Lancet 14 Jul 2007 Vol 370

The purpose of palliative chemotherapy is to provide the longest period of good quality life to a patient who is likely to die from the disease – in this case colorectal cancer. Is this best done by hammering the cancer as hard as possible with combination chemotherapy from the start, or by using the chemo sequentially? Two trials – CAIRO here and MRC-FOCUS next – come out in favour of the sequential approach, but this is contested at some length in a commentary on p. 105.

In all age groups, but particularly in elderly men (see the Oxford study in this week’s Arch Intern Med p.1373), high levels of HDL-cholesterol are associated with lower rates of cardiovascular disease. But as I have pointed out before, all attempts to reduce cardiovascular disease with drugs which raise “good cholesterol” have failed. Here once again it’s torcetrapib, showing no more benefit in clearing carotid atheroma here than it did in clearing coronary atheroma in the recent study which appeared in the NEJM.

Prescribing for the elderly
is the subject of an experiment in the UK at present, since the government decided to encourage community pharmacists to offer medication reviews to those on multiple drugs. According to this review of various interventions designed to improve prescribing, this is unlikely to help unless the pharmacists have access to the patient’s medical record. But as so often when The Lancet commissions a review of an important common but ill-defined clinical problem, the result is diffuse and inconclusive.