March 2009

Medical-Intelligence

A Periodic Review of Selected Medical Research
by Marc D. Schwartz, MD
MarcDSchwartzMD@GMail.com

Table of Contents

I Hear $400. Do I Hear $600?
Having a Hip Fracture Increases a Person's Chance of Dying for Up to Ten Years
Avoid NSAID's Following Hospitalization for Heart Failure
On the Brighter Side
New Standard for Treating Locally Advanced Prostatic Cancer

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I Hear $400. Do I Hear $600?
Fifteen percent of people who were paid $400 to stop smoking for six months did so. This is over twice the cessation rate of those not paid. A year later eleven percent were still not smoking.

This cure rate is good (for those who stopped) and no so good (for the almost 90% who didn't).
Since the annual smoking-related cost of smoking (including medical care and lost productivity) is $3,400 per person per year, I'm sure another researcher will up the bid shortly.

Having a Hip Fracture Increases a Person's Chance of Dying for Up to Ten Years
Four thousand Australians over 60 years of age were followed for 18 years. During that time, over a quarter had a fracture of some kind, most commonly of the hip. The mortality rate of those who had a fracture was almost twice that of those who did not. A second or third fracture doubled or tripled that rate.

The increased risk of dying persisted for five years for any fracture and for ten years for a hip fracture. The controllable risk factors associated with fractures are weak quadriceps (thigh) muscles, smoking, and low physical activity. If this does not get you to the gym, I don't know what will!

Avoid NSAID's Following Hospitalization for Heart Failure
Over 100,000 Danish patients who were hospitalized for heart failure were followed over a ten year period. Risks for death, hospitalization, and heart attack were all higher with any use of a non-steroidal anti-inflammatory drug. The greater the dose taken over time, the greater the risk.

On the Brighter Side
Over a three month period, women who reduced their calorie intake by 30% had a dramatic increase in memory. Don't even think about it. Most people, including you, just can't sustain this level of calorie reduction over time. The good news: new drugs are actually being developed that mimic the consequences of calorie restriction.

New Standard for Treating Locally Advanced Prostatic Cancer
A study was carried out of the effects of two cancer treatments on 875 men under 75 of age who had prostate cancer that did not involve the nodes and did not have known metastases. The study was restricted to men in otherwise good health.

Men were randomly treated with either anti-androgen hormones or anti-androgen treatment plus maximum dose radiation. Mortality was significantly lower in the combined therapy group. The authors of the editorial in Lancet, where the study was published, believe that long term combined therapy should be the new standard of care for such patients.