This month, Sydney Spiesel discusses heartening research about statins, disheartening research about vaccinating the elderly for the flu, inhaled insulin, the word from doctors treating Katrina victims, and the plague. (Click here for the August and July roundups.)
Statins revisited: They help after heart attacks, too.
State of the science: Statins, the medications that block the body's production of cholesterol, seem to have no end of valuable properties. Besides their usual job—cutting down coronary artery disease and heart attacks—they also appear to decrease the chance of getting certain kinds of cancer and strokes. Recent research, which examined more than 90,000 U.S. veterans, suggests that elderly patients taking statins are at decreased risk for broken bones. An even more striking finding emerged this month from research involving over 170,000 patients studied immediately after a heart attack. Conducted by Gregg C. Fonarow of UCLA's Division of Cardiology and his colleagues, the study makes a strong case that early use of statins following a heart attack substantially decreases the risk of death or serious complications.
Question: Interestingly, we really have no idea why these beneficial effects occur. The studies that uncovered them were following up on incidental observations in other studies or on rabbit and rat experiments that showed similar protections for animals at risk for heart attacks.
The flu vaccine: Not so good for the elderly.
State of the Science: The most recent outbreak of the avian flu (H5N1) in Indonesia has probably involved over 40 people, of whom six have died. Out of the six, perhaps two or three acquired the disease from infected people rather than birds. Sooner or later, it is likely that this virus will acquire the ability to infect human beings more efficiently. We need a vaccine. There's a problem, though: Recent research by Lone Simonsen and his colleagues at the National Institute of Allergy and Infectious Diseases casts some doubt on the protection that the current influenza vaccine gives to the elderly, who are most at risk of a bad outcome from flu.
Simonsen's group looked at mortality trends that could be attributed to an exceptionally virulent strain of human flu (H3N2) that emerged in 1968. If immunization helps prevent serious disease in elderly people infected with influenza, then the flu death rate should fall as the percentage of older people who are immunized rises. Simonsen's complex statistical modeling boils down to this finding: Even though immunization rates increased from 15 percent to 65 percent during the period under study, there was no substantial effect on influenza-related mortality.
Caveat: The authors of this study are careful to point out that their results are somewhat at odds with some earlier studies, which suggested greater value for elderly people who are immunized. As a doctor, I don't want to risk carrying flu to my patients, and I'm in the age range for which this shot has traditionally been recommended. So despite the serious questions raised by this study, I'm sure I will yet again take my flu shot this year. But it will not surprise me if future research shows that older people need a different vaccine than young adults—perhaps a more concentrated one.
Inhaled insulin: No more shots?
State of the Science: As all science-minded schoolchildren should know, in 1921 the Canadian scientists Frederick Banting, Charles Best, J.J.R. MacLeod, and J.B. Collip developed insulin, the first treatment for diabetes. Insulin was a miracle drug, capable of transforming an almost uniformly fatal disease into a survivable illness with good quality of life. But as any diabetic will tell you, its failing is that it must be injected. Other methods of giving insulin—oral administration, nasal sprays, others—have been tried, but none have worked.
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