December 9, 2007

Dear Patients,
 
I have been in the odd position of writing a lot without anybody reading it.  This happened before when I spent years writing a textbook, but in this case, it is more a matter of the volume of my writing for Veria.  I’ve been writing faster than they have been able to post it and I’ve taken the opportunity to write in greater depth.  Some of it (like the pharmaceutical marketing piece) I really want you to read, but your mailboxes are already overstuffed at this time of year so it would be better for you to choose.
 
My web designer will post the pharmaceutical marketing article on my website.  This newsletter includes some of the material that has not yet been posted by Veria. Following is a list of topics I have submitted to Veria that I have not sent to you.  Veria has not posted the underlined titles.
 
At this unusually busy time, remember that the harder it is to squeeze in the things you need to do to take care of yourself, the more essential it is to do so.  Don’t make it a mad dash.  This should be a magical, reflective and enjoyable time of the year.  Make it so.
 
Best
Michael Carlston, MD
www.carlstonmd.com

• Ginseng and Cancer Fatigue
• Adverse Drug Reactions
• Combat Stresses the Families at Home
  

September
            Resistant  Bacteria, Probiotics and Antibiotics
            New Exercise Guidelines
           Cholesterol Controversies

August
            Vitamin D
            Simple Things For Your health
 
Ginseng and Cancer Fatigue
Fatigue is the most common symptom experienced by people with cancer.  Fatigue is also the most common adverse effect suffered by patients receiving chemotherapy (80%) or radiation (90%) for cancer. It has a major impact on the quality of their lives, often keeping these patients away from their favorite activities.  Chronic cancer-related fatigue often persists for years, even following successful treatment.  Some estimates are that over 90% of cancer survivors suffer from fatigue. Pharmacologic treatment options are limited, not terribly effective and many cancer patients do not want to add more drugs to their customarily lengthy list.  There is good evidence that other options are helpful.
 
Exercise is clearly beneficial for many reasons.  Among those reasons is improving the energy levels of these patients. In fact, no other therapy has such consistent or meaningful evidence of effectiveness for cancer-related fatigue. Like so many of us, cancer patients find that rather than making the fatigue worse, exercise actually helps.
 
Nutritional therapy is extremely important.  We know that poor nutrition increases the likelihood of developing many cancers.  We are learning about genetic differences between people which create those risks, including marked differences in the amount or type of certain nutrients one individual requires compared to another.  The body’s fight against cancer demands excellent nutritional support and all conventional treatments (chemotherapy, radiation and surgery) have a major impact on nutritional requirements.
 
Many patients with cancer turn to alternative therapies.  Diagnosis with cancer has long been the impetus for people who have never used an alternative therapy to give it a try. One reason is to alleviate fatigue caused either by the disease itself or by the treatment. A large number of studies considering alternative therapies and cancer show us that patients are usually happy with the effects of the alternative therapy. One of the most frequently reported benefits is improvement in energy levels and overall quality of life.
 
A recent study from the Mayo Clinic caught my eye.  This was a placebo-controlled trial of various doses of American ginseng as therapy for cancer-related fatigue.  282 patients with over a month of cancer-related fatigue that they felt was moderate or severe (4 or above on a 1-10 scale) randomly received either a placebo, or a certain dosage level of a standardized ginseng extract (750, l,000 or 2,500 mg) for 8 weeks.  The most common cancer diagnosis was breast cancer.  Lung and colon cancer where the next most common cancers.
 
After treatment 10% of those in the placebo and 750 mg ginseng groups had a significant reduction in their fatigue compared to 25% and 27% in the 1,000 and 2,500 mg ginseng groups.  Those in the 1,000 and 2,500 mg ginseng groups were three times more likely to be satisfied with the treatment than those in the placebo or 750 mg ginseng groups.  The best overall response was reported by patients in the 1,000 mg/day group.  There were no significant adverse effects reported.
 
The inclusion of patients with breast cancer is interesting, as some have been concerned that American ginseng has a few estrogen-like components and have then cautioned breast cancer patients to avoid it.  At the same time, basic sciences research indicates that American ginseng has anti-breast cancer effects.  In other words, while there is some controversy about the good or ill effects of ginseng on patients with breast cancer, these researchers were not concerned about negative effects, at least in an 8-week experiment.
 
This is the first systematic trial using American ginseng for patients suffering from cancer-related fatigue.  Consequently, we must not get overexcited about the results.  However, this looks promising and the risks of trying it are low.  
 
Remember that there are different kinds of ginseng and the effects are often different.  The ginseng used in this study was a powdered extract of American ginseng (panax quinquefolius) harvested in Wisconsin and standardized to contain 5% ginsenoside.  Ginsenosides are believed to be the chemical in this ginseng that alleviates fatigue.
 
 
Adverse Drug Reactions
One reason many people try to avoid taking prescription medication unless they really need it is the risk of adverse effects.  Anything with the power to heal also inevitably possesses the power to harm, or as Shakepeare wrote in Romeo and Juliet:
 
Within the infant rind of this small flower,
poison hath residence, and medicine power

The US government has tracked adverse drug effects for many years.  Recent information shows a startling increase and change in the pattern of adverse drug reactions.  Over the most recent 7-year period for which we have data (1998-2005), the rate of serious and fatal drug reactions nearly tripled in the US.  In 1998 nearly 35,000 Americans experienced an adverse reaction to a drug that caused a birth defect, disability or required medical intervention to either save the person’s life or prevent further harm. By 2005, that number jumped to just under 90,000.  Fatal events jumped from 5,500 to 15,000.
 
Advertising to consumers has changed the practice of medicine and increased physician prescribing (as well as markedly increasing drug costs for everyone).  The total number of prescriptions increased by 50% (from 2.7 to 3.8 billion), so that does not entirely explain the rise. It could however be a significant factor as the more medications people take, the more likely they are to suffer from an adverse drug interaction.
 
Drugs that were withdrawn for safety reasons did not account for the rise.  Of nearly 1,500 drugs faulted in case reports, only 51 different medications accounted for over 40% of all seriously adverse drug events (nearly 204,000 reports).  Medications for pain and immune modifying drugs were the biggest problems.
 
Problems with immune modifying medication is not at all surprising.  They are very powerful drugs and the people who use them are quite ill.
 
During the same years, prescriptions for pain-killing medication nearly doubled in the US. This is probably the single biggest part of the problem.  Prescriptions for the most notorious of these medications, OXYCONTIN, increased six fold. When patients see a family physician and leave with a prescription, the most likely medication for them to receive, even more common than the statin drug LIPITOR, is the pain medication hydrocodone/acetaminophen (VICODIN).  
 
Undoubtedly, if Americans want to be healthy we need to try harder to kick the drug habit.
 
 
Combat Stresses the Families at Home
The traumatic experiences of wartime understandably have long-term health consequences for soldiers.  Effects on the families of soldiers are also significant and sometimes immediate.
 
Researchers reviewed two confidential US Army databases studying reports of confirmed incidents of child abuse among military families from 2001-2004.  They found that rates of child abuse were four times higher when the soldier was deployed in combat than when they were not deployed. Although also somewhat increased for civilian fathers married to soldiers, the highest rate of abuse was by civilian mothers married to soldiers.  Abuse rates were much higher among white families than in Black or Hispanic families.
 
The stress experienced by our soldiers extends into their families back at home.  That stress seems to be especially difficult for the wives of soldiers.

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