STUDY: One more nail

JOURNAL: JAMA. 2003;289:3243-3253, 3254-3263, 3304-3306

AUTHORS: Rowan T. Chlebowski, MD,

ABSTRACT: Two studies in the June 25 issue of The Journal of the American Medical Association provide more evidence against the use of combined hormone therapy (CHT) in postmenopausal women. The first study, from the Women's Health Initiative (WHI), shows that not only is the incidence of breast cancer increased with CHT, but that it is diagnosed at a more advanced stage. The second study again shows that progestin, not estrogen, is primarily responsible for the increase in breast cancer risk.

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COMMENTARY: "Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms," write Rowan T. Chlebowski, MD, PhD, from Harbor-UCLA Research and Education Institute in Torrance, California, and colleagues from the WHI Randomized Trial.

These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.

The WHI was a randomized, placebo-controlled trial of CHT in 16,608 postmenopausal women. As Medscape has reported previously, the WHI was stopped early, on July 9, 2002, when interim analysis revealed that the overall health risks associated with CHT, including breast cancer, exceeded the benefits. The present analysis determined the association of CHT with breast cancer characteristics and annual mammography findings.

After one year, the percentage of women with abnormal mammograms was 9.4% (716 of 7,656) in the CHT group and 5.4% (398 of 7,310) in the placebo group (P < .001). Throughout the study, more women receiving CHT had abnormal mammograms than did women receiving placebo.

According to the authors, about 3 million postmenopausal women in the U.S. currently use CHT, so the absolute increase in abnormal mammograms of about 4% per year with CHT is equivalent to approximately 120,000 otherwise avoidable abnormal mammograms annually in these women.

The breast cancers diagnosed in women in the [CHT] group had similar histology and grade but were more likely to have advanced stage vs. women in the placebo group.

These results suggest that invasive breast cancers developing in women receiving estrogen plus progestin therapy may have an unfavorable prognosis.

Consideration for use of estrogen plus progestin for any duration by postmenopausal women should incorporate the current findings into established and emerging risks and benefits of these agents."

In an accompanying editorial, admin H. Gann, MD, ScD, and Monica Morrow, MD, from the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, refer to CHT as "a single-edged sword."

Commenting on the WHI trial, they note that "alteration of a woman's basic hormonal physiology over decades in the interest of long-term disease prevention is fraught with hazard."

They point out that CHT increases the risk of developing breast cancer while decreasing mammographic sensitivity and thereby delaying detection of the cancer.

STUDY:

JOURNAL: NEPHROLOGY

AUTHORS: Fryer MJ

ABSTRACT: Progression to renal failure is significantly worsened by oxidative stress in chronic inflammatory kidney disease (IgA nephropathy, antiglomerular basement membrane nephritis, focal segmental glomerulosclerosis), rhabdomyolysis (myoglobinic acute renal failure), diabetic nephropathy and in poisoning by nephrotoxic compounds such as transition metals, paraquat and drugs such as cyclosporine A and cisplatin.

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COMMENTARY: The membrane antioxidant vitamin E (alpha-tocopherol) is examined as a potential therapeutic intervention that may help to slow the rate of decline of kidney function in such conditions.

An impaired plasma antioxidant defence system is characteristic of chronic renal failure and the uremic state.

Vitamin E therapy is also considered as a means of correcting plasma antioxidant status and attenuating the cardiovascular disease that accompanies kidney failure.

STUDY: Deceptive Marketing

JOURNAL: FDA and FTC

AUTHORS:

ABSTRACT: The Federal Trade Commission has charged the marketers of a dietary supplement called Coral Calcium Supreme with making false and unsubstantiated claims about the product's health benefits.

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COMMENTARY: FTC alleges that Kevin Trudeau; Robert Barefoot; Shop America (USA), LLC; and Deonna Enterprises, Inc., violated the FTC Act by claiming, falsely and without substantiation, that Coral Calcium Supreme can treat or cure cancer and other diseases, such as multiple sclerosis and heart disease.

The FTC charges that these and other claims go far beyond existing scientific evidence regarding the recognized health benefits of calcium.

The FTC also is suing Trudeau, who has promoted items in infomercials

for years, for allegedly violating a 1998 court order that prohibits him

from making unproven product claims. The lawsuit says the coral calcium

ads and promotions for pain-relieving product called Biotape violate that order.

STUDY: Stay away from NSAIDS on a regular basis

JOURNAL: Hypertension 2002;40:604-8.

AUTHORS: Dedier J, Stampfer MJ, Hankinson SE

ABSTRACT: ASA, acetaminophen and ibuprofen are the most commonly used medications among adults, according to a national survey of US households.

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Short-term prospective studies suggest that NSAIDs can cause acute elevations of blood pressure, and ASA and acetaminophen can influence prostaglandin homeostasis.

COMMENTARY: Short-term prospective studies suggest that NSAIDs can cause acute elevations of blood pressure, and ASA and acetaminophen can influence prostaglandin homeostasis.

The Nova Scotia Heart Health study has shown that 21% of women aged 35–64 years have hypertension, thus, even small elevations in blood pressure caused by nonnarcotic analgesic use could result in cardiovascular morbidity and mortality.

STUDY: Arthroscopic procedures for arthritis no better than placebo, study finds

JOURNAL: New England Journal of Medicine

AUTHORS: Dr. Bruce Moseley

ABSTRACT: A type of knee surgery performed on more than 300,000 Americans each year to ease arthritis pain is worthless, government researchers say.

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The provocative study compared arthroscopic knee surgery for osteoarthritis to a sham procedure and found no difference in the outcome.

COMMENTARY: THE ARTHROSCOPIC operation is done to clear out debris or repair damaged cartilage in osteoarthritis, the painful, steadily worsening, wear and tear on joints that affects 12 percent of senior citizens.

In a type of study only rarely conducted, some patients got a real knee operation, while others underwent sham surgery.

At every point over the next two years, those who had the fake surgery could climb stairs and walk slightly faster on average than those who had gotten real operations.

The study shows that all of the benefit that people receive is from a placebo effect.

Patients have benefited more from a relatively new treatment — injections of a synthetic version of fluid inside the knee that acts as a shock absorber and lubricant.