ScienceDaily (Dec. 30, 2009) — Older adults who used the herbal supplement Ginkgo biloba for several years did not have a slower rate of cognitive decline compared to adults who received placebo, according to a new study.
"Ginkgo biloba is marketed widely and used with the hope of improving, preventing, or delaying cognitive impairment associated with aging and neurodegenerative disorders such as Alzheimer disease," the authors write. "Indeed, in the United States and particularly in Europe, G biloba is perhaps the most widely used herbal treatment consumed specifically to prevent age-related cognitive decline." However, evidence from large clinical trials regarding its effect on long-term cognitive functioning is lacking.
Beth E. Snitz, Ph.D., of the University of Pittsburgh, and colleagues analyzed outcomes from the Ginkgo Evaluation of Memory (GEM) study to determine if G biloba slowed the rate of cognitive decline in older adults who had normal cognition or mild cognitive impairment (MCI) at the beginning of the study. The GEM study previously found that G biloba was not effective in reducing the incidence of Alzheimer dementia or dementia overall. The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.
In this study, the largest randomized controlled trial of G biloba to report on outcomes to date, the researchers found no evidence for an effect of G biloba on global cognitive change and no evidence of effect on specific cognitive domains of memory, language, attention, visuospatial abilities and executive functions. They also found no evidence for differences in treatment effects by age, sex, race, education or baseline cognitive status (MCI vs. normal cognition).
"In sum, we find no evidence that G biloba slows the rate of cognitive decline in older adults. These findings are consistent with previous smaller studies examining prevention of decline and facilitation of cognitive performance and with the 2009 Cochrane review of G biloba for dementia and cognitive impairment."
Beth E. Snitz, PhD; Ellen S. O%u2019Meara, PhD; Michelle C. Carlson, PhD; Alice M. Arnold, PhD; Diane G. Ives, MPH; Stephen R. Rapp, PhD; Judith Saxton, PhD; Oscar L. Lopez, MD; Leslie O. Dunn, MPH; Kaycee M. Sink, MD; Steven T. DeKosky, MD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators Evaluation of Memory (gem) Study Investigators. Ginkgo biloba for Preventing Cognitive Decline in Older Adults. Journal of the American Medical Association
Thursday, December 31, 2009
Wednesday, December 30, 2009
Take the Day Off-It’s a “Beach Day”
While the holidays can be a lot of fun, they can also become overwhelming and you need a break from them. It may sound a bit odd to recommend a “beach day,” particularly if you live in the Northeast where heavy snow is in the forecast and it’s currently zero degrees. However, a day at the beach is the best example I can think of for taking a day off.
Similar to getting ready for a day at the beach, prepare for what you’ll need. This may include getting some special foods and drinks, as well as things to do, such as a good book to read.
Wake up when you want to, and spend as much time as you want getting dressed (or not), eating, reading the paper etc. Phones, computers, faxes and other devices should be turned off. You wouldn’t want these items at the beach.
Just as you would set up camp with your umbrella and chair, map out your space at home. Place your favorite pillow on your reading chair or couch. Maybe position it to take advantage of the sun. Play music that sets the mood. Read, do a crossword puzzle, or any activity that you find relaxing. Drift off to sleep now and again.
When you are at the beach you can’t do chores or deal with work or home problems. Leave those issues for another day.
Instead of taking a dip in the water, pamper yourself with a long bath. If you were at the beach, you might stare out at the water and the distant horizon. Watch the birds in your yard or notice how the trees and shrubs have changed because of the winter season.
At some point during a beach day, you might go for a walk, fly a kite, play a round of mini golf, or play volleyball. Include the equivalent in your day by taking a walk around the block, weather permitting, or do some simple exercises.
No matter our age, you can’t help but find yourself pilling up sand and creating patterns with your finger. While you aren’t going to be able to make a sand castle, respond to the urge of creating something and sketch, draw, doodle, write a poem, or engage in a hobby or craft that you enjoy. Keep in mind that this is a de stress day, so don’t engage in an activity, though enjoyable, which could cause you a lot of stress.
On your day off, respond to the idea of a beach day by keeping it simple, leaving problems, concerns and decisions for another time, and totally immerse yourself in the moment.
Similar to getting ready for a day at the beach, prepare for what you’ll need. This may include getting some special foods and drinks, as well as things to do, such as a good book to read.
Wake up when you want to, and spend as much time as you want getting dressed (or not), eating, reading the paper etc. Phones, computers, faxes and other devices should be turned off. You wouldn’t want these items at the beach.
Just as you would set up camp with your umbrella and chair, map out your space at home. Place your favorite pillow on your reading chair or couch. Maybe position it to take advantage of the sun. Play music that sets the mood. Read, do a crossword puzzle, or any activity that you find relaxing. Drift off to sleep now and again.
When you are at the beach you can’t do chores or deal with work or home problems. Leave those issues for another day.
Instead of taking a dip in the water, pamper yourself with a long bath. If you were at the beach, you might stare out at the water and the distant horizon. Watch the birds in your yard or notice how the trees and shrubs have changed because of the winter season.
At some point during a beach day, you might go for a walk, fly a kite, play a round of mini golf, or play volleyball. Include the equivalent in your day by taking a walk around the block, weather permitting, or do some simple exercises.
No matter our age, you can’t help but find yourself pilling up sand and creating patterns with your finger. While you aren’t going to be able to make a sand castle, respond to the urge of creating something and sketch, draw, doodle, write a poem, or engage in a hobby or craft that you enjoy. Keep in mind that this is a de stress day, so don’t engage in an activity, though enjoyable, which could cause you a lot of stress.
On your day off, respond to the idea of a beach day by keeping it simple, leaving problems, concerns and decisions for another time, and totally immerse yourself in the moment.
Saturday, December 26, 2009
Tips for Staying Healthy During the Holidays
The holidays are now upon us and so are a zillion and one foods we’d be better off not eating. So to avoid unnecessary pounds, and to stay healthy this season, try the following:
Cooking Light’s 5 Best and Worst Holiday Foods
Loose Weight over the Holidays
New York Times Recipes for Health
The Best and Worst Holiday Foods (Eat This Not That)
In addition to watching what you eat, you can also add 10 minutes to the cardio portion of your workout during the holidays to help keep the weight gain down. If you are laughing and saying “as if,” well now is a good time to think about exercise. Just walking for 30 minutes burns about 180 calories for the average person. If you are walking up hill, carry weights or use ski poles you burn even more. Of course one of the easiest and most effective exercises is pushing away from the table.
Which Exercises Burn the Most Calories
Because the holidays are a stressful time, take regular yoga breaks courtesy of Kripalu.
Cooking Light’s 5 Best and Worst Holiday Foods
Loose Weight over the Holidays
New York Times Recipes for Health
The Best and Worst Holiday Foods (Eat This Not That)
In addition to watching what you eat, you can also add 10 minutes to the cardio portion of your workout during the holidays to help keep the weight gain down. If you are laughing and saying “as if,” well now is a good time to think about exercise. Just walking for 30 minutes burns about 180 calories for the average person. If you are walking up hill, carry weights or use ski poles you burn even more. Of course one of the easiest and most effective exercises is pushing away from the table.
Which Exercises Burn the Most Calories
Because the holidays are a stressful time, take regular yoga breaks courtesy of Kripalu.
Wednesday, December 23, 2009
Take a Break: Make Snow/Do Qigong Now
Whether there is snow on the ground where you live or not, it’s nice to have a way to accent craft projects or even floral arrangements with what appears to be snow. An easy recipe for fake snow is mixing small amounts together of white acrylic paint, glitter and sand. Dab on to various objects and let dry.
Another idea is to make Snowy Balloon ornaments. A variation to the directions is to sprinkle on the glitter after you’ve applied the glue so you save a step.
RELAXATION TIP: Do Qigong Now
Another idea is to make Snowy Balloon ornaments. A variation to the directions is to sprinkle on the glitter after you’ve applied the glue so you save a step.
RELAXATION TIP: Do Qigong Now
Sunday, December 20, 2009
Death: Thinking about it during the holidays
Death is a topic that everyone thinks about. But why write about it during the holiday season?
Once my siblings and I had moved out of the house, my mother would always say, “this may be the last time we’re together for Christmas.” For her, and many others, the holidays are a time to reflect on who is no longer with us, our health, and in short, it’s a time of year when we take stock of our lives. Therefore, it’s no surprise that several interesting articles and books have recently appeared.
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think. Thus begins an interesting article by Robert Lanza M.D. entitled “Does Death Exist? New Theory Says No.” Dr. Lanza is Chief Scientific Officer at Advanced Cell Technology, and a professor at Wake Forest University School of Medicine and has several hundred publications and inventions, and over 20 scientific books.
Dinesh D’Souza, a policy analyst in the Reagan White House, is the bestselling author of many books about politics, patriotism, and religion. His latest book is “Life After Death: The Evidence.” In an article about his new book he writes, In my research I also explored evidence from physics, biology, and brain science to see if life after death is consistent with or even corroborated by these fields of study…. In considering the question of life after death, I moved from why it's possible to why it's probable to why we should embrace the idea. Since we are dealing with a future event, I acknowledge that we cannot have certainty. I don't claim to prove my case beyond a reasonable doubt, but I do claim to prove it by a preponderance of the evidence. In the end, we have to resolve this residual uncertainty by asking a practical question, "Is it good for me to believe?"
Once my siblings and I had moved out of the house, my mother would always say, “this may be the last time we’re together for Christmas.” For her, and many others, the holidays are a time to reflect on who is no longer with us, our health, and in short, it’s a time of year when we take stock of our lives. Therefore, it’s no surprise that several interesting articles and books have recently appeared.
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think. Thus begins an interesting article by Robert Lanza M.D. entitled “Does Death Exist? New Theory Says No.” Dr. Lanza is Chief Scientific Officer at Advanced Cell Technology, and a professor at Wake Forest University School of Medicine and has several hundred publications and inventions, and over 20 scientific books.
Dinesh D’Souza, a policy analyst in the Reagan White House, is the bestselling author of many books about politics, patriotism, and religion. His latest book is “Life After Death: The Evidence.” In an article about his new book he writes, In my research I also explored evidence from physics, biology, and brain science to see if life after death is consistent with or even corroborated by these fields of study…. In considering the question of life after death, I moved from why it's possible to why it's probable to why we should embrace the idea. Since we are dealing with a future event, I acknowledge that we cannot have certainty. I don't claim to prove my case beyond a reasonable doubt, but I do claim to prove it by a preponderance of the evidence. In the end, we have to resolve this residual uncertainty by asking a practical question, "Is it good for me to believe?"
Saturday, December 19, 2009
Generics: Not all Drugs are the Same After All
New York Times
December 19, 2009
PATIENT MONEY
Not All Drugs Are the Same After All
By LESLEY ALDERMAN
LET me start by saying I’m a fan of generic drugs. They save Americans billions of dollars each year and give us access to wonderful drugs at affordable prices. I’ve recommended generics in this column many times and use them myself when possible.
But there is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.
Let me also prepare the groundwork for what I hope will be full and frank reader comments, by acknowledging that this issue is controversial.
Joe Graedon, who has been writing about pharmaceuticals for three decades and runs a consumer advocacy Web site, the People’s Pharmacy, was 100 percent behind generics for many years.
“We were the country’s leading generic enthusiasts,” he told me recently. But over the last eight or nine years, Mr. Graedon began hearing about “misadventures” from people who read his syndicated newspaper column, also called The People’s Pharmacy.
The stories were typically from patients who were switched from a brand name drug to a generic one and had side effects or found that their symptoms returned — or even became worse than before they were medicated. Most recently Mr. Graedon has been hearing complaints on his Web site about generic forms of the antidepressant Wellbutrin XL 300 (known as Budeprion XL 300 in one generic form), the heart medicine Toprol XL (metoprolol succinate) and the antiseizure medicine Keppra (levetiracetam).
“Consumers are told generics are identical to brand name drugs, but that is clearly not always the case,” Mr. Graedon said.
Some specialists, particularly cardiologists and neurologists, are concerned about generic formulations of drugs in which a slight variation could have a serious effect on a patient’s health. The American Academy of Neurology has a position paper that says, in part, “The A.A.N. opposes generic substitution of anticonvulsant drugs for the treatment of epilepsy without the attending physician’s approval.”
But insurers tend to argue otherwise. On Thursday, ExpressScripts, which handles drug insurance for big employers, put out a news release announcing results of a study it sponsored that found no difference in hospitalizations or emergency-room visits for people on brand-name epilepsy drugs compared with those taking generics.
The Food and Drug Administration, meanwhile, says it stands behind generic medications and its methods for approving them.
“We have not seen any scientific studies that show generics do not hold up as well as brand name drugs,” says Gary J. Buehler, director of the agency’s office of generic drugs. “We believe the generic drugs we approve work in everyone.”
The American Medical Association concurs. A spokeswoman for the group told me in an e-mail message, “the A.M.A. position is that as a whole generic drugs do work as well as name-brand drugs.”
Yet, after hundreds of consumers posted messages about problems with the generic drug Budeprion XL 300 on the People’s Pharmacy Web site, Mr. Graedon worked with an independent laboratory, ConsumerLab.com, to test the drug, which in other generic versions is typically known as bupropion.
The lab found that Budeprion XL 300 released the active drug at a different rate than the brand name Wellbutrin XL 300. Mr. Graedon and the lab conjecture that the different dissolution rates might be to blame for the reported side effects and lower effectiveness of Budeprion.
But Mr. Buehler at the F.D.A. explained to me that over the course of 24 hours a patient ends up with the same amount of the drug in the bloodstream, so there should be no reason for a variation in effectiveness. “We remain puzzled,” he said.
The maker of Budeprion XL 300, Teva Pharmaceutical Industries, recently announced that it would conduct a clinical trial comparing its product against the original, Wellbutrin XL.
A Teva spokeswoman said in an e-mail message that the company was working with the F.D.A. on a study “specifically designed to answer the questions raised following the recent anecdotal commentary on generic budeprion.”
“We believe the study and the resulting data will provide further scientific support for the product’s bioequivalence to the innovator drug,” she said.
To parse that statement — or at least understand “bioequivalence” — it is worth taking a step back to consider what a generic drug is and how it gets approved.
When a name-brand drug’s patent expires, other manufacturers are generally free to create their own version of that product. If a drug is popular, a dozen or more companies may rush in to create a copy of it.
According to F.D.A. rules, the new generic version must “have the same active ingredient, strength and dosage form” as the brand name or reference product.
A generic medication must also be bioequivalent to the brand name drug, meaning that it must “be shown to give blood levels that are very similar to” the brand name product, according to a fact sheet on the F.D.A.’s Web site. Generally, the only test that a maker of a generic medication must perform to receive F.D.A. approval is one that establishes the “bioequivalence” of the product. This test is done on healthy volunteers and compares the blood levels of the reference drug to the generic one.
According to Mr. Buehler of the F.D.A., to be considered bioequivalent, the generic drug must reach a blood serum level that is 80 to 125 percent of what the reference product achieves. But Mr. Buehler said that in reality the spread was not nearly that large. He noted that the F.D.A. conducted a large study and found that the average difference in absorption into the body between a generic and brand name drug was only 3.5 percent.
Some specialists, though, worry that the allowable range for bioequivalence is too wide, especially for patients who are taking medication to control problems like arrhythmias or seizures.
If a patient with the heart arrhythmia known as atrial fibrillation who also has risk markers for stroke gets a blood thinner for which the levels are too low, “there is risk for stroke, and if the levels are too high it could result in bleeding,” says James A. Reiffel, a cardiologist and professor of clinical medicine at Columbia.
Neurologists who treat epilepsy have similar concerns. Two studies published last year in the journal Neurology found that patients who switched from a brand-name product to a generic one had more seizures or higher hospitalization rates.
“For many drugs, generics are just fine,” said Kimford Meador, a professor of neurology at Emory University.
“But when you’re taking a seizure medication, the therapeutic window is narrow,” Dr. Meador said. “If the absorption of the drug is slightly different between brand and generic or between generics, then the patient could have a seizure, and that seizure could lead to serious injury or perhaps even death.”
The problem is not just in changing from a name-brand drug to a generic, Dr. Meador said, but also switching from generic to generic. And the patient may not even know the change is happening.
When patients are on maintenance medication for which a generic is available, they might be given a different version of the generic drug when refilling their prescriptions. A pharmacy might stock one generic for a few months, and then switch to another a few months later, if the store is offered a better deal on it.
A pharmacist is not required to notify the patient of the change, although some choose to do so.
So for a few months you might receive a drug that was on the low side in the bioequivalence test, and then be switched to one on the high side of the test.
Stephanie Ford, 29, who spoke on condition that she not be otherwise identified, had been taking Lamictal to control her bipolar disorder. When a generic version came out two years ago, her insurer switched her to it.
Ms. Ford found that the generic drug, lamotrigine, worked just as well as the name brand and cost her just $10 a month instead of the $45 copayment she had been spending on the brand name. (For a person without insurance, Lamictal can cost about $300 a month, depending on the dosage.)
But when her insurer then urged her to order her medication by mail, she received another generic version of Lamictal and her symptoms returned.
“After about a week,” she wrote in an e-mail message, “I noticed a difference in my emotional state (and nothing changed in my life) and by a week and a half, I had digressed to the state I had been before being on medication.”
Ms. Ford has found a local pharmacy that carries the original generic. She now buys the medication directly from that store. Because her insurer charges her a $5 penalty for not using mail order, her copayment is now $15.
She says her condition has once again stabilized.
December 19, 2009
PATIENT MONEY
Not All Drugs Are the Same After All
By LESLEY ALDERMAN
LET me start by saying I’m a fan of generic drugs. They save Americans billions of dollars each year and give us access to wonderful drugs at affordable prices. I’ve recommended generics in this column many times and use them myself when possible.
But there is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterparts. The problem is not pervasive, but it’s something consumers should be aware of — especially now that more insurers insist that patients take generic medications when they are available.
Let me also prepare the groundwork for what I hope will be full and frank reader comments, by acknowledging that this issue is controversial.
Joe Graedon, who has been writing about pharmaceuticals for three decades and runs a consumer advocacy Web site, the People’s Pharmacy, was 100 percent behind generics for many years.
“We were the country’s leading generic enthusiasts,” he told me recently. But over the last eight or nine years, Mr. Graedon began hearing about “misadventures” from people who read his syndicated newspaper column, also called The People’s Pharmacy.
The stories were typically from patients who were switched from a brand name drug to a generic one and had side effects or found that their symptoms returned — or even became worse than before they were medicated. Most recently Mr. Graedon has been hearing complaints on his Web site about generic forms of the antidepressant Wellbutrin XL 300 (known as Budeprion XL 300 in one generic form), the heart medicine Toprol XL (metoprolol succinate) and the antiseizure medicine Keppra (levetiracetam).
“Consumers are told generics are identical to brand name drugs, but that is clearly not always the case,” Mr. Graedon said.
Some specialists, particularly cardiologists and neurologists, are concerned about generic formulations of drugs in which a slight variation could have a serious effect on a patient’s health. The American Academy of Neurology has a position paper that says, in part, “The A.A.N. opposes generic substitution of anticonvulsant drugs for the treatment of epilepsy without the attending physician’s approval.”
But insurers tend to argue otherwise. On Thursday, ExpressScripts, which handles drug insurance for big employers, put out a news release announcing results of a study it sponsored that found no difference in hospitalizations or emergency-room visits for people on brand-name epilepsy drugs compared with those taking generics.
The Food and Drug Administration, meanwhile, says it stands behind generic medications and its methods for approving them.
“We have not seen any scientific studies that show generics do not hold up as well as brand name drugs,” says Gary J. Buehler, director of the agency’s office of generic drugs. “We believe the generic drugs we approve work in everyone.”
The American Medical Association concurs. A spokeswoman for the group told me in an e-mail message, “the A.M.A. position is that as a whole generic drugs do work as well as name-brand drugs.”
Yet, after hundreds of consumers posted messages about problems with the generic drug Budeprion XL 300 on the People’s Pharmacy Web site, Mr. Graedon worked with an independent laboratory, ConsumerLab.com, to test the drug, which in other generic versions is typically known as bupropion.
The lab found that Budeprion XL 300 released the active drug at a different rate than the brand name Wellbutrin XL 300. Mr. Graedon and the lab conjecture that the different dissolution rates might be to blame for the reported side effects and lower effectiveness of Budeprion.
But Mr. Buehler at the F.D.A. explained to me that over the course of 24 hours a patient ends up with the same amount of the drug in the bloodstream, so there should be no reason for a variation in effectiveness. “We remain puzzled,” he said.
The maker of Budeprion XL 300, Teva Pharmaceutical Industries, recently announced that it would conduct a clinical trial comparing its product against the original, Wellbutrin XL.
A Teva spokeswoman said in an e-mail message that the company was working with the F.D.A. on a study “specifically designed to answer the questions raised following the recent anecdotal commentary on generic budeprion.”
“We believe the study and the resulting data will provide further scientific support for the product’s bioequivalence to the innovator drug,” she said.
To parse that statement — or at least understand “bioequivalence” — it is worth taking a step back to consider what a generic drug is and how it gets approved.
When a name-brand drug’s patent expires, other manufacturers are generally free to create their own version of that product. If a drug is popular, a dozen or more companies may rush in to create a copy of it.
According to F.D.A. rules, the new generic version must “have the same active ingredient, strength and dosage form” as the brand name or reference product.
A generic medication must also be bioequivalent to the brand name drug, meaning that it must “be shown to give blood levels that are very similar to” the brand name product, according to a fact sheet on the F.D.A.’s Web site. Generally, the only test that a maker of a generic medication must perform to receive F.D.A. approval is one that establishes the “bioequivalence” of the product. This test is done on healthy volunteers and compares the blood levels of the reference drug to the generic one.
According to Mr. Buehler of the F.D.A., to be considered bioequivalent, the generic drug must reach a blood serum level that is 80 to 125 percent of what the reference product achieves. But Mr. Buehler said that in reality the spread was not nearly that large. He noted that the F.D.A. conducted a large study and found that the average difference in absorption into the body between a generic and brand name drug was only 3.5 percent.
Some specialists, though, worry that the allowable range for bioequivalence is too wide, especially for patients who are taking medication to control problems like arrhythmias or seizures.
If a patient with the heart arrhythmia known as atrial fibrillation who also has risk markers for stroke gets a blood thinner for which the levels are too low, “there is risk for stroke, and if the levels are too high it could result in bleeding,” says James A. Reiffel, a cardiologist and professor of clinical medicine at Columbia.
Neurologists who treat epilepsy have similar concerns. Two studies published last year in the journal Neurology found that patients who switched from a brand-name product to a generic one had more seizures or higher hospitalization rates.
“For many drugs, generics are just fine,” said Kimford Meador, a professor of neurology at Emory University.
“But when you’re taking a seizure medication, the therapeutic window is narrow,” Dr. Meador said. “If the absorption of the drug is slightly different between brand and generic or between generics, then the patient could have a seizure, and that seizure could lead to serious injury or perhaps even death.”
The problem is not just in changing from a name-brand drug to a generic, Dr. Meador said, but also switching from generic to generic. And the patient may not even know the change is happening.
When patients are on maintenance medication for which a generic is available, they might be given a different version of the generic drug when refilling their prescriptions. A pharmacy might stock one generic for a few months, and then switch to another a few months later, if the store is offered a better deal on it.
A pharmacist is not required to notify the patient of the change, although some choose to do so.
So for a few months you might receive a drug that was on the low side in the bioequivalence test, and then be switched to one on the high side of the test.
Stephanie Ford, 29, who spoke on condition that she not be otherwise identified, had been taking Lamictal to control her bipolar disorder. When a generic version came out two years ago, her insurer switched her to it.
Ms. Ford found that the generic drug, lamotrigine, worked just as well as the name brand and cost her just $10 a month instead of the $45 copayment she had been spending on the brand name. (For a person without insurance, Lamictal can cost about $300 a month, depending on the dosage.)
But when her insurer then urged her to order her medication by mail, she received another generic version of Lamictal and her symptoms returned.
“After about a week,” she wrote in an e-mail message, “I noticed a difference in my emotional state (and nothing changed in my life) and by a week and a half, I had digressed to the state I had been before being on medication.”
Ms. Ford has found a local pharmacy that carries the original generic. She now buys the medication directly from that store. Because her insurer charges her a $5 penalty for not using mail order, her copayment is now $15.
She says her condition has once again stabilized.
Friday, December 18, 2009
American Dietetic Association Releases Updated Position Paper on Nutrient Supplementation
December 7, 2009
CHICAGO – While supplements can help some people meet their nutrition needs, eating a wide variety of nutrient-rich foods is the best way for most people to obtain the nutrients they need to be healthy and reduce their risk of chronic disease, according to a newly updated position paper titled "Nutrient Supplementation" from the American Dietetic Association. This paper is an update of ADA's "Fortification and Nutritional Supplements" position paper, published in 2005.
ADA's updated position paper, published in the December issue of the Journal of the American Dietetic Association, represents the Association's official stance on nutrient supplementation:
It is the position of the American Dietetic Association that the best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.
ADA's position and accompanying paper were written by registered dietitians Melissa Ventura Marra, a nutrition consultant in Boynton Beach, Fla., and Andrea P. Boyar, associate professor of dietetics, foods and nutrition and chair of the department of health sciences at Lehman College, City University of New York.
According to the authors, supplement sales in the United States in 2007 totaled $23.7 billion, due in large part to "the aging of the population and consumer desire to maintain good health and prevent disease." Sales of supplements such as calcium, B vitamins, vitamin C, vitamin A/beta carotene, magnesium and iron have grown, while vitamin E supplement sales declined slightly.
The increase in sales of supplements may not have been accompanied by an increase in consumers' knowledge about what they are taking, according to the authors, who add that registered dietitians have the knowledge and experience to educate consumers on safe and appropriate selection and use of supplements.
The authors write: "Although many Americans use dietary supplements, a 2009 report from the U.S. Government Accountability Office stated that ‘according to experts, consumers are not well-informed about the safety and efficacy of dietary supplements and have difficulty interpreting labels on these products.' The Government Accountability Office expressed concern that the uninformed use of dietary supplements may expose consumers to health risks. The expertise of dietetics practitioners is needed to help educate consumers on safe and appropriate selection and use of dietary supplements, including nutrient supplements."
ADA's position paper reaffirms the importance of obtaining nutrients from the consumption of a variety of nutrient-rich foods while acknowledging that nutrient supplements may be needed to help fill dietary gaps for some. The paper discusses the effectiveness of nutrient supplements in helping to fill dietary gaps as well as the potential for nutrient excesses. It also highlights issues to consider when assessing the need for supplementation and provides updates on federal regulations. And ADA's position paper identifies roles and responsibilities of food and nutrition professionals such as registered dietitians in making evidence-based recommendations and provides key resources to keep RDs informed.
CHICAGO – While supplements can help some people meet their nutrition needs, eating a wide variety of nutrient-rich foods is the best way for most people to obtain the nutrients they need to be healthy and reduce their risk of chronic disease, according to a newly updated position paper titled "Nutrient Supplementation" from the American Dietetic Association. This paper is an update of ADA's "Fortification and Nutritional Supplements" position paper, published in 2005.
ADA's updated position paper, published in the December issue of the Journal of the American Dietetic Association, represents the Association's official stance on nutrient supplementation:
It is the position of the American Dietetic Association that the best nutrition-based strategy for promoting optimal health and reducing the risk of chronic disease is to wisely choose a wide variety of foods. Additional nutrients from supplements can help some people meet their nutrition needs as specified by science-based nutrition standards such as the Dietary Reference Intakes.
ADA's position and accompanying paper were written by registered dietitians Melissa Ventura Marra, a nutrition consultant in Boynton Beach, Fla., and Andrea P. Boyar, associate professor of dietetics, foods and nutrition and chair of the department of health sciences at Lehman College, City University of New York.
According to the authors, supplement sales in the United States in 2007 totaled $23.7 billion, due in large part to "the aging of the population and consumer desire to maintain good health and prevent disease." Sales of supplements such as calcium, B vitamins, vitamin C, vitamin A/beta carotene, magnesium and iron have grown, while vitamin E supplement sales declined slightly.
The increase in sales of supplements may not have been accompanied by an increase in consumers' knowledge about what they are taking, according to the authors, who add that registered dietitians have the knowledge and experience to educate consumers on safe and appropriate selection and use of supplements.
The authors write: "Although many Americans use dietary supplements, a 2009 report from the U.S. Government Accountability Office stated that ‘according to experts, consumers are not well-informed about the safety and efficacy of dietary supplements and have difficulty interpreting labels on these products.' The Government Accountability Office expressed concern that the uninformed use of dietary supplements may expose consumers to health risks. The expertise of dietetics practitioners is needed to help educate consumers on safe and appropriate selection and use of dietary supplements, including nutrient supplements."
ADA's position paper reaffirms the importance of obtaining nutrients from the consumption of a variety of nutrient-rich foods while acknowledging that nutrient supplements may be needed to help fill dietary gaps for some. The paper discusses the effectiveness of nutrient supplements in helping to fill dietary gaps as well as the potential for nutrient excesses. It also highlights issues to consider when assessing the need for supplementation and provides updates on federal regulations. And ADA's position paper identifies roles and responsibilities of food and nutrition professionals such as registered dietitians in making evidence-based recommendations and provides key resources to keep RDs informed.
Wednesday, December 16, 2009
Take a Break: Garlands and Mandalas
With Christmas being less than10 days away, if you haven’t started decorating, today’s a good day to make garlands and snowflakes to hang. Below are ideas that are simple enough to do with a child, but can be complex enough to challenge most adults.
Paper Snowflakes Some of the patterns are based on William Bentley’s photographs. Bentley was called “The Snowflake Man” because he was the first person to photograph ice crystals from snow on his farm in Jericho, Vermont.
3-D Snowflake
Popcorn Garland This can be a treat for the birds after the holiday season ends.
Paper Chains
If you like to fold and cut, try making a Christmas Tree with a star using the technique Kirigami.
RELAXATION TIP
Use colored pencils, crayons, markers, pastels or even watercolors to color a holiday mandala. As noted in the October 21 post on mandalas, coloring is a great way to meditate and relax. You can download a variety of holiday designs from http://www.kids-n-fun.com/coloringpages/kleurplaat_Mandala-Christmas_360.aspx
Paper Snowflakes Some of the patterns are based on William Bentley’s photographs. Bentley was called “The Snowflake Man” because he was the first person to photograph ice crystals from snow on his farm in Jericho, Vermont.
3-D Snowflake
Popcorn Garland This can be a treat for the birds after the holiday season ends.
Paper Chains
If you like to fold and cut, try making a Christmas Tree with a star using the technique Kirigami.
RELAXATION TIP
Use colored pencils, crayons, markers, pastels or even watercolors to color a holiday mandala. As noted in the October 21 post on mandalas, coloring is a great way to meditate and relax. You can download a variety of holiday designs from http://www.kids-n-fun.com/coloringpages/kleurplaat_Mandala-Christmas_360.aspx
Saturday, December 12, 2009
Sexuality and Chronic Disease
As administrator on call for a large University hospital, I met a woman in her late 60’s who was dying. Her husband was quite upset about the care she was receiving, which is why I was called. When the husband left the room, She told me that he had just brought her favorite perfume. She then shyly said, “it makes me feel sexy.”
It was one of those “ah-ha” moments, as I realized that we are sexual beings from the “womb to the tomb.” I was to learn this lesson over and over again in the years that I worked with people with HIV/AIDS. Sexuality became more important for many as it was the most “alive” thing they could do. Others used sex as a way to deaden the pain from so much loss. As one person noted, “the only thing strong enough to make the humans forget that they die is sex.”
In the video Sex and Chronic Disease-Can Women Still Feel Sexy, Dr. Brotto, Assist. Professor, Dept. of Obstetrics & Gynecology, UBC discusses why women may be more sexual after learning of a life threatening condition.
All people are sexual and therefore deserve a sexuality that is safe and pleasurable to them, regardless of age, gender, sexual orientation, disability or ethnicity. What may be needed more than anything else is a new way to discuss sex, which promotes not only healthy behaviors, but a better understanding of what sex is and how it fits within one’s life.
Keep in mind that sex happens between the ears not the legs. People are entitled to define what they mean by sex and to develop a relationship with it that is appropriate for them.
While the usual recommendation is to “talk to your doctor” about various health related issues, this is one area where I find medical providers to be less than well equipped to answer questions. Certainly discuss any medical concerns relating to your sexuality, but for the “how tos” below are a list of resources to help you find some of your answers.
Sexuality and Disability from Disability Resources
Moss Rehab Sexuality and Disability Internet Resources
Disability and Illness from Sexual Health.com
Tantric Sex-A Different Perspective: Instead of rushing toward a climax, a Tantric practitioner slows down, remaining in the moment, and travels toward deep relaxation. In the medical model, sexual energy builds, then is lost. In Tantra, energy is not lost but gained. Instead of using a partner for one_s own gratification, Tantric partners provide vital energy to each other.
Good Vibrations Magazine’s Archives for Sex and Disability: Note that Good Vibrations is an extremely sex positive company that carries very reliable products.
Sexuality for the Woman with Cancer from the American Cancer Society
Sexuality for the Man with Cancer from the American Cancer Society
It was one of those “ah-ha” moments, as I realized that we are sexual beings from the “womb to the tomb.” I was to learn this lesson over and over again in the years that I worked with people with HIV/AIDS. Sexuality became more important for many as it was the most “alive” thing they could do. Others used sex as a way to deaden the pain from so much loss. As one person noted, “the only thing strong enough to make the humans forget that they die is sex.”
In the video Sex and Chronic Disease-Can Women Still Feel Sexy, Dr. Brotto, Assist. Professor, Dept. of Obstetrics & Gynecology, UBC discusses why women may be more sexual after learning of a life threatening condition.
All people are sexual and therefore deserve a sexuality that is safe and pleasurable to them, regardless of age, gender, sexual orientation, disability or ethnicity. What may be needed more than anything else is a new way to discuss sex, which promotes not only healthy behaviors, but a better understanding of what sex is and how it fits within one’s life.
Keep in mind that sex happens between the ears not the legs. People are entitled to define what they mean by sex and to develop a relationship with it that is appropriate for them.
While the usual recommendation is to “talk to your doctor” about various health related issues, this is one area where I find medical providers to be less than well equipped to answer questions. Certainly discuss any medical concerns relating to your sexuality, but for the “how tos” below are a list of resources to help you find some of your answers.
Sexuality and Disability from Disability Resources
Moss Rehab Sexuality and Disability Internet Resources
Disability and Illness from Sexual Health.com
Tantric Sex-A Different Perspective: Instead of rushing toward a climax, a Tantric practitioner slows down, remaining in the moment, and travels toward deep relaxation. In the medical model, sexual energy builds, then is lost. In Tantra, energy is not lost but gained. Instead of using a partner for one_s own gratification, Tantric partners provide vital energy to each other.
Good Vibrations Magazine’s Archives for Sex and Disability: Note that Good Vibrations is an extremely sex positive company that carries very reliable products.
Sexuality for the Woman with Cancer from the American Cancer Society
Sexuality for the Man with Cancer from the American Cancer Society
Wednesday, December 9, 2009
Make a Zen Garden/Rake a Garden
Karesansui, or the “dry-landscape” style Japanese gardens have been in existence for centuries, but it wasn’t until the late sixth century with the advent of Zen Buddhism did “dry style” gardens began to evolve. The earlier gardens were created where one could enter and walk around and much larger in scale. Around the eleventh century, Zen priests adopted the “dry landscape” style and began building gardens to serve a different purpose. They were to be used as an aid to create a deeper understanding of the Zen concepts. Not only was the viewing intended to aid in meditation but the entire creation of the garden was also intended to trigger contemplation. By the late 1200’s, the basic principles had been established and up to the present day, they have been refined and extended. The garden created by the Zen priest are called “kansho-niwa” or contemplation garden and termed by many today as “ Zen gardens “. From http://www.newsfinder.org/site/more/zen_gardens/
The Photo Gallery of Japanese Zen gardens, Kyoto shows various types of rock gardens as well as flowers and other features.
You can create a small desktop Zen garden, which not makes a wonderful gift, but it can have a very calming effect.
Find a shallow
container, such as a bowl or tray. You can use a picture frame, first removing
the glass and then gluing the back to the frame. Fill it with fine sand- playground sand or
the sand used for filling bottles. Craft stores will carry the latter, while
your local hardware store can provide playground sand.
Monday, December 7, 2009
Knowing What’s Worth Paying for in Vitamins
The December 4 New York Times has an interesting article, "Knowing What's Worth Paying for in Vitamins." If you are paying a lot for supplements, read what this author has found. ConsumerLab.com says it has found a few patterns that consumers may find helpful. Products sold by vitamin chains tend to be more reliable than drugstore brands, and Wal-Mart and Costco’s vitamin lines are usually worth considering. In a recent test of multivitamins, ConsumerLab.com found that Equate-Mature Multivitamin 50+ sold by Wal-Mart was just as good as the name brand Centrum Silver, but at less than a nickel a day is half the price.
Saturday, December 5, 2009
Know What to Look For: Understanding the Diagnosis
In the Hospitalized posts, the importance of being a patient advocate when a family member or friend is in the hospital, was identified as the number one way you can help. Since the nurses and doctors will most likely be meeting this person for the first time, you can assist them by letting them know what’s normal for the patient.
In addition, it’s important that the advocate, as well as the person who is living with the chronic condition, have an understanding of the diagnosis and the treatment they may be taking place in the hospital. This also extends to home, and in the weeks following the initial diagnosis.
Regardless of whether you are the person living with the condition, the advocate or the caregiver, ask the nurses and doctors for information and to explain things you don’t understand. There are no stupid questions.
The most frequent way people learn about their health condition is the Internet. Therefore it’s important that users realize that not all information is of equal value. In fact, people with chronic conditions are the primary target of scams and “snake oil” websites. If it sounds too good to be true, it probably is.
When you Google, check the who, what and when of the website
WHO sponsors the site and who can I contact if I have a question? Sites that end with .gov, .edu and .org are generally more reliable. However, there are a growing number of. org’s that are actually sales pitches. Pharmaceutical companies are .com sites. Some of them have excellent resource information about side effects, tips on taking medications, and/or opportunities to obtain a drug for reduced or no cost.
WHAT is the purpose of the site and what is the source of information? If this is a site that is pushing a particular item to buy, be wary of it.
WHEN was the last time the site was updated? If a site isn’t being well maintained, and it’s offering information about a specific condition, be mindful that medical information that's more than a year old can already be outdated.
To learn more, check out Get the E-Facts
Sites with good information include:
• A national organization for the specific condition such as the American Cancer Society. For a list of organizations go to MedLine Plus
• Medline Plus Health Topics: In addition to information and treatment about a specific condition, it includes interactive tutorials, research, clinical trials, current research etc.
• Mayo Clinic Diseases and Conditions: This site includes the following information- definition, symptoms, causes, risk factors, tips for preparing for your appointment, treatments and drugs, lifestyle and home remedies, alternative medicine and prevention.
Resources for more information about drug and vitamin supplements
• Physician’s Desktop Reference for Consumers
• Medline Plus Drugs, Supplements and Herbal Information
Resources for Complementary and Alternative Forms of Medicine
• National Center for Complementary and Alternative Medicine
• NIH Office of Dietary Supplements
• Explore Healing Practices from the University of Minnesota’s “Taking Charge of Your Health”
In addition, it’s important that the advocate, as well as the person who is living with the chronic condition, have an understanding of the diagnosis and the treatment they may be taking place in the hospital. This also extends to home, and in the weeks following the initial diagnosis.
Regardless of whether you are the person living with the condition, the advocate or the caregiver, ask the nurses and doctors for information and to explain things you don’t understand. There are no stupid questions.
The most frequent way people learn about their health condition is the Internet. Therefore it’s important that users realize that not all information is of equal value. In fact, people with chronic conditions are the primary target of scams and “snake oil” websites. If it sounds too good to be true, it probably is.
When you Google, check the who, what and when of the website
WHO sponsors the site and who can I contact if I have a question? Sites that end with .gov, .edu and .org are generally more reliable. However, there are a growing number of. org’s that are actually sales pitches. Pharmaceutical companies are .com sites. Some of them have excellent resource information about side effects, tips on taking medications, and/or opportunities to obtain a drug for reduced or no cost.
WHAT is the purpose of the site and what is the source of information? If this is a site that is pushing a particular item to buy, be wary of it.
WHEN was the last time the site was updated? If a site isn’t being well maintained, and it’s offering information about a specific condition, be mindful that medical information that's more than a year old can already be outdated.
To learn more, check out Get the E-Facts
Sites with good information include:
• A national organization for the specific condition such as the American Cancer Society. For a list of organizations go to MedLine Plus
• Medline Plus Health Topics: In addition to information and treatment about a specific condition, it includes interactive tutorials, research, clinical trials, current research etc.
• Mayo Clinic Diseases and Conditions: This site includes the following information- definition, symptoms, causes, risk factors, tips for preparing for your appointment, treatments and drugs, lifestyle and home remedies, alternative medicine and prevention.
Resources for more information about drug and vitamin supplements
• Physician’s Desktop Reference for Consumers
• Medline Plus Drugs, Supplements and Herbal Information
Resources for Complementary and Alternative Forms of Medicine
• National Center for Complementary and Alternative Medicine
• NIH Office of Dietary Supplements
• Explore Healing Practices from the University of Minnesota’s “Taking Charge of Your Health”
Wednesday, December 2, 2009
Take a Break: Duct Tape/Music
• Wallet
• Rose, Bracelet or Tie
MUSIC: Make it part of your life
The Holidays are filled with music, but often it is in the background and we hardly notice it. Take time to listen to favorite recordings, discover a new artist or dust off the keyboard, guitar or other instrument and play. Below are links to help enhance your listening pleasure
Pandora Radio Create your own radio station of only music you want to hear. You can select by artist, song or genre.
Benjamin Zander : Don’t think you like classical music, watch this presentation from the TED Conference and you’ll see that classical music is for everyone. You may also learn more about living a “one-butt life.”
Tuesday, December 1, 2009
House Cleaning Resources
When someone is acutely or chronically ill, house cleaning can easily fall by the wayside. This is one activity that friends and family can help with. When someone offers to help, specify what you'd like them to do. Having someone to count on to take care of your trash each week can be a real help.
You may qualify for a program that offers housekeeping services. However, with increasing demand and less funding, programs can't always deliver the service. Other resources which may offer help with cleaning include:
•Many schools (from grade school through college) have programs where students help with heavy chores, including the seasonal ones of cleaning windows, stacking wood, raking leaves, mowing the lawn etc.
• Church groups
• Civic organizations, such as Rotary, Lions Club etc.
• Community Action Agencies
A good way to find out what's available in your community is to call 211, the information and referral service helpline for your state. You can also look on-line through your state's 211 directory However, many communities will have services that are not necessarily listed in the directory so also check with your social worker or case manager, members of a support group, and people you may know connected with churches, civic groups etc.
A friend passed along the following information, which might be useful for some women. If you know any woman currently undergoing Chemo, please pass the word to her that there is a cleaning service that provides FREE housecleaning - 1 time per month for 4 months while she is in treatment. All she has to do is sign up and have her doctor fax a note confirming the treatment. 'Cleaning for a Reason' will have a participating maid service in her zip code area arrange for the service. This organization serves the entire USA and currently has 547 partners to help these women.
You may qualify for a program that offers housekeeping services. However, with increasing demand and less funding, programs can't always deliver the service. Other resources which may offer help with cleaning include:
•Many schools (from grade school through college) have programs where students help with heavy chores, including the seasonal ones of cleaning windows, stacking wood, raking leaves, mowing the lawn etc.
• Church groups
• Civic organizations, such as Rotary, Lions Club etc.
• Community Action Agencies
A good way to find out what's available in your community is to call 211, the information and referral service helpline for your state. You can also look on-line through your state's 211 directory However, many communities will have services that are not necessarily listed in the directory so also check with your social worker or case manager, members of a support group, and people you may know connected with churches, civic groups etc.
A friend passed along the following information, which might be useful for some women. If you know any woman currently undergoing Chemo, please pass the word to her that there is a cleaning service that provides FREE housecleaning - 1 time per month for 4 months while she is in treatment. All she has to do is sign up and have her doctor fax a note confirming the treatment. 'Cleaning for a Reason' will have a participating maid service in her zip code area arrange for the service. This organization serves the entire USA and currently has 547 partners to help these women.
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