Should you take a nutritional supplement?

People turn to nutritional supplements for some perfectly good reasons, including a need to compensate for an inadequate diet, or a desire for a "natural" cure. But supplements lack many of the safeguards afforded to prescription or over-the-counter drugs, and even some potentially helpful supplements can pose risks. Philip J. Gregory, Pharm.D., editor of the Natural Medicines Comprehensive Database, the leading medical reference on natural remedies, explains how to find supplements that may help you—and how to protect yourself from those that almost certainly won't.

HOW DO YOU KNOW IF A SUPPLEMENT REALLY WORKS?

If someone is claiming that he has uncovered a secret that no one else in the world knows but him, that's a clue he's probably trying to promote junk. There are no such secrets. A lot of products also claim to be "clinically tested." In reality, that can mean that someone took the product and told the company, "It worked for me." Skip any product that doesn't have actual, published, peer-reviewed clinical trials to support its claims. A lot of quacky products end up targeting conditions that people have a hard time with and where the medical options aren't great - irritable bowel syndrome, cancer, migraines, weight loss. By the way, there is no such thing as a truly safe, effective weight-loss supplement, including hoodia. And if anybody makes a claim that a supplement is "nontoxic" and better than a drug, that's based purely on opinion. There are few trials out there that compare a natural product to a prescription drug.

BUT WON'T CERTAIN SUPPLEMENTS KEEP ME HEALTHY?

People take supplements with good intentions - they want to be actively involved in their health, and taking a pill is a lot easier than eating a healthy diet or getting a lot of exercise. The law allows manufacturers to say their product "supports heart health" or "supports prostate health," which is so general people interpret it to mean that it can prevent a specific disease. But in most cases we have almost no data on how well supplements prevent disease. The studies are hard and expensive to do.

ARE THERE ANY SUPPLEMENTS YOU ACTUALLY RECOMMEND?

Yes, a psyllium or fiber supplement. High fiber in the diet can reduce cholesterol absorption, and if you can't or won't get it from food, a supplement is also acceptable. Fish oil is worthwhile for people with high triglycerides or heart disease, or who don't like fish. Saw palmetto can reduce prostate symptoms. Calcium and vitamin D are helpful for preventing osteoporosis. I still think multivitamins are appropriate for people who don't like veggies. I'm one of those. It's the only supplement I take.

 

SAD: Treating the winter blues

Bupropion (Wellbutrin XL) is the first drug approved by the Food and Drug Administration for the prevention of seasonal affective disorder, or winter depression. About 5 percent of Americans, three-quarters of them women, experience SAD each year. But do you need medication to prevent or treat it? Here are answers to five questions about this type of depression.

How do I know it's winter depression?
Some symptoms are similar to those associated with other types of depression: sadness, fatigue, excessive sleepiness, social withdrawal, and trouble concentrating. But people with SAD also tend to move slowly, crave carbohydrates, and gain weight. And they're less likely than people with conventional depression to have feelings of worthlessness or thoughts of suicide. The nonprofit Center for Environmental Therapeutics has an online questionnaire that can help you determine whether you have the disorder.

Can I get SAD if I live in a warm and sunny climate?
Yes, but it's less likely. It occurs most often in people who live in northern latitudes, where winter days are shorter and darker. For example, about 10 percent of the people living in Alaska experience symptoms of SAD, compared with only 1 percent of those in Florida, where the sun shines for more hours in the winter.

If I've had the disorder, will I get it every year?
Not necessarily. People who have experienced winter depression might have a year where the symptoms are less severe or don't show up at all. The best strategy is to watch for early warning signs, including fatigue, oversleeping, carbohydrate cravings, and weight gain. They tend to creep up weeks before your mood actually plummets, says Michael Terman, Ph.D., director of the Center for Light Treatment and Biological Rhythms at the Columbia University Medical Center in New York. This gives you time to start medication if you need it.

What nondrug treatments work?
For mild cases, doing 60 minutes of outdoor aerobic exercise in the morning might bring some relief. It makes sense to try that before medication or other treatments.

For more persistent cases, there's strong evidence that spending 30 minutes a morning in front of a lamp that simulates bright white daylight—ideally within 10 minutes of waking—can help. In a May 2006 study of 96 people, Canadian researchers found that light therapy was as effective as the antidepressant fluoxetine (Prozac and generic) in reducing symptoms of winter depression. And it works faster, usually within four to seven days, compared with four to six weeks for antidepressants. For more information on light therapy, go to the Center for Environmental Therapeutics.

Other treatment options include cognitive-behavioral therapy, in which you learn to ward off negative thoughts about the season and work on finding enjoyable activities. That kind of therapy might also help prevent a recurrence.

Is Wellbutrin XL better than other drugs for the disorder?
GlaxoSmithKline, the manufacturer of Wellbutrin, was the first to undertake the expense of conducting a clinical trial specifically on preventing SAD. In the study, which involved 1,000 people prone to winter depression, 16 percent of those who took bupropion every day through the winter developed the disorder, compared with 28 percent of the group that took a placebo.

"Clinically, there's nothing special about the efficacy of Wellbutrin relative to other common antidepressants for the treatment of SAD," says Terman. But it might carry less risk of sexual side effects than SSRIs, including fluoxetine and sertraline (Zoloft and generic).

Flu shot and flu treatment FAQs

Three years ago a flu-vaccine shortage kept many people from getting the shots. Now you’re more likely to be confused by the multiple vaccine options available, including the nasal spray recently approved even for use in toddlers, and which drugs to take if you do come down with the flu. Possible health concerns have added to the uncertainty. Here’s our advice.

Who should get vaccinated?
All adults should get a flu shot every year, especially if they’re age 50 or older, live in a long-term-care facility, are pregnant, have weakened immunity or a chronic illness, or live with or care for people in any of those groups.

Should I get the shot or the newer nasal spray?
Most people, including kids, should opt for the shot. It works as well as the spray (FluMist) and costs less. Moreover, the spray is not approved for children under age 2 or adults over 49, and its live vaccine poses unacceptable risks to pregnant women and people with weakened immunity. But consider the spray if you’re overweight, since excess fat can make it hard for the needle to reach the necessary depth, or if excessive fear of shots keeps you from getting vaccinated.

Are mercury-free shots better?
There is no convincing evidence linking the mercury-containing preservative thimerosal with autism or other health problems, though research continues. If you’re concerned, ask for a preservative-free vaccine, such as Fluzone. What about the risk of Guillain-Barré syndrome? Roughly one out of every 1 million people vaccinated may develop that neurological disorder. But the shot’s protection against illness, hospitalization, and death far outweighs the risk. Still, if you’ve had Guillain-Barré syndrome, avoid the spray vaccine and discuss with your doctor whether to get a shot.

Does it matter when you are vaccinated?
Try to get your shot by December, when the flu virus usually arrives. But the disease can peak as late as April or May, so even a January shot can help.Don’t get vaccinated while you have a moderate or severe fever, and don’t take the nasalspray vaccine if you have a cold.

What should I do if I already have the flu?
Over-the-counter pain relievers can ease the fever, chills,muscle aches, sore throat, and other symptoms associated with the flu. And if your doctor diagnoses the illness within two days of the onset of symptoms, the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can shorten its duration and possibly prevent complications.

Should I keep a supply of antiviral drugs on hand?
No. Stockpiling depletes the antiviral supply that health officials count on in case of a pandemic, and encourages needless use. Experts worry that excessive antiviral use may fuel the emergence of drug-resistant flu strains, much as the misuse of antibiotics leads to antibiotic-resistant bacteria. Research suggests that up to 18 percent of children treated with oseltamivir now harbor drug-resistant variants. And a 2006 study found that certain resistant flu strains could be passed from person to person, something researchers had considered unlikely. So get a prescription for antivirals only when you have the flu, and take the full course, since stopping early can allow germs to survive and adapt.

How to curb mindless eating

So what’s mindless eating?
External cues influence how much we eat.You pour more liquid into a short, wide glass than a tall, skinny glass. You eat 92 percent of anything you serve yourself. You eat 20 percent more food served family style rather than left on a side counter. People eating with one other person eat 30 to 35 percent more than they otherwise would. Having a snack within arm’s reach doubles how much of it you eat.

How can you know all that?
We’ve tested it all empirically. For instance, most people say they eat until their plate or bowl is empty, so we wondered what would happen if the bowl was never empty. We made a soup bowl that continuously refilled through a hole in the bottom attached to a hose from a 6-gallon vat. People with refillable bowls ate an average of 73 percent more soup than people who ate from a regular bowl, yet they didn’t think they had eaten more. They said, “How can I possibly feel full? I have half a bowl of soup left.”

How can this help you control your weight?
Our research has identified the “mindless margin” of eating. Going on a diet and cutting out 1,000 calories a day triggers feelings of hunger and deprivation. But a typical person can cut out 200 to 400 calories a day without noticing the difference. That may not seem like a lot, but if you make three 100-calorie cuts a day, at the end of a year you’ll weigh 30 pounds less. Move your candy dish. Get rid of your short, wide glasses. Use smaller dishes. Make some rules for yourself. Only allow yourself to eat a midmorning doughnut if you’ve already eaten a piece of fruit, which means you probably won’t be hungry for the doughnut. Serve the vegetables family style but not the mac and cheese.

At a restaurant, use the “pick two” strategy. Order a main course and only two of the following: bread, appetizer, dessert, and alcoholic drink. At a reception buffet, follow the “rule of two.” You can have whatever you want, but you have to use the smallest plate and can put only two things on it at one time. Always have something to drink in your hand, because that’s one less hand to eat with. —Brian Wansink,Ph.D.

Dr. Wansink is director of the Food and Brand Laboratory at Cornell University and author of “Mindless Eating” (2007, Bantam Books).

Tip of the day: Take the stairs

Just 7 minutes a day of walking up stairs may help protect your heart, among other benefits. But only about 6 percent of people actually take the stairs in public buildings. Maybe we just need a friendly nudge in the right direction—in one British study encouraging signs posted in a mall nearly tripled stair use.

Off label drugs: Why you have to question your doctor

When your doctor prescribes a medication, you assume that the Food and Drug Administration has deemed it safe and effective for what ails you. That's not always the case. More than 20 percent of the drugs prescribed are for "off-label" use — that is, for conditions other than the ones for which they received FDA approval, according to a 2006 study in the Archives of Internal Medicine.

The range of drugs used off-label is far wider than thought, the federally funded study shows. They include medication for allergies, convulsions, heart conditions, indigestion, ulcers, and asthma. In 73 percent of the off-label cases, doctors had little or no scientific evidence to back up their choices.

Drug marketing plays a role, says Randall S. Stafford, M.D., Ph.D., of the Stanford Prevention Research Center in Stanford, Calif., and co-author of the study. "While direct promotion of off-label uses is illegal," he says, "there are several gray areas that provide the industry with an opportunity to increase the off-label use of their products." Over the past few years, some drugmakers have paid millions in fines for promoting off-label uses, said an official at the U.S. Department of Justice.

Physicians are not always aware that a particular use of a drug is not FDA-approved, especially if the off-label use has become commonplace, says Edward Langston, M.D., a spokesman for the American Medical Association. But he says doctors "need the flexibility to prescribe drugs off-label where it seems appropriate and there's peer-reviewed literature to support its use."

Certain off-label uses are appropriate and can even save you a lot of money. For example, some eye specialists use Genentech's cancer drug bevacizumab (Avastin), to inhibit the overgrowth of blood vessels in wet macular degeneration, an eye disorder, says R. Linsy Farris, M.D., M.P.H., a clinical ophthalmologist at the College of Physicians and Surgeons of Columbia University in New York. Published studies on its use, coupled with results in practice, have been so encouraging that Medicare frequently covers the cost despite the lack of formal FDA approval, he says.

In 2006, a similar Genentech drug, ranibizumab (Lucentis), was approved for macular degeneration. One injection costs $1,950, compared with $50 for the off-label drug, according to the April 3, 2007, Annals of Internal Medicine.

CR’s Take:
Ask your doctor whether your medication is FDA-approved for your condition. Or check at the FDA's Web site or our drug reviews. If it wasn't, ask why it was prescribed and if there's scientific support.

Q&A: How often do you really need to strength train?

What’s the least number of repetitions, sets, and days per week I can do strength training and still get results? —C.J., Midland, Texas

Good news: Unless you’re a bodybuilder or a serious athlete, a single set for each muscle group, twice a week, is all you really need. Beyond that, the benefits begin to taper off. As for repetitions, the general advice calls for 8 to 12 reps at a weight or resistance that’s challenging but lets you complete the set. If you’re frail or older than 65, substitute 10 to 15 reps at a slightly lower resistance. If you work out on consecutive days, switch off between muscle groups—say, the torso one day followed by arms and legs the next—since muscles need at least a day off to recuperate.

Q&A: Do I need a multivitamin?

How do I know whether I need to take a multivitamin? —K.B., Charlottesville, Va.

In general, a multivitamin is necessary only if you don’t get all the nutrients you need from diet alone. Such deficiencies can stem from poor eating habits, a very low-calorie or strict vegetarian diet, or advancing age, when illness, loss of appetite, dental problems, depression, limited finances, or other factors can compromise the ability to eat healthfully. In all those cases, a multivitamin supplement can help plug the gaps. In addition, the body’s ability to absorb two key nutrients—vitamin D (from sunlight) and vitamin B12 (from food)—diminishes with age, so people older than 50 often need 600 to 1,000 international units of vitamin D and at least 2.4 micrograms of B12 every day from a supplement,as part of a multivitamin, or from fortified foods. Other people with special nutritional needs who should definitely take a multivitamin include anyone who is pregnant, likely to become pregnant, or breast-feeding; anyone with a disorder that impairs digestion or absorption, such as colitis, ileitis, or pancreatitis; or anyone with a chronic, nutrient-depleting illness, such as cancer or AIDS.

This article first appeared in the November 2007 issue of Consumer Reports onHealth.

Q&A: An easy fix for back pain?

After taking my wallet out of my back pocket, my persistent lower-back pain seems to have gone away. Could something so simple really have cured me? —C.H., Branford, Fla.

Yes. Sitting on your wallet can cause low-back pain by throwing your spine out of alignment and exerting pressure against the back muscles. Back specialists often suggest carrying your wallet in a front pocket for that very reason. But it’s wise to see your doctor if the pain returns, persists for more than a week or two, or is particularly intense. That could possibly indicate a more serious condition, including arthritis, kidney stones, an infection, or a tumor.

This item first appeared in the November 2007 issue of Consumer Reports on Health.

Protect yourself from staph infections at the gym

A strain of the bacterium methicillin-resistant Staphylococcus aureus (MRSA) has spread from hospitals into communities, mostly in gyms and health clubs, where people unknowingly share contaminated towels or athletic equipment. While the strain is less deadly than the version found in hospitals, it’s now a leading cause of skinrelated visits to the emergency room.

To protect yourself, don’t share towels, put a clean towel over workout mats, and wipe down equipment with the alcohol spray that most gyms provide. And see your doctor if you have signs of skin infection: boils or a localized, painful rash that doesn’t heal.

Older drugs work best for diabetes

An advisory committee to the Food and Drug Administration concluded in July that the heavily advertised and widely prescribed diabetes drug rosiglitazone (Avandia) posed a greater heart-attack risk than older, cheaper, equally effective medications. That comes on the heels of even stronger evidence that the drug, along with its relative pioglitazone (Actos), increases the risk of heart failure.

Here’s our advice on the best way to safely and effectively treat diabetes.

The FDA initially approved rosiglitazone and pioglitazone because randomized clinical trials found that they helped control blood-sugar levels. But after several years of the drugs’ use outside of that carefully controlled setting, researchers began detecting unexpected heart risks, especially in people taking rosiglitazone.

In contrast, research continues to document the safety and efficacy of older diabetes drugs, especially metformin (Glucophage and generic). That medicine controls blood sugar as effectively as other diabetes drugs, lowers the level of “bad” LDL cholesterol, doesn’t trigger weight gain, and is less likely to cause a dangerously low blood-sugar level (hypoglycemia). Moreover, the generic version of the drug costs just $38 to $60 per month compared with $142 to $262 for each of the glitazones.

If you can’t take metformin or if it doesn’t adequately control your bloodsugar level, talk with your doctor about glimepiride (Amaryl and generic), glipizide (Glucotrol and generic), or glyburide (Diabeta, Micronase, and generic). Those drugs, called sulfonylureas,pose fewer heart risks than the glitazones, and their generic versions cost less as well.

If none of those options works for you and you’re at low risk of heart failure, you could consider pioglitazone. Or ask your doctor about exenatide (Byetta) and sitagliptin (Januvia), new drugs that might be safer than the glitazones.

For more information, see our free Best Buy Drug report on diabetes.

This article first appeared in the November 2007 issue of Consumer Reports onHealth.

Evidence-based medicine and your health

In a conversation with Beth Nash, M.D. of the BMJ Publishing Group, publishers of the British Medical Journal, she outlines evidence-based medicine and how it could fit into your health care decision making.

We hear a lot about “evidence-based medicine” these days. Haven’t doctors’ decisions always been based on science?

Not always. Several cases in which research overturned longstanding practices that were just assumed to work pointed to the need for a formal, evidence-based approach. For example, for years it was believed that kids should have their tonsils removed to prevent recurrent sore throats.

But when it was properly studied, it turned out that it hurt more than it helped. A newer example is the use of estrogen replacement therapy to prevent heart disease in women after menopause. It made good sense in theory. Then the clinical trials came out and showed that it did more harm than good.

Isn’t it “cookbook medicine” to base decisions solely on research?

A treatment decision is like a three-legged stool. The first leg is the clinical evidence, the second is the doctor’s expertise, and the third is the patient’s values and preferences. Doctors need to integrate their clinical expertise and their years of experience treating patients, and you in particular, into their treatment recommendations. But at the same time, they should be receptive to questions about what the research shows.

Where do the patient’s values and preferences factor in?

Values could include religious beliefs, ethics, thoughts about living wills and advance directives, and so on. Preferences involve individual sensitivities. Some people are keen to avoid drug therapy, while others find it difficult to make lifestyle changes. Some prefer not to undergo surgery because of the potential risks. A good example of a condition where patient preference comes into play is prostate cancer, where the evidence provides no clear-cut idea of what intervention is best; surgery, radiation, and watchful waiting are all reasonable options. Women with breast cancer have similar decisions to make about mastectomy vs. lumpectomy or in some cases whether to have additional radiation or chemotherapy. You learn as much as you can about the available options, then follow your gut.

Probiotics: Good for your kids?

Growing research suggests that the “good” bacteria in probiotic supplements and live-culture yogurts may offer certain health benefits to adults. Now manufacturers are pitching them to kids, too. Dannon, for example, has introduced Danimals, a child-friendly, probiotic-fortified yogurt. Some supplement makers now offer probiotic pills designed especially for young children and teenagers. And Nestlé even came out with a yogurt-based infant formula. Should you give them to your child? 

Beneficial bugs
Friendly bacteria normally reside in the gut, where they help break down foods and drugs and keep disease-causing bugs in check. Antibiotics and certain gastrointestinal illnesses can trigger diarrhea by killing off or overwhelming those good bugs.

Several studies now suggest that infants on antibiotics or suffering from diarrhea may get some relief when they’re fed yogurt-based formulas with specific probiotic strains, and that older children may get similar benefits from probiotic pills. Other evidence hints that probiotics help treat several common childhood conditions, including eczema, respiratory infections, and food allergies.

But all that evidence is preliminary, and it needs confirmation from larger, better-designed trials. And while probiotics appear safe for most people, they may pose a risk of infection, especially in people with weakened immunity, infants, and children with short-bowel syndrome or other chronic disorders.

What you should do
Breast-feeding remains the best option for infants. Breast milk contains a mix of carbohydrates, amino acids, fatty acids, hormones, immunity-enhancing antibodies, and assorted vitamins, minerals, and enzymes that help infants develop and maintain a healthy colony of good bugs in their intestinal tract. If you don’t breast-feed, or want to supplement breast-feeding with formula, don’t try probiotic-fortified formula without first carefully discussing the issue with your baby’s pediatrician.

Older kids generally don’t need supplemental probiotics either, provided they eat a diet rich in whole grains and produce. Those foods, like breast milk, help promote the growth of good bacteria. But there’s no reason why you can’t include some live-culture yogurt in your toddler’s or older child’s diet. You may especially want to offer it to them when they are on antibiotics or suffer from diarrhea. Probiotic pills are probably also safe and possibly helpful in those circumstances, but it’s a good idea to talk with your doctor first.

Yogurt that contains the potentially beneficial bacteria generally will bear the National Yogurt Association’s Live & Active Cultures seal. If your doctor says pills are OK for your kid, look for those containing at least 1 billion units per serving of the most often-studied strains, including Bifidobacterium and Lactobacillus. —Marilynn Larkin

CR’s Take: The friendly bacteria in yogurt may soothe a child’s digestive problems, but consult your doctor before giving supplements to a child or using yogurt-based infant formula.

‘Behind the counter’ cold meds

“Cold medicine so strong you have to ask your pharmacist for it,” boomed an ad I heard recently over the loudspeaker in my drugstore. While consumers are long used to the distinction between prescription and over-the-counter medicines, many are still unaware of a federal law that went into effect in September 2006. It requires customers to show identification and sign a log when they purchase cold medicines, such as Comtrex Day/Night Flu Therapy and Sudafed, and other products that include the common decongestant pseudoephedrine. Drugstores are keeping the medicines either in the pharmacy
section or behind the cash register counter so they can collect the mandated information.

The reason pseudoephedrine is now sold in a controlled fashion is that it can be used to make the illegal and very dangerous drug methamphetamine, or crystal meth. Keeping tabs on who is buying large quantities of medicines with pseudoephedrine is a lawenforcement—not a consumer-protection—measure, despite what the ads may imply.

Several manufacturers have substituted phenylephrine for pseudoephedrine so their product can be sold on open store shelves. But the evidence, including a thorough review published in The Annals of Pharmacotherapy in March, shows that oral phenylephrine doesn’t work. So if you need an oral decongestant, ask your pharmacist for pseudoephedrine. Check with your doctor before taking cold medicine with either ingredient if you have anxiety, diabetes, heart disease, hypertension, hyperthyroidism, or take other drugs. Children under age 2 should not be given any cough or cold medication at all. —Ronni Sandroff, Director of Health Information

Find out more about the common cold and find out which treatments are most likely to work for you in our Treatment Ratings (available to subscribers of ConsumerReportsMedicalGuide.org).

7 safety tips for mascara wearers

While most mascaras are safe when used as directed, they still carry some risk of eye injury and infection. Here’s how you can protect yourself:

1. Apply mascara only to the tips of your lashes. If you get it too close to the root, you could block glands on the eyelids that help form tears, and your eyes might not get the lubrication they need. That condition, called dry eye, can be painful or diminish your vision.
2. Don’t share mascara. The membrane around the eye can harbor bacteria that can easily latch on to a mascara brush. If you come in contact with another person’s germs, you could wind up with conjunctivitis or other infections.
3. Don’t add liquids to mascara. Tap water, which some people use to thin mascara, isn’t sterile and can allow potentially harmful bugs into the tube. Saliva is also full of bacteria and should not be used to moisten mascara.
4. Avoid lash-extending mascaras if you wear contacts. The microfibers can become trapped beneath your lens and scratch the cornea, increasing the risk of infection.
5. Never apply mascara in a moving vehicle. If the vehicle suddenly stops or jerks, you could injure yourself with the mascara brush.
6. Don’t store mascara at temperatures above 85° F (29° C) or leave it in your car for long periods, since the heat may encourage bacterial growth.
7. Throw out mascara every three months; by then bacteria will probably be growing in it. Throw it out sooner if it’s discolored, begins to smell, or if you’ve recently had an eye infection, all of which could signal contamination.

New idea for dieters

Dieters have new help in cutting calories. A six-month study of 130 obese diabetics found that those who used specially calibrated “diet” plates for portion control were more than three times as likely to lose 5 percent of their body weight than those who only got standard nutritional counseling. The plates, which are made by a British firm, have marks indicating proper portion sizes for various foods, and allow for about an 800-calorie meal for men or a 650-calorie meal for women. Go to their website to find out more about The Diet Plate.

Find out how the latest diets stack up, and see our ratings tables of the latest diet books and diet plans (available to subscribers).

Don't be taken by drug ads

Overheard recently on the radio: The pediatrician was about to conclude 6-year-old Michael's annual checkup and asked if his mother had any further questions. "No," she replied, and then felt a forceful tug on her arm as Michael blurted out, "Yes, we do, Mom. Ask the doctor if Viagra is right for me."

No, Michael was not precocious. He was merely following instructions given by a gray-haired person in a white coat in a TV ad. He might have thought that the drug ad was somehow similar to those for sugared cereals and junk food that interrupt his favorite cartoons on Saturday mornings. After all, they are both aimed at consumers who need an intermediary to get their hands on the advertised product: For one, a parent with the money to buy the "kid-friendly" food, and for the other, a doctor with a prescription pad.

Caveat prescriber

Recently, a 76-year-old retired journalist, a long-term patient, called me about an ad he saw for ropinirole (Requip), a drug previously approved for Parkinson's disease that now had been approved—the first drug ever to be so honored--for the treatment of restless legs syndrome, an uncomfortable urge to move one's legs, which can interfere with sleep. The journalist had been wrestling with that problem for years but had been coping lately with the help of a small dose of diazepam. He had seen the satisfied consumers in the Requip ad and wanted to try it. I resisted. He insisted. Against my better judgment, I gave in. At 3 a.m. I received a call from the emergency room, where he had been taken by ambulance because of a fainting episode due to a drop in his blood pressure just an hour or two after taking his first (and most likely his last) dose.

Truth in advertising?

In one survey, half of the respondents believed that drug ads had to be approved by the government before they were aired or printed, and nearly half thought that only "entirely safe" drugs were allowed to be promoted. Nothing could be further from the truth. The Food and Drug Administration (FDA), the government agency that has jurisdiction over drug promotion, rarely gets a chance to review ad copy before the public sees it. Months can go by before the agency catches up with any misrepresentation, puffery, or inaccuracies. Those months inevitably see burgeoning sales of the drug.

Direct-to-consumer (DTC) drug ads not only permeate the TV screen, but they also fill the radio waves, print media, and, more recently, the Internet. The pharmaceutical industry in 2005 spent the staggering sum of $4.86 billion on consumer advertising—more than the Gross Domestic Product of 53 countries, according to the latest World Bank data. It is a productive investment. As spending on DTC advertising has risen, so have the number of prescriptions written and drugs sold. For each dollar spent on advertising, the pharmaceutical industry recoups $4.25.

Add to that $7 billion spent on advertising to doctors and other professionals, and it's obvious why drug costs are so high in this country. Spending on drugs is only part of the overall increase in health-care costs that have now risen to the point that the U.S. is the world leader at $5,200 per capita per year. Yet we rank lower than several similar industrialized and even some less-developed countries on such public-health benchmarks as life expectancy, infant mortality, and rates of obesity and chronic disease. And people in those countries pay much less for drugs than we do here in the U.S. Is it a coincidence that DTC ads are not allowed anywhere except here and in New Zealand (where a ban is being strongly considered)?

What you can do

To be a savvy consumer, pay little or no attention to prescription drug ads. Those ads usually promote the newest and most expensive drugs. Many older drugs are available in generic form—and they can be every bit as effective as the newer brand-name drugs. Ask your doctor whether there's an older drug that has stood the test of time and can do the job as well as the newer product. Consult a nonbiased source, such as the Consumer Reports Consumer Drug Reference or the National Institutes of Health's Medline Plus, to learn about your alternatives, drug interactions, side effects, warnings, and how to take prescription medicines safely. 

And don't let the ads convince you that every personality quirk, such as shyness, fear of heights, or performance jitters, requires a pill. If you're bothered by such problems, open a discussion about them with your physician. —Marvin M. Lipman, M.D.

Dr. Lipman has been Consumers Union's chief medical advisor since 1967. He is a diplomate of the American Board of Internal Medicine (certified in endocrinology and metabolism) and is clinical professor of medicine emeritus at New York medical College.

Q&A: Should I take feverfew for migraines?

I’m considering taking the herb feverfew to help prevent my migraines. Is there any good evidence that it works?—S.B., Orland, Maine

Yes. Several studies have found that supplements of feverfew may reduce migraine frequency and symptoms such as pain, nausea, and sensitivity to light and noise. But a recent analysis of feverfew products sold in the U.S. found huge variations in their concentration and labeled dosage recommendations. Also, feverfew in theory can block a key drug-metabolizing enzyme, leading to a potentially dangerous buildup in blood levels of numerous medications, and it may thin the blood, possibly adding to the effects of blood-thinning drugs. So if you take any medications at all, ask your doctor to check for potential interactions before taking feverfew.

Beware of drug soundalikes

The name of the sleeping pill Lunesta sounds a lot like Neulasta, the name of a drug used in cancer therapy. A pharmacist confused the two in a case reported in the journal Hospital Pharmacy. Fortunately, another pharmacist corrected the mistake before the wrong drug reached the patient.

Up to 25 percent of the reported medication errors are caused by confusing drug names that sound alike, according to a recent report from the National Academy of Sciences’ Institute of Medicine. Such potentially dangerous mix-ups are compounded by labels that look alike, poor physician penmanship, and sloppy pronunciation when phoning in drug orders. When mix-ups occur, patients not only fail to receive adequate treatment for their problem but might also suffer adverse events. Here’s how to protect yourself:

When your doctor prescribes a drug, ask him or her to print the name and dosage for you, then spell it back aloud. If it’s a brand-name drug, make note of the generic name as well.

Ask your doctor to briefly note the drug’s intended purpose on the prescription form. That will enable the pharmacist to make sure the drug is for the right purpose.

Don’t leave the pharmacy until you’ve checked the label on your prescription. If a refill doesn’t look the same as your usual medication, ask the pharmacist to double-check.

Over-the-counter heartburn drug could save you thousands

The over-the-counter drug omeprazole (Prilosec OTC) is just as effective in easing heartburn and acid reflux as costlier prescription medicines--and could save consumers up to $2,000 a year, according to an updated report from Consumer Reports' Best Buy Drugs initiative.

Prilosec OTC and prescription versions of similar drugs, such as lansoprazole (Prevacid) and esomeprazole (Nexium), belong to a class of drugs called proton-pump inhibitors (PPIs). They are among the most widely prescribed drugs in the country, and manufacturers have put a great deal of marketing muscle into steering consumers to their brands. Nexium, for example, was the second-most advertised drug in 2005, with a $205 million direct-to-consumer ad campaign.

But according to the Consumer Reports' Best Buy Drugs report, none of the PPIs are significantly more effective than the others, with the only real difference being price.

Nexium, depending on the dose, costs $181 to $193 a month, while Prevacid costs $131 to $186 a month. But Prilosec OTC, which was chosen as the Best Buy PPI, costs just $19 to $26 a month on average, and may even be cheaper at discount stores. Switching to the pill could save consumers $100 to $200 a month. Still, the report cautions that not everyone with heartburn needs a PPI, and says the drugs are overused in large part because of heavy advertising. In a recent Consumer Reports survey, physicians said PPIs were high on the list of drugs that patients requested because they had seen a TV commercial . In addition, the drugs do come with some potential risks, including a higher chance of pneumonia and infection with a bacterium called C. difficile. In December 2006 a study also suggested that taking PPIs for a year or more may increase the risk of hip fractures in adults over 50 years old.

If you only experience occasional heartburn and haven't been diagnosed with gastroesophageal reflux disease (GERD), try nonprescription antacids, such as Maalox or Tums, or acid-reducing drugs, such as famotidine (Pepcid, Pepcid AC, and generic) or nizatidine (Axid, Axid AR, and generic). People 65 and over and people with chronic medical conditions who take a PPI should get vaccinated against pneumonia and be sure to get a flu shot every year. For more information, read the Best Buy Drugs Report.

Q&A: Allergy risk for flu shot?

Last year I developed a red, sore spot where my flut shot was injected. Does this mean I'm at rish of an allergic reaction and should skip the shot this year? --J.S., Hawthorne, Calif.

No. The mild discomfort you experienced around the injection site is a common side effect of the vaccine, and not indicative of an allergy. Allergic reactions to the vaccine are rare and are usually triggered by trace amounts of egg protein in the serum—the reason people with serious egg allergies may have to avoid the vaccine. If you want to bypass the discomfort this year, you might consider the inhaled vaccine (FluMist) if you're eligible. it's approved for people between the ages of 5 and 49 who have healthy immunity, aren't pregnant, and don't have a chronic disease. Otherwise, stick with the shot. Either vaccine will cut your risk of getting the flu. Any swelling or discomfort around the injection site should diminish within a few days.

For more information, read our flu overview and get ratings for flu treatments (available to subscribers) at ConsumerReportsMedicalGuide.org.