NEJM 19 Jul 2007 Vol 35

A big international trial gives a nice clear answer to an important clinical question: might patients with peripheral vascular disease do better taking warfarin as well as an antiplatelet agent? The answer, to the relief of all phlebotomists, is no. The patients on combined treatment had more bleeds for no extra benefit. The methodology of the study fell short of ideal – open label, and allowing a number of different drugs according to local preference, but I think we can accept its conclusion.

Certolizumab pegol is a pegylated humanized Fab’ fragment with a high binding affinity for tumour necrosis factor alpha that does not induce apoptosis of T cells or monocytes.” the NEJM informs its readers. Let me explain as best I can. Mab is a monoclonal antibody and pegol is polyethylene glycol, a neutral chemical which renders complex molecules soluble in various liquids including water. Fab’ is the fragment of an antibody which doesn’t kill T cells and monocytes (which is done by the Fc fragment). What we are looking at then is an agent which might induce remission in Crohn’s disease (and other inflammatory diseases in which TNF-alpha plays a harmful role) without causing some of the problems associated with a non-specific anti-TNF antibody like infliximab. Thank you for your attention. But I’m afraid that I’m leading up to telling you that the stuff is no miracle cure: it produces a modest improvement in remission and the treated group had more infections than the placebo group. Those who respond need to keep up the treatment to remain in remission.

You are vitamin D deficient, very probably, and this is making your muscles ache, slowing you brain, thinning your bones and making you more likely to get cancer and heart disease. The secret of the Mediterranean is not its food but its sunshine. Or both. Go on, take your clothes off, get outside, and eat lots of oily fish, cheese, wild fungi and eggs. Abandon your miserable existence in the dark North and start living before it is too late. Alternatively, get a sunbed and take large daily supplements of vitamin D. It’s the elixir of life, according to this very thorough and plausible review.