 | What Your Doctor Is Reading | | |
Update From the Medical Journals: August 2007
August 31, 2007  By Mary Pickett, M.D.
Harvard Medical School What's the latest news in the medical journals this month? Find out what your doctor is reading. Most People Fail to Take Prescribed Medicines Regularly In early August, The National Council on Patient Information and Education published a report on their website that detailed how often Americans with chronic illnesses skip their medicines or take them incorrectly. The report included data from surveys done by the World Health Organization, Duke University Medical Center, the National Community Pharmacists Association and others. Only a portion of the problem appears to be related to the cost of medication. The summary report is intended to bring renewed attention to the problem of "non-adherence" (un-reliable pill-taking) — with good reason. Here are a few findings from their report: - In countries like the United States, only about 50% of people with chronic illnesses regularly take their medicines.
- Nearly three out of every four Americans report they don't always take their prescription medicine as directed. Only 43% of people with asthma take their medicines as prescribed.
- Only 51% of people with hypertension take their medication.
- During the first year after a heart attack, 55% of people stop taking prescribed beta-blocker medicine (medicine that protects against heart attack recurrence) soon after they leave the hospital.
- Between 12% and 20% of patients take other people's medicines.
The report makes a number of suggestions for improving pill-taking rates. Most of these strategies focus on making communication between doctors and patients more clear when it comes to instructions and concerns, and educating patients about their health conditions and health risks. Back to top Recurrence of Colon Cancer Is Less Likely With Healthy Diet After Treatment A study in the August 15 issue of the Journal of the American Medical Association (JAMA) gives colon cancer survivors a very good reason to eat a healthy diet: better odds of curing their cancer. Researchers tracked the diets of 1,009 patients who underwent chemotherapy for colon cancer that had spread to their lymph nodes. After following the patients for about five years, researchers found that about half of these individuals had a recurrence of cancer. People who ate a lot of meat, processed carbohydrates (few or no whole grains), french fries, fat and desserts were three times more likely to have their cancer recur than patients who ate a "prudent" diet, which included many fruits and vegetables, poultry and fish. The link between colon cancer and diet is not new. Studies linking red meat and drinking alcohol to colon cancer have come as no surprise to experts. Some blame exposure to carcinogens for the link between diet and new cancers. But carcinogens are probably not the reason that diet affects existing cancers — carcinogens can trigger a cancer, but they can't nourish a cancer. So how could diet influence cancer return rates after treatment? Once a colon cancer exists, and once chemotherapy has been used to eliminate all but a few remaining cancer cells, your immune system and your body's hormones are the most important factors that can prevent "residual" cancer from growing. The foods you eat change the mixture of hormones in your body. Insulin and other hormones that are related to eating, and certain hormone patterns after eating appear to encourage cancer growth. This study can't prove that a healthy diet is what made the difference for these cancer patients, because it only made observations about patients' diets. It was not a "randomized" study, where people are divided into groups and assigned randomly to follow one diet or another. It is possible that some other characteristic of the various diets is what made the difference in cancer recurrence rates. Still, this study offers a good reason for cancer patients to eat a healthy diet. Back to top Obese Friends and Relatives May Make You Fat, Too A lot of experts call obesity an "epidemic," as if to say it's similar to an infection spread by germs. Of course, no one truly believes that obesity is contagious... or is it? A study from the July 26 issue of the New England Journal of Medicine shows that if you spend social time with people who are obese, you are more likely to become obese yourself. This study isn't really about obesity being contagious in the same way that infections are contagious. The study examines the power of friendships and family ties, and how strongly these ties can influence your habits and behavior. Researchers used data from the "Framingham Heart Study," a huge research endeavor that began in 1948 and collected health, diet and fitness information on people who lived in the same community. The study even kept records about the children and grandchildren of the original subjects in addition to close friends. More than 12,000 people in total were part of the study. With the help of a computer they mapped out these social connections, and traced body mass index using more than 30 years of collected data. It was painstaking work, as many of the original charts were handwritten and needed to be manually recorded into the computer database. What does the study show? If a friend becomes obese, you are 57% more likely to become obese than you would have if he or she had stayed at a healthy weight. If your sister, brother, or spouse becomes obese, your risk increases, too. An obese spouse increases your risk of obesity by 40%. If your spouse becomes obese, you're 37% more likely to become obese as well. At first glance, you might think it's only telling us that "birds of a feather flock together." But there's more. The study does not just look at how we choose who's in our network or at the genetic similarities within families. It looks at how we are changed over time by the people closest to us. If you associate with someone, you are more likely to emulate that person's lifestyle — exercise, food choices and portion sizes. But this study is not so much about exposure as it is about influence or peer pressure. In fact, the study found that if a pair of friends both identified each other as a close friend, the two people could affect each other more strongly than they would if the friendship was reported (and valued) by one person, but not reported by the other. You have nearly double the risk if you and a fat friend count each other as close buddies. When we realize the effect of peer pressure, we can have more control over our health habits. This awareness is important for weight control as well. Back to top More News in Brief - Smoking May Lead to Blindness. The July issue of Archives of Ophthalmology includes a study of 2,454 Australians age 49 and older who had a picture of their retinas taken at the beginning of the study and five and ten years later. The photos showed that smokers were four times more likely to develop a very common cause of blindness called macular degeneration, compared with people who had never smoked.
- Proteins in the Skin Appear to Be the Cause of Rosacea. Nature Medicine published research online August 6 that may bring us one step closer to understanding the cause of rosacea, a very common rash in adults that causes reddening of the face and visible small blood vessels on the cheeks and nose. Researchers have shown that people with rosacea have extra amounts of two proteins within the skin: an immune system protein named "cathelicidin" and an enzyme called a "serine protease." It isn't clear whether these proteins are being made in reaction to an infection (such as a mite infection, for which there is some preexisting evidence) or whether they are overproduced for another reason. However, the proteins do seem to be the cause of the rash. With this target in mind, specific medicines may be developed soon to treat this cosmetic condition.
- Marijuana Is Strongly Linked with Later Psychotic Illness. The July 27 issue of Lancet published a review of past studies that assessed the risks of marijuana. The study, called a meta-analysis, combines raw data from previous studies so that a larger number of people and side effects might be considered. The authors wanted to see if marijuana use is associated with later psychiatric illness. They reviewed 4,304 separate published studies and they added together data from 35 studies that related most closely to their question. This study is the most comprehensive meta-analysis ever done on the topic of marijuana. The study found that marijuana use was strongly associated with an increased risk for psychosis (schizophrenia, hallucinations, and related psychiatric problems). Even light use seemed to be linked to increased risk: people who reported "ever" using marijuana were 41% more likely to later develop psychotic symptoms, and people who were regular users were much more likely (50% to 200% more likely, depending upon how the data is analyzed) to have psychosis. Since none of the data came from studies that randomly assigned people to use or avoid marijuana, it does not prove that marijuana use was the cause of the psychiatric problems; it can only show that these two variables are related. To make their results more meaningful, the researchers did not include in the analysis people who showed signs of mental illness before they first smoked marijuana. In the United Kingdom (UK) where this journal is published, marijuana use may have caused as many as 14% of the existing cases of schizophrenia based on this data. Presently, regulators in the UK are considering whether to legally re-categorize marijuana as a more serious and harmful drug.
Back to top Mary Pickett, M.D. is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University. At OHSU, she is a director of student programs and she oversees teaching of students and medical residents. She practices general internal medicine in Portland, Ore.
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