Each of the two main methods of heart bypass surgery has its drawbacks: When surgeons stop a patient's heart and use a machine to do the work of the heart and lungs, it can, in rare cases, trigger a stroke or, more commonly, lead to a mental fuzziness described as "pump-head." But off-pump surgery -- performed on a beating heart -- is more technically difficult, leading to fears of surgeon error and ineffectiveness. To examine those concerns, a group of Dutch researchers did a head-to-head comparison. They followed 281 coronary bypass patients who underwent either on-pump or off-pump surgery, testing motor skills, memory, attention, and other brain functions up to five years later. They found that the off-pump patients were slightly better off at three months, but there was no significant difference between the groups after a year. They also found no differences in the heart health of patients in each group, suggesting that off-pump surgeries are as effective in the long term as on-pump ones.
BOTTOM LINE: There's no evidence to suggest that on- or off-pump bypass surgery is better than the other.
CAUTIONS: The trial did not include elderly patients or those with advanced coronary artery disease -- who are most at risk for the mental decline that can follow surgery. The excluded patients are also those who are most likely to get the surgery in the first place.
WHAT'S NEXT: Study author Dr. Diederik van Dijk, a professor of medicine at University Medical Center Utrecht, wants to study a group of more than 2,000 patients. He believes that bigger numbers will prove the benefits of off-pump surgery in decreasing stroke risk -- particularly in elderly and high-risk patients.
WHERE TO FIND IT: Journal of the American Medical Association, Feb. 21
CANCER Drug company funding seems to lead to positive results
Since 1992 the pharmaceutical industry has spent more money on clinical research than the National Institutes of Health. To see if who paid for the studies made any difference in the results, researchers from the Dana-Farber Cancer Institute looked at 140 articles about breast cancer drug trials published in 1993, 1998, and 2003. Overall, 100 of the 140 studies reviewed had positive results for the drugs they were testing. Pharmaceutical involvement -- articles written by drug company authors, research funded by the companies, or drugs supplied by them -- did not make a significant difference over the combined three time periods. But it did seem to make a difference in 2003, after the journals required more funding disclosure. Eighty-four percent of the 32 studies with industry ties came to positive conclusions, compared with 54 percent of the 24 studies with no drug company involvement. "This raises a red flag to say the face of our studies is changing and that it may be in part due to the changing contribution of industry to financing them," the author , Dr. Ann Partridge, said.
BOTTOM LINE: Pharmaceutical company involvement in breast cancer research in 2003 was correlated with the publication of positive trial results.
CAUTIONS: This was a small study intended to spur further research. It may not account for publication bias, which means that positive studies are more likely to get published than negative ones. While no drug company money funded this paper, three of the four authors are consultants and one receives research funding from drug companies.
WHAT'S NEXT: Researchers believe the new national registry of clinical trials will allow a more complete picture because it will include trials that are stopped early or completed and never published.
WHERE TO FIND IT: Cancer, early online, Feb. 26