Medical Research: A Satisfying Drink from A Firehose

As a physician, one of the most useful aspects of the internet is the ease with which I can keep up with the latest in medicine. In medical school and throughout my training, I learned that the typical medical textbook (despite its heft) was extremely limited in scope and a full five years behind current medical knowledge. I well remember opening an expensive, brand-new medical text and finding a lengthy chapter on polio even though years earlier the polio vaccine had rendered the illness virtually extinct.

To keep abreast, we were advised to read medical journals. Their reports were, generally speaking, only a year or two behind. Like most physicians, I’ve been a faithful reader of several journals since finishing my residency. By the way, the delay in much of journal information is a product of the editing process. Thousands of research papers are submitted for publication each year and a huge team of specialists (JAMA alone signs up hundreds) pores over the findings before a paper gets a thumbs-up and enters the queue, often itself a year or more long, to appear in print.

For the very, very latest in medicine, a doctor needs to attend medical meetings, and there are literally hundreds worldwide annually. You pick your particular area of practice–internal medicine, say, or cardiology–fly to the city chosen by the professional association that year, check into a hotel, and brace yourself for the onslaught of latest developments. Unfortunately, trying to absorb the blitz of content presented at a medical meeting is like trying to get a satisfying drink from a fire hose. Sometimes literally dozens of papers are presented in a single day. It’s easy to find yourself racing from one conference room to another, hoping you’re not missing some vital event down the hall.

Enter the internet

Several physician-only (sorry) websites offer “Best of the Meetings” newsletters. Equally useful are websites that should be titled “Best of the Medical Journals You’re Never Going to Read Because They’re Too Obscure.”  So let me share some worthy medical news with you. I can’t provide links because these sites require a password and are set for my email address.

From the meeting of American Academy of Neurology held in San Diego last month, researchers presented very strong data showing that the over-the-counter supplement melatonin, dosed at the standard health food store size of 3 mg and taken at 11 pm nightly, dramatically reduced the number of headaches in chronic migraine sufferers. The double-blind study had results not only better than placebo, but also superior to amitriptyline, a common migraine suppressant. There were virtually no side effects with melatonin, and while next-day sleepiness could occur with both, it was much lower in the melatonin group. Also, instead of the weight gain that occurs with amitriptyline, melatonin patients reported modest weight loss. Migraineurs (a wonderful word for people who get migraines) can order melatonin here.

In an online report from the journal Clinical Interventions in Aging, researchers from Italy finally confirmed what health food store clerks have been telling customers for years. The supplement Citicoline does indeed prevent the mild memory loss, called cognitive decline, that occurs with aging. After giving baseline mini-mental status tests to 349 people over age 64, putting half on citicoline and half on placebo, and retesting nine months later, the citicoline group improved, while the placebo group declined. We’ve been offering (and I’ve been taking) citicoline for years. You can order it here.

Doctors can also learn online what supplements patients should not be taking. The issue of calcium supplements and heart disease risk, for example, has been bandied about ever since two reports emerged from Europe last year showing increased cardiovascular risk among women taking calcium supplements. The best guess was that this occurred because the calcium threw off the delicate balance between calcium and magnesium. It was suggested that a combination product would be safer and, in fact, we’ve been encouraging our patients to make this switch.

Nevertheless, women were really nervous about their calcium. An online report (later published in JAMA Internal Medicine) released a National Institutes of Health study that dwarfed the two from Europe. Epidemiologists tracked (ready for this?) 388,229 men and women for 12 years, starting in 1995, to determine if calcium supplements had any effect, positive or negative, with regard to cardiovascular disease. The answer was this: calcium supplements in men increase the risk of death from cardiovascular disease, but the increased risk does not occur in women.

For all my readers and patients who have emailed me this year about whether or not to take a calcium supplement, the answer now depends on several factors:

• Keep in mind that dietary sources of calcium are best (click here for a list) and eat them regularly.
• Next, consider your risks. Did your mother, aunt, or grandmother shrink with age due to osteoporosis (a gradual loss of bone density)? Are you a thin Caucasian of Northern European extraction (at high risk) or a stocky African American (at low risk) or somewhere in between?
• Finally, check (or recheck) your gender. If you’re an at-risk woman, I suggest this supplement formulated by Alan Gaby, MD, author of Preventing and Reversing Osteoporosis.

If you’re guy, the solution is easy: hand your bottle over to your pale skinny wife or girlfriend.

Be well,

David Edelberg, MD