JAMA 25 Apr 2007

Do we really need a new drug for angina? I think we do, because although we already have a choice of beta-blockers, nitrates, calcium channel blockers and potassium channel activators, there will always be some patients whose angina remains hard to control, and who are not suitable for revascularisation. Ranolazine is a piperazine derivative which does not resemble any existing anti-anginal; it has no effect on pulse or blood pressure but is thought to improve coronary ischaemia by an effect on sodium currents. A previous trial showed that it was safe in chronic stable angina; now another trial (called MERLIN-TIMI 36, would you believe) shows that it is safe in patients with acute ischaemia (non-ST-elevation). But it does not improve outcomes.

Streptococus pneumoniae (pneumococcus) is a funny bug: most of the time it sits around in the nasopharynx minding its own business but now and again it gets invasive. It’s genetically versatile, with over 90 serotypes, yet it has proved mercifully bad at developing antibiotic resistance. But vaccine resistance is another matter. Knock out a mere seven varieties with childhood vaccination – as in Alaska – and other invasive strains of pneumococci will quickly seize the chance to take over.

The team which conducted the AREDS (Age-Related Eye Disease Study) trial of a vitamin-mineral supplement to prevent progression of age-related macular degeneration have now identified two common polymorphisms which confer a high risk of AMD. Rather than saying to these individuals, “Hard luck mate, you’ll go blind in your old age