Sunday, February 12, 2006

Medical Miscellanea

From Medscape news (free registration required), we learn that
Sustained-Release Naltrexone May Be Safe, Effective for Opioid Dependence: (0.25 CME) Feb. 10, 2006 — A 30-day sustained release depot formulation of naltrexone was safe and effective for the treatment of opioid dependence, according to the results of a randomized, double-blind study reported in the February issue of the Archives of General Psychiatry. [...]
Needless to say, we can infer from this that the company that makes the stuff will have it on the market soon.  I could not find any evidence of "commercial bias" in the report, but it bugs me a little bit that they would use the CME system to advertise their product.  The only caveat I would express about this, is that it is entirely possible for a drug to have a statistically significant effect in a study, but have very limited use in actual practice.  Having said that, it can't be any worse that injecting heroin bought off the street, so if it might help even a little bit, it is worth something.
Vardenafil Improves Erectile Function in Depressed Men: NEW YORK (Reuters Health) Feb 10 - Vardenafil improves erectile function and depression in men with both disorders, according to a report in the January American Journal of Psychiatry.

Although depression is common among men with erectile dysfunction, the authors explain, previous studies have not investigated the potential mental health benefits of phosphodiesterase inhibitor therapy in men with erectile dysfunction. [...]

Depression scores improved significantly during treatment with vardenafil, the researchers note, and significantly more patients treated with vardenafil (58%) experienced a remission of depressive symptoms than did patients treated with placebo (32%). [...]

Huffington Post actually picked up on this one, referring to vardenafil by its brand name, Levitra.  Levitra is similar to Viagra, in that it alleviates erectile dysfunction.  The mechanism by which it might help depression is not known.  I would add that this hardly amounts to a confirmation of a true antidepressant effect, but it is interesting to speculate about it.  
Depression Therapy in Elderly Diabetics Reduces Medical Care Costs: NEW YORK (Reuters Health) Feb 10 - Improved care of depression in elderly diabetics provides benefits at no greater cost than usual care, researchers report in the February issue of Diabetes Care.

"Our study shows that depression can be effectively treated in patients with diabetes and the costs associated with improving depression outcomes were offset by savings in medical costs," lead investigator Dr. Wayne Katon told Reuters Health.

"We believe," he added, "that cost savings occur because improving depression allows patients to better manage their self-care regimens for diabetes -- taking medication, following diet and exercising."

This is the latest of many articles demonstrating the medical offset effect.  Treatment of mental illness can reduce costs associated with medical illnesses.  This is a fact that seems to be ignored by most insurance and health-policy directors.
Omega-6 Fatty Acids Hasten Growth of Prostate Cancer Cells: NEW YORK (Reuters Health) Feb 10 - Adding arachidonic acid, an omega-6 fatty acid, to culture media causes prostate cancer cells to grow twice as fast as usual, according to a report in the February 1st issue of Cancer Research.

"Investigating the reasons for this rapid growth, we discovered that the omega-6 was turning on a dozen inflammatory genes that are known to be important in cancer," lead author Dr. Millie Hughes-Fulford, from the San Francisco VA Medical Center, said in a statement.

Further analysis indicated that arachidonic acid was activating these genes through a PI3-kinase pathway known to play a key role in the pathogenesis of cancer.

Adding an NSAID or a PI3-kinase inhibitor to the culture media blocked the arachidonic acid-induced proliferation of prostate cancer cells, the findings indicate.

This illustrates one of the reasons that it is important to be cautious in adopting any treatment, whether it is a standard pharmaceutical, or a natural product.  These things can have unanticipated effects. Having said that, the study cited aboove is only suggestive; it does not prove that taking omega-6 supplements would do anything to humans with prostate cancer.  

We already know that a small dose of aspirin can enhance the antiinflammatory effects of fish oil, so it makes sense to take a little bit of aspirin if taking a combined fish oil and omega-6 supplement.