PEOPLE S PHARMACY FDA on the hot seat over heparin horror
Physicians, pharmacists, insurance companies and hospitals have relied upon the FDA to guarantee that American medications are reliable and safe. They have assumed that the agency was capable of monitoring the drug supply chain. Perhaps it is time to re-evaluate that assumption.
Q: I have the worst-smelling feet I have ever encountered. I have tried everything to get rid of the odor, and nothing works.
I am a welder and have to wear steel-toe boots. I put odor-fighting insoles in them. They work for a week, and then the smell is back again. My girlfriend always tells me that they are really bad, and they are.
I wash my feet when I get home from work, and three hours later they are really STINKY again. Is there anything I can do get rid of this horrible problem?
A: Such a persistent smell may be caused by bacteria or fungi that have taken up residence on your feet. We have been collecting remedies for this problem for decades. Here are some favorites:
Military veterans have reported that urinating on the feet in the shower is a tried-and-true (and cheap) approach. Others tell us that foot soaks with baking soda, diluted vinegar or Listerine can also help. A waitress reported that Campho-Phenique "worked wonders."
We are sending you our Guide to Solutions for Smelly Feet. It also can be downloaded for free from our Web site: www.peoplespharmacy.com
Q: My brother-in-law has had diarrhea since radiation treatment on his prostate burned his colon. He has suffered demoralizing daily diarrhea.
I told him to try coconut macaroons to battle the diarrhea, and they worked for him. He is elated. He's actually planning on taking some extended driving trips, which he didn't dare try before.
He takes two cookies a day. He IS diabetic, so my sister makes him a batch that is sugar-free.
A: We first learned about coconut macaroons calming chronic diarrhea from Donald Agar of Pittsfield, Mass. He reported his results, and many others have benefited since.
Macaroons are easy to find and offer a fairly consistent dose of coconut. We think that coconut is the active ingredient, though, so your brother-in-law could skip the cookies that are not on his diet and just eat a teaspoon or so of unsweetened coconut. He'll have to figure out the effective dose.
Q: You recently suggested that glucosamine and chondroitin are not effective for mild to moderate knee arthritis. Your assessment was sadly incomplete.
In the study you cited, you failed to report that patients with moderate-to-severe knee pain did receive substantial benefit from this dietary supplement.
A: You have summarized one of the most curious findings of the GAIT trial (New England Journal of Medicine, Feb. 23, 2006). This large, placebo-controlled study found that people with more severe knee pain got modest benefit from glucosamine and chondroitin. Overall, however, the authors concluded that "the supplements were not shown to be effective."
A more recent study did not show that glucosamine was better than placebo for mild hip arthritis (Annals of Internal Medicine, Feb. 19, 2008). Some readers find these supplements helpful, but the research is not encouraging.
Anyone who is interested in more details about glucosamine and chondroitin, MSM, SAMe, acupuncture and other natural approaches to treating arthritis will find Best Choices From The People's Pharmacy helpful. This book is available in libraries, bookstores and online at www.peoplespharmacy.com
Q: I am surprised that I have never seen pineapple juice mentioned in your column as a cure for hiccups. It works with one sip!
A: Thanks for mentioning it. We've heard that pineapple juice can reduce joint pain, but you are the first to report that it cures hiccups.
Q: I have heard that an ingredient in plastic called bisphenol A can get into foods and beverages from containers. I was so impressed with the evidence of harm that I thought I would see what food I could buy without plastic wrap, plastic containers or cans.
My options were few! I bought a lot of fresh veggies, but had to put them in plastic bags. We don't drink sodas, but many "healthy" drinks come in plastic. I searched for glass-bottled juices and oils but found very few choices. The meats, eggs, "smart" margarines
My shopping cart was full of interesting new choices, but I wonder: How can I avoid plastics with bisphenol A?
A: There is a raging controversy about the safety of bisphenol A (BPA) found in polycarbonate plastics. This compound mimics estrogen. Water bottles, baby bottles and the lining of metal cans often contain BPA. Plastic containers may be marked with the recycling code "7."
On our radio show, we discussed the health consequences of BPA in great detail with some of the country's leading experts. Anyone who would like this one-hour CD on Sex Hormone Disruption may send $16 to: Graedons' People's Pharmacy (CD-670), P.O. Box 52027, Durham, NC 27717-2027. Show No. 670 is also available at www.peoplespharmacy.com
Q: As a physician, I have been testing my patients for 25-hydroxy vitamin D for several months. Many are deficient, and some have symptoms of pain and muscle weakness.
I advise patients to take one or two vitamin D supplements of 1,000 units daily. Many pharmacists are not aware of the new information, and some have discouraged my patients from buying such supplements if they are taking multivitamins with 400 International Units per daily dose. Please write about this issue.
A: Fatigue, high blood pressure and joint and muscle pain are just a few of the possible symptoms associated with vitamin D deficiency. Researchers are reporting high rates of this condition because few people spend much time outside, especially during the winter. During the summer, conscientious use of sunscreen can block vitamin D formation.
Experts are now recommending daily doses of vitamin D in the 1,000 to 2,000 range. Although pharmacists may worry about the potential for vitamin D toxicity, this appears to occur only at much higher doses.
Q: I have read that using decongestant nasal sprays can be addictive. What are your views on using oral OTC cold remedies for more than seven days? Will these cause any symptoms when I stop?
A: There is considerable controversy about the effectiveness of the readily available oral decongestant phenylephrine (Annals of Pharmacotherapy, March 2007). Such drugs seem less likely to cause rebound nasal congestion, but they may raise blood pressure in susceptible individuals. Since there is doubt about their benefit, we generally don't recommend them.
Q: I was diagnosed with celiac disease and advised to avoid gluten from wheat, rye and barley. Avoiding gluten in my diet has made a huge difference for me. Are there any resources to help me avoid gluten in pills?
A: In celiac disease, ingesting gluten triggers the immune system to attack the body, especially the small intestine. This interferes with nutrient absorption. The Food and Drug Administration does not require manufacturers to list gluten on drug labels, but you can look up your medicines at www.glutenfreedrugs.com
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