An occasional ongoing series of my results as I train my classifier.  I have over 400 abstracts in the training set, and I still get dreck sometimes.  Hope this is of some assistance to someone....

1: PMID 20677480 Endometrial ablation with paracervical block.

2: PMID J Reprod Med. 2009 Oct;54(10):639-44. Breast mass in a patient with ovarian cancer: a case report.

Let the gushing begin. The new son-of-Plavix, Brilinta, beat Plavix in a randomized trial, published this week.

Plavix is a leading blood thinner given to patients after a heart attack or stent procedure. Only problem is that it's set to go off patent in 2011, leaving AstraZeneca needing to fill a $6 billion/year revenue hole.

Looks like Brilinta is all but inevitable. The incremental benefit is 1.9%, leaving insurance pharmacy benefit managers having to scratch their heads over whether a 1.9% benefit is worth billions of dollars in incremental drug spending.

A few years ago a Japanese group caused something of a stir by publishing a survival advantage for irinotecan in small-cell lung cancer. In lung cancer you only get survival advantages infrequently so this was significant. I have to say I have only used irinotecan a few times for small cell lung cancer and I'm not sure it makes a big difference which topoisomerase inhibitor you use. So the news this week is that the original survival advantage reported seven years ago has evaporated and the new irinotecan is no better than standard etoposide at least in a Japanese population.

As if there aren't enough people taking Plavix already ($6 billion in sales per year) researchers published a study today showing incremental benefit to adding plavix to aspirin in atrial fib patients deemed not candidates for coumadin. The issue is this: coumadin has long been shown to be superior to aspirin for preventing stroke in atrial fibrillation. Coumadin's bleeding risk is similar to asprin but only if properly managed in a compliant patient.

I worry about the issue of narcotics dependence quite a bit in my practice so it's exciting to see a report today that a commonly used nausea drug Zofran (recently generic as ondansetron) can be used to treat narcotics dependence. The study only looked at treating a small number of subjects but the finding was that the withdrawal syndrome was improved. Hooray!

Looks like clopidogrel/Plavix genetic testing is a reality. A test called 2C19 Genotyping can predict which patients have faulty metabolism of this blood thinner leading to treatment failures and clotting problems. I got a nice review of two recent clinical trials in this area from the testing company Genelex. The testing has never previously been available to us clinicians but looks like it has come to the office setting. In the interest of disclosure I have worked with this company on projects in the past but we have never had a monetary relationship.