Medicine for People!

May 2003

Contents

• Medicine For People Newsletter Expands
• Will SARS be the Next Plague?
• Disaster Preparedness
• Scam o' the Month — Coral Calcium
• On-line Pharmacy Follow-up
• More About Generic Drug Pricing
• Monroe Street Clinic No-Cure No-Pay Policy

"Medicine For People!" Newsletter Expands
In this issue I welcome on board my new assistant editor, Carolyn Latteier. Carolyn, an experienced author, journalist and health writer, has been copyediting the last few issues of the newsletter. Recently I've asked her and she has agreed to take on a larger role. I will still be fully responsible for the content of the newsletter, bringing to bear my experience and research on each topic. Carolyn's job is to put the information into understandable language. She will also be advocating for you - the reader -asking me questions and suggesting topics. Together we hope to address health issues you've been thinking or wondering about. We'll do a better job if you let us know what you're thinking. Please email us your health question and concerns!

Will SARS be the Next Plague?
By now you've all read the headlines about SARS (severe Acute Respiratory Syndrome), a seemingly mysterious illness that sometimes proves fatal. Could this be another plague, like the 1918 influenza epidemic that originated in China, killed 675,000 Americans, and wiped out 20-40 million people around the world? The answer is probably not. Anything is possible, but it is unlikely that SARS will rampage out of control.

A Well-Known Virus

Initially the cause of SARS was unknown, but researchers quickly recognized it as a new type of coronavirus. The name comes from the virus' appearance under a microscope. It has projections protruding from the outer envelop of the virus, giving it the appearance of a crown. Corona is Latin for crown. For years we've known this virus mainly as a cause of colds and less commonly as a cause of diarrhea in infants. Read more at Microbiology & Immunology.

How bad is SARS?

There is no cure, so they say, but that is true of many viral illnesses, including infantile pertussis (whooping cough), adult polio, and many forms of encephalitis. As of May 4th, there have been about 6600 cases of suspected SARS worldwide with a death rate of about 7%. The death rate among the 319 US cases has been 0%.

All SARS isn't really SARS

Of the 319 US cases, 254 are considered "suspect" cases (mildly ill), and 65 "probable" cases (severely ill.) A "case" is defined as a fever of over 100.5 degees, cough, difficulty breathing, travel to someplace where SARS is prevalent, or close exposure to someone who has. Ninety-six percent of the probable cases have recently returned from international travel. The Centers for Disease Control (CDC) reported on 4/28/2003 they had completed testing on 60 patients and found that 6 were positive for the SARS virus. These were all among the severely ill patients. Of the 60 people who had completed testing for the SARS coronavirus, all the mildly ill and 13 of the severely ill patients were negative for the virus and presumably had some other reason for their cough and fever.

SARS case numbers you see in the media may be inflated by a factor of ten

Surprising? No, thousands of people each day enter US hospitals with cough, fever, and difficulty breathing. Usually they suffer from emphysema (also known as COPD), pneumonia, atypical pneumonia, or some respiratory infection other than SARS. The CDC has purposely cast a wide net, and considered anyone who might have SARS to be evaluated and treated as if they did. Any person with cough, fever, and travel to Hong Kong is treated as a potential hazard, even though most of them are turning out not to be infected with the SARS virus. This has protected all of us and kept spread in the US to a minimum.

Could You Have SARS?

Unless you have a fever of at least 100.5 degrees, you don't have diagnosable SARS. Even if you have such a fever, the odds are greatly against it being SARS, but check with your doctor as you would with any fever. For more information on SARS, check out the Centers for Disease Control.

Putting it In Perspective

You have a better chance of being hit by lightening than contracting SARS. There are other, real dangers to be concerned about. In US, since this illness made headlines in February, over ten thousand people have died driving down a US road or highway, and many others have been maimed forever. This isn't news, but it's a far greater danger and one you can do something about.

Dr. Rienstra's Advice

Stay out of cornfields during thunderstorms. Buckle up your seatbelt and don't drive if you've been drinking. Turn off your television set. Listen to some pleasant music. Eat whole foods, freshly prepared. Don't eat too many sweets. Get some exercise and plenty of sleep. If you can't get to sleep, go onto the web and read the information at The Monroe Street Clinic about nutritional measures to improve immune functioning.

Disaster Preparedness

Since September 11, 2002, there's been a lot of concern about how we can be prepared for a terrorist attack. In these unsettled times, all of us have moments of fear. Life is full of unknowns, but we can do things to lower our risks and be prepared for emergencies.

Although a terrorist attacks seems unlikely to strike our rural community, we may have special challenges of our own. If a disaster hit Seattle, your Seattle friends might show up at your door, needing a place to stay. They probably wouldn't bring food or water. Authorities project between 250,000 and 500,000 Seattleites would come to the Peninsula if the city had to be evacuated.

Our local, state, and national governments have developed emergency plans to deal with this and other possible disasters or emergencies. It makes sense for individuals to be prepared as well. Here are the basics of developing a family preparedness plan.

Emergencies You Might Face

• Automobile accidents.
• Fires at home or in a public building.
• Natural disasters such as earthquakes, tsunami, storms, and floods.
• Accidents to pipelines, trucks, or trains carrying chemicals.
• Failure of infrastructure such as electric power, water, bridges, or tunnels

Your Best Defense - A Family Plan

• Decide where to meet in the event of emergency.
• Agree on an out-of-state contact everyone can telephone for message service.
• Keep five days of food and water on hand.
• Keep food, water, blankets, a flashlight and first aid supplies in your car.
• Put together a family first aid kit.
• Keep flashlights and batteries in your home.
• If you are on a critical medication, always keep seven days supply on your person.
• Have a battery-operated radio and spare batteries on hand. Official radio stations for Jefferson County emergency information are KPLU 88.5 and KIRO 710.
• Remember, a cell site can handle only 25 calls at once, so in the event of a disaster, you may as well turn off your cell phone and save your batteries.

Useful Disaster Preparedness Websites and Phone Numbers

• You can email Mark Bowes, Jefferson County Emergency Preparedness Expert at mbowes@co.jefferson.wa.us. Ask, and he'll put you on his email list.
• Washington State Comprehensive Emergency Information, for information on highway and traffic conditions, water quality, and even unemployment or mental health crises.
• United States Disaster Preparedness
• Medical Letter, for information on chemical and biological weapons.
• US Disaster Preparedness Hotline 1-800- BE- READY (1-800-237-3239).
• Homeland Security Community Preparedness Information Line at (360) 385-91611.

Scam o' the Month — Coral Calcium

Unproven Claims

By now you've probably seen ads for coral calcium claiming it can cure everything from a stomachache to allergies to cancer. If only! A patient brought in a book and videotape about it. The book's scientific vocabulary sounds authoritative. Unfortunately, it is complete chemical nonsense, an edifice of speculation built upon sands of unfounded assumptions.

The Truth About Calcium

Calcium is one nutrient that has been well studied. We know it's important that all of us get enough calcium to keep our bones strong. Calcium citrate is very well absorbed, and has therefore been used in many studies. Many authorities think calcium citrate and calcium citrate-malate are the best forms of supplemental calcium. Calcium carbonate (the form in Tums), though inexpensive, is only absorbed well if we have adequate stomach acid, which we don't always have. It is best to take calcium at bedtime because we make our bones at night.

Hang on to Your Bones

There's a constant turnover of minerals in our bones, with calcium lost in our urine and new calcium gained from our diets. Caffeine increases the loss of calcium, especially if we drink three cups or more daily. Sodium or table salt also pulls calcium from our bones. In one study, reducing sodium intake had the same bone-building effect as increasing calcium intake. Healthy bones rely not just on calcium but a combination of nutrients, including iron, magnesium, boron, vitamin D, vitamin C, vitamin K, zinc, hormones, and other trace nutrients and minerals. Finally, weight-bearing exercise, such as walking, helps build and maintain healthy bones.

On-line Pharmacy Follow-Up

In follow-up to our article on shopping for affordable pharmaceuticals, one patient reports that SeniorRXSave.com, a Canadian pharmacy, mailed him 100 oxybutynin (Ditropan®) tablets for $36, compared to the $33 he was paying for 10 tablets here in the US. The bad news is that our Federal Food and Drug Administration wants to close down such pharmacies in the interests of "safety," even though patients report to me that they are receiving their meds in original US manufacturers' sealed packaging.

More About Generic Drug Pricing

In answer to our question last month as to why generic drug prices are so steep, one answer seems to be "cost shifting." Squeezed by insurers to lower costs of brand name drugs, pharmacies and drug companies respond by increasing generic prices. We see the same kind of cost shifting by doctors and hospitals. They raise their rates for cash-paying patients to make up for what they lose on Medicare and other governmental and private insurance. Go to WFTV, for an article about cost shifting.

Monroe Street Clinic No-Cure No-Pay Policy

Monroe Street Clinic offers our local patients a guarantee on three simple procedures - ear cleaning, wart removal, and toe fungus cure. We have a "No-Cure, No-Pay" policy. If we can't clear up these problems, we will refund your money. For details, see The Monroe Street Clinic.

Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington. Edited by Carolyn Latteier.

Subscribe | Previous issues | Contact Dr. Rienstra | More information