Sunday, March 16, 2008

Quick Takes: Things that don't work.

What is often reported in studies is what works. What is often reported in the media are those studies, plus anything about dangerous side effects.
Here are a few recent reports of negative studies, or studies where the treatment was found not to work. These studies are sometimes just as important as positive studies, because patients can avoid unnecessary cost and side effects for treatments that aren't effective.

Sleep-Disordered Breathing in Kids May Recur a Year After Adenotonsillectomy
A study in The American Journal of Respiratory and Critical Care Medicine looked at predictors for failure of adenotonsillectomy for children with sleep disordered breathing. This is one of the most common surgeries for children. The found that the biggest predictors of failing the surgery at one year were obesity as well as African American race. About half the children had sleep disordered breathing at one year, and almost 1/3 who had surgery were actually worse then before the surgery. The authors of the study concluded that closer follow up is needed for these children. I would add that you really need to address the problems of sleep disordered breathing in children first, primarily obesity, before putting them under the knife.

Antibiotics don't work for sinusitis
This study from the Lancet received some press in the media. This was a meta-analysis, a technique where multiple studies are examined together, looking whether common signs and symptoms in patients that have rhinosinusitis could be used by physicians to predict which patients would benefit from antibiotics. The study showed that none of the typical predictors (fever, green nasal discharge, facial pain) predicted which patients got any better from antibiotics. Though this may seem surprising, it shouldn't. Most cases of sinusitis are caused by viruses, which don't respond to antibiotics. In addition to not working, antibiotics cause side effects, cost money, and lead to resistant super-bugs like MRSA that we are starting to see cause serious infections in the community.

Vitamin E and C do not reduce dementia risk
As reported in Reuters and other sources, this study from the Journal of the American Geriatrics Society looked at almost 3,000 seniors without signs of dementia initially and found that the use of supplemental vitamin E and C, alone or in combination, did not reduce risk of Alzheimer's disease or overall dementia after more than 5.5 years.
I am not anti-supplement. Certain supplements (Vitamin D, Calcium) are important and are likely necessary in many patients. However, this does not hold true for many of the supplements and herbal medications that patients take on a regular basis. I have blogged about before, studies have shown that beta carotene, vitamin A, and vitamin E may even increase your risk of death.


Kathy NC said...

My name is Kathy, and I am the primary caregiver for my 79 year old Dad who has Alzheimer's disease and lives with me in North Carolina.

I am writing a daily blog on my Alzheimer's caregiver website that shows the lighter side of caring for someone with dementia.

I have also added over 100 pages of resources for caregivers that I have gathered over the three years Dad has lived here.

Please pass this link along to anyone you feel would enjoy it.


Anonymous said...

For a different spin on the Lancet sinusitis study see a recent entry by Dr.DB of DB's Medical Rant. A poorly done meta-analysis may not be the best guide to therapeutic decisions. If we assume all sinusitis are viral we may well be privileged to see some of the pyogenic complications of sinusitis that our the old timey ENT docs had to try and salvage.