This week's journal reviews on Doctors.net.uk
Journal Watch is a service provided to summarise some of the most popular medical journals.
Doctors.net.uk has a panel of specialist advisers responsible for reviewing a range of journals of general medical interest and some more specialised publications.
General Journal Watch is written by Dr Druin Burch, Consultant in Internal Medicine
This week's journals include....
The Lancet:
Ticagrelor for ACS
This study is worth looking at. Suffering an acute coronary syndrome normally wins you clopidogrel; that's been looking for sometime as though it were likely to change. Prasugrel, like clopidogrel, is a pro-drug, but it's converted more efficiently and so you don't have a problem with a third of patients taking a pill that they can't metabolize into an active form. Ticagrelor, the subject of this trial and another new competitor, isn't a pro-drug at all, and it has the potential extra benefit of being reversible. AstraZeneca funded the comparison of ticagrelor with clopidogrel in this double-blind RCT of over thirteen thousand ACS patients. The overall primary outcome was a composite of heart attack, stroke and cardiovascular death. It showed a small but significant drop from 11% to 9%.
Read more...
BMJ:
The risks of treating prostate cancer
Prostate cancers often grow slowly; if you're going to do something about them then you need to be confident it'll do more good than harm. This Australian study found that whatever you do, interventions for localised cancer led to reduced sexual function three years later. Oh, and external beam radiotherapy is bad for the bowels. Quite where this leads us isn't clear, except perhaps into saying that we're not as clear as we should be about how to decide when to leave well alone.
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NEJM:
Erythropoietin and eminence-based medicine
An excellent editorial on the topic of using erythropoietic drugs to raise haemoglobin levels of patients with kidney disease. This is a treatment that's been licensed since 1989 but only actually studied recently - and the studies have shown our practice has been killing people. "It remains to be shown in a controlled trial that assignment to any higher target [of haemoglobin], as compared with any lower target ... prevents cardiovascular events or indeed does not increase their likelihood." The British media are full of details on the Iraq war tribunal, and I'm minded to wonder whether there shouldn't also be a public tribunal to explore how a murderous treatment was accepted and used for twenty years before anyone did a decent study on it.
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