 Hormone-Replacement Debate Continues to Dominate |
by David
Sharp |
|
| WHAT'S
HOT IN MEDICINE |
| Rank |
Paper |
Citations
This Period (Mar-Apr 04) |
Rank
Last Period (Jan-Feb 04) |
| 1 |
J.E. Rossouw, et
al. (Women’s Health Initiat. Invest.), "Risks and benefits
of estrogen plus progestin in healthy postmenopausal women. Principal
results from the Women’s Health Initiative randomized controlled
trial," JAMA-J. Amer. Med. Assoc., 288(3): 321-3, 17 July
2002. [8 U.S. institutions] *573AK |
136 |
1 |
| 2 |
R.
Collins, et al. (Heart Protection Study Collaborative Group), "MRC/BHF
heart protection: Study of cholesterol lowering with simvastatin in 20356
high-risk individuals: A randomised placebo-controlled trial,"
Lancet, 360(9326): 7-22, 6 July 2002. [Authors’ affilations:
multiple U.K. institutions, based at Radcliffe Infirmary, Oxford] *569JR |
87 |
5 |
| 3 |
M.-C. Morice, et
al., "A randomized comparison of a sirolimus-eluting stent
with a standard stent for coronary revascularization," New
Engl. J. Med., 346(23): 1773-80, 6 June 2002. [12 institutions
worldwide] *559EK |
59 |
† |
| 4 |
C. Drosten, et
al., "Identification of a novel coronavirus in patients with
severe acute respiratory syndrome," New Engl. J. Med.,
348(20): 1967-76, 15 May 2003. [5 European institutions] *677TJ |
58 |
3 |
| 5 |
T.G. Ksiazek, et
al., "A novel coronavirus associated with severe acute
respiratory syndrome," New Engl. J. Med., 348(20):
1953-66, 15 May 2003. [7 institutions worldwide] *677TJ |
55 |
2 |
| 6 |
M.W. Fried, et
al., "Peginterferon alfa-2a plus ribavarin for chronic
hepatitis C virus infection," New Engl. J. Med., 347(13):
975-82, 26 September 2002. [12 institutions worldwide] *596RD |
55 |
† |
| 7 |
K.M. Flegal, et
al., "Prevalence and trends in obesity among US adults,
1999-2000," JAMA-J. Amer. Med. Assoc., 288(14): 1723-7, 9
October 2002. [CDC, Hyattsville, MD] *602BJ |
52 |
8 |
| 8 |
C.D. Furberg, et
al. (ALLHAT officers and coordinators), "Major outcomes in
high-risk hypertensive patients randomized to angiotensin-converting
enzyme inhibitor or calcium channel blocker vs diuretic. The
Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT)," JAMA-J. Amer. Med. Assoc., 288(23):
2981-97, 18 December 2002. [Corresponding authors: Case Western Reserve
U., Cleveland, OH; U. Texas Houston Health Center] *626CG |
50 |
10 |
| 9 |
G. Van den
Berghe, et al., "Intensive insulin therapy in critically
ill patients," New Engl. J. Med., 345(19): 1359-67, 8
November 2001. [Catholic U. Leuven, Belgium] *489VY |
48 |
† |
| 10 |
P.A. Rota, et
al., "Characterization of a novel coronavirus associated with
severe acute respiratory syndrome," Science, 300[5624]:
1394-9, 30 May 2003. [CDC, Atlanta, GA: Univ. Calif., San Francisco;
Erasmus Univ., Rotterdam, Netherlands; Bernhard Nocht Inst. Tropical Med.,
Berlin, Germany] *683ZW |
47 |
† |
SOURCE:
Thomson
Scientific
Hot Papers Database. 
the full legend. |
 nterest
continues to center on a cluster of reports from 2003 investigating
SARS, or severe acute respiratory syndrome (see Science Watch,
15[3]: 5, May/June 2004), with six such papers currently ranking among
the top 20. Between them, those six have already accumulated an
impressive 1,404 citations, but paper #1, meanwhile, has only 200 fewer
just by itself. For SARS the news is the uncovering of the genome
sequence for the causative coronavirus. A mere handful of citations
separate #10 from the companion paper in the May 30, 2003, issue of Science,
by Dr. Marco A. Marra and his colleagues (see 300[5624]: 1399-404, 2003;
currently at #14, cited 42 times this period, with 143 citations
overall). It is the promise of the postgenomic era that excites here. As
Dr. Paul A. Rota and his coworkers say in their collaborative paper from
the United States, Netherlands, and Germany (#10): "The
availability of complete genomic sequences…should have an immediate
impact on disease control efforts by making it possible to develop
improved diagnostic tests, vaccines, and antiviral agents."
Visit the ESI Special
Topic: Coronaviruses.
As hinted before (see Science Watch, 15[2]: 5, March/April
2003), the impact of safety concerns about hormone replacement therapy (HRT)
raised by paper #1 from the Women’s Health Initiative was certainly
immediate. Regulatory authorities were quick to respond with revised
advice to women. For example, in December, 2003, the U.K.’s Medicines
and Healthcare Products Regulatory Agency stated that while the balance
of risks and benefits might be favorable for HRT for severe menopausal
symptoms, provided that prescriptions were short-term and low dose, HRT
should no longer be the first choice for the prevention of osteoporosis.
In the U.K. half the many HRT products on the market were licensed for
both these indications. HRT prescribing generally fell back to 1995
levels, according to pharmaceutical sales statistics.
Visit the ESI Special
Topic: Hormone Replacement
Therapy.
WHI is a National Institutes of Health-funded research program that
began in 1991 and it has yielded far more papers than the influential
#1. For example, there had been suggestions that HRT might help prevent
or delay the onset of Alzheimer’s disease. However, findings from the
WHI Memory Study are far from encouraging in that respect (S.A.
Shumaker, et al., JAMA, 291[24]: 2947-58, 2004;
M.A. Espeland, et al., JAMA, 291[24]: 2959-68, 2004).
Those articles will have kept WHI in the public eye. So have the Million
Women Study focusing on HRT and the risk of breast cancer (E. Banks and
the Million Women Study Collaborators, Lancet, 362[9382]:419-27,
2003) and an overview of four very large HRT trials, including WHI (V.
Beral, E. Banks, G. Reeves, Lancet, 360[9337]:942-4, 2002).
Ever since it first began to appear in Science Watch listings,
the paper by Dr. Greta Van den Berghe and her colleagues from Leuven,
Belgium, (#9 this time) has been a steady accumulator of citations, with
individual bimonthly counts ranging between 23 and 48 over the last
eight periods. Yet your columnist, overexcited perhaps by SARS inter
alia, has been neglecting it. The observation that critically ill
patients, whether they have a history of diabetes or not, have
abnormally high blood-sugar levels and show resistance to the blood
sugar-lowering hormone insulin prompted a clinical trial of
"intensive" insulin therapy targeted at keeping the blood
sugar in the range 80 – 110 mg/dL. The controls were given insulin on
less-demanding criteria. The mortality rate in intensive care in this
trial, enrolling 1,548 patients, was significantly lower in the
intensive insulin group (4.6% vs 8.0%).
Mr.
David W. Sharp, M.A.(Cambridge),
is a contributing editor to The Lancet, London, U.K.
Science
Watch®, September/October 2004, Vol. 15, No. 5
Citing URL: http://www.sciencewatch.com/sept-oct2004/sw_sept-oct2004_page5.htm |
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