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Cuddly cats could cause ulcers
SCIENCE AND MEDICINE
Study puts a number on poor compliance in the elderly oor compliance with medications is one of the leading causes of drug “failure” and clinicians must always balance the possibility of drug failure against the suspicion of noncompliance. According to a North American study, only about half of patients prescribed lipid-lowering agents continued their regimen for 5 years. Compliance over 1 year was not much better; only about onethird of patients had drugs available for most of the year, and about 12% never refilled their prescription. Jerry Avorn of Harvard Medical School (Boston, MA, USA) and a US and Canadian team recorded the
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prescriptions submitted by two populations older than 65 years between January 1, 1990, and July 1, 1991. The 5611 US patients were either New Jersey Medicaid recipients or participants in the state’s Pharmacy Assistance Program. 1676 Canadian patients were randomly selected from the Quebec universal health-care system. Drugs were either free, or cost at most US$2 per prescription. The researchers then calculated the days per year for which patients were covered by presciptions for nine lipid-lowering agents. The US group was also studied for compliance after 5 years (JAMA 1998; 279: 1458–62).
The highest degree of compliance was seen with the statins (mean coverage per year 64·3%) and the lowest was with cholestyramine (36·6%). Better compliance was seen among patients with underlying risk factors for future cardiac events, such as hypertension, diabetes, and current coronary artery disease. But, poorer patients had lower compliance. “We as doctors have to be more sensitive to the problem of non-compliance”, said Avorn. “We must learn to make questions about compliance a part of the routine follow-up visit.” David Frankel
Cocktail vaccine shows promise for cutaneous leishmaniasis these results as a proof of principle”, says Fabio Zicker (WHO, Geneva, Switzerland). But, there are some difficulties when developing this kind of vaccine for largescale use. The differing species present worldwide potentially limit even a cocktail vaccine to specific regional use. And, since the cocktail vaccine was originally prepared in the laboratory, the quality and efficacy can vary greatly between batches. “The challenge now is to standardise the product”, explains Zicker.
field trial of a vaccine cocktail against New World cutaneous leishmaniasis shows that the vaccine is safe and effective in the first 12 months’ follow-up. The trial provides promise of a future vaccine against the disease. Many species of leishmania exist throughout the world, and multiple species are present even within the region of Ecuador where the vaccine was to be tested. So, Rodrigo Armijos (Central University of Ecuador, Quito, Ecuador) and coworkers used a cocktail vaccine of three different species of killed leishmania. 438 children were given
two doses of vaccine plus bacille Calmette-Guérin (BCG) as an adjuvant. 406 children received two doses of BCG alone as a control. After 12 months, no serious sideeffects had been reported and the incidence of cutaneous leishmaniasis was lower in the vaccine group than in the control group (2·1% vs 7·6%; p<0·003). The authors estimate that the vaccine’s efficacy is 73% (95% CI 36·1–88·5%), but are planning a further 3-year follow-up to see how long protection lasts (J Infect Dis 1998; 177: 1352-57). “The project seems very well designed and it is good to have
IBIS tamoxifen trial to continue
Cuddly cats could cause ulcers
he recent finding from a US trial that prophylactic tamoxifen can almost halve breast-cancer incidence has led to review of similar studies elsewhere (see Lancet April 11, p 1107). On May 13, the working party of the International Breast Cancer Intervention Study (IBIS) announced that IBIS should continue since there are “still major questions to answer”. Early closure of the US study means that the duration of any preventive effect, and the influence of tamoxifen on mortality remain unknown. Tamoxifen could simply delay onset of breast cancer or render subsequent disease more difficult to treat. In the USA, Zeneca has already applied to market tamoxifen as a breast-cancer preventive agent.
T
Kelly Morris
THE LANCET • Vol 351 • May 16, 1998
Hannah Wunsch
zoonosis, since most infected individuddling a pet cat could have uals have close contact with animals. ulcerous consequences, accordPCR testing of the H heilmannii ing to Christine Dieterich of the urease B gene in the man and his two Centre Hospitalier Universitaire cats showed that they were “highly Vaudois in Lausanne, Switzerland, homologous”. One and her colleagues. sequence from the The team describe a dentist’s biopsy was dentist with a history 100% identical to a of recurrent dyspepsequence from one of sia who was found his cats; a sequence to have ten stomach from the other cat ulcers, and infection perfectly matched with three different a human sequence strains of Helicobacter from a gene data heilmannii. bank. The similarity This bacterium is between the human related to H pylori, Not always so cute and cat H heilmannii but unlike H pylori strains, they write, suggests “the H heilmannii is not restricted to possibility of transmission between human beings and infects 80–100% household pets and their owners” of cats, dogs, and pigs, causing mild (J Clin Microbiol 1998; 36: 1366–70). gastritis. H heilmannii is estimated to infect the gastric mucosa in up to 2% of people, and is suspected to be a Marilynn Larkin
C
Tony Stone Images
A
1495
Study puts a number on poor compliance in the elderly oor compliance with medications is one of the leading causes of drug “failure” and clinicians must always balance the possibility of drug failure against the suspicion of noncompliance. According to a North American study, only about half of patients prescribed lipid-lowering agents continued their regimen for 5 years. Compliance over 1 year was not much better; only about onethird of patients had drugs available for most of the year, and about 12% never refilled their prescription. Jerry Avorn of Harvard Medical School (Boston, MA, USA) and a US and Canadian team recorded the
P
prescriptions submitted by two populations older than 65 years between January 1, 1990, and July 1, 1991. The 5611 US patients were either New Jersey Medicaid recipients or participants in the state’s Pharmacy Assistance Program. 1676 Canadian patients were randomly selected from the Quebec universal health-care system. Drugs were either free, or cost at most US$2 per prescription. The researchers then calculated the days per year for which patients were covered by presciptions for nine lipid-lowering agents. The US group was also studied for compliance after 5 years (JAMA 1998; 279: 1458–62).
The highest degree of compliance was seen with the statins (mean coverage per year 64·3%) and the lowest was with cholestyramine (36·6%). Better compliance was seen among patients with underlying risk factors for future cardiac events, such as hypertension, diabetes, and current coronary artery disease. But, poorer patients had lower compliance. “We as doctors have to be more sensitive to the problem of non-compliance”, said Avorn. “We must learn to make questions about compliance a part of the routine follow-up visit.” David Frankel
Cocktail vaccine shows promise for cutaneous leishmaniasis these results as a proof of principle”, says Fabio Zicker (WHO, Geneva, Switzerland). But, there are some difficulties when developing this kind of vaccine for largescale use. The differing species present worldwide potentially limit even a cocktail vaccine to specific regional use. And, since the cocktail vaccine was originally prepared in the laboratory, the quality and efficacy can vary greatly between batches. “The challenge now is to standardise the product”, explains Zicker.
field trial of a vaccine cocktail against New World cutaneous leishmaniasis shows that the vaccine is safe and effective in the first 12 months’ follow-up. The trial provides promise of a future vaccine against the disease. Many species of leishmania exist throughout the world, and multiple species are present even within the region of Ecuador where the vaccine was to be tested. So, Rodrigo Armijos (Central University of Ecuador, Quito, Ecuador) and coworkers used a cocktail vaccine of three different species of killed leishmania. 438 children were given
two doses of vaccine plus bacille Calmette-Guérin (BCG) as an adjuvant. 406 children received two doses of BCG alone as a control. After 12 months, no serious sideeffects had been reported and the incidence of cutaneous leishmaniasis was lower in the vaccine group than in the control group (2·1% vs 7·6%; p<0·003). The authors estimate that the vaccine’s efficacy is 73% (95% CI 36·1–88·5%), but are planning a further 3-year follow-up to see how long protection lasts (J Infect Dis 1998; 177: 1352-57). “The project seems very well designed and it is good to have
IBIS tamoxifen trial to continue
Cuddly cats could cause ulcers
he recent finding from a US trial that prophylactic tamoxifen can almost halve breast-cancer incidence has led to review of similar studies elsewhere (see Lancet April 11, p 1107). On May 13, the working party of the International Breast Cancer Intervention Study (IBIS) announced that IBIS should continue since there are “still major questions to answer”. Early closure of the US study means that the duration of any preventive effect, and the influence of tamoxifen on mortality remain unknown. Tamoxifen could simply delay onset of breast cancer or render subsequent disease more difficult to treat. In the USA, Zeneca has already applied to market tamoxifen as a breast-cancer preventive agent.
T
Kelly Morris
THE LANCET • Vol 351 • May 16, 1998
Hannah Wunsch
zoonosis, since most infected individuddling a pet cat could have uals have close contact with animals. ulcerous consequences, accordPCR testing of the H heilmannii ing to Christine Dieterich of the urease B gene in the man and his two Centre Hospitalier Universitaire cats showed that they were “highly Vaudois in Lausanne, Switzerland, homologous”. One and her colleagues. sequence from the The team describe a dentist’s biopsy was dentist with a history 100% identical to a of recurrent dyspepsequence from one of sia who was found his cats; a sequence to have ten stomach from the other cat ulcers, and infection perfectly matched with three different a human sequence strains of Helicobacter from a gene data heilmannii. bank. The similarity This bacterium is between the human related to H pylori, Not always so cute and cat H heilmannii but unlike H pylori strains, they write, suggests “the H heilmannii is not restricted to possibility of transmission between human beings and infects 80–100% household pets and their owners” of cats, dogs, and pigs, causing mild (J Clin Microbiol 1998; 36: 1366–70). gastritis. H heilmannii is estimated to infect the gastric mucosa in up to 2% of people, and is suspected to be a Marilynn Larkin
C
Tony Stone Images
A
1495