NEJM 5 July 2007 Vol 357

The success rate of in-vitro fertilisation in women over the age of 35 is about 35% in this Dutch series, provided there is no tinkering with the embryo to remove a cell for preimplantation genetic screening. If this is done, the live birth rate drops to 24%. So it is best not done without some compelling reason.

Did you realise that when you fly in a pressurised aircraft, you experience a rarefaction of atmosphere equivalent to nearly twice the height of Ben Nevis? That’s because cabin pressures are kept lower than ground atmospheric pressure to save on energy and structural stresses. The stress may be transferred to the occupants instead, who can suffer mild discomfort proportionate to their time at reduced pressure, according to this simulation study.

In both meta-analyses and large randomised trials, ripeness is all. If you pluck the raw fruit, you will get indigestion, as the New England Journal continues to demonstrate with rosiglitazone and cardiovascular outcomes. Three weeks ago, a meta-analysis of the published trial data showed that there might be cause for worry, but just failed to reach the one-in-twenty significance upon which the medical world places absolute reliance. Now the investigators of the RECORD study have rushed out an unplanned interim analysis which shows approximately the same, i.e. possible harm, but within over-wide confidence intervals. No fewer than three editorials follow, all of them counselling caution, asking for openness, more data etc. The one definite fact is that rosiglitazone can precipitate heart failure. And whatever it may do to reduce HbA1c, it is very unlikely to reduce any meaningful end-point.

Cutting-edge cancer pharmacology is not something most of us get too involved with, unless perhaps when a patient asks our advice about going into a trial, or one of the drugs becomes a major political issue, like trastuzumab (Herceptin). Trastuzumab targets the HER2 receptor which is over-expressed in 20-30% of invasive breast cancers. But hang on a minute: HER stands for human epidermal growth factor receptor and elsewhere in the cancer literature this is abbreviated to EGFR, as in this weeks’s JAMA. In that paper, HER2 is referred to as ErbB-2. If the oncology anoraks really want us to understand their territory, we need some better signposting. Here Clifford A Hudis attempts to take us on a guided tour of the mechanisms by which trastuzumab inhibits a subset of breast cancer, and concludes that we still don’t know how best to use it.