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This week in the medical journals

By Michael Smith
MedpageToday.com staff writer

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

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HEALTH LIBRARY

Coffee-heart attack link clarified

Is that extra cup of coffee bringing a heart attack closer?

Only if you have a certain genetic makeup, say researchers in Toronto. In a large study carried out in Costa Rica, the researchers found that people whose bodies are slow to break down caffeine are more likely to have heart attacks the more coffee they drink. But people whose bodies get rid of the stimulant quickly can pretty much drink as much java as they like, the researchers reported in the Journal of the American Medical Association.

The only problem is there's no commercial test available to tell you where you sit. So one thing was clear. One small cup a day is safe no matter what.

Coffee-gene interaction raises heart attack riskexternal link

Sweet! Losing sugary drinks means losing pounds

We turn from coffee to sugar. Ban the cola from the home, and you kick out some of the extra pounds on teens, according to pediatricians.

Researchers at the Children's Hospital in Boston reported that getting sugar-sweetened soft drinks out of the home can help teens drop almost a pound of excess weight a month. In a clinical trial reported in the journal Pediatrics, they replaced the sugary drinks with noncaloric drinks and their teen subjects saw the pounds melt away.

Cutting sugary drinks at home helped teens shed poundsexternal link

Fat chance, slim chance, little chance

Still harping on weight, there was more evidence this week that a moderate weight is better for you than being too fat or too skinny.

Obese men are more likely to suffer a fatal injury in a car crash than men of normal weight, but beanpoles don't do well either, according to researchers at the Medical College of Wisconsin in Milwaukee.

In a study in the American Journal of Public Health, the researchers reported that men who were moderately overweight, but not obese, were least likely to die -- possibly because of a "cushioning effect."

Obese and skinny male drivers fare worse in car crashesexternal link

Anorexia blamed on genes, not fashion models

Now to thinness. The phenomenon of anorexia -- mostly among young girls and women -- has been blamed for years on an inappropriate response to images of skinny fashion models and actresses.

But research at the University of North Carolina, using data from a huge group of twins in Sweden, suggested that more than half of the disease can be laid at the feet of genetics. So called "twin studies" compare the rates of disease in identical twins (who share the same genetic makeup) and fraternal twins (who are no more alike than ordinary siblings). If identical twins share a disease more often than fraternal twins, that's an indication there's a genetic basis for it.

In the case of anorexia, the researchers reported in the Archives of General Psychiatry, the contribution of genetics is probably about 56 percent.

Genes, more than fashion, induce anorexiaexternal link

A bit of restraint

One risk of extra weight is a stroke, and some stroke patients lose the use of an arm. Now it seems that in rehab, they may get better results with one arm tied behind their backs.

Researchers at the University of Alabama at Birmingham found that when a stroke leaves one arm weak and unable to function properly, restraining the working arm for two weeks -- even years after the stroke -- leads to dramatic improvements in the injured arm.

The reason, they suggested in Stroke, a Journal of the American Heart Association, may be that when the good arm is restrained, the brain rewires itself to use the other arm. The method worked dramatically better than standard methods of rehabilitation.

With one arm restrained, stroke patients gain use of the otherexternal link

Gene link eyed in AMD

In addition to stroke, blindness is one of the main terrors of aging.

Now researchers at Columbia University say that much of the development of age-related macular degeneration -- the leading cause of vision loss in those over 65 -- can be laid at the door of two genes that play a role in immune reactions.

The finding, they reported in Nature Genetics, will make it possible to identify those at risk long before the condition actually appears and could lead to new ways to treat or prevent the condition, which currently has no cure.

Macular degeneration tied to immune system genesexternal link

Mammograms over-diagnose breast cancer

Screening by mammography can reduce mortality from breast cancer.

But a Swedish study indicates that as many as one in 10 of the women who undergo a mammogram will get an undeserved diagnosis of breast cancer. In those cases, Swedish researchers said, the disease would never have come to the attention of either the woman or her doctor without the screening.

They said in the British Medical Journal that was because the tumor was very slow-growing or because death from other causes would have come before the cancer was noticed.

Breast cancer screening over-diagnoses many womenexternal link

Boob tube cleared on ADHD charge

Here's one fewer concern for parents. TV isn't causing kids to have attention deficit hyperactivity disorder.

Researchers at Texas Tech University in Lubbock studied kindergartners and found that kids who watched a lot of television weren't any more prone to ADHD than kids who weren't hooked on the tube.

In fact, they wrote, in the journal Pediatrics, parents shouldn't beat themselves -- there's no evidence that parenting plays any role in the development of ADHD.

TV exonerated as cause of attention deficitexternal link

Many doctors miss superbugs

Some superbugs are reaching epidemic proportions in the some parts of the United States, but doctors aren't recognizing them or treating them appropriately.

In an Atlanta, Georgia, study, researchers found that 72 percent of community-acquired Staphylococcus aureus infections of the skin and soft tissue were actually so-called superbugs -- methicillin-resistant Staphylococcus aureus.

But doctors treated them with the wrong antibiotics 65 percent of the time, indicating the physicians didn't suspect MRSA, the researchers said in the Annals of Internal Medicine.

Vigilance urged for community-acquired MRSAexternal link

Thalidomide fails test

Thalidomide -- yanked from the markets decades ago after it caused birth defects -- has been making a comeback because it appears to be beneficial in treating people with a bone cancer called multiple myeloma.

But in a new study, by researchers at the University of Arkansas, the drug (under the brand name Thalomid) failed to extend life, although it did increase the number of people who saw their cancer go into remission, and reduced the rate of relapse.

In the New England Journal of Medicine, the researchers said adding Thalomid to intensive chemotherapy for the disease did not improve the five-year survival rate.

No survival advantage for thalomid in multiple myelomaexternal link

And finally

If Marcus Welby and Gregory House had a popularity contest with patients, Dr. House would get few votes. He is the antithesis of the ideal physician.

The ideal doctor, researchers in Ohio State say, is confident, empathetic, humane, personal, forthright, respectful and thorough -- exactly the characteristics of the avuncular Dr. Welby, played by actor Robert Young. The study derived its seven ideal characteristics from a survey of a random sample of 192 Mayo Clinic patients.

Competence doesn't enter into the equation, the researchers said in Mayo Clinic Proceedings, because most patients can't judge medical skill. But they can tell when a doctor cares about them. And that's bad news for the grouchy Dr. House.

Ideal doctor is thorough, empathetic, humane -- the antithesis of TV's House...external link

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