Commentary by Michael Poles MD, Associate Editor Clinical Correlations
The latest estimates from the US Census Bureau suggest that the number of uninsured Americans has increased from 44.8 million in 2005 to roughly 47 million in 2006. This jump of 5 percent is the largest one-year increase in the number of uninsured since 2002. In that year, more than 18,000 American deaths were attributable to the lack of insurance and proper health care.
Physicians commonly look to systematic reviews to obtain current evidence to guide clinical decisions. In an article in this week’s Annals of Internal Medicine, Shojania and colleagues performed a study to examine how quickly the conclusions from these reviews changed as new evidence became available. They studied 100 quantitative systematic reviews and found that conclusions about the effectiveness or harms of therapies changed very soon after the systematic reviews were published. The median time before a change in the conclusion of these studies was 5.5 years, and significant new evidence had become available within 2 years for 23% of them. This seems to suggest, as we should well know, that while we can rely somewhat on these reviews, it is nonetheless important to continually update our knowledge with the latest from the medical literature.
This week, in Vienna, the European Congress of Cardiology is ongoing. I imagine that one of the most important presentations will be given by the ADVANCE (Action in Diabetes and Vascular Disease) Study investigators. This study, the largest-ever, of diabetes treatment has shown that a fixed combination of two antihypertensives (perindopril and indapamide) reduced the risk of death from any cause by 14% and the risk of death from cardiovascular disease by 18%. The risk of coronary heart disease events was reduced by 14% and the risk of new or worsening kidney disease was reduced by 21%. In this trial, a total of 11,140 patients with diabetes from 20 countries world-wide participated over 4.3 years. Half received daily treatment with a single tablet containing fixed combination of the drugs and half received placebo.
Last week, the US national guidelines for the diagnosis and management of asthma were updated for the first time in 10 years. Issued by the National Asthma Education and Prevention Program (NAEPP), and called the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report, 2007, the guide is available from the National Heart, Lung and Blood Institute (NHLBI). The main updates in the new EPR-3 guidelines cover assessing and monitoring, patient education, controlling environmental triggers, proper use of medications, and stepwise management charts, based on patient age.
Lastly, to this internal medicine doc, it seems that it has been a long time since we heard much good news with regard to treatment of schizophrenia, but testing of a new experimental schizophrenia drug, which targets glutamate receptors in the brain rather than dopamine is promising. In a study, published in Nature Medicine, subjects with schizophrenia who received the drug, LY2140023, experienced significant improvements in their symptoms without any of the side effects commonly associated with schizophrenia drugs such as weight gain, elevated prolactin levels or extrapyramidal symptoms.
Image of Alter Elbtunnel, the old Elbe tunnel in Hamburg, Germany. Courtesy of Wikimedia Commons