Health Newsletter:November 2008
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Contents |
[edit] Pills For Diabetes Not Always Useful
Oral anti-diabetic drugs have been on the market for decades. They are often prescribed to patients with type 2 diabetes in an effort to control blood sugar levels. Type 1 diabetes patient-those who suffer from diabetes since childhood-generally require a different therapeutic approach. They receive insulin in the form of injections, or more recently by pump. The usefulness of the oral antidiabetic drugs has been researched by Elizabeth Sevin, PhD,MPH of John Hopkins Blomberg School of Public Health, Baltimore. Pooled data analysis found that patients who took one of the older medications, metformin hydrochloride, were at a reduced risk of death from cardiovascular illness. None of the other oral medications for type 2 diabetes was significantly linked to cardiovascular illness, but cardiovascular disease and mortality was higher in the patient group that took the drug rosiglitazone. Due to the controversial reports about this drug, the researchers took a closer look at all the other oral anti-diabetic medications. None of them, not even the newest ones, proved to be superior, and the only one that showed a slight benefit was metformin. The author cautions that the association is too weak to be of significance, and a lot more long-term research would be needed to substantiate the benefits for cardiovascular protection.
Comments: I do not see any further benefit for more research on oral anti-diabetic agents. Rather this type of research would indicate that subcutaneous insulin treatment 3 or 4 times per day as originally suggested by Banting and Best is still the best treatment for diabetes.
References: Arch Intern Med. 2008;168:2070-2080
[edit] A Study About Parents’ Concerns Regarding Childhood Vaccinations
In the October issue of the medical journal Pediatrics researchers published a study where 3,924 parents had been interviewed in a National Immunization Survey. 28% of the parents either delayed the vaccination because of concerns or refused vaccination of their child altogether. A multivariate analysis was performed that shed more light on this. There was a probability of about 2.35-fold (compared to parents who had no concerns) that one of the following factors was responsible for this: parents who would delay a vaccination had on average 2 or more children (4.3-fold more likely to delay than parents with one child) and unmarried mothers also were more likely to delay (probability 2.14-fold). Parents had a probability of 2.68-fold to refuse a vaccination when the child was 25 to 35 months old when compared to those with a child younger than this. The varicella vaccine, which is a live attenuated vaccine, was mostly the reason given when parents were unsure as to whether to give permission for vaccination or when they refused to give consent. In contrast, reasons for delays of vaccination were that the child was ill and the vaccination was given at a later date when the child had recovered. The reason that parents decided not to delay or not to decline vaccination was that they discussed their concerns with the health care provider and they felt now informed and assured that vaccination was the right thing to do. The authors felt that the study emphasized how important it is to inform the parents of the science behind vaccinations.
Comments:The study did not review the fears of mercury poisoning with the preservative thimerosal, which is still contained in the vaccines of many countries and has been shown to be particularly devastating in autistic children and children with learning disabilities.
Pediatrics. 2008;122:718-725
[edit] Early Childhood Weight Gain Leads To Weight Problems in Teens
A Finnish Study enrolled 541 children in a prevention trial at the age of 7 months. The same children were seen again at the age of 13 years. Every year the height and weight were measured. By the time the children were 13 years old, 16% were classified as overweight, based on body mass index determinations. For girls, there was an abnormally high weight gain (2.8 to 7.5 kg annually) from the 3rd to 4th year until the 12th year of age while normal weight kids gained only 2.1 to 4.8 kg annually. Boys showed no difference in weight gain pattern until the age of 5 years or older. Now the boys who developed an overweight pattern showed an increase from 3.5 to 7.9 kg annually while normal weight boys gained only from 2.6 to 5.5 kg annually. With respect to the body mass index the upper limit of a normal was exceeded for girls at the age of 5 years and for boys at the age of 8 years. Another important finding of the study was that the parents of the overweight adolescents were also overweight while the parents of norm weight adolescents were also within the normal body mass index. Two major risks of developing overweight and later obesity were found: overweight parents and abnormally high weight gain in early childhood (ages 2 to 4). The investigators concluded that treatment for developing overweight problems in childhood needs to be addressed at this age, not later when it is much more difficult to treat.
Pediatrics. 2008;122:e876-e883
[edit] Hormone Dependency of Prostate Cancer
In this month’s Lancet Oncology Manit Arya et al. have reviewed the outstanding research and clinical achievements of Harvard Medical School trained Charles Huggins. This Canadian-born American surgeon won the Nobel Prize in Physiology and Medicine in 1966 for his outstanding research on treatment of prostate cancer. Here are the key findings of a publication in 1941 by Huggins and Hodges: 1. Prostate cancer is a cancer that is hormone controlled 2. Prostate cancer that has spread to other organs can be inhibited in growth by removal of testosterone production (surgical removal of testicles or orchiectomy) or by treating with female hormones (estrogens). 3. Prostate cancer that has spread to other organs is made to grow faster, if testosterone is injected. The authors of this review pointed out that despite hundreds of further research papers these original studies have withstood the test of time. Estrogen treatment has caused cardiovascular and thromboembolic complications, which resulted in cessation of this treatment modality. Newer studies attempted to improve prostate cancer survival with synthetic luteinising-hormone-releasing-hormone (LHRH) agonists and various antiandrogens, but nothing compares to the survival success of a simple orchiectomy. The authors concluded that Huggins and Hodges have provided an “epic work”, which will stand out from the myriad of publications in science for years to come.
Manit Arya, Dr, FRCS, Iqbal S Shergill, FRCS, Philippe Grange, MD, Mark Emberton, FRCS , The Lancet Oncology - Volume 9, Issue 11 (November 2008)
[edit] Low Testosterone And Heart Disease
More men than women seem to be affected by cardiovascular illness, and the reasons have been manifold. At one time work stress was cited for the prevalence of heart disease in men. Other lifestyle factors, lack of exercise, being overweight, poor dietary choices and smoking have been found to play significant roles. The risk for cardiovascular disease increases with age, as does the likelihood for hypertension, elevated cholesterol levels and glucose intolerance.
Some attention has been paid to the fact that hormones can also play a role, and research has now shown that testosterone has some direct cardiovascular effects. Testosterone has been found to dilate blood vessels. The effect can be likened to the calcium channel blocker Nifedipine. It has also been substantiated that males with coronary artery disease and heart failure tend to have low levels of testosterone. If testosterone deficient men receive replacement therapy, vasodilatation (dilation of blood vessels) has been demonstrated in males who have received testosterone replacement for a few months. Male hormone replacement therapy has also been found to relieve the symptoms of angina in patients with heart failure. The question, how testosterone fits into the concept of disease prevention, comes up in this context. Researchers have found enough evidence that a low testosterone blood level has an independent association with accelerated atherosclerosis (hardening of arteries). Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding is the fact that this condition is reversible by replacement of testosterone. Male hormone therapy has received a lot of bad press in the case of overtreatment with androgens to achieve muscle growth in body building. However, in this case there was no testosterone deficiency and athletes and their coaches were using doses that were too high. This type of administration entails grave health risks and has nothing to do with good medicine. In case of hormone deficiency replacement the normal body function of a younger male is restored with bioidentical testosterone, which can be a tool to better health for the ageing male. Anti-aging physicians are very familiar with this treatment modality.
Journal of Men's Health - Volume 5, Issue Suppl (September 2008)
