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Lexapro For Treatment Of Hot Flashes

In a well done placebo-controlled study published in this week’s Journal of the American Medical Association (JAMA), use of escitalopram (Lexapro) reduced hot flashes in menopausal women.

Investigators enrolled 205 women, randomizing them to either Lexapro 10 mg or placebo, with instructions to increase to two pills a day if needed after four weeks. Lexapro users experienced about a 60 percent reduction in hot flash frequency over the eight-week study. About half ended up on the larger 20 mg daily dose by study’s end. The drug’s effect was apparent at about one week of use, and it was well tolerated.

As in almost studies of menopausal treatments, the placebo group also experienced a significant reduction in symptoms — about 40 percent — but the difference between placebo and drug groups was significant. Compared to placebo users, Lexapro users had a bigger rebound of symptoms when stopping their treatment, were more satisfied, and more likely to want to continue the study drug, another validation of the drug’s efficacy. Read more »

*This blog post was originally published at tbtam*

Farm Woo And Our Food

Google is an amazing thing — it occasionally tosses you a link that lands you in an alternate universe of folks you’d never encounter in real life.

Like cattle ranchers. I’ve just spent the good part of an hour wandering their world — reading about their concerns (water, wolves, the economy), seeing how cattle breeding has changed (you pick a sire at Bullsemen.com, then do genomic profiling on your stock — did you know that cows bred for docility have more tender meat ?), and learning that ranchers are not immune to marketing from the world of scientific woo.

Check this out — it’s called SOP Life Vibration or “Serio Bio-Hygienization.” They’re selling it to farmers and ranchers in Europe and the U.S. as the latest and greatest answer to bacterial growth and odors in farm feed and bedding:

SOP products are formulated with the innovative Sirio Operating Process technology to improve the environment of the farm in a more effective and longer lasting way than current available means.

SOP® products are natural and scientifically tested. They are not enzymes, bacteria nor disinfectants. Using a process of “frequential bio-conditioning” they selectively favor the activity of the “beneficial” micro-organisms and create unfavorable conditions to inhibit the development of the “pathogenic” ones.

A 100% natural product. Through a bio-frequency method, SOP® is created with strategic wavelength and harmony. This same technology is comparable to the electronic systems used for radio broadcasting.

SOP Bio-Hygienization“100% natural,” “Bio-hygeinization,”  ”Frequential bio-conditioning”…

I smell a woo. And that makes me nervous.

After all, I’m a meat eater. If someone’s putting something wacky into and around my food source, I want to know about it. So I decided it was worth my while to find out what the heck was in this SOP® stuff. Read more »

*This blog post was originally published at tbtam*

Contraceptive Failures: A Reality Check

The media has been buzzing over recent reports of pregnancies occurring in women using Implanon, a single rod progestin-only contraceptive inserted under the skin of the upper arm and lasting for up to three years.

The headlines make it sound horrifying: “Hundreds Become Pregnant Despite Contraceptive Implanon” and “British Pregnancy Scare in UK Implicates Implanon.” I love how terminology can make something so common sound so frightening.

Actually, what happened was that 584 pregnancies occurred in Britain among about 1.3 million women using Implanon, for a failure rate of .04 percent. In other words, the method had an efficacy of over 99 percent. That’s a pretty effective contraceptive if you ask me.

But it should have been better than that

As good as it may seem, this failure rate is significantly higher than most of us would have expected based upon data from clinical trails of Implanon.

I recall being told at an Implanon insertion training just prior to its introduction in the U.S.  that in fact, not a single pregnancy had been reported at that point among users of the device in clinical trails. This would put the method up there with sterilization and IUD in terms of efficacy.

So what happened?

How did Implanon go from perfect efficacy to something less than perfect? Read more »

*This blog post was originally published at tbtam*

“What’s Wrong?” It’s A Generic-Drug Rip Off, That’s What

Cute packaging and product placement in the checkout lane at Duane Reade will get you generic Tylenol for a price equivalent to $50 for 100 tabs, as opposed to $6 per 100 count in the usual package.

*This blog post was originally published at tbtam*

Vaginal Steam Baths: A Medical Opinion

A spa in California is offering vaginal steam baths, in which spa-goers squat or sit on open stools over a tub of hot steam, as a cure-all for menstrual, digestion, and mood disorders:

The V-Steam: Inspired by an ancient ritual practiced for many years in Korea. The steam from the herbal tea rises and absorbs into your skin & orifice. This steaming treatment stimulates the production of hormones to maintain uterine health, aids regular menstrual cycles, helps correct digestive disorders while soothing the nervous system. The natural antibiotic and anti-fungal properties are said to help maintain internal health as well as keeping your skin looking young. (30 min: $50. Series of 6: $180.)

It’s a douche, folks. A $50 douche made with mugwort and 13 other herbs and having a fancy Korean name: Chai-Yok. True, the water gets up there as steam, and if you don’t squat just right over the steam bath, I imagine it may not get up there at all. But in the end, it’s a douche.

We docs strongly advise against douching since we know that women who do it have higher rates of vaginal and pelvic infections. Not to mention that the vaginal mucosa is highly-absorptive surface, meaning anything you put in there is likely to end up in the rest of your body. And so I ask: What herbs are they using, at what doses, and what side effects might they have? Not to mention what might be growing in those wooden tubs they have you squatting over? Read more »

*This blog post was originally published at tbtam*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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