Category: Prior Clinic Blog
STUDY: Risks of hormone replacement outweigh benefits
JOURNAL: Journal of the American Medical Association
AUTHORS: Dr. Jacques Rossouw
ABSTRACT: Not only did hormone replacement therapy not prevent heart disease, it actually increased the risk of heart disease, strokes and blood clots, say researchers.
The large federal study designed to help settle the raging debate over whether hormone replacement therapy benefits postmenopausal women has been abruptly halted, researchers said Tuesday. The reason: The overall health risks of the hormones taken by some six million American women exceed their benefits, the study showed.
COMMENTARY: For Years, doctors and patients alike have struggled with the question of whether the benefits of the drugs, estrogen and progestin, outweigh their risks.
Given to replace the hormones that naturally decline after menopause, the drugs relieve hot flashes, mood swings and night sweats. And early research suggested the hormones also improve a woman’s overall health.
Instead, the large Women’s Health Initiative has found that combined hormone replacement therapy raises a woman’s risk of breast cancer, stroke and heart disease.
Doctors have been anxiously awaiting the results of the trial — the first and largest study to compare the effects of the drugs to placebo in healthy women.
Upon stopping the trial, the federal government immediately sent a letter to the 16,000 participants and their doctors, advising them to stop the drugs.
DO NOT PANIC
But women taking the medications should not panic, experts stressed, noting that the absolute risk of harm to any individual is extremely small.
And there are some benefits — chiefly a reduced risk of colorectal cancer and hip fractures, the study showed.
THE BOTTOM LINE
Women who are currently taking estrogen plus progestin should have a serious talk with their doctor to see if they should continue it,” said study author Dr. Jacques Rossouw of the National Heart, Lung, and Blood Institute.
Not only did this therapy not prevent heart disease, it actually increased the risk of heart disease, strokes and blood clots. Compared with placebo, HRT raised the risk of strokes by 41 percent, heart attacks by 29 percent and breast cancer cases by 26 percent, the study showed.
Women taking the hormones for the short-term for hot flashes and other symtoms of menopause may not have a higher risk of disease but taking the drugs for years is no longer advisable, experts said. For women who have had hysterectomies and who need HRT, estrogen alone may be safer.The study did not address the question of taking estrogen alone. Its benefits and risks are being evaluated in a second clinical trial of 11,000 women, also by the Women’s Health Initiative.
This is very important to all of you out there taking HRT. Please contact your doctor and talk it over. Here at the clinic we support many women with alternatives to HRT.
You do have Options!!!!!!!
STUDY: C Section Effects A Womens Ability to Conceive Again.
JOURNAL: Human Reproduction 2002;17
AUTHORS: Dr. Deirdre Murphy
ABSTRACT: Women who give birth by caesarean section take longer on average to become pregnant again, according to the results of a large British study released on Tuesday.
COMMENTARY: After analyzing data from more than 14,500 women, Dr. Deirdre Murphy from the University of Bristol and others found that about one in eight women who have a C-section take more than a year to become pregnant again, compared with 1 in 12 of those who deliver vaginally.
The study accounted for other factors that might have reduced fertility, including the ages of both mother and father, how long they had lived together, whether oral contraceptives had previously been used, smoking and drinking and ethnic background.
It also eliminated women who decided not to have another child after caesarean, by only looking at women who actually did become pregnant again.
The increased difficulty in conceiving remained significant after taking these factors into consideration, the researchers report in the July issue of Human Reproduction.
For some women, a caesarean is a necessity to deliver the baby safely. On other occasions the decision may not be as clear-cut. We need more research into the long-term effects of all methods of delivery, so that doctors and midwives are better equipped to help women make informed decisions.
STUDY: Leptin, the "Obesity Hormone" thought to be involved in appetite regulation
JOURNAL: Circulation 2002;10.1161
AUTHORS: Dr. Virend K. Somers
ABSTRACT: Members of an African tribe who eat fish every day have relatively low blood levels of leptin, the "obesity hormone" thought to be involved in appetite regulation, according to new research.
COMMENTARY: Fat cells and other tissues in the body produce leptin, which is believed to notify the brain to reduce appetite when fat cells are "full." Exactly how the hormone works to control appetite is uncertain, however.
Leptin has generated great scientific interest in recent years due to its apparent role in fat metabolism and weight gain. For example, previous research has linked high levels of leptin to an increased risk of cardiovascular disease, while eating fish has been shown to reduce that risk.
A diet rich in fish is associated with lower plasma leptin, independent of body fat. These findings may have implications for understanding the reduced cardiovascular risk in subjects on a high-fish diet.
Somers and his team measured the effect of fish consumption on leptin levels in the blood by comparing two neighboring tribes in Tanzania, one whose 279 members consumed fish daily, while the 329 members of the other tribe ate fish only rarely.
Both tribes consumed around the same number of calories each day, and both maintained similar lifestyles. However, the group that lived close to a lake consumed about one quarter of their total calories from fish, while the other, whose members lived further inland, consumed most of their calories from fruits and vegetables.
Reporting in Journal of the American Heart Association Somers and his colleagues found that male fish-eaters had 2.5 nanograms of leptin per milliliter of blood (ng/mL), less than one quarter of the leptin level of the male vegetarians. Female fish-eaters also had markedly lower leptin levels than their vegetarian peers, with 5 ng/mL versus 12 ng/mL for female vegetarians.
Members of both tribes had virtually identical body mass indices, an indication of obesity that measures weight in relation to height, which suggests that these findings are not influenced by obesity.
In addition, the investigators found the relationship between leptin and diet persisted even when they accounted for age, body fat, alcohol consumption or insulin. "We speculate that a fish diet may change the relationship between leptin and body fat and somehow help make the body more sensitive to the leptin message," Somers said in a statement.
He added that it was not clear whether these results would apply to other people living in different environments. "We don't know if the findings will apply to a semi-overweight, urban-dwelling North American population."
Regardless I think that the take home message here is to try and eat as much fish as possible.
STUDY: Many people do not routinely protect themselves against bites from disease-carrying ticks.
JOURNAL: American Journal of Preventive Medicine 2002;29
AUTHORS: Dr. Timothy F. Jones
ABSTRACT: Many people do not routinely protect themselves against bites from disease-carrying ticks, according to the results of a new US study.
COMMENTARY: What is most surprising, or disheartening, is that people don't adhere very well to pretty basic preventive recommendations," said study lead author Dr. Timothy F. Jones from the Tennessee Department of Health in Nashville.
Jones and his colleagues focused on the use of insect repellent by 1,820 Tennessee residents included in a nine-state telephone survey conducted by the Centers for Disease Control and Prevention (CDC) in Atlanta between February 2000 and February 2001. Although people of all ages were included, more than two thirds of the respondents were between 16 and 60. Almost 40% were male, and nearly 80% were white.
In the July issue of the American Journal of Preventive Medicine, the authors report that only one quarter of those surveyed said they used insect repellent before entering a tick-infested area and also checked their bodies for ticks after leaving. Over 60% said they ever used repellent in such situations, while 29% said they always did. Women and whites generally used repellent more often than men and blacks, respectively.
One in six respondents said a tick had bitten them in the past year. Multiple bites, however, did not seem to drive preventive messages home, the researchers found. Although 12% of those surveyed said they had been bitten at least twice in the past year, less than half of this group said they usually put on repellent in appropriate situations.
Among the more than 40% of those surveyed who owned dogs, about one-quarter said they had picked ticks off their pets using their bare hands--despite public health advisories to avoid such contact. Dog owners were much more likely to report at least one tick bite in the past year than non-owners.
Vulnerability to tick bites appeared to be related to location, the investigators found--with more than one third of rural residents reporting tick bites, compared with about 10% of urban residents and about 18% of suburban residents. Rural residents were, however, less likely than non-rural residents to use insect repellent.
Jones and his team note that in the absence of vaccines for any tick-borne illness other than Lyme disease (which is now being withdrawn from the market), education efforts must be ratcheted up to better promote effective and easy-to-follow bite prevention measures.
If there are easy steps you can take to protect yourself from some pretty severe diseases--even if they're relatively rare--then it's certainly worth doing. "It's kind of like putting on your seatbelt. After you've done it for a while you don't even think about it."
In 1999, there were over 16,000 cases of Lyme disease, 579 cases of Rocky Mountain spotted fever, and 302 cases of ehrlichiosis diagnosed in the US. Tennessee is one of three states that account for nearly half of US Rocky Mountain spotted fever cases.
Remember that an ounce of prevention can go a long way to avoid serious consequences.
STUDY: Frequency f previously unrecognized adverse drug reactions.
JOURNAL: Journal of the American Medical Association
AUTHORS: Dr Karen Lasser
ABSTRACT: The May 1 2002 issue of the Journal of the American Medical Association reported the results of a study that sought to determine the frequency of previously unrecognized adverse drug reactions occurring in recently approved drugs.
COMMENTARY: By analyzing volumes of the Physician's Desk Reference published over a twenty-five year period as well as other information, researchers at Harvard University discovered that half of the newly established adverse effects, which include liver, bone marrow and heart damage as well as pregnancy risks, are found within seven years of their approval, and half of the drugs withdrawn were taken off the market within two years following their release.
Study author and primary care physician and researcher at Cambridge Hospital and Harvard Medical School, Dr Karen Lasser, stated, "This study will change the way I talk to patients about the use of new drugs. If there is a safer, effective drug that has been in use for a number of years, I would strongly recommend it over a newer drug whose safety profile is unknown. I would prescribe a new drug only when absolutely necessary, and then watch for adverse effects very, very closely."
The authors attribute the widespread use of new drugs to extensive promotion by pharmaceutical companies. They note that drug companies may fail to conduct the postmarketing studies the Food and Drug Administration requires when a safety issue is discovered during the drug's preapproval phase.
Coauthor Dr. Paul Allen , an internal medicine specialist at Cambridge Hospital and Harvard Medical School, commented, "Twenty million patients, almost 10 percent of the U.S. population, were exposed to the five drugs withdrawn from the market between September 1997 and September 1998. Yet the drug companies push the public and doctors to use new drugs that are more profitable but also more dangerous."
What this tells us is that using safer natural alternatives where possible is the most prudent path to take.