JAMA 18 Jul 2007 Vol 298

This trial prejudged its outcome by calling itself the Women’s Healthy Eating and Living (WHEL) study; it was based on the supposition that a diet very high in vegetables, fruit, and fibre and low in fat might reduce cancer-related events and mortality in women with breast cancer. It did no such thing. History should teach us to be very wary of any fad diet for the treatment of cancer, even one we consider to be “healthy”.

We’re sending off more blood for fasting lipid profiles than ever before, but what are we supposed to do if they come back showing raised triglycerides? I tend to ignore them except as a warning of possible insulin resistance. And that’s probably correct, because fasting TG levels predict little, whereas nonfasting triglycerides are independently predictive of myocardial infarction, ischaemic heart disease and death in both men and women. This observation comes from a  Danish cohort study which ran from 1976/8 up to 2004; confirmatory data for women are available from the larger but shorter Women’s Health Study in the USA (median follow-up 11.4 years). So we really need to measure the fasting sugar and cholesterol and the non-fasting triglycerides in all our at-risk middle-aged patients.

Electroconvulsive therapy is a crude treatment which has had a bad press, despite the efforts of The Journal of ECT (formerly Convulsive Therapy) to galvanise us in its favour. Images from One Flew Over the Cuckoo’s Nest and Janet Frame’s autobiography Angel at my Table haunt the imagination. Here’s a little article which tries to redress the balance by reporting on two recent trials, one in severe depression and the other in psychotic depression. The main thing is that it works – often very well – when all else has failed, and that we now know exactly how much to give and where to put the electrodes so as to balance the best response with the least memory impairment.