February 2007 (1)

Once again, steroids don't help
In the last issue of this newsletter, I reported that steroids did not help and may have worsened the long term course of tennis elbow. Now a different study found that intramuscular steroids did not help in the treatment of non-radiating low back pain.

Antacid medications, SSRI's, and hip fractures
Two of the most common types of medications prescribed to reduce stomach acid in order to treat disorders such as ulcers or esophageal reflux are proton pump inhibitors (PPI's) like Nexium or Prilosec and histamine receptor antagonists (H2RA's) like Tagamet (cimetadine) and Zantac. In a study of about 150,000 patients, the risk of hip fracture among those taking PPI's for at least a year was found to be 44% higher than those who did not use any acid-suppression therapy. The relationship between PPI use and hip fractures was particularly high in those who took high doses and those who used them for four years or more. Journal Watch suggests that "clinicians should consider minimizing both the dose and duration of PPI use in older patients." The use of H2RA's did not have a significant effect on hip fractures.

SSRI's (Prozac, Paxil, Zoloft, Celexa, Lexipro, Effexor) also reduce bone density and are linked to an increased number of fall. Check with your doctor if you are taking both a PPI and an SSRI.

Estrogen and breast cancer - another study
A recent study of over 100,000 women over 50 years of age found that in those who had had hysterectomies and had used replacement estrogen but not progesterone for at least six months, there was about a 50% increased risk for breast cancer. Those using a estradiol patch had a greater risk than those taking other forms of estrogen. The data indicated that in 10 years, there may be two or three extra cases of breast cancer per 1,000 women who use the patch for 5 years or more.

Herbal alternatives not effective for menopausal symptoms
A study of 351 women with menopausal symptoms found no difference in the degree of reduction of menopausal symptom among those using a wide variety of botanicals including black cohosh and those taking a placebo.

Should everybody be screened for HIV?
A computer analysis of the costs and benefits of HIV testing suggests that it would be cost-effective to test all adults in populations that had 2 or more cases of HIV per 1,000. In the United States, 3 of every 1,000 people is positive for HIV. The Centers for Disease Control recommends almost universal testing. A very low risk individual might quite reasonably forgo testing, but as public policy, that would be costly to society because some low risk individuals will not know they are be carrying the virus.

Treatment vs observation only for prostate cancer
Of forty four thousand men between 65 and 80 with localized prostate cancer, only 2% died of the disease. Those receiving active treatment were 1/3 less likely to die of prostate cancer than those who were not treated, but that may have been, at least in part, because they were generally healthier and would be expected to live longer. More studies are needed.