Forget using Ginkgo biloba for dementia.

A recent study found that ginkgo biloba did not improve cognitive function compared to placebo. This was a well-designed, 6 year randomized controlled trial. This proves my usual skepticism for dietary supplements. An interesting study to do would be to compare ginkgo biloba and Forrest's Namenda (memantine), and see how both do against placebo. In the meantime, better going back to using post-its and refrigerator notes.

JAMA. 2008 Nov 19;300(19):2253-62. Ginkgo biloba for prevention of dementia: a randomized controlled trial.

FDA Medical Devices Approval

A recent meta-analysis suggested that FDA-approved high risk medical devices often have lacking support data. Many devices' support data had no randomization, no blinding, no controls, and often based on a single study. Though I have not read the entire article, it should be important to note that "soft" evidence does not mean no evidence. Furthermore, many drugs, such as generics, also go through a relatively simple approval process. For instance, generic drugs' ANDA often only needs BA/BE data, with no efficacy trials. Moreover, the BE data only looks at AUC, no cmax, tmax, or overall PK profile. Despite all this, generics often work as well as the brands! Also, many devices are probably "followup" or "me-too" devices and would not need extensive data for efficacy/safety support. Finally, if regulatory stringency is increased, the cost of development will increase, stifling innovation, driving up healthcare costs.

JAMA. 2009;302(24):2679-2685. Strength of Study Evidence Examined by the FDA in Premarket Approval of Cardiovascular Devices

Antibiotic Resistance

With recent news of highly drug-resistant TB and MRSA, one has to wonder if it's just a matter of time before antibiotics stop working altogether. The obvious solution that most experts agree on is controlling the use of antibiotics. In addition, we would need to come up with newer antibiotics through research and innovation. That is all the more reason there should be increased federal NIH funding for scientific research and decreased corporate taxes in order to stimulate private R&D. With deadly infections on the rise, it is vital that we combat these easily curable conditions.

Reflection on Heme Oncology Rotation

This 6-week rotation from Nov-Dec was very fulfilling. There were ~13 patients to be followed daily. I learned a lot about the various chemotherapy treatments for various kinds of leukemias. Frequently, patients will go through nadir and neutropenia after chemo, which activates a cascade of events/protocols. I’ve also learned a lot about the complications from these chemotherapies. Some patient cases are extremely complicated, which facilitates the learning process. This rotation fit in very nicely with my AML project. Now I have context on how the patients are like and the clinical ramifications of AML. On a more practical level, it was very grueling. It involved near 12-hour shifts daily + 1 day/weekend. On top of this, I was flying around the country for fellowship interviews and applications. It definitely tested my organizational abilities.

Childhood Asthma GWAS

A new study published in the Jan 7th issue of New England Journal of Medicine used an Illumina chip to do a GWAS (genome wide association study) and found a link between some genes and childhood asthma using around 1700 subjects. Huge study with an expensive chip. Study must have been very expensive. The thing I like about these gene chips is that so much data is generated that you can get many papers out of these data. Even though the paper only discussed one gene, they can probably look back and find some other genes to look at later on, and maybe even other diseases if they have the patient's medical records. Wow, it's a gift that keeps on giving :) Though I'm by no means an expert statistician, the association kind of makes me wonder if it's by chance alone. I know the p-value must have been great, but one still wonders...

Sleiman PM, Flory J, Imielinski M, Bradfield JP, Annaiah K, Willis-Owen SA,
Wang K, Rafaels NM, Michel S, Bonnelykke K, Zhang H, Kim CE, Frackelton EC,
Glessner JT, Hou C, Otieno FG, Santa E, Thomas K, Smith RM, Glaberson WR, Garris
M, Chiavacci RM, Beaty TH, Ruczinski I, Orange JM, Allen J, Spergel JM,
Grundmeier R, Mathias RA, Christie JD, von Mutius E, Cookson WO, Kabesch M,
Moffatt MF, Grunstein MM, Barnes KC, Devoto M, Magnusson M, Li H, Grant SF,
Bisgaard H, Hakonarson H. Variants of DENND1B Associated with Asthma in Children.
N Engl J Med. 2009 Dec 23. [Epub ahead of print] PubMed PMID: 20032318.

Breast Cancer Screening

With the recently released breast cancer screening recommendation from the US Preventive Services Task Force (USPSTF) and AHRQ conflicting against those of the American Cancer Society, what is a woman to do? I don't think there is a right answer - there are no tests that is absolutely 100% accurate. There's always a possibility of false (+), and the more people you test, the higher false (+) rate - simple probability. I think each individual is different, so a woman should speak to her doctor about their particular situation and use the recommendations as a guide, not rules to follow blindly.

Healthcare Reform and Medicare Drug Price Negotiation

It's about time that our health care system is being closely examined for inadequacies. Though this process so far has been torturous, with the votes looking non-partisan and strictly along party lines, it is still great news that something is finally being done to take care of the uninsured. It's a relief that medicare drug price negotiations are (largely) off the table. In our great free-market system, price negotiations will not only artificially lower the cost of medication at the expense of shareholder return, it will also stifle innovation that has characterized the drug industry.