Sub-Arachnoid Hemorrhage Vasospasm Damage Reduced by Magnesium: Magnesium reverses cerebral vasospasm and reduces infarct volume after experimental subarachnoid hemorrhage (SAH) in rats. In a DB PC study, 283 patients with SAH were started on magnesium sulfate 64 mmol/L/day IV within four days of the bleed until 14 days after the occlusion of the aneurysm.  Magnesium reduced the risk of delayed cerebral ischemia by 34%. After 3 months, the risk reduction for poor outcome was 23%. Magnesium Sulfate in Aneurysmal Subarachnoid Hemorrhage. A Randomized Controlled Trial. van den Bergh WM. Stroke. 2005 Mar 24. For more, see Sub-Arachnoid Hemorrhage.

High Maternal Titers Linked to Increased Risk of Schizophrenia in Offspring: In a nested case-control design, serological assays for Toxoplasma antibody on maternal serum specimens from pregnancies giving rise to 63 cases of schizophrenia and other schizophrenia spectrum disorders and 123 controls, the adjusted odds ratio of schizophrenia with high maternal Toxoplasma IgG antibody titers was 2.61. There was no association between moderate Toxoplasma Ig antibody titers and the risk of schizophrenia/spectrum disorders. Maternal exposure to toxoplasmosis and risk of schizophrenia in adult offspring. Brown AS, Schaefer CA, et al. New York State Psychiatric Institute. Am J Psychiatry. 2005 Apr;162(4):767-73. For more, see Toxoplasmosis and Schizophrenia Risk Factors.

Mediterranean Diet Helps You Live Longer: In the huge EPIC study of 74,607 adults over age 59 from Denmark, France, Germany, Greece, Italy, the Netherlands, Spain, Sweden, United Kingdom with an average of 7 1/2 years of follow-up, adherence to a modified Mediterranean diet of vegetable, legumes, fruit, fish, meat-avoidance, grains (ideally whole), and moderate alcohol intake was associated with a 7% decrease in mortality. Researchers estimate realistic full adherence would lower mortality by 11% to 14%. Other confounding factors were controlled for including smoking, weight, exercise, diabetes, educational achievement, energy intake, eggs, potatoes, sugar, etc. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Antonia Trichopoulou et al. University of Athens and many other universities.  BMJ 4/30/05:330-991. For more, see Longevity.

Vitamin D and Calcium Alone Don't Helped Reduce Osteoporosis Fractures: In a 25-month DB PC trial of 3314 elderly women over age 69 and living in community at risk for fractures, vitamin D 800 IU and calcium 1000 mg was of no benefit in reducing fractures. A literature review showed that any benefit is minor for falls or fractures. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D-3) for prevention of fractures in primary care. Jill Porthouse et al. Univ. York. BMJ  2005;330:1003 (30 April). Ed: The authors carefully avoided mentioning that vitamin K is essential to preventing osteoporosis and fractures. For more, see Osteoporosis. 

Three Cheers for the National Institute of Health: The US National Institutes of Health has asked all investigators who receive federal funds to make their results freely available to the public. Dr Robert Steinbrook of the New England Journal of Medicine predicts that some journal editors and publishers will be "riled" (BMJ 2005;352:1739). Dr Zerhouni of the NIH has asked researchers whose work was supported by public funding to voluntarily submit an electronic copy of their manuscripts, when they are accepted for publication, to PubMed Central, a free internet service. A similar initiative in the United Kingdom led to controversy recently when some editors and publishers said that free online dissemination of research articles might cause some medical journals to "go broke and close" (BMJ 2005;330:923, 23 Apr). Dr Michael Wilkes, vice dean for medical education and professor of medicine at the University of California School of Medicine at Davis, reacted to the charge that some medical journals might be forced to close by asking, "So what?" He said, "How is the world going to be any poorer if [some journals] go out of business? Publicly funded studies belong to the public. I don't think there should be a system where a middleman makes a profit at the public's expense. If journals are going to survive, they have to have added value."

State College, Pennsylvania, Prison Nurses Offered Free Bar Drinks by Anti-Psychotic Drug Rep: In a typical America drug bribe, nurses at SCI-Rockview Pennsylvania state prison on April 27, 2005, were offered free drinks after work at a local bar after a presentation for Geodon at the prison on the psychiatric unit. The nurses happily accepted. Every month, local State College psychiatrists are treated to free drinks and a $25/head meal by other local drug reps with no presentation at all, just schmoozing with the drug reps. AstraZeneca, manufacturer of Seroquel, has been censured by the UK watchdog, the Prescription Medicines Code of Practice Authority, for offering nurses excessive hospitality at educational meetings located in luxury hotels. The meeting, which AstraZeneca cancelled after a complaint from a local GP, was due to be held at the 4-star Cameron House Hotel in Loch Lomond. Nurses who were due to attend the meeting were scheduled to have three hours of talks on asthma during a stay of nearly 24 hours at the hotel, which included dinner, bed and breakfast, and lunch.  AstraZeneca was also reprimanded for giving nurses a free meal at another four-star hotel followed by a brief 45-minute drug talk. BMJ 330:984 4/30/05. Ed: Such bribes are routine, standard, and effective across the U.S. For more, see Irresponsible Medicine. 

Epsin 4 Gene Enthoprotin Abnormality a Cause of Schizophrenia: Chromosome 5q33 is a region that has previously shown good evidence of linkage to schizophrenia. In a study of 450 unrelated patients with schizophrenia and 450 ancestrally matched supernormal controls, four adjacent markers at the 5' end of the Epsin 4 gene showed significant linkage with schizophrenia: two microsatellite markers, D5S1403 (P=.01) and AAAT11 (P=.009), and two single-nucleotide-polymorphism markers within the Epsin 4 gene, rs10046055 (P=.007) and rs254664 (P=.01). Haplotypes were also significantly associated with schizophrenia (HapA, P=.004; HapB, P=.0005; HapC, P=.007; and HapD, P=.01). The Epsin 4 gene encodes the clathrin-associated protein enthoprotin, which has a role in transport and stability of neurotransmitter vesicles at the synapses and within neurons. Pimm J, McQuillin A, et al. University College London Medical School, UK. Am J Hum Genet. 2005 May;76(5):902-7. Ed: These authors are more confident of their findings than any others I have seen. Still, this abnormality is only one of many linked to schizophrenia. For more, see Schizophrenia's Genetics.

Olanzapine (Zyprexa) and Clozapine Increase Diabetes Risk: In a study of 3663 Medicaid patients who developed type 2 diabetes after starting treatment for schizophrenia and 14,523 who had not developed diabetes, with a 52-week exposure window, the risks were 41% higher with olanzapine and clozapine or 58% if on both, but no significant increase with risperidone or quetiapine. Antipsychotic exposure and type 2 diabetes among patients with schizophrenia: a matched case-control study of California Medicaid claims. Lambert BL, Chou CH, et al. University of Illinois, Chicago. Pharmacoepidemiol Drug Saf. 2005 Mar 22. For more, see Diabetes and Schizophrenia.

Schizophrenia Damages IQ Performance: Linear regression analyses were performed on a healthy control population to determine a predicted composite cognitive score based on maternal education, paternal education, and reading score as indicators of premorbid intellectual function.  When the Wide Range Achievement Test-3 (WRAT-3) score and maternal education are both used to predict current cognitive performance, as expected, about half (42%) of control subjects fall below expectations. However, 98 % of patients fall below expectations. Defining a cognitive function decrement in schizophrenia. Keefe RS, Eesley CE, Poe MP. Duke University. Biol Psychiatry. 2005 Mar 15;57(6):688-91. v

Children with Seizures and Insomnia Helped in DB: In a DB PC study of 31 children ages 3-12 with seizures treated with valproate, the decrease in the median total sleep score was 24% with valproate + melatonin vs. 14% with valproate + placebo group(P < .05). The decrease in the parasomnias score was 60% with melatonin vs. 36% with placebo (P < .05). There was no significant difference in daytime drowsiness or sleep fragmentation. Add-on melatonin improves sleep behavior in children with epilepsy: randomized, double-blind, placebo-controlled trial. Gupta M, Aneja S, Kohli K. Lady Hardinge Medical College, New Delhi, India. J Child Neurol. 2005 Feb;20(2):112-5. Ed: This is the 20th DB studying showing sleep benefits from melatonin.  It is superior to any other approach, although doesn't work for everyone. For more, see Melatonin for Insomnia.

Vitamin E, Donepezil (Aricept) Fail to Help Mild Cognitive Impairment: In a 3-year DB PC study of 769 patients with mild cognitive impairment, vitamin E had no effect on 769 patients with mild cognitive impairment. The expensive anti-dementia drug donepezil (Aricept) showed no slowing of the rate of progression of the disease after three years compared with placebo, although it had a limited benefit during the first year. Donepezil will no longer be prescribed by the National Health Service in England for new dementia patients. The overall rate of progression from mild cognitive impairment to early Alzheimer's disease was 16% a year. Probability of progression for vitamin E was increased by 2% and for donepezil decreased by 20%, both of which were far from significant. New England J Med 6/9/05. For more, see Alzheimer's.

Obesity Kills 112,000 Americans per Year: Using a nationally respresentative sample date from NHANES 1971-5 and NHANES II (1976-80), with follow-up to 1992, and from NHANES III (1988-94), with follow-up to 2000, researchers conclude obesity (BMI over 30) was associated with 111,909 excess deaths in the year 2000 and underweight (BMI<18.5) with 33,746 excess deaths compared with people of normal weight (BMI=18.5 to 25). Overweight (BMI=25 to 30) was not associated with excess mortality. Deaths due to obesity in more recent data from NHANES II and NHANES III than in NHANES I have actually been decreasing. Compared with obese people in the first NHANES data from 1960-2, the obese group in 1999-2000 had a 21% lower prevalence of high cholesterol level (39%  v 18%), an 18% lower prevalence of high blood pressure (42% v 24%), and a 12% lower rate of smoking (32% v 20%). There was a 55% increase in total diabetes due to an increase in obesity. Excess Deaths Associated With Underweight, Overweight, and Obesity. Flegal KM, et al. JAMA. 2005;293:1861-1867. Ed: The ideal BMI was 23-25. The excess deaths among the underweight was 80% concentrated in elderly over age 70, while 2/3rds of deaths due to obesity were under age 70 and especially concentrated in the very obese (BMI>35). Smoking kills four times as many Americans per year as obesity. For more, see Obesity. v

FDA Warns on Atypicals for Dementia: The FDA has finally issued a warning of fatal adverse events in elderly demented patients treated with atypical antipsychotic drugs: 17 controlled studies of elderly demented patients have shown that patients treated with the drugs were 1.6 to 1.7 times more likely to die than patients given placebo. The causes of death included congestive heart failure, sudden death, and infections, such as pneumonia. A "black box" warning will appear on drug labels—indicating an adverse reaction that may result in death or serious injury—noting the increased death rates and that "these drugs are not approved for the treatment of behavioural symptoms in elderly patients with dementia." The drugs affected include aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), clozapine (Clozaril), and ziprasidone (Geodon). A drug used for depression associated with bipolar disorder, olanzapine (Symbyax), was included in the advisory warning.  Zyprexa and Risperdal are the two top sellers. Whether Geodon and Abilify cause as severe a problem is not mentioned.  Although the FDA required diabetes risk labeling of these along with the older atypicals, research has been quite consistant in finding no increase diabetes risk with the later two. Benzodiazepines may increase the risk. Zyprexa was the world's fourth best selling drug in 2003. For more, see Atypical Side-Effects in the Elderly.

Is The American College of Physicians Corrupt or What?: The American College of Physicians has refused a booth at its annual meeting to the not-for-profit group No Free Lunch, which works to reduce conflicts of interest. The group warns about the harmful effect of free meals and drug reps on physician prescribing practices. In 2003, the BMJ features pigs in white coats (doctors) and weasels (drug reps) on its front cover on an issue investigating the ethical and corrupt marketing practices rampant in doctors offices across the U.S. and in other countries. BMJ concludes that nothing has changed. Brit J Med 4/16/05.

Maybe Less Post-Partum Depression with Natural Spontaneous Delivery: In the ALSPAC study of 14,663 women recruited before delivery, the odds of post-partum depression was lower for spontaneous vaginal delivery (11% lower the average) compared to planned vaginal delivery (6% higher than average) and emergency C-section (17% higher than average). The authors state that none of these differences are statistically significant. Operative delivery and postnatal depression: a cohort study. Roshni R Patel, et al. St. Michael's, Bristol, UK. BMJ  4/16/2005;330:879. Ed: I have a hard time accepting the authors' claim that the difference are not significant. Research from Brazil has found that the vast majority of women prefer vaginal deliveries if they experience them, even women who had planned C-sections in order to avoid vaginal deliveries, but the baby just wouldn't wait.  Other studies have also found higher rates of post-partum depressions with C-sections. For more, see C-sections.

Cancer of the Lung: Vitamin D Increases Benefit of Surgery: Of 456 lung cancer patients treated surgically, of which only 10% had had either radiation treatment of chemotherapy, looking at the effect of the seasons, researchers found patients who had operations in the winter were 40% more likely to die from their cancer than those who had the operation in the summer. When the joint effect of the season and vitamin D levels were taken into consideration, there was a three-fold better chance of survival, evidence presented to the American Association of Cancer Research showed. Wei Zhou et al. Harvard. 4/26/05. For more, see Benefits of Vitamin D.

Raloxifene Very Minor Beneficial Effect on Cognitive Impairment: In the 3-year DB PC MORE study of 5,386 postmenopausal women with osteoporosis, 3.4% developed mild cognitive impairment, and 1.0% dementia. Compared to those taking placebo, women receiving 120 mg/day of raloxifene had a 33% lower risk of mild cognitive impairment (relative risk, 0.67; 95% confidence interval [CI], 0.46-0.98) and somewhat lower risks of Alzheimer's disease (relative risk=0.52, not significant) and any cognitive impairment (relative risk=0.73, not significant). Risks of mild cognitive impairment, Alzheimer's disease, and any impairment were not significantly different in the group taking 60 mg/day of raloxifene. Effect of Raloxifene on Prevention of Dementia and Cognitive Impairment in Older Women: The Multiple Outcomes of Raloxifene Evaluation (MORE) Randomized Trial. Yaffe K, Krueger K, et al. University of California, San Francisco. Am J Psychiatry. 2005 Apr;162(4):683-90. Ed: Although 33% sounds like a lot, in fact, so few women in the study developed cognitive impairment tht only the massive size of the study was able to detect the effect.  The size of the effect barely reached the level of statistical significance.  Many less expensive ways are available to lower with risk of cognitive impairment. For more, see Prevention of Alzheimer's.

AIDS: Three Quarters Didn't Know They were Infected: In a CDC survey of 5,600 HIV carriers, 77% did not know they were infected. Most believed they were at low risk for the disease. Half said they had gay relations in the prior six months. Of the total number tested, 10% were HIV-positive. People were recruited for the study in bars, stores and in parks in six major US cities. Federal authorities would like to make AIDS tests routine, in a bid to reduce infection rates believed to be caused by people being ignorant they are carriers of the virus. African-Americans make up over 50%. For more, see AIDS.

New HIV Infections Spread Quickly: People who contract the HIV virus are much more infective in the first weeks after a new infection according to a longitudinal 10-month study of 15,000 volunteers in Uganda. HIV spreads in only 0.1% of heterosexual acts, but new infections spread 10-20 times faster. Wawer, et al. J Infectious Dis 5/05. This fits research showing that Africans do not have more sexual partners during their lives than in the developed world, but whereas in the developed world, most have only one partner at a time, while in Africa, it is normal to have several long-term relationships ongoing at the same time.  This dramatically increases the speed and extent to which HIV infection can spread in a population. For more, See HIV and AIDS.

Lifestyle Change, Metformin, Troglitazone Prevent Diabetes: In the Diabetes Prevention Program 3-year DB PC study of 2340 high-risk pre-diabetic adults, (DPP) was a randomized clinical trial of prevention of type 2 diabetes in high-risk people, metformin redued the risk of developing diabetes by 43% (6.7 cases per 100 person-years vs. 12 with placebo). An intensive lifestyle intervention program did even better with a 65% decreased risk (5.1 cases per year). Troglitazone, an insulin-sensitizing agent, did best with a 75% decrease, but it had to be stopped after nine months because of liver toxicity. After the troglitazone was stopped, there was no long-term benefit with those patients developing just as much diabetes as the placebo group. Prevention of Type 2 Diabetes With Troglitazone in the Diabetes Prevention Program. Diabetes. 2005 Apr;54(4):1150-1156. For more, see Diabetes.

Lycopene Supplement Helped Mouth Pre-Cancerous Leukoplakia: In a 3-month DB PC study of 58 patients with pre-cancerous leukoplakia, lycopene 4 mg b.i.d. and 2 mg b.i.d. did better than placebo (P<0.01). The response, assessed histologically, after the 8-mg lycopene treatment was significantly better than that from 4 mg lycopene (P<0.05) and than the response seen in the control group (P<0.001). Oral lycopene - an efficacious treatment for oral leukoplakia? Zakrzewska JM. Queen Mary's School of Dentistry, London UK. Evidence-Based Dentistry (2005) 6, 17-18. Ed: One study found lycopene supplement helped asthma. Lycopene is very inexpensive, but obviously needs much more research.  One study is not enough. To date there is no evidence of any effective treatment in preventing malignant transformation of leukoplakia.

Bogus "Research" from the University of Chicago on Children with Pervasive Developmental Disorder: The authors claim to have "assess(ed) the effect of escitalopram in the treatment of pervasive developmental disorders by doing a 10-week "study" using an open-label design, i.e., no scientific controls at all. Twenty-eight children with a PDD were given escitalopram (Lexapro) at doses up to 20 mg/d. There was significant improvement in ABC-CV Irritability Subscale Scores (20.5 to 10.9; p </= .001) and a slight Improvement on a Clinical Global Improvement Scale (5.2 to 4.6; p </= .001). The researchers made the totally unproven claim that 25% of children "responded at a dose less than 10 mg" and and an additional 36% "responded" at a dose greater than or equal to 10 mg. They claim that their bogus open-label study found "escitalopram to be useful" in treating PDDs. An open-label trial of escitalopram in pervasive developmental disorders. Owley T, Walton L, Salt J, Guter SJ Jr, Winnega M, Leventhal BL, Cook EH Jr. Department of Psychiatry, University of Chicago. J Am Acad Child Adolesc Psychiatry. 2005 Apr;44(4):343-8. Ed: It is absolutely impossible to attribute any improvement during the study to the medication since there was no control group.  This study is intellectually dishonest and will mislead numerous psychiatrists to use a drug that has never been scientifically tested on similar children.  Instead of irresponsibly publishing this "study," these psychiatrists should have done the right thing, i.e., done a real DB PC study.  For more, see Irresponsible Medicine.

Asking for an Anti-Depressant Makes it Much More Likely You Will Be Given One: Women actors made 298 unannounced visits to the offices of 152 doctors. Half pretended to have symptoms indicating they could have major depression, while others described an "adjustment disorder" -- fatigue, stress and some sleeplessness. All of the actors followed three different scripts: in one they said they had seen an ad for Paxil and asked for it. In another they said they had seen a TV program on depression and wondered if a drug would help. In the third scenario they made no request. In the group portraying major depression, antidepressants were given 53% of the time when Paxil was requested, with that drug making up 27 percent of the total. When the actors made a general request for drugs, they were given one 76% of the time. When they asked for nothing, they received prescriptions 31% of the time. In the less serious adjustment disorder group, antidepressants were prescribed 55% of the time when Paxil was mentioned, 39% when a general request was made and 10% when no drugs were requested. Paxil accounted for two-thirds of all antidepressant prescriptions given to the second group among those who asked specifically for it. Richard Kravitz, Univ of Calif, Davis, JAMA 4/27/05. v

Low Sodium in Slower Marathon Runners Drinking Lots of Fluids: In a study of 488 runners of the 2002 Boston Marathon, at the finish line 13% had hyponatremia (serum sodium concentration, 135 mmol/L or less), and 0.6% had critical hyponatremia (serum sodium concentration, 120 mmol/L or less). Univariate analyses suggested that hyponatremia was associated with substantial weight gain, consumption of more than 3 L of fluids during the race, consumption of fluids every mile, racing time more than four hours, female sex, and low body mass index (BMI). Multivariate analysis revealed that hyponatremia was strongly associated with weight gain (odds ratio 4.2), racing time more than four hours (OR 7.4 vs less than 3.5 hours), and BMI extremes. N Engl J Med. 2005;352:1516-1518, 1550-1556. U.S. Track and Field, the national governing body, suggests that athletes use thirst as a guide for fluid replacement and not try to "stay ahead of your thirst to replace sweat loss." Don't use water loading and don't take NSAIDs like ibuprofen, etc. Sports drinks did no better than water. v

Obesity in Midlife Increases Risk of Dementia: In a Kaiser Permanente study of 10,276 Californians in their 40s and followed for 27 years, obese people were 74% more likely to develop dementia while those who were merely overweight were only 35% more likely. Skin fold thickness was more accurate for men than BMI. BMJ 4/30/05. Ed: This study adds to earlier ones with the same findings. For more, see Causes of Dementia.

Over-the-Counter BiosLife Fiber Worked for Cholesterol in Small Study: In a 90-day DB PC manufacturer study of 78 type 2 diabetics, participants received 10g to 15g of BiosLife 2, an over-the-counter fiber supplement manufactured by Unicity International. The drink contains both soluble and insoluble fiber from guar gum, gum arabic, locust bean gum, pectin and oat fiber dispersed in calcium carbonate. It was administered in 5-gram doses two to three times daily 5 to 10 minutes before eating. The manufacturer claims the fiber decreases reabsorption of cholesterol from a meal. Total cholesterol had dropped from 215 mg/dL to 184 mg/dL, 14.4%. Triglycerides decreased 14% from 299 mg/dL to 257 mg/dL. LDL decreased 28.7% from 129 mg/dL to 92 mg/dL. HDL rose 21.8% from 43 mg/dL to 55 mg/dL. Amer. Heart Assoc. Convention. Washington DC. 4/30/05. For more, see Cholesterol.

Traffic Fumes Increase Breast Cancer Risk: According to the University of Buffalo case-control Western New York Exposures and Breast Cancer study of women 35-79, higher exposure around the time of first menstruation to polycyclic aromatic hydrocarbons (PAHs), potential carcinogens found in traffic emissions, was associated with increased risk of premenopausal breast cancer. For postmenopausal women, higher exposure to PAHs at the time of the first birth was associated with increased risk. Neither association was found in women with a history of smoking. American Association for Cancer Research Convention, Anaheim, Calif. Jing Nie, et al. Ed: This is similar to several studies showing traffic fumes and natural gas fumes from kitchen stoves increasing asthma risks. For more, see Breast Cancer.

Fluoride Gel by Dentist Not Worth It for Most Children: In a DB PC study of 594 children ages 9-12 using fluoride toothpaste, professionally applied fluoride gel showed no statistically significant effect on permanent teeth score in low-caries children. J Dent Res. 2005 May;84(5):418-21.

Leave Disease-Free Impacted Wisdom Teeth: No reliable studies exist to support removal of trouble-free impacted wisdom teeth, according to a systematic review of evidence. Despite this surprising lack of data, extraction of third molars has long been considered appropriate care in most developed countries. “Watchful monitoring” of asymptomatic wisdom teeth may avoid 60% of operations. Dirk Mettes, et al. Radboud University, Nijmegen, Netherlands. Cochrane  4/29/05. For more, see Dental.

Insecticides Harmful to Farmers: In a National Institute of Environmental Health Sciences study of 18,726 North Carolina and Iowa farmers investigating lifetime exposure to herbicides, insecticides, fungicides, and fumigants, and their history of 23 neurological symptoms, nearly 3,000 participants had a high lifetime exposure to insecticides, more than 500 days in their lifetime. Nearly 800 of these farmers reported more than 10 neurological symptoms compared to those using insecticides fewer than 50 days. The researchers found no significant association between neurological symptoms and other chemicals, including herbicides or fungicides, and only a weak association between fumigant exposure and neurological symptoms. Some of the pesticides examined, including carbaryl and some pyrethroids, are available to home gardeners, although in different formulations and in lower concentrations, which may make them less hazardous. Freya Kamel, et al. Environmental Health Perspectives 6/05. v

Sildenafil (Viagra) Helps Multiple Sclerosis Men: In a 12-week DB PC study of 217 men with multiple sclerosis with an open extension after 12 weeks, those on sildenafil (25-100 mg) had much improved erections 89% vs. 24% (p<0.0001). At the end of the extension phase, 95% of men reported improved erections. Men receiving sildenafil also showed improvements in five of the eight general quality of life questions compared with men receiving placebo (p<0.05) with 43% improving vs. 13% (p<0.0001). A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. Fowler CJ, Miller JR, et al. London, England. J Neurol Neurosurg Psychiatry. 2005 May;76(5):700-5.

Gingko Might Help MS: In a DB PC study of 39 MS patients matching in the areas of gender, education, type of MS, years since onset, and baseline performance on a battery of neuropsychological tests, those in the ginkgo group were four seconds or 13% faster than the placebo group on a Stroop timed color and word test that measures attention and such "executive functions" as planning, decision making, and controlling goal-directed behavior and execution of deliberate actions. In a recent survey of 1,913 patients in Oregon, 20% reported using the supplement and 39% thought it to be beneficial. However, until now, there was no evidence the supplement had any effect on memory. Jesus Lovera, Oregon Health Science Univ., American Academy of Neurology's 57th Annual Meeting in Miami Beach, Fla., 4/05. For more, see Multiple Sclerosis.

720 American Infants Die Each Year Due to Being Bottlefed Instead of Breastfed: In a U.S. nationwide study of CDC records of 1,204 children who died between 28 days and one year of causes other than congenital anomalies or cancer with those of 7,740 children still alive at one year, children who were breastfed had 20% lower risk of dying between 28 days and one year than children who weren't breastfed. Longer breastfeeding was associated with lower risk. The effect was the same in both African- and European-American children. Breastfed infants in the U.S. also have lower rates of illness, especially from infectious disease. If all mothers breastfed, 720 infant lives would be saved each year. Aimin Chen and Walter J Rogan. Pediatrics 05/05. For more, see Breastfeeding. 

COPD Helped by Polyunsatured Fatty Acids: In an 8-week DB PC study of 80 patients with COPD, the peak load of the incremental exercise test increased more in the PUFA group than in the placebo group (p = 0.009). The duration of the constant work rate test also increased more in patients receiving PUFA (an increase of 4.3 min, p = 0.023). The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP, IL-6 and TNF-alpha. Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease. Broekhuizen R, Wouters EF, et al. University Hospital Maastricht, The Netherlands. Thorax. 2005 May;60(5):376-82. For more, see Omega-3s and Asthma.

Melatonin Good for Pre-operative Anxiety in Children: Unlike midazolam, a minor tranquilizer and the current standard pre-operative medication for anxiety, melatonin premedication is not associated with cognitive impairment in adults despite its anti-anxiety properties. In a DB PC study comparing perioperative melatonin vs. midazolam in children, 7 groups of children (15 in each) were randomly assigned to: midazolam 0.1, 0.25 or 0.5 mg/kg orally, melatonin 0.1, 0.25 or 0.5 mg/kg orally each mixed in 15 mg/kg acetaminophen, or placebo only (15 mg/kgacetaminophen). Melatonin or midazolam each in doses of 0.25 or 0.5 mg kg(-1) were equally effective as premedicants in alleviating separation anxiety and anxiety associated with the introduction of the anaesthesia mask. Midazolam tended to prolong recovery times as the dosage increased. Melatonin had a lower incidence (P = 0.049) of excitement at 10 min postoperatively, and a lower incidence (P = 0.046) of sleep disturbance at week 2 postoperatively than that observed with midazolam and control groups. No postoperative excitement was noted in the melatonin groups at 20, 30 and 45 min. Melatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study. Samarkandi A, Naguib M, et al. King Saud University, Riyadh, Saudi Arabia. Ed: Melatonin is great for insomnia and may help prevent stroke damage, Alzheimer's, and increase longevity! For more, see Melatonin.

Divalproex (Depakote) No Better than Lithium in Child/Teen Bipolars: In an 18-month DB PC study of youths ages 5-17 with bipolar I or II disorder initially treated with lithium and divalproex until in remission for 4 weeks,  divalproex alone did no better than lithium alone in survival time until emerging symptoms of relapse or survival time until discontinuation for any reason. Double-Blind 18-Month Trial of Lithium Versus Divalproex Maintenance Treatment in Pediatric Bipolar Disorder. Findling RL, McNamara NK, et al. Case Western Reserve University. J Am Acad Child Adolesc Psychiatry. 2005 May;44(5):409-417. Ed: Adult research has found a much higher suicide rate and greater weight gain with divalproex than lithium. For more, see Bipolar Disorder in Children.

Melatonin Effective for Nonalcoholic Fatty Liver Disease: In an open label, randomized trial, nondiabetic patients with Nonalcoholic Fatty Liver Disease were given metformin (2 g/day) for 12 months or vitamin E (800 IU/day) or were treated by a prescriptive, weight-reducing diet (n = 27). Aminotransferase liver enzyme levels improved in all groups in association with weight loss. The effects of metformin were larger (p < 0.0001), and alanine aminotransferase normalized in 56% of cases (OR vs. controls, 3.11; p= 0.0013). In multivariate analysis, metformin treatment was 500% more likely to have aminotransferase normalization, after correction for age, gender, basal aminotransferases, and change in body mass index. The criteria for metabolic syndrome were reduced only in the metformin arm (p= 0.001). A biopsy in 17 metformin-treated cases (14 nonresponders) showed a significant decrease in liver fat (p= 0.0004), necroinflammation, and fibrosis (p= 0.012 for both). No side effects were observed during metformin treatment. A Randomized Controlled Trial of Metformin versus Vitamin E or Prescriptive Diet in Nonalcoholic Fatty Liver Disease. Bugianesi E, Gentilcore E, et al. University of Turin, Italy. Am J Gastroenterol 2005;100:1082-1090. v

Metformin Helped DM Type 2 Insulin Patients: In a 12-month DB PC study of 183 patients with Type 2 diabetes on maximum tolerated oral agents referred for insulin conversion, those given metformin up to 2 g a day or maximum tolerated dose in addition to insulin had less weight gain [6.1 kg vs. 7.6 kg; P = 0.02], a greater reduction in HbA(1c)[1.5% vs. 1.3%; P = 0.02] and a lower insulin requirement [62 units vs. 86; P < 0.001], but 24% more hypoglycaemia [P = 0.03]. Treatment satisfaction improved more in patients on metformin than on placebo (P < 0.001), as did the positive well-being score (P = 0.02). Metformin should be continued in patients with Type 2 diabetes who transfer to insulin. Continuing metformin when starting insulin in patients with Type 2 diabetes: a double-blind randomized placebo-controlled trial. Douek IF, Allen SE, et al. University of Bristol, UK. Diabet. Med. 22, 634-640 (2005). For more, see Diabetes.

For Lowering High Blood Pressure, the Systolic Lowering is What Counts: In an analysis for trials including 12,903 patients ages 30-49, 14,324 ages 60-79 years, and 1209 very old (over 79), antihypertensive treatment reduced SBP/DBP by 8.3/4.6 mm Hg in young, by 10.7/4.2 mm Hg in old, and by 9.4/3.2 mm Hg in very old, resulting in ratios of DBP to SBP lowering of 0.55, 0.39, and 0.32 (P=0.004 for trend with age). Treatment reduced the risk of all cardiovascular events, stroke and myocardial infarction in the 3 age strata to a similar extent. Absolute benefit increased with age and with lower ratio of DBP to SBP lowering. In patients with a larger-than-median reduction in SBP, active treatment consistently reduced the risk of all outcomes irrespective of the decrease in DBP or the achieved DBP, even if the achieved DBP averaged <70 mm Hg. Systolic and diastolic blood pressure lowering as determinants of cardiovascular outcome. Wang JG, Staessen JA, et al. University of Leuven, Belgium. Hypertension. 2005 May;45(5):907-13. For more, see High Blood Pressure.

Omega-3 Fatty Acids (Fish Oil, etc.) Best for Lowering Mortality, Statins and Resins Help: In an analysis of 97 studies of lipid-lowering interventions covering 137,140 individuals in intervention and 138,976 individuals in control groups, compared with control groups, risk ratios for overall mortality were 0.87 for statins, 1.00 for fibrates, 0.84 for resins, 0.96 for niacin, 0.77 for omega-3 fatty acids, and 0.97 for diet. Effect of different antilipidemic agents and diets on mortality: a systematic review. Studer M, Briel M, et al. University Hospital Basel, Switzerland. Arch Intern Med. 2005 Apr 11;165(7):725-30. For more, see Omega-3s.

Trichuris Suis Worm Eggs Help in DB: Ulcerative colitis is most common in Western industrialized countries, but uncommon in developing countries where helminths (worms) are frequent. People with helminths have an altered immunological response to antigens. In animal models, helminths prevent or improve colitis by the induction of regulatory T cells and modulatory cytokines. In a DB PC study of 54 ulcerative colitis patients, trichuris suis ova orally at 2-week intervals for 12 weeks resulted in 43% improving vs. 17% with placebo.  Treatment induced no side effects. The worms die harmlessly. Trichuris suis therapy for active ulcerative colitis: a randomized controlled trial. Summers RW, Elliott DE, et al. University of Iowa. Gastroenterology. 2005 Apr;128(4):825-32. Ed: The treatment is not yet available. For more, see Ulcerative Colitis.

Depression: Ask for Medicine and You Shall Receive: Possible Effects of Consumer Ads: Actors were trained and visited 152 family physicians and internists in San Francisco and Rochester, NY either asking for a brandnamed antidepressant, asking for medication for depression, or making no request. When asked, the actors gave either the symptoms of major depression or an adjustment disorder.  With major depression symptoms, 100% more received medication if they asked for meditation, either the brandnamed or just in general, 57% vs. 31%.  With adjustment disorder, 450% more received the brandnamed medication (55% vs. 10%) and 300% more if asking for medication with specifying (39% vs. 10%). In general, the doctors did a poor job detecting serious depression unless actors asked for medication and doctors considerably over prescribed medication when actors only complained of an adjustment disorder. Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse. Influence of patients' requests for direct-to-consumer advertised antidepressants: a randomized controlled trial. Kravitz RL, Epstein RM, et al. University of California, Davis. JAMA. 2005 Apr 27;293(16):1995-2002. v

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

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