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February 14, 2002 Vol. 346 No. 7
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Within three years, 13 cases of pure red-cell aplasia, a rare disease, were identified in patients with chronic renal failure who were receiving recombinant human erythropoietin (epoetin): 12 in France and 1 in Britain. All patients had antibodies that inhibited erythropoiesis in vitro and bound to epoetin with high affinity. Despite the discontinuation of epoetin treatment, most of the patients remain transfusion-dependent.
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A cohort of 1092 elderly subjects who were free of dementia were studied prospectively. After a median of eight years of follow-up, dementia had developed in 111 subjects. Even after adjustment for other known risk factors, an elevated plasma total homocysteine level at base line was an independent predictor of the development of clinical dementia, most cases of which were caused by Alzheimer's disease. The risk of Alzheimer's disease was nearly doubled for those with the highest plasma homocysteine levels.
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Pulmonary Langerhans'-cell histiocytosis in adults is a rare interstitial lung disease, and its course and outcome have not been well defined. In this study, the records of 102 adults with clearly established disease were reviewed. Over a median follow-up period of four years, 33 deaths occurred, about half of which were attributable to respiratory failure. The overall survival was significantly shorter than that expected for persons matched for sex and calendar year of birth.
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This double-blind, placebo-controlled study evaluated the use of a conjugate vaccine containing the two most common capsular polysaccharides that confer virulence on S. aureus. Among adults receiving long-term hemodialysis, a single dose of the vaccine had an efficacy of 57 percent against S. aureus bacteremia from week 3 to week 40 after vaccination.
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Spending on direct-to-consumer advertising of drugs tripled between 1996 and 2000, when it reached $2.5 billion. The majority of this advertising is on television. Highly selected drugs are targeted for this form of advertising, and the intensity of such advertising may fluctuate markedly over time (antihistamines, for example, are advertised seasonally).
The authors sharply criticize the now-common practice of marketing high-technology medical screening tests directly to the consumer. As a prominent example, they select electron-beam computed tomography to screen for lung cancer. The authors voice concern about the validity of such screening, the financial consequences, and potential ethical problems.
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