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HRT: The danger drug that wasn't, then was again

WONDER HEART DRUG: No, sorry, it still doesn't work

`BAD' CHILDREN: Try a little kindness and attention (and it does

wonders for hyperactivity, too)

BLOOD THINNERS: Treatment is too long, and dangerous – just as they

pointed out 15 years ago

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HRT: The danger drug that wasn't, then was again

 

 

A week can be a terribly long time in medicine. Take, for example,

the arguments over the safety of hormone replacement therapy (HRT),

designed to ease women through the menopause.

 

Researchers finally cottoned on in 2002 – and years after the fact –

that HRT was dangerous, and that its risks outweighed any benefits.

 

These risks were most famously highlighted in the Women's Health

Initiative Study, which discovered that HRT increased the likelihood

of heart problems by 29 per cent, stroke by 41 per cent, and breast

cancer by 26 per cent. The researchers were so alarmed by their

findings that they stopped the study early.

 

As a result, HRT drug sales plummeted, and companies such as Pfizer

and Wyeth, which both manufacture leading HRT brands, suffered.

Sales of Wyeth's Premarin family of HRT drugs fell sharply from

around $1.25 billion in 2003 to $880 million a year later.

 

Now, for whatever reason, the same research team recently decided to

take a fresh look at its own data – and decided that HRT is good for

you. Yes, they'd got it wrong, silly them. Actually, HRT decreases

the risk of heart disease by 24 per cent, and it didn't increase the

risk of stroke at all.

 

HRT advocates like Dr John Stevenson were incensed. He said the

original findings meant that women were deprived of a great drug, and

so went on to suffer heart attacks and other illnesses that " they

didn't deserve " . Obviously, those who did deserve one got what was

coming.

 

So, cause for much celebrating in the boardrooms of Pfizer and Wyeth –

well, for a week anyway.

 

Then, to spoil the party, a new study, rush released by The Lancet on

the web, has found that HRT is bad for you after all, just as the

original Women's Health Study had found. The Million Women Study has

discovered that the drug causes ovarian cancer, and that at least a

thousand women in the UK alone have died from the disease as a direct

result of using the therapy.

 

Overall, HRT increases the risk of ovarian cancer by 20 per cent, the

researchers found, and a woman who takes HRT has a 63 per cent

greater risk of developing either ovarian, breast or endometrial

cancer.

 

This tallies with the earlier finding that HRT has been directly

responsible for the deaths of 30,000 women in the UK, and around

200,000 in the USA, since the early 1990s.

 

(Sources: Journal of the American Medical Association, 2007; 297:

1465-77 (revised Women's Health study); The Lancet, 19 April 2007,

published online (Million Women study)).

 

 

 

 

 

 

 

 

WONDER HEART DRUG: No, sorry, it still doesn't work

 

 

More bad news for Pfizer, this time for their new wonder heart drug,

which they believed was going to be their biggest seller ever.

 

Torcetrapib is designed to increase levels of `good' HDL cholesterol,

and was supposed to be a novel way of preventing heart attacks and

other cardiovascular problems.

 

But a trial of the drug last year was stopped prematurely when it was

discovered it was actually causing heart disease.

 

Now ultrasound studies have found that the drug doesn't help prevent

coronary atherosclerosis, either.

 

Nobody is quite sure why the theory is failing in practice. Perhaps,

some conjecture, the drug is producing some weird variety of HDL

cholesterol that is malfunctioning.

 

(Source: New England Journal of Medicine, 2007

doi:10.1056/NEJMoa070635).

 

 

 

 

`BAD' CHILDREN: Try a little kindness and attention (and it does

wonders for hyperactivity, too)

 

 

Are we born bad or do we become so? A new study among small children

suggests it's more to do with nurture than nature.

 

A group of socially disadvantaged children in Wales, who were raised

with `positive parenting' techniques – such as consistent praise and

positive role models – displayed less antisocial behaviour than those

who were neglected or abused.

 

Fewer `positive parenting' children were hyperactive or had learning

problems, which are normally remedied with powerful drugs.

 

In all, 153 parents from deprived areas with children aged between

three and five participated. Of those, 104 adopted `positive

parenting' techniques, while the remainder continued with their usual

approach to parenting.

 

(Source: British Medical Journal, 2007; 334: 678-82).

 

 

 

 

 

 

 

BLOOD THINNERS: Treatment is too long, and dangerous – just as they

pointed out 15 years ago

 

 

Doctors still routinely give patients a blood thinner such as

warfarin and heparin for six months to treat deep vein thrombosis

(DVT) or pulmonary embolism – and they could be putting the patient's

life at risk by doing so.

 

Since 1992, recommended treatment time for anticoagulants, or blood

thinners, has been set at three months' maximum, and yet doctors

still regularly prescribe them for a six-month period.

 

The patient gets no benefit from the extended therapy – in fact, he

or she is more likely to die, or suffer a recurrence or hemorrhage,

than if he stopped the drug therapy after the recommended three

months.

 

The difference has been underlined in yet another trial, which tested

the two treatment periods on a group of 749 DVT or pulmonary embolism

patients. After a year, 19 of those who had the six months'

treatment had died, compared with 14 in the three-month trial group,

while 35 suffered some serious reaction from the treatment – usually

a major hemorrhage – after the six months' therapy, as against 31 in

the three months' trial.

 

Not that anticoagulants are especially safe even when given over a

short time. The UK's National Patient Safety Agency has revealed

that, last year, 120 people in the UK died and a further 480

suffered `serious harm' after being given warfarin. These deaths and

reactions were mainly due to doctor error and a failure to monitor

the patient after prescribing a powerful dose of the drug.

 

(Source: British Medical Journal, 2007; 334: 674-7, and 714).

 

 

 

 

 

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