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This week in the medical journals

By Peggy Peck
Medpage Today Senior Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.
Mayo Clinic
Food and Drug Administration (FDA)
Health Organizations
Medical Research
Health Treatment

Great news for seniors

Medical journals had a mixed bag of reports this week, highlighted by big news about a common and painful disease of aging -- shingles.

Everyone who had chickenpox as a child is at risk of shingles in old age because both diseases come from the same herpes virus, which hides out in the body's central nervous system long after its initial appearance as chickenpox. As age or illness weaken the body's immune system the virus awakens from hibernation, this time as herpes zoster, better known as shingles, a condition that causes a blistering rash that is often followed by extreme pain called postherpetic neuralgia.

Shingles affects about 1 million Americans every year, but researchers say that a super-potent version of the chickenpox vaccine can not only prevent shingles outbreaks but can lessen the severity if the disease does flare despite the vaccine.

The researchers tested the vaccine in more than 19,000 volunteers, age 60 or older. Writing in the New England Journal of Medicine, the researchers reported that the vaccine reduced the incidence of shingles by more than 51 percent and reduced the incidence of painful shingle side effects by 66 percent, compared with 19,000 volunteers who were given a dummy vaccine.

But while the experimental vaccine is effective, the researchers said it is unlikely that the regular-strength chickenpox vaccine can be used to prevent shingles. So shingles prevention must await FDA approval of the experimental vaccine.

Investigational vaccine halves shingles incidenceexternal link

Also in the New England Journal of Medicine, an international team of breast cancer researchers reported that changing one of the ingredients in a common chemotherapy cocktail given to women after surgery for breast cancer can increase both disease-free survival and overall survival.

The researchers randomized more than 1,400 women to six cycles of chemotherapy with a standard fluoruracil-based regimen or with a Taxotere-based regimen. Substituting Taxotere for fluoruracil boosted five-year disease-free survival to 75 percent versus 68 percent.

The Taxotere-treated women also had a 30 percent reduction in risk of death compared to the women treated with fluoruracil. The downside was a significant increase in toxic side effects.

Taxotere plus adriamycin and cytoxan improves outcomes in breast cancerexternal link

Box score: two for two.

Go-guide to good food

The United States is growing into a nation of fat kids, but this week Pediatrics provided evidence that it may be possible to reverse that trend, a way to teach kids to substitute healthy meals for happy meals.

Researchers at Northwestern in Chicago recruited 363 boys and 301 girls, ages 8 to 10, who already have high blood levels of LDL -- the bad cholesterol. This suggested that they were already at risk for obesity-related conditions like diabetes and heart disease.

The researchers taught half of the kids about good nutrition, using a visual aid called a "Go-Guide" that labels foods using terms like "go," meaning healthy foods that should make up most of a child's diet, or "Whoa" foods like french fries and pizza that should be avoided. The other kids were given standard healthy eating guides.

After three years, about 67 percent of the food consumed by the kids randomized to the Go-Guide training was healthy foods that fit the "go" label, while only 57 percent of the calories consumed by the kids in the control group came from "go" food category. "Go" training did not, however, didn't make a dent in pizza consumption and didn't reduce overall snacking.

Please pass the "go".

'Whoa,' 'go,' and 'slow' labels aim to make kids say no to junk food

There really is a malpractice crisis, isn't there?

The American Medical Association has been spending its lobbying dollars trying to get the federal government to reform malpractice laws, and this week's Journal of the American Medical Association included a pair of studies that the AMA says support its call for change.

First up, the journal reported a survey of Pennsylvania doctors practicing in six specialties all considered a high-risk for malpractice suits -- obstetricians, orthopedic surgeons, neurosurgeons, general surgeons, and emergency physicians. The survey found that 93 percent of the doctors say they regularly practice defensive medicine, defined as ordering unnecessary tests, prescribing unnecessary medicine, avoiding risky procedures, and generally trying to stay below the radar of malpractice attorneys.

Pennsylvania is a state where malpractice premiums have risen sharply and many insurance companies refuse to write insurance in the state. This is why, the doctors said, they are practicing defensively.

A second study reported that states that change malpractice laws to limit damages or eliminate payments for pain and suffering attract more doctors -- but only slightly more than states with no malpractice reforms.

Bottom line: The best defense may be good medicine.

Defensive medicine is norm if malpractice threatensexternal link

To pump or not to pump?

This week two journal reports that focused on the heart are likely to have an immediate impact on treatment.

The American Heart Association went on record saying that coronary bypass surgery can be safely performed with or without use of the cardiopulmonary bypass machine. The bypass machine takes over the work of the heart during surgery, but some critics claim that using the machine increases the risk that patients will have memory or thinking problems after surgery.

These critics say it is safer to operate on a "beating heart." A blue-ribbon panel from the AHA, writing in Circulation, Journal of the American Heart Association, said results are "excellent" either way -- but who performs the operation and where it is done can influence outcome. So choose carefully your surgeon and hospital.

Pump use isn't the determinant of CABG outcomeexternal link

And zing went the strings of the heart

In the second heart study, researchers from the Cleveland Clinic reported that zapping an erratically beating heart, an abnormal rhythm called atrial fibrillation, with a radiofrequency probe is a more effective way to treat the problem than using antiarrhythmic drugs.

According to the report in the Journal of the American Medical Association, 63 percent of patients who underwent radiofrequency ablation had only one repeat episode of atrial fibrillation during the year following treatment. Only 13 percent of the patients using antiarrhythmic drugs were able to achieve that level of control.

Additionally, half of the patients taking the drugs were hospitalized during the year, while only 9 percent of the zapped patients required hospitalization. Currently radiofrequency ablation is used as backup procedure when drugs don't do the job, but researchers say their findings suggest it could be an option for first line therapy.

The AHA estimates that about 2.2 million Americans -- most of them older than 65 -- have atrial fibrillation, in which part of the heart quivers. As a result, blood pools and forms clots, which can cause strokes when the clots become lodged in the arteries that carry blood to the brain. About 15 percent of strokes occur in people with atrial fibrillation.

Inner meaning? Some ideas are better than others.

Afib recurs less often with catheter-based ablation vs. drugsexternal link

You light up my life

And finally, remember those "You've come a long way, baby" cigarette commercials? How about the commercials with a bunch of bikini-clad surfers taking a cigarette break? Or the ads that featured a sleek model puffing away while gazing out from a penthouse terrace at the Paris skyline?

Well, it turns out that the tobacco companies were actually trying to hook women through a series of commercials specifically designed to convince women that smoking made them faster, smarter, prettier and -- thinner.

All this was according to tobacco company documents, as reported in Addiction.

Take-home message: Sometimes smoke gets in your eyes.

Cigarette industry plots to hook more womenexternal link

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