Journals Watch - HPV, IVF and prostate cancer

Too busy to catch up on the research? Let Dr Bryan Palmer guide you through some recent papers.

Vitamins E and C do not prevent prostate cancer JAMA 2009; doi:10.1001/jama.2008.862
Many patients decide that supplements, complementary and alternative medicines are worthwhile.

The Physicians' Health Study II is a randomised, double blind, placebo-controlled trial that ran from 1997 to 2007 and included 14,600 American male doctors.


Prostate cancer: vitamins C and E showed no benefit in decreasing the risk of cancer among men

The objective was to evaluate whether long-term vitamin E or C supplementation decreases risk of prostate and total cancer events among men. The active drugs were 400IU of vitamin E every other day and 500mg of vitamin C daily.

The data showed there was no benefit in preventing prostate cancer or any other form of cancer for either vitamin.

It is doubtful that the study will reduce the amount of vitamin supplements being taken but it provides useful evidence.

Sham acupuncture is better than real for IVF treatment Hum Reprod 2008; doi:10.1093/humrep/den380

Fake acupuncture needles may be better than the real thing when looking at success rates in IVF treatment.

A randomised trial of 370 patients having embryo transfer was carried out in Hong Kong. Each woman received 25 minutes of either real or placebo acupuncture both before and after embryo transfer.

They found that 55 per cent of those treated with blunt, non-penetrating needles achieved pregnancy compared with 44 per cent of those who had real acupuncture.

The authors suggested that pressure points were being triggered or acupuncture adversely affects pregnancy rate.

Beware the octogenarian BMJ 2008; 337: a2,467
This interesting paper is a prospective cohort study looking at the incidence of cardiovascular disease and cancer in advance age. A total of 22,000 male US doctors aged 40-84 who were disease free in 1982 were followed up over 23 years.

They found that the incidence of cardiovascular disease increased after age 80 and often was a cause of death. Cancer rates peaked between ages 80-89 but then declined.

The decrease in incidence of cancer late in life may be due to a decline in cancers usually detected by screening.

The authors concluded that there was a substantial amount of undiagnosed disease in those aged 80 and over.

Hypersensitivity to HPV vaccine is very rare  BMJ 2008; 337: a2,642
This study is a review of hypersensitivity to the quadrivalent HPV vaccine in school girls in Australia.

In Australia all women aged 18-26 have been eligible for free vaccine for about two years and all Year 8 (13-year-old) female students are offered it as part of the school-based vaccination programme.

This was a retrospective cohort study of 35 schoolgirls aged 12-18.9 years with suspected hypersensitivity reactions.

As part of the study they had a clinical evaluation, skin prick testing, intradermal testing and subsequent challenge with the vaccine. Of the 35 cases, 25 agreed to take part and three were found to be truly hypersensitive.

Considering that 380,000 doses had been given, hypersensitivity was a very rare event. Vaccination hysteria is much more common.

Incentives and registered mail boost survey responses Fam Pract 2008 doi:10.1093/fampra/cmn097
Just what sort of carrot do you have to dangle in front of a doctor to get them to complete a survey rather than file it to the waste paper bin?

Primary healthcare researchers often use information gathered through questionnaires to study GPs' attitudes and experiences.

Postal studies are a common form of sampling and achieving maximal responses can be critical to a study's success or failure.

A research team in Canada looked back at postal surveys from 2001 to 2004 to identify which techniques improved response rates.

Without any incentives the response rate was a miserly 48 per cent but if you added a gift certificate that rose to 76 per cent and if sent by registered or recorded delivery they both achieved 74 per cent.

The bottom line is that researchers will have to factor this into their budget or grant requests in the future.

Traditional Chinese medicine for plaque psoriasis Arch Dermatol 2008; 144: 1,457-64
This was a randomised 12-week study of 42 patients with treatment-resistant plaque psoriasis.

The active group received a traditional Chinese ointment-based powder (indigo naturalis ointment), which produced an 81 per cent improvement compared with 26 per cent with non-treated lesions.

The authors concluded that topical indigo naturalis ointment was a safe and effective therapy for plaque-type psoriasis, but that more research was required on what is in the crude extract.

  • Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who regularly review the journals

The quick study

  • Prostate cancer was not prevented with vitamins C and E.
  • Sham acupuncture was more beneficial to women trying to achieve pregnancy through IVF than real acupuncture.
  • Cancer rates peaked in men aged 80-89 but then declined in a study population.
  • Vaccine hypersensitivity was found to be a rare event among schoolgirls who had received the HPV vaccine.
  • Survey response rates were improved when a gift certificate incentive was used.
  • Psoriasis improved when treated with topical indigo naturalis ointment.

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