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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.


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(MedPage Today) -- A pair of landmark studies -- one on breast cancer and the other on schizophrenia -- jumped off the pages of the major medical journals. The first study's results were decisive; the second's much cloudier.

Digital mammography

For those women who have not yet reached menopause, digital mammography is better at detecting breast cancer than traditional mammography, say researchers who studied views of nearly 50,000 women. Results of the study, which was funded by the National Cancer Institute, were published online by the New England Journal of Medicine.

Digital mammography displays images on a computer monitor rather than x-ray film. In the study, women had both types of mammography screening but digital was clearly superior to film mammography for women younger than 50 and in women with very dense breasts, also more common in younger women. The downside is the price tag: Digital mammography can cost as much as four times more than standard mammography.

Digital mammography proves superior for younger women

Schizophrenia study: No simple answer

By contrast to that clear finding, results of a National Institute of Mental Health study of almost 1,500 adults with schizophrenia were murky at best. The researchers compared four new anti-psychotic drugs, also known as atypicals, with one old-line treatment. They found that one drug, Zyprexa (olanzapine), did marginally better than the other drugs tested -- but patients who used the drug had significant weight gain that increased their risk of diabetes and heart disease.

All the drugs tested shared a common problem: Patients were only willing to take them for short periods, the researchers reported in the New England Journal of Medicine. About 75 percent of patients discontinued their assigned medication. Zyprexa edged ahead because its 64 percent dropout rate was lower than the rate for the other drugs.

The researchers concluded that even though anti-psychotic medications can be effective at controlling symptoms, the clinical value of the drugs is "severely limited" because patients are unlikely to take them for any significant length of time.

Zyprexa edges four other agents with modest benefit for schizophrenia

Research spending skyrockets

Meanwhile, the Journal of the American Medical Association this week devoted an entire issue to the care and feeding of medical research. Funding for biomedical research increased from $37.1 billion in 1994 to $94.3 billion in 2003 and more than half of that money comes from industry.

But how much bang emerges from those big bucks? Relatively little, according to analysts. They said that the average annual FDA approvals of new drugs dropped from 35.5 in 1994-1997 to 23.3 in 2001-2004.

Spending on biomedical research is booming. But the dollar amount spent on health services research studies -- studies that report just which treatments really work -- is languishing. Currently about 6 percent of health care spending goes to research, but only 0.1 percent of health care dollars is spent on those real world studies.

Medical research spending doubled over past decade

Fall is here, is flu far behind?

Ready for flu season? Probably not, according to CDC researchers who reported in the British medical journal The Lancet, that about 12 percent of influenza A strains worldwide -- including bird flu -- are resistant to the most commonly used anti-flu drugs.

Also in The Lancet comes this good news/bad news take on flu vaccines. They work great to prevent flu outbreaks among elderly residents in nursing homes but are not that effective at stopping the flu in the neighborhood.

Common flu drugs meet growing resistance

One-pill solution

A single Zithromax (azithromycin) pill worked as well as a shot of penicillin for preventing or treating syphilis, according to researchers from the London School of Hygiene and Tropical Health, who reported the finding in the New England Journal of Medicine. A shot of penicillin, the researchers said, is the gold standard treatment but a pill that works just as well is a patient-friendly option that eliminates the need for a trained health professional to administer the shot.

Zithromax equivalent to Bicillin LA in treating syphilis

Downside to popular acne treatment

But antibiotics treatment can have unexpected effects, according to researchers at the University of Pennsylvania. They said that patients who use antibiotics for acne may increase their risk of upper respiratory infections. Writing in Archives of Dermatology, the researchers said risk increases when people use antibiotics for more than six weeks, which is a common practice among acne patients. Long-term antibiotic use did not, however, increase the risk of urinary tract infections.

Antibiotics for acne raises respiratory infection risk

Smoking unsafe at any number

Social smokers, the people who only have the occasional cigarette to take the edge off, don't escape the health risks of tobacco, according to researchers in Oslo, Norway. Writing in the September issue of Tobacco Control, the researchers reported that a study of 43,000 men and women found that people who smoke one to four cigarettes a day triple their risk of heart disease and lung cancer.

Even one cigarette a day jeopardizes health

New cancer test in wings

Diagnosing prostate cancer could get a whole lot easier in the future, said researchers at the University of Michigan who are working to develop a new blood test for the disease. According to a report in the New England Journal of Medicine, early studies of the new test suggest that the blood test will be more accurate than testing for prostate specific antigen (PSA). But the researchers said they envision the new test as an adjunct to PSA testing rather than a replacement for it.

Potential prostate cancer screening tool waits in the wings

Wash your hands!

Finally, if cleanliness is indeed next to godliness, women rank high.

A team of microbiologists who studied 6,300 men report that only 75 percent of men regularly wash their hands after a trip to a public restroom versus 90 percent of women.

Endnote: And this is surprising?

Microbiologists find men the great unwashed

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