Two years ago, we were all rather shocked when the COX-2 specific drug rofecoxib was accused of increasing cardiovascular risk. There has been a flurry of reviews and meta-analyses since then, to which this study (MEDAL) comes as an afterword, confirming what we already know. more…

This paper consists of subgroup analyses from ALLHAT, trying to work out how it is that some blood pressure lowering agents—notably the thiazide diuretics—increase blood sugar but still appear to protect against cardiovascular events. The conclusion is worth pondering on: “Fasting glucose levels increase in older adults with hypertension regardless of treatment type. For those taking chlortalidone vs other medications, the risk of developing fasting glucose levels above 6.9 mmol/L is modestly greater, but there is no conclusive or consistent evidence that this diuretic-associated increase in diabetes risk increases the risk of clinical events.

“If history has taught us anything, it’s that Internet business models are like buses: If you miss one, all you have to do is wait a little while another one will come along.” Steve Krug, Don’t Make Me Think

On the basis of recent mega-deals (Rupert Murdoch’s $580m for MySpace, Google’s $1.65bn for YouTube) it seems reasonable to conclude that the targetted marketing of products to end users is the favoured internet business model of the moment. In these transactions, advertisers pay; end users don’t. more…

As many people get older, they become fatter and their blood pressure rises. Some become diabetic. To maintain cardiac output, heart myocytes hypertrophy and stay hypertrophied over long periods, causing some of them to die early (apoptosis), and giving rise in the long term to a stiff left ventricle. more…

Is it time that we had another go at eliminating malaria from the world? According to Nicholas White, prof at Bangkok, we already have the necessary tools and do not need to wait for a vaccine. “We can do it now, and it won’t cost that much.

Most of us are willing to concede, with varying degrees of regret, that civilised nations need standing armies, and that for these to be effective, soldiers need to be trained to kill and to withstand the brutality of battle. We have come a long way from the attitudes towards mental collapse in battle crudely depicted in Pat Barker’s Regeneration, but psychological morbidity in soldiers after combat is still common. more…

from Auguries of Innocence

A truth that’s told with bad intent

Beats all the lies you can invent.

What is the equation used to calculate the cardiovascular mortality burden in populations due to higher-than-optimum blood glucose? Pencils at the ready: you have thirty minutes. Or you may prefer to read this paper, which estimates that cardiovascular deaths associated with mildly elevated blood sugar are about twice those associated with diabetes. more…

As I approach the threshold of old age, I wonder whether I will accept the process of crumbling with good grace, or discover that I have a strong desire to postpone death. I suspect that like most people I won’t be consistent and won’t want to discuss the matter. This is a dilemma raised by this study, one of several dozen already this year to bear the name of Harlan Krumholz. more…

I write on Nov 11^th, when we remember the dead of all wars, but especially those of the Great War, which ended with an armistice on this date, allowing the world to prepare for newer and greater brutalities. A quarter of those sent out from Britain lay dead. Nobody who took part was unmarked. more…