ABSTRACTS

SAN DIEGO, CALIFORNIA. Ciprofloxacin is a member of the fluoroquinolone family of antibiotics. It is used in the treatment of pneumonia, bronchitis, sinusitis, prostatitis, and urinary infections. Recently Cipro has received a lot of attention as an antidote to anthrax infection. Thousands of prescriptions have been filled recently for this drug, many people are taking it as a preventive measure, and governments are stockpiling millions of dosages. Is this a prudent response to the anthrax threat? Professor Jay S. Cohen of the University of California doesn't think so. He has identified 45 cases where patients developed serious adverse effects after taking Cipro (11 cases) or other fluoroquinolones. The primary reactions involved the peripheral nervous system and were manifested as numbness, twitching, spasms, tingling or burning pain. About 78 per cent of the cases also had central nervous system involvement with symptoms such as dizziness, agitation, hallucinations, and impaired cognitive function. Over 90 per cent of the adverse reactions showed up within two weeks with 33 per cent occurring within 24 hours of starting treatment. Symptoms were often long-term in nature with 58 per cent of patients having them for a year or more. In 40 per cent of the cases the prescribing physician did not recognize the symptoms as a reaction to fluoroquinolones or dismissed their significance.
Dr. Cohen concludes that fluoroquinolones such as Cipro are far from benign and should be used with great care. He also points out that less dangerous antibiotics such as penicillin and doxycycline are often all that is required to cure an infection.
Cohen, Jay S. Peripheral neuropathy associated with fluoroquinolones. The Annals of Pharmacotherapy, Vol. 35, December 2001, pp. 1-7

GADSDEN, ALABAMA. PC-SPES is a mixture of eight herbs – seven of them Chinese. It has been used in alternative medicine for some time in the treatment of prostate cancer. Now the results of three clinical trials confirm its effectiveness, not only in decreasing PSA (prostate specific antigen) levels and slowing down progression of the cancer, but also in alleviating pain and improving quality of life. One major trial included 33 patients with androgen-dependent (AD) prostate cancer and 37 patients with androgen- independent (AI) disease (a more severe form). The patients received three capsules of PC-SPES three times a day (BotanicLab, http://www.botaniclab.com). Patients with AD disease saw an average 80 per cent decrease in PSA levels over a 23-week period - two patients experienced a reduction in bone metastasis. All patients experienced loss of libido, impotence and a precipitous fall in testosterone levels. PSA levels also declined in the AI group, but to a somewhat lesser degree (greater than 50 per cent). Another study of patients with AI disease concluded that PC-SPES significantly reduced pain and improved quality of life scores.
Dr. John Pirani of Clinical Urology Associates concludes that PC-SPES is a valid therapy option for prostate cancer. However, it is not entirely benevolent. It can cause nipple tenderness and breast enlargement. If taken in excessive dosages it can cause internal bleeding because of its content of warfarin-like compounds. Medical doctors at the University of Washington warn that PC-SPES should only be taken under the supervision of a physician and dosages in excess of six capsules a day should be avoided.
Pirani, John F. The effects of phytotherapeutic agents on prostate cancer: an overview of recent clinical trials of PC SPES. Urology, Vol. 58, suppl. 2A, August 2001, pp. 36-38
Weinrobe, Mark C. and Bruce Montgomery. Acquired bleeding diathesis in a patient taking PC-SPES. New England Journal of Medicine, Vol. 345, October 18, 2001, pp. 1213-14 (correspondence)

ESSEN, GERMANY. Leeches were used throughout antiquity and well into the 20th century for the treatment of pain and inflammatory diseases. The last few years have seen a rise in leech therapy with a reported 70,000 treatments now taking place in Germany every year.
Researchers at the University of Essen have just completed a controlled pilot study to investigate the effect of leech therapy in relieving pain. The study involved 16 patients with painful osteoarthritis of the knee. Ten were treated once by the application of four leeches at the corners of the knee joint (front) for about 80 minutes. The six remaining patients were treated with conventional anti-inflammatory drugs. The patients undergoing leech therapy stopped their use of anti-inflammatories during the study period. All patients had their pain rated on a scale of 0 to 10 with 0 being no pain and 10 being extremely painful. The average pain score for the leech-treated patients was 7.4 at baseline, this decreased to 1.3 ten days after the treatment and remained at 1.0 28 days after treatment. In comparison the average pain score of the control patients was 4.8. It is known that the saliva of leeches contains a number of compounds with anaesthetic and analgesic properties. The researchers believe that these compounds, hyaluronidase in particular, are responsible for the pain-killing effects and urge further trials to confirm the benefits of leech therapy for osteoarthritis of the knee.
Michalsen, A., et al. Effect of leeches therapy (Hirudo medicinalis) in painful osteoarthritis of the knee: a pilot study. Annals of the Rheumatic Diseases, Vol. 60, October 2001, p. 986

ROTTERDAM, THE NETHERLANDS. Peripheral arterial disease is a manifestation of atherosclerosis in the lower limbs and is considered to be a precursor of intermittent claudication. Peripheral arterial disease is diagnosed by measuring systolic blood pressure at the upper arm in the sitting position and dividing it with the systolic pressure at the ankle in the supine position. If this ratio is equal to or less than 0.9 then peripheral arterial disease (PAD) is present.
A team of Dutch and German researchers now reports that a high intake of vitamin C or vitamin E reduces the risk of PAD. Their study involved 1673 men and 2694 women with an average age of 67 years. All participants underwent a thorough clinical evaluation and completed a 170-item food questionnaire. After adjusting for age and other confounding variables the researchers found that women with a vitamin C intake of more than 142 mg/day had a 36 per cent lower incidence of PAD than did women with an intake of less than 80 mg/day. The intake of beta-carotene and vitamin E was not related to PAD risk among women.
The findings for men were quite different. Here a vitamin E intake of more than 17.2 mg/day reduced the risk of PAD by 33 per cent when compared to an intake of less than 10.1 mg/day. The intake of beta- carotene and vitamin C was not related to PAD risk among men.
The researchers conclude that antioxidants are helpful in preventing PAD. They are not sure why there is a difference between men and women in regard to the relative benefits of vitamin C and vitamin E, but surmise that it could be due to a different food pattern.
Klipstein-Grobusch, Kerstin, et al. Dietary antioxidants and peripheral arterial disease: the Rotterdam Study. American Journal of Epidemiology, Vol. 154, July 15, 2001, pp. 145-49

SHANGHAI, CHINA. A team of American and Chinese researchers has discovered that folic acid (folate) is highly effective in preventing breast cancer in both pre- and postmenopausal women. Their investigation involved 1321 women with breast cancer and 1382 healthy controls. The women were between the ages of 25 and 64 years when they enrolled in the Shanghai Breast Cancer Study during 1996-98.
The researchers found a clear correlation between dietary intake of folic acid and the risk of breast cancer. Women with a daily intake of 345 micrograms or higher had a 38 per cent lower risk than did women with an intake of less than 195 micrograms – after adjustment for total vegetable, fruit and animal food intake. The protective effect of folic acid was even more pronounced in women who also had a high dietary intake of vitamin B6, vitamin B12 and methionine. Women with a daily intake equal to or higher than 345 micrograms of folic acid, 8.47 micrograms of vitamin B12, 2 mg of vitamin B6, and 1.9 grams of methionine had a 53 per cent lower risk of breast cancer than did women with daily intakes at or below 195 micrograms of folic acid, 1.32 micrograms of vitamin B12, 1.35 mg of vitamin B6, and 1.27 grams of methionine.
Researchers believe that folic acid exerts its protective effect by preventing errors in DNA replication and by helping to regenerate methionine, a vital component in DNA synthesis. They also point out that both vitamin B12 and vitamin B6 are vital cofactors required for folic acid to "do its job". NOTE: Most multivitamins have levels of folic acid, vitamin B6 and vitamin B12 well above the levels found to be beneficial in the Shanghai study.
Shrubsole, Martha J., et al. Dietary folate intake and breast cancer risk: results from the Shanghai Breast Cancer Study. Cancer Research, Vol. 61, October 1, 2001, pp. 7136-41

BOSTON, MASSACHUSETTS. Researchers at the Johns Hopkins University School of Medicine have just released a study concerning the use of alternative therapies in the treatment of Parkinson's disease (PD). They found that 40 per cent of the 201 patients interviewed used one or more alternative therapies. Vitamins and herbs, massage, and acupuncture were the most common. Almost 25 per cent of all patients used vitamins with 68 per cent of them using vitamin E (dosage range of 400-2,000 IU/day), 15 per cent using coenzyme Q10 (dosage range of 30-540 mg/day), 11 per cent taking multivitamins, 8.5 per cent using vitamin C, and 8.5 per cent using Ginkgo biloba. Most (58 per cent) of the patients did not consult with their regular physician before embarking upon the alternative treatments.
The use of alternative treatments was most common among college-educated, married, high-income patients who had developed PD at an early age. About 75 per cent of married, college-educated, 35- year-old patients used alternative therapies as compared to only 10 per cent among 65-year-old, single patients with a low education level. The researchers point out that the observed 40 per cent usage rate may be low on a national basis as people in the Baltimore area tend to be fairly conservative when compared with people on the west coast. They also conclude that communication between patients and physicians in regard to the use of alternative treatments leaves a lot to be desired.
Rajendran, Pam R., et al. The use of alternative therapies by patients with Parkinson's disease. Neurology, Vol. 57, September 2001, pp. 790-94

SUNBURY, OHIO. Attention-deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, emotional instability, poor coordination, short attention span, poor concentration, impulsiveness, and learning disorders. It is very common among school-age children with an incidence of between four and twenty per cent. Dr. Eugene Arnold, MD, Professor of Psychiatry at Ohio State University, points out that ADHD is not just a childhood disorder, but can be found among adults as well. Dr. Arnold has just completed an exhaustive survey of alternative treatments for adult ADHD. Although none of these treatments have undergone strictly controlled clinical trials some of them may nevertheless be worth a try. Relaxation training, biofeedback, meditation and massage are safe therapies that may have benefits. Fish oil supplementation, vitamins and minerals (in RDA dosages), herbal and homeopathic remedies, laser acupuncture, and anti-fungal (Candida) therapy may also be of benefit. Thyroid dysfunction and chronic lead poisoning are possible causes of ADHD and should be investigated and treated if necessary. Chelation is effective in removing lead. Zinc and magnesium supplementation may be useful if a deficiency is present and St. John's wort (hypericum) should at least be given a pilot study according to Dr. Arnold.
Arnold, L. Eugene. Alternative treatments for adults with ADHD. Annals of the New York Academy of Sciences, Vol. 931, June 2001, pp. 310-41

CHARLOTTESVILLE, VIRGINIA. The National Institute on Aging Advisory Panel on Testosterone Replacement in Men has just issued a report summarizing the current knowledge about testosterone deficiency and replacement in older men. The panel concluded:

• A total testosterone level below 250 nanograms/mL is associated with decreased sexual function and osteoporosis.
• It is possible that as many as 5 to 50 per cent of older men would be candidates for testosterone replacement therapy.
• Most studies have shown a small increase in lean body mass and bone mineral density and a reduction of fat mass with testosterone replacement.
• It is possible that testosterone replacement may be favourable as far as heart disease is concerned, but unfavourable in regard to prostate cancer.
• Further studies are urgently required to determine if testosterone replacement therapy increases the risk of prostate cancer and benign prostatic hypertrophy (enlarged prostate). It is also possible that it could increase the level of prostate specific antigen (PSA) with the possible consequence of unnecessary biopsies and surgery.
• If testosterone replacement therapy is warranted it should be administered in the form of a gel or patch.

Report of National Institute on Aging Advisory Panel on Testosterone Replacement in Men. Journal of Clinical Endocrinology and Metabolism, Vol. 86, October 2001, pp. 4611-14

TORONTO, CANADA. Reports in the medical literature attest to the fact that information about drugs conveyed to physicians by pharmaceutical company representatives is often biased, inaccurate and unduly favourable to the drug being promoted. Unfortunately, it is also a fact that many doctors rely on this information when prescribing for their patients. It has also been shown that physicians' prescription practices can be influenced by gifts, all-expenses-paid symposia, and other incentives.
Because of these findings McMaster University in Hamilton, Ontario decided in 1992 to restrict contact between residents (interns) and pharmaceutical company representatives. In particular drug salesmen were barred from attending educational events and from providing free lunches to residents. A survey of former McMaster residents and doctors who had graduated from the University of Toronto, which has no policy restricting contact, has just been completed. Although 88 per cent of all survey respondents reported that they had met with pharmaceutical company representatives over the past year there was a clear difference in how those meetings had influenced their prescription habits. Physicians trained under the policy restricting contact were 60 per cent less likely to find information from drug salesmen beneficial in guiding their practice.
McCormick, Brendan B., et al. Effect of restricting contact between pharmaceutical company representatives and internal medicine residents on posttraining attitudes and behavior. Journal of the American Medical Association, Vol. 286, October 24/31, 2001, pp. 1994-99

BOSTON, MASSACHUSETTS. More than a third of postmenopausal women in the United States use some form of hormone therapy (estrogen alone or a combination of estrogen and progesterone/progestin). Researchers at the Harvard Medical School and the Brigham and Women's Hospital how report that hormone replacement therapy (HRT) can lead to dry eye syndrome. Dry eye syndrome can be debilitating and cause corneal infection and, in some cases, permanent visual impairment.
The study involved 25,665 postmenopausal female health professionals who provided information about their use of HRT when entering the study and 12 and 36 months thereafter. They also provided information regarding the presence of dry eye syndrome 48 months after entering the study. Women who had never used HRT were found to have the lowest (5.9 per cent) prevalence of the syndrome. Women who had used estrogen by itself (even as little as 1 mg/day or less) had the highest incidence (9.1 per cent) and women who had used estrogen combined with progesterone/progestin had an intermediate prevalence of dry eye syndrome (6.7 per cent).
The researchers conclude that HRT with estrogen alone increases the risk of developing dry eye syndrome by 69 per cent while the use of estrogen plus progesterone/progestin increases it by 29 per cent. They also found that each additional 3-year use of HRT increases the risk by 15 per cent. They recommend that physicians who care for women on HRT should watch out for symptoms of dry eye syndrome.
Schaumberg, Debra A., et al. Hormone replacement therapy and dry eye syndrome. Journal of the American Medical Association, Vol. 286, November 7, 2001, pp. 2114-19

COPENHAGEN, DENMARK. The prestigious Cochrane Institute has issued a review of the benefits of breast cancer screening. This latest review is based on the conclusions reached by two Danish researchers, Ole Olsen and Peter Gotzsche, in a previous study published in 2000. The review concludes that there is no evidence that mass screening mammography reduces overall mortality among women (www.cochranelibrary.net). Says Richard Horton, editor of The Lancet in commenting on the study, "At present, there is no reliable evidence from large randomized trials to support screening mammography programs."
The Danish researchers also concluded that mass screening programs are associated with a 20 per cent increase in mastectomies and a 30 per cent increase in overall surgery (www.thelancet.com). The Cochrane Breast Cancer Group did not include this observation in the final review as they found it too controversial.
It would appear that the support for mass screening (mammography) for breast cancer is waning. The Cochrane review concludes, "The currently available reliable evidence does not show a survival benefit of mass screening for breast cancer (and the evidence is inconclusive for breast cancer mortality). Women, clinicians and policy makers should consider these findings carefully when they decide whether or not to attend or support screening programs." Editor's Note: The fact that mass screening for breast cancer is ineffectual does not mean that mammography cannot be a useful diagnostic tool if breast cancer is suspected.
Olsen, Ole and Gotzsche, Peter C. Cochrane review on screening for breast cancer with mammography. The Lancet, Vol. 358, October 20, 2001, pp. 1340-42 (research letter)
Horton, Richard. Screening mammography – an overview revisited. The Lancet, Vol. 358, October 20, 2001, pp. 1284-85 (commentary)
Mayor, Susan. Row over breast cancer screening shows that scientists bring "some subjectivity into their work". British Medical Journal, Vol. 323, October 27, 2001, p. 956

ROCKVILLE, MARYLAND. Age-related macular degeneration (AMD) is the leading cause of blindness amongst people 65 years or older. The macula is the central portion of the retina (back surface of the eyeball) directly opposite the lens. In macular degeneration the light-sensing cells of the macula malfunction and may eventually cease to work at all. The presence of drusen (waste deposits on the underside of the retina) is a precursor of AMD and can be observed during an eye examination.
Researchers at the National Eye Institute now report that supplementation with zinc and antioxidants can markedly retard the progression from the presence of extensive drusen to full-blown AMD. The study involved 3640 participants between the ages of 55 to 80 years. They had a thorough eye examination that divided them into four groups. Group 1 had few if any drusen, group 2 had extensive small drusen, group 3 had extensive intermediate-size drusen or at least one large drusen, and group 4 had advanced AMD or visual acuity less than 20/32 due to AMD in one eye. The participants were then randomized to receive daily oral supplements as follows:

• A 500 mg vitamin C, 400 IU vitamin E, and 15 mg beta-carotene
• B 80 mg zinc (as zinc oxide) plus 2 mg copper (as cupric oxide)
• C A + B
• D placebo

The progression towards AMD was measured at six-month intervals for an average of 6.3 years. At the end of the trial the researchers observed that daily supplementation with antioxidants and zinc (A + B) reduced the risk of progression to advanced AMD by 25 per cent in groups 3 and 4. The incidence of progression to advanced AMD in groups 1 and 2 was so low, even with placebo treatment, that no benefit of supplementation was observed.
The researchers conclude that patients with extensive drusen or advanced AMD should consider taking zinc and antioxidants in the dosages used in the study. They found no indication of serious adverse effects from the treatment, but warn that smokers may wish to avoid beta-carotene.
A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss. Archives of Ophthalmology, Vol. 119, October 2001, pp. 1417-36, 1533-34

NEWSBRIEFS

A cure for snoring
American Army doctors have developed a new technique for eliminating snoring. A single injection of tetradecyl sulphate into the fleshy soft palate at the back of the throat apparently does the trick. The injection destroys part of the palate thereby making it less likely to "flutter" and cause snoring.
New Scientist, September 22, 2001, p. 16

Bright light improves sleep
Researchers at the University of Glasgow believe that one of the reasons older people have difficulties getting a good night's sleep is that they do not get enough light during the day. Experiments with hamsters showed that their internal clocks deteriorated if they did not get enough light exposure. This, in turn, caused increasingly disrupted sleep. The researchers suggest that turning up the lights or getting outside more during the day may help older people improve their sleep pattern.
New Scientist, September 8, 2001, p. 8

Stroke victims should not lie down
A team of researchers from Edinburgh University has discovered that brain damage caused during a stroke can be reduced by letting patients sit upright rather than letting them lie down. The team found that the oxygen supply to the brain was reduced by 3 per cent when patients were moved from a chair to a bed.
New Scientist, September 1, 2001, p. 25

Omega-3 eggs and vitamin E
Eggs high in omega-3 fatty acids are a recent addition to the dietary scene. These eggs are produced by including fish oil in the chicken feed. German researchers now report that it is essential that the feed also contains relatively large amounts of vitamin E if the formation of toxic aldehydes (malondialdehyde) in the egg yolk is to be avoided. Their research showed that if 2.8 per cent of fish oil is added to the chicken feed then 80 IU of vitamin E should also be added per kg of feed. The researchers also observed that storage of the omega-3 enriched eggs resulted in a marked decrease in vitamin E content and that the DHA (docosahexaenoic acid) content of the eggs was five to nine times higher than the EPA (eicosapentaenoic acid) content. The cholesterol content of the omega-3 eggs did not differ from that of normal eggs.
Lipids, Vol. 36, August 2001, pp. 833-38

MMR vaccine controversy surfaces again
A British physician, Dr. Peter Mansfield, is being investigated by the General Medical Council for giving separate vaccines for rubella, measles, and mumps rather than using the all-encompassing MMR vaccine. Many parents are concerned about the MMR vaccine because of its possible link to autism. Giving three separate vaccines six weeks apart is considered to be safer, but much more expensive than giving the standard MMR vaccine in one shot. Other British doctors are concerned about the investigation and its implication in limiting the rights of physicians to give their patients the best possible care and treatment rather than the cheapest.
British Medical Journal, Vol. 323, August 18, 2001, p. 356

Acupuncture is safe
Two major British studies have reached the conclusion that acupuncture is very safe. One study evaluated a total of 32,000 treatments and found that only 43 of them had a "significant" side effect. Another study involving 34,000 treatments found 43 minor events. Not a single serious adverse event was reported in the combined sample of 66,000 treatments. The "significant" and minor events included nausea, fainting and heavy sweating. All these events resolved themselves within one week except for a case of pain that lasted two weeks.
British Medical Journal, Vol. 323, September 1, 2001, pp: 485-87

BOOK REVIEW

Numb Toes and Other Woes:
More on Peripheral Neuropathy
John A. Senneff
Med Press, San Antonio, Texas 78269
250 pages, 2001

It is estimated that over 20 million Americans suffer from peripheral neuropathy. Diabetes is the most common cause, but the HIV virus, toxic metals and chemicals, vitamin deficiencies, nutritional imbalances, and a whole host of other factors can also initiate this painful and debilitating disorder. Peripheral neuropathy (PN) results from damage to the peripheral nerves or their protective coatings and most often manifests itself by pain, tingling and numbness in the legs, feet and hands. The disorder may also present itself with vague symptoms such as dizziness, insomnia, bladder problems, constipation, and sexual dysfunction. Because of its diverse symptoms PN is often misdiagnosed launching its victims on the all too familiar pattern of an increasingly desperate search for an explanation and cure.

John Senneff, the author of "Numb Toes and Other Woes" has suffered from PN for more than 10 years and has been through the gamut of tests and therapies himself. His earlier book "Numb Toes and Aching Soles: Coping with Peripheral Neuropathy" became a best seller and rightly so. This book dispelled the mystery and myths surrounding PN and provided a wealth of practical advice on how to cope with it.

In his new book John has done it again. This book contains the latest thinking and breakthroughs in the treatment of PN. It covers pain medications from antidepressants to narcotics and provides detailed information about medical therapies like TENS and H-Wave therapy. It also discusses supplements and alternative and complementary therapies. As a health researcher myself I found John's chapters on new, experimental therapies and the "creeping progress" in gaining a better understanding of the causes absolutely fascinating. Apparently there is now evidence that cholesterol-lowering drugs (statins) and at least 30 other common medications can cause PN. John lists them all and his statements are backed by impeccable references. He also goes into great detail about current and experimental pharmaceutical drugs used. This section alone is worth the price of the book if you are about to try a new drug. If you suffer from PN order John's book now! It can save you untold hours of time, trouble and pain in your battle against peripheral neuropathy.