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Wednesday, September 30, 2009

PSA test unreliable and "unusable"

In a follow up on a previous post ( there is now another study, this time from the British Medical Journal, showing that PSA testing does not give enough valuable information to be worth doing.

FRIDAY, Sept. 25 (HealthDay News) -- The inability of the prostate specific antigen (PSA) test to distinguish between deadly and harmless prostate cancers makes it unusable as a population-wide screening tool, new research claims.

Because of its unreliability, results from the test lead to overdiagnosis and overtreatment, according to two reports in the Sept. 25 online edition of BMJ.

"Our findings strongly indicate that, in addition to PSA, further biomarkers are needed before inferring population-based screening for prostate cancer," said Benny Holmstrom, a urologist with Gavle Hospital in Gavle, Sweden, and lead author of the first study.

"The direct implication of our findings in a screening situation is that no matter which PSA cut-off you adopt for selecting men for further diagnostic work-up, you will either have too many false positives or too many false negatives," said study co-author Mattias Johansson, a postdoctoral fellow at Umea University in Sweden."

"Given the current trend in lowering the PSA cut-off to about 3 nanograms per milliliter, it seems clear that a large number of healthy men will be subject to painful, stressful and costly diagnostic procedures," he said. "In addition, and perhaps more serious, is the wide overdiagnosis of slow-growing tumors causing unnecessary medical treatment and anxiety..."

Sunday, September 27, 2009

Anti depressants and heart defects
THURSDAY, Sept. 24 (HealthDay News) --
"Women who take certain antidepressants during the first three months of pregnancy may have a slightly increased risk of giving birth to babies with heart defects.

Septal heart defects -- malformations in the wall separating the right side of the heart from the left -- were more common among women taking antidepressants in the first trimester, Danish researchers found. Some of these heart defects resolve on their own, while others require surgery.

The risks were seen in sertraline (trade names Zoloft and Lustral) and in citalopram (Celexa), both of which belong to the class of medications known as selective serotonin reuptake inhibitors (SSRIs)."

Women who took more than one SSRI early in their pregnancy had a fourfold higher risk of having babies with this problem, said the authors of a study appearing online Sept. 24 in BMJ."

Overall, it doesn't sound as if the threat is particularly large from the way the data is presented, but this topic is certainly worth keeping an eye on. The article goes on to underscore the risk of women with major depression going off anti-depressants in pregnancy implying that the risk/benefit ratio is in favor of keeping the medications in place. I doubt many would argue with that, but the fact of the matter is that these medications are not only prescribed for women with severe depression. On the contrary, these medications are one of the most prescribed medications out there, and often women do not know they are pregnant until well into the second month so there is some cause for concern.

Friday, September 11, 2009

Medical Research Corruption Continues
September 11, 2009 Ghostwriting Is Called Rife in Medical Journals, By DUFF WILSON and NATASHA SINGER

Following up on a previous blogpost ( about the common practice of drug companies facilitating and, at times, even doing the research studies for their own products, the NYTimes is reporting that six of the top medical journals had a significant number of articles that were written by "ghostwriters." "Ghostwriters" are authors from drug companies whose names do not appear on the list of authors on a research study. This is an obvious blow to transparency, since the authors could not be traced to the company they work for. From the article-

"Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.

Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.

In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.

The concern, the researchers said, is that the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.

According to the study, responding authors reported a 10.9 percent rate of ghostwriting in The New England Journal of Medicine, the highest rate among the journals.

Editors of the Boston-based journal said Thursday that they were “puzzled” and “skeptical” of the findings. "

Wednesday, September 9, 2009

Use of Acupuncture Soaring since 2002

Acupuncture and oriental medicine use is soaring dramatically.
The National Center for Complementary and Alternative Medicine (NCCAM) which is a part of the National Institute of Health, has reported that 3.1 million Americans used acupuncture and Oriental medicine in 2007, a 50% increase since 2002.
Part of what’s causing the increase is the frustration with the standard health care system in the U.S. In 2002 2.1 million Adults used “acupuncture care.” But in 2007 the number jumped to an estimated 3.1 million. Also the number of people who practiced yoga jumped from 10,386,000 in 2002 to 13,172,000 in 2007.

The study also gave AOM high marks for its research quality. Out of 40 systematic reviews identified by the National Library of Medicine involving acupuncture, massage therapy, naturaopathy or yoga published between 2002 and 2007, the only studies that found sufficient evidence to conclude that the given therapy was effective for a given condition all used acupuncture as a form of treatment.

Tuesday, September 8, 2009

Growing Attention to Placebo

A fascinating article from Wired magazine ( addresses the curious problem that the placebo effect seems to be increasing in clinical trials and has torpedoed the launch of several new medications. Any new drug coming to market needs to demonstrate significant efficacy compared to a "dummy" pill, or placebo. Recently new "blockbuster" medications ranging from anti-depressants, to Parkinson medications, to medications for Crohn's disease have been shown to be effective, but not as effective as placebo, so have had to be pulled. Even Prozac, the work horse of mood enhancers, has not shown effectiveness compared to placebo in recent clinical studies.
The NIH and Big Pharma alike are (finally) looking into the science of placebos, though Big Pharma is reluctant to pay for the studies (natch.)
"Ironically, Big Pharma's attempt to dominate the central nervous system has ended up revealing how powerful the brain really is. The placebo response doesn't care if the catalyst for healing is a triumph of pharmacology, a compassionate therapist, or a syringe of salt water. All it requires is a reasonable expectation of getting better. That's potent medicine."
I actually had the opportunity to speak to the author of this article on a recent radio call-in talk show to discuss how the keen attention paid to placebo effect in acupuncture research is glaringly absent from surgery research. Surgeries are often compared to other surgeries or conservative treatment, but rarely are "sham" surgeries performed. see posts and
He reminded me of the open heart procedure called Mammary Artery Ligation which had finally been debunked. But that is one of very few surgical procedures that have been subjected to any sort of even handed scrutiny. I would add that open heart surgery has to be one of the most powerful, ritualistic procedures performed in medicine and must have extremely powerful placebo properties.
My interest in this topic is because of my involvement in acupuncture research, but I also am interested in therapies that don't fit the medical model and are therefore unexplained. The Western Medical Model is phenomenally valuable, but it does have its limits and there is a tyranny of the mechanistically rational when it comes to alternatives. I also think that the placebo effect is the ultimate testament to the power of "mind-body" medicine. I think it is high time that it should be studied and hopefully harnessed, not ridiculed.
I, personally, have no interest in handing out placebos for a living, but studying what is happening physiologically interests me no end.

happened on another article from Wired about the effectivenes of sham acupuncture for back pain. Even sham acupuncture worked better than physical therapy or medications, as the NHS in Britain is now acting on.