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Herbs & Vitamin Supplements: A Word Of Caution

Complementary and alternative medicine (CAM) is important and popular, but ignorance about its potential harms can be dangerous to consumers. Physician passivity about the subject may also be doing consumers a disservice. Two interesting articles underscore this:

From the NIH:

In spite of the high use of complementary and alternative medicine (CAM) among people age 50 or older, 69 percent of those who use CAM do not talk to their doctors about it…

A telephone survey, administered to a nationally representative group of 1,559 people age 50 or older, revealed some reasons why doctor-patient dialogue is lacking. Respondents most often did not discuss their CAM use with doctors because the physicians never asked (42 percent); they did not know that they should (30 percent); or there was not enough time during the office visit (19 percent).

From MSNBC:

If you’re banking on a daily vitamin to make up for any deficiencies in your diet, you may be getting a whole lot more — or less — than you bargained for.

Of 21 brands of multivitamins on the market in the United States and Canada selected by ConsumerLab.com and tested by independent laboratories, just 10 met the stated claims on their labels or satisfied other quality standards.

Most worrisome, according to ConsumerLab.com president Dr. Tod Cooperman, is that one product, The Vitamin Shoppe Multivitamins Especially for Women, was contaminated with lead.

The same product also contained just 54 percent of the 200 milligrams of calcium stated on the label.

The analysis also showed that Hero Nutritionals Yummi Bears, a multivitamin for children, had 216 percent of the labeled amount of vitamin A in the retinol form, delivering 5,400 International Units (IU) in a daily serving. That’s substantially more than the upper tolerable level set by the Institute of Medicine of 2,000 IU for kids ages 1 to 3 and 3,000 IU for those 4 to 8.

Because too much vitamin A can cause bone weakening and liver abnormalities, the Yummi Bears “could be potentially doing more harm than good,” Cooperman said. “Vitamin A is one of those vitamins where you really don’t want to get too much.”

It’s important for physicians to educate themselves about CAM therapies and make it a part of their practice to ask their patients about the supplements they take. The Natural Standard databases are a great resource for physicians and consumers, and will be available soon at Revolution Health. Natural Standard, initially created by a team of Harvard physicians, systematically reviews the evidence behind the efficacy claims of various herbal remedies and supplements.

What resources do you use to evaluate the safety and efficacy of the herbs and supplements you’re taking?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Conflicting research studies: how do I know what’s true?

Consumers often express frustration with new research findings reported to them by the media.  One day a medicine is being promoted on TV as the cure for arthritis pain, the next it is being removed from the market by the FDA, citing increased risk of death.  One day margarine is considered a healthy alternative to butter, the next day trans fats are being banned from entire states.  And so medical research is eyed with suspicion and people are left to wonder about the safety of their food, medications and treatments.

I sympathize with the confusion and frustration.   Here’s part of what fuels it:

1)  Clinical trials are designed to answer very specific questions under a set of limited conditions. They have to be designed this way in order to prove a cause and effect.  The results should be repeatable, given the same conditions.  Sometimes when a drug is used in a different way (like, at a higher dose or for a longer period of time, or in older patients) it has different or more frequent side effects.  It’s important not to generalize efficacy or safety to use cases outside those tested in a clinical trial.  What’s good for the goose is NOT necessarily good for the gander.

2)  Large observational studies can often pick up trends that might not have been noted in a clinical trial. This is why previously unknown (or rare) side effects are sometimes detected after clinical trials seem to indicate that a drug or treatment is safe and effective.

3)  We are all tempted to over-simplify research data, especially the media. How many of us would like to read a headline that says, “Drug X may reduce your arthritis pain by 10% if you are over 80, have no history of high blood pressure or diabetes, use it 3 times a day at 10mg doses and take it on an full stomach” versus “Drug X can cure your arthritis!”  Yup, we just want something easy to understand, and so we opt for statement #2, even though it’s not accurate.  Inaccurate statements generate a lot of confusion and lead to unwarranted hype.

So, what is a consumer to do? My opinion is that the educated consumer’s best friend is an educated physician.  Doctors are natural skeptics – they are formally trained (for a minimum of 7-10 years at good schools) to understand the limitations of research studies and effectively communicate all the caveats that are so critical for informed decision making.  If you’re having a hard time figuring out if a drug or treatment is right for you, ask your doctor (wow, did that sound like a TV ad!)  Or better yet, keep reading the physician blogs and medical news commentary at Revolution Health.  We are committed to translating research news into a format that you can understand and use.  We’ll do our best to cut through the hype and give you the real facts.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Brand Name or Generic Drugs: Does it Matter?

To tell you the truth, I used to think that there was no real difference between a generic drug and its trade name equivalent. The active ingredients in both formulations are identical, so I assumed that they worked the same way. Sure I knew that the inactive “filler” compounds are different – but what does a filler do anyway? It’s just there to hold the active ingredients into a pill shape, right?

Well, Dr. Barry Rumack, Founder of Micromedex, Inc. set me straight yesterday. According to Dr. Rumack, as many as 15% of people have drug sensitivities to fillers, therefore raising the question of whether or not people should take an even closer look at their prescription medications. In some cases generic medications might be best for a person, and in others the name brand might be worth the extra cost.

Dr. Rumack explained that he had previously tried to create a filler database that people could use to seek out the best formulation of their particular drug based on their personal allergy and intolerance profiles. Unfortunately, demand for such a tool was too low to make the database worthwhile. Maybe demand is low because people are unaware of this issue? Or maybe I’m making a mountain out of a mole hill. What do you think?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Scary virus revived by scientists

In 1918, a man died of a vicious strain of “Spanish Flu” and was buried in the Alaskan tundra. Almost a century later, scientists found his well preserved body poking through some permafrost and decided to take tissue samples to a Canadian laboratory to thaw out the virus that killed the man.

Sounds like the beginning of a made-for-TV, horror movie, doesn’t it? Well, I wish it were fiction. This is a true story.

So why did the scientists revive this infectious menace? To see what it would do to modern day macaque monkeys, of course.

The BBC news reports:

“Symptoms appeared within 24 hours of exposure to the virus, and the subsequent destruction of lung tissue was so widespread that, had the monkeys not been put to sleep a few days later, they would literally have drowned in their own blood.”

Um… gross?

The scientists say,

“This research provides an important piece in the puzzle of the 1918 virus, helping us to better understand influenza viruses and their potential to cause pandemics.”

The BBC continues:

“Analysis at the University of Wisconsin-Madison (UW-M) revealed that a key component of the immune system, a gene called RIG-1 appeared to be involved.

Levels of the protein produced by the gene were lower in tissue infected with the 1918 virus, suggesting it had a method of switching it off, causing immune defenses to run wild. This ability to alter the body’s immune response is shared with the most recent candidate for mutation into a pandemic strain, the H5N1 avian flu.”

There is a final word from Dr. Jim Robertson, a British virologist:

“Many influenza virologists remain nervous about creating and experimenting with a reconstructed 1918 Spanish flu virus.”

Yeah, I’m nervous too.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Dermatologists more elusive than ever…

Thanks to med blogger Kevin MD for highlighting an interesting, though cynical, comment about the extended wait times that many people have in getting an appointment to see a dermatologist.

“It’s just as well that there’s a long wait. Someone who comes in with a rash is likely to be biopsied and end up with a scar. If they wait until an appointment is available the rash will probably have cleared up.”

The Boston Globe explains why consumers are having a hard time getting dermatologist appointments:

“In dermatology, the waits are created both by patient demand and, some believe, by dermatologists’ shifting their time to new, more lucrative or complex procedures. Public service campaigns have heightened fear of skin cancer, and melanoma cases are rising, meaning more people are seeking appointments.

At the same time, some dermatologists are devoting time to cosmetic procedures, or to skin cancer surgery that used to be done by general surgeons. Meanwhile, the federal government limits the number of residents hospitals can train, and hospitals would have to create more dermatology slots at the expense of other specialties. This means the number of dermatologists entering practice each year has remained flat, at about 300 nationally, making it difficult for practices to hire new doctors. Just as many have been retiring in the past five years.”

Have you had a hard time finding a dermatologist?


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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