 | What Your Doctor Is Reading | | |
Update From the Medical Journals: June 2011
June 30, 2011  By Mary Pickett, M.D.
Harvard Medical School What's the latest news in the medical journals this month? Find out what your doctor is reading. Back to top MyPlate Replaces the Food Pyramid A simple plate icon has replaced the food pyramid as the symbol of good nutrition. The U.S. Department of Agriculture (USDA) introduced MyPlate on June 2. The new symbol describes the way your plate should be divided among food groups for healthy eating. There's a new and informative website, ChooseMyPlate.gov, that explains the change and has helpful resources. The USDA created the original Food Guide Pyramid in 1992. MyPyramid was updated in 2005. MyPlate has much clearer — and consumer-friendly — messages. The plate is divided into different colored sections. Each section stands for a major type of food. Fruits and vegetables make up half of the plate. The grains section is a bit larger than one-quarter. Proteins (meats and beans) and dairy take up smaller areas of the total plate and place setting. Fats and desserts do not have separate sections on the plate. Nutrition experts are praising the new symbol because it makes things simple, and it's based on sound nutritional advice backed up by research. Here are the major messages the USDA is sending to consumers with MyPlate: Balancing Calories - Enjoy your food, but eat less.
- Avoid oversized portions.
Foods to Increase - Make half your plate fruits and vegetables.
- Make at least half your grains whole grains.
- Switch to fat-free or low-fat (1%) milk.
Foods to Reduce - Compare sodium in foods like soup, bread, and frozen meals — and choose the foods with lower numbers.
- Drink water instead of sugary drinks.
Back to top Cancer Doctors Cheer Advances in Melanoma Treatment Three new treatments offer hope to people with malignant melanoma. This cancer is difficult to treat if it isn't found early. The first treatment is a vaccine that helps the immune system fight the cancer. It is given to patients who have already been diagnosed with melanoma. Some people want to call this kind of vaccine a "theracine" because it is used for therapy, not for prevention. The vaccine exposes the immune system to a peptide (a portion of a protein) that is also found on the cancer cells. In a study published June 1 in The New England Journal of Medicine, the patients with advanced melanoma who got the vaccine survived for 18 months or longer. By contrast, only half of people with advanced melanoma who did not get the vaccine survived for longer than 11 months. On June 5 The New England Journal of Medicine published studies of two drugs: the experimental drug vemurafenib and the newly-approved drug ipilimumab (Yervoy). These drugs are injected. Each is an antibody-containing serum that helps the immune system fight melanoma cells. Vemurafenib only fights certain types of melanoma. Genetic studies on the cancer cells are required before it can be used. Many melanoma patients appear to improve after treatment with these drugs. Each of these treatments offers hope by slowing melanoma. However, we do not yet know whether any of them can offer long-term survival, even to the people who responded best to them. Back to top More News in Brief - Side Effects Lead to Lower Dose Limits for Simvastatin. On June 8 the U.S. Food and Drug Administration (FDA) flagged a high dose of a common cholesterol drug as dangerous. The FDA asked doctors to restrict use of the 80-milligram dose of simvastatin (Zocor). This dose is commonly prescribed. It issued a consumer update to doctors and consumers. Recent studies have shown this dose frequently leads to muscle pain or damage. Only people who have taken the 80-milligram dose of simvastatin for more than a year without side effects should continue this dose. The FDA recommends that other patients change to a lower dose of simvastatin, or switch to a different drug.
- E. coli Outbreak Unveils a New and Lethal Strain. The deadliest E. Coli outbreak in history infected more than 3,900 people in Europe. It killed at least 48 people before the outbreak began to fade. Most cases occurred in Germany. Contaminated sprouts from a German farm appear to have been the culprit. A review of cases published June 23 in The New England Journal of Medicine showed that kidney failure occurred in 20% of infected patients. This is an unusually high rate of this complication for E. Coli infections. In another study published June 23 in Lancet Infectious Diseases, researchers analyzed the E. Coli responsible for this outbreak. They found it was a new and more dangerous strain than previous strains. This strain produces a toxin. The strain also sticks to the gut lining and irritates the gut in a way that allows a large amount of toxin to be absorbed into the bloodstream. Experts are concerned that this outbreak could be repeated in other areas, and are anxious to quickly learn more about the source and spread of this E. Coli type.
- New Drug Cures Hepatitis C. New drugs can cure hepatitis C infection for most people who have it, according to two studies published June 23 by The New England Journal of Medicine. Interferon (an injectable drug) and ribavirin are currently used to treat hepatitis C. However, not everyone can safely take interferon. It frequently causes bothersome side effects. These older treatments cure less than half of all patients with hepatitis C. The new studies focused on a medicine that gained FDA approval in March. The drug is telaprevir (Incivek). After 24 weeks of treatment with telaprevir, 79% of people who had not received other treatments were cured. The drug also cured 86% of people who had initially responded to older treatments but whose infection had returned. People with hepatitis C who had tried and failed to respond to old treatments — those with a hard-to-treat form of the virus — were cured by the new drug in 32% of cases. These are impressive results. So far, the drug appears to cause few side effects, although rashes and anemia are possible. This drug is similar to another that was approved this year, boceprevir (Victrelis). These new drugs are a huge advance in the care of hepatitis C.
- IUDs and Implants are Named Best Birth Control. The American College of Obstetricians and Gynecologists (ACOG) has named intrauterine devices (IUDs) and contraceptive implants in the arm (Implanon) as the most effective reversible forms of birth control for women. Two forms of IUDs are available: copper (Copper T) and hormonal (Mirena). They are inserted in the uterus and prevent pregnancy for 5 years (hormonal) or 10 years (copper IUD). The contraceptive implant (Implanon) prevents pregnancy for 3 years. The ACOG favors these birth control methods over birth control pills as being the most reliable. Placement of an IUD or contraceptive implant is expensive, so these treatments may not be as practical as other birth control methods for women who do not have insurance that will cover the procedures. The ACOG's statement was released June 20, and appears in the July issue of Obstetrics & Gynecology.
Back to top Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.
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