Archives Int. Medicine

Dietary Fiber and Mortality

March 21st, 2011 | No Comments | Source: Archives Int. Medicine, LA Times, USNews, Wall Street Journal

Scientists have proven that dietary fiber lowers the risk of coronary artery disease, diabetes and certain cancers. Surprisingly however, they had yet to show that fiber could impact overall mortality. Now apparently, they have done just that. 

fiberonecancer0 300x264 Dietary Fiber and MortalityA research team led by Yikyung Park of the National Cancer Institute has published a study showing that high fiber intake is indeed associated with longer survival.

To reach these conclusions, Park’s group looked at data from nearly 400,000 men and women between the ages of 50 and 71 using the AARP Diet and Health Study. They assessed dietary fiber intake with a questionnaire that had been administered at the beginning of the 9-year study. They excluded people with diabetes, heart disease and most cancers, as well as those who reported extremely high daily fiber intake.

After controlling for smoking, exercise and body weight, the researchers showed that dietary fiber intake was associated with a reduced risk of death in both sexes.

Specifically, people in the highest quintile for fiber consumption (29.4 grams per day for men and 25.8 grams for women) were 22% less likely to die from all causes than those in the lowest quintile (12.6 grams per day for men and 10.8 for women). Women were 34-59%, and men were 24-56%  less likely to die from heart, respiratory and infectious diseases, in particular. Fiber consumption was associated with a lower risk of dying from cancer in men (who are prone to get cancers thought to be reduced by dietary fiber intake) but not in women.

Interestingly, the type of fiber consumed made a huge difference in this study. Participants who consumed fiber from grains, like oatmeal, brown rice and cornmeal experienced all the benefits. In this study at least, fiber derived from vegetables, fruits and beans did not reduce mortality. (more…)

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Predicting the Impact of a Tax on Sugary Drinks

January 12th, 2011 | 1 Comment | Source: Archives Int. Medicine, BurrillReport, NPR

Several studies have confirmed the link between excessive intake of sugary drinks and obesity, especially in kids and teenagers. Other studies have shown that steep taxes on cigarettes can cut smoking rates. So it’s plausible that a steep tax on sugary drinks could cut their consumption as well.

fanta Predicting the Impact of a Tax on Sugary DrinksA dozen states have followed this logic; they already impose taxes on sugar-laced drinks. But how big an impact can we expect from a national tax on such beverages?

Not that much, according to a new study by Eric Finkelstein and colleagues at Duke. What is more, the impact would end-up being localized to middle-class Americans, leaving the rich and poor relatively untouched.

To reach these conclusions, Finkelstein’s group looked at the association between beverage prices, energy intake, and body weight using a multivariate regression model. Their data set was derived from the 2006 Nielsen Homescan panel, in which a nationally-representative sample of US households  uploaded their store-bought food and beverage purchases into a database every week for one year.
 
The scientists found that a 20% and 40% tax on all sugary drinks would reduce calorie intake by a bunion-sized 7 and 12 calories per day, respectively. This would result in an average weight loss of 0.7 and 1.2 pounds per person per year, respectively. Interestingly however, nearly all of this impact accrued to those in the middle-income tax bracket.

The scientists also calculated that the 40% tax would generate about $2.5 billion per year in tax revenue, and that the lion’s share of this money would come from high-income households. They suggested that extending the tax to restaurants and vending machines would increase the take, but only modestly.

sprite Predicting the Impact of a Tax on Sugary Drinks“Although small, given the rising trend in obesity rates, especially among youth, any strategy that shows even modest weight loss should be considered,” Finkelstein commented.

But Susan Neely, president of the American Beverage Association didn’t think much of the idea. “Taxes are not going to teach our children how to have a healthy lifestyle,” she has said.

Regardless, public support for a soda tax would be weak, at best. Last April, a survey conducted by NPR and Thomson Reuters revealed that 51% of Americans were moderately or strongly opposed to such a tax. Only about a third liked the idea. Responses were not affected by income or age, although party affiliation did: 70% of Republicans were against the sugar tax, whereas only about 55% of Democrats were against the idea.

Finkelstein’s write-up appears in the Archives of Internal Medicine.

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Smoking in Middle Age Increases Dementia Risk

December 1st, 2010 | No Comments | Source: Archives Int. Medicine, Wall Street Journal

Most people know that cigarette smoking causes lung cancer and cardiovascular disease. Now, as if anyone needed another reason to kick the habit, a new study has shown that heavy smoking in middle-age is associated with an increased risk of Alzheimer’s disease and other forms of dementia as well.

squashed 200x300 Smoking in Middle Age Increases Dementia RiskTo reach these conclusions, Minna Rusanen, Rachel Whitmer and colleagues at Kaiser Permanente identified 21,000 patients that had completed a cigarette smoking survey between 1978 and 1985, and then tracked down diagnoses that had been entered into their medical records between 1994 and 2008.

It turned out that nearly 5,400 people (25%) from the original cohort were diagnosed with dementia, including 1,100 people that developed Alzheimer’s disease and another 400 that developed vascular dementia. After adjusting for a host of possibly confounding factors, Rusanen’s group found that people who reported smoking at least 2 packs of cigarettes per day on that initial survey were 2.15 times more likely than non-smokers to develop dementia from all causes, 2.5 times more likely to develop Alzheimer’s disease, and 2.7 times more likely to develop vascular dementia during follow-up.

The deleterious impact of smoking grew with increasing cigarette consumption. Thus, people who smoked “only” 1-2 packs per day had 1.4 times the risk of all-cause dementia. And former smokers—those who said they’d quit at the time of the initial survey—were not at increased risk for dementia.

“It’s a pretty clear picture that heavy smoking … elevates your risk of dementia,” said Whitmer, who works at Kaiser Permanente’s research division in Oakland. “If you are a heavy smoker and you’re lucky enough to make it to old age, you’re not in the clear. You’re still at risk for dementia.”

The study confirms the results of recent clinical trials on the relationship between cigarette consumption and Alzheimer’s disease. An interesting historical note is that older studies had actually suggested that smoking reduced the risk of cognitive impairment and dementia in elderly folks. Most scientists have discounted these older studies because many of the heavy smokers in those studies ended up dying before they had a chance to develop Alzheimer’s disease; that’s a phenomenon which could have biased the results.

The write-up of the current study appears in the Archives of Internal Medicine.

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Red Yeast Rice and Cholesterol: Let the Buyer Beware

November 11th, 2010 | 1 Comment | Source: Archives Int. Medicine, MedPageToday

Millions of people consume red yeast rice to lower their cholesterol levels. The dietary supplement contains monacolins, which are known to inhibit cholesterol synthesis in the liver. A purified version of one member of the monacolin family, monacolin K, is also known as lovastatin, the widely prescribed, highly effective cholesterol-lowering drug.

redyeastrice Red Yeast Rice and Cholesterol: Let the Buyer BewareStudies of some (but not all) red yeast rice formulations have shown that they do in fact reduce blood levels of low-density lipoprotein (LDL, or “bad”) cholesterol, and reduce the risk of heart attacks and cardiovascular disease.

Does anybody have a problem with this?

Well, yes. The problem is that since red yeast rice products are classified as dietary supplements and not drugs, they are not regulated by the FDA and hence not always subjected to quality and safety checks that legit drugs get before hitting the shelves. With dietary supplements, you don’t know how much of the “good stuff” you’re getting, and you don’t know what else you may be getting with it.

Ram Gordon and colleagues at the University of Pennsylvania highlighted the problem in a recent study, which they published in the Archives of Internal Medicine.  For their study, Gordon’s team asked an independent laboratory to measure monacolin levels in 12 commercially available formulations of red yeast rice. They also asked the lab to test for citrinin, a byproduct of fungal metabolism of red yeast rice, which is how monacolins are produced from rice in the first place.

Citrinin is toxic: it causes kidney damage, at least in animals.

The label on each formulation in Gordon’s study said it contained “600 mg capsules” of active product, yet Gordon’s team found that the total monacolins per capsule varied by more than 30-fold across the 12 preparations (lowest = 0.31 mg, highest = 11.15 mg). The range of monacolin K (a.k.a lovastatin) varied even more, by a remarkable 100 fold (lowest = 0.10, highest = 10.09 mg).

Four of the 12 products contained citrinin, in levels ranging from 24 parts per million to 189 parts per million.
 
Of interest, the average dose of lovastatin contained in the 12 red yeast rice formulations was 6 mg/day. The maximum dose was 14.5 mg/day. The normal dose of FDA-approved lovastatin is 10-80 mg/day.

“Our findings suggest the need for improved standardization of red yeast rice (RYR) products and product labeling. Until this occurs, physicians should be cautious in recommending RYR to their patients for the treatment of hyperlipidemia and primary and secondary prevention of cardiovascular disease,” the authors wrote.

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Press Overly Optimistic on Cancer Progress

April 14th, 2010 | 1 Comment | Source: Archives Int. Medicine, BurrillReport

Cancer is always in the news. Yet although nearly half of all US cancer patients die of their disease or related complications, no one seemed to know whether news reports reflected this reality.

greatbigbeautifultomorrow 300x199 Press Overly Optimistic on Cancer ProgressJessica Fishman and colleagues at the University of Pennsylvania decided to look into the matter by reviewing the content of cancer news stories in 8 high-circulation newspapers and 5 popular magazines.

The scientists identified 2,228 cancer-related articles appearing between 2005 and 2007, and focused on a randomly selected sample of 436 of them. They found that in general, the stories were overly optimistic about survival, more likely to focus on aggressive treatments and rarely covered negative things like death, treatment failure and adverse events. Almost none of the stories covered end-of-life issues.
 
In particular, 140 stories focused on people who survived or were cured of the disease, while 33 focused on people who were dying or had died of cancer. Just 57 articles mentioned that aggressive cancer treatments can fail. A majority of articles (249) discussed aggressive treatment exclusively, but only 57 reported that such treatments can fail to extend life or cure the disease, or that some cancers are incurable. Just 131 mentioned adverse events associated with treatment, and a grand total of 2 articles focused on palliative or hospice care exclusively.

“These portrayals of cancer care in the news media may give patients an inappropriately optimistic view of cancer treatment, outcomes, and prognosis,” the authors write in the Archives of Internal Medicine.

“For many patients with cancer, it is important to know about palliative and hospice care because this information can help them make decisions that realistically reflect their prognosis and the risks and potential benefits of treatment.”

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CT Scans Pose Cancer Risk

January 13th, 2010 | No Comments | Source: Archives Int. Medicine, LA Times, NY Times

The radiation produced by CT scans performed in 2007 will cause 29,000 cancers and kill 14,500 Americans, according to a study published in the Archives of Internal Medicine

Dontlooknow 300x199 CT Scans Pose Cancer RiskTo reach this conclusion, Amy Berrington de Gonzalez and colleagues from the National Cancer Institute used a computer simulation to estimate the impact of the 70 million or so CT scans that were performed in the US that year (only 3 million were performed in 1980).

The scientists estimated that about a third of the future cancers will occur in people who were between the ages of 35 and 54 when they received their CT, and 15% of them will develop in people who were children or teens when the scan was performed.

About two-thirds of the new cancers will develop in women, since they are more vulnerable to radiation.

“There is a significant amount of radiation with these CT scans, more than what we thought, and there is a significant number of cancers,” Rita Redberg, the editor of the Archives of Internal Medicine, told the LA Times.

“While certainly some of the scans are incredibly important and life saving, it is also certain that some of them were not necessary,” Redberg added.

CT scans provide pristine images by combining data from multiple x-ray images. They can also expose patients to up to 400 times more DNA-damaging radiation than conventional chest x-rays. 

In another study, Rebecca Smith-Bindman and colleagues from UCSF found that radiation exposure varies almost 13-fold for different kinds of CT studies, from about 2 millisieverts for a routine head CT scan to 31 millisieverts for a scan of the abdomen and pelvis.

The average American receives about 3 millisieverts of radiation per year, a level not considered to be a health risk.

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DTC Advertising and Drug Costs

December 24th, 2009 | No Comments | Source: Archives Int. Medicine, BurrillReport

Most people have assumed that direct-to-consumer advertising has helped drive up the cost of drugs, but there really hadn’t been much proof of that. Until now, that is.

Plavix DTC Advertising and Drug CostsThe proof comes in the form of a study published in the Archives of Internal Medicine.

In the study, Michael Law of the University of British Columbia and others looked at US sales of Plavix, the $4 billion clot-busting blockbuster co-marketed by BMS and Sanofi-Aventis for the prevention of recurrent heart attacks and strokes, and thrombotic complications following stent placement.

Plavix was introduced to the US market in 1998. DTC advertising for the drug began 3 years later, and exceeded $350 million dollars over the next 4 years.

Law’s group queried pharmacy data from 27 Medicaid programs from 1999 through 2005 to analyze changes in Plavix prescription volume, the cost per unit dispensed, and total pharmacy expenditures before and after DTC advertising was introduced.

gettingbettereveryday 150x112 DTC Advertising and Drug CostsThe scientists detected no change in the preexisting trend in the number of Plavix prescriptions written after DTC advertising was introduced.

They did, however, detect a sudden, sustained increase in cost per unit of the drug, of $0.40 per unit dispensed which coincided with the introduction of DTC advertising.

This resulted in an incremental cost of $40.58 per 1000 Medicaid enrollees per quarter, or an additional $207 million in total pharmacy expenditures.

“The key issue is whether advertising to consumers, which has risen 330% in the last 10 years in the US, contributes to the significant cost increases in publicly funded health insurance programs such as Medicaid,” Stephen Soumerai told BurrillReport.

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Dead Meat

April 10th, 2009 | No Comments | Source: Archives Int. Medicine, BBC, Washington Post

A study from the National Cancer Institute has shown that excessive consumption of red meat, processed meat and pork increases all-cause mortality.

Rashmi Sinha and colleagues published the bad news in the Archives of Internal Medicine.

The scientists reviewed data from 545,653 adult volunteers who participated in the NIH-AARP Diet and Health Study. Participants completed dietary questionnaires and were followed for 10 years.

After controlling for confounding variables, the scientists found that the most carnivorous women, who were good for a quarter-pound of red meat per day, were 36% percent more likely to die for any reason, 50% more likely to die of cardiac disease and 20% more likely to die of cancer.

It was about the same for men.

Heavy consumption of sausage, cold cuts and other processed meat resulted in the same fate, whereas big-time consumers of fish and white meat died off 8% less frequently than those who rarely ate them.

Previous studies had identified an association between red meat consumption and a higher risk of cardiac disease and colorectal cancer, but this one was the first to reveal a link to all cause mortality.

“The uniqueness of this study is its size and length of follow-up,” Barry Popkin told the Washington Post. The professor of nutrition at UNC added “if people want to be healthy and live longer, consume less red and processed meat.’”

The rap sheet on red meat is longer than Blagojevich’s. Cooking it generates carcinogens. It’s laced with saturated fat, which is linked to colorectal and breast cancer. It’s high in iron, another cancer promoter. It jacks up blood pressure and cholesterol, and so forth. 

For their part, processed meats contain carcinogenic nitrosamines, and pork bumps up cancer risk too, probably because it contains iron.

youcantbeserious 300x200 Dead MeatThe American Meat Institute blew off the findings.

“Meat products are part of a healthy, balanced diet,” James Hodges, the group’s EVP told the Washington Post.

“Studies show they provide a sense of satisfaction and fullness that can help with weight control. Proper body weight contributes to good health overall.”

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Time for the Big Easy

March 20th, 2009 | No Comments | Source: Archives Int. Medicine, MedPageToday

thisgoeswhere1 Time for the Big EasyThat Canadian study showing colonoscopy screening wasn’t as effective as first thought caused quite a dust up around the New Year, but consensus remains strong that the Big Easy is a life-saver and people need to get it done.

Yet only 60% of eligible patients report being up-to-date with the test and harried physicians often don’t have the time to discuss preventive services with their patients.

Which is why the results of a trial of a decidedly low-tech reminder system are so heartening.

timeforthebigeasy 245x300 Time for the Big EasyThomas Sequist and colleagues from the Brigham implemented a randomized trial of mailed reminders to patients and lo and behold, they actually improved colonoscopy utilization!

The scientists enrolled 21,860 patients between the ages 50-80 from 11 clinics during 2006-2007. All patients were overdue for the ‘scope.

Subjects either received nothing or a mailing that contained an educational pamphlet, a fecal occult blood testing pad, and instructions for scheduling a colonoscopy.

The scientists also sent electronic reminders to the patients’ primary care physicians.

Among patients who received the mailed reminders, 44% got it done. The number was 38% in the control group.

Reminders were increasingly effective as subjects got older, with the difference favoring the reminded group rising from 3.7% for ages 50 to 59 to 10.1% for ages 70 to 80.

The study is in the Archives of Internal Medicine.

ifoneworksdoes20workbetter 114x150 Time for the Big Easy“Our findings underscore that informed patients can play an active role in completing effective preventive services,” the scientists concluded.

Interestingly, the electronic reminders to physicians didn’t boost colonoscopy rates, “in part because over one-third of patients had no visits with their primary care physician during the 15-month study period,” the scientists reported.

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Bag the Multivitamins

February 27th, 2009 | No Comments | Source: Archives Int. Medicine, Wall Street Journal

The millions of postmenopausal women who use multivitamins in the belief they prevent cancer, cardiovascular disease and premature mortality can forget about it, according to Marian Neuhouser and colleagues at Seattle’s Fred Hutchinson Cancer Research Center.

moneyspentonvitamins1 254x300 Bag the MultivitaminsThey don’t do any such thing.

To reach this conclusion, the scientists examined data from 161,808 participants in Women’s Health Initiative, an observational trial that enrolled women between 1993 and 1998 and tracked them through 2005.

The findings appear in the Archives of Internal Medicine.

Nearly 42% of women in the study took multivitamins.

During the observation period, there were 9,865 deaths, 8,751 cardiovascular events and 9,619 cases of bladder, breast, colon, endometrial, kidney, lung, ovarian or stomach cancer.

The multivitamin poppers tended to be more physically active, more likely to consume alcohol, more likely to be white and less likely to smoke than nonvitamin poppers.

After controlling for these factors, the scientists observed no difference in disease outcomes between the 2 groups.

lifesavers 100x150 Bag the Multivitamins“Multivitamin use does not confer meaningful benefit or harm in relation to cancer or cardiovascular disease risk in postmenopausal women,” they concluded.

It’s still possible that vitamins and other nutrients obtained from whole foods do impact survival, however.

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