On-line Pharmacies
Section titled “On-line Pharmacies”Many of you buying prescription drugs have discovered discount pharmacies, available locally (for example at Costco), through mail order catalogues, or online. Whenever you order on line, it's always important to verify the quality of the product and integrity of the pharmacy. For this issue of Medicine for People, I have researched ways you can be sure your online purchase is safe and reliable. At the end, I'll ask you to write in with your experiences of all of these discount pharmacies, and I'll share the information in a future newsletter.
Reliable Guides to Online Pharmacies
The National Association of Boards of Pharmacy certifies US online pharmacies. This is your most reliable guide to an online pharmacy. Its web site lists pharmacies that have passed an on-site inspection. The list even includes that favorite of the old-timers, Walgreen's! And for your protection, it also lists pharmacies that have been suspended. These you should definitely avoid.
The US Food and Drug Administration website lists helpful hints to buying medication online and offers the opinion that the only safe course of action is to limit yourself to US pharmacies. US pharmacies, for example, are unlikely to sell you drugs that are past their "pull date." (Of course the FDA can't vouch for anything outside the US anyway).
Foxes in the Hen House?
The North American Pharmacy Accreditation Commission is group of online pharmacies that has begun its own accreditation program. The website claims that it is "not funded by pharmaceutical companies, pharmaceutical manufacturers, major retail pharmacy chains and/or government agencies. NAPAC answers to no one but the consumer and is concerned with the care, quality, licensing and customer service offered by NAPAC member sites to consumers." Well, who does pay for the site? Member pharmacies that have passed their own credentialing programs foot the bill. Is this a congregation of foxes that believe they more ethically harvest the chickens than the other foxes do? When I checked out the website, it wasn't working properly. I'm skeptical about these claims.
The Best Deal on the Web?
Beware of sites that claim to find you the lowest prices for online meds. I found one site that made that promise. Was the claim true? I can only say that you'll find lower prices at the pharmacies here in town. Another site promised to "find you the best deal" for a $35 (for 90 days) membership fee. And yes! This website will give you prescription drugs without a prescription, and no! it can't refund your money ("due to the confidentiality of the information given.") My final analysis? Your $35 is safer in a lottery ticket.
Buying North of the Border
Neither the National Association of Boards of Pharmacy nor the FDA evaluates Canadian pharmacies. If you do want to try an online Canadian pharmacy, universaldrugstore.com looks legitimate. I can base this only on the fact that its website looks a great deal more professional than the other sites I looked at. Therefore, I can't vouch for the site. Another Canadian enterprise takes your prescription to a licensed Canadian pharmacy and mails you the medication. It posts prices on its website on the internet. I cannot vouch for them, either.
If I were buying a prescription drug from a foreign pharmacy, I would want to see the manufacturer's packaging. I would check the expiration date. I would buy only if I recognized the pharmaceutical manufacturer's name and if the packaging and contents appeared to have been produced in the USA. Another safeguard would be to compare the tablet or capsule with the photographs in the Physician's Desk Reference. This limits you to brand name drugs, but provides an assurance not available with a generic product.
Tips and Feedback
In the end, the only legally-defensible advice I can give you is this: If you are buying on line, check the National Association of Boards of Pharmacy web site to verify the online pharmacy's credentials
Consumer Feedback
I looked on the web for consumer guides and reviews of online pharmacies. I did not find any. However, for those of you buying medications in foreign countries, let me ask that you share your experiences with me so we can pass it on to other patients.
Cold Water on Ear Candles
Section titled “Cold Water on Ear Candles”Who'd a thunk it! A "candle" you put in your ear and light, in hopes of removing your earwax!
What's Supposed to Happen
For those of you unfamiliar with ear candles, they are cone-shaped rolls of wax-impregnated paper. The instructions tell you to lie on your side with the blocked ear up, place the small end of the cone in your ear, and light a wick in the big end of the cone. The burning paper is said to create a vacuum in your ear and remove the wax. And voila! You do as instructed and sure enough, there is wax in the bottom of the cone!
What Usually Happens
Often what happens next is that your ear still feels blocked, so you try another candle. Still no help. Then you come to our office. We usually do one of two things. We tell you that you don't have earwax at all, that your Eustachian tube is blocked or you have some other problem. Or we clean out your earwax.
A Vacuum in your Ear? I don't think so
In diagnosing ear problems, by the way, we generate a vacuum in the ear canal with our pressure-otoscope. Even coming at it from the outside, it takes some care and you have to see just what you are doing. I do not see how you can develop negative pressure in the ear canal with a relatively rigid waxy cone and no visibility. Published studies by ear specialists trying the cones agree- they don't produce negative pressure.
"But they helped my friend"
I can believe that. Sometimes local application of heat can improve ear problems. But how do you know the problem was impacted earwax? Until I see wax in the ear and see an ear candle remove it, I'm gonna prescribe candles only for candlesticks.
Summary Recommendation? Thumbs Down
A survey of ear specialists resulted in the opinion that ear candles are more likely to deposit than to remove wax. Sometimes they drip hot wax into the ear and injure it. You can check it out in the article "Ear candles--efficacy and safety." by D Seely and others in the journal Laryngoscope (1996 Oct;106(10):1226).
Immunization for Influenza
Section titled “Immunization for Influenza”The Argument For
In a Minneapolis study of 849 working adults, those given the influenza vaccine had 25% fewer bouts of upper respiratory infection than those given a placebo injection. They each averaged only 6 hours of sick-leave during the year compared with 10 hours of sick-leave for each person on placebo. Taking reduced physician costs into account, the immunization group saved $47 on health care and lost work compared to the placebo group. (New England Journal of Medicine 1995 Oct 5;333:889)
In older age groups, and people with an impaired immune system, influenza can kill. Vaccination reduces this death rate.
The Argument Against
Though the benefits of vaccination are carefully accounted for and broadcast, the adverse effects seem to me to receive less attention. For example, a study published in Gerontology (2001 Nov-Dec;47(6):311) looked at 552 people in Liverpool, England given an influenza injection, comparing them to 177 people who received placebo. Flu-like symptoms occurred in 11% of the vaccine group versus 5% of the placebo group. The conclusion of the authors was "Healthy people belonging to this age group can be reassured that, when compared with placebo, influenza vaccination causes few, if any, systemic side effects and only a low incidence of local side effects." What distresses me is to read that their method of discovering adverse reactions was to ask the participants to mail in a report card three days after vaccination. This is not what I would call an obsessive search for adverse effects. The patients check off a few boxes on a card, the researchers grab their three-days (!) worth of information, they decide not to call an increased incidence of "flu-like symptoms" a systemic side-effect, and then trumpet the "reassuring" news. This is science?
Having studied this question for years, I have found that the pro-vaccine people are not looking really hard at the long-term effect of vaccines. There are huge conflicts of interest in the professional groups setting vaccination policy. On the other side of the coin, I have found the anti-vaccination camp to engage in scare tactics, emotional appeals, and half-truths. Fact One is, vaccination has saved many lives. Fact Two is, we've been lax about looking at what exactly the cost has been.
Final Recommendation
People at higher risk of serious complications from influenza are most likely to benefit from the injection. High-risk people will also benefit if those people who care for them are immunized as well. People at higher risk include the elderly and those people with chronic illness including diabetes.
Another approach is to keep the prescription drug amantadine or rimantadine at home, ready for immediate use in case symptoms of the "flu" appear.
We can help you with either approach. For more information about amantadine, ask for our "flu kit." If you would like a "flu shot," come in during office hours. (except lunchtime Monday and Friday.)