Friday, December 28, 2007

Be careful with supplements

Today MSNBC quickly picked up on a recently released FDA warning on Chinese made supplements for erectile dysfunction. The products in question are Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, Lady Shangai, and Shangai Regular. It appears that these supplements contain actual Viagra or similar compounds.

So many of my patients take supplements for a variety of reasons. I am not entirely against supplements, but I wish patients had a little more scepticism about supplements, and less about the medications I prescribe. Unlike prescription medications which need to meet the FDA's rigorous standards that they are safe and effective before coming to market, supplements are regulated as if they are food, so as long as there is no proof these products are harmful, anyone can sell them. In addition, it is not clear that even common supplements like vitamins are all that beneficial. A review of 68 trials in over 200,000 patients published in February 2007 in JAMA showed that treatment with beta carotene, vitamin A, and vitamin E may increase your risk of death!

If you are going to take supplements, make sure they are at least from a known and reputable manufacturer so you at least have a better chance of getting a safe product. Next, look at the evidence that these medications can help you, and more importantly won't harm you. Also, if you are taking regular medications, make sure that these supplements won't interact with your medications (many do). Do not be afraid to discuss supplements with your regular doctor.

Tuesday, December 25, 2007

Top 10 things

As with many end of year articles that talk about steps for the New Year, today's Washington Post Health Section describes "Nine Traps to Avoid For a Smarter, Healthier New Year." I found this article surprisingly accurate, with some exceptions. It warns about misinformation that can be found on health websites, scientific claims without any real science, and the fact that (unfortunately) there is little evidence to support taking supplements, and some (like Vitamin E) can actually harm you. WebMD is generally an OK place to start looking for consumer oriented information. Also, Medlineplus is sponsored by the National Library of Medicine. The information is credible and free of bias.

One of the nine traps that I take some issue with is the recommendation to "skip the (drug) samples" that your physician may give you. They correctly point out that free drug samples of prescription drugs are almost always the newest and most expensive drugs. Pharmaceutical companies use samples as a way to introduce physicians to new products so that they will eventually prescribe them. This in fact does lead to increased sales of these drugs, and thus higher overall cost. However, having new drugs is not necessarily a bad thing. If drug companies didn't think their products filled a need, they wouldn't make the product. It is possible your doctor may give you a drug sample because he or she feels that this is actually the best product for you. Therefore, I would ammend their recommendation. Rather than skipping the samples, if your physician prescribes a medication with a sample, ask them whether a cheaper, equally effective alternative is available.

The Post request that readers send them a tenth trap, likely for a later publication. I would say that the tenth trap is to not believe everything you hear in the media about the latest study or dangerous drug. Medicine is tricky. If there was a perfect drug or other regimen that always worked without any dangers, than every patient with that condition would be on it. The media works in sound bites, and generally tends to prefer the bad news/scary side of things. When the controversial article about Avandia came out in May this past year, there was tremendous media attention about Avandia causing heart attacks. However, when the FDA came out with a label change which generally said that the risk was uncertain, there was little media attention at all. Before jumping to conclusions (and stopping a medication that may be helping you) do some research on your own, and if you are still not sure, ask your doctor. One of the purposes of this blog is to help provide patients with some guidance on just these issues.

Initial Post

This is the first post for my new blog. The purpose of this blog is to provide insight and perspective to the daily onslaught of health related topics in the news and media from a health care professional. I am a physician practicing internal medicine for over a decade at a major academic institution. So many of my patients have contacted me asking questions about something that they heard or saw recently, that I thought sharing that advice with others might be useful.