The 61 year old female was being seen two months after surgery for tubular carcinoma of the breast. She complained of an abdominal wall mass which was mildly tender, subcutaneous and nodular, measuring 4x2x2 cm. Her doctors were immediately concerned about either metastatic breast carcinoma or a recurrence of her follicular lymphoma diagnosed in 2001.
She underwent total excision of the mass, and the tissue was analyzed in using various immunohistochemical studies. There was no evidence of malignancy, only lobular panniculitis with paraseptal lymphoid follicles and vasculitis. Her doctors then continued the workup, including consideration of SLE. It was only after talking with her surgeon that it was revealed that she had been giving herself subcutaneous injections of mistletoe extract in her abdomen. She had heard about this treatment from a friend and was referred to a "complementary therapist" through her primary care practitioner.
The details in this real-life case published in the British Medical Journal in December, 2006 illustrate well the findings in a recent survey released in January. In this nationwide study, investigators at the NCCAM measured complementary and alternative medicine (CAM) use among patients. They found that two out of three adults age 50 and older have used some form of CAM, but 77% of them never discussed it with their physician. The two most common reasons why CAM was not discussed were that patients didn’t know they should (30%) and the doctor never asked (42%). According to the respondents, family and friends were their primary source of CAM information, followed by publications, physicians, Internet, and radio (interestingly, though, the second most common response regarding CAM sources was "I don’t know"). The survey also found that nearly three-fourths of respondents were currently taking multiple prescription medications, and 60% were taking one or more over-the-counter medications.
This study is available at the National Institutes of Health website and provides valuable insights into CAM use among patients.
Showing posts with label Expensive Urine. Show all posts
Showing posts with label Expensive Urine. Show all posts
Friday, March 23, 2007
Monday, January 8, 2007
Did you know that the word "gullible" isn’t in the dictionary?
The Federal Trade Commission has levied 25 million dollars in fines and penalties against companies marketing 4 weight loss products: One-A-Day Weight Smart, Xenadrine EFX, Cortislim, and TrimSpa.
When ephedra became the first dietary supplement to be banned by the FDA after being linked to 155 deaths, manufacturers scrambled to offer "ephedra-free" alternatives. For example, Xenadrine EFX contains bitter orange (Citrus aurantium); but bitter orange is metabolized into synephrine which is still very similar to ephedra in its pharmacodynamics. Ironically, the FTC also discovered that in one of the Xenadrine studies the placebo group actually lost more weight than the study group!
The makers of Cortislim (and Cortistress) were accused of using infomercials that were deceptively formatted to look like legitimate talk shows as well as making unsupported claims of weight loss and prevention of osteoporosis, obesity, diabetes, Alzheimer’s disease, cancer, and cardiovascular disease.
Trimspa contains Hoodia gordonii and is known for its famous spokeswoman, Anna Nicole Smith, who claimed to have lost 69 pounds in 8 months. Apparently Trimspa thought that a woman whose main claim to fame was being an topless dancer who married a billionaire thrice her age was a compelling enough reason to have her represent their product.
One-A-Day Weight Smart is brought to you by Bayer which also makes Cipro, Avelox, and Levitra (and the ill-fated cholesterol drug Baycol). The FTC concluded that Bayer's claims that it increased body metabolism were unscientific and objected to their ad that recommended only one exercise: "lift the bottle, twist the cap, and bend your wrist to take the pill."
No, seriously. For their transgressions Bayer will pay a 3.2 million settlement, the largest civil penalty ever issued by the FTC. At the press conference January 4th, FTC chairman Deborah Majoras discounted the use of testimonials in advertising by pointing out that the person is paid to do so, and that they often had additional diet and personal trainers to help them. She also listed some "red flag" claims that consumers should be wary of:
Causes substantial weight loss regardless of calories consumed.
Causes permanent weight loss even if one stops using it.
Blocks absorption of fat or calories.
Enables users to lose more than three pounds a week for more than four weeks.
Causes substantial weight loss for all users.
Causes substantial weight loss by wearing it or by rubbing it into the skin.
When ephedra became the first dietary supplement to be banned by the FDA after being linked to 155 deaths, manufacturers scrambled to offer "ephedra-free" alternatives. For example, Xenadrine EFX contains bitter orange (Citrus aurantium); but bitter orange is metabolized into synephrine which is still very similar to ephedra in its pharmacodynamics. Ironically, the FTC also discovered that in one of the Xenadrine studies the placebo group actually lost more weight than the study group!
The makers of Cortislim (and Cortistress) were accused of using infomercials that were deceptively formatted to look like legitimate talk shows as well as making unsupported claims of weight loss and prevention of osteoporosis, obesity, diabetes, Alzheimer’s disease, cancer, and cardiovascular disease.
Trimspa contains Hoodia gordonii and is known for its famous spokeswoman, Anna Nicole Smith, who claimed to have lost 69 pounds in 8 months. Apparently Trimspa thought that a woman whose main claim to fame was being an topless dancer who married a billionaire thrice her age was a compelling enough reason to have her represent their product.
One-A-Day Weight Smart is brought to you by Bayer which also makes Cipro, Avelox, and Levitra (and the ill-fated cholesterol drug Baycol). The FTC concluded that Bayer's claims that it increased body metabolism were unscientific and objected to their ad that recommended only one exercise: "lift the bottle, twist the cap, and bend your wrist to take the pill."
No, seriously. For their transgressions Bayer will pay a 3.2 million settlement, the largest civil penalty ever issued by the FTC. At the press conference January 4th, FTC chairman Deborah Majoras discounted the use of testimonials in advertising by pointing out that the person is paid to do so, and that they often had additional diet and personal trainers to help them. She also listed some "red flag" claims that consumers should be wary of:
Friday, December 15, 2006
Noni No-No
Proprietors of the Polynesian and South Pacific noni plant (Morinda citrifolia) believe it to be the next great panacea. Of particular interest is the substance named "xeronine" by Ralph Heinicke, former pineapple enzyme researcher for Dole. Noni's various phytochemicals are thought to have beneficial effects based on isolated findings in animal and laboratory tests. For example, a Hawaiian study suggested that high-dose intraperitoneal injections of noni extended the life of mice with lung carcinoma (Proc West Pharmacol Soc. 1994;37:145-6). A separate unpublished study reported in vitro activity against mycobacteria. Another study suggested sedative and analgesic effects on animals.
Although no human studies have been completed, there have been case reports of potential harm such as hyperkalemia (Am J Kidney Dis. 2000 Feb; 35 (2):330-2), hepatoxicity (Europ J Gastroenterol., 2005; 17:445-7) and possible Coumadin resistance (Am J Hematol. 2004 Sep;77(1)103). Furthermore, one study of noni leaf extract screening for antibacterial activity using disc diffusion demonstrated no effect on K. pneumoniae, P. aeruginosa, E. coli, S. aureus, and MRSA (Trop Biomed. 2005 Dec;22(2):165-70). Interestingly, even Heinicke admits that xeronine is almost impossible to detect, and that noni's activity is dependent upon fresh fermentation and gastric motility. After a comprehensive review, Dixon concluded that "the celebrity of noni is out of proportion to the facts" (Economic Botany. 1999. 53(1) pp 5 1-68).
Despite the paucity of evidence, noni has attracted many ardent followers including spokesman actor Danny Glover (star of "Lethal Weapon" and admirer of Hugo Chavez). The National Center for Complementary and Alternative Medicine is currently enrolling patients in a Phase I clinical trial, but at this point it appears that one can get the same antioxidant properties from a can of V-8 juice, and that the "energy boost" achieved is merely from all the sugar sweeteners used to conceal its putrid taste and smell. Perhaps it is no coincidence that the only existing patent for noni is actually for "eliminating grease, sewage odor and hydrogen sulfide from restaurant grease traps and municipal sewage systems" (patent #4666604).
Although no human studies have been completed, there have been case reports of potential harm such as hyperkalemia (Am J Kidney Dis. 2000 Feb; 35 (2):330-2), hepatoxicity (Europ J Gastroenterol., 2005; 17:445-7) and possible Coumadin resistance (Am J Hematol. 2004 Sep;77(1)103). Furthermore, one study of noni leaf extract screening for antibacterial activity using disc diffusion demonstrated no effect on K. pneumoniae, P. aeruginosa, E. coli, S. aureus, and MRSA (Trop Biomed. 2005 Dec;22(2):165-70). Interestingly, even Heinicke admits that xeronine is almost impossible to detect, and that noni's activity is dependent upon fresh fermentation and gastric motility. After a comprehensive review, Dixon concluded that "the celebrity of noni is out of proportion to the facts" (Economic Botany. 1999. 53(1) pp 5 1-68).
Despite the paucity of evidence, noni has attracted many ardent followers including spokesman actor Danny Glover (star of "Lethal Weapon" and admirer of Hugo Chavez). The National Center for Complementary and Alternative Medicine is currently enrolling patients in a Phase I clinical trial, but at this point it appears that one can get the same antioxidant properties from a can of V-8 juice, and that the "energy boost" achieved is merely from all the sugar sweeteners used to conceal its putrid taste and smell. Perhaps it is no coincidence that the only existing patent for noni is actually for "eliminating grease, sewage odor and hydrogen sulfide from restaurant grease traps and municipal sewage systems" (patent #4666604).
Wednesday, December 13, 2006
The Civilized Bowel
Does "death begin in the colon"? Patients may be asking about the virtues of colon cleansing products on TV such as Almighty Cleanse or Dual Action Cleanse. The latter is marketed by a man possessing the dubious name of Klee Irwin and an even more dubious-appearing pencil mustache. All of these informercials essentially resurrect the concept of colon autointoxication made popular by John Harvey Kellog (inventor of corn flake cereal) around the turn of the 20th century. In fact, Kellogg's practices at his Battle Creek Sanitarium in Michigan were what prompted T. Coraghessan Boyle to write "The Road to Wellville".
The theory of autointoxication is that fecal matter adheres to the walls of the colon, allowing toxins or bacteria to enter while preventing nutrients from gaining access by "clogging up your colon". Remember that this idea was refuted back then (JAMA 72:8-13, 1919; JAMA 78:884-888, 1922) and today (J Clin Gastroenterol 1997 Jun; 24(4):196-8). Besides, we've all seen the intestines intraoperatively or during colonoscopy enough times to know that this is simply untrue.
In addition to citing the urban legend that John Wayne had 40 pounds of stool in his colon at the time of autopsy, Mr. Irwin guarantees a "buoyant sense of energy and cleanness". According to him, the benefits of Dual Action Cleanse include several nebulous claims such as "supports the liver", "blood purifier", and "digestive support". The numerous ingredients range from the relatively benign (Milk Thistle) to the potentially dangerous (garlic and ginger inhibit platelet aggregation; Hawthorn can augment effects of vasodilators and digoxin).
Incidently (or not), Mr. Irwin has received warning letters and "cease and desist" letters from the FDA and FTC for some of his prior marketing effots.
If you're like me, you must first resist the urge to tell your patients that the reason people like Irwin are fascinated with cleansing the colon is because that is where their heads are permanently located. Instead, inform them that while constipation can be a real problem in clinical practice, there is no evidence that these aggressive bowel cleansing products are able to cure fatigue, sinus problems, skin blemishes, mood swings or other maladies. They can lead to electrolyte disturbances and would be dangerous with ongoing colitis conditions. Educate them that it is not necessary to have 2-3 bowel movements daily, nor is it even possible to achieve the kind of surgical sterility of the colon that they insist is important. Remind them that the colon is designed specifically for the purpose of eliminating fecal matter, which is by definition "dirty".
In the 1994 movie adaption of "The Road to Wellville", the character Goodloe Bender exclaimed, "Health! The 'open sesame' to the sucker's purse!" Before your patients "waste" their money, you might consider referring them to the following website:
http://www.infomercialscams.com/scams/dual_action_cleanse
The theory of autointoxication is that fecal matter adheres to the walls of the colon, allowing toxins or bacteria to enter while preventing nutrients from gaining access by "clogging up your colon". Remember that this idea was refuted back then (JAMA 72:8-13, 1919; JAMA 78:884-888, 1922) and today (J Clin Gastroenterol 1997 Jun; 24(4):196-8). Besides, we've all seen the intestines intraoperatively or during colonoscopy enough times to know that this is simply untrue.
In addition to citing the urban legend that John Wayne had 40 pounds of stool in his colon at the time of autopsy, Mr. Irwin guarantees a "buoyant sense of energy and cleanness". According to him, the benefits of Dual Action Cleanse include several nebulous claims such as "supports the liver", "blood purifier", and "digestive support". The numerous ingredients range from the relatively benign (Milk Thistle) to the potentially dangerous (garlic and ginger inhibit platelet aggregation; Hawthorn can augment effects of vasodilators and digoxin).
Incidently (or not), Mr. Irwin has received warning letters and "cease and desist" letters from the FDA and FTC for some of his prior marketing effots.
If you're like me, you must first resist the urge to tell your patients that the reason people like Irwin are fascinated with cleansing the colon is because that is where their heads are permanently located. Instead, inform them that while constipation can be a real problem in clinical practice, there is no evidence that these aggressive bowel cleansing products are able to cure fatigue, sinus problems, skin blemishes, mood swings or other maladies. They can lead to electrolyte disturbances and would be dangerous with ongoing colitis conditions. Educate them that it is not necessary to have 2-3 bowel movements daily, nor is it even possible to achieve the kind of surgical sterility of the colon that they insist is important. Remind them that the colon is designed specifically for the purpose of eliminating fecal matter, which is by definition "dirty".
In the 1994 movie adaption of "The Road to Wellville", the character Goodloe Bender exclaimed, "Health! The 'open sesame' to the sucker's purse!" Before your patients "waste" their money, you might consider referring them to the following website:
http://www.infomercialscams.com/scams/dual_action_cleanse
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