Chondrointin Doesn’t Help Arthritis Pain

I have many patients who swear by alternative therapies that are unproven or, worse, proven not to work.  How should I counsel them?  On the one hand, each individual is unique and it's possible that what applies to thousands of patients in a study shouldn't be generalized to the specific patient sitting in my office right now.  On the other hand, we all (I included) have a staggering capacity for self-delusion, and it's possible that my patient is just engaging in wishful thinking because he si...
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Garlic Doesn’t Lower Cholesterol

Garlic is frequently touted as a natural treatment for high cholesterol, and many garlic extracts are sold with the suggestion that they improve cholesterol levels.  The current issue of the Archives of Internal Medicine has an article reporting the most definitive study yet looking at the effects of garlic on cholesterol.  Volunteers were randomized into four groups:  raw garlic, powdered garlic suppl...
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Book Review: A New IBS Solution

In November I wrote about an important study in the Annals of Internal Medicine that demonstrated the effectiveness of an antibiotic for the symptoms of irritable bowel syndrome (IBS).  Dr. Mark Pimentel, the author of the study, is the director of the Cedars-Sinai Medical Center Gastrointestinal Motility Program.  Last year he published a book outlining his theories about the cause and treatment of IBS:  A New IBS Solu...
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Reclaiming the Q Word

A generation ago, in the bad old days, physicians were thought of as unquestioned experts who dispensed orders rather than advice, and expected dutiful compliance from their patients.  Fortunately those days are long gone, and today the patient and the physician see each other as partners in the patient's healthcare, with the patient able to question and even challenge the doctor's recommendations.  This keeps doctors smart and honest and keeps patients ultimately in control of their health.  Bu...
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Management of Menopausal Symptoms

Yesterday's issue of the New England Journal of Medicine had a very helpful review article: Management of Menopausal Symptoms. (The full text is available even to non-subscribers.) The article reviews the existing evidence about the prevalence of symptoms related to menopause and the risks and benefits of various treatments. I summarize the article below. The symptoms most associated with menopause are v...
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DHEA and Testosterone Don’t Help Elderly Patients

Antiaging is the latest wellness craze, with many supplements promising to turn back the clock and help people feel younger.  Very few antiaging supplements have received rigorous attention. Dehydroepiandrosteone (DHEA) and testosterone are two hormones widely promoted as antiaging supplements which were investigated in a randomized double-blind study published last month in the New England Journal of Medicin...
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Horse Chestnut Seed Extract Is Effective for Symptoms of Venous Insufficiency

Chronic venous insufficiency is a very common and very uncomfortable condition. It occurs when the valves in the veins of the legs become leaky, leading to leg swelling, pain and itching. When severe, skin breakdown can occur. The most effective treatment is compression stockings, which can be uncomfortable and difficult to use. An effective oral medication would be a major advance in terms of convenience. Horse chestnut seed extract (HCSE) is a herbal remedy sometimes used for venous insuffici...
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Saw Palmetto Does Not Help for Prostate Enlargement

Some of my patients ask me if I "believe in" Eastern, or holistic, or homeopathic medication. The truth is I don't "believe in" any kind of medicine. I need to be convinced. I'm not a Western medicine chauvinist; I'm an evidence-based medicine chauvinist. If there is a good study that supports that a medication is safe and effective I'll use it. I won't ask if it comes from the East or West, or if it's natural or artificial, or if it's a tablet or a crushed leaf. I just want the evidence. Tha...
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