geoffrey modest medical blogs

Clinical trial of 95 pts being treated with 8wk course of antibiotics for  TB  with added high-dose vit  d  (100K units q2wk x 4 wk) vs placebo (see Coussens AK, PNAS. 2012; 109 (38):15449) showed that those on  vitamin   d  had: --faster sputum smear conversion to normal --faster resolution of lymphopenia, monocytosis and high circulating cytokines --decreased antigen-stimulated proinflammatory cytokines, in particular.  Raises issue that some of  TB  mortality during treatment (not found in this small study) is related to an exaggerated immune/inflammatory response.  In this study there seemed to be an improved clinical response and the immune modulation actually decreased cytokines associated with increased inflammation. So, small trial but reinforces positive role of vit  d  in immune function.  However, important to note that no real clinical outcome differences in this study (other than about a...

in the new york times yesterday, there was a good analysis of the " nocebo  effect"--people on placebo in various studies who have significant side-effects. can be up to the 40% range.  an example of a patient who attempted suicide by taking an overdose of meds, which, unbeknownst to him, was placebo -- and his blood pressure dropped!! other studies suggest that when provider describes potential side-effects of a new med, there is a greater likelihood of the patient developing that side-effect.  see: http://www.nytimes.com/2012/ 08/12/opinion/sunday/beware- the- nocebo -effect.html?_r=1 in my practice, i mention common side-effects but more in a dismissive way (like, "although some people may develop some inflammation of the liver when on a statin, it is really unlikely, i have seen it rarely in the many patients i have on statins, and i will monitor you closely just in case"), especially if i think the med in question is really important for the patient. h...

1. looked at 5 trials using aspirin, at least 75mg/d, to decrease vasc events, with 6.5 yrs followup.   Many old studies suggested dec in colon ca with asa or nsaids, most with positive results. This study of 17K pts found 36% dec risk of distant mets overall in pts with cancer, with the vast majority of effect in adenoca -- 48% dec risk of metastases in those with adenoca. Esp effective in those without mets at diagnosis (50% decrease). Essentially all of the graphs show continuing divergence of curves for the first approx 8 years, then plateauing, for lung, bone, brain, and other mets.   The total number of cancers detected and elligible for analysis was 775. (they do not give absolute risk reductions, but to my simplistic analysis, about 5% of pts had cancer, about 50% reduction, so on the order of 2.5% of population with benefit). Those on lower dose aspirin did the best.   For the most common adenocarcinomas (esp those without mets already), the results were cons...