Tuesday, July 24, 2007


It would be very encouraging to those who like a gin and tonic if so. "Tonic" is quinine water. From the research below, it seems that a quinine derivative is beneficial in some cases. Popular summary below followed by journal abstract. It must be noted that the population studied was NOT a general population sample -- so no generalization is possible without further research

Drugs that protect against malaria may also prevent diabetes in patients with rheumatoid arthritis, claims a study in the latest issue of the Journal of the American Medical Association. The anti-malarial drug hydroxychloroquine has long been a safe and inexpensive treatment for joint inflammation in rheumatoid arthritis. The study included 4905 adults with rheumatoid arthritis - 1808 had taken hydroxychloroquine and 3097 had never taken the drug. None of the patients showed any diabetes symptoms at the start of the study, and they were followed for an average of 21.5 years. During this time, diabetes was diagnosed in 54 patients who had taken hydroxychloroquine and in 171 patients who had never taken it. Those who had taken hydroxychloroquine for any length of time had a 38 per cent lower risk of developing diabetes compared with those who had not. Patients who took hydroxychloroquine for more than four years had a 77 per cent lower risk of diabetes compared with those who had never taken the drug.



Hydroxychloroquine and Risk of Diabetes in Patients With Rheumatoid Arthritis

By Mary Chester M. Wasko et al.

Context: Hydroxychloroquine, a commonly used antirheumatic medication, has hypoglycemic effects and may reduce the risk of diabetes mellitus.

Objective: To determine the association between hydroxychloroquine use and the incidence of self-reported diabetes in a cohort of patients with rheumatoid arthritis.

Design, Setting, and Patients: A prospective, multicenter observational study of 4905 adults with rheumatoid arthritis (1808 had taken hydroxychloroquine and 3097 had never taken hydroxychloroquine) and no diagnosis or treatment for diabetes in outpatient university-based and community-based rheumatology practices with 21.5 years of follow-up (January 1983 through July 2004).

Main Outcome Measures: Diabetes by self-report of diagnosis or hypoglycemic medication use.

Results: During the observation period, incident diabetes was reported by 54 patients who had taken hydroxychloroquine and by 171 patients who had never taken hydroxychloroquine, with incidence rates of 5.2 per 1000 patient-years of observation compared with 8.9 per 1000 patient-years of observation, respectively (P < .001). In time-varying multivariable analysis with adjustments for possible confounding factors, the hazard ratio for incident diabetes among patients who had taken hydroxychloroquine was 0.62 (95% confidence interval, 0.42-0.92) compared with those who had not taken hydroxychloroquine. In Poisson regression, the risk of incident diabetes was significantly reduced with increased duration of hydroxychloroquine use (P < .001 for trend); among those taking hydroxychloroquine for more than 4 years (n = 384), the adjusted relative risk of developing diabetes was 0.23 (95% confidence interval, 0.11-0.50; P < .001), compared with those who had not taken hydroxychloroquine.

Conclusion: Among patients with rheumatoid arthritis, use of hydroxychloroquine is associated with a reduced risk of diabetes.

JAMA. 2007;298:187-193


There seems to be a determination to find something wrong with HRT but the scares about heart disease and cancer have proved poorly founded. So let's take a look at dementia. The study reported below is one of the "panic" studies but the key point to note, however, is the usual one in this field -- that only a tiny percentage (one fifth of one percent) of the HRT takers got Alzheimers. So even if the relationship is causative it is a very low risk as medical risks go -- rather less than the risk of getting a superbug infection in a British public hospital, for instance. Women who take some "herbal" remedies probably undertake much greater risks. It should also be noted that findings concerning women who go straight on to HRT after menopause and those who go on to it much later do seem to differ and it is the late adopters who are concerned below.

Hormone therapy doubled the risk of Alzheimer's disease and other types of dementia in women who began the treatment at age 65 or older, a large study has found. The finding disappointed many researchers and doctors, who had hoped for the opposite result: that hormone therapy would prevent Alzheimer's disease. "No one anticipated this outcome," said Dr. Marilyn Albert, a professor of neurology at Johns Hopkins, in a statement issued by the Alzheimer's Association.

The new report on dementia, being published today in The Journal of the American Medical Association, is one more piece of bad news about hormone therapy. Indeed, it is the latest in a string of studies showing that purported benefits do not exist and that the hormones actually raise the risk of several serious diseases, including some they were thought to prevent.

The latest finding is based on a four-year experiment involving 4,532 women at 39 medical centers. Half took placebos, and half took Prempro, a combination of estrogen and progestin, the most widely prescribed type of hormone therapy. In four years, there were 40 cases of dementia in the hormone group, and 21 in the placebo group. Translated to an annual rate for a larger population, the results mean that for every 10,000 women 65 and older who take hormones, there will be 45 cases of dementia a year, with 23 of them attributable to the hormones.

"The clear message is that there's no reason for older women to be taking combination hormone therapy," said Dr. Sally A. Shumaker, the director of the study and a professor of public health sciences at Wake Forest University, in Winston-Salem, N.C. Researchers said the risk to individual women was slight, and that even though the numbers worked out to a doubling of the risk, 23 cases for every 10,000 women should not be cause for alarm. "A small number doubled is still a small number," said Dr. Samuel E. Gandy, vice chairman of the medical and scientific advisory council of the Alzheimer's Association, and director of the Farber Institute of Neurosciences at Thomas Jefferson University in Philadelphia.

Still, Dr. Shumaker said, women 65 and older who are taking Prempro or other hormone combinations should discuss why they are taking the drugs with their doctors and decide whether to quit.

Because the women in the study were 65 or older, it is not known whether the findings apply to younger postmenopausal women. It is not known, either, whether the results apply to women who take other hormone combinations or estrogen alone. Women who take estrogen alone are being studied separately. Estrogen alone can cause cancer of the uterus and so is prescribed only for women who have had hysterectomies. But adding progestin protects the uterus, so women who have not had hysterectomies are given combination treatment.

The report on the study is accompanied in the journal by two other reports that also have unfavorable findings on combined hormone therapy and the brain. One study found that women on the drugs did not perform as well on cognitive tests as women on placebos; the other confirmed previous research showing that the combination therapy increased the risk of stroke.

About 2.7 million American women take combination hormone therapy, including 1.2 million who use Prempro. Wyeth said that the majority of users were 51 to 55 years old, and only 14 percent of all new prescriptions were for women 65 or older. The hormones were never approved to prevent or treat Alzheimer's disease. They are approved by the Food and Drug Administration for only two purposes: to treat menopausal symptoms like hot flashes, night sweats and vaginal irritation; and to prevent the bone-thinning disease osteoporosis. But because the hormones can slightly increase the risk of breast cancer, strokes and heart attacks, the agency recommends that women use the lowest dose for the shortest time possible, and that they consider other treatments to prevent osteoporosis.

Last July, a large federal study of the combination therapy was halted ahead of schedule because the drugs were found to cause a small but significant increase in the risk of invasive breast cancer. That study, the Women's Health Initiative, also found that hormones increased the risks of heart attack and stroke, which they were once thought to prevent. The drugs increased the odds of blood clots as well. The study, which included 16,000 women, was the first and the largest to compare women on hormones with a group taking placebos. Many women gave up hormone therapy after the study came out. Before it was published, about 6 million women were taking combination therapy.

After the disappointing findings, the last great hope for hormone therapy was that it might protect the brain and help prevent Alzheimer's disease. Some women, encouraged by their doctors, clung to that belief and continued taking the drugs despite the negative reports, figuring that the risks would be worthwhile if hormones could offer that protection from dementia. The dementia study is part of the Women's Health Initiative. Dr. Shumaker said it was the most comprehensive and rigorous study to investigate whether combination hormone therapy could prevent Alzheimer's. "Unfortunately, the risks outweigh the benefits," she said. [In her opinion]

The theory that estrogen might prevent Alzheimer's was based on earlier, survey-type studies suggesting that women on hormones had lower rates of dementia than women not on hormones. But those studies were not considered as reliable as the Women's Health Initiative, because they were smaller and did not contain control groups. Evidence also came from studies in test tubes and in laboratory animals showing that estrogen seemed almost to nourish the brain, making new connections sprout in areas that control learning and memory. The new study suggests that what goes on in the body is much more complicated than what happens in laboratory rats and test tubes. Even if hormones have some good effects on brain cells, Dr. Shumaker said, those benefits may be offset by harmful effects.

She said that it was not known how the combination therapy might increase the risk of dementia, but one possibility was that it increased the risk of blood clots and clogged tiny blood vessels in the brain, which might injure brain cells and contribute to Alzheimer's disease and a condition called vascular dementia.

Some researchers have suggested that hormone therapy may help protect the brain if women take it around the time of menopause, when natural hormone levels plummet, instead of waiting until age 65. They think there may be a "critical period" in which hormone therapy can protect brain cells from the sudden withdrawal of hormones and that once the period is over the damage is done and it is too late. But no one knows whether such a period exists, and no studies now under way will answer that question.

Dr. Gandy said that some of the most promising earlier results on hormone therapy and the brain came from studies of estrogen alone, and that the progestin in the combination pills might cancel out estrogen's good effects. He said that another part of the Women's Health Initiative, still in progress, was studying women who take estrogen alone. That study is scheduled to be completed in 2005. "That is the most likely place to show any benefit against Alzheimer's, if indeed one does exist," Dr. Gandy said.

Dr. Wolf Utian, executive director of the North American Menopause Society, agreed that benefits might come from estrogen alone, and suggested that research should be done to find out whether hormone regimens that use lower doses over all and give progestin only on some days of the month might have less of a negative effect than Prempro and other treatments that use progestin every day.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


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