Apr 20, 2018

Dry times

The story

We’re aware that with the kind of work you do the occasional beer is therapeutic, but the risks and benefits of moderate alcohol consumption remain a source of debate. This week a whopping meta-analysis weighs in.

The background

Just like when a date goes great and you don’t ever get a call back, it’s hard to put a finger on what’s really going on with alcohol and long-term health. Observational studies like 2014’s INTERHEART linked moderate drinking – 1 drink a day for women and 2 drinks a day for men – to a reduced risk of myocardial infarction, but the data can be hard to trust. A stunning investigation in March found that NIH researchers asked the alcohol industry to fund an 8,000 person RCT designed to find a health benefit for moderate alcohol consumption, making us wonder if alcohol-friendly research is just another form of marketing.

The evidence

An analysis of 600,000 patients in 83 studies looked at how individual drinking patterns affect cardiovascular (CV) outcomes. Alcohol was tied to an increased risk of all-cause mortality, stroke, heart failure, and fatal hypertensive disease in a dose-dependent fashion, with harmful effects seen after just 100 grams (5 - 6 drinks) per week. Alcohol was tied to a mild decrease in risk of myocardial infarction that did not appear to match the excess risk from other CV morbidity. Here are curves showing estimated years of life lost for weekly alcohol consumption.

The takeaway

Alcohol is a tricky subject, and the dust on this topic is unlikely to settle for a long time. This analysis should serve as a caution to doctors promoting alcohol as heart healthy.

Say it on rounds

When you keep your list full to block admissions

Sometimes more is better. Targeted treatments and immunotherapy have revolutionized initial treatment of advanced non-small-cell lung cancer (NSCLC), but chemotherapy remains the upfront treatment for the more than half of patients who don’t qualify based on biomarker testing. In much-anticipated results from KEYNOTE-189, patients with untreated metastatic NSCLC saw increased 1-year survival when treated with chemo and immunotherapy agent pembrolizumab compared to chemo alone, regardless of biomarker status. Upfront immunotherapy is now an option for many more patients.

When the caffeine headache hits 2 days into your vacation

Like your subtle-but-real coffee addiction, patients taking aspirin and NSAIDs face a smoldering risk of GI bleed from impaired platelet function. An on-treatment re-analysis of the 24,000-patient PRECISION trial found that for patients on aspirin, use of celecoxib for arthritis was associated with fewer cardiovascular events and a better GI safety profile than ibuprofen or naproxen. The original trial had high crossover between treatment arms, and the authors argue that the on-treatment analysis better evaluates safety endpoints.

When you fit a full weekend getaway into your one day off

You have to work with what you have. Due to overdoses from the opioid epidemic, available transplant organs have risen by 17% since 2000. A prospective cohort study of 7,300 overdose-death donors (ODD) and 20,000 ODD transplants found similar 5-year patient survival for ODD organ recipients compared with trauma-death donor recipients and medical-death donor recipients, despite concerns about increased infectious risk from hepatitis C in ODD organs. Even with the newly available organs, transplant lists continue to grow.

Brush up

Hidradenitis suppurtiva

Will you ever feel comfortable with rashes and skin stuff? That's not really for us to say, but hidradenitis suppurtiva (HS) looks like this. Characteristic findings include painful lesions, abscesses, and sinus tracts that form along skin bearing apocrine glands in the axillary, inguinal, and anogenital areas. Obesity, smoking, and family history are the strongest risk factors, and the disease has a point prevalence of up to 4% in young adults. Treatment includes topical or oral antibiotics. Surgical excision is used for advanced wounds.

What's the evidence

For the relationship between HS and other autoimmune disorders? A 2010 pilot study of 160 patients with Crohn's disease found that 17% of participants had HS. The disease has also been linked to rheumatoid arthritis, and immunosuppression with biologic agents like infliximab is often used in cases refractory to antibiotic therapy. 

What your astronomy friends are talking about

Stuck on nightfloat? Take a break from chasing down labs ordered at noon and head to the hospital roof. The Lyrid meteor shower peaks this weekend and will be best seen when the moon sets at 2 AM.

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