SARS, Coral Calcium and Mood Disorders
Dr. Marc answers readers' questions every other week. To send a query, click here.
Dear Dr. Marc,
I have been reading the March/April edition of American Scientist. The article "Influenza," which is co-authored by the director of WHO's collaborating center on the ecology of influenza viruses in lower animals and birds, is most interesting. My question is this: As the prescribing physician for a SARS patient, would you prescribe the M2 inhibitors or the antineuraminidase drugs, and by what means would you reach a clinical judgment?
NIKKI VANESSA LEGER
New York, NY
Please keep in mind that there are still only some 4,000 cases of SARS worldwide, so the chances of my being a treating physician on such a case is very low. Further, SARS doesn't often make people sick enough to justify rushing a patient to an antiviral drug like the two you mentioned until they have been better studied or the patient is deathly ill. SARS resembles many other respiratory viruses, though it is currently more progressive in some cases. Suspected SARS patients can be isolated for a period of days for the purposes of observation and viral testing. For much more on SARS, see my online Nation article coming soon to www.thenation.com.
Dear Dr. Marc,
Recently I bought antiradiation pills. Do these do anything? I also read in the New York Times that pediatricians are recommending antiradiation pills for children. As a grandma, I'm especially curious about that. I figure I have to carry them around all the time. Also, will these pills protect my skin from radiation burns?
These pills only protect the thyroid against long-term risks of some cancers if you are exposed to certain kinds of radiation, which many of the potential terrorist weapons do not contain. Further, these pills may do harm to those with hidden thyroid conditions for those over 40. For children, there may be some temporary limited value, but overall, I don't think they're of great efficacy and of some possible harm.
Dear Dr. Marc,
I have been seeing infomercials on TV selling coral calcium. What can you tell me about this product? Mr. Robert Barefoot, who is an author, scientist and promoter of this product, sings its praises for practically everything under the sun, including pain, weight gain and sleeplessness. Please tell me if this product has any validity. I have osteoarthritis and take twenty-five milligrams of Vioxx once a day. I don't like to take prescription drugs if there is something else available. Thank you for whatever information you can provide.
Grand Rapids, MI
There has been a lot in the news lately about calcium as a preventative for all sorts of things including cancer. But there haven't been sufficient studies on this. There may be some effectiveness in preventing bone loss, but no convincing data yet exist. Nonsteroidal anti-inflammatory agents such as Vioxx may relieve symptoms, but chronic daily use is not good for the kidneys or liver, among other possible negative side effects. Acetominophen may be an alternative, but also has toxicity and may be harmful if overused. There is no magic pill for osteoarthritis, unfortunately, which essentially is due to "wear and tear," as you probably already know.
Dear Dr. Marc,
I recently read a story out of Britain that tells about vigorous exercise being required to prevent premature death from cardiac disease. Quoting from Reuters, it says: "Closer analysis showed that it was the intensity of exercise, rather than the number of calories burned, that seemed to be the crucial factor. The few men who regularly engaged in the highest levels of heavy exercise, expending more than 54 calories a day in this way, were 47 percent less likely to die early and 62 percent less likely to die of heart disease. Those 54 calories equate to just nine minutes of jogging or doubles tennis, or seven minutes of climbing stairs."
I am trying to understand the point of the above quote. Does this mean I only need to burn fifty-four calories a day (in exercise) to prevent heart disease? I think this is invalid. I think what is meant here is that the heart rate must be challenged at or near the maximum for a period of time each day, in this research it says fifty-four calories worth, and this equates to the various times for types of exercise. However, seven minutes of climbing stairs will not achieve maximum heart rate for the entire seven minutes, it'll do so for perhaps only half of that time. I tested myself yesterday on a Stairmaster machine, and did not achieve 95 percent of my max heart rate for my age until about eleven minutes, and then maintained it for seven more minutes. Is that the way to measure this? This is very confusing.
I saw the story as well. There have also been some recent studies in the medical literature in America looking at the beneficial effects of moderate exercise. I tend to believe, despite what limited information there is to the contrary, that the best way to decrease your risk of heart disease is to exercise regularly, eat right and decrease stress as much as possible. And I suspect that long-term studies will bear me out--that frequent regular moderate exercise does more good than a sudden extreme surge up to a preset target heart rate. The latter may ultimately prove beneficial to heart-rate monitoring and Nautilus equipment companies, the former to real patients. And while there are numerous other factors in play, as I said, it does seem clear to me that countering a sedentary lifestyle with regular, moderate physical activity will absolutely increase your chances of living longer and healthier.
Dear Dr. Marc,
I recently read your response to the inquiry from the husband of a woman with a mood disorder. I appreciated your willingness to be objective in your reply, but I can tell you from personal experience that I have never felt so unwell, emotionally, as when I was trying to find my way out of a maze created by psychiatrist-prescribed drugs and time-limited treatment. I initially was referred to a doctor (very well-known and a national media hound no less) for problems with sleep, which I have had for years. This led to a medication, which led to a medicine to help wake me up during the day, which led to medicines to control the symptoms of those medicines, which led to the addition of an antipsychotic, which led to a near-hospitalization.
From there, I led myself, with the support of a very understanding partner, out of this maze and back to where I had been a year before, although perhaps permanently scarred by the experience. I lost a job in the process, due to uncontrollable mood swings brought on by the daily fistful of medications. I could give you details of this experience that would be shocking--of just how upset these medicines made me and of how this doctor became increasingly in control of my life. But, the main thing I need to make clear is that these medicines, combined with the limited time available to psychiatrists to monitor their effect, is a very dangerous combination that should be avoided unless the illness has put you in a position where there is absolutely no alternative. The relatively new discipline of psychiatry and its bag of medicines provides a very crude tool used to combat the symptoms of illnesses that are often more construct than reality.
A heart-rending story, and I suspect, it is too easy for physicians of all specialties to throw pills around rather than take a close look. And you're right to point out that the side effects of one medication may lead to a second, and perhaps a third, more powerful and perhaps more stigmatizing with each addition. I've also heard of many instances where psychopharmacologists overprescribe. But there are many other instances where these drugs are lifesaving.
It's hard to generalize, though it seems clear that you are one who is far better off without the "cocktail." Frankly, the group I am most concerned about are children, who cannot always defend themselves or represent themselves properly. I am not alone among physicians who believe that many children who suffer from "situational anxiety" emanating from an unstable home situation are overdiagnosed with attention-deficit disorder and put on a cocktail of medications, each to counteract the side effects of the other, akin to the problem you describe.