CRP? Fuggedaboutit.

Big news from JAMA today: High C-reactive protein (CRP) levels don't appear to cause heart disease. Cardiologists have debated for years about whether patients should have their CRP levels routinely screened as a risk factor for CV disease, and whether CRP should be targeted therapeutically. The authors of the JAMA genetics study say nope:

"In summary, our mendelian randomization study of more than 28,000 cases and 100,000 controls found no association of variants in the CRP locus and CHD, arguing against a causal role for CRP in atherosclerosis. Moreover, this study suggests that development of therapeutic strategies targeting specific reductions in plasma levels of CRP are unlikely to be fruitful," the researchers write in their article.

I'm sure this study won't be the final word on the subject, but it's a strong argument toward trending back to the basics: Using BP levels, obesity, smoking, cholesterol and family history as risk factors for CHD. Plus ca change...

Labels: c-reactive protein, heart disease

More

posted by Jessica Berthold at 9:46 AM   0 Comments

Medical news of the obvious

We've noticed a slowdown in studies that qualify for our Weekly e-newsletter in the last few weeks, and it seems the sluggish study season now applies to obvious news as well.

Yes, for the first time in the history of Medical News of the Obvious, we didn't find anything last week that wasn't actually sort of reasonable. But, hey, we'd love it if we were wrong about this, so feel free to toss some studies our way if you feel we've missed something eye-rollingly obvious.

Labels: medical news of the obvious

More

posted by Jessica Berthold at 10:05 AM   0 Comments

If they don't give you the flu...

It's good news for people who like to cuddle wild animals. The CDC's Advisory Committee on Immunization Practices has determined that four, rather than five, rabies shots are enough to protect an exposed human, according to an AP report.

Apparently (bet you didn't know this either) there's been a nationwide shortage of rabies vaccine, so the experts are hoping that reducing the number of shots will help to alleviate that problem. On the other hand, Novartis, which charges $100 to $200 per shot, expressed concern about the recommendation and hasn't announced any plans to change their labeling info from 5 shots to 4.

Maybe you can offer that extra shot to your friendly neighborhood bat. They seem to be having a rough year.

Labels: rabies, vaccination

More

posted by Stacey Butterfield at 2:41 PM   0 Comments

One more thing to learn

As part of ACP Internist's standard profile feature, we ask physicians "What's one thing you wish you had learned in medical school?" Their answers are usually something about communicating with patients or accepting people's inability to change.

But an article on Slate.com makes the argument that what's missing from medical education is health policy. The authors report on how some schools are trying change the system, so that students actually know what a "third-party payer" is by the time they graduate.

The article may exaggerate students' ignorance a little. I've certainly seen a lot of med students/policy activists at ACP's Leadership Day. But spreading the knowledge more widely sounds like a good thing. Only one problem: what classes will these health policy lessons replace? Maybe, to be more useful, we should rephrase our profile question. What do you wish you hadn't learned in med school?

Labels: health policy, medical education

More

posted by Stacey Butterfield at 3:20 PM   0 Comments

The doughnut hole will need a new name

Yesterday, pharmaceutical companies agreed to shrink the Medicare doughnut hole by offering a 50% discount on meds purchased while a patient in the hole. The full price of the medicines will continue to count toward getting back out the other side. Given this development, the gap in coverage is going to need a new name to convey its smaller size--maybe the icing in the eclair or the Oreo filling?

More seriously, the most interesting thing about this change is how it benefits everyone involved. The advantages to patients are obvious. But the seemingly altruistic move by big pharma will probably benefit their bottom line, too, according to an analyst interviewed by the New York Times.

"'Because of the discounts,' he said, 'Medicare beneficiaries are likely to continue filling prescriptions in the doughnut hole, whereas in the past many stopped taking their medications because the drugs were unaffordable to them.'"

It makes you wonder why they didn't do it sooner. Was this strategy reserved until it would have the biggest possible PR impact as a contribution to health reform?

And if the talk of doughnuts and Oreos has made you desperately crave some junk food, my apologies. The NYT also has an interesting article about this psychological torment.

Labels: diet, drug companies, health care reform

More

posted by Stacey Butterfield at 2:30 PM   0 Comments

Medical news of the obvious

It's best not to get holes in one's surgical gloves in the middle of a procedure, as this leads to a higher risk of infection for the patient, the Archives of Surgery reports in a study about the effect of ripped gloves. "Pathogens can still be transmitted through contact with skin or blood," quoth the press release. Which is, perhaps, why the surgeons put on the gloves in the first place?

Teens often stop drinking milk after they leave home. A study (Eating Among Teens, or EAT) in the July/August issue of the Journal of Nutrition Education and Behavior notes that the transition from high school to young adulthood often triggers a dramatic drop in calcium intake--a problem, since bones are still developing until roughly age 30. The authors don't address whether the drop is linked to leaving the family meal table (typically with limited, healthy choices) for the cafeteria smorgasboard or solo apartment (abundant or limited choices, but rarely healthy). They suggest fixing the problem by using peer pressure, so it becomes cooler to swig a carton of milk than a bottle of beer ("c'mon, have another one, it won't hurt you--really!")

People who live close to fast-food restaurants and convenience stores tend to eat fattening food. Researchers at the University of Alberta studied associations between the "retail food environmental index" and levels of obesity, boldly concluding that people are more likely to eat healthy food if they actually have easy access to it (i.e., by living close to supermarkets that sell more than burgers, fries and super-size sodas). Writing in BioMed Central's BMC Public Health, researchers make the astute observation: "Your local food environment can affect your weight."

Contributors: Jessica Berthold, Janet Colwell

Labels: medical news of the obvious

More

posted by Jessica Berthold at 9:00 AM   0 Comments

ADHD drug study swerves way off course

Recently, parents of children with ADHD were subjected to some alarming headlines warning of a possible association between the use of stimulant medications for the disorder and sudden cardiac death.

The study, published in the American Journal of Psychiatry, seemed to carry some weight and even prompted a communication from the FDA (who provided funding, along with the National Institute of Mental Health), but pay close attention to the study's many limitations. Consider the unusual design of the study: researchers compared two groups of healthy children using stimulant medications. Half died suddenly in car accidents while the other half died suddenly from other causes. Because fewer kids in the car accident group died than in the other causes group (10 vs. 2), while taking the drugs, researchers surmised that there may be an association betwen the drugs and sudden death in healthy children. Huh?

And how did the researchers determine whether the deceased children were taking stimulants at time of death? They simply asked the grief-stricken parents, often years after the fact -- that's one of the "limitations" mentioned by the FDA. Another is the very real possibility that a child's death from unexplained causes prompted an autopsy investigating medication use. According tothe FDA, "the low frequency of stimulant use in both groups, as well as possible differences in the type of post-mortem inquiry, could have a profound biasing effect on the results." No kidding.

It's bewildering as to how this study even got funded. With so many problems with the methodology and possibilities for biases, the only effect of publicizing the results appears to be stirring up needless panic in the many parents whose children are being treated for ADHD.

Labels: adhd, FDA

More

posted by Janet Colwell at 1:48 PM   2 Comments