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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.




Better than a spoonful of sugar

Timing is everything, just ask the editors of Circulation, journal of the American Heart Association. They proved that this week when they published a chocolate study Monday, right after Johnny Depp set weekend movie box office records in "Charlie and the Chocolate Factory."

Those with high blood pressure who ate a 3.5-ounce dark chocolate bar daily for 15 days were rewarded with lower blood pressure, lower LDL (bad) cholesterol, and improved sugar metabolism, discovered researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts in Boston.

But while dark chocolate showed benefit in the 20 patients tested, white chocolate did not. The difference, said the researchers, is that the dark chocolate is rich in flavanols, which are antioxidants derived from plants, while white chocolate is not.

They pointed out that the dark chocolate used in the study is not available at local candy stores and, while a little bit of dark chocolate daily is a good thing, too much dark chocolate will add pounds. That is a bad thing.

Dark chocolate good for the heart

Vitamin news

Speaking of good things, another team of Tufts researchers reported that good nutrition doesn't come in a pill bottle. Writing in the Journal of the American Medical Association, they found that relying on vitamins and supplements for nutritional balance may sometimes do more harm than good by giving people the false impression that a healthy diet isn't needed.

And even while some supplements such as calcium and vitamin D are helpful for maintaining bone health, mixing these with massive amounts of other supplements can cancel out the benefit. The best advice, they say, came from moms: Eat your veggies and drink your milk.

In other vitamin news this week, a report in the American Journal of Respiratory and Critical Care Medicine is generating some red faces in the cystic fibrosis treatment community. Researchers at Johns Hopkins in Baltimore reported that when they gave high doses of vitamin D2 to cystic fibrosis patients it was "strikingly ineffective." The "oops" reaction came because the Hopkins researchers were following treatment recommended in a guideline issued by the Cystic Fibrosis Foundation last March.

Nutrients in foods are best, with supplements filling narrow niche

Seeing the problem

Another disturbing report came from the Journal of the American Medical Director's Association, which found that a third of visually impaired Alzheimer's disease patients studied did not have necessary eyeglasses. The nursing home patients lost or damaged their glasses or weren't using them because the prescription was outdated, the researchers reported.

The visual difficulty that these patients have is likely to contribute to their confusion, the researchers report. The answer, say the researchers, is simple: label patients' glasses, have spare glasses available for patients and ensure that all patients get regular eye exams.

Alzheimer's patients at nursing homes suffer vision problems

What's good for Granny...

A brief report in the New England Journal of Medicine highlighted another Alzheimer's disease-related risk -- although this time it is a caution for family members. Researchers at Children's Hospital and the Massachusetts College of Pharmacy and Health Sciences, both in Boston, reported that an Alzheimer's drug called Exelon (rivastigmine), can cause a pesticide-like poisoning in babies.

That's what happened when an 11-month-old baby swallowed some of her grandmother's medicine. The baby had a rapid onset of weakness that looked like pesticide poisoning until the doctors discovered she had no access to pesticides but apparently found one of grandma's pills on the floor. Fortunately, the child responded to treatment and is unlikely to have long term effects from the poisoning.

Remember: Grandma's Alzheimer's drug can be poison to baby

Not so benign breast disease

Researchers at the Mayo Clinic reported that benign breast disease is not really that benign. A biopsy for a suspicious lump increases the risk of developing breast cancer by about 50 percent compared with women who are never biopsied, they wrote in the New England Journal of Medicine.

But a number of factors including the way the benign lump looks under a microscope, a family history of breast disease, and age at biopsy all influence the real cancer risk. For instance, a woman with no family history of breast cancer who has a nonproliferative lump removed has no increase in cancer risk. Yet, if the woman had a strong family history of breast cancer, she would have a 62 percent increase in risk of breast cancer compared with women who didn't have a biopsy.

Women who have biopsies while still in their 30s have about twice the risk of a woman who has a first biopsy after age 55. The bottom line, said researchers, is that women should have a detailed discussion with their physicians to determine what risks, if any, they face.

Benign breast disease linked to increased risk of breast cancer

A simple answer

The same week that sorting out breast cancer risks became a little more complicated, there was news that assessing heart disease risk in women may be a little simpler than previously believed.

Harvard researchers reported in the Journal of the American Medical Association that two simple measures--the ratio of LDL (bad) cholesterol to total cholesterol or non-HDL-cholesterol -- can accurately predict the risk of heart disease in healthy women.

There is no need, the researchers reported, for newer, more expensive tests when these old standbys are reliable and easy to calculate. For example, non-HDL-cholesterol is obtained by subtracting the value for HDL (good) cholesterol from the total cholesterol value.

Simpler cardiovascular risk prediction in women suggested

Avian flu protection

Bird flu is the 800-pound gorilla in the World Health Organization's closet and worries that this flu may trigger the next flu pandemic are a daily conversation topic among public health experts, but this week there was a hint of good news on this front.

According to researchers at the University of Michigan, an anti-influenza drug called Tamiflu (oseltamavir) protected mice that were injected with the avian (bird) flu strain. Of course the jump from mice to humans is a big one, but the researchers, who reported their findings in The Journal of Infectious Diseases, said the results are encouraging.

Meanwhile, public health officials are concentrating efforts on increasing stockpiles of antiviral drugs.

Tamiflu spares mice from lethal avian flu strain

A chink in the prayer chain

Finally, researchers at Duke Clinical Research Institute in Durham reported that long-distance prayer did not improve the outcome of patients undergoing minimally invasive procedures to open blocked arteries.

But patients who were randomized to bedside new age interventions such as "healing touch" had a better six-month survival rate than those who didn't receive the bedside ministrations, researchers reported in The Lancet.

Does prayer work? God only knows.

Prayer does not affect primary heart outcomes

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