Interesting Articles in Today's NEJM

If you can read only one journal, let it be NEJM. Whatever is there, it will be in the next edition of Harrison's.

There are several interesting articles in today's NEJM:

Statins and the Risk of Colorectal Cancer. Did we find the magic drug?
Statins were associated with a 47 % relative reduction in the risk of colorectal cancer. Statins for reducing the rate of cardiovascular events are the standard of care. How about a statin for everybody over 50? Are we heading towards the Polypill?

Exhaled Nitric Oxide (NO) to Guide Treatment in Asthma
No more painful recollections of wheezing symptoms, inhaler use and PEF recordings. Just check the NO in the exhaled air, and you known where you stand with your asthma control.

Will nitric oxide be for asthma what HbA1c is for diabetes (the best test to monitor the activity of a chronic disease)? The NEJM editor is asking the same question - Targeting Biologic Markers in Asthma -— Is Exhaled Nitric Oxide the Bull's-Eye?

Long-Term Outcomes of CABG versus Stent Implantation
CABG was better. It looks like cardiovascular surgeons will not be without a job in the future after all.

By the way, the NEJM has a very interesting online-only section - Featured Images in Clinical Medicine (free access). Great for rapid review.

4 comments:

  1. truly a mine of good studies this issue. i still have trouble convincing patients to start statins, i think i'll add this benefit to my counseling.

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  2. You can add the additional benefit of decreasing the dementia risk (observational studies only) and the statins begin to look more and more like the proverbial "silver bullet".

    They attack the two most common causes of death: cardiovascular and cancer, plus the greatest scare of old age - dementia.

    Just remember that other drugs were looking promising too (estrogen HRT) before the large RCT were done. And then we had to call all our female patients to stop the "magic estrogen panacea". There was an essay in the Lancet a few years ago in which a doctor shared his strange hobby – to collect pens with the names and logos of drugs withdrawn from the market. Remember these nice Vioxx pens?

    This is the Tamhane's law (named after one of my colleagues): a new study is out and then the doctors run in its direction as fast as they can, prescribing the new drug left and right, Then, several years later, another new study shows no benefit or even harm. Then, the doctors run just as fast in the opposite direction. (Have a mental picture of a flock of sheep).

    We should do something about it.

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  3. NEJM is a must read, but you have to be careful. A cutting-edge journal is also a sword that cuts both ways; a good many studies later turn out to be wrong - this is the price we pay when reporting on cutting-edge research.
    The "cool" study showing that thrombolytics was good for acute pulmonary embolism was deeply flawed, as most are now aware. I think that the purpose of the NEJM is oftentimes to spur further research in that area...

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  4. So very true, see the Tamhane's law above...

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