ShortCuts-This Week in the Journals

June 23, 2008

napali-coast.JPGCommentary by Michael Poles MD, Associate Editor, Clinical Correlations 

Hey Blogophiles,

In case you were blogopenic, awaiting the latest installment of shortcuts, here we go.

It is still early morning as I write this. Many folk the world over are sitting down to their 1st or 2nd or perhaps 3rd cup of coffee. Caffeiniacs rejoice because an article in the latest issue of the Annals of Internal Medicine suggests that you may be headed for a longer life. The authors sought to assess the association between coffee consumption and mortality from cardiovascular disease, cancer, and all causes during 18-24 years of follow-up. They examined 41,736 men and 86,214 women with no history of cardiovascular disease or cancer at baseline. After adjustment for age, smoking, and other cardiovascular disease and cancer risk factors, they found that the relative risks for all-cause mortality in men decreased as coffee consumption increased (<1 cup per month, RR=1.0 to 6 cups per day, RR= 0.80) (P for trend = 0.008). For women, the relative risks were for <1 cup per month, RR=1.0 to 6 cups per day, RR= 0.83) (P for trend < 0.001). While the decreased risk of death was mainly due to a moderately reduced risk for cardiovascular disease, it was not statistically significantly associated with risk for cancer death. For those who need their sleep, decaffeinated coffee consumption was associated with a small reduction in mortality. Either way, bottoms-up.

Ok, let’s move on from our morning activities to other leisurely pursuits. We all like our vacation time, but I don’t know anyone who relishes the possibility of developing traveler’s diarrhea when they are on those trips. Well, could vaccination make that a thing-of-the-past? While a tantalizing proposal, I’ll burst your bubble and say no. Still, as this article in the latest Lancet shows, the risk can be significantly decreased. The authors investigated a vaccination strategy using a cutaneous patch-delivered vaccine against the LT toxin of the most common source of traveler’s diarrhea, enterotoxigenic Escherichia coli (ETEC), on travelers to Mexico and Guatemala. They found that 22% of 111 placebo recipients developed diarrhea, of whom 10% of cases were due to ETEC. In comparison, only 15% of vaccination recipients developed diarrhea, of which 5% of cases were due to ETEC.  The 59 LT-patch vaccination recipients were protected against moderate-to-severe diarrhea (protective efficacy 75%, p=0.0070) and severe diarrhea (PE 84%, p=0.0332). Those vaccination recipients who did become ill had shorter episodes of diarrhea with fewer loose stools than those who received the placebo. The vaccine was safe and immunogenic.

Some additional items of interest this week include an FDA warning that the use of  antipsychotic medications in elderly patients treated for dementia-related psychosis is associated with an increased risk of mortality. This stresses that antipsychotics are not indicated for the treatment of dementia-related psychosis, though there is no effective treatment for this issue.

The NY Times picked up on an article that was printed in the journal “Cancer Prevention Research.” They both reported that finasteride taken for 7 years in the Prostate Cancer Prevention Trial (PCPT) reduced the risk of prostate cancer by 25%, but with an apparent increased risk of high-grade disease. They now report that the observed higher risk of high-grade disease with finasteride seems to be due to increased diagnosis resulting primarily from increased biopsy sensitivity with finasteride. Therefore, men undergoing regular prostate cancer screening or who express an interest in cancer prevention should be informed of the opportunity to take finasteride for preventing prostate cancer. That being said, as the NY times points out, the controversy now turns to the question of whether healthy men should take a drug for the rest of their lives to avoid getting and being treated for prostate cancer, given that it is a relatively slow-growing disease, that while it may be lethal, is more often not. Screening may therefore lead to the discovery of cancers that may or may not be dangerous, and for which treatment can lead to impotence or incontinence.