NEJM 8 Feb 2007

Polycystic ovary syndrome is a frustrating diagnosis for doctors and patients, as a case discussion in this week’s JAMA illustrates: if you don’t want a pregnancy, go on the pill and try to lose some weight. But if you do want a baby, should you take metformin, clomifene or both? Just take some clomifene, is the message of this three-way randomised study, which did not include a placebo-only arm: metformin may help you ovulate, but it will not help you get a successful pregnancy, say the authors.

For several years now, the journals (especially the New England) have been full of papers about new monoclonal antibodies to various bits of various inflammatory pathways. Some of these have proved their value in treating chronic inflammatory diseases of unknown aetiology, such as Crohn’s disease or rheumatoid arthritis, but worrying short- and long-term hazards have also emerged. Psoriasis is another example: it can be disabling and disfiguring, and this trial of blocking interleukin-12/13 clears it up by 75% in most people after just a dose or two. But if in time it allows some nasty dormant virus to become active, or carries a risk of some rare cancer, the price may prove to have been too high.

The classic “incidentaloma