NEJM -- September 27th,2007

NEJM -- Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years

The NEJM this week carries a report on a cohort study that assessed the impact of thiomersal (a mercury containing preservative in some vaccines) on neuropyschological outcomes in children aged 7 to 10 years. The bottom line of the study is that there is no association between exposure to thiomersal between birth to 7 months of life and neuropsychological functioning. You can read the entire article here.
However, there are certain subtler interpretations that need to be cited from the study. Tics seem to be associated with exposure to thiomersal in patients from one HMO (whether they differ in any way from the rest of the cohort is not addressed) and this replicates studies done earlier in the US and Britain. This is probably something which needs to be looked into for the future.
The excellence of the study lies in their rigorous measurement of exposure to thiomersal, assessment of 42 neuropychological outcomes and measurement of possible confounding factors that may affect developmental status of the child.

If you are treating patients with cardiovascular disease with statins to lower their LDL cholesterol level, HDL cholesterol levels are still a significant inverse, predictor for cardiovascular disease outcomes even in patients with lowered LDL levels. That's the message of this NEJM article, which tried to answer whether lowering levels of LDL cholesterol with statin therapy might cover the risk posed by low levels of HDL cholesterol. The study suggests that HDL by itself is an important factor to control in patients on statins.

You know about HLA matching before transplants, now these researchers believe that antibodies against another set of molecules expressed on endothelial cells are associated with graft rejection. These new molecules are called MICA and because of their absence on PBMC's are not detected during cross-matching tests before transplants.

There is a great perspective article by Dr. Sugarman on the development of a Vaccine Court in the US. This has arisen from the number of claims filed by parents for vaccine-related injuries and autism following vaccination. The article outlines the history of the Vaccine Injury Compensation Program (VICP), which is a federal body set up to protect vaccine manufacturers from vaccine-injury related law suits. The article highlights how little proof is required to prove causation of vaccine related injury.
In the VICP context, proof of causation does not need to be shown to the extent of what some
might call scientific certainty.Rather, it suffices to prove causation according to the civil-law standard of “the preponderance of the evidence,” showing that causation is “more likely than not.”

Another article, which is also a public forum for posting your own view on the issue, is a personal account on the detachment physicians develop during their professional careers and our inability to express emotions of sympathy, compassion and involvement in our patients' lives or deaths. A physicians' life goes on from one case to the next, micromanaging and compartmentalising a patients life into smaller diagnostic or treatment conundrums and more often that not, peer pressure and implied standards of professional demeanour prevent us from vocalising common feelings.