(Circulation. 2001;103:e9047.)
© 2001 American Heart Association, Inc.
Cardiovascular News
New Measures Considered to Eliminate "Mad Cow" Disease
Because fears of mad cow disease spread more rapidly than the disease itself, the American Red Cross announced on May 21, 2001, that people who have spent as little as 3 months in Britain or 6 months anywhere in Europe are not eligible to be blood donors. The restrictions are thought to be more strict than those being considered by the US Food and Drug Administration (FDA), according to a report in the May 21, 2001, issue of the Wall Street Journal.
The Red Cross’ rules would also ban donations from anyone who had received a blood transfusion in the United Kingdom. Last year, the FDA decided that anyone who had spent a total of 6 months in Britain between the years 1980 and 1996 could not give blood. The new rules from the Red Cross could decrease the current donor pool by 8% in an era when blood donations are down and shortages of blood are chronic.
European Tests of Using Skeletal Muscle Cells to Replace Heart Muscle Planned
Studies in the Netherlands and France will test an American researcher’s plan to use cells from skeletal muscle to replace damaged myocardium in humans. Safety trials are set to begin soon at the University Hospital Dykzigt in Rotterdam of an approach pioneered in animals by Doris Taylor, PhD, a scientist at Duke University Medical Center. A second study, which is already underway at Hospital Bichat in Paris, uses a different approach to deliver the skeletal muscle cells to the heart.
Dr Taylor’s plan uses muscle cells from the leg that are grown in culture outside the body. The cultured cells are then returned to damaged areas of the heart. In animal studies, the cells have behaved like myocardial cells, and the heart’s function has improved.
"This is the first time we actually have a hope for recovery, not just stabilizing and then managing heart patients," Dr Taylor said. "We might actually be able to regain lost heart function, which would improve the quality and quantity of life. Now, only the sickest heart failure patients get heart transplants. With myoblast therapy, there are no limitations on whose quality and quantity of life can be improved."
Dr Taylor, in a release from her university, said she thinks that someday a patient with a heart attack will appear in the emergency room, where doctors will remove a plug of cells from his or her leg. Those cells will grow in the laboratory for 3 to 4 weeks, allowing doctors time to assess the extent of heart damage. Then, the cells could be infused into the damaged area of the heart with a catheter. She said she hopes her technique will not just stabilize patients who have had heart attacks, but that it will give them hope for a nearly complete recovery.
Study Says Internet Health Information Is Accurate but Incomplete
Most of the health information found on the Internet is accurate, but it often fails to cover key points and is frequently written in complicated language that is incomprehensible to the ordinary patient, said Rand researchers in a report commissioned by the California HealthCare Foundation. The report was published in the May 23/30, 2001 issue of the Journal of the American Medical Association (2001;285:2612–2621).
The Internet is an increasingly important source of health information for American consumers, said the Rand consultants. "Little is known, however, about whether the available material is sufficiently complete and accurate to support consumer decision-making."
The Rand experts performed 3 studies to assess the accessibility of relevant content, the quality of the health information, and the reading grade level of the text for the following 4 conditions: breast cancer, childhood asthma, depression, and obesity. They determined that the search engines "are only moderately efficient" in finding information on a particular condition. One in 5 links identified by 10 English search engines and 1 in 8 links from 4 Spanish search engines led to a Web page containing relevant information. When the researchers considered whether key information was covered, they found that only half of the necessary topics were covered sufficiently. "This deficiency was particularly striking across Spanish-language sites, where more than half of the condition-related topics were not addressed."
"Our results suggest that consumers using the Internet may have a difficult time finding complete and accurate information on a health problem. If people are relying on the Internet to make treatment decisions, including whether to seek care, deficiencies in information could negatively influence consumer decisions," the researchers noted.
They advised further studies. "Research is needed on how the public’s use of the Internet facilitates, complements, and/or complicates patient-physician communication."
Study Challenges Placebo Effect
Danish researchers who evaluated studies of the placebo effect in 114 clinical studies reported in the May 24, 2001, issue of the New England Journal of Medicine that "although placebo had no significant effects on objective or binary outcomes, they had possible small benefits in studies with continuous subjective outcomes and on the treatment of pain. Outside the setting of clinical trials, there is no justification for the use of placebos" (N Engl J Med. 2001;344:1594–1602).
The authors from the University of Copenhagen said they pursued the study because of claims that placebo itself might have a powerful therapeutic effect which could challenge that of drugs and other treatments. Asbjorn Hrobjartsson, MD, and Peter C. Gotzsche, MD, said their study did not detect a difference between the effect of the placebo and the effect of "no treatment" in pooled data from trials with objective outcomes. However, there was a difference in trials with continuous subjective outcomes and in those involving the treatment of pain.
In an accompanying editorial, John C. Bailar III, MD, PhD, of the University of Chicago, wrote, "Overall, the uncompromising condemnation of placebos advocated by Hrobjartsson and Gotzsche seems to me just a bit too sweeping...However I believe there should be a sharp reduction in the prescription of placebos and careful justification for each continued use...At present, I would not want to prescribe or receive a placebo without some reason that was far more specific than weak evidence of some general ‘placebo effect.’"
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