As the spring approaches it is time to get out and take to the woods, hills, ocean or streets as your passion moves you. Although I have lived in California for close to 20 years now I am still delighted and a bit surprised by the gentle climate. Truthfully, every spring I find myself a bit confused, believing it is fall, because winter never really arrived. I grew up synchronized to extremely dramatic shifts throughout the seasons. The day I first seriously considered the irrationality of enduring the severe weather and the climatic wisdom of moving out here, the high temperature was 20 degrees below zero. Don't take this special and beautiful place for granted.

• MISTLETOE AND BREAST CANCER
• HORMONE REPLACEMENT THERAPY (HRT) AND BREAST CANCER
• VASECTOMY AND PROSTATE CANCER
• SMALLPOX VACCINATIONS
• NEW FDA REGULATION OF SUPPLEMENT LABELING
• ANTIDEPRESSANT DRUG WITHDRAWAL?

Many know the herb mistletoe as a tree parasite or from holiday traditions. We may have another reason to seek it out.  For many years an extract of mistletoe (Iscador) has been used as a cancer treatment.  Although a relatively large amount of clinical research has been conducted, the quality of the studies has not been good enough to provide definitive proof that it works.  A recent well-designed large clinical trial found it quite useful as an adjunctive treatment in women with breast cancer.  In addition to the indicated conventional treatment (surgery, radiation, chemotherapy) half of the patients also received injections of Iscador.  There was no significant difference on how long the patients lived however there was a big difference in how they felt.  Patients receiving the Iscador lived a longer time before their cancers returned and they experienced adverse effects at a rate less than 1/3 of the other patients.  Just under 18% of those receiving the Iscador experienced local reactions to the injection but less than 1% had any systemic ill effects.

Although there are some who believe the progesterone side of hormone replacement therapy is not a concern, evidence continues to mount contradicting that position.  A very large Swedish study recently had several important findings.

  The longer patients used HRT the greater their risk of breast cancer.  Those women using cyclic HRT for over 4 years increased their rate of breast cancer to 2.23 times that of women not using HRT.  Continuous HRT was associated with a greater risk � using it for less than 4 years increased the breast cancer rate to 1.37 times of women not on HRT.  Continuous HRT use for more than 4 years markedly increased the breast cancer rate (4.6 times controls).  Overall, women who used HRT for more than 4 years had an 80% greater likelihood of developing breast cancer than nonusers.

Progesterone appears to be the main suspect.  Women taking estrogen alone, even for more than 4 years had no increased risk of breast cancer.  Women who took only progesterone (orally) had a risk of breast cancer 3.5 times that of women not using HRT.

Investigators estimated that 9% of the breast cancers in Swedish women aged age 45 and older are caused by HRT.  On the other hand, there was no overall increased risk of cancer in women on HRT compared to women not on HRT.  Huh?  Well the HRT reduced the risk of colon cancer and some smoking-related cancers. 

So what is the bottom line?

• Understand your individual risks.
• Don't take strong medicine unless there is a very good reason to do so.
• Do everything else you can to be healthy.

Now, on to male cancers.  This is a nonstory that is a story because it was a story.  Years ago there was suspicion that vasectomies might lead to various types of cancer (testicular and prostate).  Years ago we learned that the apparent rise in testicular cancer was a result of paying more attention to that specific area of the body and not an increased incidence.  Now we know not to worry about prostate cancer either.

If any of you are thinking of them please think carefully.  The most official governmental agency dealing with this matter (the Advisory Committee on Immunization Practices at the Centers for Disease Control) has a list of contraindications estimated to include 30% of the US population. The vaccine is contraindicated for anyone with a family member or household contact who has ever been diagnosed with eczema on any other allergic skin disease (this includes themselves).  The committee recommended excluding individuals who have ever in their life had an "itchy, red scaly rash that lasts more than 2 weeks and often comes and goes".  Patients with burns, shingles, herpes, chicken pox, impetigo, psoriasis or severe acne are also to be excluded.  The vaccine is contraindicated for women who are pregnant or plan to become pregnant within a month.  Also people with HIV should not receive the vaccine.

There are many needless risks of using herbs and dietary supplements.  Although some risk is unavoidable, as any substance which has the power to heal also has the power to harm, other problems can be avoided.  This proposal will be a very positive step.

  The biggest problem with herbs and supplements currently is that the buyer cannot be certain that what they are buying is what is listed on the label.  A very large percentage of tableted Chinese herbs for example have been found to contain a variety unexpected materials such as lead, mercury and steroids.  Years ago L-tryptophan was outlawed when many people became ill because the genetically-engineered bacteria making the L-tryptophan made another chemical which caused the disease.  25 probiotics were tested and 8 of them contained less than 1% of the organisms claimed on the labels.

  These new standards would be phased in over 3 year period.  According to the FDA "Examples of product quality problems that the proposed rule would help prevent are:

• dietary supplements that contain much more than listed on the label and may be harmful,
• dietary supplements that contain less ingredients than listed on the label, wrong ingredient,
• drug contaminant, other contaminant (e.g., bacteria, pesticide, glass, lead),
• foreign material in a dietary supplement container, improper packaging, and mislabeled"

Some few manufacturers already surpass these standards (such as those that make the supplements available in my office).  Others have been working towards this level of quality control.  I believe this is a very positive step for consumer safety and better health care.

The relatively new antidepressant drug Serzone (generic name nefazodone) has been withdrawn from European markets. The drug rarely causes liver failure, which is usually fatal. A consumer group in the US is calling for the drug to be withdrawn here as well.

While the FDA currently states that there is no way to predict who will die from using this drug, any patient with a history of liver problems should certainly avoid it in my opinion (and everyone should consider other options).