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Cholesterol Increases Ovarian Cancer; Vegetables, Vitamin E, Beta-carotene, B-Complex Decrease: In a case-control study 442 cases of ovarian cancer and 2,135 matched controls, compared with women in the lowest quartile of cholesterol intake, those in the second, third, and fourth quartiles had a multivariate adjusted odds ratio of OR 1.12, 1.20, and 1.42, (P = 0.031). Higher egg consumption was associated with a nonsignificant increase in ovarian cancer risk. The ORs for ovarian cancer were 0.77 and 0.76 in the highest quartile of total vegetable and cruciferous vegetable intake as compared with the lowest quartile. Women who took supplements of vitamin E, beta-carotene, and B-complex vitamins for > or =10 years had ORs of 0.49, 0.31, and 0.61, respectively. There was no association of ovarian cancer risk with dietary fat intake, including saturated, monounsaturated, and polyunsaturated fatty acids, protein, carbohydrate, dietary fiber, fruit, dairy products, meat products, fish, chicken, grain products, nut products, baked desserts, margarine, butter, mayonnaise, and supplement of multiple vitamins, vitamin A, vitamin C, calcium, iron, zinc, and selenium. A case-control study of diet and the risk of ovarian cancer. Pan SY, Ugnat AM, Mao Y, Wen SW, Johnson KC; Canadian Cancer Registries Epidemiology Research Group. Ontario, Canada. Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1521-7. For more, see Ovarian Cancer.

Selenium Helps Lower Homocysteine: In a study of elderly adults, serum selenium was inversely associated with homocysteine (tHcy), explaining 5.8% of tHcy variance vs. 2.2% accounted for by serum folate. There was a 63% decreased risk of higher tHcy concentrations (>14 micro mol/L) for subjects with serum selenium in the highest tertile (P = 0.013). There was an inverse association of protein intake with tHcy in men (beta = -0.144; P = 0.036), which disappeared after controlling for serum Se concentrations (beta = -0.055; P = 0.003). Serum selenium is associated with plasma homocysteine concentrations in elderly humans. Gonzalez S, Huerta JM, Alvarez-Uria J, Fernandez S, Patterson AM, Lasheras C. Oviedo, Spain. J Nutr. 2004 Jul;134(7):1736-40. Ed: Lowering homocysteine might lower heart disease, since high homocysteine is associated with heart disease.

Selenium Supplement Improves Immune Function: 22 adults with low plasma selenium (<1.2 micromol/L, 60% of UK adults screened) received 50 or 100 microg Se or placebo daily for 15 wk in a double-blind study. All received an oral live attenuated poliomyelitis vaccine after 6 wk and enriched stable (74)Se intravenously 3 wk later. Selenium supplementation increased lymphocyte phospholipid and cytosolic glutathione peroxidase activities and augmented the cellular immune response through an increased production of interferon gamma and other cytokines, an earlier peak T cell proliferation, and an increase in T helper cells. Humoral immune responses were unaffected. Selenium-supplemented subjects also showed more rapid clearance of the poliovirus, and the poliovirus reverse transcriptase-polymerase chain reaction products recovered from the feces of the supplemented subjects contained a lower number of mutations. The additional 100 microg Se/d may be insufficient to support optimal function. An increase in selenium intake improves immune function and poliovirus handling in adults with marginal selenium status. Broome CS, McArdle F, Kyle JA, Andrews F, Lowe NM, Hart CA, Arthur JR, Jackson MJ. University of Liverpool. Am J Clin Nutr. 2004 Jul;80(1):154-62

Selenium May Help by Protecting DNA From Alkylating Agents: Human exposure to alkylating agents metabolized from tobacco- and food-borne carcinogens occurs regularly. Dietary inorganic compounds such as selenium and vanadium have been chemoprotective benefits in rat and humans. Inorganic compounds to protect DNA from alkylation damage. An enzyme cleavage assay is used to observe alkylated DNA. Simple salts (e.g., NaCl or NiCl(2)) did not prevent DNA alkylation, whereas anionic oxo species (e.g., Na(2)SeO(4) or Na(3)VO(4)) did inhibit alkylation. Inhibition of DNA alkylation damage with inorganic salts. Hamilton EE, Wilker JJ. Purdue University. J Biol Inorg Chem. 2004 Sep 16. Ed: Selenium appears to protect against several cancers. This might be how. For more, see Selenium.

Inhaled Steroids Thin Bones: In a 3-year DB PC study of 412 smokers with COPD who used inhaled triamcinolone acetonide (ICS), 600 mcg, or placebo, twice daily, BMD at the femoral neck decreased 1.8% more with ICS than with placebo (p < 0.001). Lumbar spine BMD increased 0.98% with placebo; but decreased 0.35% with ICS (p = 0.007). Loss of Bone Density with Inhaled Triamcinolone in Lung Health Study II. Scanlon PD, Connett JE, Wise RA, Tashkin DP, Madhok T, Skeans M, Carpenter PC, Bailey WC, Buist AS, Eichenhorn M, Kanner RE, Weinmann G, The Lung Health Study Research Group. Mayo Clinic, Rochester. Am J Respir Crit Care Med. 2004 Sep 16

Ibebenone Helped Multi-infarct Dementia: In a DB PC study of 108 elderly, idebenone 45 mg/day for 120 days significantly improved the scores on the Mini Mental State, Randt Memory Test, Gottfries Rating Scale, Token Test, Toulouse Pieron Test, indicating improvements in memory attention and cognitivity. The drug was well tolerated. No changes in laboratory parameters were observed. Randomized, double-blind, placebo controlled, multicentre study of idebenone in patients suffering from multi-infarct dementia. Marigliano V, Abate G, Barbagallo-Sangiorgi G, Bartorelli L, Capurso A, Cucinotta D, Cuzzupoli M, Senin U, Tammaro AE, Fioravanti M. University of Rome 'La Sapienza'. Arch Gerontol Geriatr. 1992 Nov-Dec;15(3):239-48

Saw Palmetto Did Better than Flomax: In a 12-month, DB study of a lipido-sterolic extract (Permixon) of Serenoa repens (Saw Palmetto) 320 mg/day and tamsulosin (Flomax) 0.4 mg/day, 685 patients with benighn prostatic hypertrophy and an IPSS > 10, total IPSS decreased by 7.8 with Permixon and 5.8 with tamsulosin (p = 0.051); the irritative symptoms improved significantly more (p = 0.049) with Permixon (- 2.9 versus - 1.9 with tamsulosin). The superiority of Permixon in reducing irritative symptoms appeared as soon as month 3 and was maintained up to month 12 (p = 0.03). Evaluation of the clinical benefit of Permixon and tamsulosin in severe BPH patients--PERMAL study subset analysis. Debruyne F, Boyle P, Calais da Silva F, Gillenwater JG, Hamdy FC, Perrin P, Teillac P, Vela-Navarrete R, Raynaud JP, Schulman C. Nijmegen, Pays-Bas. Prog Urol. 2004 Jun;14(3):326-31

Tropisetron IV Helped Fibromyalgia: In a DB PC trial, 21 females with fibromyalgia were given the serotonin receptor (5-HT(3)) antagonist tropisetron 5 mg IV daily for 5 days. With tropisetron, the visual analogue scale (VAS) score for pain decreased by 28.9 compared with a decrease of 6.8 with placebo [probability (p)=0.063; effect size: 0.794]. A body diagram pain score decreased 27.2 for tropisetron vs. 2.8 for placebo (p=0.038; effect size: 0.902). Efficacy and tolerability of intravenous tropisetron in the treatment of fibromyalgia. Spath M, Stratz T, Neeck G, Kotter I, Hammel B, Amberger C, Haus U, Farber L, Pongratz D, Muller W. University of Munich. Scand J Rheumatol. 2004;33(4):267-270

Escitalopram (Lexapro) Does Well vs. Venlafazine (Effexor) in Manufacturer's Study: In an 8-week 195-patient DB trial by the manufacturer of escitalopram, escitalopram 20 mg/day did as well as venlafaxine 225 mg/day for major depressive disorder. Mean decreases in MADRS depression scores for escitalopram and venlafaxine XR were -15.9 and -13.6, respectively. Remission (MADRS score of </= 10) rates at endpoint were 41.2% for escitalopram and 36.7% for venlafaxine XR. Venlafaxine had a higher rate of side-effects than the escitalopram (85.0% vs. 68.4%) with more discontinuing due to side effects (16.0% vs. 4.1%; p <.01). A double-blind comparison of escitalopram and venlafaxine extended release in the treatment of major depressive disorder. Bielski RJ, Ventura D, Chang CC. Forest Laboratories. J Clin Psychiatry. 2004 Sep;65(9):1190-6

Another Short Study of COX-2 Inhibitor vs. NSAID: In a large 583-adult 4-week DB PC study of another cyclooxygenase 2-selective inhibitor lumiracoxib vs placebo and diclofenac for osteoarthritis (OA), patients received lumiracoxib 50, 100, or 200 mg twice daily or 400 mg once daily; placebo; or diclofenac 75 mg twice daily. Pain relief was comparable among all lumiracoxib dosages and similar to diclofenac. Lumiracoxib tolerability was superior to diclofenac and comparable to placebo. Arthritis Rheum. 2004 Aug 15;51(4):549-57. Efficacy and safety of four doses of lumiracoxib versus diclofenac in patients with knee or hip primary osteoarthritis: a phase II, four-week, multicenter, randomized, double-blind, placebo-controlled trial. Schnitzer TJ, Beier J, Geusens P, Hasler P, Patel SK, Senftleber I, Gitton X, Moore A, Sloan VS, Poor G. Northwestern University. Ed: Both COX-2 inhibitors and NSAIDs in general are inferior to glucosamine and chondroitin since the former have little or no impact on disease progression. They are cost a ton more.

Ayurvedic Pancreas Tonic Helped Some Diabetics: Pancreas Tonic is a botanical mixture of traditional Indian Ayurvedic herbs currently available as a dietary supplement. In a 36-patient, 3-month DB PC trial of Pancreas Tonic (2 tabs 3 times a day) in type 2 diabetic patients inadequately treated with diet/lifestyle or stable doses of sulfonylureas and/or metformin for at least 3 months, HbA(1c) decreased for those with initial HbA(1c) over 10.0% (Pancreas Tonic: 10.1% to 8.8%, P =.004; placebo: 10.8% to 11.2%). No significant HbA(1c) reductions were seen for those below 10.0%. Effect of Pancreas Tonic (an ayurvedic herbal supplement) in type 2 diabetes mellitus. Hsia SH, Bazargan M, Davidson MB. Metabolism. 2004 Sep;53(9):1166-73

Lactobacillus Powder and Pessary No Help in Post-Antibiotic Vaginal Candidiasis: In a DB PC study of 278 women with short courses of oral antibiotics for non-gynecologic infections, women were given oral powder, either Lactobac (containing Lactobacillus rhamnosus and Bifidobacterium longum) or placebo and (b) a vaginal pessary, either Femilac (containing L rhamnosus, L delbrueckii, L acidophilus, and Streptococcus thermophilus) or placebo. Lactobacillus preparations were taken orally or vaginally, or both, from starting antibiotics until four days after completion of their antibiotic course. There was no difference in the percentages of women developing post-antibiotic vulvovaginitis. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. Pirotta M, Gunn J, Chondros P, Grover S, O'Malley P, Hurley S, Garland S. Victoria, Australia. BMJ 9/2004. Ed: Powders and tablets have repeatedly been shown to have far fewer viable colonies of lactobacillus than advertised. Even yogurt loses some viability as it ages, although I haven't been able to find any studies to quantify this issue. The researchers confirmed lactobacillus viability, but since yogurt is what is used by the vast majority of women, it is disappointing that real yogurt was not used in the study. It's less expensive, fresher, and much more readily available. These results are disappointing, but I don't think they disprove the anti-fungal benefits of lactobacilli. The authors note that lactobacilli should be more effective for bacterial infections.

Another New COX-2 Better than Addictive Percocet for Acute Severe Pain: In a DB PC study of etoricoxib (Arcosia), Merck's new COX-2 inhibitor, and oxycodone/acetaminophen for postoperative dental pain (moderate to severe pain after extraction of two or more third molars), total pain relief over 6 and 24 hours was clearly less with etoricoxib 120 mg (n = 100), than with oxycodone/acetaminophen (Endocet, Percocet) 10/650 mg (n = 100), or placebo (n = 25) (P < 0.001). Oxycodone/acetaminophen treatment resulted in more frequent side-effects, nausea, and vomiting. The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute postoperative pain model: a randomized, double-blind clinical trial. Chang DJ, Desjardins PJ, King TR, Erb T, Geba GP. Merck Pharmaceuticals. Anesth Analg. 2004 Sep;99(3):807-15. Ed: Yet another study proves opioids are inferior pain relievers for acute pain.

Dog Rose Extract Helps Osteoarthritis: In a 3-month DB PC crossover study 112 osteoarthritis sufferers (knees, hips, hands, neck, or shoulders) average age 66, when given Hyben Vital, a Danish-brand herbal remedy made from a subtype of Rosa canina, 5 g daily or an identical placebo for 3 months, followed immediately by the alternative treatment. When given Hyben Vital second, patients improved markedly for mood, sleep quality, energy, p < 0.0078 for pain and < 0.0025 for stiffness. With Hyben Vital 66% reported improvement vs. 36% with placebo. Stiffness improved 48% vs. 23%. Cholesterol decreased 8.5% with Hyben Vital. When given Hyben Vital first, the marked improvement occurred with no relapse when placed on placebo, suggesting a strong "carryover" effect of Hyben Vital. Side-effects were no different from placebo. In another study testing a possible interaction between Rose hip and warfarin, the authors did not find any effect on coagulation and platelet aggregability (Winther, 2000). This suggests that Rose hip does not affect the arachidonic acid and cyclo-oxygenase system. A herbal remedy, Hyben Vital (standard powder of a subspecies of Rosa canina (Dog rose) fruits), reduces pain and improves general wellbeing in patients with osteoarthritis--a double-blind, placebo-controlled, randomised trial. Rein E, Kharazmi A, Winther K., Kolding, Denmark. Phytomedicine. 2004 Jul;11(5):383-91. The manufacturer did support the study. Hyben Vital can be purchased from Denmark from http://anivet.dk/shop/default.asp?ProductID=153 for $10 for a one-month supply (150 g). However, the website is in Danish and I don't know what the shipping costs, etc. are. A liquid extract of 60 g is available from iherb.com for $10, but this may not be as good as the product researched.

Rosa Canina May Protect Stomach: Five herbal remedies used as gastroprotective crude drugs in Turkey were assessed for anti-ulcerogenic activity using the EtOH-induced ulcerogenesis model in rat. The crude drugs investigated comprises fruits of Elaeagnus angustifolia L. (Elaeagnaceae), fresh fruits of Hibiscus esculentus L. (Malvaceae), fresh roots of Papaver rhoeas L. (Papaveraceae), leaves of Phlomis grandiflora H.S. Thomson (Lamiaceae) and fresh fruits of Rosa canina L. (Rosaceae). Extracts were prepared according to the traditional indications of use. All extracts exhibited statistically significant gastroprotective effect with better results for Phlomis grandiflora and Rosa canina (100%). At the concentration under study, both crude drugs were more effective than the reference compound misoprostol at 0.4 mg/kg. Even the weakest anti-ulcerogenic effect observed for Papaver rhoeas roots was found statistically potent (95.6%). Histopathological studies confirmed the results of the in vivo test. Anti-ulcerogenic activity of some plants used as folk remedy in Turkey. Gurbuz I, Ustun O, Yesilada E, Sezik E, Kutsal O. Gazi University, Ankara, Turkey. J Ethnopharmacol. 2003 Sep;88(1):93-7

Dog Rose Hips Blocks Chemotaxis of Neutrophils: A galactolipid isolated from dried and milled fruits of Rosa canina is an anti-inflammatory agent with inhibitory effects on chemotaxis of human peripheral blood neutrophils. The inhibition of cell migration is not related to toxicity. This galactolipid may explain the clinically observed anti-inflammatory properties of rose hip herbal remedies. An antiinflammatory galactolipid from rose hip (Rosa canina) that inhibits chemotaxis of human peripheral blood neutrophils in vitro. Larsen E, Kharazmi A, Christensen LP, Christensen SB. Aarslev, Denmark. J Nat Prod. 2003 Jul;66(7):994-5

Weekly Fluconazole Helps Prevent Vaginal Yeast Recurrence: In a DB PC study of 387 women with recurrent vulvovaginal candidiasis, half received fluconazole (150 mg) or placebo weekly for six months. At 6, 9, and 12 months with fluconazole 91%, 73%, and 43% remained disease-free , vs. 36%, 28%, and 22% with placebo (P< 0.001). The median time to recurrence with fluconazole was 10.2 months, vs. 4.0 months with placebo (P<0.001). There was no evidence of fluconazole resistance in isolates of Candida albicans or of superinfection with C. glabrata. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, Sperling M, Livengood C 3rd, Horowitz B, Von Thron J, Edwards L, Panzer H, Chu TC. Wayne State University. N Engl J Med. 2004 Aug 26;351(9):876-83

Hepatitis B Vaccine May Slightly Increase Multiple Sclerosis Risk: From a representative sample of over three million British patients, 163 cases of multiple sclerosis were 1604 matched controls. The proportion of cases that received at least one hepatitis B immunization during the 3 years before the date of first symptoms was 6.7%, compared with 2.4% of controls. The odds ratio was 3.1. Several previous studies have looked for evidence of a link between hepatitis B vaccination and multiple sclerosis, but all found either no significant association or a lower odds ratio than this study. The number of subjects with both multiple sclerosis and hepatitis B vaccination was only 11. 93% of the cases of multiple sclerosis in their study had not taken the vaccine. Miguel Hernán (Harvard), et al. Neurology 2004;63:838-42; BMJ 9/25/2004;329:703.

Physiotherapy No Help For Back Pain: 286 patients with low back pain of more than six weeks' duration were given either a standard course of physiotherapy or one session of advice on remaining active from a physiotherapist. Both groups received an advice book. Patients in the therapy group reported enhanced perceptions of benefit, but there was no evidence of a long term effect of physiotherapy in either disease specific or general outcome measures. The most common treatments were low velocity spinal joint mobilization techniques (72%, 104 of 144 patients) and lumbar spine mobility and abdominal strengthening exercises (94%, 136 patients). The British NHS treats around 1.3 million people for low back pain each year, but there is only weak evidence for the effectiveness of routine physiotherapy and no evidence for the effectiveness of electrotherapy, laser treatment, ultrasound therapy, or traction. BMJ 2004;329:708 (25 September). Ed: Assuming the U.S. is like the U.K., eliminating such wasteful physiotherapy would save over $5 billion per year. Of course, it won't happen.

C-Sections Very Slight Benefit for Breech Presentations: For 3-4% of pregnancies, the fetus is in the breech presentation at term. In a randomized trial in 26 countries, 2088 women with a single infant in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Of the women assigned to C-section, 90% had C-sections. For planned vaginals, 57% had vaginal deliveries. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was lower for the planned caesarean sections (1.6% vs. 5.0%; p<0.0001). There were no differences between groups in terms of maternal mortality or serious maternal morbidity (3.9% vs. 3.3%). Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Toronto, Ontario. Lancet. 2000 Oct 21;356(9239):1375-83. Ed: Most C-sections are due to fetal distress and dystocia (abnormal or difficulty labor). There are no controlled studies on these comparing C-sections to vaginal delivery. C-sections have increased dramatically since 1980, when there was already considerable concern about their high rates. While the U.S. and Canada average 25%, the increase has occurred in many countries with Britain over 20%.

Cholesterol Levels Vary Dramatically by Country: Men in parts of Europe are up to 25 times more likely to have high cholesterol levels as men in China, from 2% for men in Beijing to 51% in Ticino, Switzerland. International Journal of Epidemiology 10/04. The data is from the WHO MONICA Project, using standardized methods over 10 years in adults in 19 countries. The prevalence in men averaged 27% and women 25%. On average, 30% of men had had their cholesterol measured in the past year, from 2% in Moscow to 57% in Bremen. The highest rates of measuring cholesterol were in France, Belgium, Germany, Italy, and Spain, and the lowest were in Russia and Lithuania. Overall, 19% of men were aware of their hypercholesterolaemia, ranging from 1% in Lithuania, to 33% in Strasbourg and Bremen. Some recommend that everyone have total cholesterol measured every five years. To fulfill this goal would require huge financial investment and is unrealistic according to the report. BMJ 9/11/2004;329:590

Multiple Sclerosis: Marijuana Oral Spray Minimally Beneficial on Subjective Measure of Spasticity, But Not on Primary Symptoms or Any Objective Measures: In a 160-patient DB PC study of oromucosal sprays of matched placebo, or whole plant marijuana containing equal amounts of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) at a dose of 2.5-120 mg of each daily, in divided doses using a subjective visual analogue measure for each patient's most troublesome symptom. Following CBME the primary symptom score reduced from mean of 74 to 49 following CBME and from 74 to 55 following placebo [ns]. Spasticity VAS scores were significantly reduced by CBME (Sativex) in comparison with placebo (P =0.001). Results on measures of disability, cognition, mood, sleep and fatigue were gathered but not reported in the abstract. There were no significant adverse effects on cognition or mood and intoxication was generally mild. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Wade DT, Makela P, Robson P, House H, Bateman C. Oxford, UK. Mult Scler. 2004 Aug;10(4):434-41. Ed: It is extremely unlikely that the patients were effectively blinded. There is no report asking patients to guess whether they received the real drug or placebo. Since the only benefit was a subjective one where a much larger study found no impact on objective measures of spasticity, blindedness is very important to report.

Multiple Sclerosis: Marijuana Claimed Helpful in Very Odd Study Showing Minimal Subjective Benefit if Any At All: In a small, poorly designed DB PC crossover study of 57 MS patients with poorly controlled spasticity, all received cannabis-extract capsules standardized to 2.5 mg tetrahydrocannabinol (THC) and 0.9 mg cannabidiol (CBD) each for 14 days.  Only 50 patients were included into the intention-to-treat analysis. There were no statistically significant differences associated with active treatment compared to placebo, but trends in favor of active treatment were seen for spasm frequency, mobility and getting to sleep. No differences were present in objective measures of a 10-m timed walk, nine-hole peg test, paced auditory serial addition test (PASAT), and the digit span test. The authors state, " In the 37 patients (per-protocol set) who received at least 90% of their prescribed dose, improvements in spasm frequency (P = 0.013) and mobility after excluding a patient who fell and stopped walking were seen (P = 0.01)." Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M. Switzerland. Mult Scler. 2004 Aug;10(4):417-24. Ed: A crossover study with marijuana is absolutely senseless.  Virtually every patient is going to be able to tell the difference of the marijuana and the placebo.  This was essentially an "open-label study." The authors apparently never asked patients to see if they could tell the placebo from the real stuff, but it appears obvious. The authors then really massage their data to draw exaggerated claims of benefit.  For more, see Multiple Sclerosis.

Donepezil (Aricept) Minor Benefit for Mild Cognitive Impairment: In a 24-week, 270-patient DB PC study of mild cognitive impairment (MCI), those receiving donepezil (5 mg/day for 42 days, then 10 mg/day) or placebo (n = 137) did not show benefit on the primary efficacy measures of the NYU Paragraph Recall test and the ADCS CGIC-MCI. More did show improvements in ADAS-cog total scores, in tests of attention and psychomotor speed, and in PGA scores. Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Salloway S, Ferris S, Kluger A, Goldman R, Griesing T, Kumar D, Richardson S; Donepezil 401 Study Group. Brown University. Neurology. 2004 Aug 24;63(4):651-7. Ed: At the high cost of donepezil, the small amount of improvement is just not worth the public's money. For more, see Treatments for Dementia.

Patients Low in Folic Acid Less Likely to Respond to Fluoxetine (Prozac) Anti-Depressant: In a study of 55 patients given fluoxetine as part of a longer study, the 14 patients who had low folate levels were much less likely to improve than those with normal levels during the first 4 weeks of treatment at 20 mg/day (7% vs. 45%). B-12 and homocysteine levels had nothing to do with responsiveness. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 1: predictors of clinical response in fluoxetine-resistant depression. Papakostas GI, Petersen T, Mischoulon D, Ryan JL, Nierenberg AA, Bottiglieri T, Rosenbaum JF, Alpert JE, Fava M. Harvard-MGH, J Clin Psychiatry. 2004 Aug;65(8):1090-5. For more, see Vitamins for Depression. 

Gepirone Inferior Medication Pushed by Harvard Researchers for Drug Company; Slightly Better than Placebo: In an 8-week, DB PC study of 133 major depression patients with high levels of anxiety, the extended-release version of gepirone was found to be slightly better than placebo. Gepirone caused a statistically significant (p <.05) reduction in mean HAM-D-17 depression scores compared with placebo-treated patients. A statistically significant effect (p <.05) in favor of gepirone ER was observed in mean change from baseline in HAM-D-17 total scores and for HAM-D factor I (anxiety/somatization) scores from week 2 onward.  Gepirone extended-release treatment of anxious depression: evidence from a retrospective subgroup analysis in patients with major depressive disorder. Alpert JE, Franznick DA, Hollander SB, Fava M. Harvard-MGH. J Clin Psychiatry. 2004 Aug;65(8):1069-75. Ed: Gepirone is an old medication related to buspirone which was never marketed because of its marginal benefits. The manufacturer has come out with an extended release version in order to allow patent protection.  Harvard carefully worded its abstract to make gepirone sound much better than it actually was. For more, see Gepirone for Depression.

Atypical Quetiapine (Seroquel) Useful OCD Add-On: In an 8-week, 40-patient DB PC study of obsessive-compulsive disorders unresponsive to at 2 SRI meds, quetiapine increased up to 300 mg/day in intent-to-treat, last-observation-carried-forward analysis showed a 31% decrease in Y-BOCS score vs. a 7% for the placebo (p <.001). The most common side effects in the quetiapine group were somnolence, dry mouth, weight gain, and dizziness. A double-blind, randomized, placebo-controlled trial of quetiapine addition in patients with obsessive-compulsive disorder refractory to serotonin reuptake inhibitors. Denys D, de Geus F, van Megen HJ, Westenberg HG. University Medical Center Utrecht, Netherlands. J Clin Psychiatry. 2004 Aug;65(8):1040-8. Ed: Three atypicals, Zyprexa, Seroquel, and Risperdal have all shown about the some benefit as add-ons for OCD.  There is no reason to think that any of the other atypicals would be any different.  I prefer Geodon due to fewer side-effects and lower cost. For more, see Obsessive-Compulsive Disorders.

Artificial Coloring and Sodium Benzoate Cause Slight Hyperactivity in Children Regardless of ADHD Status: 277 of 1,873 children age 3 were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1,246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT and not-HA/not-AT (n = 277). In a careful DB PC crossover study, children received one week of a special diet with a drink containing artificial colorings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. There were significant reductions in hyperactive behavior during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behavior during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. BatemanB, WarnerJO, HutchinsonE, DeanT, RowlandsonP, GantC, GrundyJ, FitzgeraldC & StevensonJ. (2004) Archives of Disease in Childhood, 89, 506-511. Also, Child Care Health Dev. 2004 Sep;30(5):561. For more, see Causes of ADHD.

Omitting Weekend Methylphenidate (Ritalin) Reduces Side-Effects Without Loss of Benefit: In a 28-day DB PC study of 40 children, half received placebos during the weekend.  Both groups showed a significant reduction on the ABRS hyperactivity scores over time as the dose was increased. However, the group difference in the ABRS scores was not statistically significant, either on weekend parent ratings or on teachers' ratings. The omission of MPH on weekends was associated with significantly less severity of insomnia (p = 0.05) and a trend for less interference on appetite (p = 0.08). Weekend holidays during methylphenidate use in ADHD children: a randomized clinical trial. Martins S, Tramontina S, Polanczyk G, Eizirik M, Swanson JM, Rohde LA. University of Rio Grande do Sul, Porto Alegre, Brazil. J Child Adolesc Psychopharmacol. 2004 Summer;14(2):195-206. For more, see Stimulants for ADHD.

Non-Addictive Melatonin as Good as Addictive Midazolam for Pre-Laparoscopy Anxiety and Sedation: In a DB PC study of 66 patients undergoing laparoscopic cholecystectomy, patients were given melatonin 5 mg, midazolam 15 mg or placebo, 90 min before anaesthesia, sublingually. Patients who received premedication with either melatonin or midazolam had a significant increase in sedation and decrease in anxiety before operation compared with controls. Perioperative effects of melatonin and midazolam premedication on sedation, orientation, anxiety scores and psychomotor performance. Acil M, Basgul E, Celiker V, Karagoz AH, Demir B, Aypar U.Hacettepe University, Ankara, Turkey. Eur J Anaesthesiol. 2004 Jul;21(7):553-7. For more, see Melatonin.

Bupropion (Zyban) Helps 15% Stop Smoking at Six Months: In a DB PC study of 509 smokers motivated to quit smoking, those on bupropion 150 mg b.i.d. for 7 weeks, and followed-up for 26 weeks showed a six months' point abstinence rate were 31% vs.  16%. Craving decreased significantly more with bupropion, but there was no difference for total withdrawal symptoms score. Low level of nicotine dependence, high motivation, absence of smoking-related disease, long duration of previous quit attempts, male gender, low level of current alcohol problems and living as a couple were predictive of successful cessation. Efficacy of bupropion and predictors of successful outcome in a sample of French smokers: a randomized placebo-controlled trial. Aubin HJ, Lebargy F, Berlin I, Bidaut-Mazel C, Chemali-Hudry J, Lagrue G. Limeil-Brevannes, France. Addiction. 2004 Sep;99(9):1206-18. Ed: Unfortunately, the one year success rates in three large studies for Zyban is only 5% over placebo.  For more, see Bupropion for Smoking.

Policosanol Decreases Bone Loss in Rats: Mevalonate is required for producing lipoids that are important in osteoclast activity and thus drugs affecting mevalonate production can prevent bone loss in rodents. Policosanol is a cholesterol-lowering drug isolated from sugar cane wax that inhibits cholesterol biosynthesis through an indirect regulation of hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase activity. Estradiol and policosanol prevented these effects compared with ovariectomized controls. Both treatments also prevented an increase in the number and area of osteoclasts. Estradiol, but not policosanol, significantly prevented an increase of osteoblast surface area compared with ovariectomized controls. Policosanol prevents bone loss in ovariectomized rats. Noa M, Mas R, Mendoza S, Gamez R, Mendoza N, Gonzalez J. Havana City, Cuba. Drugs Exp Clin Res. 2004;30(3):117-23. Ed: Statins decrease bone loss in humans. Maybe policosanol does as well.

Wheat Germ Policosanol Didn't Help Normals: Sugar cane policosanol, a mixture of long-chain primary alcohols (67% as octacosanol). In a short 4-week DB PC study of wheat germ policosanol (WGP) 20 mg/d on plasma lipid profiles in 58 adults with normal to mildly elevated plasma cholesterol, neither the WGP nor the control significantly changed plasma total cholesterol, LDL- and HDL-cholesterol, or triacylglycerol. WGP consists of 8% hexacosanol, 67% octacosanol, 12% triacosanol, and 13% other long-chain alcohols, which is similar to the composition of sugar cane policosanol. Lin Y, Rudrum M, Van Der Wielen RP, Trautwein EA, McNeill G, Sierksma A, Meijer GW. Metabolism. 2004 Oct;53(10):1309-14. Ed: It would have been better to use sugar cane policosanol for 10 weeks with adults with truly elevated cholesterols as in previous studies. Still, the results are of concern. Someone needs to replicate the policosanol studies outside of Cuba.

Policosanols Didn't Work in Rabbit Replication Study: Normocholesterolemic rabbits were given either a plain sunflower oil emulsion, 100 mg/kg sugar cane policosanol (SCP), or 100 mg/kg sunflower policosanol (SFP) for 4 weeks. There was no treatment effect of either policosanol, even though a lower dose of SCP than used here (5 mg /day) has been reported to lower cholesterol in rabbits. Lack of effect of sugar cane and sunflower seed policosanols on plasma cholesterol in rabbits. Murphy KJ, Saint DA, Howe PR. University of South Australia. Asia Pac J Clin Nutr. 2004: Aug;13(Suppl):S69. For more, see Policosanol.

Recycling Endosomes Put Neurotransmitter Receptors Back on the Surface: Neurotransmitter receptors inside the neuron are carried to the surface from sac-like carriers called endosomes and vesicles, which enclose and transport various molecular cargos in the cell. Depending on the type of carrier, the cargo may be destroyed, or recycled back to the cell surface. The movement of AMPA receptors studied had to be regulated by activation by NMDA receptors, which are known to trigger long term potentiation in neurons. "Recycling endosomes" transport "used" receptors back to the neuronal surface after they have been drawn into the neuron. Triggering LTP not only affected insertion of AMPA receptors, but the generalized recycling of molecular cargo to the dendritic surface. Aging and neurodegeneration has been associated with enlarged and expanded endosomes in neuronal dendrites. There is an association of aging and neurodegeneration with altered synaptic function and plasticity. Michael Ehlers, Duke Univ., Julie Kauer Brown Univ. 9/24/2004, Science.

Exercise Helps Prevent Asthma: Data shows that lungs not regularly stretched by deep breathing become prone to wheezing. Physical activity has anti-inflammatory effects. Harvard research. Thomas Platts-Mills, Univ. Virginia, Chic Trib 9/26/04.