Friday, January 28, 2011

An interesting study was published this week in the British Medical Journal. For years it’s been known that sufferers of migraine headaches show small abnormalities on MRI scans that may indicate small strokes. This new study extends this finding to people who likely have tension-type headaches as well as older individuals. Until now, it was unclear whether such small structural brain lesions impair cognitive function. The findings show that they do not.

The study included 780 older adults (mean age, 69 years). Of these, 163 had a history of severe headache and 116 had migraine, of whom 17 reported aura symptoms. Subjects were given a battery of tests including Mini Mental Status Exam (a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia. It is also used to estimate the severity of cognitive impairment at a given point in time and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual's response to treatment).

The researchers had MMSE scores for 769 of the 780 subjects. There was no association between overall or specific headache types and impaired cognitive function on the MMSE, regardless of the presence of brain lesions. The researchers note in their report that the battery of cognitive function tests they used yielded similar association patterns, and they chose to report only findings from the MMSE in the current article and will be submitting the full cognitive data in a separate manuscript. Still, this is encouraging news for suffers of migraines and tension headaches.

Wednesday, January 12, 2011

I’ve not written much in this blog lately, because there wasn’t a great deal of breaking developments to comment on. However, the recent story on the fraud surrounding childhood vaccination is noteworthy.

The British Medical Journal published a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield and colleagues linking the childhood measles-mumps-rubella vaccine to a "new syndrome" of regressive autism and bowel disease was not just bad science but fraud. According to the first article published in BMJ the study's investigators altered and falsified medical records and facts, misrepresented information to families, and treated the 12 children involved unethically. In addition, Mr. Wakefield accepted consultancy fees from lawyers who were building a lawsuit against vaccine manufacturers."

Although The Lancet published a retraction of the study last year right after the UK General Medical Council announced that the investigators acted "dishonestly" and irresponsibly," the BMJ editors note that the journal did not go far enough. "The Lancet retraction was prompted by the results from the hearing and was very much based on the concerns about the ethics of the study. What we found was that it was definite fraud and that is a very important thing for the world to know. This article shows that the science was falsified and should be discounted. This evidence "should now close the door on this damaging vaccine scare.

The study of only 12 patients (small, by any standard) faced almost immediate criticism by the scientific community, which only fueled the paranoia of those paranoid about organized medicine. And although the study was never validated, the media hyped it, setting off a panic among parents. As a result vaccinations decreased dramatically. The 2003 to 2004 vaccination rate of 80% has now recovered slightly in the United Kingdom, but it is still well below the recommended 95% level recommended to ensure "herd immunity."