The Salina Journal from Salina, Kansas on May 28, 1998 · Page 11
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The Salina Journal from Salina, Kansas · Page 11

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Thursday, May 28, 1998
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Page 11
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THE SAL OURNAL Health CLASSIFIED / C3 c T IMPOTENCE DRUG Scientist: Viagra doesn't match reality Researcher says pill for impotence could damage eyesight, not effective for all By NELL BOYCE New Scientist The backlash against Viagra has started. A scientist involved in ongoing clinical trials of the first pill for erectile dysfunction claims the reality doesn't match the hype surrounding the drug. More troubling, ophthalmologists are concerned that long-term use could damage eyesight. Viagra dilates blood vessels, allowing more blood to flow into the penis..Since its approval by the Food and Drug Administration on March 27, Viagra has achieved huge sales for its manufacturer, Pfizer of New York, and extensive media coverage. "The hype that came out was incredible," says James Barada of the Center for Male Sexual Health in Albany, N.Y. The clinical studies that convinced the FDA to approve Viagra were published in mid-May in The New England Journal of Medicine. Viagra significantly improved the quality of men's erections and quadrupled their success at having intercourse. In one study of 532 men taking either Viagra or a placebo, those receiving 100 milligrams of Viagra doubled their frequency of erections. Among men taking this dose of Viagra, 69 percent of the attempts at intercourse were successful, compared with only 22 percent in the placebo group. But many of the men in these studies had achieved intercourse in the previous three months and so were not clinically impotent, according to Barada. He is now running an eight-week study of Viagra, funded by Pfizer, to see how it compares with other impotence treatments. Barada has written more than 150 prescriptions for Viagra and doesn't dispute that it improves the erections of most men who take it. But of those who are genuinely impotent, rather than merely lamenting the loss of youthful vigor, only a third achieve a sufficient erection to have intercourse after taking the drug. "I consider them Viagra failures," Barada says. "You don't take a drug just because it helps a little bit." Because Viagra doesn't treat the underlying causes of impotence, the condition probably will continue to worsen until even the highest recommended doses can't help, Barada adds. Viagra also causes side effects, among them headaches and fainting due to dilation of blood vessels in other parts of the body. These symptoms occur more often as the dose increases. Most men end up taking 100 milligrams of the drug, the highest recommended dose, but there are fears that some already are taking higher doses despite their doctors' warnings. The most worrying side effect is blue- tinted vision in some men taking Viagra. "Blue vision is a very unusual symptom," says Michael Marmor, an eye specialist at Stanford University in California, who has seen Pfizer's data on Viagra. Viagra works in the penis by inhibiting an enzyme called phosphodiesterase. A similar enzyme exists in the cone cells responsible for color vision in the retina. "Somehow, the way this drug blocks the enzyme in the cone cells leads to the perception of blue," Marmor says. This has ophthalmologists worried because people with congenitally abnormal phosphodiesterase suffer irreversible damage to their retinas over time. What's more, a common cause of impotence is diabetes, which also can damage the retina. Pfizer has issued a statement saying it has "conducted rigorous visual function tests at doses well above those recommended for Viagra. These studies showed no clinically significant effect on vision in either the short or long term." But the American Academy of Ophthalmologists wants Pfizer to conduct more studies into how Viagra affects vision. "The company has not measured the electrical activity of the cone cells in the long term," Marmor says. This could be done using contact lenses containing tiny electrodes capable of recording the retina's electrical activity. BRIEFLY Viscous blood linked to men's heart attacks The stickier, or more viscous, a man's blood is, the greater his risk of developing the kind of blood vessel damage that eventually can lead to a heart attack or stroke, a new study reports. The increased risk does not hold true for women, which may shed light on why males tend to develop heart disease and suffer strokes at a younger age than females, says lead author Amanda J. Lee, research statistician at the University of Edinburgh Medical School in Scotland. The study is the first to link blood stickiness to the early development of atherosclerosis, which results from the build-up of cholesterol, fats and biological debris in the tissue lining the inside of blood vessels. This buildup can obstruct blood flow to the heart and brain and thereby cause a heart attack or stroke. ' Rat study may help explain cravings Rats going through nicotine withdrawal showed a brain reaction similar to what's seen in am• phetamine and cocaine withdrawal, which might help explain nicotine craving in people who've quit cold turkey. The finding also might help scientists develop better ways of treating the symptoms of nicotine withdrawal, such as depression, anxiety, irritability and craving, all of which interfere with attempts to kick the habit, said Dr. Alan I. Leshner, director of the National Institute on Drug Abuse. NIDA helped pay for the study, which appeared in an early May issue of the journal Nature. The study focused on brain circuitry that produces pleasure from activities like eating and sex. It found that during nicotine withdrawal, this "reward" system' became harder to turn on, just as previous studies had found for withdrawal from other drugs. Pain relievers can damage kidneys Just because you can buy a certain medication without a prescription, that doesn't mean it's right for you. When it comes to over-the-counter pain relievers called analgesics, for example, long-term use can harm your kidneys. Here's what you need to know about over-the-counter pain relievers in order to keep your kidneys healthy, according to the National Kidney Foundation: • Don't use over-the-counter pain relievers more than 10 days for pain or more than three days for fever without consulting your doctor. • Avoid using pain relievers that contain a mixture of aspirin, acetaminophen and caffeine in !one pill: These are most likely to harm the kidneys. Some health , care experts believe that up to 10 percent of new chronic kidney failure cases each year may caused by overuse of these medications. • If you are taking over-the- ceunter pain relievers, be sure to drink six to eight glasses of fluid a day. • If you have kidney disease already, talk to your doctor before choosing a pain reliever. For more information and a free brochure on "Analgesics and Your Kidneys" call the National Kidney Foundation at (800) 6229010 or send a stamped, self-addressed envelope to: The National Kidney Foundation, Box PK, 30 E. 33rd Street, New York, NY 10016. From Wire Service Reports Unregulated dietary supplements, like hermal remedies, can be risky By LAURAN NEERGAARD The Associated Press W ASHINGTON — Burkhard Bilger and his wife never had heard that ancient people used the herb pennyroyal to induce abortion. They just liked the tangy mint taste of pennyroyal tea — until she discovered she was two months pregnant, and her doctor asked her to avoid caffeine: Soon after, Jennifer Bilger had a miscarriage. When he learned the tea may have been to blame, "I was horrified," said Bilger, a New York science editor who contends supplements don't come with proper warnings. "There are a lot of very potent herbs out there. You go into a food co-op, and you don't know what you're getting." Side effects, deaths found An Associated Press analysis of Food and Drug Administration records suggested Bilger's experience is not uncommon: The agency has logged more than 2,500 reports of side effects and 79 deaths associated with dietary supplements. About 900 of the illnesses and 44 deaths involved people taking herbal products that contain ephedrine-like stimulants. Other possible culprits range from "diet teas" to hormones like DHEA and even high-dose vitamins. Millions of Americans take dietary supplements, particularly the herbs that are the fastest- growing segment. They spent $3.2 billion last year. Supplements promise they'll slow aging, improve memory, clean kidneys, protect the heart, even prevent cancer. There is evidence that certain herbs, vitamins and minerals do help. Folic acid prevents birth defects. Calcium wards off osteoporosis. Many scientists agree that garlic may help lower cholesterol, ginger calms nausea, and valerian is a mild sleep aid. The National Institutes of Health is studying whether St. John's wort is an anti-depressant. Claims unsupported But scores of other products have sparse, if any, data to support claims that even some in the industry call exaggerated. The pills, tonics and teas are sold The Associated Press Jennifer Bilger drinks tea while talking to her son, Hans, 4. Her daughter Ruby, 18 months, and husband, Burkhard, decide what book to read one recent Saturday afternoon. Before giving birth to Hans and Ruby, Jennifer drank a tea made with pennyroyal, unaware that it was used in ancient times to induce abortion, and had a miscarriage. with little to guide consumers about what actually works or potential side effects. "You almost have to be a detective," said Mary Ellen Camire, food sciences chief at the University of Maine, who studies natural remedies. Most such products do not raise safety concerns, said Elizabeth Yetley, FDA's chief of special nu- tritionals, but the agency has listed 16 supplements as risky. "You're self-medicating," notes Mark Blumenthal of the nonprofit American Botanical Council. "People should learn how to use these products properly." Shields led to boom The boom in dietary supplements dates to 1994, when Congress shielded them from most government oversight. They sell without prior certification or purity inspections. The 1994 law prohibited supplements from advertising that they directly treat or prevent disease but allowed more vague claims of "supporting bodily functions." The FDA is supposed to intercede only if it proves a supplement poses an unreasonable risk or is marketed as a drug. The result is a gray area where Vitamin A, for example, can advertise as "essential for healthy vision" but not to treat eye diseases. Willow bark contains the same chemical as aspirin but doesn't have to carry aspirin's warning: "Do not give to children or teen-agers with flu or chicken pox because they could develop deadly Reye's syndrome." Change called for A presidential commission called last fall for changes to clear the confusion. It urged the FDA to review herbal supplements and let those that clearly work sell as over-the-counter drugs — clearly labeled with proved benefits and side effects. The panel also urged that industry provide studies backing a product's claims if consumers request proof, that the FDA act swiftly against risky supplements, and that makers adopt proper warnings. Some in industry are acting. A American Herbal Products Association handbook classifies the risks of 700 herbs with suggested warning labels for its 200 member companies. And the botanical council is expected this spring to publish a long-awaited translation of Germany's "Commission E" safety and effectiveness evaluations of 300 herbal products, 200 of which were approved as drugs in that country. The document is considered the world's best guide. "There is a sensitivity in the industry about all the concerns that exist and the need to provide as much information as possible," said Annette Dickinson of the Council for Responsible Nutrition. Some supplements that the government and other experts warn can be risky: • Ephedra: Also called ma huang, epitonin and sida cordifolia, It contains stimulants known chemically as ephedrine. • Chaparral: Sold as teas and pills to fight cancer and "purify blood," it has been linked to serious liver damage. • Comfrey: Banned in Canada and severely restricted in Germany, comfrey root originated as a poultice to reduce swelling but later was used internally. It contains alkaloids toxic to the liver, and animal studies suggest it is carcinogenic. • OHEA: A hormone that turns into estrogen and •' testosterone inside trie body. The National Institutes of Health says there is no evidence that DHEA fights aging as it V claims, and warns that it could increase cancer risk and may lead to liver damage even when taken briefly. • "Dieter's teas:" Herbal blends-containing such ingredients as senna — also known as cassia angustifolia — alpe, rhubarb root, buckthorn, , cascara and castor oil. They act as laxatives that, when consumed in excessive amounts, can disrupt potassium levels to endanger the heart. The teas are linked to diarrhea, vomiting, chronic constipation and fainting. • Pennyroyal: A member of the mint family, it Induces abortion., • Sassafrass: Once a flavoring for root beer, the oil is banned as a US. food additive. It has been shown to cause liver cancer in animals. T MEDICINE Exercise can help emphysema patient breathe easier Dear Dr. Donohue: My husband has emphysema and gets out of breath after walking up eight steps or after any small exertion. Would a daily walking routine strengthen his lung power? — J.H. Dear J.H.: Exercise does not undo the damages of emphysema, but exercise does teach muscles to extract oxygen from the blood more efficiently. When that adaptation takes place, the emphysema patient becomes less short of breath on exertion. Your husband can start out modestly by walking half a block or less. Every other day, he should increase walking distance a bit. By the end of the summer, he could be walking a full mile without panting for air. While walking, your husband should inhale through his nose, then slowly exhale DR. PAUL DONOHUE North America Syndicate 0 through the mouth, taking four to six seconds to do so. While exhaling, he should purse his lips as though he were whistling. By bending over just a tad at the waist, the diaphragm — the chief breathing muscle — can draw more air into the lungs with less effort. Your husband can check if he's using his diaphragm correctly by placing his hands on his abdomen. If he has engaged the diaphragm in his breathing, his abdomen will move out as he inhales. Dear Dr. Donohue: Four months ago I had a pacemaker installed and at the same time I started on verapamil. Two months later I went back to my exercise program. I had lost about 10 percent of my aerobic capabilities. My running time increased from 23 minutes to 25 minutes for three miles. I run out of breath earlier in the run. My doctor says my heart and lungs are OK. My pacemaker keeps my heart beating at a minimum of 60 and can increase to the beat to 160 when I exercise. I didn't expect to go downhill so quickly. Do you have any suggestions? — B.S. Dear B.S.: It might just be a matter of deconditioning. It takes the body at least as much time to recoup its former performance as the time spent not exercising. In the first stages of a run, energy comes from metabolic pathways that do not depend so heavily on oxygen, so-called anaerobic exercise. On completing a mile run, the body obtains energy equally from oxygen — aerobics — as from nonoxygen sources. Perhaps you need to focus more on anaerobic training. If your doctor gives you the green light, revise your running program. Run 20 yards rapidly, then rest for 20 seconds. Every day increase the number of sprints until you can do 15 to 20 with only a 20-second pause between each 20-yard sprint. That is strenuous training, so I repeat: Check with your doctor before you begin. Dear Dr. Donohue: I notice that when I drink water during or immediately after an athletic event like a five-kilometer run, my stomach cramps and feels gaseous. Is this normal? — J.C. Dear J.C.: Staying well-hydrated is the llth commandment of all athletic endeavors, but you might be overdoing it. An 8-ounce glass of water every 15 minutes suffices to keep you hydrated. If that amount sloshes around in your stomach, cut back on the water. . When you run, blood is diverted from the digestive tract to exercising muscles. If your stomach is too full, the water lies there, unable to be absorbed. Please let me know if a small reduction in your water intake provides relief. Dr. Donohue is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him at P.O. Box 5539, Riverton, NJ 08077-5539. SUGGESTIONS? CALL BECKY FITZGERALD, LIFE EDITOR, AT (785) 823-6363 OR 1-800-827-6363 OR E-MAIL AT slbfitzgerald@saljournal.com

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