High Quality
Open the downloaded document, and select print from the file menu (PDF reader required).
THE LEADERIN NEWSANDMEETINGCOVERAGE
A
NTIEPILEPTICS TO
C
ARRY
S
UICIDALITY
W
ARNING
,
PAGE
6
Internal Medicine News
Amyloid TheorySputters for AD
BY MICHELE G.SULLIVAN
Mid-Atlantic Bureau
T
he amyloid hypothesisisn’t dead, but it seems to be limping a bit in therace for an Alzheimer’s cure.Some researchers who pre-dicted 5 years ago that an anti-amyloid disease-modifying ther-apy was imminent are nowreevaluating that optimism—in-cluding the geneticist who firstsuggested the pathologic link between amyloid plaque depo-sition and Alzheimer’s disease.“Everything is taking a lotlonger than I thought it would;there’s no question about that,” John Hardy, Ph.D., said in aninterview.In 1991, Dr. Hardy, a professorofneuroscience at UniversityCollege London, postulated that
-amyloid deposition was theroot ofa pathologic cascade thatresulted in Alzheimer’s disease.The concurrent discovery that amutation in the amyloid pre-cursor protein (APP) genecaused early-onset Alzheimer’s,coupled with the association of plaque deposition and early Alzheimer’s in Down syndromepatients, added weight to thetheory (Trends Pharmicol. Sci.1991;12:383-8). A new research boom was born.But the first phase III trials of antiamyloid agents have broughtno good news.Tramiprosate, a
-amyloid an-tagonist, was the disappointmentof2007; tarenflurbil, a gamma-secretase modulator, this year’sdowner. Andpositive findings in bapineuzumab’sphase II trialwere slim. A post hoc analysisshowed that some patients withmild to moderate Alzheimer’s,with no genetic risk factors, hadcognitive improvement after get-ting the vaccine. Apparently, thefinding was enough for ElanPharmaceuticals Inc.and WyethPharmaceuticals,but maybe notfor Dr. Hardy.“The data right now are nei-ther positive nor negative. Atthis point, the only thing we can
BY ROBERT FINN
San Francisco Bureau
S
AN
F
RANCISCO
— Myelo-dysplastic syndrome is far morecommon than previous estimat-ed, and patients with this blooddisorder tend to be older andsicker than the general Medicarepopulation, based on an analysisofclaims by more than 1.7 mil-lion Medicare enrollees.Each year, there are about76,000 new cases ofmyelo-dysplastic syndrome (MDS), ac-cording to the study oftheMedicare Standard Analytic File,a random sampling of5% of Medicare patients. This is abouteightfold greater than previousestimatesbased on the Nation-al Cancer Institute’s Surveil-lance, Epidemiology, and EndResults (SEER) Program, Dr.Stuart L. Goldberg said at theannual meeting ofthe Ameri-can Society ofHematology.The current analysis alsoshowed that during a 3-year fol-low-up, newly diagnosed MDSpatients weremore likely thanthe general Medicare popula-tion to have cardiac complica-tions, dyspnea, diabetes, andkidney complications. These
New WHI data affirm hormonal link.
Breast CancerDecline Linked toHT Cessation
Myelodysplastic Syndrome‘Severely Underestimated’
BY BRUCE JANCIN
Denver Bureau
S
AN
A
NTONIO
— Two newstatistical analyses ofWomen’sHealth Initiative data persua-sively indicate that the recentabrupt decline in breast cancerincidence in the United States isattributable to a dramatic dropin the use ofestrogen-plus-prog-estin menopausal hormonetherapy, and not—as skepticshave argued—to less utilizationofmammography. Academic fencing over causal-ity aside, the practical take-home message from the latestWomen’s Health Initiative(WHI) data analyses is that the breast cancer risk imparted byhormone therapy rises soonerand more steeply than previ-ously recognized, and it swiftlydeclines after HT is discontin-ued, Dr. Rowan T. Chlebowskisaid at the San Antonio BreastCancer Symposium.“The good news for womenhere is that the risk rapidly dis-sipated in just a year or year anda half,” said Dr. Chlebowski, amedical oncologist at the Los Angeles Biomedical ResearchInstitute in Torrance, Calif.The WHI was a very largeNational Institutes ofHealth– sponsored study on the preven-tion ofcardiovascular disease
Dr. Rachelle Doody says the phase II trial of bapineuzumab ‘atleast had some signal’ that the agent is safe and effective.
See
Amyloid
page 20
V
OL
. 42, N
O
. 3
The Leading Independent Newspaper for the Internist—Since 1968
F
EBRUARY
1, 2009
See
Breast Ca
page 2See
Syndrome
page 6
www.internalmedicinenews.com
A
G A P I T O
S
A N C H E Z
J
R
. / B
A Y L O R
C
O L L E G E O F
M
E D I C I N E
Self-Harm
Some abused teens maydeliberately embed foreignobjects into soft tissues.
PAGE 10
Genetics in YourPractice
Dr. Matthew R.G. Taylor looks at genome-wideassociation studies.
PAGE 28
Tea Time
Regular consumption of hibiscus tea may helpcontrol blood pressure.
PAGE 30
ProjectedPayments
Medicare panel suggestsboosting physician feesby 1.1% in 2010.
PAGE 33
INSIDE
Add a Comment