ShortCuts- This Week in the Journals

June 11, 2007

It has been a little while, but stem cells are back in the news. Congress has passed legislation to provide more money for stem cell research, but did not reach a veto-proof majority. Meanwhile, scientists at MIT have successfully transformed mice skin cells into the equivalent of embryonic stem cells. The presumption is that these cells, which are indistinguishable from embryonic stems cells can then be forced to develop into any tissue under the proper stimulation. While this approach might obviate the need to utilize embryonic human tissue to obtain stem cells, it has not yet been shown to work with human cells. Until this is accomplished, the scientific and political wheels will continue to churn over this issue.

Over the past few years, we have spent much time discussing the impact of the 405 work hour regulations on medical education. This week, the Annals of Internal Medicine┬ápre-released an article that examined the effect of these regulations on patient outcomes. I wouldn’t have predicted this, but the authors actually showed that the regulations, limiting the work-week, have decreased medical patient mortality. They measured inpatient mortality of 1,268,738 patients admitted to 551 hospitals with medical diagnoses and 243,207 patients admitted for surgical diagnoses before and after 2003 when the work-hour regulation took effect. After 2003, the regulations were associated with a statistically-significant 0.25% reduction in the absolute mortality rate and a 3.75% reduction in the relative risk for death. In comparison, the regulations were not associated with statistically significant changes in mortality of surgical patients. I have no doubt that this study and the findings will result in a great deal of discussion in academic medical centers.

Scientists can’t seem to get enough of the question, “Does folic acid supplementation decrease the risk of colorectal cancer?” Well, the Polyp Prevention Study Group, in this week’s JAMA, has tried once again to look at this question. They examined folate supplementation in 1021 subjects with a recent history of colorectal adenomas. In this double-blind, placebo-controlled, randomized clinical trial conducted at 9 clinical centers, the authors found, as has been shown previously, that the receipt of 1mg/day folate does not decrease development of colorectal cancer. What makes this study more interesting is that folic acid was associated with higher risks of having 3 or more adenomas and of noncolorectal cancers.

In additional news, a team of Arizona researchers may have identified a gene (GAB2) that could be used to predict a person’s risk of developing Alzheimer’s disease, and of cultural interest, Edwin Traisman, a food scientist who created the process for freezing McDonald’s french fries and helped develop Cheez Whiz died of a heart attack this week. It should be noted that he was age 91 at his passing.

Michael Poles MD, Associate Editor, Clinical Correlations