Only Lowest Ritalin10 mg Dose Associated with Academic Improvement in Two Studies: A 6-week DB PC study of 45 ADHD children given 10 mg, 20 mg, and 30 mg per day found that overall academic improvement occurred with the lowest dose and that no additional improvement came with increasing doses. Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Evans SW, Pelham WE, et al. Exp Clin Psychopharmacol. 2001 May;9(2):163-75. A replication with 36 children ages 5-6 found the same thing at 0.3 and 0.6/mg/kg. J Am Acad Child Adolesc Psychiatry. 2005 Mar;44(3):249-257. Ed: These studies focused on short-term learning, i.e., daily quizzes and in-class behavior. Whether there is any long-term learning boost remains to be seen.  Other research suggests that stimulants do not improve long-term academic performance. For more, see Stimulants for ADHD.

Fish Oil May Have Lowered Impulsivity and Aggression in Grade School Girls: In a DB PC study of 166 children ages 9-12, fish oil group took fish oil-fortified foods (bread, sausage and spaghetti) equivalent to 2 capsules of fish oil per day for 3 months. Physical aggression in girls increased significantly (median: 13 to 15) in the control group and did not change (13 to 13) in the fish oil group (P=.008). No significant changes in physical aggression occurred in boys. Impulsivity of girls assessed by parents/guardians using the diagnostic criteria for attention deficit/hyperactivity disorder of DSM-IV was reduced in the fish oil group (1 to 0) with a significant (P=.008) intergroup difference from the control group (1 to 1). The effect of fish oil on physical aggression in schoolchildren - a randomized, double-blind, placebo-controlled trial. Itomura M, Hamazaki K, et al. Toyama Medical University, Japan. J Nutr Biochem. 2005 Mar;16(3):163-71. For more, see Fish Oil in ADHD.

Harvard Says Ritalin Helped Adult ADHD: In a 6-week DB PC study of 146 adults with DSM-IV ADHD, those given methylphenidate (1.1 mg/kg/day or 77 mg for a 154# male) had a marked reduction in ADHD symptoms of 76% vs. 19% for placebo. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Spencer T, Biederman J, et al. Massachusetts General-Harvard. Biol Psychiatry. 2005 Mar 1;57(5):456-63. Ed: I disagree with the stampede to prescribe Ritalin to huge numbers of adults. I don't agree with the standard listing of adult ADHD symptoms. Stimulants will make anyone focus and concentrate better while temporarily under the medication effect. However, this doesn't lead to any improvement in learning, since much of the learning is state-dependent and forgotten. Also, a 6-week study for what would be a many-year treatment doesn't make sense.  Child research suggests all of the benefit occurs in the first weeks of treatment and that long-term benefit is minor. Putting 5% of America's adult population on stimulants for a minor benefit seems misguided.  I'd like to see long-term research with randomized control groups. For more, see Adult ADHD.

Celiac Disease May Cause 3-4% of Osteoporosis: In a study of 840 patients, researchers found osteoporosis victims have a much higher rate of celiac diase. 3-4% of osteoporosis victims had it due to celiac disease, an intestinal disease caused by an allergy to gluten, a wheat protein. The diarrheal type disease makes them unable to absorb normal amounts of calcium and vitamin D. William Stenson, Washington University, St. Louis. Treatment is a gluten-free diet. Arch Int Med 3/05. For more, see Osteoporosis.

No Increased Risk of Stroke With Atypical Antipsychotics Found: In a population-based retrospective study of 32,710 older adults (< or = 65 years) with dementia (17,845 given an atypical antipsychotic, 14,865 a traditional antipsychotic), there was no significant increase in risk of ischemic stroke compared with those receiving typical antipsychotics (adjusted hazard ratio 1.01); this included risperidone, olanzapine, and quetiapine. Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. Gill SS, Rochon PA, et al. Toronto, ON, Canada. BMJ. 2005 Feb 26;330(7489):445. For more, see Strokes from Antipsychotics.

Aripiprazole (Abilify) Weight Loss vs. Olanzapine (Zyprexa) Weight Gain: In a DB study done by the makers of Abilify of 317 patients for 26 weeks, at the end of the study, patients on aripiprazole had lost 3 pounds vs. those on olanzapine had gained 9 pounds. The total cholesterol, high-density lipoprotein cholesterol, and triglycerides worsened with olanzapine. Psychiatric improvement was similar between the two. A comparison of weight change during treatment with olanzapine or aripiprazole: results from a randomized, double-blind study. McQuade RD, Stock E, et al. Otsuka America Pharmaceutical. J Clin Psychiatry. 2004;65 Suppl 18:47-56. For more, see Abilify.

Suicide Attempts Common: Depression, Smoking, Drugs Factors: Data from 3357 men and 4004 women ages 17-39 interviewed as a part of the Third National Health and Nutrition Examination Survey, 1988-1994 found the prevalence of lifetime attempted suicides was 7.6% in women and 3.7% in men. In men, low income and smoking were associated with attempted suicide, while attempted suicide in women was associated with poor self-evaluated health, low educational attainment, and drug use. A history of medical and psychiatric illnesses was associated with attempted suicide in both genders, for cancer/pulmonary disease, OR=2.9 in men and 1.9 in women; for major depressive disorder, OR=9.9 in men and 5.0 in women. Gender differences in risk factors for attempted suicide among young adults: findings from the Third National Health and Nutrition Examination Survey. Zhang J, McKeown RE, et al. University of South Carolina. Ann Epidemiol. 2005 Feb;15(2):167-74. For more, see Causes of Depression.

Depression Common in HCV Treatment: In 162 HCV-infected patients being treated with pegylated IFN alpha-2b (PEG IFN) plus weight-based (N = 86) versus standard dose (N = 76) ribavirin, depression scores were significantly increased by week 4 and remained elevated throughout the study. In all, 39% developed moderate to severe depressive symptoms at some point during PEG IFN/ribavirin therapy. Baseline depression scores predicted severity of depressive symptoms during PEG IFN/ribavirin treatment (p < .0001). Weight-based ribavirin treatment and history of depression were associated with increased likelihood of developing moderate to severe depressive symptoms (odds ratio [OR] = 2.7, and OR = 3.3, p < .01). epression during pegylated interferon-alpha plus ribavirin therapy: prevalence and prediction. Raison CL, Borisov AS, et al. Emory University. J Clin Psychiatry. 2005 Jan;66(1):41-8. For more, see Hepatitis C.

Cocaine Dependence: Neither Olanzapine nor Valproate nor L-Carnitine with CoQ10 Helped: In an 8-week DB PC study of 68 cocaine addicts using either olanzapine (10 mg/day), or valproate (1500 mg/day), or coenzyme Q10 (200 mg/day) and L-carnitine (500 mg/day) combination or placebo with all receiving individual cognitive behavioral counseling, none of the study medications were superior to placebo. A placebo-controlled screening trial of olanzapine, valproate, and coenzyme Q10/L-carnitine for the treatment of cocaine dependence. Reid MS, Casadonte P, et al. New York University. Addiction. 2005 Mar;100 Suppl 1:43-57. Ed: Medications aren't of much value for cocaine addiction. We need to eliminate illicit drugs from America and the world. Prevention is the answer. Treatment is OK, but treatment has never stopped a drug epidemic anywhere in the world. For more, see Stimulant Dependence. 

Interferon Beta-1a Weekly No Benefit for Relapses of Multiple Sclerosis in 3 Year Study: At a variety of doses an using the standard weekly frequency of injections for relapsing-remitting multiple sclerosis, once weekly IFN beta-1a, particularly at the 44 mcg highest dose, induced a significant MRI, but not relapse, effect, compared with placebo. In contrast to the significant effect with three-times-weekly dosing of subcutaneous IFN beta-1a, once-weekly dosing was not of benefit. Randomized study of once-weekly interferon beta-1la therapy in relapsing multiple sclerosis: three-year data from the OWIMS study. Freedman MS, Francis GS, et al. University of British Columbia. Mult Scler. 2005 Feb;11(1):41-5.

Interferon Beta-1a Every Other Day Did Not Stop Progression of Multiple Sclerosis in Huge 3-Year Study: In a 3-year DB PC study of 939 adults with secondary progressive multiple sclerosis (SPMS), those given IFNbeta-1b (250 microg or 160 microg/m2 body surface area) every other day showed no significant difference in time to progression of EDSS scores. IFNbeta-1b treatment resulted in improvement on secondary outcome measures involving clinical relapses, newly active MRI lesions, and accumulated burden of disease on T2-weighted MRI. Interferon beta-1b in secondary progressive MS: results from a 3-year controlled study. Panitch H, Miller A, et al. University of Vermont. Neurology. 2004 Nov 23;63(10):1788-95.

Interferon and Glatiramer Not at All Cost-Effective for Multiple Sclerosis According to Harvard Researchers: Treatments for newly diagnosed nonprimary progressive MS with interferon beta-1a, interferon beta-1b, and glatiramer acetate, assuming a 10-year treatment duration found that interferon beta-1a yielded the largest gain with an incremental cost-effectiveness ratio of $2,200,000/quality-adjusted life year added for women and $1,800,000/QALY for men, compared with no treatment. For a 5-year treatment duration, a "no treatment" strategy yielded more quality-adjusted life years than any of the treatment strategies. Cost-effectiveness ratios were similar for all three immunomodulatory treatments evaluated. Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis. Prosser LA, Kuntz KM, et al. Department of Ambulatory Care and Prevention, Harvard. Value Health. 2004 Sep-Oct;7(5):554-68.

Vitamin D: Fetuses Developing During Sunny Months Have Less MS: In a study of 17,874 Canadian, 11,502 British, and 12,700 Danish and Swedish patients with multiple sclerosis, fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. Timing of birth and risk of multiple sclerosis: population based study. Willer CJ, Dyment DA, et al. University of Michigan. BMJ. 2005 Jan 15;330(7483):120. Ed: Infants born in November would have developed during the months of greatest sunlight and therefore highest vitamin D levels in the mothers, especially in the 4th to 6th months which are critical for nervous system development.  May is the opposite. Vitamin D very likely helps already established MS, but has never been researched.

Fatigue Sign of On-Going Brain Atrophy: In a study of 134 patients previously enrolled in a 2-year clinical trial of interferon beta-1a and re-evaluated 8 years after randomization into the trial, there was a clear relationship between fatigue and brain atrophy which was independent of changes in disability, mood, or other MRI characteristics. Fatigue appears linked to destructive pathologic processes in RRMS patients. Association of fatigue and brain atrophy in multiple sclerosis. Marrie RA, Fisher E, et al. Cleveland Clinic. J Neurol Sci. 2005 Feb 15;228(2):161-6. Ed: Acetyl-L-carnitine is good for MS fatigue and may help treat the underlying disease. For more, see Multiple Sclerosis.

St. John's Wort Did as Well as Paroxetine (Paxil) for Moderate to Severe Depression: In a 6-week DB PC study of 251 adults with acute Major Depression comparing hypericum 300 mg three times a day to paroxetine 20 mg once a day with a doubling of the doses after two weeks if necessary, the HAMD depression scores decreased by 57% with hypericum and 45% with paroxetine. Side-effects were twice as high with paroxetine. This is the second study to show hypericum as good as a standard anti-depressant for severe depression. Significantly more showed remission with hypericum (50% vs. 35%). Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. A Szegedi et al. Karlsruhe. BMJ 3/5/2005;330:503

St. John's Wort Did as Well as Sertraline (Zoloft) for Depression: In a 24-week DB PC study of 241 adults with moderate depressive disorder, 50 mg sertraline or 612 mg hypericum extract were equally effective with HAMD depression scores decreasing 22.0 points for hypericum and 22.1 points for sertraline to 8.3 (hypericum) and 8.1 points (sertraline). Side-effects were less with hypericum. Efficacy and Tolerability of Hypericum Extract STW3 in Long-term Treatment with a Once-daily Dosage in Comparison with Sertraline. Gastpar M, Singer A, Zeller K. University of Essen, Germany. Pharmacopsychiatry. 2005 Mar;38(2):78-86. For more, see St. John's Wort for Depression.

Folate and B-12 Reduce Hip Fractures in Stroke Victims: In a 2-year DB PC study of 628 Japanese stroke victims over age 64 with residual hemiplegia at least 1 year following first ischemic stroke, those taking 5 mg of folate and 1500 microg of mecobalamin had homocysteine levels decrease by 38% vs. increased by 31% with placebo (P<.001). The number of hip fractures per 1000 patient-years was 10 vs. 43 for placebo  (P<.001). One hip fracture was prevented for every 14 treated or roughly $2,000 per hip fracture prevented by my calculations. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. Sato Y, Honda Y, et al. Tagawa, Japan. JAMA. 2005 Mar 2;293(9):1082-8. For more, see Osteoporosis.

Escitalopram (Lexapro) Small Benefit for Social Anxiety: In a 12-week DB PC study of 358 adults with generalised social anxiety disorder, 10-20 mg escitalopram resulted in slightly more responders than placebo (54% v. 39%; P<0.01). Escitalopram in the treatment of social anxiety disorder: Randomised, placebo-controlled, flexible-dosage study. Kasper S, Stein DJ, Loft H, Nil R. University of Vienna. Br J Psychiatry. 2005 Mar;186:222-6. Ed: This means seven need to be treated for every one who responds.  That's not very impressive.  Many older medications do just as well or better without the high cost of Lexapro. For more, see Social Anxiety.

DHEA Up Dramatically in Schizophrenics: Plasma DHEA were strongly elevated in 23 schizophrenic patients (91 nmol/l) compared to 23 controls (24 nmol/l) (p<0.0001). Plasma dehydroepiandrosterone levels are strongly increased in schizophrenia. Michele F, Caltagirone C, et al. University of Rome, Italy. J Psychiatr Res. 2005 May;39(3):267-73. Ed: This is a very small study, but an unexpected finding needing to be replicated in a larger study. For more, see Biochemistry of Schizophrenia.

Over 80% of Elderly Over 80 Showed Evidence of Alzheimer's Damage: In a long-term follow-up of 180 elderly Catholic clergy, at the time of death, 37 had mild cognitive impairment, 83 had dementia, and 60 had no cognitive difficulties. Of the 37 with mild cognitive impairment, 23 showed brain pathology consistent with probable or definite Alzheimer's disease, and 12 had areas of dead brain tissue due to loss of blood supply. Of the 60 without cognitive impairment, 28 showed evidence of probable or definite Alzheimer's disease. One third of the group, whose average was more than 80 years, did not experience cognitive decline over several years of follow-up, despite having a significant amount of Alzheimer's disease damage. David A. Bennett, Rush Alzheimer's Disease Center, Chicago. Reuters Health NY 3/8/05. For more, see Alzheimer's.

Smoking But Not Past Smoking Causes Depression: In a 3, 5, and 10-year follow-up of young adults, current daily smoking, but not past smoking, was associated with an 82% increase in subsequent occurrence of suicidal thoughts or attempts, independent of prior depression and substance use disorders (OR = 1.82). Smoking and the risk of suicidal behavior: a prospective study of a community sample. Breslau N, Schultz LR, et al. Michigan State University. Arch Gen Psychiatry. 2005 Mar;62(3):328-34. For more, see Causes of Depression.

Death: Depression Linked to Marked Increase in Death in Elderly: In a prospective, community-based study of 5632 Italians, 65 years and older, recruited from the demographic registries, depressive symptoms using the Geriatric Depression Scale were associated with a later 66% higher incidence of fatal and nonfatal heart problems, a 149% higher cardiovascular mortality in men, and with a 102% higher total mortality in men and 43% for women at the 4-year follow-up assessment after adjusting for a vast array of potential confounding variables, including major chronic conditions. Depressive symptoms and development of coronary heart disease events: the italian longitudinal study on aging. Marzari C, Maggi S, et al. University of Padua, Italy. J Gerontol A Biol Sci Med Sci. 2005 Jan;60(1):85-92. For more, see Harm of Depression.

Elderly: Duloxetine (Cymbalta) Better than Placebo; Side-Effects Common: In an industry DB PC 9-week study of 90 adults over age 54, duloxetine 60 mg/d had a 44% rate of remission vs. 16% with placebo. Side-effects requiring discontinuation occurred in 21% with duloxetine vs. 7% with placebo. Pain symptoms also decreased. Duloxetine for the treatment of major depressive disorder in older patients. Nelson JC, Wohlreich MM, et al. Eli Lilly Co. Am J Geriatr Psychiatry. 2005 Mar;13(3):227-35. For more, see Cymbalta.

Telomeres Shorter with MAOA Polymorphisms: Telomere shortening and increased MAOA gene activity both occur with aging. In a stratified random household sample of 433 adults, their telomere lengths were distributed (6.4-11.63 kb). The rate of shortening per year was 69 base pairs, and the gender difference in length was not significantly different. The lognormal distribution of telomere lengths was linear. The high-activity allele of the MAOA promoter polymorphisms were negatively associated with telomere length (P=0.013). Telomeric length varies with age and polymorphisms of the MAOA gene promoter in peripheral blood cells obtained from a community in Taiwan. Lung FW, Fan PL, et al. National Cheng-Kung University, Tainan, Taiwan. Psychiatr Genet. 2005 Mar;15(1):31-35. Ed: It's amazing what they can measure now. For more, see Longevity.

Muscle Soreness from Exercising Not Helped: In a DB PC crossover study of 23 young adults doing exhaustive eccentric exercise of both the right and left elbow flexor muscle groups, those wearing a 350G magnet for 5 consecutive days did not better than for 5 days wearing a placebo device in anthropometric measurements, perceived discomfort, and muscle force production. Static magnetic fields neither prevent nor diminish symptoms and signs of delayed onset muscle soreness. Reeser JC, Smith DT, et al. Arch Phys Med Rehabil. 2005 Mar;86(3):565-70. For more, see Magnets.

Panic Disorder Gene Study: Example of Genetic Array Testing: In a study of 127 patients with Panic Disorder and 146 healthy adults using Arrayed Primer Extension technology, researchers genotyped 90 single nucleotide polymorphisms in 21 candidate genes of serotonin, cholecystokinin, dopamine and opioid neurotransmitter systems. Eight single nucleotide polymorphism markers in eight genes displayed at least a nominal association with any of the studied PD phenotype subgroups. Several polymorphisms of cholecystokinin, serotonin and dopamine systems were associated with PD-all and/or PD-comorbid phenotypes, while pure PD was associated only with HTR2A receptor 102T-C (P=0.01) and DRD1 receptor -94G-A (P=0.02) polymorphisms. Haplotype analysis supported an association of the cholecystokinin gene TG haplotype with the PD-all group (P=0.04), whereas DRD1 receptor CAA and HTR2A receptor AT haplotypes were associated with a lower risk for PD-pure phenotype (P=0.03 and P=0.04, respectively). Association study of 90 candidate gene polymorphisms in panic disorder. Maron E, Nikopensius T, et al. University of Tartu, Estonia. Psychiatr Genet. 2005 Mar;15(1):17-24.  Ed: While this type of testing is totally useless at present for clinical practice because no studies exist telling physicians what to do with the results, the incredible ability to simultaneously test for so many abnormalities will definitely affect future treatment. v

Exercise May Be Important in Alzheimer's Depression: In a study of 224 Alzheimer's victims, 18% depressed patients took exercise compared with 44% of non-depressed [OR = 2.9, p = 0.001]. Independent predictors of depression were: lack of exercise (p < 0.001, OR = 3.4), taking cholinesterase inhibitors (p < 0.05, OR = 2.4) and having less involvement in hobbies or interests (p < 0.05, OR = 1.2). Relationship of exercise and other risk factors to depression of Alzheimer's disease: the LASER-AD study. Regan C, Katona C, et al. University College London, London, UK. Int J Geriatr Psychiatry. 2005 Feb 16;20(3):261-268. For more, see Exercise and Depression.

Heavy Fish Consumption No Added Benefit in Japan: In a 19-year follow-up of 8879 adults, there were 1745 deaths. Those who ate fish more than twice daily compared with those of subjects who ate 1 to 2 times weekly were 1% less like to die, no a significant difference ( OR =0.99 for all-cause, 1.26 for stroke, 0.92  for cerebral hemorrhage, 1.09  for cerebral infarction, and 0.91 (for coronary heart disease mortality). Association between fish consumption and all-cause and cause-specific mortality in Japan: NIPPON DATA80, 1980-99. Nakamura Y, Ueshima H, et al. Kyoto Women's University, Japan. Am J Med. 2005 Mar;118(3):239-45. For more, see Omega-3.

Gingivitis: Soft Water Linked to Harm: In a study of adults from the third National Health and Nutrition Examination Survey (NHANES III), those using soft water had a significantly higher risk of periodontitis (p < 0.05), adjusting for confounders. Smoking further increased this risk. Use of water 'softening and conditioning systems' significantly increases the risk of periodontitis: smoking considerations. Wood N, Johnson RB. University of Mississippi. J Periodontal Res. 2004 Dec;39(6):367-72. For more, see Hard Water.

Calcium Supplement Increases Skeletal Growth and Height in Teenage Boys: In a 13-month DB PC study of 143 boys ages 16-18, those taking calcium 1000 mg/d developed greater bone mineral content (BMC) of the whole-body (+1.3%, P = 0.02), lumbar spine (+2.5%, P = 0.004) and hip (total +2.3%, P = 0.01; neck +2.4%, P = 0.02; intertrochanter +2.7%, P = 0.01). This was associated with greater height (+0.4%, P = 0.0004, equivalent to 7 mm or over 1/4 inch), lean mass (+1.3%, P = 0.02) and lumbar spine bone area (+1.5%, P = 0.003). The increases in BMC diminished after size adjustment, suggesting that the intervention effect was mediated through an effect on growth. The BMC response at the intertrochanter was greater in subjects with high physical activity (+4.4%, P = 0.05). Calcium supplementation increases stature and bone mineral mass of 16-18 year old boys. Prentice A, Ginty F, et al. Institute of Child Health, London, UK. J Clin Endocrinol Metab. 2005 Mar 8. For more, see Calcium.

High Dose Atorvastatin (Lipitor) Made Absolutely No Difference on Rate of Death; May Even Increase Death: In a massive 4.9-year DB PC study of 10,001 patients with clinically evident coronary heart disease and LDL cholesterol levels of less than 130 mg, but no history of a heart attack, there was no difference in the rate of death between those on 10 mg or 80 mg of atorvastatin per day. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal heart attack, resuscitation after cardiac arrest, or fatal or nonfatal stroke. LDL cholesterol levels dropped to 77 mg/dl with 80 mg of atorvastatin and 101 mg/dl with 10 mg of atorvastatin. Persistent elevations in liver enzymes occurred in 0.2% with 10 mg and 1.2% with 80 mg of atorvastatin (P<0.001). "Major cardiovascular events" occurred in 8.7% receiving 80 mg vs. 10.9% with 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2% (P<0.001). Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease. Larosa JC, Grundy SM, et al. N Engl J Med. 2005 April 7. 

    Ed: The number of patients needing to take the high dose for 5 years to prevent one non-fatal event was 45. That means that $95,000 extra Lipitor had to be taken to prevent one non-fatal event. The news coverage of this study made it sound like the treatment was great and saved lives. The people behind this study slyly lumped together the fatal and non-fatal events, then headlined the word "died" ("died or suffered a stroke, heart attack or other major problem") to the news media as part of the events that were decreased by 22% without ever saying that fatal events weren't decreased at all!  In fact, deaths, especially cancer deaths, were actually non-significantly higher with the high dose treatment! Also, a 22% decrease sounds like a lot. In fact, only an extra 2% of the people over the 5 years were helped by the high dose. Only such a huge study was able to tease out such a small difference. 

    The Associated Press said, "The risk of strokes and heart attacks was cut more impressively than expected."  Since the impact was so small, I wonder what had been expected.  The PRNewswire-FirstCall, like AP, made no mention of the fact that deaths were not decreased.  It used the same wording as AP so as to leave the reader with the misimpression that lives were saved. Dr. Joseph Feczko, Pfizer's chief medical officer, crowed, “TNT is the very first study to demonstrate even greater cardiovascular benefits of lowering LDL beyond recommended guidelines with Lipitor 80 mg." He claims "outstanding benefits" and that this study was "critical new information" in Medical News Today which also made no mention of death rate. Only Healthday News told the lack of benefit on death and, even then, it was buried in the fluff.  No one bothered to calculate the money that would have to be spent on all that Lipitor.  www.WebMD.com made no mention that deaths were not reduced by Lipitor and gave readers the same misimpression. Only, investment sources, like www.Forbes.com  mentioned the problem with the increased death rate and shareholders dropped the value of the stock.

    If all of the work, expense, benefit, and side-effects of high dose Lipitor occurred to the same person, the doctor would be telling the patient, "Now, high dose Lipitor is really great.  If you will just take 80,000 pills and spend an extra $95,000 for them, I absolutely guarantee that they will prevent one non-fatal heart attack.  You will only have a 50% risk of getting high liver enzymes and a non-significantly higher risk of dying.  Is that great or what?" I think that most patients would ask if there were something better. Is America corrupt, or what?

Oiling Skin Reduces Premature Infant Infections: Premature babies (497) weighing under 1500 g (3 pounds) and under 33 weeks gestation were either given routine care or twice a day amassages with sunflower oil or Aquaphor petroleum-based ointment.  In both the treatment groups, infections decreased by 60% for infants treated from the first day.  Massaging babies with oil is traditional in many cultures. G. Darmstadt, Johns Hopkins, Lancet 2005. v

People Testing Positive for APOE e4 Much More Likely to Purchase Long-Term Care Policies: In a study of 148 cognitively normal adults with family histories of Alzheimer's, some were informed and other not informed on how they tested on a APOE genetic test for Alzheimer's disease. Those who tested positive for an increased risk were 476% more likely to purchase long-term care insurance policies than those who tested positive and were not informed.  This adverse selection tendency on a national scale could effect the rates that insurance companies would have to charge.  Almost 17% of those who tested positive subsequently changed their long-term care insurance coverage in the year after APOE disclosure, compared with 2% of those who tested negative and 4% of those who did not receive APOE disclosure. C. Zick et al. Univ Utah, Health Aff. 2005; 24 (2): 483-490. For more, see Alzheimer's Genetics.

Gait Slowing Increases Risk of Cognitive Impairment Progressing: The Sydney Older Persons Study examined 6-year outcomes of 630 community-dwelling elderly of age 74. Those with cognitive impairment in combination with gait and motor slowing were the most likely to develop dementia over the next 6 years (OR 5.6) and to die (OR 3.3). White matter indices on MRI scanning were not consistently correlated with gait abnormalities. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. Waite LM, Grayson DA, et al. University of Sydney. J Neurol Sci. 2005 Mar 15;229-230(1):89-93.

Mortality: Vascular Dementia Dies More Quickly: A study of mortality of 3602 adults of the Cardiovascular Health (CHS) Cognition Study over 6.5 years found that those who developed Vascular Dementia were 340% more likely to die (HR: 4.4) vs. 110% more likely for Alzheimer's and 150% for the combined VaD-AD. Adjusted accelerated life models estimated median survival from dementia onset to death as 3.9 years for VaD, 7.1 years for AD, 5.4 years for mixed dementia, and 11.0 years for matched controls with normal cognition. While persons with VaD died primarily from cerebrovascular disease, those with AD/mixed dementia died more frequently from dementia/failure to thrive. Survival following dementia onset: Alzheimer's disease and vascular dementia. Fitzpatrick AL, Kuller LH, et al. University of Washington, Seattle. J Neurol Sci. 2005 Mar 15;229-230(1):43-9. For more, see Dementia.

Light-Moderate Drinking Linked to Reduced Diabetes and Obesity in Older Adults: In a cross-sectional study of 8,125 adults from the Third National Health and Nutrition Examination Survey, after adjustment for age, sex, race/ethnicity, education, income, tobacco use, physical activity, and diet, those who consumed 1-19 and greater than 19 drinks of alcohol per month had 35% and 66% lower risk of having metabolic syndrome (diabetes, obesity and hypertension) (ORs 0.65 and 0.34, respectively, P < 0.05 for all), compared with current nondrinkers. These findings were particularly noteworthy for beer and wine drinkers. The association of greater than 19 alcoholic drinks per month with the prevalence of the metabolic syndrome was consistent across ethnicities but was most striking in white men and women (ORs 0.35 and 0.22, respectively; P < 0.05). Alcohol consumption was significantly and inversely associated with the prevalence of the following three components of the metabolic syndrome: low serum HDL cholesterol, elevated serum triglycerides, high waist circumference, as well as hyperinsulinemia (P < 0.05 for all). Freiberg, et al. Alcohol consumption and the prevalence of the metabolic syndrome in the U.S.: a cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey. Diabetes Care 12/04. For more, see Diabetes Risk Factors.

Brain Derived Neurotrophic Factor Affect Hypocampal Volume: MRI hippocampal alterations are in the pathogenesis of schizophrenia. Brain-derived neurotrophic factor (BDNF) is widely expressed in the hippocampus. BDNF gene variant val66met is a functional and abundant missense polymorphism in the coding region of the BDNF gene. In 19 patients with first-episode schizophrenia and 25 healthy volunteers, val/val homozygotes (N=27) had larger volumes of the hippocampal formation compared to val/met heterozygotes (N=17). Val66met genotype accounted for a greater proportion of the variance in the volume of the hippocampal formation in patient compared to healthy adults. Brain-derived neurotrophic factor Val66met polymorphism and volume of the hippocampal formation. Szeszko PR, Lipsky R, et al. Albert Einstein. Molecular Psychiatry 15 March 2005. For more, see Genetics of Schizophrenia.

Schizophrenia Life-Time Suicide Rate 4.9%: In a meta-analysis of 32 studies of at least 2 years duration, with at least 90% follow-up, and reported suicides of 25,578 schizophrenic patients, authors conclude 4.9% will commit suicide during their lifetimes, usually near illness onset. The lifetime risk of suicide in schizophrenia: a reexamination. Palmer BA, Pankratz VS, Bostwick JM. Mayo Medical. Arch Gen Psychiatry. 2005 Mar;62(3):247-53. For more, see Schizophrenia.

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Thomas E. Radecki, M.D., J.D.

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