When Trust in Doctors Erodes, Other Treatments Fill the Void
February 3, 2006
By BENEDICT CAREY, The New York Times
A few moments before boarding a plane from Los Angeles to New York in January, Charlene Solomon performed her usual preflight ritual: she chewed a small tablet that contained trace amounts of several herbs, including extracts from daisy and chamomile plants.
Ms. Solomon, 56, said she had no way to know whether the tablet, an herb-based remedy for jet lag, worked as advertised. Researchers have found no evidence that such preparations are effective, and Ms. Solomon knows that most doctors would scoff that she was wasting her money.
Yet she swears by the tablets, as well as other alternative remedies, for reasons she acknowledges are partly psychological.
"I guess I do believe in the power of simply paying attention to your health, which in a way is what I'm doing," said Ms. Solomon, who runs a Web consulting business in Los Angeles. "But I also believe there are simply a lot of unknowns when it comes to staying healthy, and if there's a possibility something will help I'm willing to try it."
Besides, she added, "whatever I'm doing is working, so I'm going to keep doing it."
The most telling evidence of Americans' dissatisfaction with traditional health care is the more than $27 billion they spend annually on alternative and complementary medicine, according to government estimates. In ways large and small, millions of people are taking active steps to venture outside the mainstream, whether by taking the herbal remedy echinacea for a cold or by placing their last hopes for cancer cure in alternative treatment, as did Coretta Scott King, who died this week at an alternative hospice clinic in Mexico.
They do not appear to care that there is little, if any, evidence that many of the therapies work. Nor do they seem to mind that alternative therapy practitioners have a fraction of the training mainstream doctors do or that vitamin and herb makers are as profit-driven as drug makers.
This straying from conventional medicine is often rooted in a sense of disappointment, even betrayal, many patients and experts say. When patients see conventional medicine's inadequacies up close — a misdiagnosis, an intolerable drug, failed surgery, even a dismissive doctor — many find the experience profoundly disillusioning, or at least eye-opening.
Haggles with insurance providers, conflicting findings from medical studies and news reports of drug makers' covering up product side effects all feed their disaffection, to the point where many people begin to question not only the health care system but also the science behind it. Soon, intuition and the personal experience of friends and family may seem as trustworthy as advice from a doctor in diagnosing an illness or judging a treatment.
Experts say that people with serious medical problems like diabetes or cancer are least likely to take their chances with natural medicine, unless their illness is terminal. Consumers generally know that quackery is widespread in alternative practices, that there is virtually no government oversight of so-called natural remedies and that some treatments, like enemas, can be dangerous.
Still, 48 percent of American adults used at least one alternative or complementary therapy in 2004, up from 42 percent a decade ago, a figure that includes students and retirees, soccer moms and truckers, New Age seekers and religious conservatives. The numbers continue to grow, experts say, for reasons that have as much to do with increasing distrust of mainstream medicine and the psychological appeal of nontraditional approaches as with the therapeutic properties of herbs or other supplements.
"I think there is a powerful element of nostalgia at work for many people, for home remedies — for what healing is supposed to be — combined with an idealized vision of what is natural and whole and good, " said Dr. Linda Barnes, a medical anthropologist at Boston University School of Medicine.
Dr. Barnes added, "People look around and feel that the conventional system does not measure up, and that something deeper about their well-being is not being addressed at all."
Healthy and Dabbling
Ms. Solomon's first small steps outside the mainstream came in 1991, after she watched her mother die of complications from a hysterectomy.
"I saw doctors struggling to save her," she said. "They were trying really hard, and I have great respect for what they do, but at that point I realized the doctors could only do so much."
She decided then that she needed to take more responsibility for her own health, by eating better, exercising more and seeking out health aids that she thought of as natural, meaning not prescribed by a doctor or developed by a pharmaceutical company.
"I usually stay away from drugs if I can, because the side effects even of cough and cold medicines can be pretty strong," she said.
The herbal preparations she uses, she said, "have no side effects, and the difference in my view is that they help support my own body's natural capability, to fight off disease" rather than treat symptoms.
If these sentiments are present in someone like Ms. Solomon, who regularly consults her internist and describes herself as "pretty mainstream," they run far deeper in millions of other people who use nontraditional therapies more often.
In interviews and surveys, these patients often described prescription drugs as poisons that mostly mask symptoms without improving their underlying cause.
Many extend their suspicions further. In a 2004 study, researchers at the University of Arizona conducted interviews with a group of men and women in Tucson who suffered from chronic arthritis, most of whom regularly used alternative therapies. Those who used alternative methods exclusively valued the treatments on the "rightness of fit" above other factors, and they were inherently skeptical of the health care system.
Distrust in the medical industrial complex, as some patients call it, stems in part from suspicions that insurers warp medical decision making, and in part from the belief that drug companies are out to sell as many drugs as possible, regardless of patients' needs, interviews show.
"I do partly blame the drug companies and the money they make" for the breakdown in trust in the medical system, said Joyce Newman, 74, of Lynnwood Wash., who sees a natural medicine specialist as her primary doctor. "The time when you would listen to your doctor and do whatever he said — that time is long gone, in my opinion. You have to learn to use your own head."
From here it is a small step to begin doubting medical science. If Western medicine is imperfect and sometimes corrupt, then mainstream doctors may not be the best judge of treatments after all, many patients conclude. People's actual experience — the personal testimony of friends and family, in particular — feels more truthful.
To best way to validate this, said Ms. Newman and many others who regularly use nontraditional therapies, is simply to try a remedy "and listen to your own body."
Opting Out
Cynthia Riley effectively opted out of mainstream medicine when it seemed that doctors were not listening to her.
During a nine-year period that ended in 2004, Ms. Riley, 47, visited almost 20 doctors, for a variety of intermittent and strange health complaints: blurred vision, urinary difficulties, balance problems so severe that at times she wobbled like a drunk.
She felt unwell most of the time, but doctors could not figure out what she had.
Each specialist ordered different tests, depending on the symptom, Ms. Riley said, but they were usually rushed and seemed to solicit her views only as a formality.
Undeterred, Ms. Riley, an event planner who lives near New London, Conn., typed out a four-page description of her ordeal, including her suspicion that she suffered from lead poisoning. One neurologist waved the report away as if insulted; another barely skimmed it, she said.
"I remember sitting in one doctor's office and realizing, 'He thinks I'm crazy,' " Ms. Riley said. "I was getting absolutely nowhere in conventional medicine, and I was determined to get to the root of my problems."
Through word of mouth, Ms. Riley heard about Deirdre O'Connor, a naturopath with a thriving practice in nearby Mystic, Conn., and made an appointment.
In recent years, people searching for something outside of conventional medicine have increasingly turned to naturopaths, herbal specialists who must complete a degree that includes some standard medical training in order to be licensed, experts say. Fourteen states, including California and Connecticut, now license naturopaths to practice medicine. Natural medicine groups are pushing for similar legislation in other states, including New York.
Licensed naturopaths can prescribe drugs from an approved list in some states, but have no prescribing rights in others.
Right away, Ms. Riley said, she noticed a difference in the level of service. Before even visiting the office, she received a fat envelope in the mail containing a four-page questionnaire, she said. In addition to asking detailed questions about medical history — standard information — it asked about energy level, foods she craved, sensitivity to weather and self-image: "Please list adjectives that describe you," read one item.
"It felt right, from the beginning," Ms. Riley said.
Her first visit lasted an hour and a half, and Ms. O'Connor, the naturopath, agreed that metal exposure was a possible cause of her symptoms. It emerged in their interview that Ms. Riley had worked in the steel industry, and tests of her hair and urine showed elevated levels of both lead and mercury, Ms. O'Connor said.
After taking a combination of herbs, vitamins and regular doses of a drug called dimercaptosuccinic acid, or DMSA, to treat lead poisoning, Ms. Riley said, she began to feel better, and the symptoms subsided.
Along the way, Ms. O'Connor explained the treatments to Ms. Riley, sometimes using drawings, and called her patient regularly to check in, especially during the first few months, Ms. Riley said.
Other doctors said they could not comment on Ms. Riley's case because they had not examined her. Researchers who specialize in lead poisoning say that it is rare in adults but that it can cause neurological symptoms and bladder problems and is often missed by primary care doctors.
Dr. Herbert Needleman, a psychiatrist who directs the lead research group at the University of Pittsburgh, said DMSA was the pharmaceutical treatment of choice for high blood lead levels.
Researchers say there is little or no evidence that vitamins or herbs can relieve symptoms like Ms. Riley's. Still, she said, "I look and feel better than I have in years."
Life and Death
Diane Paradise bet her life on the uncertain benefits of natural medicine, after being burned physically and emotionally by conventional doctors.
In 1995, doctors told Ms. Paradise, now 35, that she had Hodgkin's disease. After a six-month course of chemotherapy and radiation, she said, she was declared cancer free, and she remained healthy for five years.
But in 2001 the cancer reappeared, more advanced, and her doctors recommended a 10-month course of drugs and radiation, plus a marrow transplant, she said.
Ms. Paradise, a marketing consultant in Rochester, N.Y., balked.
"I was burned badly the first time around, third-degree burns, and now they were talking about 10 months," she said in an interview, "and they were giving me no guarantees; they said it was experimental. That's when I started looking around. I really had nothing to lose, and I was focused on quality of life at that point, not quantity."
When she told one of her doctors that she was considering an alternative treatment in Arizona, the man exploded, she said.
"His exact words were, 'That's not treatment, that's a vacation — you're wasting your time!' " she said.
And so ended the relationship. With help from friends, Ms. Paradise raised about $40,000 to pay for the Arizona clinic's treatment, plus living expenses while there.
"I had absolutely no scientific reason for choosing this route, none," she said. "I just think there are times in our life when we are asked to make decisions based on our intuition, on our gut instinct, not based on evidence put in front of us, and for me this was one of those moments."
Cancer researchers say that there is no evidence that vitamins, herbs or other alternative therapies can cure cancer, and they caution that some regimens may worsen the disease.
But Ms. Paradise said that her relationship with the natural medicine specialist in Arizona had been collaborative and that she had felt "more empowered, more involved" in the treatment plan, which included large doses of vitamins, as well as changes in diet and sleep routines. After four months on the regimen, she said, she felt much better.
But the cancer was not cured. It has resurfaced recently and spread, and this time Ms. Paradise has started an experimental treatment with an oncologist in New York.
She is complementing this treatment, she said, with another course of alternative therapy in Arizona. She moved in with friends near Phoenix and started the alternative regime in January.
"It's 79 degrees and beautiful here," she said by phone in mid-January. "Let's hope that's a good sign."
For all their suspicions and questions about conventional medicine, those who venture outside the mainstream tend to have one thing in abundance, experts say: hope. In a 1998 survey of more than 1,000 adults from around the country, researchers found that having an interest in "personal growth or spirituality" predicted alternative medicine use.
Nontraditional healers know this, and they often offer some spiritual element in their practice, if they think it is appropriate. David Wood, a naturopath who with his wife, Cheryl, runs a large, Christian-oriented practice in Lynnwood, Wash., said he treated patients of all faiths.
"We pray with patients, with their permission," said Mr. Wood, who also works with local medical doctors when necessary. "If patients would not like us to pray for them, we don't, but it's there if needed."
He added, "Our goal here is to help people get really well, not merely free of symptoms."
That is exactly the sentiment that many Americans say they feel is missing from conventional medicine. Whatever the benefits and risks of its many concoctions and methods, alternative medicine offers them at least the promise of affectionate care, unhurried service, freedom from prescription drug side effects and the potential for feeling not just better but also spiritually recharged.
"I don't hate doctors or anything," Ms. Newman said. "I just know they can make mistakes, and so often they refer you on to see another doctor, and another."
Seeing a naturopath, she said, "I feel I'm known, they see me as a whole person, they listen to what I say."
Read entire article at the original source
Sunday, December 16, 2007
Despite Appearances, Science Doesn't Deny The Existence of God
Despite Appearances, Science Doesn't Deny The Existence of God
By SHARON BEGLEY
Staff Reporter of THE WALL STREET JOURNAL
January 27, 2006
Pierre Laplace didn't do science any favors when he let Napoleon provoke him.
After reading the French mathematician's opus on celestial mechanics -- the movements of planets -- the emperor asked him why the treatise, unlike the work of Isaac Newton, made no mention of God. Laplace reportedly replied, in a huff, that he had no need of that hypothesis.
Ever since, science has been saddled with the canard that it arbitrarily and a priori rules out the existence of a deity. When the Kansas board of education deleted the words "natural explanations" from the definition of science last year, it seemed like an effort to right that supposed wrong. But those who attack science as anti-God are fighting a mirage, say both secular and religious scholars.
"It is a serious error to arbitrarily insert God or the supernatural as explanations for scientific mysteries," says biologist Richard Colling of the evangelical Olivet Nazarene University, Bourbonnais, Ill. "But it is equally unjustified to claim science excludes God." As Barbara Forrest, a philosopher of science at Southeastern Louisiana University, Hammond, explains, "Science doesn't rule out anything a priori. Saying it does is false, and makes science look dogmatic."
Even to those who have never heard of Laplace, it's easy to get the idea that science starts with an atheistic, or at least agnostic, presumption. A report by the quasigovernmental National Academy of Sciences says science "is limited to explaining the natural world through natural causes." The National Science Teachers Association says science "cannot use supernatural causation in its explanations" and calls supernatural forces "outside its provenance."
Although both definitions make it sound as though science rules out the supernatural from the get-go, what actually happens is that working scientists simply find that entertaining a supernatural explanation doesn't get them very far. In that sense, argues Thomas Clark, director of the Center for Naturalism, a nonprofit educational group in Somerville, Mass., "Science doesn't presume the natural-supernatural distinction; it generates it" by dividing what works from what doesn't.
The supernatural is a dead end because science strives for testable explanations and predictions: The sun will rise in the east because Earth spins west to east, not because "God wanted it that way." Since only the most arrogant would claim the ability to predict what He will do next (and would likely be struck dead for hubris anyway), supernatural explanations fail as science. It isn't that they don't fit science's preconceptions, but that they don't get you anywhere in either deeper understanding or predictive power.
"What science is is settled methodologically," says Prof. Forrest. "It's not that science rules out the supernatural as a precondition. But scientists want to apprehend the world, and there is no procedure for studying the supernatural. God is not a controlled variable."
Although science can consider any hypothesis, natural or supernatural, a scientist who entertains the possibility of the supernatural will quickly reach a dead end. Consider the hypothesis, "Angry gods make volcanoes erupt." It doesn't get you anywhere -- not predictively (how do you know when a god will be mad?) and not mechanistically (how does the angry god make lava and gas explode out of the volcano?). Including unspecifiable processes doesn't advance understanding. As a classic Sidney Harris cartoon showed, the explanation "then a miracle occurs" doesn't cut it.
"Unless you specify the agent, its purposes and characteristics, it's an explanatory dodge," says Mr. Clark. "Agents have to be described specifically enough to be verified."
That includes specifying when and how a supernatural agent intervenes in nature. If you want to credit the supernatural with designing human beings, for instance, you have to specify why it built in autoimmune diseases, put remnants of old viral DNA in our genes, spliced in repetitive breakage-prone DNA that causes awful diseases, and took away one enzyme in the biochemical pathway that makes vitamin C but left the rest to hang around uselessly. "Working in mysterious ways" falls short. A scientific explanation must account for why one thing happens and another doesn't.
Prof. Colling, a lifelong Christian, argues that foregoing supernatural explanations "should not bother religious folks. God is not a micromanager." Explaining wondrous phenomena naturally "expands our comprehension of the created order." None of this is to deny the supernatural, just to say that it doesn't work in science. Students "are being told that they must choose between scientific reality and God," he says. "Nothing could be further from the truth."
If scientists ever bring the supernatural into science by specifying how it works and predicting what it will do next, the result may not be to the liking of those pushing for science to include God. The supernatural "will then generate reliable, predictive knowledge," notes Mr. Clark, and become just another explicable, predictable force of nature, stripped of its awe and mystery.
Read entire article at the original source
By SHARON BEGLEY
Staff Reporter of THE WALL STREET JOURNAL
January 27, 2006
Pierre Laplace didn't do science any favors when he let Napoleon provoke him.
After reading the French mathematician's opus on celestial mechanics -- the movements of planets -- the emperor asked him why the treatise, unlike the work of Isaac Newton, made no mention of God. Laplace reportedly replied, in a huff, that he had no need of that hypothesis.
Ever since, science has been saddled with the canard that it arbitrarily and a priori rules out the existence of a deity. When the Kansas board of education deleted the words "natural explanations" from the definition of science last year, it seemed like an effort to right that supposed wrong. But those who attack science as anti-God are fighting a mirage, say both secular and religious scholars.
"It is a serious error to arbitrarily insert God or the supernatural as explanations for scientific mysteries," says biologist Richard Colling of the evangelical Olivet Nazarene University, Bourbonnais, Ill. "But it is equally unjustified to claim science excludes God." As Barbara Forrest, a philosopher of science at Southeastern Louisiana University, Hammond, explains, "Science doesn't rule out anything a priori. Saying it does is false, and makes science look dogmatic."
Even to those who have never heard of Laplace, it's easy to get the idea that science starts with an atheistic, or at least agnostic, presumption. A report by the quasigovernmental National Academy of Sciences says science "is limited to explaining the natural world through natural causes." The National Science Teachers Association says science "cannot use supernatural causation in its explanations" and calls supernatural forces "outside its provenance."
Although both definitions make it sound as though science rules out the supernatural from the get-go, what actually happens is that working scientists simply find that entertaining a supernatural explanation doesn't get them very far. In that sense, argues Thomas Clark, director of the Center for Naturalism, a nonprofit educational group in Somerville, Mass., "Science doesn't presume the natural-supernatural distinction; it generates it" by dividing what works from what doesn't.
The supernatural is a dead end because science strives for testable explanations and predictions: The sun will rise in the east because Earth spins west to east, not because "God wanted it that way." Since only the most arrogant would claim the ability to predict what He will do next (and would likely be struck dead for hubris anyway), supernatural explanations fail as science. It isn't that they don't fit science's preconceptions, but that they don't get you anywhere in either deeper understanding or predictive power.
"What science is is settled methodologically," says Prof. Forrest. "It's not that science rules out the supernatural as a precondition. But scientists want to apprehend the world, and there is no procedure for studying the supernatural. God is not a controlled variable."
Although science can consider any hypothesis, natural or supernatural, a scientist who entertains the possibility of the supernatural will quickly reach a dead end. Consider the hypothesis, "Angry gods make volcanoes erupt." It doesn't get you anywhere -- not predictively (how do you know when a god will be mad?) and not mechanistically (how does the angry god make lava and gas explode out of the volcano?). Including unspecifiable processes doesn't advance understanding. As a classic Sidney Harris cartoon showed, the explanation "then a miracle occurs" doesn't cut it.
"Unless you specify the agent, its purposes and characteristics, it's an explanatory dodge," says Mr. Clark. "Agents have to be described specifically enough to be verified."
That includes specifying when and how a supernatural agent intervenes in nature. If you want to credit the supernatural with designing human beings, for instance, you have to specify why it built in autoimmune diseases, put remnants of old viral DNA in our genes, spliced in repetitive breakage-prone DNA that causes awful diseases, and took away one enzyme in the biochemical pathway that makes vitamin C but left the rest to hang around uselessly. "Working in mysterious ways" falls short. A scientific explanation must account for why one thing happens and another doesn't.
Prof. Colling, a lifelong Christian, argues that foregoing supernatural explanations "should not bother religious folks. God is not a micromanager." Explaining wondrous phenomena naturally "expands our comprehension of the created order." None of this is to deny the supernatural, just to say that it doesn't work in science. Students "are being told that they must choose between scientific reality and God," he says. "Nothing could be further from the truth."
If scientists ever bring the supernatural into science by specifying how it works and predicting what it will do next, the result may not be to the liking of those pushing for science to include God. The supernatural "will then generate reliable, predictive knowledge," notes Mr. Clark, and become just another explicable, predictable force of nature, stripped of its awe and mystery.
Read entire article at the original source
Most Cough Medicines Don't Do a Thing -- Here's What Works
Most Cough Medicines Don't Do a Thing -- Here's What Works
By TARA PARKER-POPE
Staff Reporter of THE WALL STREET JOURNAL
January 10, 2006
Every year consumers spend billions on cough medicines, but a new report from the nation's top chest doctors says many of them don't work.
The finding was issued by the American College of Chest Physicians as part of its comprehensive guidelines for dealing with various forms of cough. The doctors group reviewed numerous medical studies evaluating cough preparations and concluded that many of the key ingredients in popular cough and cold medications simply aren't effective in quieting coughs caused by the common cold.
But there was good news as well. The group concluded that the ingredients found in certain older allergy medications and pain relievers are actually far more effective against cough, even though they aren't marketed as cough treatments.
Among other findings, the group concluded that the drug guaifenesin -- an expectorant found in popular brands such as Wyeth's Robitussin and Mucinex from Adams Respiratory Therapeutics in Chester, N.J. -- is ineffective in curbing cough caused by the common cold. The drug is supposed to work by thinning the mucus and making it easier to cough up phlegm. But among four studies evaluating guaifenesin compared with a placebo, two studies showed benefit while two showed no improvement. As a result, the panel concluded there isn't enough evidence to support its use to help cough caused by colds.
The panel also considered two popular cough suppressants, codeine and dextromethorphan, which potentially work by quieting the brain's cough center. Although the drugs may be effective against certain types of coughs -- like those associated with cancer -- these drugs don't work against cough due to colds, says Richard Irwin, professor of medicine at University of Massachusetts Medical School in Worcester, Mass., and editor in chief of the ACCP guidelines. In addition, codeine, even in large doses, hasn't been shown to work on cough due to a common cold, says Dr. Irwin.
Wyeth, the maker of the Robitussin line of cough products, which contain guaifenesin and dextromethorphan, says the group's findings run counter to conclusions by the Food and Drug Administration, which found the ingredients to be both safe and effective during a sweeping review of over-the-counter cough and cold remedies more than a decade ago.
"Robitussin has a long history of being sold, and it has a loyal following of customers," says Francis Sullivan, spokesman for the Wyeth Consumer Healthcare unit in Madison, N.J. "We believe that if the product didn't work these customers wouldn't purchase it."
Dr. Irwin says one explanation for the popularity of cough remedies might be the placebo effect -- which is a positive reaction to an inactive substance that the patient believes will work. In cough studies, the placebo effect has been shown to be as high as 40%.
The Chest panel also concluded that products containing zinc also are ineffective against cough due to colds. The herb echinacea has also been shown to be ineffective against cough.
The panel did conclude that some older antihistamines -- the kind that make you drowsy -- can be effective against cough caused by a cold. The medication in the drugs that makes you sleepy is the same drug that dries up the secretions in the back of the throat that can contribute to cough. The drugs may also act on the brain center to suppress cough, although how they work isn't entirely clear.
Drugs that may help quiet a cough due to cold include diphenhydramine, the active ingredient in Benadryl, dexbrompheniramine, an active ingredient in Drixoral, and chlorpheniramine, the active ingredient in Chlortrimeton.
Drugs like Benadryl and other drowsiness-inducing antihistamines aren't for everyone. The drowsy side effect is a real concern for people who must operate equipment or drive, and men with prostate problems may suffer additional side effects, such as difficulty urinating. "People think all antihistamines are equal, but it's not the case," says Dr. Irwin.
Many newer antihistamines have been altered so as to not make patients drowsy -- a major selling point of the drugs. However, the change that makes them nondrowsy also may render them ineffective against cough, notes Dr. Irwin.
Pain relievers called nonsteroidal anti-inflammatory drugs, such as naproxen, the active ingredient in Aleve, also may help patients with cough caused by cold. In studies naproxen has been shown to decrease the severity and frequency of cough. As a result, doctors believe it's likely similar drugs, such as the ibuprofen found in Advil, might also help relieve cold-related cough. The drugs may cause stomach upset or increase risk for serious gastrointestinal problems. One study has also linked naproxen with a higher risk for heart problems, although the finding remains controversial.
While the guidelines generally dispute the notion that most over-the-counter cough remedies help coughs due to colds, there is some evidence that drugs like dextromethorphan might help other types of coughs, such as those due to bronchitis.
As a result, it's important that patients with a nagging cough seek a doctor's advice on how to best treat it. Patients also should read the label, because different versions of the same brand often contain different active ingredients. "There are medicines that do work for just about all conditions that cause cough," says Dr. Irwin. "I would think people would want to take a medicine that's got a pretty good chance of working."
Read entire article at original source
By TARA PARKER-POPE
Staff Reporter of THE WALL STREET JOURNAL
January 10, 2006
Every year consumers spend billions on cough medicines, but a new report from the nation's top chest doctors says many of them don't work.
The finding was issued by the American College of Chest Physicians as part of its comprehensive guidelines for dealing with various forms of cough. The doctors group reviewed numerous medical studies evaluating cough preparations and concluded that many of the key ingredients in popular cough and cold medications simply aren't effective in quieting coughs caused by the common cold.
But there was good news as well. The group concluded that the ingredients found in certain older allergy medications and pain relievers are actually far more effective against cough, even though they aren't marketed as cough treatments.
Among other findings, the group concluded that the drug guaifenesin -- an expectorant found in popular brands such as Wyeth's Robitussin and Mucinex from Adams Respiratory Therapeutics in Chester, N.J. -- is ineffective in curbing cough caused by the common cold. The drug is supposed to work by thinning the mucus and making it easier to cough up phlegm. But among four studies evaluating guaifenesin compared with a placebo, two studies showed benefit while two showed no improvement. As a result, the panel concluded there isn't enough evidence to support its use to help cough caused by colds.
The panel also considered two popular cough suppressants, codeine and dextromethorphan, which potentially work by quieting the brain's cough center. Although the drugs may be effective against certain types of coughs -- like those associated with cancer -- these drugs don't work against cough due to colds, says Richard Irwin, professor of medicine at University of Massachusetts Medical School in Worcester, Mass., and editor in chief of the ACCP guidelines. In addition, codeine, even in large doses, hasn't been shown to work on cough due to a common cold, says Dr. Irwin.
Wyeth, the maker of the Robitussin line of cough products, which contain guaifenesin and dextromethorphan, says the group's findings run counter to conclusions by the Food and Drug Administration, which found the ingredients to be both safe and effective during a sweeping review of over-the-counter cough and cold remedies more than a decade ago.
"Robitussin has a long history of being sold, and it has a loyal following of customers," says Francis Sullivan, spokesman for the Wyeth Consumer Healthcare unit in Madison, N.J. "We believe that if the product didn't work these customers wouldn't purchase it."
Dr. Irwin says one explanation for the popularity of cough remedies might be the placebo effect -- which is a positive reaction to an inactive substance that the patient believes will work. In cough studies, the placebo effect has been shown to be as high as 40%.
The Chest panel also concluded that products containing zinc also are ineffective against cough due to colds. The herb echinacea has also been shown to be ineffective against cough.
The panel did conclude that some older antihistamines -- the kind that make you drowsy -- can be effective against cough caused by a cold. The medication in the drugs that makes you sleepy is the same drug that dries up the secretions in the back of the throat that can contribute to cough. The drugs may also act on the brain center to suppress cough, although how they work isn't entirely clear.
Drugs that may help quiet a cough due to cold include diphenhydramine, the active ingredient in Benadryl, dexbrompheniramine, an active ingredient in Drixoral, and chlorpheniramine, the active ingredient in Chlortrimeton.
Drugs like Benadryl and other drowsiness-inducing antihistamines aren't for everyone. The drowsy side effect is a real concern for people who must operate equipment or drive, and men with prostate problems may suffer additional side effects, such as difficulty urinating. "People think all antihistamines are equal, but it's not the case," says Dr. Irwin.
Many newer antihistamines have been altered so as to not make patients drowsy -- a major selling point of the drugs. However, the change that makes them nondrowsy also may render them ineffective against cough, notes Dr. Irwin.
Pain relievers called nonsteroidal anti-inflammatory drugs, such as naproxen, the active ingredient in Aleve, also may help patients with cough caused by cold. In studies naproxen has been shown to decrease the severity and frequency of cough. As a result, doctors believe it's likely similar drugs, such as the ibuprofen found in Advil, might also help relieve cold-related cough. The drugs may cause stomach upset or increase risk for serious gastrointestinal problems. One study has also linked naproxen with a higher risk for heart problems, although the finding remains controversial.
While the guidelines generally dispute the notion that most over-the-counter cough remedies help coughs due to colds, there is some evidence that drugs like dextromethorphan might help other types of coughs, such as those due to bronchitis.
As a result, it's important that patients with a nagging cough seek a doctor's advice on how to best treat it. Patients also should read the label, because different versions of the same brand often contain different active ingredients. "There are medicines that do work for just about all conditions that cause cough," says Dr. Irwin. "I would think people would want to take a medicine that's got a pretty good chance of working."
Read entire article at original source
Better Final Days
Better Final Days
By Shannon Brownlee, New America Foundation
Los Angeles Times | November 26, 2005
Whenever Americans stop to think about how they want to die, most conclude that they don't want to spend their last days in a hospital bed. They don't want to be stuck in an intensive care unit unnecessarily, or hooked up to machines if they can possibly avoid it. And they do not want a lot of tests and procedures, especially painful ones, if undergoing them won't improve their chances of surviving -- or at least make their passing a little easier.
But that's exactly the sort of high-tech death thousands of elderly patients with chronic illnesses are suffering, depending on which hospital they find themselves in during the last two years of life. A landmark study, published by a team of Dartmouth University researchers in the journal Health Affairs last week, looked at the care received by Medicare recipients who died in 226 California hospitals between 1999 and 2003.
The study found huge variations in the amount of care being delivered in different hospitals to similar, chronically ill patients. Let's look first at UCLA Medical Center, a hospital that is renowned for its geriatric services. The average Medicare recipient who died there spent 19 days in the hospital during the last two years of life, 11 of them in the ICU. He saw a doctor in the hospital 52 times, and Medicare paid $71,922 for his care.
At Garfield Medical Center in Monterey Park, the average patient fared worse: He spent 23 days in the hospital, saw a doctor a whopping 92 times and cost Medicare $106,254.
But if that same patient had lived instead near UC Davis, he would have been hospitalized for just over 11 days, been in the ICU for about seven days and seen one-quarter the number of doctors for a cost to Medicare of $55,323.
Did the extra care make these chronically ill patients live longer or better? Probably not, according to a previous study by the Dartmouth team. That study, published in 2003 in the Annals of Internal Medicine, concluded that Medicare patients in higher-spending regions "receive more care than those in lower-spending regions but do not have better health outcomes."
Hospitals will correctly argue that there's no way to know ahead of time which patients are likely to recover with aggressive treatment and which are in their last few months of life. And academic medical centers such as UCLA will say they provide more care because they attract sicker patients.
But are the hospitals that are spending the most any better at helping patients get well? Most patients would agree that all those days in the hospital, doctor visits and often unpleasant tests and treatments would be worth it if it actually made a difference in the quality and length of their lives. But a growing body of research suggests that it does not. And more spending does not mean that hospitals are better at delivering proven treatments, like pneumonia vaccines or beta blockers for patients admitted to the hospital with a heart attack. In fact, patients in hospitals delivering the most intensive care were often less likely to get tests and treatments that are known to work, according to the latest California study as well as previous research.
What's more, winding up in those intensive-care hospitals may actually increase a patient's chances of dying by as much as 2% to 6%. That's because hospitals, for all their power to deliver lifesaving treatments, can also be dangerous places where every drug, every treatment, every test carries the risk of error and harm.
Americans have come to believe that more healthcare equals better health. But what these studies show is that's not always true. And as anybody who has spent time in an ICU can tell you, a lot of treatment for terminal conditions can certainly make a misery of a patient's final few weeks of life.
Certainly hospitals such as Garfield and UCLA, and the doctors who work in them, generally don't think they are delivering excess care--or that they are failing to provide needed care. But doctors and hospitals are paid more for doing more, not for doing better. They often profit from giving excess care and lose money when they provide some kinds of care that really makes a difference, such as monitoring a heart failure patient once he goes home.
Those who study healthcare also note that the supply of medical resources -- not how sick the patients are -- often determines what care patients get. The more beds a hospital has, the more patients will be hospitalized, and the more MRI machines a hospital buys, the more scans will be ordered. And as much as Americans like being able to see their specialists, having more specialists involved can complicate care.
How can this problem be fixed? Patients and their distraught families cannot possibly be expected to decide what kind of care is appropriate. It's up to insurers, Medicare and Congress to restructure the financial incentives to make sure that good care pays.
Whenever payers begin talking about cutting costs, Americans begin worrying about rationing. It would be rationing if hospitals or insurers were to withhold effective care in order to save money. This isn't about denying elderly patients treatment that could help them; it's about not inflicting expensive treatments that aren't likely to improve or substantially prolong their lives.
Before Americans broach the topic of rationing, we ought first to make our hospitals deliver better care more efficiently. If every hospital in the country were to hit the benchmark of those that keep unneeded care down and quality up, it would reduce Medicare costs by 30%.
The Dartmouth group is working on a similar study of hospitals across the nation. Acting on its findings could go a long way toward averting the fiscal train wreck that is facing Medicare in the next 50 years, when costs are projected to rise to $2.67 trillion. It might also make the end of life a little easier for millions of Americans.
Read the entire article at the original source
By Shannon Brownlee, New America Foundation
Los Angeles Times | November 26, 2005
Whenever Americans stop to think about how they want to die, most conclude that they don't want to spend their last days in a hospital bed. They don't want to be stuck in an intensive care unit unnecessarily, or hooked up to machines if they can possibly avoid it. And they do not want a lot of tests and procedures, especially painful ones, if undergoing them won't improve their chances of surviving -- or at least make their passing a little easier.
But that's exactly the sort of high-tech death thousands of elderly patients with chronic illnesses are suffering, depending on which hospital they find themselves in during the last two years of life. A landmark study, published by a team of Dartmouth University researchers in the journal Health Affairs last week, looked at the care received by Medicare recipients who died in 226 California hospitals between 1999 and 2003.
The study found huge variations in the amount of care being delivered in different hospitals to similar, chronically ill patients. Let's look first at UCLA Medical Center, a hospital that is renowned for its geriatric services. The average Medicare recipient who died there spent 19 days in the hospital during the last two years of life, 11 of them in the ICU. He saw a doctor in the hospital 52 times, and Medicare paid $71,922 for his care.
At Garfield Medical Center in Monterey Park, the average patient fared worse: He spent 23 days in the hospital, saw a doctor a whopping 92 times and cost Medicare $106,254.
But if that same patient had lived instead near UC Davis, he would have been hospitalized for just over 11 days, been in the ICU for about seven days and seen one-quarter the number of doctors for a cost to Medicare of $55,323.
Did the extra care make these chronically ill patients live longer or better? Probably not, according to a previous study by the Dartmouth team. That study, published in 2003 in the Annals of Internal Medicine, concluded that Medicare patients in higher-spending regions "receive more care than those in lower-spending regions but do not have better health outcomes."
Hospitals will correctly argue that there's no way to know ahead of time which patients are likely to recover with aggressive treatment and which are in their last few months of life. And academic medical centers such as UCLA will say they provide more care because they attract sicker patients.
But are the hospitals that are spending the most any better at helping patients get well? Most patients would agree that all those days in the hospital, doctor visits and often unpleasant tests and treatments would be worth it if it actually made a difference in the quality and length of their lives. But a growing body of research suggests that it does not. And more spending does not mean that hospitals are better at delivering proven treatments, like pneumonia vaccines or beta blockers for patients admitted to the hospital with a heart attack. In fact, patients in hospitals delivering the most intensive care were often less likely to get tests and treatments that are known to work, according to the latest California study as well as previous research.
What's more, winding up in those intensive-care hospitals may actually increase a patient's chances of dying by as much as 2% to 6%. That's because hospitals, for all their power to deliver lifesaving treatments, can also be dangerous places where every drug, every treatment, every test carries the risk of error and harm.
Americans have come to believe that more healthcare equals better health. But what these studies show is that's not always true. And as anybody who has spent time in an ICU can tell you, a lot of treatment for terminal conditions can certainly make a misery of a patient's final few weeks of life.
Certainly hospitals such as Garfield and UCLA, and the doctors who work in them, generally don't think they are delivering excess care--or that they are failing to provide needed care. But doctors and hospitals are paid more for doing more, not for doing better. They often profit from giving excess care and lose money when they provide some kinds of care that really makes a difference, such as monitoring a heart failure patient once he goes home.
Those who study healthcare also note that the supply of medical resources -- not how sick the patients are -- often determines what care patients get. The more beds a hospital has, the more patients will be hospitalized, and the more MRI machines a hospital buys, the more scans will be ordered. And as much as Americans like being able to see their specialists, having more specialists involved can complicate care.
How can this problem be fixed? Patients and their distraught families cannot possibly be expected to decide what kind of care is appropriate. It's up to insurers, Medicare and Congress to restructure the financial incentives to make sure that good care pays.
Whenever payers begin talking about cutting costs, Americans begin worrying about rationing. It would be rationing if hospitals or insurers were to withhold effective care in order to save money. This isn't about denying elderly patients treatment that could help them; it's about not inflicting expensive treatments that aren't likely to improve or substantially prolong their lives.
Before Americans broach the topic of rationing, we ought first to make our hospitals deliver better care more efficiently. If every hospital in the country were to hit the benchmark of those that keep unneeded care down and quality up, it would reduce Medicare costs by 30%.
The Dartmouth group is working on a similar study of hospitals across the nation. Acting on its findings could go a long way toward averting the fiscal train wreck that is facing Medicare in the next 50 years, when costs are projected to rise to $2.67 trillion. It might also make the end of life a little easier for millions of Americans.
Read the entire article at the original source
Myth: Hospitals Keep You Safe from Germs
Myth: Hospitals Keep You Safe from Germs
Hospital Infections Kill Tens of Thousands Every Year
ABC News
Oct. 14, 2005
There's a deadly threat hiding inside America's hospitals. What's even scarier, your hospital is probably keeping it a secret.
Maureen Daly's mother was a healthy 63-year-old woman when she had surgery to fix a broken shoulder. However, after being admitted to the hospital, Daly's mother got an infection that left her immobilized on a respirator. Daly was told that life-threatening germs are an inevitable fact of hospital life.
Daly was shocked. "I cannot accept that it would be a fact of life that you can walk into a hospital with a broken shoulder and leave practically dead," she said.
Her mother died four months later.
Betsy McCaughey, former lieutenant governor of New York and founder of the Committee to Reduce Infection Deaths, said, "These infections kill as many people each year in our country as AIDS, breast cancer and auto accidents combined."
McCaughey said it's secrecy that's allowed the problem to grow. "Most states have not required hospitals to report their infections, or provide that information to the public," she said.
Pennsylvania is one of only six states that has passed a law requiring the reporting of infections. Experts say public disclosure forces hospitals to reduce infection rates. Dr. Rick Shannon, chief of medicine at Allegheny General Hospital in Pittsburgh, looked at the data on patients in the hospital's intensive care units. He was stunned.
"Fifty-one percent of everyone who got these infections died. Half the people who got one died," he said. Dr. Shannon wasted no time. He gave an order to the ICU staff. Reduce hospital infections to zero -- in just 90 days.
Staff nurses said they didn't think it could be done.
But after just one week, the ICU staff identified the culprit. It wasn't a superbug -- it was the staff. And the fact they each had their own way of washing hands, changing dressings, and putting in catheters. "No one actually knew what the right way to do it was. And not knowing what the right way to do it was that all these little errors could creep in that would lead to infection," Dr. Shannon said.
Dr. Shannon and his team quickly found solutions, like putting in more hand-sanitizers and raising the head of the bed 30 degrees to prevent pneumonia. The results were unbelievable.
"Ninety days later, we went from 49 infections to zero," he said.
And the results a year later are equally impressive. Only one patient in the ICU has died from an infection.
McCaughey says it's important for the public to know about infection rates at hospitals. "The public has a right to this information. If you are going into the hospital, you should be able to find out which hospital in your area has a serious infection problem, so you can stay away from that hospital," she said. Her advocacy group is working to pass more state laws -- like Pennsylvania's -- requiring hospitals to release this data.
And McCaughey says there's a simple thing you can do to keep yourself safe from dangerous germs in any hospital.
"Ask doctors and nurses to clean their hands before touching you. If you are worried about being too aggressive, just remember, your life is at stake," she said.
Read entire article at the original source
Hospital Infections Kill Tens of Thousands Every Year
ABC News
Oct. 14, 2005
There's a deadly threat hiding inside America's hospitals. What's even scarier, your hospital is probably keeping it a secret.
Maureen Daly's mother was a healthy 63-year-old woman when she had surgery to fix a broken shoulder. However, after being admitted to the hospital, Daly's mother got an infection that left her immobilized on a respirator. Daly was told that life-threatening germs are an inevitable fact of hospital life.
Daly was shocked. "I cannot accept that it would be a fact of life that you can walk into a hospital with a broken shoulder and leave practically dead," she said.
Her mother died four months later.
Betsy McCaughey, former lieutenant governor of New York and founder of the Committee to Reduce Infection Deaths, said, "These infections kill as many people each year in our country as AIDS, breast cancer and auto accidents combined."
McCaughey said it's secrecy that's allowed the problem to grow. "Most states have not required hospitals to report their infections, or provide that information to the public," she said.
Pennsylvania is one of only six states that has passed a law requiring the reporting of infections. Experts say public disclosure forces hospitals to reduce infection rates. Dr. Rick Shannon, chief of medicine at Allegheny General Hospital in Pittsburgh, looked at the data on patients in the hospital's intensive care units. He was stunned.
"Fifty-one percent of everyone who got these infections died. Half the people who got one died," he said. Dr. Shannon wasted no time. He gave an order to the ICU staff. Reduce hospital infections to zero -- in just 90 days.
Staff nurses said they didn't think it could be done.
But after just one week, the ICU staff identified the culprit. It wasn't a superbug -- it was the staff. And the fact they each had their own way of washing hands, changing dressings, and putting in catheters. "No one actually knew what the right way to do it was. And not knowing what the right way to do it was that all these little errors could creep in that would lead to infection," Dr. Shannon said.
Dr. Shannon and his team quickly found solutions, like putting in more hand-sanitizers and raising the head of the bed 30 degrees to prevent pneumonia. The results were unbelievable.
"Ninety days later, we went from 49 infections to zero," he said.
And the results a year later are equally impressive. Only one patient in the ICU has died from an infection.
McCaughey says it's important for the public to know about infection rates at hospitals. "The public has a right to this information. If you are going into the hospital, you should be able to find out which hospital in your area has a serious infection problem, so you can stay away from that hospital," she said. Her advocacy group is working to pass more state laws -- like Pennsylvania's -- requiring hospitals to release this data.
And McCaughey says there's a simple thing you can do to keep yourself safe from dangerous germs in any hospital.
"Ask doctors and nurses to clean their hands before touching you. If you are worried about being too aggressive, just remember, your life is at stake," she said.
Read entire article at the original source
Antibiotics may not help sinus infections
Antibiotics may not help sinus infections
A study comparing the use of a placebo with the drug treatment finds little difference. Patience and over-the-counter remedies are recommended.
By Jia-Rui Chong
Los Angeles Times Staff Writer
December 5, 2007
The widespread use of standard antibiotics to treat sinus infections does not help cure patients and may harm them by increasing their resistance to the drugs, according to a study released Tuesday.
The researchers found that the percentage of patients who recovered in 10 days was about the same whether they took an antibiotic or a placebo.
"With a little bit of patience, the body will usually heal itself," said Dr. Ian Williamson, a family medicine researcher at the University of Southampton in England and lead author of the paper published today in the Journal of the American Medical Assn.
The results showed that patients should be more willing to forgo antibiotics, although they should still check with their doctors when a cold worsens into a sinus infection, he said.
Dr. Daniel Merenstein, a family physician at Georgetown University in Washington, who was not involved in the study, said the report was more evidence of the overuse of antibiotics, which has caused enormous problems with drug resistance.
More than 80% of American physicians prescribe antibiotics for sinus infections, he said. Recent studies also have shown that antibiotics are unnecessary for treating ear infections and bronchitis.
"Doctors and patients get into habits and use antibiotics," Merenstein said. "Now people know . . . we should just give supportive care," such as pain relievers and saline nasal mists.
Sinusitis is an inflammation of the sinuses that commonly develops as a complication from a cold.
Allergies can also cause sinusitis, but researchers in this study focused on cases likely to be caused by bacteria.
Bacterial cases often lead to localized pain in the face and to thick discharges from the nose, with more coming from one nostril.
In the latest study, which was funded by the British government, Williamson and his group looked at about 200 sick adults from family practice offices around southwestern England.
Of the 100 patients who took the antibiotic amoxicillin, 29% had symptoms lasting 10 or more days. Of the 107 patients taking a placebo, about 34% of patients had symptoms of a similar length. Researchers deemed the difference statistically insignificant.
Williamson surmised that the antibiotic was ineffective because it had trouble penetrating pus-filled sinus cavities. Though the researchers did not test other antibiotics, he said, they probably would fare no better because amoxicillin is considered the most appropriate drug for sinusitis.
The researchers also tested the efficacy of a nasal steroid spray called budesonide because it was thought to reduce inflammation.
The proportion of patients in the steroid group and the placebo group who had symptoms lasting 10 or more days was the same at 31%.
The researchers found that the nasal spray helped a subset of patients with milder symptoms who reported feeling less ill by day 10. Williamson said the spray probably helped in milder cases because it wasn't washed away as quickly as it was in sicker patients with more nasal discharges.
Read entire article at the original source
A study comparing the use of a placebo with the drug treatment finds little difference. Patience and over-the-counter remedies are recommended.
By Jia-Rui Chong
Los Angeles Times Staff Writer
December 5, 2007
The widespread use of standard antibiotics to treat sinus infections does not help cure patients and may harm them by increasing their resistance to the drugs, according to a study released Tuesday.
The researchers found that the percentage of patients who recovered in 10 days was about the same whether they took an antibiotic or a placebo.
"With a little bit of patience, the body will usually heal itself," said Dr. Ian Williamson, a family medicine researcher at the University of Southampton in England and lead author of the paper published today in the Journal of the American Medical Assn.
The results showed that patients should be more willing to forgo antibiotics, although they should still check with their doctors when a cold worsens into a sinus infection, he said.
Dr. Daniel Merenstein, a family physician at Georgetown University in Washington, who was not involved in the study, said the report was more evidence of the overuse of antibiotics, which has caused enormous problems with drug resistance.
More than 80% of American physicians prescribe antibiotics for sinus infections, he said. Recent studies also have shown that antibiotics are unnecessary for treating ear infections and bronchitis.
"Doctors and patients get into habits and use antibiotics," Merenstein said. "Now people know . . . we should just give supportive care," such as pain relievers and saline nasal mists.
Sinusitis is an inflammation of the sinuses that commonly develops as a complication from a cold.
Allergies can also cause sinusitis, but researchers in this study focused on cases likely to be caused by bacteria.
Bacterial cases often lead to localized pain in the face and to thick discharges from the nose, with more coming from one nostril.
In the latest study, which was funded by the British government, Williamson and his group looked at about 200 sick adults from family practice offices around southwestern England.
Of the 100 patients who took the antibiotic amoxicillin, 29% had symptoms lasting 10 or more days. Of the 107 patients taking a placebo, about 34% of patients had symptoms of a similar length. Researchers deemed the difference statistically insignificant.
Williamson surmised that the antibiotic was ineffective because it had trouble penetrating pus-filled sinus cavities. Though the researchers did not test other antibiotics, he said, they probably would fare no better because amoxicillin is considered the most appropriate drug for sinusitis.
The researchers also tested the efficacy of a nasal steroid spray called budesonide because it was thought to reduce inflammation.
The proportion of patients in the steroid group and the placebo group who had symptoms lasting 10 or more days was the same at 31%.
The researchers found that the nasal spray helped a subset of patients with milder symptoms who reported feeling less ill by day 10. Williamson said the spray probably helped in milder cases because it wasn't washed away as quickly as it was in sicker patients with more nasal discharges.
Read entire article at the original source
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