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....
By their stools ye shall know them
It's impossible not to admire something about this trial and its publication: faecal incontinence is such a miserable and unglamorous condition that there's worthiness to treating and talking about it. Injecting a bulking agent around the anal sphincter, to strengthen it against the life's trials, is one possible mechanism to help. Here it shows promise, and does so in a trial that takes the trouble to compare it to a sham injection rather than a less reliable placebo. My main clinical efforts with faecal incontinence these days come from a different perspective, and I'm proud to share with you, gentle reader, the news that I've returned home from work for 3 days running to find poo has been successfully delivered into our son's bright blue Thomas the Tank Engine potty.
Drug treatment for anxiety
The link between depression and the drugs known as antidepressants is far from clear; there's no known biochemical basis for the former, and a wide variation in action for the latter. The link between these same drugs and anxiety is even murkier and less well studied. The delivery of drugs for anxiety has been driven more by the efforts of drug companies to find new markets than by any theoretical conviction that these drugs treat a biochemical brain disease of which anxiety is the chief symptom. This paper is a systematic overview of the evidence we have. Consider for a moment this sentence, which introduces its main findings: "Though the frequentist analysis was inconclusive because of a high level of uncertainty in effect sizes (based on the relatively small number of comparative trials), the probabilistic analysis, which did not rely on significant outcomes, showed that…" With such an opening, how much faith are you really willing to invest in what it then showed? "Our analysis did not identify a single drug (or class of drugs) that could be considered superior to other drugs … As our primary probabilistic analysis did not rely on significant outcomes, however, the comparative effectiveness of active treatments could still be assessed". It's enough to make you anxious.
Anti-IgE for asthma
Interfering with the development of asthma seems a fundamentally more promising approach than treating its symptoms, although currently we do far better at the latter than the former. The liberal application of muck, parasites and bugs (or a drug which will mimic exposure to them) is probably the Holy Grail, but interfering with a hyperactive immune system after it's already developed may be helpful too. This trial looks at inner-city kids and youths given omalizumab, a monoclonal antibody against IgE. It dropped the number of days they were symptomatic by one per month.
Go to the Journal Watch page
to see all monthly and weekly reviews.