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This week in the medical journals

Potential adverse reactions arise with long-accepted therapies

By Peggy Peck
Managing Editor, MedPage Today

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



Medical Research
Centers for Disease Control and Prevention

Once again the thorny issue of replacement estrogen grabbed attention in the major medical journals -- the latest in a seemingly never-ending string of studies that document the pluses and risks of this hormone.

This week the estrogen story came from Harvard researchers who have tracked the health of almost 29,000 nurses for more than 20 years. They reported in Archives of Internal Medicine that women who took the hormone for more than 10 years had an increased risk of breast cancer, a risk that went up with each additional year of use. But women who took the hormone for less than 10 years had no increase in their risk of developing breast cancer.

10 years of estrogen alone increases breast cancer riskexternal link

That was just one of a handful of studies this week that raised the caution flag about potential adverse reactions associated with a number of long-accepted medical therapies.

High corticosteroids set hearts aflutter

Dutch researchers reported that high-dose corticosteroid treatment, a regimen that is sometimes used to treat asthma, chronic obstructive lung disease or arthritis, was associated with a six-fold increase in the risk of atrial fibrillation, a type of irregular heartbeat that is known to increase the risk of stroke. The study, published in Archives of Internal Medicine, prompted the American Heart Association to issue a statement warning patients taking high-dose corticosteroids not to stop taking the drugs abruptly. The AHA said more data are needed. But meanwhile it urged patients to discuss corticosteroid treatment with their physicians.

High-dose steroids linked to risk of atrial fibrillationexternal link

Inhaled corticosteroids don't stop childhood asthma

On the theme of corticosteroids, specifically inhaled corticosteroids for treatment of childhood asthma, two studies reported in the New England Journal of Medicine debunked a popular myth about their benefit. Use of inhaled corticosteroids does not alter the development of asthma in early childhood and the drugs are not without risk, the researchers from Boston's Brigham and Women's Hospital wrote. The message to parents and physicians is clear: Use of these drugs in children under age 2 "should be highly selective."

Inhaled corticosteroids in childhood do not stop asthmaexternal link

Folate linked to twin births

Researchers in Scotland said that it is possible to get too much of a good thing if the good thing is folate or vitamin B-12. A team of Aberdeen University researchers wrote in The Lancet that women who have very high plasma concentrations of folate or B-12 at the time that they are undergoing in vitro fertility treatments are more likely to give birth to twins than women with lower folate levels. Increased folate, on the other hand, reduces the risk of spina bifida, which is why foods such as bread and cereal are fortified with the vitamin in the United States.

Folate overload linked to birth of twins after IVFexternal link

Bone problems seen in some Gleevec patients

And Gleevec (imatinib mesylate), the molecularly targeted pill that has shown impressive results for treatment of chronic myelogenous leukemia and gastrointestinal stromal tumors, showed a slight flaw. In this case, Gleevec given at high doses or to patients younger than 50 may impair bone metabolism. Patients with elevated levels of parathyroid hormone may also have an increased risk for a condition called hypophosphatemia, meaning very low levels of phosphate, wrote researchers at Memorial Sloan-Kettering Cancer Center in New York in the New England Journal of Medicine.

High doses of Gleevec may increase risk of bone wastingexternal link

Evidence has nothing to do with it

If all of this evidence is confusing, don't worry because doctors may not be paying much attention. A study in the Journal of the American Medical Association found that about one in five prescriptions written by American doctors are for "off-label" uses of drugs, meaning prescribing drugs for symptoms or diseases that the drugs are not approved to treat. Physicians, wrote a team of Dartmouth researchers, write about 150 million off-label prescriptions a year with "little or no scientific support" to back up their drug choice.

Most off-label drug use on iffy scientific groundexternal link

Grapefruit danger explained

On the other hand, if you've had occasion to pick up a prescription for Lipitor (atorvastatin) or Plendil (felodipine) or various other drugs, you would be hard-pressed to miss a warning on the label that you should not take the drug with grapefruit juice. This week a team of University of North Carolina at Chapel Hill researchers explained in the American Journal of Clinical Nutrition what it is in grapefruit juice that makes for dangerous interactions with some drugs. A family of plant toxin called furanocoumarins boosts the blood levels of the drugs, including some antibiotics, to higher than intended levels.

Grapefruit juice drug interaction culprit identifiedexternal link

The real deal about flu

This was the week that network television offered a made-for-TV movie that detailed just how scary bird flu could be. But science was fighting back with a pair of upbeat studies about the potential scourge.

First, French researchers reported in The Lancet that an experimental H5N1 avian influenza vaccine was effective in an early clinical study. Moreover, the French team said that when aluminum hydroxide was added to the highest tested doses of the bird flu vaccine there was a statistically significant immune response.

Second avian flu vaccine reported to protectexternal link

And all the brouhaha over sick birds is having an unintended benefit. It has refocused scientific interest on seasonal flu -- the virus that every year sickens thousands. Researchers are now using the same high-tech genetic research used to study H5N1 to study the garden-variety influenza, according to a report from Peter Doherty Ph.D., a Nobel Prize-winning researcher from the University of Melbourne School of Medicine, in Nature Immunology.

Avian flu threat spurring seasonal flu researchexternal link

Legal system blamed for malpractice woes

This week's "unexpected finding" award went to a team of doctors and lawyers from Harvard's Risk Management Foundation who reported in the New England Journal of Medicine that frivolous lawsuits don't drive up the cost of medical malpractice insurance, nor do they clog the courts. The real problem with the nation's medical malpractice system, they wrote, is that patients who are really injured by medical error have to wait way too long for compensation and, when the money is paid, 54 cents of every dollar goes to lawyers, experts and courts.

Frivolous litigation unlikely in medical malpractice casesexternal link

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