PrimeCuts: This Week in the Journals

February 16, 2009

pilot.JPGCommentary by Josh Remick MD, NYU Senior Chief Resident 

It was quite the week in Medicine, spanning from politics to plagiarism, pregnancy to pain, steroids to statins and artificial limbs to A-Roid.  And that’s not even getting into Octomom or Michael Phelps and the physiology of bong smoking.

The news only seems to be getting better for statins.  In a recent trial published in the Archives of Internal Medicine, consistent use of statins improved mortality in patients with coronary artery disease (this much we knew) AND in patients without it (this much we have suspected).  In their retrospective cohort study of roughly 230,000 Israeli patients who participated in a particular HMO, statin use for 90% of days was found to reduce mortality over a 4-5 year period by roughly half over those using statins for 10% of days regardless of baseline coronary heart disease or LDL values.  While the results are from retrospective data and used pharmacy prescription data to determine the length of time that the patients were on statins, this study only adds to the belief held by many that the benefit of statins goes way beyond patients with coronary disease or high LDL levels.

An article from this past week’s JAMA has been getting quite a bit of buzz lately.  Researchers analyzed 18 observational studies of women who had given birth to children with congenital birth defects and performed a meta-analysis.  They found that women who were obese (based on BMI criteria) prior to, or soon-after becoming pregnant had a higher risk of having children (compared to women with normal BMIs) born with neural tube defects, cardiovascular abnormalities, cleft lips and palates and other congenital abnormalities like anorectal atresia, limb reduction abnormalities and hydrocephaly.  Of note, the odds ratios for each of these abnormalities was between 1 and 2, and aome of the unanswered question from this study include the role of supplemental vitamins such as folate and whether proper weight maintenance during pregnancy affects these outcomes.  However, given the obesity epidemic in the United States, this study only reiterates the excess risk obese patients face with regards to adverse health outcomes.

Over in Washington D.C., the Obama administration has been getting quite a fight over the proposed stimulus bill for the ailing economy (which should be signed into law on Tuesday, February 17th, 2009).  But the fight is not just coming from Republicans in the House and Senate; it is also coming from the Drug and Medical Device Industries and the reason why they are fighting it may shock you.  It seems that there is a provision in the stimulus bill that would give 1.1 billion dollars towards research comparing medical treatments.  It seems the industry is very concerned that such research would lead to cuts in reimbursements for procedures and technology deemed to be inferior.  Clearly this is an effort on the part of the Obama administration to try and reform health care by finding areas of excess cost and reducing the waste in the system; an effort that will clearly be hotly contested along the way.

The NY Times ran an article highlighting the advances made in artificial limb technology.  The industry has come a long way from the days of Captain Hook for sure!  The technology that now allows artificial limbs to be controlled by thoughts from the brain, known as targeted muscle reinnervation, involves taking the nerves that remain after an arm is amputated and connecting them to other muscles in the body, usually in the chest, which then has electrodes attached to serve as a type of antenna.  Then, when the patient wants to move their arm, the brain sends signals that the chest picks up which then relay the information to the prosthetic limb; per the article the process requires no more conscious thought than it takes for people without prosthetic limbs to move their arms and legs.  The article goes on to talk about where these innovations are coming from and how they expect that, due to the growing obesity trends in the US, the pool of diabetic patients will only increase and ultimately they will probably end up seeing more amputations as a result.

From a story of hope to a story of downright horror, new reports out of the Times of London this past week accuse Dr. Andrew Wakefield, the father of the “Vaccines causing Autism” theory, of fudging much of his data from his seminal paper in the Lancet in 1998.  The report states that Dr. Wakefield altered clinical data on 8 of the 12 patients in his original paper.  The allegations come on the heels of disclosures that Dr. Wakefield’s research was secretly funded by plaintiffs’ lawyers in suits against vaccine makers and that he had cut procedural corners in his research.  On a related note, a court this week ruled that there was no scientific evidence that vaccines administered in childhood caused autism.  While a horrible disease without a known cause or cure, the “Vaccines causing Autism” theory has been largely kept in the spotlight thanks to many celebrities who advocate its merits.

I know I have gone way over my word count, so we’ll wrap up with the speed round.  The FDA had two big announcements this week.  In one, they announced that the anticoagulant Antithrombin alfa was approved for patients with hereditary antithrombin deficiency.  The significance of the announcement is that Antithrombin alfa is the world’s first pharmaceutical product made from genetically engineered animals.  The second announcement was that opioid restrictions are going to be getting tighter so as to prevent the number of abuses and overdoses of this class of pain killers.  The New England Journal of Medicine published a study that looked at financial incentives to help workers at a company quit smoking.  While the short term effects showed that it worked (what won’t people do for some extra cash in this economy?) almost 90% had started smoking again within one year.  And lastly, it’s not a week in medicine without a famous athlete doing something stupid.  This week, Alex Rodriguez, the heir apparent to the tainted all-time home run crown held by Barry Bonds, admitted to using steroids when he played for the Texas Rangers from 2001-2003.  You can watch his interview with Peter Gammons where he admits to his steroid use here.

One Response to PrimeCuts: This Week in the Journals

  1. cathy carron on February 20, 2009 at 5:03 pm

    It finally ocurred to me to look for a NYU medical blog and wow, it’s fabulous. I am a General Internist down at NYU Trinity Center and have had little time to get to know anyone at the hospital (except the hospitalists, who are great)so finding this came as a pleasant suprise. And Josh, before I went to medical school I was an editor for the Paris Review and it’s great to find someone that can write as well as you do.
    I look forward to exploring this site.
    Cathy Carron

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