Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. These highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.
Two herbal weight-loss products manufactured in China and sold in Japan and on the Internet caused liver injury to 12 patients taking the product, according to a new study (Brief Communication, p. 488). One patient died and another needed a liver transplant; the remaining patients recovered after stopping the products, Chaso and Onshido. Both were advertised by their manufacturers as containing only botanicals, but were found to contain N-nitroso-fenfluramine, a relative of the drug fenfluramine that was taken off the market in the United States after it was linked to heart problems. The authors caution that consumers and health professionals should be aware that so-called herbal supplements for weight loss may be harmful.
In a follow-up study of 7,891 people 55 or older, those who took thiazide diuretics for at least one year had a 50 percent lower risk for hip fracture than people who never took the diuretics (Article, p. 476). The protective effect of these inexpensive pills, commonly prescribed to lower blood pressure, disappeared within four months after the pills were discontinued.
A group of physicians and others with experience in developing clinical guidelines have come up with an 18-point checklist to standardize reporting of medical guidelines (Academia and Clinic, p. 493). The great variation in documentation of many current guidelines can lead to misunderstandings by clinicians, patients and reporters about what some guidelines actually recommend, thus reducing chances that they'll be adopted into clinical practice and improve medical care. The Conference on Guideline Standardization asks that guideline developers describe how the evidence was collected or evaluated, mention funding sources or sponsors, state who reviewed the draft guidelines and state the recommended action precisely, among other actions to improve the quality of guidelines. The group hopes that the new uniform framework for guideline documentation will be as successful as the Consolidated Statement for Reporting Trials (CONSORT statement) has been in improving reporting of clinical trial data.