Study Finds Slight Benefit for Chelation Therapy in Patients After Heart Attack

A new study reported at the American Heart Association’s Scientific Sessions found that in patients who had previously had a heart attack, chelation therapy resulted in a slightly reduced rate of cardiovascular events, including heart attack, stroke, and death.

Los Angeles—Most cardiologists listening to late-breaking findings of a clinical trial presented here at the annual Scientific Sessions of the American Heart Association (AHA) likely expected to hear that chelation therapy does not help prevent future cardiovascular problems in patients who previously experienced a heart attack. Instead, researchers reported the surprising finding that the treatment did improve outcomes, although the effect did not appear to be large.

The randomized, placebo-controlled trial found that in patients who had previously had a heart attack, chelation therapy resulted in fewer cardiovascular events, defined as death, heart attack, stroke, coronary revascularization, and hospitalization for angina. But the difference between the 2 groups barely reached significance: 26% of those given chelation therapy experienced such an event compared with 30% for patients randomized to receive a placebo. Continue reading

Author Insight: Milk Thistle Doesn’t Improve Outcomes for Patients With Hepatitis C

Michael W. Fried, MD, director of the Liver Center at the University of North Carolina–Chapel Hill, and colleagues found that silymarin (milk thistle), a supplement used by many patients with chronic liver disease, did not improve liver function, decrease virus levels, or improve quality of life among patients with chronic hepatitis C virus infection. (Image: Nicolette DeGroot)

Patients who are not helped by the standard treatments for hepatitis C virus (HCV) infections often turn to unproven alternative therapies, including silymarin, an extract of milk thistle that is a popular supplement among patients with liver conditions. But a study published in JAMA today found that silymarin does not improve patient clinical outcomes or quality of life.

About one-third of patients with chronic hepatitis and cirrhosis take or have taken silymarin to improve their liver condition, according to the authors of the study, despite mixed results from previous studies about the supplement’s effectiveness. To provide more definitive data, Michael W. Fried, MD, and his colleagues conducted a multicenter placebo-controlled trial of 154 patients with chronic HCV infection who had been unsuccessfully treated with interferon-based therapy, the standard treatment for the infection. Patients were randomized to receive either 420-mg silymarin, 700-mg silymarin, or a placebo 3 times daily for 24 weeks. The treatment did not improve markers of liver function or reduce HCV RNA levels, and patients who took silymarin reported no better quality of life than those who took placebo.

Dr Fried, who directs the Liver Center at the University of North Carolina–Chapel Hill, discussed the findings with news@JAMA. Continue reading

Author Insights: Refocus Questionable US-Funded Complementary and Alternative Therapies Research

Paul A. Offit, MD, of Children’s Hospital in Philadelphia, says that much federally funded research of alternative and complementary medicine is misguided. (Image: April Saul at the Philadelphia Inquirer)

The mission of the National Institutes of Health’s (NIH) National Center for Complementary and Alternative Medicine (NCCAM) is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.” In the 2 decades since the center was created (initially with the name of the Office of Alternative Medicine), NCCAM has spent $1.6 billion funding studies and has a current annual budget of $130 million.

In a Viewpoint appearing today in JAMA, Paul A. Offit, MD, chief of the division of infectious diseases and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, argues that NCCAM-funded scientific investigation has failed to uncover many successful uses for complementary and alternative medicine, and these negative findings have had little effect on changing certain practices and patient perceptions. He notes that NCCAM has spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or speed recovery from breast reconstruction surgery; and $700 000 to find that magnets do not offer relief from arthritis, carpal tunnel syndrome, or migraine headaches. At best, he said, many of these studies reaffirm the placebo effect among certain patients undergoing these therapies. Continue reading