Breast-feeding may benefit a woman's heart.

Moral of the story: Again, another benefit to breast-feeding.

Source: AMA Morning Rounds 12/22/09

Breast-feeding may benefit a woman's heart.

HealthDay (12/21, Gordon) reported that breast-feeding may help protect a woman's heart, according to research scheduled to be published in Obstetrics and Gynecology. Investigators, "in a study of nearly 300 women," employed "two imaging techniques -- electron beam tomography and ultrasound -- to assess the health of the women's blood vessels." The researchers "found that 32 percent of the women who had not breast-fed had coronary artery calcification, compared with 17 percent of the breast-feeding moms."

Antidepressants' effectiveness may vary according to severity of depression.

Moral of the story: Antidepressants may not be useful for all patients with depression.

Source: AMA Morning Rounds 1/6/10

Antidepressants' effectiveness may vary according to severity of depression.

The New York Times (1/6, A12, Carey) reports that "some widely prescribed" medications "for depression provide relief in extreme cases, but are no more effective than placebo pills for most patients," according to a study published Jan. 6 in the Journal of the American Medical Association. After reviewing "data from previous trials on two types of" medicines, paroxetine (Paxil) or imipramine (Tofranil), researchers found that "their effectiveness varies according to the severity of the depression being treated."

        USA Today (1/6, Rubin) explains that University of Pennsylvania researchers "pooled data from six trials in which a total of 718 depressed patients were randomly assigned to take either an antidepressant or a placebo." After obtaining "patient-specific data from scientists involved with each trial," the team found that "antidepressants were more effective than a placebo only for patients with very severe depression, who made up 40% of trial participants but...represent fewer than 30% of depressed people who seek treatment in the real world."

        While "antidepressant medications probably provide little or no benefit to people with mild or moderate depression," the Los Angeles Times (1/6, Roan) reports that the study also suggests that "the mere act of seeing a doctor, discussing symptoms, and learning about depression probably triggers the improvements many patients experience while on medication." Meanwhile, "other research has also found that antidepressants are most effective for severe symptoms, said" Philip Wang, MD, PhD, deputy director of the National Institute of Mental Health. While antidepressants may not "work well for mild to moderate depression, it's also possible that people enrolled in antidepressant studies have robust placebo responses that mask some of the impact of the medication."

        According to the Wall Street Journal (1/6, Dooren), study author Robert DeRubeis, PhD, pointed out that the majority of studies assessing antidepressant medications included patients with severe depression and that such studies were submitted to the Food and Drug Administration for approval of these medicines. In contrast, because far fewer studies have included patients with mild depression, it remains unclear just how effective antidepressants, such as fluoxetine (Prozac) or paroxetine (Paxil), are in this large patient population.

        Meanwhile, Bloomberg News (1/6, Bennett) reports, "doctors, policy makers, and consumers should be made aware that there's little evidence to show antidepressants will benefit the majority of patients with less severe symptoms," the study authors concluded. Forbes (1/6, Langreth), the Columbus (OH) Dispatch (1/6, Crane), and Reuters (1/6, Stern) cover the story, as did HealthDay (1/5, Gardner), WebMD (1/5, Doheny), and MedPage Today (1/5, Gever).

Cutting global warming said to lead to positive health effects.

Moral of the story: Health improves as green house gas emisions fall.

Source: AMA Morning Rounds 12/28/09

Cutting global warming said to lead to positive health effects.

The AP (12/27, Borenstein) reported that research in a special issue of the Lancet suggests that "cutting global warming pollution would not only make the planet healthier, it would make people healthier too." United Nations Secretary General Ban Ki-Moon and the head of the World Health Organization," HHS Secretary Kathleen Sebelius said, "Relying on fossil fuels leads to unhealthy lifestyles, increasing our chances for getting sick and in some cases takes years from our lives. ... As greenhouse gas emissions go down, so do deaths from cardiovascular and respiratory diseases. This is not a small effect." Linda Birnbaum, director of the US National Institute of Environmental Health Sciences, explained that the Lancet studies looked "at the immediate benefits of doing something about the problem" rather than "looking at the health ills caused by future global warming, as past studies have."

Bedside exam may be superior to CT in detecting post-brain surgery complications.

Moral of the story: CT is shown yet again to be less effective than originally thought, but will likely to continue to be gold standard because of litigation and societal desire for technology

Source: AMA Morning Rounds 12/29/09

Bedside exam may be superior to CT in detecting post-brain surgery complications.

HealthDay (12/28, Dotinga) reported that, according to a study appearing online in the Journal of Neurosurgery, "the low-cost, simple, but elegant neurological exam appears to be superior to a routine CT scan in determining return to the operating room" due to "post-brain surgery complications." A review of "the medical records of 251 patients who underwent CT scans within 24 hours of surgery" revealed that "the scans failed to show who would need to go back to the operating room." But, bedside exams showed "serious problems in 10 cases that required urgent CT scans; three of the patients needed to go back to the operating room."

Gingko biloba not effective in preventing cognitive decline, improving memory.

Moral of the story: Ginko is probably not worth buying for your mental health.

Source: AMA Morning Rounds 12/30/09; JAMA. 2009; 302:2663-2670

Gingko biloba not effective in preventing cognitive decline, improving memory.

The CBS Evening News (12/29, story 9, 0:20, Smith) reported, "Americans spend a quarter billion dollars a year on" gingko biloba supplements, "hoping to improve their memory and slow cognitive decline."

        NBC Nightly News (12/29, story 5, 2:00, Williams) reported that "now, a major study shows" that gingko biloba, "one of the most popular supplements, flat out does not work."

        USA Today (12/30, Weise) reports that, according to a study published in the Dec. 23-30 issue of the Journal of the American Medical Association, "the popular botanical...does not improve memory, nor does it prevent cognitive decline in older people." After analyzing data "from the Ginkgo Evaluation of Memory study" on "more than 3,000 people between ages 72 and 96 for seven years," researchers from the University of Virginia Medical School "found that a twice-daily dose of 120 milligrams of ginkgo biloba extract was not effective in reducing the incidence of Alzheimer's dementia or dementia overall."

        According to the Los Angeles Times (12/29, Kaplan) "Booster Shots" blog, the National Center for Complementary and Alternative Medicine, "a branch of the National Institutes of Health, has been researching ginkgo for 10 years to see whether the type of clinical trials required for FDA-regulated pharmaceuticals would reveal any benefit. The new findings are in line with several other studies, including a Cochrane review published this year that found 'no convincing evidence' that the herb preserves mental function in any way."

        The investigators "found no evidence that ginkgo delayed or prevented normal declines in memory, language, attention, visuospatial abilities, or executive functions, such as anticipating outcomes and adapting to changing situations and thinking abstractly," HealthDay (12/29, Reinberg) reported. Moreover, "these results remained the same regardless of sex, age, race or education," the investigators found. However, the supplement was found to be safe, "and no serious side effects were noted," study author Steven T. DeKosky, MD, said.

        WebMD (12/29, DeNoon) reported that "in a written statement," Douglas MacKay, ND, of the Council for Responsible Nutrition, "a group representing the supplement industry," said that "the DeKosky study 'should not be viewed as the final work' on ginkgo." He stated that "as a former practicing licensed naturopathic doctor," he "would continue to recommend ginkgo biloba to older adults as a safe, effective option for supporting cognitive health."

Ginkgo biloba for Preventing Cognitive Decline in Older Adults
A Randomized Trial
Beth E. Snitz, PhD; Ellen S. O’Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators

JAMA. 2009;302(24):2663-2670.
Context  The herbal product Ginkgo biloba is taken frequently with the intention of improving cognitive health in aging. However, evidence from adequately powered clinical trials is lacking regarding its effect on long-term cognitive functioning.
Objective  To determine whether G biloba slows the rates of global or domain-specific cognitive decline in older adults.
Design, Setting, and Participants  The Ginkgo Evaluation of Memory (GEM) study, a randomized, double-blind, placebo-controlled clinical trial of 3069 community-dwelling participants aged 72 to 96 years, conducted in 6 academic medical centers in the United States between 2000 and 2008, with a median follow-up of 6.1 years.
Intervention  Twice-daily dose of 120-mg extract of G biloba (n = 1545) or identical-appearing placebo (n = 1524).
Main Outcome Measures  Rates of change over time in the Modified Mini-Mental State Examination (3MSE), in the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog), and in neuropsychological domains of memory, attention, visual-spatial construction, language, and executive functions, based on sums of z scores of individual tests.
Results  Annual rates of decline in z scores did not differ between G biloba and placebo groups in any domains, including memory (0.043; 95% confidence interval [CI], 0.034-0.051 vs 0.041; 95% CI, 0.032-0.050), attention (0.043; 95% CI, 0.037-0.050 vs 0.048; 95% CI, 0.041-0.054), visuospatial abilities (0.107; 95% CI, 0.097-0.117 vs 0.118; 95% CI, 0.108-0.128), language (0.045; 95% CI, 0.037-0.054 vs 0.041; 95% CI, 0.033-0.048), and executive functions (0.092; 95% CI, 0.086-0.099 vs 0.089; 95% CI, 0.082-0.096). For the 3MSE and ADAS-Cog, rates of change varied by baseline cognitive status (mild cognitive impairment), but there were no differences in rates of change between treatment groups (for 3MSE, P = .71; for ADAS-Cog, P = .97). There was no significant effect modification of treatment on rate of decline by age, sex, race, education, APOE*E4 allele, or baseline mild cognitive impairment (P > .05).
Conclusion  Compared with placebo, the use of G biloba, 120 mg twice daily, did not result in less cognitive decline in older adults with normal cognition or with mild cognitive impairment.
Trial Registration  clinicaltrials.gov Identifier: NCT00010803

Author Affiliations: Departments of Neurology (Drs Snitz, Saxton, Lopez, and DeKosky and Ms Dunn) and Epidemiology (Ms Ives), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Biostatistics, University of Washington, Seattle (Drs O’Meara and Arnold); Department of Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland (Dr Carlson); Departments of Psychiatry and Behavioral Medicine (Dr Rapp) and Internal Medicine (Geriatrics/Gerontology), School of Medicine (Dr Sink), Wake Forest University, Winston-Salem, North Carolina; and School of Medicine, University of Virginia, Charlottesville (Dr DeKosky).

Women urged to seek STD testing within 12 months of first intercourse.

Source: AMA Morning Rounds 12/8/09

Women urged to seek STD testing within 12 months of first intercourse.

The Los Angeles Times (12/7, Roan) "Booster Shots" blog reported, "Young women should be screened for sexually transmitted diseases within a year of first intercourse and should be retested every three to four months if an infection is found, according to a study published...in the Archives of Pediatrics and Adolescent Medicine." Indeed, the "US Preventive Services Task Force and Centers for Disease Control and Prevention have recommendations for STD screening, but those documents are somewhat vaguely worded." The work conducted by researchers at Indiana University, however, "suggests that starting at a young age and conducting regular screening may prevent many health problems," such as pelvic inflammatory disease and ectopic pregnancy, in the years to come.

Diabetes cases projected to nearly double in next 25 years.

Source: AMA Morning Rounds 11/30/09

Diabetes cases projected to nearly double in next 25 years.

The Chicago Tribune (11/27, Shelton) reported that, according to a study published Nov. 27 in the journal Diabetes Care, "diabetes cases will nearly double in the US in the next 25 years and the cost of treating the disease will almost triple." University of Chicago researchers "found the number of people with diagnosed and undiagnosed diabetes will climb from almost 24 million this year to about 44 million in 2034. Over the same period, annual diabetes-related treatment costs are expected to increase from $113 billion to $336 billion in 2007 dollars."

        Bloomberg News (11/27, Waters) reported, "Diabetes prevents people from breaking down sugar in their blood and can lead to complications, including heart disease, kidney disease, vision loss, and amputation of limbs. While some people have an inherited form of the condition, the majority of cases are linked to obesity."

        HealthDay (11/27, Thomas) reported that, besides obesity, another "factor driving the soaring costs" is "the number of people living with diabetes for lengthy periods, the researchers said. Over time, the cost of caring for someone with diabetes tends to rise along with their risk for developing complications, such as end-stage renal disease, which requires dialysis." Notably, "among Medicare beneficiaries, the number with diabetes is expected to rise from 8.2 million to 14.6 million in 2034, with an accompanying rise in spending from $45 billion to $171 billion."

        "As a result, by 2034, half of all direct spending in diabetes care is projected to occur in the Medicare population," WebMD (11/27, Boyles) reported. Still, "although little can be done about the aging of the population, much can be done about the other major risk factor for type 2 diabetes -- obesity." MedPage Today (11/27, Gever) and CNN (11/27, Hellerman) also covered the study.

        Rituximab seen as promising for type 1 diabetes. Bloomberg News (11/26, Doherty) reported that, according to a study in the Nov. 26 issue of the New England Journal of Medicine, the "arthritis and lymphoma medicine Rituxan [rituximab] cut the need for insulin treatment among patients with type 1 diabetes after a year."

        In a phase 2 trial, researchers from Indiana University randomly assigned "87 patients with newly diagnosed type 1 diabetes...to receive rituximab infusions or a placebo at one-week intervals for four weeks," HealthDay (11/25, Gardner) reported. The investigators discovered that "after one year, C-peptide levels -- an indicator of how much insulin is being produced by the body -- were higher in people taking rituximab versus those in the placebo group," with "those in the rituximab group also" needing "less external insulin." In other words, rituximab "helped patients keep producing some of their own insulin."

        WebMD (11/25, DeNoon) noted, however, that "a single course of Rituxan wasn't enough to stop diabetes. After a year, B cells in treated patients increased to 69% of their original values." Nevertheless, "the study does show that a treatment targeting B cells can preserve beta-cell function in early type 1 diabetes."

        MedPage Today (11/25, Gever) reported that Joel Zonszein, MD, of the Albert Einstein College of Medicine, cautioned, "The molecule [rituximab] is not free of side effects, and" that "important long-term side effects are unknown." Dr. Zonszein, who was not involved in the study, agreed, however, that the "study opens a new pathway of exploration."

Pharmacists seen as integral to helping patients manage healthcare.

Moral of the story: Physicians need help from pharmacists, especially considering the high number of drugs people take these days and all the potential interactions that can occur.

Source: AMA Morning News 11/20/09

Pharmacists seen as integral to helping patients manage healthcare.

In a series of articles on pharmacists and their role in managing patients' healthcare, the Los Angeles Times (11/30, Ravn) reports, "Pharmacists now can help patients get the most good from their medications, manage side effects, avoid interactions, even save money." Most states also "have laws requiring pharmacists to give patients specific information," and in California, the law specifies that pharmacists "should give patients directions for how to use and store their medications, making clear that it's important to follow those directions." In addition, "they should warn patients about possible side effects or interactions that occur frequently and may be severe."

        In a separate article, the Los Angeles Times (11/30, Ravn) reports on "a growing subset" of pharmacists called "clinical pharmacists," who "provide direct care, using their expertise to ensure that patients receive the most appropriate medications and that they take them properly. These professionals often spend time with patients that physicians can't." Evidence also "shows that when clinical pharmacists collaborate with physicians, they improve health outcomes. And with their extensive knowledge of available drugs, pharmacists can help to save money by using the most cost-effective ones."

        The Los Angeles Times (11/30, Ravn) also reports on "medication therapy management" and how "it's crucial to ensure that none of the patient's medications are duplicating each other, or canceling each other out, or interacting in a problematic, even dangerous way." In medication therapy management, "the pharmacist can work with a patient's physician (or physicians) to develop a comprehensive program of drug therapy -- perhaps eliminating or adding or switching medications," which can help save "the patient money and, more important," improve "the patient's health."

        The Los Angeles Times (11/30, Ravn) also includes an article detailing "a list of questions" patients "should pose before taking your medications home." The Los Angeles Times (11/30, Ravn) also runs a story on "five of the most-prescribed drugs and their possible risks, side effects, and possible interactions."

Many medical students sustain needle-stick injuries, data indicate.

Moral of the story: Reporting needs to be made simpler, faster.

Source: AMA Morning Rounds 11/30/09

Many medical students sustain needle-stick injuries, data indicate.

The Los Angeles Times (11/25) "Booster Shots" blog reported that, according to research appearing in the Dec. issue of the journal Academic Medicine, "medical students often come in too-close contact with needles, possibly putting them at risk for contracting HIV or hepatitis C." The survey of "699 surgeons-in-training at 17 general surgery residency programs," showed that "almost 60 percent said they sustained a needle-stick injury as a medical student, with many suffering two injuries."

        Those "who had been stuck in medical school" also "had a 2.51-fold increased risk of needle-stick injury involving a high-risk patient -- one with a history of intravenous drug use or infection with HIV, HBV, or HCV," MedPage Today (11/27, Fiore) reported. But, data indicated that 47 percent of respondents who "sustained their most recent needle-stick injury during medical school" failed to "report their injury to an employee health office." Researchers found that "the most common reason for not doing so was the amount of time involved in making a report."

Study shows no link between increased cell phone use, brain cancer incidence.

Moral of the story: No proven connection between cell phone use and brain cancer, although it wouldn't hurt to be careful.

Source: AMA Morning Rounds 12/4/09

Study shows no link between increased cell phone use, brain cancer incidence.

NBC Nightly News (12/3, story 9, 0:20, Williams) reported, "There's been speculation for years that there's been a link between" cell phones and brain cancer, but "the results of a very large, very long study of just about everybody in Scandinavia found no link."

        USA Today (12/4, Szabo) reports that, according to the study, published in the Journal of the National Cancer Institute, researchers found "no link between rising cell phone use and rates of brain cancer." The finding is "consistent with most other studies," but Melissa Bondy, of MD Anderson Cancer Center, noted that "even if the study had found an increase in brain tumor rates," cell phones may not be "to blame," because "lots of other trends" can "help explain changes in disease rates."

        The Los Angeles Times (12/3, Roan) "Booster Shots" blog reported that "the study is important, because it mirrors the international Interphone case-control studies which have shown no overall increase in glioma or meningioma rates." The authors of the current study pointed out, however, that "the Interphone studies...'leave open the possibility of a small to moderate increased risk for glioma among the heaviest users of mobile phones.'"

        Their own analysis of "data on 60,000 people diagnosed with glioma and meningioma in Denmark, Finland, Norway, and Sweden" revealed that "the incidence of brain tumors...were stable, decreased, or gradually increased, starting before cell phones became popular," HealthDay (12/3, Reinberg) reported. They also found "no change in incidence of brain tumors...during a period of rapid increase in cell phone usage."

        The researchers argued that "if cell phones were a significant cause of brain tumors after five to 10 years of usage," the "incidence rates should show an acceleration in brain tumors relative to earlier trends," MedPage Today (12/3, Gever) reported. They speculated that "increased brain cancer rates may simply reflect an increase in diagnoses from new imaging technologies."

        WebMD (12/3, Hendrick) reported that the authors mentioned other "reasons for their finding," including that "the induction period relating cell phone use to brain tumors exceeds five to 10 years," or that "the increased risk is restricted to subgroups of brain tumors or cell phone users." Reuters (12/3, Fox) also covered the story.

Lack of diabetes knowledge in USA

Moral of the story: go online and look it up if you don't know anything about it. It can kill you.

Source: AMA Morning Rounds 11/3/09

Useful Information:
Your Doctor!
http://www.diabetes.org/
http://diabetes.webmd.com/
http://www.nlm.nih.gov/medlineplus/diabetes.html

Survey suggests many Americans may lack basic knowledge about diabetes.

HealthDay (11/2, Gordon) reported that, according to a survey by the American Diabetes Association, "many Americans lack basic knowledge about" diabetes, a disease "responsible for more deaths each year in the" US "than breast cancer and AIDS combined." The ADA survey "included 2,081 men and women from across the" US, "285 of" whom "been diagnosed with diabetes," finding that one common myth "is that sugar and overeating cause diabetes." However, type 1 diabetes is "an autoimmune disease in which the body mistakenly attacks the islet cells in the pancreas, destroying the body's ability to produce insulin," and "genetics and other unknown factors -- not just diet -- can be contributors" to type 2 diabetes.

BPA

Moral of the story: BPA is found in more products than originally believed, and there is mounting pressure to do something about it. If you know a product has BPA in it, especially if it is for kids, and there are alternatives, use them. Research is starting on this and the FDA may get involved, so stay tuned for an update. BPA = Bad

Source: AMA Morning Rounds

Variety of foods found to contain dangerous levels of BPA.

The Los Angeles Times (11/3, Zajac) reports that a survey released Monday by the consumer advocacy group Consumers Union "has found measurable levels of the chemical additive bisphenol A (BPA) across a range of foods, including some that were labeled 'BPA free.'" According to the analysis, "children eating multiple servings of some of the tested food could get doses of BPA 'near levels that have caused adverse effects in several animal studies.'" In a letter to FDA Commissioner Margaret Hamburg, the group said that the findings "bolster the case for banning BPA from use in materials that come in contact with food and beverages." Although the FDA "had no immediate comment," a spokesman "noted that a review of existing evidence about BPA's health effects was nearly completed and that Hamburg would 'make a decision how to proceed' by the end of the month."

Kristof warns of BPA dangers.

In his column in the New York Times (11/8, WK10), Nicholas Kristof noted a recent report by Consumer Reports in which they "tested an array of brand-name canned foods...and found BPA in almost all of them." He asks, "Should we be alarmed? The chemical industry doesn't think so." But "more than 200...studies have shown links between low doses of BPA and adverse health effects." Recently the Endocrine Society "warned...that these kinds of abnormalities may be a consequence of the rise of endocrine-disrupting chemicals, and it specifically called on regulators to re-evaluate BPA." And now the FDA -- which "has generally been asleep at the wheel -- is studying the issue again. Bills are also pending in Congress to ban BPA from food and beverage containers." On BPA, Kristof decided, "While the evidence isn't conclusive, it justifies precautions."

NIH grants $30 million to BPA research.

USA Today (10/29, Szabo) reports, "The National Institutes of Health will devote $30 million to study the safety of bisphenol A, or BPA, an estrogen-like chemical used in many plastics." Robin Mackar, spokeswoman for the National Institute of Environmental Health Sciences (NIEHS), said that "almost half of that money comes from the economic stimulus bill." Previously, animal studies linked "BPA with infertility, weight gain, behavioral changes, early onset puberty, prostate and breast cancer and diabetes. New research will focus on low-dose exposures to BPA and effects on behavior, obesity, diabetes, reproductive disorders, asthma, cardiovascular diseases and various cancers." NIEHS director Linda Burnbaum said, "We know that many people are concerned about bisphenol A and we want to support the best science we can to provide the answers."

Moral of the story: The WHO and others are looking at how the different strategies will affect the health of the public. Overall, it is likely to improve health (and drive down health care costs).

Source: WHO, http://www.who.int/globalchange/news/2009/greenhouse_25112009/en/index.html

25 November 2009
London and Washington D.C.

Public health impact of strategies to reduce greenhouse gas emissions

Different mitigation strategies are likely to have different implications for health. For example, how much would a move to low carbon sources of power improve public health by reducing air pollution? What could be the health benefits of encouraging people to cycle and walk rather than take the car? Could improved biomass cook stoves in developing countries have impacts on child and maternal health as well as greenhouse gas emissions?

In the first major study of its kind, an international team of researchers in collaboration with WHO, have been modelling the health effects of different policies to reduce greenhouse gas emissions in high and low-income countries. Case studies focus on four key sectors: power generation, transport, household energy, and food and agriculture. The study findings will be published in a special issue in the Lancet in November 2009.

The results were launched at events in London and Washington on 25 November 2009.

Related links

- Dr Margaret Chan, editorial - Cutting Carbon, Improving Health [pdf 91kb]

- The Health benefits of tackling climate change
An executive summary for the Lancet series

- The Wellcome Trust

- The London School of Hygiene & Tropical Medicine

Keeping cholesterol in check may reduce prostate cancer risk, studies suggest.

Moral of the story: So many reasons to keep your heart healthy. Cholesterol is now linked to prostate cancer.

Source: AMA Morning Rounds 11/4/09

Keeping cholesterol in check may reduce prostate cancer risk, studies suggest.

The AP (11/4, Marchione) reports, "Men may protect more than their hearts if they keep cholesterol in line: Their chances of getting aggressive prostate cancer may be lower." Scientists at two institutions detailed the research that led them to that conclusion in Cancer Epidemiology Biomarkers & Prevention. Even though the papers "are not definitive and have some weaknesses," they do "fit with plenty of other science suggesting that limiting fats in the bloodstream can lessen cancer risk."

HealthDay (11/3, Edelson) reported that NCI investigators reviewed "data from a study that has followed more than 29,000 Finnish men for 18 years," finding that "cholesterol levels below the generally recommended 200 milligrams per deciliter were associated with an 18 percent higher overall risk of cancer."

Generic drug use can help save money

Moral of the story: Generics are low cost, and THE EXACT SAME THING as name brand pharmaceuticals. This is the obvious way to save, but there are also cheaper options within the same family of drug that work just as well, or as well as you may need. While physicians don't have all the answers, they do have access to extensive drug information they can use to help you save.

Source: AMA Morning Rounds 11/5/09

Asking physicians about generic drugs seen as key to cutting prescription costs.

The AP (11/5, Perrone) reports, "The senior advocacy group AARP reports that prices for the most popular drugs rose 8.7 percent on average last year, more than twice the rate of inflation." And "last year, pharmaceutical companies spent more than $4 billion urging patients like you to 'ask your doctor' about their drugs. But, if you want a prescription that won't empty your wallet, while still keeping you well, you might start asking your doctor about drugs you don't see on TV." For instance, "AstraZeneca's acid reflux drug Nexium [esomeprazole magnesium] -- the 'purple pill' -- was the second best-selling drug in the US last year, with a hefty price tag of about $215 per month. But, a drug from the same family, that works the same way, is available over-the-counter for about $20 a month as Prilosec [omeprazole]."

Early morning colonoscopies may detect more polyps than those done later.

Moral of the story: Thinking about that nasty colonoscopy you need soon? Better schedule it for the morning, it will be more effective.

Source: AMA Morning Rounds 11/9/09

Early morning colonoscopies may detect more polyps than those done later.

HealthDay (11/6, Preidt) reported, "Early morning colonoscopies detect more polyps than colon cancer screenings done later in the day," according to a study published in the Nov. issue of Clinical Gastroenterology and Hepatology. The study of "477 people who had colonoscopies in a one-year span" showed that screenings "that started at 8:30 a.m. or earlier detected 27 percent more polyps per patient than colonoscopies performed at a later time."

Furthermore, researchers appeared to find "fewer polyps...hour by hour as the day progresses," WebMD (11/6, Hendrick) reported. The investigators speculated that "more polyps are found early in the day" because of "better bowel preparation the night before by patients," and "fatigue of physicians and assistants."

Death and Dying

Editor's Choice
Death and dying

Jane Smith, deputy editor, BMJ

jsmith@bmj.com

The main theme of this week’s issue is death and dying, a subject where the public and the private jostle uncomfortably. This week’s BMJ contains several articles that add to the debate about public policy and throw light on to the nuances of private thoughts and behaviour.

Dutch law on euthanasia requires that the doctor must be convinced that the patient who requests euthanasia has unbearable suffering. In their qualitative study H R W Pasman and colleagues explored what this concept meant for patients whose request for euthanasia was either refused or granted but not carried out, and for their doctors (doi:10.1136/bmj.b4362). They found that doctors had a narrower view of unbearable suffering than patients, tending to concentrate on physical suffering. In some cases doctors thought that the suffering was not unbearable because patients behaved in a way that didn’t seem compatible with unbearable suffering, such as reading books. Patients emphasised psychosocial suffering, such as fear of dependence, not being able to do ordinary things, and deterioration. < P> This difference is illustrated in Alex Paton’s moving account of the death of his wife (doi:10.1136/bmj.b4982): "She wanted to die, and we realised she meant it...a keen plantswoman, she said there was no point in living if she could no longer garden." Yet she was resuscitated in spite of an advance directive, and her family signed her out of hospital against medical advice, to die at home. Paton also argues for care with words, preferring "euthanasia...the bringing about of a gentle and easy death" to "assisted suicide...which continues the myth that euthanasia is a nasty business."

Another article in this week’s issue shows how private acts and thoughts can reach the public stage. Debbie Purdy writes in her patient’s journey about having multiple sclerosis and how she has come to terms with increasing loss of function (doi:10.1136/bmj.b4470). Her main point is the importance of making her "own choices about what constitutes an acceptable quality of life" rather than having others, including professionals, make assumptions about what that is. She says it was this desire that led her to campaign to ensure that "assisted death is part of the support available to patients who are suffering unbearably"—alluding to her very public fight to be allowed to control the manner of her dying. Debbie Purdy hasn’t managed to change English law to allow assisted dying, but as a result of her court cases the House of Lords directed the Director of Public Prosecutions to publish his guidance on the factors that would prompt or argue against prosecution in individual cases.

That guidance was published in September and is now being consulted on. Richard Huxtable and Karen Forbes discuss some of the imponderables in their editorial (doi:10.1136/bmj.b4900), concluding that this guidance has not really clarified things for doctors or made end of life decisions and discussions easier. They fear "stealth lawmaking," where the law slides "from an apparent prohibition to a de facto position of permission."

Yet end of life decisions are already unstraightforward, as the ethical debate led by Stephen Bonner and colleagues illustrates (doi:10.1136/bmj.b4667). They were faced with a woman, unconscious as a result of attempted suicide, who had written an advance directive five years earlier saying she did not want life sustaining medical treatment. Should the directive be followed or should the emergency department staff initiate life saving treatment? Read the article, and its commentaries, to find out what they did, and what others think about it.

Cite this as: BMJ 2009;339:b5044

Non-profit reports breakthrough in understanding chronic fatigue syndrome.

Moral of the story: A virus might be responsible for Chronic Fatigue Syndrome.

Source: AMA Morning Rounds 11/12/09

Non-profit reports breakthrough in understanding chronic fatigue syndrome.

The New York Times (11/12, SPG8, Grady) reports that the Whittemore Peterson Institute for Neuro-Immune Disease, a nonprofit in Reno, recently had a breakthrough in understanding chronic fatigue syndrome. The Institute was founded by Harvey and Annette Whittemore "out of desperation to find answers" for their daughters condition. Instead of "doling out money to far-flung researchers," the Whittemores "wanted to employ their own scientists who would be devoted full time to the cause." They hired Dr. Judy A. Mikovits, a virus expert from the National Cancer Institute, who discovered that a retrovirus called XMRV, "may cause or at least contribute to chronic fatigue syndrome." Other doctors have "emphasized that more research was needed," and the Centers for Disease Control and Prevention will "try to replicate the XMRV findings." The CDC's Dr. William C. Reeves, "has said that he does not expect to find the virus in blood samples from patients."

Scientists find link between gut microbiota, diet, and weight gain.

Moral of the story: What you eat matters. A lot. The link between diet and weight is rather complicated and taking out fats and sugars can help to change the fauna of your stomach to help you lose weight. Chewing gum and breastfeeding help shed pounds too.

Source: AMA Morning Rounds 11/12/09

Scientists find link between gut microbiota, diet, and weight gain.

The Los Angeles Times (11/12, Maugh) reported, "A high-fat, high-sugar diet does more than pump calories into your body. It also alters the composition of bacteria in your intestines, making it easier to gain weight and harder to lose it," according to a new paper in Science Translational Medicine. What's more, the "changeover can happen in as little as 24 hours."

Technically known "as the gut microbiota," intestinal "microbes perform a vast range of vital functions, including helping to regulate the calories the body obtains from food and stores as fat," according to Time (11/12, Park). Through earlier experiments, however, Washington University researchers found that the "gut microbiota of obese mice...have significantly more of one main type of bacteria called Firmicutes, and fewer of another kind called Bacteroidetes (both types populate human guts as well); in normal mice, the distribution is the opposite." With that in mind, the team devised a new study in which human microbiota was used "to colonize mice guts." The rodents were then fed "equivalents of typical human diets to see how their microbes -- and their weight -- might change."

Lead investigator Dr. Jeffrey I. Gordon told HealthDay (11/11, Gordon) that when his team "switched these humanized animals [from a low-fat] to a junk-food diet, high in fat with lots of simple sugars, the structure of the microbial community changed dramatically and very rapidly." What's more, the mice "became obese on Western diets." Investigators also discovered that "the microbiota passes from generation to generation."

Study points to chewing gum as weight loss aid. The Washington Post (11/11, Huget) reports that for anybody trying to lose weight, "taking up gum-chewing might not be a bad idea," as "there's actually a bit of scientific evidence showing that chewing gum helps fight fat in a number of ways." The research, sponsored by the Wrigley Science Institute, has suggested "that chewing gum may help reduce cravings, particularly for sweet snacks, and spur people to cut their daily intake by about 50 calories." The findings were presented at the annual scientific meeting of the Obesity Society last month, and "showed that gum-chewing people consumed 67 fewer calories at lunch and didn't compensate by eating more later in the day."

Breastfeeding's effect on postpartum weight discussed. The New York Times (11/12, E3, Louis) reports, "That breastfeeding gives mothers an edge shedding baby weight has long been suspected." A Danish study published last year showed that "the more a mother breast-feeds, the less weight she retains six months after birth." But, other research has shown that "breast-feeders don't necessarily shed fat quicker than women who feed their newborns formula." Meanwhile, "a small double-blind randomized study conducted at Cincinnati Children's Hospital Medical Center found that non-lactating women lost more body fat than lactating women at six months, and at a faster rate." Still, "others suggest that women who view breast-feeding as a dieting tool may have 'deeper body issues.'" One expert said "she was troubled by our cultural preoccupation with postpartum weight."

Dark chocolate may lower stress hormone levels.

Moral of the story: Every wonder why dark chocolate makes you feel better? It changes your stress hormone metabolism. Cool.

Source: AMA Morning Rounds 11/13/09

Dark chocolate may lower stress hormone levels.

HealthDay (11/12, Dotinga) reported that "a dose of dark chocolate could cheer you right up by lowering your stress hormone levels," according to a study published online in the Journal of Proteome Research. After following 30 "volunteers who said they were highly stressed," researchers found that "a daily consumption of 40 grams [1.4 ounces] during a period of two weeks is sufficient to modify the metabolism of healthy human volunteers" by helping "correct other imbalances in the body that are related to stress." Reuters (11/13, Goldsmith) and also covers the story.