Chick-Chack - the Lice Remover

After our rant about head lice in the November 2003 Newsletter, we ranacross an interesting study of head lice in Israel.

According to the study, 15-20 percent of all Israeli children between theages of four and 13 have been infested with head lice. So, if your childturns up with head lice, you've got company. The Israelis, however, havesomething we don't -- Chick-Chack, a natural remedy containing coconut oil,anise oil, and ylang ylang oil. The study compared Chick-Chack with thetraditional "shot-gun" treatment of permethrin, malathion, piperonylbutoxide, and isododecane, drugs that we use in the US.

Guess what? In these 940 children, Chick-Chack was just as successful asthe synthetic brew, both being about 92 percent effective. My search enginedidn't turn up any sources of Chick-Chack, but did come up with severalvendors selling a mixture of coconut oil, anise oil and ylang ylang oil.If you want to read the study, it was published in the Israeli MedicalAssociation Journal (2002 Oct; 4(10): 790-3).

Arthritis Relief - New Drugs or Old

You may have seen compelling ads for new arthritis pain relievers such asVioxx, Celebrex, and Bextra. The prospect of going about life pain-freesounds pretty tempting to arthritis sufferers, but these new drugs may notbe the best answer. Here's a brief update on arthritis medication that mayhelp you think about what medications may be best for you.

The tradition pain relievers for arthritis are called NSAIDS, anabbreviation for non-steroidal anti-inflammatory drugs, which includeaspirin, naproxen, ibuprofen, and many other common prescription drugs.The newer drugs, Celebrex, Vioxx, and Bextra, are all brands of COX-2inhibitors.

COX what? COX is an abbreviation for cyclooxygenase, an enzyme producedin the body that causes pain. There are two types: COX-1 leads to pain,stimulates platelets to aggregate and cause clots, and protects the stomachfrom ulcers. COX-2 merely causes pain and inflammation. Now NSAIDS suchas aspirin inhibit both COX-1 and COX-2, so they relieve pain andinflammation and reduce the tendency of the blood to clot. However, theyalso interfere with the COX-1 protective effect on the stomach. COX-2inhibitors, on the other hand, inhibit COX-2 much more than COX-1, and sothey reduce pain without the risk of bleeding or stomach ulcers.

Advertisements for some of the COX-2 inhibitors can be misleading. The adsfor these COX-2 inhibitors, as far as I can see, never directly come outand say that they are any better at relieving pain or reducing arthritisthan are the non-prescription pain relievers ibuprofen, aspirin, ornaproxen. But somehow, through the magic of advertising, that messagecomes across, and patients ask me to prescribe them. Unfortunately, COX-2inhibitors will not relieve pain any better than good old aspirin.

Rofecoxib (Vioxx) and its cousins, valdecoxib (Bextra) and celecoxib(Celebrex) truly are breakthroughs in reducing the risk of bleeding andstomach ulcers associated with ibuprofen, aspirin, naproxen, and the olderanti-arthritis drugs. The downside is that they are much more costly.For short-term use in young people with little risk of damage from ulcers,the older drugs give a good deal of bang for the buck. They are, in fact,just as effective pain relievers and just as effective anti-inflammatoryagents as the newer drugs.

The risk of ulcers, however, is real. I remember one woman in particularwho had no pain at all; she just started bleeding, so seriously that Ihospitalized her. The best solution is to work with your health careprovider to determine whether, for you, the additional cost of these COX-2inhibitors is worth it.

Estrogen - Behind the Headlines

Eighteen months ago the Women's Health Initiative study reported thatestrogen therapy did not reduce heart attack risk, but it did increase therisk of breast and uterine cancer. We were among those who pointed out(in our July 2002 Newsletter) that thisinformation was certainly relevant to the synthetic hormones used in thestudy but did not tell us anything about identical-to-natural hormones.

Since then, physicians have had a chance to read, study and ponder thesedata and have found shortcomings in the study. John Woodward, MD, agynecologist in Dallas, has pointed out that the study did not includewomen actually having menopausal symptoms. (Such women would have hadlittle trouble distinguishing PremPro from a sugar pill, and could haveintroduced bias into the study.) Since younger women were excluded, theaverage age of the participants was 63. Consequently, we really only knowthe effects of estrogens on these older women, not on women in their 50swho use it to reduce hot flashes and other symptoms of menopause. Finally,a further look at the data indicated that there really was no statisticallysignificant increase in heart disease, as initially reported. A reminder,Dear Reader: Don't jump to conclusions based on a headline. Read more atDr. Woodward's Website:

News You Can Use - Health Savings Accounts

The Medicare Drug Bill includes a provision to allow Health SavingsAccounts. These are like IRA's, except you may spend the money only formedical expenses. You or your employer put money into the accounttax-free, and the account grows tax-free. You can roll over the balanceyear after year. At age 65 you may treat the account as an IRA. You mustalso have a high-deductible health insurance policy to pick up expenses toogreat for the account to cover. Republicans say this system will reducespending, because people will have a reason to pay attention to healthexpenses. Democrats say this will hinder progress towards socializedmedicine. Read more at American Medical News:..

Rant 'O The Month - The Health Care Payment Wars

This month several vendors demonstrated their electronic medical recordsystems at the hospital. Those of you who have a long or complicatedmedical history can appreciate the problems we have keeping track of yourmedical data. Say someone shows up with elevated liver function tests, wemay spend considerable time leafing back through years of paper reports ofprevious liver tests and other lab tests that may be relevant. With anelectronic record, we can find such information more rapidly. Not onlythat, but an electronic record promises to save us from the avalanche ofpaper medical records that is filling up every spare corner in mostoffices. So we docs were all interested enough in this issue to get up forseveral meetings at 7:30 in the morning.

Although such a system is potentially helpful, I was amused by part of thesales pitch. Most of the vendors boasted that their system could helpgenerate many of the codes needed for insurance billing. These codes dependon over a hundred different combinations of medical history taking,examination, complexity of decision-making, length of visit, and otherfactors. They are so complex that medical billing coding experts withyears of experience often disagree on the correct code. Since doctors knowthat Medicare prosecutes incorrect coding as fraud, they tend to"undercode." These computer programs can instantly look at the variouselements of your medical record and tell you what the correct code shouldbe. In fact, the computer can go further and tell you that your servicequalifies for code 99213 for $65, but if you go back into the exam room andask more about the family history, or examine another body system, that youwill qualify for a 99214 for $110.

Certainly administrators trying to cover clinic overhead will view thiscoding assistance as a desirable thing. Insurance companies are famous formaking doctors jump through hoops to get their claims approved, draggingtheir feet before sending the doctor a check, and sometimes concluding,long after the patient has moved to Alaska, that they won't cover the service.

And so the battle goes on, with the physicians using computers to generatemore bullet-proof medical records, better claims, and more payments. Fromthe patients' side, "don't tell the insurance company, but my knee has beenhurting for years, and I told them there was nothing wrong with me." Fromthe insurance company side, more rules to try to limit the damage. Can youspell G-A-M-E?

Coming Next Month - Vitamin D, the Real Story

Up until about a century ago, numerous people suffered from aheart-breaking condition called rickets. With rickets, children fail togain much height, and women fail to develop a roomy enough pelvis tosurvive childbirth. When Vitamin D was finally discovered, it was ablessing. When it was first identified as the missing factor without whichrickets occurred, it was mistakenly thought that we couldn't make Vitamin Don our own. Happily, even primitive life forms make vitamin D, and so canwe, from cholesterol and sunlight. Sunlight, however, can be in shortsupply in northern climates, so many people require vitamin D supplements.

Since excessive vitamin D can be harmful, people have been urged not totake "too much" vitamin D. How much is too much? Therein lies a growingcontroversy.

Next month, we'll discuss the real story about vitamin D and itrelationship to osteoporosis, prostate cancer, and a whole host of otherhealth conditions. For a preview, check out the Vitamin D Council Website:

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

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