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This week in the medical journals

Many reports about treatments that don't work

By Peggy Peck
MedPage Today Managing Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.



Food and Drug Administration (FDA)
Health Organizations
Health Treatment

Little good news

Medical headlines are usually reserved for treatments that work. Not this week. Many of the top stories in journals this week were about treatments that don't.

Diabetes study disappointing

For example, a study of more than 9,500 people confirmed TriCor (fenofibrate) does not significantly reduce heart-related deaths in people with diabetes.

This was disappointing because many researchers hoped that TriCor would be a viable alternative to cholesterol-lowering drugs such as Lipitor (atorvastatin) and Zocor (simvastatin), a team of Australian researchers reported in The Lancet.

Heart disease is the No. 1 killer of diabetics, so finding drugs that work in these patients is a challenge. As a result, physicians are likely to continue investigating TriCor and other fibrates as "add-on" therapy with Lipitor and Zocor and the other statins.

AHA: Fibrate fails to reduce heart disease deaths in diabetics

Not so IDEAL results

The TriCor study also was reported at the American Heart Association's annual meeting in Dallas, Texas, as was a statin study that was optimistically named IDEAL (Incremental Decrease in End Points through Aggressive Lipid Lowering).

In the IDEAL study, published in the Journal of the American Medical Association, patients with a history of heart disease did not do better with daily high-dose Lipitor therapy (80 milligrams) than they did with 20 milligrams of Zocor, which costs a lot less than 80 milligrams of Lipitor.

The finding was a surprise to cardiologists because it was generally accepted that high-dose Lipitor, which can lower LDL (bad) cholesterol to targets well below 100 milligrams/deciliters, is the best way to prevent recurrent heart attacks, strokes and heart-related death.

It was so surprising that even the authors of the study treated the finding as a statistical blip on the Lipitor radar screen. Adopting an "it's only one study" line, the researchers recommended that physicians continue to use "whatever is needed" to achieve super-low LDL levels.

AHA: High-dose Lipitor does not outdo standard-dose Zocor

Gene therapy flops

The flop-of-the-week award, however, went to a gene-therapy drug called edifoligide, which was touted as a major breakthrough for heart bypass surgery and has been on the road to a fast approval by the Food and Drug Administration.

It got tripped up by evidence. The drug was supposed to prevent failure of leg-vein grafts used in bypass surgery, but it did no better than saltwater at keeping the veins open and functioning after they are stitched into the heart.

The results of the edifoligide study were published online by the Journal of the American Medical Association and also reported simultaneously at the heart meeting. Researchers said the once-promising drug has been dropped like a hot potato.

AHA: Gene therapy fails to prevent saphenous vein graft failure

What's not to like?

All medical news this week wasn't negative, though. The New England Journal of Medicine reported that an experimental diet drug called Acomplia (rimonabant) not only helps patients lose an average of 15 pounds and more than 2 inches from the waist, but it also improves their cholesterol levels. Acomplia accomplishes this by targeting one of the pleasure receptors in the brain.

Acomplia is not yet FDA-approved, but it is being studied as a way to help smokers kick the habit -- and lose weight at the same time.

Investigational diet drug leads to host of improvements

Easing childhood pain

And there was good news for kids who are hurting. A pain patch called Duragesic (fentanyl) appears to be effective for treating cancer pain in children.

A study reported in Cancer found that half of children treated with the patch achieved good pain control and 37 percent had less pain. But doctors will be moving cautiously on these findings because the FDA warned physicians last summer that high doses of the drug from the patch led to some deaths.

Pain patch wins high marks in children

Cutting stroke surgery risk

You can't keep a good cholesterol drug down, so while high-dose statins such as Lipitor were not big winners this week, there was still good news about statins.

A study in the Journal of Vascular Surgery that reviewed medical records of more than 1,500 patients found that taking statins for at least a week before surgery to open up blood vessels in the neck can cut deaths from the operation by 80 percent and strokes by 65 percent.

Every year about 180,000 Americans undergo this operation, which is called carotid endarterectomy.

Statins reduce deaths and strokes after carotid surgery

Viagra works for more than ED

Kudos, too, for Viagra (sildenafil), the drug that conquered erectile dysfunction.

The drug, researchers reported in the New England Journal of Medicine, also can relieve symptoms of pulmonary arterial hypertension or PAH, a disabling condition that is marked by extreme breathlessness with exertion. PAH patients can walk only short distances before they are winded, but those who took Viagra could walk longer without stopping to catch their breath.

The results convinced the FDA to approve a new formulation of Viagra, called Revatio, specifically for treatment of mild-to-moderate PAH.

Viagra spinoff promising for mild-to-moderate PAH

Baby, it's cold outside

And finally, this time grandma knows best.

When the weather outside is frightful, grandmothers usually advise children and grandchildren to "bundle up, so you don't catch your death of cold."

Now scientists in Cardiff, Wales, reported in Family Practice that getting a chill can indeed lead to runny noses. They "chilled" the feet of 90 healthy volunteers and reported that 13 came down with cold symptoms.

Among the 90 volunteers who were kept toasty? Five runny noses.

Endnote: Dear Santa, about that cashmere scarf. ...

Cold feet? Aah-choo!

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