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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.



Hospitals and Clinics
Medical Research
Government Health Care
Centers for Disease Control & Prevention

Smaller tumors, better outcomes

Breast tumors are being diagnosed earlier and significantly smaller these days than they were 25 years ago, reported researchers at the Memorial Sloan-Kettering Cancer Center in New York in the journal Cancer. This has led to improved survival.

Smaller tumors at diagnosis accounted for 61 percent of the improvement in survival for women with tumors that haven't spread and 28 percent of the improved survival in women whose cancer has moved elsewhere in the body.

The news about better treatment involved one of the new drugs in the class called aromatase inhibitors, which are taking over the role in breast cancer that tamoxifen has held for so many years. Women who switched to Arimidex (anastrazole), an aromatase inhibitor, after taking tamoxifen for two years had a 40 percent decrease in breast cancer recurrence or death from breast cancer, researcher from the Austrian Breast and Colon Cancer Study group reported in The Lancet.

The tamoxifen-Arimidex treatment is given as therapy following surgery to remove the tumor. The switch to Arimidex was associated with a 3.1 percent absolute increase in cancer-free survival.

Breast tumors smaller at diagnosis

Dynamic duo for bones

Also this week, a pair of studies suggested that two drugs are better than one when it comes to building and maintaining healthy bones. Two studies, both reported in the New England Journal of Medicine, suggest that parathyroid hormone plus Fosamax (alendronate) appears to be the best treatment strategy.

Researchers from the University of California San Francisco and the Helen Hayes Hospital in West Haverstraw, New York, said that either drug is effective all by itself, but when given either in combination, or when a year of parathyroid hormone therapy is followed by a at least a year of Fosamax, the benefits are both impressive and long-lasting.

Two drugs are better than one for osteoporosis

Yoga benefit

As bone density decreases with age, waistlines tend to increase. But a half-hour of yoga once a week for four years or longer may offset middle-aged spread, according to a report in Alternative Therapies in Health and Medicine.

People of a normal weight who practiced yoga weekly reduced expected weight gain by just over three pounds, said researchers at the Fred Hutchinson Cancer Research Center in Seattle. Yoga was even more effective for overweight volunteers -- they lost five pounds, compared with an average weight gain of 13 pounds for overweight people who didn't practice yoga.

Yoga practitioners reduced fat intake by 11 percent and increased fruit and vegetable consumption by 45 percent.

Yoga in middle age linked to reduced weight gain

Multivitamins a bust

But while yoga seemed beneficial, multivitamins didn't.

A daily dose of multivitamins had no benefit in a study that compared health outcomes for adults aged 65 or older randomized to a daily multivitamin versus those taking daily placebo.

The multivitamins did not reduce infections nor did a daily vitamin mean fewer trips to the doctor, researchers from the University of Aberdeen reported in BMJ.

Multivitamins fail to benefit elderly patients

Cookbook medicine needs better recipes

Here's more for the Medicare set to consider. The best clinical recommendations from the major medical specialty groups may be expensive and dangerous when applied en masse to elderly patients, said a team from Johns Hopkins. It turns out, the researchers reported in the Journal of the American Medical Association, that treatment guidelines developed to help doctors practice good medicine are not flexible enough to accommodate the multifaceted health conditions of elderly patients.

Elderly patients often have a number of chronic diseases, but the guidelines are designed to address just one condition at a time. The upshot is that if doctors used all the recommended guidelines to treat a hypothetical patient -- a 79-year-old woman with diabetes, high blood pressure, emphysema, osteoarthritis, and osteoporosis -- she would be given prescriptions for 12 drugs and a series of conflicting recommendations about lifestyle interventions. The drugs, many of which could interact with each other, would cost $406 a month.

The researchers are sounding the alarm just as Medicare is set to roll out a new physician payment scheme that will pay top dollar to doctors who meet or exceed performance standards, many of which will be based on the clinical recommendations.

One-size-fits-all guidelines don't fit elderly patients

School bells ring

School bells are already ringing in some parts of the country, which means a return to reading, writing, and head lice. Just in time for a new school year came a report from British researchers that a fine-tooth comb dampened with hair conditioner is four times better at killing lice than over-the-counter remedies.

Researchers at the London School of Hygiene and Public Health compared a kit containing four fine-tooth combs that are used with hair conditioner to over-the-counter lice killers that contained water-based solutions of malathion and permethrin.

The cure rate for the kit was 57 percent versus 13 percent for the pesticides, they reported in BMJ. The comb kit, called Bug Buster, is not sold in the United States, but a Harvard lice expert said that similar products are available here.

Comb and conditioner combat lice better than chemicals

Beware the brown dog tick

Researchers at the Centers for Disease Control and Prevention reported that an outbreak of Rocky Mountain spotted fever has killed two people in Arizona, where the tick-borne disease was once rare.

The CDC team, which described the outbreak in the New England Journal of Medicine, said 16 people came down with the infection after being bitten by the brown dog tick. In the past the infection was associated with the American dog tick, so this latest outbreak suggests a new host for the bacteria, Rickettsia rickettsii.

Rocky Mountain spotted fever symptoms include rash, cough or sore throat, nausea, vomiting, muscle aches, diarrhea, and headache. The infection responds to five- to seven-day treatment with doxycycline.

Rocky Mountain spotted fever goes to the dogs

Insulin and Alzheimer's

Even moderately elevated levels of insulin in the blood may increase the risk of Alzheimer's disease, according to a report in Archives of Neurology by investigators at the University of Washington in Seattle.

They focused on insulin resistance, a condition that occurs when the body loses the ability to efficiently metabolize sugar and which causes the pancreas to release more insulin into the blood stream. This, they said, increases the inflammation in the central nervous system.

That spike in central nervous system inflammatory markers may be a risk factor for Alzheimer's disease, they reported.

Elevated insulin Increases Alzheimer's disease risk

We're not crying, we're just sensitive

Finally, Americans are sensitive. Really sensitive.

More than half of U.S. adults are allergic to something, and most of us are allergic to three or four things, said a report in the Journal of Allergy and Clinical Immunology from the National Institute of Allergy and Infectious Diseases.

The most common causes of teary-eyes are dust mites, rye, ragweed and -- of course -- cockroaches. But, on the flipside, only about 9 percent of adults are allergic to peanuts.

More than half of U.S. population sensitive to allergens

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