Good news for the many postmenopausal women at risk for osteoporosis and those who already have the bone degenerating disease: they may be able to take a break from their osteoporosis drug due to the potential lasting effects it has on increased bone mineral density that prevent and treat the condition. Branded as Fosamax, the osteoporosis drug alendronate continues to protect against nonvertebral fractures in women who take it for five years and then stop, according to a recent issue of the Journal of the American Medical Association.

Using the most rigorous model of scientific study, investigators extended a trial conducted between 1996 and 1998, called the Fracture Intervention Trial, to look at the effect of the potent bisphosphonate on 1,099 postmenopausal women. The participants had taken alendronate for an average of five years and either continued with the drug in 5 mg or 10 mg daily doses or took a sugar pill—to stop treatment—for an additional five years, between 1998 and 2003. Researchers found that after five years, those who switched to the sugar pill had insignificant decreased bone density in the total hip area (-2.4%) and spine (3.7%) and overall mean levels remained above or stayed at those of pretreatment levels from 10 years earlier. After five years, there was no significant difference between those who discontinued alendronate and those who continued it in terms of their risk of bone fractures not related to the spine, although those who continued with the drug had a slightly lower risk of vertebral fractures.

What it means: Physicians are uncertain about the optimal length of time needed to treat postmenopausal osteoporosis. This study shows that a woman who has taken the osteoporosis drug alendronate for five years can stop without significant risk of decline in bone mineral density and nonvertebral fractures. But if a woman is at high risk for vertebral fractures the recommended option might be to continue the drug. A tip: weight bearing exercises also improve bone density.

From the Archive:

Mar. 20, 2006: Bones of Contention
Feb, 27, 2006: Do Calcium Pills Work?

Humans have a tendency to mirror behavior that we observe in others, to pick up visual and verbal clues, gestures that help us in our socialization. Milan Kundera, in his novel Immortality, went so far as to suggest that gestures use us to survive immortal. (A concept that might be called a meme in other circles.) And in a small study published this week in the Journal of Neuroscience, University College London researchers shed light on the mechanism that allows our brains—and ultimately our faces—to respond to nonverbal clues, particularly those that are positive, such as laughter. 

In the blind trial, 20 subjects were asked to listen to 2.5-second snippets of human voices indicating four types of emotions—amusement, triumph, fear and disgust—while lying in a functional magnetic resonance imaging (fMRI) machine. Sounds were nonverbal, such as a laugh or a scream. Brain scans showed that all sounds triggered a response in the premotor cortical region (specifically the left posterior inferior frontal region), which has been linked to the control of facial muscles, but positive sounds garnered the greatest response. The parts of the brain that lit up corresponded to those that would, were someone to appropriately make a similar expression or noise. And unlike a negative sound, something like laughter, say the researchers, causes people to also want to participate in the emotion.

What it means: Based on this study, researchers say that an involuntary smile or laugh is our natural and appropriate response to the triggering of “orofacial motor cortical fields” by vocalized emotion. The response is more than imitative, but suggests understanding of a common goal, empathy. A stronger response to positive sounds—often important in bonding situations—shows an innate inclination to improving socialization, necessary, of course, for survival.

Earlier this year it was also found that laughter increased blood flow to the heart. So when thinking of holiday gifts this weekend, perhaps comedy is the way to go.

From the Archive:

Dec. 4, 2005: The Year In Medicine From A to Z

Danish researchers find that first-time mothers—but not first-time fathers—are at an increased risk for mental disorders, including schizophrenia, bipolar disorder and depression. The risk is greatest in the first three months following childbirth, according to a study published in this week’s issue of the Journal of the American Medical Association.

Postpartum depression affects between 10% and 15% of mothers and their families. Fortunately, severe psychoses are less common, affecting first-time moms in about one per 1,000 singleton births.

The JAMA study, which was based on data from 2,357,942 people in the Danish health and civil service registers, showed that the risk of postpartum mental illness remained statistically significant for up to three months after giving birth, regardless of the mother’s age.

More specifically, the study looked at 630,373 first-time mothers and 547,431 first-time fathers from 1973 to 2005. During that time, 1,171 women and 658 men developed mental disorders. The 10 to 19 days following childbirth were critical for new mothers and associated with the highest risk—7.3 times higher than women who had given birth previously.

Men and women (under about 25 years-old) who did not become parents during this time also had a lower incidence of hospital admission with a mental disorder.

What it Means: The study suggests that women may undergo physiological changes that increase their susceptibility to mental illness. The researchers call their results regarding risk of postpartum mental disorders an “underestimate” with the consideration that 40% to 50% of postnatal depression goes undetected. A related JAMA editorial stresses the importance of postpartum depression as a major public health problem.

At least one previous study has shown that some fathers, too, suffer from depression eight weeks after their child is born, but the current JAMA study argues against any association between fatherhood and the onset of mental disorders.

From the Archives:
01/20/03 Through The Ages
03/12/01 One Labor-Intensive Job

A new father, whose baby boy went from the delivery room straight to the neonatal intensive care unit, recently shared one piece of advice with me: take notes on what the doctors say about your baby’s condition because chances are you’re not going to remember. As the conduit to his extended family in the waiting room and on the phone—asking questions left and right about his wife and the newborn—he is glad that he did. After two months, he still has the scrap of paper on which he wrote everything down.

The joy and stress of a complicated birth can be overwhelming and new parents don’t often know what to think, or remember, what they hear from doctors immediately following delivery. Researchers in the NICU of a North Queensland hospital in Australia set out to study the effects of audio recordings of mothers’ conversations with their neonatal care providers on how well they recalled information and their psychological well-being. The study, published online this week at BMJ.com, shows that the use of audio recordings improves recall significantly, but postnatal depression, anxiety and stress about parenting showed no significant differences between the group with the recording and the group without.

In the randomized trial, 102 mothers had recordings of their conversations with their neonatologist; 98 mothers who didn’t represented the control group. All participants had infants in the NICU and were asked how well they recalled information about diagnosis, tests, treatment and outcome of their infants, and also about attitudes and use of the tape, postpartum depression, anxiety, general health and stress about parenting at 10 days, four months and one year. At four months—having listened to the tape at least twice—mothers were more than 75% more likely than moms in the control group to recall information about treatment (59% versus 34%). Although small in number, mothers of babies with poor outcomes were significantly more satisfied with the conversations than mothers of babies with good outcomes and recalled more than mothers of babies with poor outcomes in the control group. The study notes that six mothers, all in the control group, did not remember anything that had been said during the conversations.

What it means: Mothers, fathers and family members can benefit from recorded conversations with neonatal care specialists—something that anyone can do on their own with access to a recording device. After the initial stress subsides, doctors’ terminology and explanations can be listened to in greater detail. While the recordings did not improve mothers’ well-being or satisfaction with the neonatologist, other studies can be done—including fathers, for instance—to further measure the effects of this simple and useful intervention. 

From the Archive:

 Nov. 13, 2006: Ahead of Their Time
Oct. 18, 2004: Born Too Soon

The bad news is that if you are one of millions of Americans who suffer from lower back pain and still wonder which is better, surgery or nonsurgical intervention, prepare to continue wondering. The efficacy of a lumbar diskectomy (total or partial removal of the disk between vertebrae of the lower back) to relieve low-back pain is highly controversial and the findings of the Spine Pain Outcomes Research Trial (SPORT), published in today’s JAMA, do little to favor surgery over avoiding the knife. The good news: depending on one’s condition, surgery is just one of many options for relief.

The SPORT study set out to compare surgical and nonoperative treatment of patients who have a herniated disk, a focus of previous studies, but this time researchers led by a Dartmouth Medical School investigator worked with a sizeable, randomized group of participants. Between March 2000 and November 2004, 472 candidates for surgery (disk herniation) from 13 multidisciplinary spine clinics in the U.S. self-reported satisfaction with symptoms of pain, individual progress, employment status and so forth at regular intervals over two years. Individuals were randomly assigned lumbar diskectomy (232) and nonoperative treatment (240), which includes physical therapy, education and counseling with do-at-home exercises and anti-inflammatory medications.

The results: adherence to a particular type of treatment was extremely limited. Half of patients assigned to surgery did so within three months of enrollment, and about one-third of patients who were to have nonoperative treatment opted for surgery in the same time period. Intent-to-treat analysis—based on the original number of participants who were supposed to complete a particular treatment, rather than the actual number—showed that surgery and nonsurgery had consistent, improved outcomes, with respect to pain, physical function, etc. A corresponding observational study (conducted at the same time as the randomized trial and one in which patients chose surgery) showed outcomes favored diskectomy, but improvements narrowed after 2 years. 

What it means: Rates of diskectomy vary by up to 15-fold in the U.S. and the procedure is performed at lower rates internationally, calling into question its efficacy. While both groups of patients in this trial improved significantly over a two-year period, the low rates of adherence, which is not uncommon in studies, do not allow for determining one treatment as better than another, or even showing that they are of equal value in relieving pain.

Also, a JAMA editorial cautions against self-reported results, since the expectations of the patients might interfere with the results of the intervention. So even though the observed trial seemed to favor surgery “this interpretation might be flawed,” it says.

From the Archive:

Sept. 10, 2006: To An Athlete, Aching Young
Nov. 24, 2003: Debunking the Myth of the Firm Mattress

The development of a breakthrough vaccine to guard against transmission of the human papillomavirus (HPV) is a big win for prevention. But for those already infected with HPV—about 6.2 million new cases in the U.S. each year—a new Swedish study sheds light on one more way to potentially reduce their risk of developing cervical cancer: quitting smoking.

Cigarette smoking by individuals with high levels of HPV type 16 infection can increase their risk of developing the most prevalent form of cervical cancer (cancer in situ) by as much as 27 times that of a smoker who does not have HPV, according to the November issue of Cancer Epidemiology, Biomarkers & Prevention. Swedish researchers at Stockholm’s Karolinska Institutet reviewed 105,760 medical records of Swedish women including Pap smear examination data over time and pulled 499 cases of cervical cancer in situ for the study and 499 cancer-free records to represent the control group. Investigators were surprised by the increases in risk associated with high viral loads in women who smoked. Overall, HPV-positive smokers were 14 times more likely to develop cervical cancer in situ compared with HPV-negative smokers; nonsmokers with HPV had just six times the increased risk of cervical cancer compared with HPV-negative nonsmokers.

What it means: These findings highlight the issue for public health, as we consider how many young women who smoke also fall into the primary risk category for contracting HPV. While previous major studies have looked at the role of smoking in cervical cancer, they have remained unclear about the mechanism. The researchers in this study, of one of the largest to date to address smoking and HPV, suggest that one possible explanation is that smoking leads to local immune suppression, particularly if a woman has been smoking for an extended period of time. Smoking, they suggest, might also enhance the virus’s ability to avert detection by the immune system.

Further studies are necessary to elucidate the exact relationship and to investigate the possibility of causation between smoking and HPV. But for now, researchers conclude a "synergistic action" between smoking and HPV status is detectable nearly one decade before cervical cancer is found.

From the Archive:

Jun. 19, 2006: A Shot Against Cancer
Jul. 24, 2006: Lung Cancer and the Sexes

Normally you don’t want your blood pressure to be too high. But if you suffer from congestive heart failure—a progressive weakening of the heart muscle that is more common with age—there is new evidence that links an elevated systolic pressure (the top number in a blood pressure reading) with a decreased risk of dying prematurely.

For the study, which was funded by GlaxoSmithKline and was published in the Nov. 8 issue of the Journal of the American Medical Association, researchers mined a private patient registry database of people with an average age of 73 who had suffered heart failure. The registry cohort included 48,612 patients seen at 259 hospitals nationwide between March 2003 and December 2004.

According to the results, patients with very high systolic pressures (above 161 mm Hg) had the lowest percent mortality rate at 1.7%, while patients with slightly lower but still high systolic blood pressure (within the 140 to 161 mm Hg range) was 2.5%. The rate of mortality for patients with a systolic blood pressure below 120 mm Hg was 7.2%; and 3.6% for patients with pressures between 120 and 139 mm Hg.

A blood pressure reading of 120/80 mm Hg is considered normal blood pressure and 140/90 is considered high or hypertensive.

What it Means: Over 1 million patients were discharged from hospitals in 2003 with heart failure, making the condition the number one discharge diagnosis for patients over 65 years old.

The investigators state that systolic blood pressure readings at the time of hospital admission might be “useful for the risk stratification of patients with heart failure” and that future studies should consider this possibility and further investigate the relationship between systolic blood pressure and heart failure. Such stratification might help doctors to determine the best way to manage a particular patient’s condition.

From the Archives:
12/06/04 Blowing A Gasket
http://www.time.com/time/magazine/article/0,9171,1009656,00.html
12/02/02 A Hurry-Up Lifestyle Can Hurt the Young

The rate of suicide has increased significantly for blacks since the 1980s and is now higher than previously thought, according to this week’s JAMA. The suicide rate for African Americans and Caribbean blacks has now reached a rate comparable with the general American population of 4.6%. Suicide is the nation’s 11th leading cause of death.

Sean Joe, with his doctorate in social work, led his University of Michigan colleagues in a study to determine the lifetime prevalence of suicide attempts, including the degree to which African Americans and Caribbean blacks considered suicide and planned it. The team used data from the National Survey of American Life conducted between February 2001 and June 2003 of respondents 18 years and older. Of the 5,181 participants, 86% had face-to-face interviews; 14% provided their responses partially or entirely by phone.

Joe’s team found that the rate of suicide attempts among blacks in the U.S. is 4.1%. About three times that percentage (11.7%) had suicidal thoughts, of which 34.6% made plans for an attempt and 21% made an unplanned attempt. Caribbean black men—or those who self-identified being from a country in the Caribbean-area or who had at least one of their parents or grandparents from such a country—had the greatest incidence of attempted suicide, 7.5%. Second to Caribbean black men were African American women, 5%.

Investigators found that being younger, having a lower level of education, residing in the Midwest, and having one or more psychiatric disorders increased a person’s risk of attempted suicide and suicidal thoughts. Additionally, once being married (being divorced or widowed) increased one’s chances of considering suicide compared to being married.

What it means: As with any self-reported data, accuracy varies with participants’ willingness to share information. But the thoroughness of the survey in the current study suggests that the rate of suicide has indeed increased since the last estimate of 2.3%, according to a study from the National Institute of Mental Health for 1980 to 1984. In future studies, clinicians and health care providers can use current findings to further investigate a possible link between suicidal thoughts and attempts and factors, such as immigration experiences, and to assess whether or not adequate support and treatment are in place. The U.S. population of blacks is expected to double by 2050, increasing the significance of this study as a public health concern.

From the Archive:

 Feb. 3, 2006: Happiness Isn't Normal
Sept. 27, 2004: Teen Suicide Pills?

It’s cold season again and the average adult American will suffer between two and four colds this year, adding up to one billion nationwide. That’s a lot of Kleenex. And while there’s no cure for the common cold, there is always prevention: moderate daily exercise for about 30 minutes a day halved a postmenopausal woman’s chance of coming down with the sniffles, according to a study in the November issue of the American Medical Journal.

Researchers at the Fred Hutchinson Cancer Research Center led a team that studied the effect of physical activity on the incidence of the common cold in 115 overweight and obese, sedentary postmenopausal women. All women, averaging 61 years old, did not smoke or take hormone therapy and lived in the Seattle area. Participants of the randomized, controlled trial did 45 minutes of moderate aerobic activity—such as brisk walking—five times a week for 12 months or engaged in weekly stretching sessions lasting 45 minutes, performed by the control group. The women completed questionnaires every three months, making note of any episodes of allergies, upper respiratory tract infections (colds and flu) and other infections. Researchers advised participants of the difference between the symptoms of a cold and those of an allergy to ensure accurate self-reporting.

Participants chose brisk walking as a primary activity (52% at a gym or other facility; 74% at home), averaging about 30 minutes a day, or 85% of their target time. About 48% of stretchers had one cold during the year, compared with 30% of exercisers. And in the last three months of the study stretchers were three times more likely to come down with a cold than those who exercised, suggesting that the benefit of activity increases over time. Still, there was no decline in the number of upper respiratory infections with exercise.

What it means: We can all benefit from a little moderate, daily activity, but this is the first randomized clinical trial to draw a link between increased exercise and reduced incidence of the common cold. It has been shown that 30 minutes of brisk walking can increase the number of a particular immune cell, leukocytes, and this might account for the protective benefit exhibited by moderate exercise in this study involving only postmenopausal women. The key word here is “moderate,” however, as very intense and exhaustive exercise could reduce immune function.

From the Archive:

Aug. 8, 2005: How Come We Can't Cure the Cold?
Oct. 24, 2005: A Cure for the Common Cold?

Sometimes when we want to believe that the fountains of youth and beauty are just a bottle of supplements away a study comes along and we snap out of it. In such a study published in the New England Journal of Medicine, Mayo Clinic endocrinologists rebuff the supposed benefits of the steroid dehydroepiandrosterone (DHEA), often touted as an age-defying supplement. Researchers found that the precursor to sex hormones has no significant affect on measures such as muscle strength, peak endurance and muscle and fat mass in elderly women and men.

Over two years, Mayo researchers conducted a double-blind, randomized study of 144 men and women at least 60 years old, giving a regimen of DHEA to 29 men (75 mg per day), testosterone to 27 men (a 5 mg patch per day) and sugar pills to 31 men. Twenty-seven women received DHEA (50 mg per day); 30 received sugar pills. Blood samples were taken every three months and each participant’s supply of patches and pills was replenished. The Mayo team, led by Dr. K. Sreekumaran Nair, measured physical performance, body composition and bone mass density, including hormone, insulin and glucose tests and PSA tests for men.

Participants were also asked to fill out a questionnaire asking about their perceived quality of life in order to assess emotional function while involved in the study. The team observed slight but significant increases in bone mass density in the femoral neck of men taking DHEA and testosterone, and in the ultradistal radius of women taking DHEA. Overall, DHEA did not have an impact on body-composition measurements or on many other measures, such as insulin sensitivity, monitored by the researchers. The also study found that DHEA supplements did not improve quality of life or cause adverse affects.

What it means: The Internet is rife with DHEA and its proposed health benefits but the studies are inconclusive and the primary investigator of the current study advises against the elderly taking DHEA as anti-aging supplements.

Previous studies on the health affects of DHEA have had mixed results, sometimes positive and sometimes neutral. The DHEA doses provided to men (75 mg) and women (50 mg) in this study were meant to mimic those within younger people of the same sex. Restoring DHEA levels to those of younger people might have some short-term benefits for the elderly, but the long-term effects are not known—and certainly not represented in the study. The researchers say that the positive change in bone density to very specific parts of the hip for those taking DHEA is far smaller than “established therapies for osteoporosis” and that the long-term consequences of taking DHEA is still unknown.

From the Archive:

 Aug. 30, 2004: How To Live To Be 100
Jan. 19, 2006: Sexual Healing

Young people with severe psoriasis—a condition that causes inflammation and often results in painful, scaly patches of skin—have a significantly higher risk of heart attack than those without the disease, according to a study in JAMA out today. About 4.5 million Americans suffer from the chronic immune condition and an estimated 150,000 more cases will be diagnosed this year. Previous research shows a link between psoriasis and cardiovascular disease and this study, done by a team of investigators at the University of Pennsylvania, is the first to control for major risk factors related to cardiovascular problems, such as smoking, age, body mass index, high blood pressure and diabetes.

The team analyzed medical records (from a UK database) of more than 550,000 patients who did not have psoriasis, 127,139 with mild cases and 2,837 with severe psoriasis, all of whom were between the ages of 20 and 90. Younger patients—under 50 years old—with severe psoriasis had the greatest relative risk of a heart attack, compared to patients of a different age with no psoriasis or a mild case. According to the team’s findings, a 30-year old patient with severe psoriasis has three times the risk of having a heart attack than someone without psoriasis; and someone with mild psoriasis has a 29% greater risk. Older patients with psoriasis have a lower relative risk. For example, a 60-year old patient with severe psoriasis has a 36% higher risk of a heart attack than someone without the disease. 

What it means: The findings suggest that psoriasis might be an independent factor that contributes to the risk of heart attacks, perhaps as significant as other risk factors for cardiovascular disease, such as smoking. Psoriasis appears before the age of 40 in about 75% of cases and can result in a severe case that requires specific types of treatment, including phototherapy and drugs such as methotrexate. While this study is not conclusive in terms of the relationship of psoriasis to the increased risk of heart attack, patients with psoriasis should be aware of the level of severity of their condition, seek out appropriate treatment and work with their health care providers to reduce the risk of heart attack through other factors under their control, such as smoking, diet and high blood pressure.

From the Archive:

 Sept. 8, 2003: Here’s To Your Health
Jan. 20, 2003: A Frazzled Mind, a Weakened Body

Many Americans often reach for a sugary, caffeinated soda to quench their thirst. But aside from the increased risk of obesity and diabetes, regular consumption of cola might lead to lower bone mineral density in older women and increase their risk of osteoporosis, according to a new study published in the American Journal of Clinical Nutrition.

Katherine Tucker, director of Tuft University’s Epidemiology and Dietary Assessment Program, led her colleagues in a study that analyzed dietary questionnaires submitted by 1,125 men and 1,413 women between the ages of 29 and 86. Overall, participants were largely former smokers and moderate drinkers who were slightly overweight and, on average, men drank cola five times a week while women drank it four times a week. Density measurements show cola consumption significantly reduced bone mass in the hip regardless of the woman’s age, menopausal status, intake of calcium and vitamin D and her history of smoking and alcohol consumption. Diet cola had a similar affect on women’s bone density. By contrast, the bone density of male was not similarly affected.

What it means: A so-called silent disease, osteoporosis is progressive and often misunderstood as a natural consequence of aging. Four times as many women will develop osteoporosis than men and currently 10 million Americans suffer from it. But osteoporosis is preventable and the nearly 34 million Americans who have the potential to develop the disease can take steps to prevent it. Caffeine has been considered a risk factor for osteoporosis and phosphoric acid, found in cola, has been shown to reduce calcium absorption. Additionally, high fructose corn syrup might also weaken bone. It is important to note that at least one previous study showed a link between cola consumption and increases in the amount of calcium measured in urine.

This study shows that women are more sensitive to the effects of cola than men, but the mechanism is still unclear. Researchers ruled out the possibility that cola replaces healthier beverages, such as milk, in the diet that might lead to lower bone density. And to the point of gender, they suggest that more physical activity, a diet higher in calcium and different hormone levels might help protect males from the downside of drinking cola. Until further research is done, however, women (and men) can keep their bones strong with regular weight-bearing exercise and high intake of calcium and
vitamin D.

From the Archive:

 Mar. 20, 2006: Bones of Contention
Oct. 25, 2004: No Bones About It

As school gets into full swing, so do sports—and sports-related injuries. The findings of the High School Sports-Related Injury Surveillance Study, sponsored by a grant from the Centers for Disease Control and Prevention, shed light on injury rates and the most injurious high school sports for boys and girls during the 2005-06 school year.

Each week, an injury research center at an Ohio-based children’s hospital collected data from a nationally representative sample of 100 schools via an online surveillance system. Results showed that participation in nine high school sports led to 1.44 million injuries. The overall injury rate was nearly three injuries per 1,000 practices or competitions. Researchers defined injury as something that: results of participation in an organized, academic practice or competition; requires the attention of a certified athletic trainer or a doctor; and keeps the student out of the game or practice for one or more days after the injury.

Severity of injury differed by sport, but the injury rate was highest for football among boys (4.36 per 1,000) and for soccer among girls (2.36 per 1,000). Other evaluated sports included boys’ wrestling, boys’ soccer, basketball, volleyball, baseball and softball. And perhaps school spirit got the best of many high schoolers since the injury rate was higher during competition than during practice, often resulting in more concussions and fractures. Eighty percent of injuries were new, as opposed to recurring.

What it means: U.S. high schools now offer about 30 sports and participation has grown by 180% over the last 33 years. This rise, and the study’s exclusion of injuries seen by doctors, emergency rooms or other urgent-care facilities, suggest that injuries might be more substantial than those recorded. 

Students, coaches and parents need to be aware of the risks involved with high school sports to minimize injury and develop prevention strategies—including correct use of protective equipment, adequate hydration and training—to keep kids on the field and off the sidelines. 

From the Archive:

 Sept. 10, 2006: To An Athlete, Aching Young
Jun. 6, 2005: Why More Kids Are Getting Hurt

Juice-drinkers might want to pour another glass and toast to good health. A recent study in the American Journal of Medicine shows that people who drank fruit and vegetable juices more than three times a week were 76% less likely to develop Alzheimer’s disease than those who drank juice less than once a week. A glass once or twice a week correlated to a 16% reduction in the risk of the onset of the disease.

The study participants, about 1,800 Japanese Americans living in King County, Wash., submitted self-reported questionnaires about their diets and eating habits every two years beginning in 1992 and through 2001. The group was part of a larger study called the Ni-Hon-Sea Project, which focused on Alzheimer’s disease and vascular dementia among people of Japanese descent in Hiroshima, Japan; on Hawaii’s island of Oahu; and in the urban area of Seattle, Wash. All participants were free of dementia at the start of the study. Researchers paid particular attention to juice intake because of the high level of antioxidants, or polyphenols, in fruits and vegetables that might play a role in disrupting the accumulation of a certain amino acids in the brain that are associated with Alzheimer’s disease.

Overall, those who drank fruit and vegetable juices were found to consume less fat and more dietary vitamin C, and were generally nonsmokers who had completed higher levels of education and exercised regularly. Researchers accounted for these factors in determining the significance of their results. They also found that those subjects who possessed a genetic marker linked to late-onset of Alzheimer’s (the most common form of the disease and starting usually after 65) experienced an enhanced health benefit when they consumed juices three or more times a week. Researchers found no significant link between reduced risk of the disease and dietary intake of vitamins E, C or beta-carotene or tea.

What it means: Antioxidant vitamins such as vitamins C and E and beta-carotene were thought to provide some protection against the Alzheimer’s, but researchers in this study thought to look beyond those to another antioxidant chemical group known as polyphenols. Polyphenols are usually found in the peels and skins of fruits and vegetables—and wind up in juices made by a juicer at home or manufactured into a concentrate. Apple, grape and citrus fruit juices have been shown to afford greater protection to the brain than antioxidant vitamins, according to the study. 

This is the first study to address the consumption of fruit and vegetable juices and the onset of Alzheimer’s, but it doesn’t mean that drinking juice frequently will reduce the risk of the disease. More studies need to be done—with other populations.  Researchers chose to look at people of Japanese descent because of the population’s low incidence of Alzheimer’s disease. But among Japanese Americans, the incidence is higher than in other Japanese populations, suggesting that other factors, such as diet and lifestyle, play into increased risk of the onset of Alzheimer’s.

From the Archive:

Jan. 16, 2006: You (and Your Brain) are What You Eat
Jan. 21, 2002: 10 Foods That Pack A Wallop

As summer draws to a close, we sigh with relief and loosen our belts, eager to trade swimsuits for sweaters and anticipating all the holiday meals to come. But a large study in this week’s New England Journal of Medicine has news for baby boomers who might be minding their weight: being even slightly overweight in middle age isn’t doing you any good.

Obesity and increased risk of health problems (ranging from heart disease to type-2 diabetes, even death) have long gone hand in hand. But researchers in this study chose to explore the effect of being overweight on the risk of illness and death. Led by a researcher from the National Cancer Institute, the team examined the self-reported body-mass index (BMI, or the weight in kg divided by the square of the height in meters) of more than 520,000 men and women between the ages of 50 and 71 who comprised a sample group created by the National Institutes of Health and the non-profit organization AARP. 

The team followed the participants for ten years, during which about 61,000 participants died. Initial analysis showed that overweight (a BMI of between 25.0 and 29.0) slightly increased the risk of death among women, but not among men. Relative risks were adjusted for age, race or ethnic group, education level, smoker or nonsmoker, exercise and alcohol intake. A closer look at data for men and women who had never smoked showed that overweight in midlife increased the risk of death by 20% to 40% compared with people of a normal weight. Obese people (with a BMI of 30.0 or more) had nearly double or triple the risk of death than seen in the general population.

What it means: Last year the Centers for Disease Control and Prevention and the National Cancer Institute determined that maintaining a few extra pounds in midlife might actually be healthy. This study contradicts those findings. Still, the complex relationship between being overweight and one’s health cannot easily be summed up by one study. It is not healthy to obsess over our weight, but shedding a few pounds when we’re tipping the scale isn’t a bad idea. A good diet and exercise help not only with weight but with stress relief and overall well-being. 

From the Archive:

July 7, 2006: More Than Just A Little Chunky
Jun. 6, 2005: Exercise Tips for The Oversized

Few of us are strangers to pimples and the bag of treatments to make them go away. One, isoretinoin (better known as the breakthrough drug Accutane, marketed by Roche Pharmaceuticals for severe acne), has been associated with health risks since its approval by the FDA in 1982. But side effects of elevated levels of cholesterol, triglyceride and liver enzymes appear greater than previously thought, according to a recent study in the Archives of Dermatology.

Researchers at the University of California, San Francisco, analyzed abnormal test results of nearly 14,000 patients between the ages of 13 and 50 who were treated with at least one course of isoretinoin between 1995 and 2002. The team, led by dermatologist Lee Zane, looked at three study periods: a baseline period before treatment; treatment (averaging 21 weeks with a daily oral dose of 65 mg) and three months following treatment. Their findings show that 44% of the participants developed high levels of triglycerides (compared with 25% reportedly written in the cautionary statement included in the Accutane package insert); 31% developed high cholesterol and 11% had high levels of liver enzymes, which could indicate inflammation or liver damage. High triglyceride levels can be linked with a higher risk for heart disease and stroke.

The study, however, did find that when patients stopped taking the drug, their levels of cholesterol, triglycerides and liver enzymes largely returned to what they were before treatment started.

What it means: No drug is a miracle drug. All side effects should be thoroughly considered before beginning a new regimen. While currently the most effective treatment for severe acne, taking isoretinoin (as Accutane or a similar generic drug) is linked with birth defects. Roche and the FDA have warned that women who are in their childbearing years (about half of total users) should not take the drug when pregnant or nursing.

The current findings suggest that both patients and health care providers might benefit from paying special attention to these measures during isoretinoin treatment, to avoid increased risk of metabolic syndrome or other harm caused by high cholesterol, triglygeride and liver enzyme levels. Diet and exercise are good for maintaining overall health, and statins can help to manage cholesterol levels.

From the Archive:

Jun. 12, 2006: Does My Diet Fit My Genes?
Dec. 6, 2004: A Safer System For Prescribing A Dangerous Drug

One might think that the feat of surviving cancer would give people a renewed appreciation for life. But the stress and emotional and often physical pain that accompany childhood cancer, even two decades later, can be debilitating enough to cause suicidal thoughts and attempts in surprisingly high numbers, according to a new study in the Journal of Clinical Oncology.

Researchers at the Harvard Medical School’s Dana-Farber Cancer Institute found that one in eight study participants (12.8%) who had cancer as children reported suicidal symptoms as adults. (Death from suicide is about .01% of the U.S. population.) The 226 participants (100 men and 126 women) were aged 18 to 64 (with average age of 28) and the average time since their diagnosis of childhood cancer, including leukemias and lymphomas, was 18 years. Suicidality outcomes were not significantly related to age or sex, but they were linked to a younger age at diagnosis, longer time since diagnosis, leukemia diagnosis, cranial radiation treatment, depression, hopelessness, pain and concern over physical appearance.

What it means: The small study involves only survivor clinic patients, who may have greater physical and emotional needs than other childhood cancer survivors, but the findings are significant in that they can guide health providers in modifying follow-up care with these groups.

Only 11 of the 29 suicidal individuals showed evidence of significant depression according to depression rating scales used in the study. This suggests that asking an individual about his or her depressive state alone is an inadequate measure in identifying people with suicidal thoughts. Previous studies have shown a link between cancer and suicidal tendencies but this is the first study to connect suicidality and physical problems (including pain and concern over appearance). And since problems with physical health, depression and pain are treatable, researchers suggest that health providers consider a multi-disciplinary approach to follow-up care to better understand cancer survivors’ health and to achieve an improvement in their quality of life.

From the Archive:

May 22, 2006: When Colleges Go On Suicide Watch
Feb. 13, 2006: Happiness Isn't Normal

Racial disparities in treatment for lung cancer are well documented. Different races might prefer different types of treatment, but studies show that this is not substantial enough to account for the magnitude of racial disparities in health care. In light of this research, the communication between doctors and their patients have become a new focus.

A small study published in the Sept. 15 issue of Cancer suggests that African Americans are less likely to ask questions during one-time office visits, therefore, they receive significantly less information from their doctors than their Caucasian counterparts. When doctors and patients were of the same race, however, this disparity disappeared.

At two clinics in a Houston Veterans Affairs Medical Center, researchers made audio recordings of one-time office visits made by 137 patients between 2001 and 2004. Participants were mostly male patients with lung cancer or nodules (or growths) in their lung; 30 were African American and the rest were Caucasian. Age, gender, marital and health status were similar by race throughout the study. After analyzing the audio data for doctors’ information-giving and patients' (or their companions') active participation (classified as “utterances”) researchers found that African Americans were significantly less likely to receive information from their Caucasian doctors than Caucasian patients.

Doctors provided the same amount of information when they initiated information-giving, but African Americans were less likely than Caucasians to initiate a discussion in which they raised concerns or asked questions, and they did usually went alone to the appointments.

What it means: This study might not apply to women, as there were few female participants. Also, the study looked at a single office visit and did not consider that communication between African American patients and their doctors might improve over time. But even with its limits, this small study raises important issues about doctor-patient communication. Race aside, doctors provide more information to patients who are actively engaged in the office visit or consultation. Heath practitioners might help their patients by focusing even more on aligning goals, communication styles and perceptions to optimize doctor-patient interactions—particularly if each is of a different race. 

We all get nervous sitting face to face with our doctor in his or her office. But remember: our concern, or someone else’s concern, brought us there. The following tips might make the visit a better one:

Don’t feel shy or intimidated. If we don’t speak up and voice our concerns, we might miss out on important information concerning our health and treatment options.
No question is a dumb question. Doctors often say that they appreciate questions from patients, because it shows them that patients are actively concerned, want to be informed and want the ensuing health care to be a team effort.
Bring a friend. A friend might have a question that you don’t think to ask—or raise an issue that causes the doctor to provide a more elaborate explanation.

From the Archive:

May 29, 2006: Teaching Doctors To Care
May 1, 2006: Q: What Scares Doctors? A: Being the Patient

Army personnel deployed to war zones in Iraq are more likely to experience impaired mental function—related to memory and ability to focus—upon their return home than their non-deployed counterparts, say researchers in a large study released yesterday by the Journal of the American Medical Association. According to the study, deployment increased confusion and anxiety in the soldiers. But it also showed faster reaction times, suggesting that some mental abilities might improve with active duty. The study ruled out post-traumatic stress disorder, depression and head injury as possible causes.

Researchers say that the slight changes in mental function might be a result of the troops’ need to adapt to the demands of a war zone, including increased vigilance, emotional control and quick decision-making. Slight changes in mental function might not be perceived by the individual but could affect their health in other ways, and researchers point to the rise in accidental deaths following those deployed to the Persian Gulf War. The results of the study do not indicate exposure to toxic chemicals, which was suspected in the Gulf War but not definitely proven due to a lack of health data prior to deployment.   

Since the Gulf War, the health of deployed military personnel has increasingly drawn the attention of scientists. But as the U.S. continues to send mostly young military personnel into war zones, the affects of deployment on mental function, short- and long-term, are still not understood. The failure has often been due to the lack of pre-deployment health data, and the JAMA study is the first to take a look at such mental and emotional changes over a specific period for troops who were deployed to combat zones versus those who weren’t.

Led by Jennifer Vasterling of the Veterans Affairs Medical Center in New Orleans Tulane University, the research team administered a battery of tests to 654 male and female active duty army personnel between April and December of 2003 and upon their return from deployment—which averaged 73 days—between January and May 2005. During the same periods, a control group of 307 soldiers with similar military profiles who were not deployed underwent the same tests. The team measured factors such as verbal skills, spatial memory and motor speed. The study had its limits, however. Only Army soldiers (not other branches or reserve personnel) participated. Mental impairment was measured only with behavioral tests. And testing was done within 75 days following the soldiers' return from Iraq, so there are only short-term—not long-term—results.

What It Means: While further studies need to be done on the cognitive and emotional effects of deployment, the findings clearly show that deployment to Iraq can cause an increased risk of lapses in memory and inability to focus. Not only do the findings have implications for prevention, but the community, including public health officials, employers and families, might consider these results and those in the future to help deployed personnel readjust to life back at home.

From the Archives:

July 17, 2006: A Place for the Kids of War
Oct. 19, 2005: The Iraq War Comes Home

In this peak month for births, parents who are protecting their infants from sun exposure, excessive heat, potential allergens—anything that might complicate new life—will be interested in a small study recently published online in the Archives of Disease in Childhood. Researchers have found that a formula with natural prebiotics, short sugar molecules found in breast milk, significantly reduces an infant’s chance of developing an itchy skin allergy (called atopic eczema) within his or her first six months of life. Prebiotics act as food for “friendly” bacteria that lead to healthier immune systems—which can help prevent the onset of allergies.

The rigorous scientific model of the double-blind, randomized trial included 206 infants born after a normal term and whose parents had the allergic skin condition, hayfever or asthma—factors that put infants at high risk for atopic eczema. Infants were fed breast milk and formula until the sixth week whereupon researchers divided the infants into two groups: 102 babies were given a prebiotic formula; 104 babies were given a normal formula. Both formulas were made with hydrolyzed whey protein, which is the recommended formula for babies at risk for the skin allergy. Infants were seen on a monthly basis for six months and parents kept diaries of the infant’s symptoms. According to the researchers, the skin allergy peaks in infants at six months. 

Over that time period, 10% (10 babies) of the prebiotic formula group developed a mild form of the skin allergy versus 23% (24 babies) fed the normal formula. In addition, stool samples showed a significant increase in one kind of healthy bacteria in the prebiotics group.

What it means: In this study, the prebiotic formula had an effect on reducing infants’ risk of the allergic skin condition by boosting the children’s immune systems via intestinal flora (or “good” bacteria in the gut)—something we could all benefit from.

Researchers suggest that there is further evidence—not included in this study—that the natural prebiotic in breast milk might also help reduce disease through direct interaction with immune cells. It might also have anti-inflammatory properties. But the complex nature of breast milk prebiotics requires further study to understand the mechanism that leads to enhanced immunity.

Probiotics, perhaps a more widely understood term, are the bacteria that feed on prebiotics. Both have become buzzwords in the dairy industry.

From the Archive:

Mar. 7, 2005: Baby Bulletins
May 20, 2002: Of Brains and Breast Milk

It’s summertime. Do you know where your moles are? The results of a recent small study in the Journal of the American Academy of Dermatology suggest that people who physically "map" their moles, by marking the location of their existing moles on an image of their back or torso, were better able to detect new growths than those who didn’t mole-map. Researchers concluded that such diagramming during monthly self-screening improves people’s chances of finding changes to their skin and could lead to early detection of melanoma, the deadliest form of skin cancer.

Brown University Medical School researchers, who devised the concept of "mole mapping" in self-examination, gave half of the 88 participants a diagram of their back on which to document their existing moles, while the other participants (without diagrams) became the control group. The groups went home to do their self-examinations and returned two weeks later for a follow-up visit. Upon their return, the groups were presented with photos of their backs taken during their first visit and were asked to identify any changes to the moles. Some of the photos were digitally manipulated; others were not. Were there more moles? Were they bigger? Did they change in shape or color? Sixty percent of the mole-mappers caught “new growths” on their backs, versus 33% of the control group. Overall, 52% of the mole-mappers correctly assessed their photos, versus, again, 33% of the control group.

What it means: Melanoma rates have soared 15-fold in the last 50 years and mortality has gone up 28% in the last 25. Screening and self-examination of sun-exposed areas are effective in early detection of skin cancer and melanoma, but few of us routinely map out our constellation of moles. If detected early, melanoma has a 95% survival rate. Self-examination with mole-mapping increases the likelihood that people will notice changes in the number, size, shape and color of their moles. And it’s not just our backs but our whole body, including areas we might forget like our scalps and the bottoms of our feet.

From the Archive:

Aug. 25, 2005: Tanning Addicts
Aug. 2, 2004: New Skin Saver

Get ready to coo because July is baby month—or at least the month of the greatest number of births in the U.S., according to the National Center for Health Statistics. And some mothers who have given birth by cesarean section might now reconsider vaginal birth, following a study published in Obstetrics & Gynecology that says it is a safe, viable option for them.

In the past, doctors and new mothers thought that the scar from the incision made to the uterus during a C-section was associated with an increased risk of uterine rupture or tearing during subsequent vaginal births. But in this study, involving the data of nearly 18,000 women who gave birth at 19 U.S. medical centers between 1999 and 2001, a team of doctors found that mothers who had had multiple C-sections were no more likely to experience a uterine tear than women who had only one C-section. 

By contrast, women who had undergone multiple C-sections were more likely to need blood transfusions than those who had had just one C-section (3.2% versus 1.6%) if they delivered vaginally.  But the actual risks are still very small according to the study’s lead investigator. Whether a woman had a previous vaginal delivery had no bearing on the results.

What it Means: Vaginal birth after C-section is a relatively safe option. Up until now, the American College of Obstetricians and Gynecologists' Obstetrics Practice committee advised that vaginal births after C-sections be allowed only in hospitals with a medical team on hand to deal with emergencies. As a result, the vast majority of women who had a C-section underwent C-sections for subsequent births as well. It is expected that the committee will revise its stance to align them with the findings of this study.

From the Archives:
04/19/04 Too Posh To Push?
03/01/04 Birth Bliss
04/10/2000 Unkindest Cut?

With summer in full swing, many green-thumbs are donning their gloves and taking spade, bug-and weed-killer in hand to do some serious gardening.But the findings of a new study from the Harvard School of Public Health (HSPH) published in the July issue of Annals of Neurology may is worth considering first.

In the first large-scale prospective study to look at the link between chronic, low-dose exposure to pesticides and Parkinson’s disease, researchers showed that individuals who reported exposure to pesticides had a 70% higher incidence of Parkinson’s disease than those who did not, after adjusting for age, sex, smoking and potential risk factors. Parkinson’s disease is a progressive condition that affects the nerve cells in the part of the brain that controls movement.

Participants were drawn for the HSPH study from the Cancer Prevention Study II Nutrition Cohort, started in 1992 by the American Cancer Society, if they responded to the 2001 follow-up survey. (The exposure data was taken from information gathered in 1982 during a related study.) Of the 143,325 participants, about 8% (5,203 people) reported exposure to pesticides and they were more likely to be male and report their occupation as farmer, rancher, fisherman or blue-collar worker than those who reported no exposure. Ten to 20 years after exposure, 413 cases of Parkinson’s disease were identified.

What it means: Exposure to pesticides and herbicides in the garden, while limited, is still something to consider. Non-toxic alternatives to common pesticides are increasingly popular and a variety are on the market, either in garden shops or online.

This study supports on a larger scale what other studies have found: a correlation between pesticide and herbicide exposure and increased risk of Parkinson’s disease. Certain compounds in pesticides are believed to cause oxidative stress, cellular dysfunction, inflammation and adversely affect dopamine levels, but the relation of these mechanisms to Parkinson’s has yet to be clearly understood. Exposure to pesticides could also indicate other aspect of rural living not accounted for in the study, but there is strong evidence from previous studies to back the current findings. The study does not, however, specify the kinds of pesticides that might trigger mechanisms that lead to Parkinson’s, an objective that the researchers pose to future studies. They suggest that attempts to reduce overall exposure to pesticides, to avoid being at higher risk of the disease, might be "insufficient and impractical".

From the archives:
06/12/06 The Grass-Fed Revolution
04/17/06 The Green Home

After a night of drinking, a morning cup-of-Joe might relieve more than your aching head: it might be helping your liver. Every cup of coffee per day you average confers a 22% reduced risk of developing alcoholic cirrhosis—a liver disease often caused by long term alcohol consumption—compared with people who never drank coffee, according to a new study published in the Archives of Internal Medicine

Through interviews and questionnaires, researchers asked more than 125,000 individuals in the Kaiser Permanente Medical Care Program about their consumption of alcohol, coffee and tea per day during the previous year for an average of more than 14 years. None of the participants had liver disease upon entering the study and, by 2001, 199 of them had developed alcoholic cirrhosis.

Researchers found that the more coffee one drinks, the lower his or her risk of developing alcoholic cirrhosis. At one to three cups per day—compared with people who never drank coffee—the risk was lowered by 40%. Those who drank more than four cups per day had a reduced risk of 80%. Coffee has no effect on nonalcoholic cirrhosis.

What it means: Excess consumption of alcohol has many harmful effects on the body—not only on the liver—so the primary way to avoid cirrhosis is to control alcohol consumption. Still, the study might offer a casual connection between coffee, a known source of antioxidants, and the reduced risk of developing alcohol cirrhosis, but more studies need to be done to support these findings and to identify the ingredient in coffee that acts as the protective mechanism. (Caffeine is not that ingredient because drinking tea did not confer the same benefits as coffee.)

From the archives:  
06/05/06 What Alcohol Does to a Child
01/23/06 Balding, Wrinkled, and Stoned

Doctors always tell us to be sure to swallow every last antibiotic pill—but do we always need to?

Investigators in the Netherlands have found that, in certain cases, a shorter duration of antibiotic therapy—just three days—for adults with mild-to-moderately severe pneumonia is as effective as the commonly prescribed 7-to-10 day regimen of antibiotics, such as amoxicillin. Their study was published in the British Medical Journal.

Applying the most rigorous scientific model available, the study involved 119 patients from nine hospitals who had community-acquired pneumonia (without complications and with a severity score of 110 or less) and who showed significant improvement after three days’ treatment with intravenous amoxicillin. (Investigators measured improvement with a five-point symptom scale and patients who showed improvement of two or more points were included in the study.)

Researchers then randomly assigned oral amoxicillin (750 mg) or a sugar pill three times a day for five days to each of the participants and evaluated their symptoms on days 7, 10, 14 and 28.

Clinical success at day 10 (two days after treatment ended) was 93% for both the three-day and eight-day treatment groups and about the same on day 28, 90% vs. 88%.  Both groups also had similar x-ray results, symptom resolution and length of hospital stay.

What it means
Doctors consider many factors when prescribing antibiotics–namely, the patient's health and the cause of the infection.

Some infections require long-term treatment with antibiotics to prevent a relapse. But this study challenges the 7-to-10 day regimen for pneumonia with this level of severity.

Two studies in children with non-severe pneumonia have also shown that three days of treatment with antibiotics is as effective as five days of treatment.

Still, shortening the duration of your antibiotic therapy is a decision that's best left to your doctor. Whatever the duration of the prescription he or she gives you, you should complete the full course of treatment.

From the archives:
06/12/06 The Grass-Fed Revolution
05/01/06 Q: What Scares Doctors? A: Being the Patient

Stifled by summer air? If you have mild asthma, the results of small study in the journal Thorax may help you to breathe easier. Breathing exercises reduced the use of inhaled corticosteroids by 86% and halved the dose of inhalers used for relief over more than eight months, according to researchers in Sydney, Australia, who conducted the study with 57 people with mild asthma.

In a double-blind, controlled trial, researchers compared the effects of two different breathing techniques, which were randomly assigned to each of the participants, who were nonsmokers and who used reliever inhalers on four or more occasions weekly (usually averaging about three puffs each day).

One exercise focused on reducing hyperventilation and breathing more through the nose; the other focused on upper body exercises and relaxation. Participants practiced their 13-minute exercise routines twice daily and used shorter versions (about three to five minutes) when symptoms prompted them to reach for their reliever inhaler.

In the end, it didn't matter which exercise the participants performed. In addition to cutting their use of the relief inhaler and halving the corticosteroid dosage, participants in both groups experienced more reliever-free days.

There were no changes, however, in lung function or airway responsiveness in either group.

What it means: If you’re one of the 17 million adult Americans who have asthma you know that when you need your relief inhaler, you use it. This study, however, provides more evidence that breathing techniques can reduced the dosage required.

Researchers also note that the breathing techniques might have helped reduce the anxiety in the participants, making them less likely to use the reliever inhaler for prevention.

From the archives:
05/11/06 Drugs Treat But Don’t Cure Asthma
04/03/2006 How It Affects Your Health
12/20/04 Asthma Alarm

The stale smell of cigarette smoke can linger on clothing and in hair for what seems like ages, but the residual effect of smoking a single cigarette for the first time could last for as long as three years, according to a study of children in Tobacco Control, a specialty publication of the British Medical Journal.

A team led by a researcher from the University College London conducted five annual surveys and saliva tests (to detect nicotine) from 1999 to 2003 with more than 2,000 students between the ages of 11 and 16 from 36 London schools. Of the sample, 260 students were “one time triers” of a cigarette by age 11 and—without smoking in the intervening period—about 18% of them were regular smokers by age 14, in contrast to just 7% who had never smoked by age 11.

The team concluded that smoking just one cigarette for the first time has a “sleeper effect” that can increase a child’s vulnerability to nicotine addiction and could result in their becoming a regular smoker after a number of years. Factors that might make a child more susceptible to becoming a smoker, such as parental smoking or conduct problems, did not change the results.

What it Means: Even a single cigarette can have consequences. Teachers, health professionals, parents and other adults might help kids from becoming smokers by trying even harder to keep them from that first cigarette and by paying more attention to those early experimenters.

From the Archive:
08/08/2005 Being 13
06/20/05 Behind the Tobacco Retreat
12/06/04 The Year In Medicine From A To Z

The more weight a woman gains, the greater her risk of developing all types, stages and grades of breast cancer, according to a study in the July 1 issue of Cancer. This is the first study to link weight gain to specific types of breast cancer.

Researchers of the American Cancer Society studied 44,161 post-menopausal women who were not taking hormone therapy. They found that women who gained 60 lbs. or more in adulthood were almost doubly likely to have cancerous tumors in their milk ducts and one-and-a-half-times more likely to have lobular cancer, than women who gained 20 lbs. or less.

The risk of the cancer spreading from the original site increased for all women who gained weight but was more than three times greater for extremely obese women who gained more than 60 lbs.

The study investigators also observed an increase of “estrogen-positive” receptor tumors. That's important because previous studies have documented a positive link between the amount of estrogen circulating in the bloodstream over a woman's lifetime to her risk of breast cancer. But excess fatty tissue is also known to increase the amount of estrogen in the blood.

What it Means: Weight gain—and not just body mass—may be an important risk factor for breast cancer.

From the archives:
02/07/06 No Miracles For Heart Disease or Cancer
05/16/05 Menopause: A Healthy View

Doctors are said to prescribe drugs “off-label” when they use a medication as a treatment for which the drug had not originally been approved by the U.S. Food and Drug Administration. The practice is routine among physicians, and a new study from a team of researchers, led by a professor of medicine at the Stanford Prevention Research Center, shows just how common it is.

The study, published in the Archives of Internal Medicine, looks at data from 2001 that represent 403,957 encounters between doctors and their patients. Of the drugs selected for the survey—including the 100 most commonly prescribed drugs and 60 randomly selected drugs—21% were prescribed off-label. About three-quarters of those prescriptions were for indications that had little or no scientific backing, according to the study authors, meaning evidence of the drug’s effectiveness was not demonstrated during drug trials or in clinical settings.

Psychiatric drugs were very often prescribed off-label with little or no scientific evidence to back up their use, as were allergy medications. Researchers also found that more than 40% of cardiac medications, drugs to relieve or prevent convulsions and drugs to treat asthma were prescribed off-label without much acientific backing.   

Gabapentin, a drug approved by the FDA as an anticonvulsant and pain reliever for patients suffering from shingles, was prescribed off-label about 83% of the time. For example, doctors prescribe the drug for bipolar disorder and chronic pain—indications that are not supported by sufficient scientific backing.

What it Means: Just because a drug isn’t approved for a particular condition by the FDA doesn’t mean that it isn’t effective in that situation. Off-label prescriptions allow doctors, guided by their judgment and expertise, a little more flexibility in the practice of medicine.

Classes of drugs can work in similar ways so it makes sense that a doctor might prescribe a drug off-label if he or she thinks it would have a comparable effect on a condition as another drug in its class.

But there are risks and researchers say that it is important to distinguish between off-label prescriptions that are “clinically reasonable” and those that may pose a greater risk to the patient.

The study authors call for more attention to “mandatory postapproval surveillance” of drugs to avoid possibly jeopardizing patient safety with the widespread use of off-label prescriptions.

Patients, too, can ask what sort of scientific backing exists for the drug that is being prescribed for their condition.

From the Archives:
05/01/06 What Scares Doctors
03/20/06 The New Cancer Fighter