New Eng J Med Vol 354
557 Saw palmetto is used by millions of men to relieve the symptoms of prostatism, with the support of meta-analyses in JAMA and a Cochrane review. But now a meticulously conducted RCT casts doubt on this. Who should we believe?
669 Calcium plus vitamin D produced no reduction in fractures in healthy postmenopausal women, and did not prevent bowel cancer. But half of these women were taking oestrogen. In Arch Intern Med (166: 424) a study in men and women aged over 65 shows a 46% reduction in falls among women, but not among men.
795 Glucosamine with chondroitin is another ‘alternative’ remedy endorsed by meta-analyses and a Cochrane review, for reducing progression of knee arthritis. But does it help the pain? It did in patients with more severe arthritis, though not by much and not significantly when they were lumped with less severely affected patients.
809 The huge cost of trastuzumab (Herceptin®) has made the drug a political hot potato: if it were cheap, women with breast cancer carrying the HER2/neu gene would get it routinely, because this study suggests that it is not toxic to the heart, except when given at the same time as anthracyclines.
899 Another controversial humanised monoclonal antibody is natalizumab, used for the treatment of relapsing MS. It reduces relapses in MS, though not by much more than interferon β-1a; and it carries the risk of triggering lethal progressive focal leukoencephalopathy in about 1/2000 patients per year of use (see page 924).
Lancet Vol 367
475 The news we wanted to hear: a method of producing huge amounts of H5N1 flu vaccine quickly (and without eggs, as most hens will be dead). If this is right, these guys will be millionaires and the world will be safe; if not, don't rely on adamantane antivirals to save you (see JAMA page 891).
489 Cone biopsies are associated with pre-term delivery, low birthweight babies, and caesarean section, but no serious neonatal problems.
569 Providing immediate percutaneous intervention (PCI) for every myocardial infarction is medically ideal but logistically impossible. Thrombolysis is second best, and once it has been given, it makes PCI more hazardous.
740 By combining polysaccharide from pneumococci with protein from Haemophilus influenzae, GlaxoSmithKline have developed a vaccine, which the Czech Republic Defence University has used to prevent a third of otitis media in toddlers. Perhaps the Czech Republic regards otitis media as a national threat; although you can't put it in the same league as Hitler.
JAMA Vol 295
629 The Women's Health Initiative Dietary Modification Trial has shown that invasive breast cancer, bowel cancer (page 643) and cardiovascular disease (page 655) in women over 50 are not affected by the amount of fat eaten or the amount of fresh fruit and vegetables.
784 That's not to say, however, that people should get fat. A huge study from China confirms that a BMI between 24 and 26 is associated with the best life expectancy.
1003 Replacing dead cardiac myocytes with bone marrow stem cells is a nice idea, but it hasn't yet shown any clinical success. However, this unsuccessful German trial is not the end of hope.
Arch Intern Med Vol 166
357 Unopposed conjugated equine oestrogens have no effect on the rate of coronary heart disease in women between 50 and 79; and the same seems true of esterified oestrogen (page 399), and of any kind of oestrogen in relation to stroke.
431 The Zutphen Elderly Study looks at what predisposes to a long life in the Netherlands: the answer seems to be a cheerful disposition and a mug of cocoa (see page 411).
Ann Intern Med Vol 144
229 This observational study suggests that not only do statins and β;-blockers prevent cardiac events, but that they also cause coronary disease to prevent in a more benign way — as stable angina rather than myocardial infarction.
257 A fascinating study of adverse reactions to placebo: they vary from 13–77% according to how you enquire about them.
Guest Publication: CMAJ
The national medical journal of Canada was going from strength to strength, until its editors were abruptly sacked for a news item critical of the health minister. A good example of its quality is the paper: What matters most in end-of-life care: perceptions of seriously ill cancer patients and their family members (174: 627).
Plant of the Month: Chaenomeles speciosa ‘Moerloosei’
A lovely Japanese quince with fragrant fruits in autumn and scentless, waxy flowers in spring, well described by its common name, ‘Apple Blossom’.
- © British Journal of General Practice, 2006.