No link between MMR and autism, study finds

Parents may be skeptical when it comes to vaccinations, especially if they already have a child diagnosed with autism spectrum disorder (ASD). A study published in the Journal of the American Medical Association has found no link between the measles-mumps-rubella (MMR) vaccine and increased risk of ASD. The study evaluated the insurance claims of about 96,000 children who received the MMR vaccine and were born between 2001 and 2007. The children included also had an older sibling with or without ASD. From this population, researchers recorded that 1.04% of the children were diagnosed with ASD and 2.01% had an older sibling with ASD. In the group of children whose older siblings were diagnosed with ASD, about 7% had ASD. On the other hand, 0.9% of children whose older siblings did not have ASD were diagnosed with the disorder. Researchers determined that MMR vaccine was not linked to a higher risk of ASD at any age. Furthermore, the children who received one or two doses of MMR vaccine whose older siblings had ASD were not at a higher risk of being diagnosed with ASD. What are your thoughts of this finding? How often do you counsel parents about concerns of vaccinations?

For more information, please see JAMA.

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Discontinuing Statins in Terminally Ill Patients

A new study published in The Journal of the American Medical Association suggests that a class of medications used for high cholesterol known as statins, may be discontinued in patients who are terminally ill and/or approaching the end of life. The multi-centered, randomized clinical trial involved a statin continuation and a discontinuation group. It lasted approximately 2 years and included 381 participants with life expectancies ranging from 1 month to 1 year. The change in 60-day mortality rates between both groups was not significant. Furthermore, in the statin discontinuation group compared to the continuation group, quality-of-life (QOL) was significantly greater and a cost savings of $3.37/year and $716/patient was achieved. Although their findings support the safe discontinuation of statins, the investigators believe additional studies and patient-provider discussions in this regard are needed.  How often do you counsel terminally ill patients?  What are your thoughts about the conclusions of this research?

For more information, please click here.

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Genetic variations may affect association level of aspirin and NSAIDs with colorectal cancer risk

There is evidence supporting the negative association between aspirin/non-steroidal anti-inflammatory drug (NSAID) use and colorectal cancer risk however, a new study suggests genetic differences, particularly two single-nucleotide polymorphisms (SNPs) at chromosomes 12 and 15, play a role in this association. The case-control study recently published in The Journal of the American Medical Association, analyzed data from 5 cohort and 5 case-control studies that started between 1976 and 2003. They exclusively involved participants of European descent and were conducted in the United States, Canada, Australia and Germany. Confirming previous studies, this study observed a reduced risk of colorectal cancer in participants who used aspirin/NSAIDs regularly versus those who did not and a greater risk reduction in those with the aforementioned SNPs. Although the data are not conclusive they may allow for more targeted therapies based on an individual’s genetics in the future. What are some risks associated with aspirin/NSAID use? What other strategies can help reduce colorectal cancer risk?

For more information, please click here.

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Peanuts May Be Good for Your Heart

A recent study published in the Journal of the American Medical Association explored the association of eating nuts (some tree nuts, but mostly peanuts) with mortality/cardiovascular disease among Americans of African and European descent (of low socioeconomic class) as well as Chinese individuals in China. Over 200,000 subjects were followed for a period of up to 12 years. Food frequency questionnaires were given and analyzed for nut consumption during the investigation. The researchers observed a 21% and 17% reduced risk of mortality in the American and Chinese cohorts respectively with statistical significance. Also, a statistically significant inverse association was observed with ischemic heart disease in all study groups while the risk reductions of ischemic stroke and hemorrhagic stroke were significant only in the Chinese sample. This cohort study controlled for numerous factors (e.g., smoking) that could be responsible for these associations. Tree nut and peanut consumption may reduce risk of mortality and cardiovascular morbidity, however, additional studies are needed to validate these findings. What other benefits are associated with eating nuts? What are your favorite nuts to recommend to patients?

For more information, please click here.

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The Little Blue Pill May Boost Risk of Deadly Skin Cancer

A recent preliminary study has found that men taking the popular medication, Viagra, for erectile dysfunction are more likely to develop melanoma than those that did not. Although more information needs to be gathered, it is believed that the medication affects a genetic pathway making melanomas more invasive. It has been suggested that primary care doctors discuss this risk especially with patients that have family history of skin cancers. As the active ingredient sildenfil is in two different formulations (Viagra for ED and Revatio for Pulmonary Arterial Hypertension), do you feel that we now see an increased risk of melanomas in the next generation? What could we try to prevent this from occurring?

For additional information, please see the article in NBC News.

Click on the link for the study in JAMA.

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A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation

The latest Journal of American Medical Association published a longitudinal analysis evaluating the smoking cessation rates in close to 1600 current smokers using electronic cigarettes. The authors stated that the study did not achieve statistical power, but contributed to the building evidence that e-cigarettes do not increase smoking cessation rates, as often suggested by manufacturers. What is your experience with e-cigarettes – personally or with your patients? Would your current recommendations change after reading this survey?

For additional information, please see JAMA.

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A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation

The latest Journal of American Medical Association published a longitudinal analysis evaluating the smoking cessation rates in close to 1600 current smokers using electronic cigarettes. The authors stated that the study did not achieve statistical power, but contributed to the building evidence that e-cigarettes do not increase smoking cessation rates, as often suggested by manufacturers. What is your experience with e-cigarettes – personally or with your patients? Would your current recommendations change after reading this survey?

For additional information, please see JAMA.

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Steep Increase in ADHD Diagnoses

The Journal of American Medical Association published recent findings from the National Survey of Children’s Health.  When the data was compared between 2003 and 2011, a significant increase in diagnosis of Attention Deficit and Hyperactivity Disorder and medication use among children and teenagers were reported.  Some potential reasons include – physicians are more comfortable with the diagnosis and treatment and there is an increased awareness of this condition.  How often do you talk to parents of these patients about potential alternatives for their ADHD medications?

For additional information please see JAMA.

Image courtesy of [stockimages]/ FreeDigitalPhotos.net

Steep Increase in ADHD Diagnoses

The Journal of American Medical Association published recent findings from the National Survey of Children’s Health.  When the data was compared between 2003 and 2011, a significant increase in diagnosis of Attention Deficit and Hyperactivity Disorder and medication use among children and teenagers were reported.  Some potential reasons include – physicians are more comfortable with the diagnosis and treatment and there is an increased awareness of this condition.  Have you noticed increased sales of ADHD medications in the past few years? How often do you counsel pediatric patients about these medications?

For additional information please see JAMA.

Image courtesy of [stockimages]/ FreeDigitalPhotos.net