Monday, November 15, 2010

The £2-a-day heart pill that could save thousands of lives a year (?)

A bit of understandable but quite excessive enthusiasm about some very limited findings. The journal article is "Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms". The study was not of a normal population but of people who already had heart disease and who were taking the pill in conjunction with other heart medications. The pill reduced deaths or hospitalizations from 25.9% to 18.3% in the patients concerned. A worthy start but not a lot to write home about for the man in the street.

It's also a pity that the study was terminated early. That was ethically cautious but not very scientific. Trends observed over a short time period often do not persist over a longer period. See one rather spectacular example of that in the sidebar here.

Note also that the hazard ratio (.76) was well below what is acceptable as indicating causation (2.0). Even at this stage then, the finding is a weak basis for public or private policy.

A heart disease pill costing just £2 a day could save tens of thousands of lives a year, scientists claim. The drug promises to revolutionise the treatment of Britain’s biggest killer and prevent many people being admitted to hospital. Eplerenone apparently reduces the risk of death by almost 40 per cent. Patients are also far less likely to need long-term care or need surgery such as bypass operations.

Researchers say their findings have ‘huge public health implications’ and could potentially cut millions from the NHS bill for treatment. Currently, doctors give patients the pill, also known Inspra, only if the standard medications do not work.

Heart disease patients are normally prescribed treatments including aspirin and anticoagulants to prevent the blood clotting, statins to lower cholesterol and beta blockers for high blood pressure.

However, the researchers say that if all heart disease patients were also prescribed the drug it would save millions every year through cost of treatment and loss of earnings.

The daily pill costs between £1.50 and £2 a day. It works by reducing the effects of the potentially harmful hormones cortisol and aldosterone, which are produced excessively in those with heart disease.

The University of Glasgow researchers – in collaboration with doctors from France, the U.S., Sweden and the Netherlands – compared the effects of the drug on almost 3,000 patients over four years. Their study, published in the New England Journal of Medicine, showed that those who took the drug were 37 per cent less likely to die or need hospital treatment.

Researcher Professor John McMurray, from the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, said: ‘This trial will change the way we manage our patients. ‘Everyone with heart failure should be considered for treatment with a drug of this type – it will make patients feel better, stay out of hospital and live longer. ‘Eplerenone is not expensive and there is a related, generic drug, spironolactone, with similar properties, which is likely to have similar effects. ‘This type of treatment should be available and affordable across the globe. ‘Our trial has huge public health implications.’


Cancer myths

It's no wonder young people believe this junk. Most of it has appeared in medical journals

Some young people believe toilet seats can give you cancer and only fat people get the disease, a UK poll has found.

Other myths include being able to catch cancer from kissing, a kick in the genitals causing the disease and eating coloured jelly sweets increasing the risk.

Living near electricity pylons and keeping a mobile phone in your bra are also exposed in the list of common beliefs.

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The poll of 13 to 24-year-olds for the Teenage Cancer Trust comes as data shows the rate at which children are dying from cancer has fallen almost 60 per cent over the last 40 years.

In the late 1960s, around 940 children died from the disease every year but this has dropped to around 290 a year, according to the Cancer Research UK report.

Today's survey of 520 young people revealed the top myth as being everyone is born with the cancer gene (believed by 53 per cent).

Some 37 per cent believe people are never really cured of cancer and 36 per cent think mobile phones cause brain tumours while 35 per cent are worried about electricity pylons.

More than one in 10 (15 per cent) young people believe keeping a mobile phone in your bra causes cancer and 12 per cent think a kick in the genitals causes testicular cancer.

More than one in five (22 per cent) think the colour of your skin determines your cancer risk, 19 per cent think cancer in pregnancy is passed on to the baby and 7 per cent think only fat people get cancer.

Some 8 per cent are worried about eating coloured jellies and 6 per cent believe cancer can be caught from kissing.

Simon Davies, chief executive of Teenage Cancer Trust, said: "Cancer is a complex and frightening disease so it is easy to understand why such strange myths exist.

"Sometimes people are even surprised to hear teenagers get cancer at all. In fact six teenagers and young adults every day hear they have cancer and at Teenage Cancer Trust we work hard to make sure they receive the best possible care and support."

The Cancer Research UK report revealed high survival rates for some particular types of cancer.

Forty years ago, less than 40 per cent of children diagnosed with a lymphoma would survive more than five years but that figure is now almost 90 per cent.

Around 80 per cent of children with leukaemia are now cured through treatment compared to less than 10 per cent in the late 1960s.

The overall death rate for childhood cancer dropped from 73.4 per million children between 1966 and 1970 to 31.9 per million children between 2001 and 2005.

However, five-year survival remains low for some types of cancer, at just 44 per cent for certain types of gliomas, a kind of brain tumour.

Dr Pam Kearns, director of the Cancer Research UK children's cancer trials team, said: "More children are beating cancer thanks to the transformation and improvements of treatments over the last 30 years, with ways of treating the disease offering greater hope to children diagnosed with cancer.

"We need to continue this work so that every child who is diagnosed with cancer has the best possible chance of beating the disease."

In the UK around 1500 children are diagnosed with cancer every year, and leukaemia is the most common childhood cancer.

There are an estimated 26,000 childhood cancer survivors in Britain.


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