... And What You Can Do About It

If you've ever bought stocks of major pharmaceutical companies, you've probably made money. If you take their drugs, you've lost money!

Drug companies are bleeding us dry. The high cost of medications is adding to their profits. But it's doing so at the expense of sick people. Sadly, many of these folks can't even afford the medications they need to get better or keep their illnesses from progressing. The answer is not to get better Medicare drug coverage. The answer is not to get cost-saving prescription drug cards from pharmaceutical companies or buy from Canada.

We need to re-think what we're taking and why we're taking it. We need to take a closer look at the companies that are making and promoting their prescription drugs.

Pharmaceutical companies complain that the price of new drugs is driven sky-high by research and development (R&D) costs. But this isn't true. In 2002, the top 10 American drug companies spent more than twice as much on marketing and administration costs as they did on R&D. Medications cost as much as they do because pharmaceutical companies want higher profits.

Drug companies are not just big business. They're huge! In fact, lobbyists in the pharmaceutical industry outnumber our elected representatives in Congress. No wonder the recent Medicare bill to keep down prices on prescription drugs prohibits Medicare from negotiating lower prices from drug companies. These companies are making the rules that they profit by!

How do I know so much? I've been listening to Marcia Angell, MD, a senior lecturer at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine. She's written an important exposE9 on drug companies called The Truth About the Drug Companies: How they deceive us, and what to do about it (Random House, August 2004). If you want the whole truth behind high drug prices, you'll want to read her book. Here's some of what Dr. Angell has found:

Pharmaceutical companies are not making many new drugs

Only 14 percent of 415 "new" drugs approved by the FDA between 1998 and 2002 were significantly different from those already on the market. Most are the same, or similar, but with different doses. There was no improvement over drugs already on the market that were treating the same conditions. Why? Well, it's much cheaper and easier to launch a copycat drug than to look for new ones. The end result: higher profits. Why take the time and expense to find something completely new when you can boost your profits by recycling an old drug and calling it a new one?

What's more, drug companies don't have to prove that this copycat drug is more effective than those that are already available. They don't even have to show that this "new" drug is just as effective as those already on the market. All they have to do is show that it's better than nothing! So, pharmaceutical companies get tricky. They compare their "new" drug with a placebo, or sugar pill. The drug passes if it's better than the placebo, even if it's not as good as similar medications.

What you can do: Ask your doctor for proof that any drug prescribed for you is better than another drug, or better than a different type of treatment. This proof should be in the form of scientific studies published in peer-reviewed medical journals.

Ask if the prescribed drug is the same as others on the market with different doses. If so, could you take more of a less-expensive medication? What's the cheapest way to get the amount of active ingredients you need?

Pharmaceutical companies are pushing drugs you may not need

Like you, I grew up before drugs were advertised in magazines, newspapers, and on TV. Now, ads for prescription drugs are everywhere. Turn on the television and you're being bombarded with them. And advertising firms are using scare tactics.

If you don't take this drug, you'll be bent over with osteoporosis. How about eating a healthy diet and doing bone-saving exercises instead?

You need this other drug if you have irritable bowel with constipation. But do you really have this condition? Could lifestyle changes help? More magnesium, exercise, more water, and increasing fiber could be an inexpensive, safe first step.

These companies are appealing to your desire for a quick fix. Don't be conned.

What you can do: Ignore all the ads you see touting the benefits of specific medications. Here's why: Their purpose is to sell drugs, not to inform you. Advertising costs are added into the price of these drugs. They will be more expensive than a similar drug that's not well advertised. If enough of us stop using drugs we hear about in the media, pharmaceutical companies will stop running these ads.

Ask your doctor if you really need a particular medication. Perhaps you just need to make some lifestyle changes instead of taking any drug. All drugs have side effects. Are the benefits you're receiving from your medications worth the risk of side effects and expense? Maybe not.

Pharmaceutical companies have controlled the direction of clinical trials

They can design and pay for a study that's most likely to result in a favorable outcome. When you hear the results of a study, there's no way of knowing whether or not the study has been skewed to favor the drug company. Many of these studies are conducted in academic medical centers where the researchers, often faculty members, must "publish or perish." So they accept the drug company's guidelines. Once again, drug companies are in control. They can design studies that will show their drug in a favorable light.

The problem is, not all of these studies are even released. We hear about the favorable ones, rarely those with negative outcomes or side effects. But this is about to change. A number of medical journals have signed a statement to pharmaceutical companies asking them to release all of their research data on new drugs, beginning this July. And the International Committee of Medical Journal Editors (ICMJE) is asking all eleven of their member medical journals* to publish only studies that have been registered in a public trial registry. All studies will have to meet strict criteria before being evaluated for possible publication.

Now, here's the best news of all

The results of these studies will be available at no charge to anyone who wants to read them — doctor, patient, or those of us who are just plain curious. With all of the checks and balances proposed by the ICMJE on registered trials, I expect we'll have better studies within a few years. Don't want to sift through them? No problem. I'll be doing this for you as always.

For now, you need to know that just because a study is quoted doesn't mean it's a good study. Until now, pharmaceutical companies have been in the driver's seat, controlling some of the results to reflect their marketing strategies. With the help of the ICMJE and Dr. Angell, this is about to change. Perhaps then we will be able to afford the medications we need, and continue to seek alternative treatments that are both safer and less expensive.

* These journals include JAMA, New England Journal of Medicine, The Lancet, Annals of Internal Medicine, and medical journals from a number of other countries.

Angell, Marcia, MD. The Truth About the Drug Companies: How they deceive us and what to do about it, Random House, 2004.

De Angeles, Catherine, MD, MPH, et al. "Clinical trial registration: A statement from the International Committee of Medical Journal Editors," www.nejm.org, September 8, 2004.

How to Heal Ulcers Without Antacids or Antibiotics

If you have ulcers and your doctor wants you to take drugs to treat it, I've got a better idea. Try something simple. Here's what I mean:

Twenty years ago, a woman came to me with ulcers. She had tried stress reduction, a bland diet, and antacids. They hadn't helped her at all. Now her doctor wanted to give her a prescription for drugs that either blocked hydrochloric acid or had anti-inflammatory properties. The medications would allow her stomach to heal and repair itself. However, they didn't address the cause of her inflammation and pain. So she turned to me.

I remembered having read about an Australian doctor, Barry Marshall, who found that a particular bacterium, Helicobacter pylori (H. pylori) was present in almost everyone who had either gastritis or ulcers. When the bacterium was treated, the ulcers went away and didn't come back.

Sure enough, a simple blood test through her doctor revealed that this woman had an overgrowth of H. pylori. At that time, most physicians treated this overgrowth with antibiotics. But my patient wanted to avoid the side effects from taking antibiotics. So I searched for another alternative and found one that had no side effects. It's still being used today. It's called bismuth. You know it as the active ingredient in Pepto-Bismol.

The FDA had already approved the form of bismuth in Pepto-Bismol to treat peptic ulcers, and her physician agreed to monitor her progress. Whether she had a peptic ulcer (chronic inflammation) or gastric ulcer (burning the stomach's lining with harsh gastric juices), H. pylori turned out to be the underlying cause of her pain. Once her H. pylori was under control, her pain and her ulcers disappeared.

Don't assume that if you have ulcers, you have H. pylori. If you have ulcers, or suspect you have them, the first thing to do is to see your doctor and get a diagnosis. A simple blood test or breath test can determine if you have a bacterium overgrowth.

Don't self-medicate with bismuth. When doctors use bismuth to treat H. pylori, they most frequently combine it with two or more different antibiotics. I prefer to use antibiotics only when there are no other solutions. If you want to use bismuth with or without antibiotics, you need a doctor to monitor you and make sure it works.

Don't stop with bismuth

Probiotics (friendly bacteria) are always helpful when you have an overgrowth of any type of bad bacteria, including H. pylori. In study after study, patients with H. pylori recovered more quickly when they took acidophilus or other friendly bacteria. This was true whether or not their treatment included antibiotics.

Please re-read my article on probiotics (October 2004) for information on some of the best ones available. Choosing the right probiotic is vital. You can find this article on my website (www.womenshealthletter.com).

NSAIDS

Another cause of ulcers is NSAIDS, non-steroidal anti-inflammatory drugs. When you take these common medications — Aspirin, Advil, Celebrex, and Vioxx — on a regular basis (not just occasionally) you run the risk of developing a peptic ulcer. In fact, you're more likely to get ulcers from NSAIDS than from H. pylori!

NSAIDS can cause excessive bleeding, kidney problems, and fluid retention. In fact, an article in the New England Journal of Medicine found that as many people die from ulcers caused by NSAIDS as from cervical cancer. Ulcers caused by NSAIDS need a treatment that soothes and helps repair the stomach's mucous lining.

Ulcer remedies

There are a number of medications used for ulcers. Fortunately, there are also more natural remedies that work. Of all herbs, DGL made from licorice root has been used and studied the most for ulcers.

DGL is deglycyrrhized licorice (Glycyrrhiza glabra). It's a form of licorice root that helps heal your stomach lining. It's not licorice candy.

Licorice root has been used therapeutically for thousands of years in both Eastern and Western medicine. It's used in orthodox medicine to treat ulcers. Dosage, according to the Expanded Commission E Monograph (the gold standard of herbal information) is to chew two to four DGL tablets before each meal. Don't take it for more than four to six weeks except under the supervision of your doctor. If you're taking any medications, check with your pharmacist before taking DGL. Some other drugs, when taken with DGL, can cause a loss of potassium.

There are other plant-based ulcer remedies, from aloe vera gel (one teaspoon after meals for up to two months) to fresh cabbage juice (drink one cup every three to four hours and expect to have gas). Personally, I'd use DGL or the newest ulcer remedy, Zinc-Carnosine.

Zinc-Carnosine — a remedy that does it all

Some remedies kill H. pylori. Others have anti-inflammatory activity. Still others soothe damaged mucous membranes. A newly formulated combination of zinc and L-carnosine (a combination of two amino acids) does all of these. It's another example of a combination that outperforms either nutrient alone.

I first heard about Zinc-Carnosine from Dr. Georges M. Halpern, an MD who has written an excellent book, Ulcer Free! Nature's safe & effective remedy for ulcers (SquareOne Publishing, 2004).

There are a number of studies on the use of Zinc-Carnosine for gastric ulcers. I would use it for mild to moderate conditions without hesitation. But I think that any severe condition should be evaluated and monitored by your doctor. Here's what it does:

It's an antioxidant. Zinc-Carnosine destroys hydrogen peroxide, a free radical that's produced in the stomach. But hydrogen peroxide also damages the stomach lining. Zinc-Carnosine reduces this damage.

It's an anti-inflammatory. Inflammation is painful. In addition to reducing inflammation in general, one study found it reduced inflammation caused specifically by aspirin.

It inhibits H. pylori. By strengthening your stomach's lining, Zinc-Carnosine creates an environment that appears to keep H. pylori from growing.

Bottom line

Zinc-Carnosine is more than a good Band-Aid. It seems to address the major causes of ulcers. Because it works at the source of your pain, it takes a while to work. Give it a two-month trial, and don't be surprised if you start to feel better much sooner.

Studies indicate several doses for Zinc-Carnosine. To end my own confusion and to eliminate yours, I contacted Dr. Halpern directly. Based on all the studies he reviewed in writing his book, he recommends taking 37.5 mg twice a day. You can get this formula from GNC stores under the name of PepZin-GI. A one-month supply costs around $20 – less if it's on sale.

How to Eat Sweets Without Gaining Weight or Upsetting Your Blood Sugar

One afternoon about 20 years ago, I got a phone call I'll never forget. A man who had listened to my radio show for years was calling me from Japan.

"There's a sweetener that's being used all over Japan that doesn't affect diabetics," he said excitedly. "I don't know what it is, but if I send you some of it, can you get the label translated? I know a lot of people in the U.S. would want to use it and you've always done a lot of research on products. I'm diabetic, and I can use this sweetener without any changes in my blood sugar!"

I asked the Japanese parents of one of my friends to translate the labels for me. The common ingredient in all the products he sent to me was called "stevia." I began studying then, when there was little information about it. So while some of you may not be familiar with stevia, I am. And I'm still impressed!

I've written about sugar-free sweeteners before. In my opinion, none are as good as stevia. Some are artificial (aspartame and saccharin), while others are derived from sugar (sucralose, or Splenda – an undigestible product made from table sugar with added maltodextrin). Some months ago, I spoke about sugar alcohols, used in a lot of low-calorie desserts. All have reported side effects. Stevia doesn't. You can find these past articles on my website (www.womenshealthletter.com). To log on, use the user name and password on page 7.

The truly natural, no-calorie sweetener

Stevia rebaudiana is a South American shrub. Its leaves contain natural sweeteners called stevioside and rebaudioside that are 250 times sweeter than table sugar. Stevia has no calories, doesn't cause dental caries, won't kill off beneficial bacteria in your colon, causes no allergic reactions, and won't raise your blood sugar.

So why haven't you heard much about it? Ask the folks at the FDA who appear to be protecting the sugar industry more than your blood sugar and waistline. Stevia is an unapproved food additive, they say. No one has convinced them that it's safe, although numerous toxicology reports say it is.

Apparently, the FDA became concerned after reading a 1968 study on rats that hasn't been duplicated. And one of its researchers says it doesn't necessarily even apply to humans. The study found that stevia could act as a contraceptive — after the rats drank the equivalent of two-and-a-half quarts of stevia-liquid, containing parts of the plant we don't ingest, in half an hour! Isn't it nice to be protected by the FDA?

Still, you can buy stevia in any health food store. It's approved as a dietary supplement. But it can't be promoted as a sweetener unless you live in Brazil or Japan, where stevia is an approved food additive and sugar substitute. In fact, Coca-Cola sweetens its drinks with stevia in Japan and other countries!

Stevia's medical applications

Probably the most valuable use of stevia is to replace sugar in your diet. There's a rise in both obesity and adult-onset diabetes, and sugar-sweetened sodas are one of the biggest culprits. In fact, a Harvard study found that women who drink one or more sugary drinks a day have an 80 percent increased risk of diabetes over women who rarely drink sodas with sugar. Some of my patients took a small packet of powdered stevia and made a week's worth of sweetened lemonade with it.

For many years, stevia extracts have been used to treat diabetes in Paraguay and Brazil. This herb is being used successfully to fight diabetes, obesity, hypertension, fatigue, depression, infections, and sweet cravings. Several studies on rats with type-2 diabetes strongly suggest that stevia could become a new antidiabetic drug because it stimulates insulin secretion and lowers blood sugar.

Using Stevia

You won't find commercially made foods with stevia in this country, but it's easy enough to use. Here are a few tips to get you started.

You can find stevia powder or liquid in your health food store. Use the smallest amount necessary. If you get a bitter aftertaste, you've used too much. One-quarter teaspoon of the powder equals about half a cup of sugar. The powder is convenient to use for baked goods. But if you're sweetening a drink, such as lemonade, coffee, or tea, add a few drops of an extract.

You can make your own extract by mixing one teaspoon of stevia powder into three tablespoons of pure water. Put it in a dropper bottle, refrigerate, and shake well before using.

If you're looking for recipes using stevia, I have a couple of suggestions. The Stevia Cookbook, by Ray Sahelian, MD and Donna Gates (Avery, 1999) is packed with recipes for breakfast crepes, salad dressings, sweet and sour entrees, and desserts. It also has a lot of background information on stevia.

If you're more interested in desserts, Stevia Dessert Cookbook by Kristen Younger (self-published) has great recipes. It includes a section on adapting recipes for vegans, gluten-free diets, and people with lactose intolerance. Her book is available for $10 plus shipping (1948 Pleasant Hill Road, Sebastopol, CA 95472).

Gardana, C., et al. "Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora," J Agric Food Chem, October 22, 2003.

Geuns, J.M., "Stevioside," Phytochemistry, November 2003 (contains information on Stevia's very low toxicity and concludes it is safe when used as a sweetener).

Jeppesen, P.B., et al. "Stevioside induces antihyperglycaemic, insulinotropic and glucagonostatic effects in vivo," Phytomedicine, January 2002.

Raintree Nutrition, www.rain-tree.com

Ask Dr. Nan

Q: A friend of mine had surgery and radiation for cancer. The radiation affected her colon. Now she occasionally suffers from bleeding and irritation. Are there any specific foods you would advise her to avoid until she's healed? — B.W., Brooklyn, NY

A: The best way I know to heal the colon is to take massive amounts of probiotics. For this reason, I'd suggest taking one capsule twice a day of Dr. Ohhira's Probiotics 12 Plus (call 877-262-7843 to order), the product I talked about in October.

Slippery elm herb capsules also are healing for the colon and can be found in most health food stores. Take as directed. And both oatmeal and barley are soothing foods.

Tell your friend to be sure to chew her food very well. If she has digestive problems (gas, constipation, etc.) she might benefit from taking digestive enzymes with her meals. I'd suggest she avoid irritating foods such as popcorn, nuts, seeds, and spicy foods.

Zicam Update: STOP THE PRESS!

Just as this issue was being sent to the printer, I received an e-mail from a subscriber who had an episode of anosmia (loss of smell) that she directly traced back to using Zicam cold remedy nasal gel. I stopped the presses to bring you this update immediately.

This woman was fortunate. Her loss of smell lasted only a few weeks and then returned. Her episode occurred after she used the nasal gel and then lay down to rest. And her theory — suggested in several studies — is that something in the gel might possibly desensitize the olfactory receptors if it comes into contact with them.

An article out of the University of Colorado School of Medicine suggests this may well be the case. It could explain why so many people use Zicam without any incident. If you're using Zicam, you may want to avoid swabbing or spraying high in the nose and remain upright until it dries, just to be extra safe.

Zinc-related anosmia has been documented in several studies, so Zicam could be the culprit. One mouse study, for instance, found a temporary loss of smell in mice whose nasal passages were irrigated with a solution of zinc sulfate. Another study found that intranasal zinc did not produce anosmia. But there are a number of other factors that can cause anosmia including silver sulfate, doxycycline (an antibiotic), and a lack of zinc. This does not exonerate Zicam.

A third study uncovered a clue as to what may be happening. It found that anosmia occurred in some mice when it was used in higher concentrations. I found evidence that a loss of smell is less likely to occur when the nasal passages are congested. Swollen tissues can prevent zinc from getting too far up the nose to cause any problem.

Knowing all of this, I've decided to continue using Zicam, but differently. I intend to use the Zicam swabs rather than the spray, and to use it sparingly. I won't lie down immediately after using it, and I won't try to swab as high up into my nose as I can.

The percentage of people with anosmia that may be linked to Zicam are small. This doesn't mean we should ignore the issue. I have no doubt that the reader who alerted me to some of these articles did suffer temporary anosmia after using Zicam. Did Zicam cause it? Everything points in that direction.

For even more information, go to http://www.coldcure.com/anosmia/anosmia.html.

Ackerman, B.H. and N. Kasbekar. "Disturbances of taste and smell induced by drugs," Pharmacotherypay, 1997 May-June.

McBride, K., et al. "Does intranasal application of zinc sulfate produce ansomia in the mouse? An olfactometric and anatomical study," Chem Senses, 2003 October.

Jafek, B.W., et al. "Anosmia after intranasal zinc gluconate use," Am J Rhinol, 2004, May-June.

Hansen, L.F., et al. "Effects of intranasal ZnSO4 irrigation on olfactory and trigeminal cues," Physiol Behav, 1994 April.

Bleasel, A.F. "Anosmia after doxycycline use," Med J Aus, 1990 August.

CORRECTION re: Postherpetic neuralgia

Postherpetic neuralgia is a pain that often occurs after shingles, a herpes virus, not hepatitis, as reported in last month's article on thermography and pain. I apologize for any confusion that this error caused.