Thursday’s online version of the British Medical Journal has published an article by British journalist Brian Deer which once again refutes the connection between a vaccine and autism. The original study by Andrew Wakefield and his colleagues published in 1998 was later refuted by 10 of its 13 authors and retracted in the Lancet which originally published the article.

Even though Wakefield claimed that the 12 children evaluated in the original study were all normal until they received the MMR vaccine, further analysis revealed that at least 5 of the 12 had already been diagnosed with developmental problems. In interviewing the children’s parents and reviewing medical records it was found that all of the cases were somehow misrepresented. An accompanying editorial called the entire original study a “fraud.”

Wakefield was stripped of his medical license in Britain and has now moved to the United States where he has authored a book once again touting the vaccine-autism connection. This is where celebrity Jenny McCarthy gets the ammunition for her diatribes against vaccines. I fault Oprah and others for giving her a platform to spread information that has been disproved by other medical studies. There has been a large resurgence of measles in the United Kingdom where the original study first gained popularity.

Keep all of this information in mind the next time you hear one of the conspiracy theorists claiming that vaccines cause autism. bjmdjd

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British Medical Journal · Jenny McCarthy · Lancet · MMR · vaccine-autism connection

I can remember not too many years ago cardiac patients usually took aspirin as a preventative medication (anti platelet med) and if you were at a high risk for problems (and you could afford it) you took clopidogrel (Plavix). Both excellent and fairly safe drugs if used as recommended. Not long ago it became fashionable to give patients both drugs for added protection. Is that a good idea?

This week a study published in the Archives of Internal Medicine states that the risk of bleeding in these patients taking both medications is substantial and should be treated as such. Even though this approach is still safer than warfarin which is also prescribed for several cardiac problems, the risk needs to be recognized. 

In this study there were 7,764 emergency room visits among the dual treated patient group and most of those were for bleeding though usually minor. There were 40,924 warfarin treated patients for bleeding which were recorded for context. Once again most of this bleeding was also minor. The bleeding risk with warfarin is rarely ignored while the risk for dual anti platelet therapy is often down played or not recognized.

While the bleeding may not usually be serious in these patients on both aspirin and clopidogrel (Plavix), the risk is real and should be taken seriously by doctors and patients alike. The authors of the study also suggest that patients should be made aware of the risk of bleeding but stress that the risk is not a reason to abandon the therapy.

If you or a loved one is on both aspirin and clopidogrel (Plavix) you may want to discuss what you might expect with your prescriber. bjmdjd

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Archives of Internal Medicine · aspirin · Plavix · risk of bleeding · warfarin

The results of two new meta analyses has revealed that the lower a person’s LDL (bad cholesterol) the better. There is benefit shown without risk all the way down to an LDL of 50 mg/dL. The results were published in the Lancet this week.

While the results were based on patients with a high risk of cardiovascular disease it is felt that they hold true for people at any elevated risk level. Instead of using simvastatin 80 mg to shoot for these low levels it is felt that high doses of the newer statins like Lipitor or Crestor or a combination of simvastatin 40 mg with pravastatin 40 mg is better to lower the risk of myopathy.

Data from 170,000 patients was analyzed. bjmdjd

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Crestor · Lancet · LDL · Lipitor · simvastatin

Research presented today at the American College of Emergency Physicians 2010 Scientific Assembly found that the small cups sold over the counter for dosing children’s liquid medications may be marked inaccurately causing too large of a dose to be given.

The research was done using the cups measuring water and then measuring the same liquid in an accurate scientific cylinder. The testing was done by the researchers under controlled conditions and not by an untrained person. It was felt that an untrained person  holding a screaming baby at 4 A.M. might get an even more inaccurate result than the researchers.

The type of dosing cup, how the numbers and lines were printed on the cups, and the color of the liquid used all affected the accuracy of the results. The average result in the cylinder was 0.33 milliliters greater than in the dosing cups.

Whether these findings make any difference clinically or not is not known but dosing medications in a very young infant would seem to be clinically significant as 0.33 mL is not a small amount in these patients. I might suggest to have your pharmacist check your measuring cup against one of the scientific cylinders that they keep in their work area. bjmdjd

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American College of Emergency Physicians · dosing children's liquid medications · dosing cups

According to research performed in the United Kingdom and published in the Canadian Medical Association Journal the influenza vaccine seems to reduce the risk of a first heart attack by 19%.

The study included people at least 40 years of age. It also found that the pneumococcal vaccine (pneumonia shot) had no affect on the occurrence of heart attacks.

Just one more reason to get the all important flu shot! bjmdjd

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Canadian Medical Association Journal · flu · flu shot · flu vaccine · influenza · pneumococcal vaccine

According to a study by the Centers for Disease Control and Prevention 19% of gay and bisexual men in 21 major U.S. cities are HIV+ and nearly half of them don’t know it.

Young black men were found to be the least likely to know that they were infected. A CDC spokesman said that there is less urgency and fear associated with HIV now than there was in the past likely due to the advancements made in AIDS treatments.

With the increased availability in HIV testing one would think that those in such a high risk category would be more vigilant in getting tested. It’s very important to know when someone is HIV+ because early treatment can help keep people healthy and less likely to infect others. bjmdjd

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Centers for Disease Control and Prevention · HIV

A study conducted at Massachusetts General Hospital and the University of Michigan and published in this months issue of Arthritis and Rheumatism found that there are differences in the pain processing centers of the brain in patients with fibromyalgia when compared to others without the disease.

Researchers performed MRIs of the brain on patients and non patients and found that those suffering from fibromyalgia had more activity and connectivity in regions of the brain that perform pain processing.

Up until about ten years ago many doctors didn’t know what to think about fibromyalgia and many didn’t think that it even existed as a disease process. The feeling was that the pain was secondary to psychological problems that usually accompany the problem. It’s possible that this study will be an important part of the puzzle in understanding this confusing disease. bjmdjd

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Arthritis and Rheumatism · fibromyalgia · Massachusetts General Hospital · MRI of the brain · Univ. of Michigan

A study conducted at Stanford University School of Medicine and published earlier this month in the online version of the Journal of Clinical Oncology states that men who take various common medications can have a deceptively lower PSA Level when being screened for prostate cancer.

The study stated that men who take statins to lower their cholesterol, non – steroidal anti - inflammatory drugs (NSAIDs) for pain, and thiazide diuretics for fluid buildup and high blood pressure may have lower PSA levels than men who don’t take these drugs. It was noted that the affects of these drugs on PSA levels are greater the longer the drugs are taken.

The clinical implications of these findings are not known at this time without further study. Does the affect lower the believability of PSA in prostate cancer screening or do these drugs actually decrease the likelihood of developing the disease? No one knows for sure.

If you or someone you know takes these drugs and is being screened for prostate cancer using a PSA level they might want to discuss these results with their doctor. bjmdjd

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Journal of Clinical Oncology · NSAIDs · PSA · Stanford Univ. School of Medicine · statins · thiazide diuretics

You might feel that you are in pretty decent shape except for that few extra inches around your mid section. However, a study printed in the current issue of Archives of Internal Medicine begs to differ. Waist size in older adults is a mortality risk factor regardless of the all important body mass index (BMI).

The authors concluded that regardless of an older adults weight they should pay close attention to their waist circumference to avoid earlier mortality.

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Archives of Internal Medicine · body mass index (BMI) · health · waist circumference · wellness

There has long been a concern over the possible cardiac risks of taking certain non steroidal anti inflammatory drugs. So much so that Vioxx was actually removed from the market in 2004. A report outlining the results of a study from Denmark was included in the latest issue of the AARP Bulletin.

The study which was originally reported in the June 8th online edition of the American Heart Association’s Circulation showed that even the short term use of NSAIDs in healthy men and women is associated with an increase in heart attacks and stroke. Previous studies had shown the same association but in patients with already existing heart disease.

The researchers found that ibuprofen had a 29% increase in the risk of fatal or non fatal stroke. Diclofenac (Voltaren) had almost double the risk of death from heart disease. Celebrex results were inconclusive while the results for Naprosyn (Alleve) revealed that it might be a safer alternative to the other drugs. 

Patients requiring chronic use of these meds for arthritis or other aches and pains might want to discuss these findings with their doctor. bjmdjd

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AARP Bulletin · Alleve · Celebrex · Circulation · diclofenac · ibuprofen · Naprosyn · Non steroidal anti inflammatory drugs · NSAIDs · risk of heart attack and stroke · Voltaren