NEJM 19 Oct 2006

I first became aware of dehydroepiandrosterone some years ago when a patient with Addison’s disease asked if I could prescribe it to help her general well-being and libido. Not wishing to deny her these benefits, I read up about it and discovered that it is the most abundant hormone produced by the adrenal cortex but nobody is sure what it is for. And no, it is not prescribable in the UK, though you can buy it from innumerable websites (5 million Google hits) selling the stuff as the elixir of youth. In this trial old people were randomised to DHEA or placebo for two years; some of the men were also randomised to testosterone. Did they leap and rut like young deer? Not a bit of it. DHEA stands for Dreadfully Hyped and Entirely Actionless.

You’ll remember that a trial called SPACE a couple of weeks ago showed that carotid stenting was probably inferior to endarterectomy in patients with moderate to severe carotid stenosis. In this French trial (EVA-3S) the stented group had nearly double the rate of death or further stroke compared with the endarterectomy group. So although the previous editorial was probably right in saying that SPACE is not the final frontier (in the carotid stenting debate), EVA-3S probably is.

Slowly, oh how slowly, we are piecing together what actually makes children wheeze (or “causes childhood asthma