received a laptop computer and a scale for daily weight measurement). The face-to-face group did significantly (p=0.05) better in maintaining weight loss than the control group, whereas the Internet group was similar to controls. The authors performed a subgroup analysis comparing those with and without daily self-weighing; daily self-weighing was associated with significantly less risk of regaining 2.3 kg or more. The abstract concluded that "a self-regulation program based on daily weighing improved maintenance of weight loss". However, in the body of the text, the authors commented that "frequent self-weighing could be either a cause or a consequence of weight-loss maintenance". In addition, and perhaps more importantly, since patients were not randomized to daily weighing or no daily weighing, and baseline variables were not examined to show comparability of the daily weighing and no-daily weighing groups, it cannot be concluded from these data that daily weighing helps to maintain weight loss. However, daily weighing is intuitively appealing and may be worth evaluating in a properly controlled study.

Smarter breast-feeding mothers mean smarter breast-fed children

October 4, 2006: Scottish researchers analyzed a US observational study and concluded that, after adjusting for confounding factors, increased intelligence in breast-fed children may be largely related to increased intelligence in the breast-feeding mothers. The authors conclude “Breast feeding has little or no effect on intelligence in children. While breast feeding has many advantages for the child and mother, enhancement of the child's intelligence is unlikely to be among them.” The three authors were male and did not mention the potential impact of the intelligence of the fathers. Observational studies cannot establish causal relationships, although they can suggest the need for further study.

It's OK to eat canned or frozen spinach

September 25, 2006: As of September 24, 173 cases of people with E. Coli infection from spinach have been reported to FDA. Infected spinach has come from three coastal California counties (Monterey, San Benito, Santa Clara). FDA says that fresh spinach known to be grown outside the implicated counties, as well as canned and frozen spinach, is safe to eat. E. coli O157:H7 causes diarrhea, often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called HUS (hemolytic uremic syndrome). HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death. [Added Note: October 8 - FDA has now cleared the eating of fresh spinach.]

Being overweight at age 50 increases risk of death, particularly in women. Waist/hip ratio may be a better measure than BMI.

August 23, 2006: Over half a million US adults 50-71 years old were enrolled in a prospective study to evaluate self-reported Body Mass Index (BMI). In healthy people who had never smoked moderate increase in BMI (25.0-29.9 - “overweight”) was associated with an increase in the risk of death during up to 10 years follow-up, particularly if present at age 50 (20-40% increase in death risk). However, risk increased in women at the lower levels in the “overweight” range whereas increase in risk in men occurred at higher levels in the “overweight” range. In a second study published in the same issue of the New England Journal of Medicine (Korean BMI Study), the association between BMI and risk of death was examined in a 12-year prospective study of over 1 million Koreans aged 30-95. Risk of death and risk of atherosclerotic death was increased with higher BMI. Risk of respiratory death was higher with lower BMI. The impact of BMI on risk was less with higher age. However a recent study (Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death), as well as a number of previous studies, has shown that the waist/hip ratio may be more useful than BMI in predicting increased mortality; in this study in elderly patients (>75 years) increase in waist/hip ratio but not increase in BMI or waist size was associated with increased total and cardiovascular mortality.

Computerized feedback increases short-term weight loss

August 15, 2006: A randomized study compared weight loss using three Internet treatments in 182 overweight adults (mean BMI 32.7). All subjects had one weight loss group session, coupons for meal replacements and access to an interactive website. The human e-mail counseling and computer-automated feedback groups also had access to an electronic diary and message board. The human e-mail counseling group received weekly email feedback from a counselor, and the computer-automated feedback group received automated, tailored messages. At 3 months, weight loss with computer-automated feedback (-5.3 kg) and human email counseling (-6.1 kg) was comparable and significantly greater than with no counseling (-2.8 kg). However, at 6 months weight loss was significantly greater with human email counseling (-7.3 kg) than with computer-automated feedback (-4.9 kg) or no counseling (-2.6 kg). The authors state "Further research is needed to improve the efficacy of automated computer-tailored feedback as a population-based weight loss approach."

Increased energy expenditure associated with reduced mortality in high-functioning older adults

July 12, 2006: In an observational study in 302 high-functioning, community-dwelling older adults (70-82 years) followed for 6 years, objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality. After adjusting for various confounders, the "hazard ratio" for mortality was 0.31 for the most active third versus the least active third (12% vs. 25% mortality). According to self-reports, more active subjects were more likely to work for pay (P = .004) and climb stairs (P = .01) but self-reported high-intensity exercise, walking for exercise, walking other than for exercise, volunteering, and caregiving did not differ significantly. A major strength of this study was recruitment of high-functioning, community-dwelling individuals and the objective measurement of total energy expenditure, but a weakness is the lack of objective measurement of the relationship of peak intensity of exercise to mortality. Observational studies cannot establish causal relationships, but can suggest the need for further study.

Trans fats associated with coronary heart disease and sudden cardiac death

April 14, 2006: A New England Journal of Medicine review and meta-analysis of four prospective cohort studies with nearly 140,000 subjects showed that trans fats were associated with an increased risk of coronary heart disease (CHD; 23%), and sudden cardiac death (47%). The authors believe that long-term controlled trans fat trials would be unethical and that a "reasonable approach" is to combine short-term controlled studies of intermediate endpoints with "carefully performed observational studies". The authors write “Trans fats, unsaturated fatty acids with at least one double bond in the trans configuration, are formed during the partial hydrogenation of vegetable oils, a process that converts vegetable oils into semisolid fats .... From the perspective of the food industry, partially hydrogenated vegetable oils are attractive because of their long shelf life, their stability during deep-frying, and their semisolidity, which can be customized to enhance the palatability of baked goods and sweets…. Major sources of trans fats are deep-fried fast foods, bakery products, packaged snack foods, margarines, and crackers”. The authors conclude “Thus, given the 1.2 million annual myocardial infarctions and deaths from CHD in the United States, near-elimination of industrially produced trans fats might avert between 72,000 (6 percent) and 228,000 (19 percent) CHD events each year.”

In a small controlled trial, 2 longevity markers (insulin & temperature) fell with 6-months calorie restriction; larger, longer studies needed to assess aging/longevity

April 5, 2006: Prolonged calorie restriction increases life span in rodents and in previous uncontrolled studies in humans has been associated with significant decreases in cardiovascular risk factors, blood pressure, inflammatory markers, and fasting insulin and glucose levels. The CALEIRE 6-month randomized controlled trial in 48 healthy, sedentary, "overweight" (but not "obese") adults compared 4 groups: 1) control (weight maintenance diet); 2) calorie restriction (25% calorie restriction of baseline energy requirements); 3) calorie restriction with exercise (12.5% calorie restriction plus 12.5% increase in energy expenditure by structured exercise); 4) very low-calorie diet (890 kcal/d until 15% weight reduction, followed by a weight maintenance diet). Weight loss from baseline was 1%, 10%, 10% and 14% for groups 1, 2, 3 & 4 respectively. Compared with baseline, fasting insulin levels and DNA damage fell in the intervention groups 2, 3 & 4, but DNA damage was not significantly reduced compared with controls (group 1). Compared with baseline, core body temperature was reduced in groups 2 & 3 but not in groups 1 & 4. Compared with controls, metabolic adaptation (decrease in energy expenditure more than predicted by loss of metabolic mass) was significantly more common (p<0.05) in the intervention groups. The other primary outcome measures (DHEAS, glucose, protein carbonyls) showed no significant changes, perhaps because the study was of only 6 months duration. The authors conclude that calorie restriction reduces metabolic rate more than would be expected from the "reduced metabolic body mass" but that studies "of longer duration are required to determine if calorie restriction attenuates the aging process in humans".

Omega 3 fats (found in fish oils and some plants) do not have a clear effect on mortality, heart disease, or cancer

March 27, 2006: A review of 48 controlled clinical trials (37,000 participants) and 41 cohort observational studies showed no clear reduction in total mortality, combined cardiovascular events, or cancer from consumption of long chain and shorter chain omega 3 fats [found in fish oils (especially mackerel, lake trout, herring, sardines, albacore tuna and salmon), and some plants (such as soybeans, canola and flaxseed)]. There was a slight beneficial trend for overall mortality (13% reduction - relative risk 0.87, 95% confidence interval 0.73 to 1.03), with evidence of benefit being stronger in people with established heart disease. To determine effects in people without established heart disease, larger primary prevention studies would be needed.

You're never too old to exercise

February 28, 2006: A study in the February issue of The Journal of Aging and Health says that people are never too old to gain health benefits from exercise. An elderly group of 64 volunteers were divided into three groups: 1) exercise by walking twice a week. 2) resistance training twice a week. 3) control group who did no exercise.  The age range was 66-96 years (average age 84) and three-quarters were women. All volunteers could take care of daily tasks on their own. Some of the exercisers used canes or walkers during their exercise sessions. After 16 weeks, the exercise groups had lower systolic blood pressure, improved upper and lower body strength, improved hip and shoulder flexibility and improvements in tests of agility, balance and coordination when compared with the no-exercise group. Beneficial effects were similar in the walking and resistance exercise groups.

FDA will require better labeling of whole grains

February 16, 2006: FDA says that anything labeled as containing whole grains must contain a comparable amount of the fibrous, protein-dense and nutrient-rich portions of grains — the endosperm, germ and bran — in the same proportion normally present in the intact grain. Whole grains include barley, buckwheat, bulgur, corn, millet, rice, rye, oats, sorghum, wheat and wild rice. The FDA suggests that people eat at least 3 ounces of whole-grain cereals, breads, crackers, rice or pasta every day. One ounce is about a slice of bread, a cup of breakfast cereal, or a half cup of cooked rice or pasta.

Calcium/Vitamin D Supplement does not reduce Risk of Hip Fracture or Colon Cancer in Postmenopausal Women

February 16, 2006: As part of the WHI study, over 36,000 postmenopausal women were randomized to placebo or daily calcium + vitamin D supplementation for an average of 7 years.  There was no significant difference between the randomized groups in the frequency of hip fracture or colorectal cancer, but there was a significantly increased risk of kidney stone in the calcium+vitamin D group. However, subjects in both groups were allowed to use additional calcium, vitamin D, bisphosphonates, calcitonin and hormone therapy - which may have obscured any potential benefit. Overall, the yearly rate of hip fracture was 0.14% in the active treatment group versus 0.16% in the placebo group (a 12% reduction that was not statistically significant). However, subset analyses (which should be interpreted cautiously) showed that women who consistently took the full supplement dose had a 29% reduction in hip fracture, and in women 60 years or older there was a 21% decrease in hip fracture risk. There was also a very small (but statistically significant) overall increase in hip bone density. There was no reduction in colorectal cancer although the calcium/vitamin D dosage and 7-year duration of the study may have been insufficient to detect a benefit.

Study Finds Low-Fat Diet Won't Stop Cancer or Heart Disease

February 7, 2006: A low-fat diet did not prevent cancer or heart disease in a $415 million NIH WHI study of nearly 49,000 women aged 50 to 79 randomly assigned to a low-fat or normal diet and followed for eight years. The results were reported in the Feb. 8 issue of JAMA and showed that the women assigned to the low-fat diet did eat significantly less fat (about 25% versus about 35% of calories as fat), but they had no statistically significant differences in rates of breast cancer, colon cancer, heart disease or diabetes, and showed little or no effect on body weight, insulin or glucose blood levels. For heart disease risk factors, only LDL cholesterol was lower with the low-fat diet but this effect was small. The breast cancer data showed a 9% non-statistically-significant reduction in risk with the low fat diet and the study women will continue to be followed, and the possibility of beneficial effects in certain subgroups will be examined. This study was designed 2 decades ago and does not reflect current thinking on the possible benefits of the Mediterranean diet or exercise - life style modifications that have not yet been tested in a large randomized clinical trial. These disappointing results are similar to those shown with dietary fiber, vitamin therapy and hormone replacement therapy in which non-randomized observational studies suggested benefit, but in which subsequent randomized studies showed no benefit.

Fruits & Vegetables May Reduce Stroke Risk

January 27, 2006: Five or more daily servings of fruits and vegetables were associated with a  26% reduction in stroke risk compared with less than 3 servings daily in a meta-analysis of 8 observational studies including over 250,000 adults with average follow-up of 13 years. The risk reduction applied to both hemorrhagic and ischemic strokes. Although the results of observational studies should be regarded with some caution, these latest results certainly support many other studies (as well as your mother's admonitions to eat your vegetables).

2. PAIN

Combination of sumatriptan and naproxen useful for acute treatment of migraine

April 4, 2007: A fixed dose tablet containing sumatriptan (85mg) and naproxen (500mg) was more effective than placebo and than either agent alone for acute treatment of a moderate or severe migraine attack. 

Ibuprofen best pain killer for kids with acute traumatic musculoskeletal injuries

March 5, 2007: In a double blind study in 336 children 6-17 years old with musculoskeletal injury (to extremities, neck, and back) in the last 48 hours, ibuprofen (10 mg/kg) was better than acetaminophen (15 mg/kg) and codeine (1 mg/kg) in pain relief. 

Arthritis and related conditions cost over $500 per year per American adult

January 11, 2007: The US Government Center for Disease Control and Prevention (CDC) says that arthritis and other rheumatic conditions (46 million people) cost $128 billion in 2003, i.e., $538 per American 15 years or older. Direct costs were $81 billion, with $47 billion for indirect costs such as lost wages. The 2003 figure is an increase of almost 60% in six years and is attributed by CDC to more Americans being overweight and to the aging of the population. The government recommends lowering costs with self-management programs to teach patients how to manage their pain and continue working despite the pain. Note: Over 2,000 people with chronic pain have used TMT's chronic pain questionnaires to help them understand their pain (http://masterdocs.com/pain.htm). 

Pain gene variants can increase or eliminate pain

December 14, 2006: Variants of the SCN9A gene can cause pain hypersensitivity or total elimination of the sensation of pain. Pain signals are carried to the brain through nerve impulses generated by a SCN9A-coded voltage-gated sodium channel. Because all pain fibers depend on the SCN9A gene’s protein for amplification, all signals of pain are assumed to be muted when the gene is inactive. This finding may provide a new therapeutic target for drug development. 

Most back & sciatica patients who don't require urgent surgery improve with either medical or surgical therapy. You can always get surgery later.

November 22, 2006: JAMA today published the two SPORT trials (randomized and observational) and two editorials comparing surgical (open diskectomy) and non-surgical (standard medical care) treatment of patients with a herniated intervertebral disk and sciatica for at least 6 weeks but without evidence of an urgent need for surgery such as loss of bowel or bladder control. Medical and surgical patients improved at about the same rate with a slight but unconvincing trend in favor of surgery. There was no evidence that delaying surgery increased the risk of serious complications. Neither trial gave adequate reason for saying either that the treatments were equivalent in effectiveness or for saying that one or other was better. One trial was randomized but 30% of medical patients actually received surgery in the first 3 months of the study. The non-randomized study (patients from the same clinics who declined randomization) showed an advantage for surgery by patient self-assessment of outcome but observational studies such as this cannot establish causality and require confirmation in a randomized trial of adequate size, design and execution. It is reasonable for patients with a herniated disk with sciatica but without urgent indications for surgery to select medical or surgical therapy on the basis of personal preference and level of pain; they can always decide to have surgery later if they don’t improve. A TMT associate has suggested that any superiority of surgery might not be because of the surgery itself but because it is socially and medically acceptable to have a period of bed rest and enforced inactivity following such surgery. 

Pain relief in fibromyalgia reported with pregabelin (Lyrica) in 6-month double-blind study

November 17, 2006: Previous short-term studies with pregabelin (Lyrica) have reported pain relief in patients with fibromyalgia, a poorly understood condition that affects 2-4% of the population. In a new 6-month double-blind trial, Lyrica relieved fibromyalgia pain significantly more than placebo. This trial used a placebo-withdrawal design in which responders (at least 50% improvement in pain score) after 6 weeks of open-label Lyrica treatment (663 of 1051 patients, 63%) were assigned to continue Lyrica or to be switched to placebo. By the end of the 6-month trial, 68% of Lyrica patients had maintained their pain response versus only 39% of placebo patients. Although these findings are encouraging, a definitive assessment of this study must await full publication of the results.

Americans are living longer but have more long-term pain

November 15, 2006: The annual report for the US Government Centers for Disease Control and Prevention (CDC) says that chronic pain is common in US adults: 1) One in 10 have pain that lasts a year or more, 2) One quarter had a day-long bout of pain in the past month, 3) More than a quarter had low back pain in the past three months. 4) Fifteen per cent had migraines or severe headaches in the past three months, and 5) Almost one in twenty used a narcotic drug in the past month for pain relief. Americans are living longer, with life span at a record average of almost 80 years. At birth, life expectancy for females is just over 80 years and nearly 75 for males. The gap in life expectancy between white and black Americans also has narrowed from seven years in 1990 to five years in 2004.

Unblinded randomized study suggests acupuncture is effective in patients with osteoarthritis

October 31, 2006: In a study in over 700 patients with osteoarthritis, patients were randomly assigned to acupuncture or to a control group. Over a 6-month period, acupuncture patients improved significantly more than control patients. Neither patients nor physicians were blinded to treatment group allocation, so that bias may explain the differences between treatment groups. However, previous evaluation using sham acupuncture has supported the efficacy of acupuncture for the treatment of arthritis (see the June 19, 2006 TMT review below).

Test for H. Pylori Before Starting NSAIDs in High GI Risk Patients

September 25, 2006: The American Gastroenterology Association recommends evaluation of both gastrointestinal and cardiovascular risks when considering NSAID therapy. This should include a routine test for Helicobacter pylori (H. Pylori) infection for all such patients at high risk of GI complications. Short-term studies have shown that eradicating H. Pylori infection before starting an NSAID reduces the risk of peptic ulcers from the NSAID.

Fibromyalgia symptoms respond to acupuncture in controlled trial 

June 19, 2006: A 50-patient clinical trial from the Mayo Clinic suggests that acupuncture may ease pain, fatigue and anxiety in patient with fibromyalgia. Patients were randomly assigned to acupuncture or (in a technically interesting approach) to simulated acupuncture in which subjects were unaware whether the needle merely pricked the skin or was inserted into the muscle beneath the skin. The acupuncture group improved significantly compared to the simulated acupuncture group, as determined by serial measurements of the Fibromyalgia Impact Questionnaire (FIQ) and the Multidimensional Pain Inventory (MPI). Effects were maximal at 1 month and were somewhat attenuated by 7 months. The level of clinical benefit seen was similar to that seen with drug interventions.

Before undergoing knee cartilage surgery, make sure the symptoms come from the cartilage damage  

February 28, 2006: According to the Boston Osteoarthritis Knee Study, patients with osteoarthritis of the knee commonly have damaged cartilage (medial meniscus in 86% and lateral meniscus in 63%).  However, the lead author of the study stated that while meniscectomies are often performed to relieve pain, "all efforts should be made not to go in and remove the menisci unless they are likely to be the cause of arthritis symptoms." A previous study found that tears of the menisci, common in osteoarthritis of the knee, are often incidental findings that don’t cause symptoms. Non-surgical methods to manage osteoarthritis pain include exercise and weight loss, knee braces, motion control shoes, and analgesics and anti-inflammatory drugs. (Hunter DJ et al., Arthritis & Rheumatism. 2006; 54(3):795-801).

Celebrex effective in knee osteoarthritis. Glucosamine & chondroitin did not show clear improvement. 

February 23, 2006: The GAIT study was a 1583-patient, 24-week, double-blind study in patients with painful osteoarthritis of the knee and compared 1) glucosamine (1500 mg/day), 2) chondroitin (1200 mg/day), 3) glucosamine + chondroitin, 4) celecoxib (200 mg/day), and 5) placebo. The results for the primary efficacy measure (20 percent decrease in knee pain from baseline to week 24) showed no significant improvement versus placebo for glucosamine or chondroitin (alone or in combination), although an exploratory analysis of patients with more severe pain suggested some improvement. In the celecoxib (Celebrex) patient group, there was a statistically significant (P=0.008) increase in the primary efficacy measure (70.1% response versus 60.1% for placebo). The study was not large enough or long enough for definitive evaluation of cardiovascular safety. There were three serious adverse events judged by the investigator to be related to study treatment - one patient on combined glucosamine and chondroitin had congestive heart failure; one patient on glucosamine had chest pain; and one patient on celecoxib had a stroke. A review of all adverse events requested by the data and safety monitoring board did not suggest that celecoxib increased ischemic cardiovascular events. Most adverse events were mild, infrequent, and evenly distributed among the groups.

Fewer upper gastrointestinal complications with Celebrex than NSAIDs 

February 23, 2006: The SUCCESS-I osteoarthritis trial (March 2006 issue of American Journal of Medicine) was a 13,274 patient, double-blind, 12-week comparison of twice daily dosing with celecoxib (Celebrex 200 mg or 400 mg/day), and non-COX-2-selective NSAIDs (diclofenac 100 mg/day or naproxen 1,000 mg/day). The treatments were equally effective in treating osteoarthritis. Celebrex was associated with significantly fewer serious upper gastrointestinal events than NSAIDs. The study was not designed to look at cardiovascular safety, was not large enough to answer this question definitively, and did not provide clear definitions of cardiovascular endpoints (e.g., heart attack). Although heart failure was 4.5 times as common in the non-selective NSAID group (P=.01), this finding should be interpreted cautiously and would need to be confirmed in a further prospective clinical trial. Additional analysis comparing the effects of the high (400 mg/day) and moderate (200 mg/day) doses of Celebrex would be useful.

Inflammation may be "driving force" for atherosclerosis 

February 23, 2006: Rheumatoid arthritis (RA) patients had a threefold increase in preclinical carotid atherosclerotic plaque, independent of traditional risk factors, according to a matched cross-sectional study. The researchers recommend rigorous control of rheumatoid disease activity because chronic inflammation is "probably a driving force for premature atherosclerosis." This report supports previous work showing that chronic pain conditions associated with inflammation are associated with increased cardiovascular risk and increased mortality. This work does not establish that the inflammation causes cardiovascular disease. Additional research is required to determine if effective drug treatment of inflammation associated with chronic pain might reduce cardiac risk and mortality.

Headache more common in women 

February 18, 2006: In a British general practice study, women consulted their doctor for headache 2.6 times as often as men. Consultation rates were highest in the 15 to 24 year age group and declined with age. In one third of the consultations, drug treatment for migraine was prescribed.

Heat Therapy Proves Effective for Acute Lower Back Pain 

January 27, 2006: A Johns Hopkins study suggests that continuous low-level heat wrap therapy is an effective adjunct or alternative to painkillers in treatment of acute lower back pain (Journal of Occupational and Environmental Medicine, December 2005). In a randomized study of 43 patients, those wearing the wrap (worn under the clothes and uses a chemical reaction to deliver low-level topical heat) improved by nearly two points from baseline on a 10-point pain-intensity scale, compared with less than one point of improvement in the standard care group (P=0.0029).The heat-therapy group also rated their pain relief as "more than half better" on average at day one, compared with an average assessment of "less than half better" for the standard care group (P=0.0027). The benefits of heat therapy were maintained through two weeks of follow-up. The heat-therapy group also had significantly greater improvements in mobility. The ThermaCare HeatWrap, manufactured by Proctor & Gamble, is an FDA-approved class I medical device and can be purchased without a prescription.

3. CANCER

HPV vaccine could prevent cancer of cervix, vulva, vagina, mouth and throat.

May 18, 2007: The vaccine against the human papillomavirus (HPV) is believed to reduce the risk of cancer of the cervix (http://content.nejm.org/cgi/content/abstract/356/19/1915). Mandatory HPV vaccination of girls has been suggested but is controversial (http://content.nejm.org/cgi/content/full/356/19/1905). Recent controlled trials indicate that the HPV virus may also be implicated in oropharyngeal cancer (cancer of the mouth and throat in which HPV virus may be transmitted by oral sex; http://content.nejm.org/cgi/content/abstract/356/19/1944) and in cancer of the vulva and vagina (http://www.thelancet.com/journals/lancet/article/PIIS0140673607607776/abstract).
 

Religious people with advanced cancer get inadequate spiritual support and want aggressive measures to extend life

February 9, 2007: The “Coping with Cancer” federally-funded study examined religiousness among cancer patients and its associations with end-of-life treatment preferences and quality of life. The authors stated: “Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57).” They concluded that “Many advanced cancer patients’ spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life.”

In observational study, dense breast tissue increased risk of breast cancer and increased difficulty of diagnosis

January 18, 2007:  In an observational study, women with breasts with higher "mammographic density" (more epithelium/stroma and less fat) had a higher rate of breast cancer. As compared with women with density in less than 10% of the mammogram, women with density in 75% or more had an almost 5 times increase in risk. Fat is radiographically lucent and appears dark on a mammogram. In contrast, breast epithelium (layers of cells derived from membranous tissue covering internal surfaces) and stroma (connective tissue providing a support framework) are radiographically dense and look light, an appearance referred to as "mammographic density". Cancer in breasts with higher mammographic density was also more difficult to detect. The authors conclude "Extensive mammographic density is strongly associated with the risk of breast cancer detected by screening or between screening tests. A substantial fraction of breast cancers can be attributed to this risk factor". Observational studies cannot establish causality but can suggest the need for additional study.

Cancer deaths are down. Cancer pain is treatable.

January 17, 2007: Fewer people died of cancer in 2004 than in 2003, the second consecutive year cancer deaths declined in the United States. Rates declined for most major cancers. Breast cancer death rates have been dropping steadily since 1990, attributed by the American Cancer Society (ACS) to earlier detection and better treatments. Both incidence and death rates have dropped for colorectal cancer in recent years. Lung cancer remains the top cancer killer among both men and women; rates among women have flattened in recent years, but fewer men are getting lung cancer or dying from it. African-Americans are still much more likely than any other group to develop cancer and die from it. Hispanics, Asian Americans, and Pacific Islanders have lower rates of most cancers than whites, but tend to have higher rates of cancers that may be linked to infections, such as cervical cancer and liver cancer. About 30% of cancer deaths in the US are caused by smoking. Another third are linked to nutrition and physical activity. ACS recommends keeping weight in a healthy range, getting plenty of exercise, and eating a healthy diet with lots of fruits and vegetables to reduce cancer risk. The ACS has a special section in this year's Facts & Figures focusing on cancer pain and how to treat it; cancer survivors and doctors should discuss pain at every visit, and treat it promptly. [Note: TMT has an ongoing collaboration with the MD Anderson Cancer Center evaluating bone pain in patients with bony metastases.]

Randomized study suggests reduced fat in diet reduces breast cancer recurrence

December 18, 2006: An interim analysis of data from the 2,437 subjects in the Women's Intervention Nutrition Study (WINS) found that after 5 years women with previous breast cancer who were randomized to a low fat diet (compared with those randomized to a normal diet) consumed about 20 grams less fat, weighed about 6 pounds less, and had a 24% lower risk of recurrence (9.8% versus 12.4%). A reduced fat diet is known to reduce estrogen levels and the reduction in relative risk was greater for estrogen-negative cancer (42%) than for estrogen-positive cancer (15%). Although there were possible imbalances in treatment between the two groups, randomized studies like WINS provide more persuasive evidence than can be obtained from an observational study.

Breast cancer rate dropped 7% in 2003, possibly because of less female hormone therapy

December 14, 2006: In 2003, the US breast cancer rate dropped 7%, the largest-ever recorded yearly drop. Rates have risen most years since 1945. The drop could be related to slowing, stopping or reversal of the growth of small cancers because of sudden discontinuation of female hormone therapy (~50% drop in the number of hormone users in 1 year) by millions of women following the July 2002 publication of the 26% increase in risk of breast cancer associated with hormone therapy in the WHI trial. In California, where hormone therapy had been highest, the drop was larger than in other states. The drop in estrogen-positive breast cancers (the 70% of breast cancers that are fueled by female hormones) dropped twice as much as estrogen-negative breast cancer. Women 50-69 years old (those most likely to take hormones) had a drop 3 times greater than other age groups. Yearly breast cancer rates dropped 2.5% from 2001 to 2002 and dropped 7% from 2002 to 2003 (6% in the first half of 2003 and 9% in the second half). Until 2002 about one third of American women over 50 took hormones. Other explanations for the drop are possible. Observational studies cannot establish causality but can suggest the need for further study.

Observational study suggests that surgery or radiation for localized prostate cancer improves survival in elderly men

December 12, 2006: Over 44,000 men 65-80 years old with localized and well/moderately well differentiated prostate cancer who had survived for 1 year after diagnosis were followed for up to 12 years. Mortality was 37% in the observational group and 24% in the treatment group (those who received radical prostatectomy or radiation); adjusted analysis showed a statistically significant advantage for the treatment group. Observational studies cannot establish causality but can suggest the need for further study. The authors state that “these results must be validated in randomized controlled trials of alternative management strategies in elderly men with localized prostate cancer”.

Higher PSA velocity 10-15 years before prostate cancer diagnosis may be associated with higher prostate cancer mortality

October 26, 2006: An observational study in the Journal of the National Cancer Institute suggests that the rate at which serum PSA levels change (PSA velocity) may be an indicator of the risk of prostate cancer death 25 years later. However, an accompanying Editorial suggests that definite conclusions on this issue should await completion of large randomized trials that are ongoing. Observational studies cannot establish causality but can suggest the need for further study.

CT screening detects early lung cancer

October 26, 2006: Lung cancer was detected in 1.5% of over 30,000 people at risk of lung cancer who were screened by CT. The cancer was judged to be early (Stage I) in 1.3%. The authors "estimated" 10-year survival rates at 88% for all Stage I cancer patients, and 92% for the 73% of Stage I cancer patients who had surgical resection of the cancer within one month of diagnosis. Although these results are encouraging, without a control group it is not possible to determine if survival in the screening group was improved by the early detection of the lung cancer.

Observational study suggests that NSAIDs may protect against development of prostate cancer only in men with the gene type associated with higher LTA levels

August 30, 2006: An observational (case-control) study suggests that a protective effect of NSAIDs against the development of prostate cancer may be confined to those with a particular inflammatory response gene type (the LTA +80CC genotype). Aspirin or ibuprofen reduced risk of prostate cancer by 33% overall. However, this beneficial effect appeared to be confined to men with the LTA + 80CC genotype (which is associated with increased production of lymphotoxin alpha) in whom a significant 57% reduction was seen (compared to men without this genetic variant in whom no significant reduction in risk was seen with NSAIDs). Observational studies cannot establish causality but can suggest the need for further study.

Node-positive breast cancer women who have more HER2 receptor activity do better with epirubicin as part of a triple therapy regimen

May 18, 2006: An article in the New England Journal of Medicine describes a prespecified subgroup multivariate analysis of the Mammary.5 controlled trial in women with node-positive breast cancer and concludes “Amplification of HER2 in breast-cancer cells is associated with clinical responsiveness to anthracycline-containing chemotherapy.” Amplification of the human epidermal growth factor receptor type 2 (HER2) means an increased response of breast cancer cells to this growth factor. The 710 women in the trial were followed for an average of 10 years; 363 had a recurrence and 284 died. Women who had HER2 amplification (about one-quarter of the women) had a greater risk of relapse and death respectively of 24% and 53% compared to non-HER2 amplification women. However, if the Pfizer drug epirubicin [Ellence] rather than methotrexate was given as part of a triple drug therapy regimen to the HER2 amplification women, prognosis was improved: 48% (p=0.003) better for relapse-free survival, and 35% (p=0.06) better for overall survival; the adjusted hazard ratio for the “interaction between treatment and amplification status” was 1.96 (p=0.01) for relapse-free survival and 2.04 (P=0.02) for overall survival. No clear advantage was seen for epirubicin in the non-HER2 amplification group. The authors conclude that the increase in benefit attributable to the triple therapy regimen with epirubicin "is confined almost completely to women whose tumors exhibit amplification or overexpression of HER2” and they recommend that women with non-HER2 amplified breast cancer should receive the “less toxic regimen” containing methotrexate. An accompanying Editorial expresses a few caveats about this study (women were premenopausal, topoisomerase IIa may be a better molecular predictor than HER2, trastuzumab [Herceptin] may prove superior to chemotherapy) but concludes “The time has come to divide breast cancer into clinically relevant molecular subgroups, to prioritize the clinical questions applicable to each subgroup, and to strengthen collaboration between clinicians and laboratory scientists in identifying molecular signatures that can predict the success or failure of treatment.”

Observational study of breast cancer in post-hysterectomy women supports safety of estrogen therapy for up to 15 years, but breast cancer risk might increase with longer duration of estrogen therapy 

May 9, 2006:  In an observational study, post-hysterectomy women in the Nurses Health Study were divided into six pre-specified 5-year groups depending on t