Chick-Chack - the Lice Remover
Section titled “Chick-Chack - the Lice Remover”After our rant about head lice in the November 2003 Newsletter, we ran across an interesting study of head lice in Israel.
According to the study, 15-20 percent of all Israeli children between the ages of four and 13 have been infested with head lice. So, if your child turns up with head lice, you've got company. The Israelis, however, have something we don't -- Chick-Chack, a natural remedy containing coconut oil,anise oil, and ylang ylang oil. The study compared Chick-Chack with the traditional "shot-gun" treatment of permethrin, malathion, piperonylbutoxide, and isododecane, drugs that we use in the US.
Guess what? In these 940 children, Chick-Chack was just as successful as the synthetic brew, both being about 92 percent effective. My search engine didn't turn up any sources of Chick-Chack, but did come up with several vendors selling a mixture of coconut oil, anise oil and ylang ylang oil.If you want to read the study, it was published in the Israeli Medical Association Journal (2002 Oct; 4(10): 790-3).
Arthritis Relief - New Drugs or Old
Section titled “Arthritis Relief - New Drugs or Old”You may have seen compelling ads for new arthritis pain relievers such as Vioxx, Celebrex, and Bextra. The prospect of going about life pain-free sounds pretty tempting to arthritis sufferers, but these new drugs may not be the best answer. Here's a brief update on arthritis medication that may help you think about what medications may be best for you.
The tradition pain relievers for arthritis are called NSAIDS, an abbreviation for non-steroidal anti-inflammatory drugs, which include aspirin, naproxen, ibuprofen, and many other common prescription drugs. The newer drugs, Celebrex, Vioxx, and Bextra, are all brands of COX-2 inhibitors.
COX what? COX is an abbreviation for cyclooxygenase, an enzyme produced in the body that causes pain. There are two types: COX-1 leads to pain,stimulates platelets to aggregate and cause clots, and protects the stomach from ulcers. COX-2 merely causes pain and inflammation. Now NSAIDS such as aspirin inhibit both COX-1 and COX-2, so they relieve pain and inflammation and reduce the tendency of the blood to clot. However, they also interfere with the COX-1 protective effect on the stomach. COX-2inhibitors, on the other hand, inhibit COX-2 much more than COX-1, and so they reduce pain without the risk of bleeding or stomach ulcers.
Advertisements for some of the COX-2 inhibitors can be misleading. The ads for these COX-2 inhibitors, as far as I can see, never directly come out and say that they are any better at relieving pain or reducing arthritis than are the non-prescription pain relievers ibuprofen, aspirin, or naproxen. But somehow, through the magic of advertising, that message comes across, and patients ask me to prescribe them. Unfortunately, COX-2inhibitors will not relieve pain any better than good old aspirin.
Rofecoxib (Vioxx) and its cousins, valdecoxib (Bextra) and celecoxib (Celebrex) truly are breakthroughs in reducing the risk of bleeding and stomach ulcers associated with ibuprofen, aspirin, naproxen, and the older anti-arthritis drugs. The downside is that they are much more costly.For short-term use in young people with little risk of damage from ulcers, the older drugs give a good deal of bang for the buck. They are, in fact,just as effective pain relievers and just as effective anti-inflammatory agents as the newer drugs.
The risk of ulcers, however, is real. I remember one woman in particular who had no pain at all; she just started bleeding, so seriously that I hospitalized her. The best solution is to work with your health care provider to determine whether, for you, the additional cost of these COX-2inhibitors is worth it.
Estrogen - Behind the Headlines
Section titled “Estrogen - Behind the Headlines”Eighteen months ago the Women's Health Initiative study reported that estrogen therapy did not reduce heart attack risk, but it did increase the risk of breast and uterine cancer. We were among those who pointed out (in our July 2002 Newsletter) that this information was certainly relevant to the synthetic hormones used in the study but did not tell us anything about identical-to-natural hormones.
Since then, physicians have had a chance to read, study and ponder these data and have found shortcomings in the study. John Woodward, MD, a gynecologist in Dallas, has pointed out that the study did not include women actually having menopausal symptoms. (Such women would have had little trouble distinguishing PremPro from a sugar pill, and could have introduced bias into the study.) Since younger women were excluded, the average age of the participants was 63. Consequently, we really only know the effects of estrogens on these older women, not on women in their 50s who use it to reduce hot flashes and other symptoms of menopause. Finally, a further look at the data indicated that there really was no statistically significant increase in heart disease, as initially reported. A reminder, Dear Reader: Don't jump to conclusions based on a headline. Read more at Dr. Woodward's Website.
News You Can Use - Health Savings Accounts
Section titled “News You Can Use - Health Savings Accounts”The Medicare Drug Bill includes a provision to allow Health Savings Accounts. These are like IRA's, except you may spend the money only for medical expenses. You or your employer put money into the account tax-free, and the account grows tax-free. You can roll over the balance year after year. At age 65 you may treat the account as an IRA. You must also have a high-deductible health insurance policy to pick up expenses too great for the account to cover. Republicans say this system will reduce spending, because people will have a reason to pay attention to health expenses. Democrats say this will hinder progress towards socialized medicine. Read more at American Medical News.
Rant 'O The Month - The Health Care Payment Wars
Section titled “Rant 'O The Month - The Health Care Payment Wars”This month several vendors demonstrated their electronic medical record systems at the hospital. Those of you who have a long or complicated medical history can appreciate the problems we have keeping track of your medical data. Say someone shows up with elevated liver function tests, we may spend considerable time leafing back through years of paper reports of previous liver tests and other lab tests that may be relevant. With an electronic record, we can find such information more rapidly. Not only that, but an electronic record promises to save us from the avalanche of paper medical records that is filling up every spare corner in most offices. So we docs were all interested enough in this issue to get up for several meetings at 7:30 in the morning.
Although such a system is potentially helpful, I was amused by part of the sales pitch. Most of the vendors boasted that their system could help generate many of the codes needed for insurance billing. These codes depend on over a hundred different combinations of medical history taking, examination, complexity of decision-making, length of visit, and other factors. They are so complex that medical billing coding experts with years of experience often disagree on the correct code. Since doctors know that Medicare prosecutes incorrect coding as fraud, they tend to "undercode". These computer programs can instantly look at the various elements of your medical record and tell you what the correct code should be. In fact, the computer can go further and tell you that your service qualifies for code 99213 for $65, but if you go back into the exam room and ask more about the family history, or examine another body system, that you will qualify for a 99214 for $110.
Certainly administrators trying to cover clinic overhead will view this coding assistance as a desirable thing. Insurance companies are famous for making doctors jump through hoops to get their claims approved, dragging their feet before sending the doctor a check, and sometimes concluding, long after the patient has moved to Alaska, that they won't cover the service.
And so the battle goes on, with the physicians using computers to generate more bullet-proof medical records, better claims, and more payments. From the patients' side, "don't tell the insurance company, but my knee has been hurting for years, and I told them there was nothing wrong with me." From the insurance company side, more rules to try to limit the damage. Can you spell G-A-M-E?
Coming Next Month - Vitamin D, the Real Story
Section titled “Coming Next Month - Vitamin D, the Real Story”Up until about a century ago, numerous people suffered from a heart-breaking condition called rickets. With rickets, children fail to gain much height, and women fail to develop a roomy enough pelvis to survive childbirth. When Vitamin D was finally discovered, it was a blessing. When it was first identified as the missing factor without which rickets occurred, it was mistakenly thought that we couldn't make Vitamin D on our own. Happily, even primitive life forms make vitamin D, and so can we, from cholesterol and sunlight. Sunlight, however, can be in short supply in northern climates, so many people require vitamin D supplements.
Since excessive vitamin D can be harmful, people have been urged not to take "too much" vitamin D. How much is too much? Therein lies a growing controversy.
Next month, we'll discuss the real story about vitamin D and its relationship to osteoporosis, prostate cancer, and a whole host of other health conditions. For a preview, check out the Vitamin D Council Website.