Commentary by Cara Litvin MD, Executive Editor Clinical Correlations
Avandia again made headlines this week when an FDA advisory committee voted to allow the drug to remain on the market despite new data that suggests it may increase the risk of ischemic heart disease. The committee overwhelmingly agreed that Avandia increases the risk of myocardial infarction in diabetic patients. However, in a remarkable vote of 22 to 1, the committee nevertheless agreed that the drug should be kept on the market with new labeling. Based on available data, the panel urges risk assessment when deciding when to prescribe Avandia and concluded that diabetic patients requiring insulin, those with established coronary artery disease, and patients on nitrates are probably not good candidates for the drug.
Also making the nightly news this week came a report of deep brain stimulation restoring awareness in a man who had been in a minimally conscious state for several years. According to the report published in Nature, after deep brain stimulation, a man who had been barely conscious after a traumatic brain injury and previously only able to make slight motions is now able to perform complex movements, no longer requires a feeding tube, and communicates with his family using words and gestures. Although only a single case report, this opens the door to a possible new modality for the treatment of patients with severe brain damage.
Published in the Lancet this week was an interesting study linking marijuana use to an increased risk of psychotic illness. According to the study, a systematic review of 35 previous studies, people who had ever used cannabis had a 41% increased risk of psychosis compared to those who had never used the drug. A dose response effect was found, with the most frequent users having double the risk of a psychotic outcome compared to non-users. Dude…that’s crazy.
Finally, the NEJM published three articles this week linking variants of specific genes with clinical diseases. One article discusses a specific genetic loci found in patients with sporadic amyotrophic lateral sclerosis (ALS). Another genomewide study identifies two specific alleles as heritable risk factors for multiple sclerosis. The third article discusses possible genetic loci that may affect the risk of development of coronary artery disease. Taken together, these three articles represent the first exciting steps toward a new frontier in medicine when genetic analysis may become a crucial factor in the diagnosis and treatment of disease.