Pace yourself for better health in 2008

Around this time each year, I see a rush of patients with medical conditions and injuries related to New Year’s resolutions gone awry. Recently enrolled health club members come in with back pain and slipped discs, and crash dieters complain of dizziness and headaches. Simply put, pushing too fast or too hard often causes more harm than good. Just because you’ve made a decision to get healthy and fit, doesn’t mean that you have to try to reach your target by the end of January. To paraphrase a celebrity NFL quarterback, unless you are under the age of 23 or are a professional football player, it probably isn’t going to happen.

As someone who’s tried most diets from Atkins and Cabbage Soup to the Zone, and has been drawn to nearly every exercise craze du jour, I understand the craving to get quick results. But after recurring sprains and rebound weight gain, I’ve had to revise my approach. Contrary to the adage, “no pain, no gain,” good fitness programs start by finding enjoyable exercise that doesn’t hurt, and permanent weight loss begins with a nutritional plan designed for the long run. So, set your goals, make them reasonable, and pace yourself for a healthy 2008!—Dr. Orly Avitzur, Medical Adviser, Consumer Reports

Insights into acupuncture

We spoke with Lixing Lao, Ph.D., a licensed acupuncturist and director of traditional Chinese medicine research at the University of Maryland School of Medicine to find out more.

When did acupuncture begin?
It started in China 2,000 to 3,000 years ago. In that ancient time, people knew little about the anatomy of the human body. They believed that people in pain had blocked qi, pronounced “chee,” which is energy that flows through channels, or meridians, to different parts of the body. They found that pain would lessen if you used stimulation such as a needle at certain points on these meridians. There are 361 acupuncture points in all, along 14 different meridians. From China, acupuncture spread throughout Asia, then Europe and the U.S. It really took off in the U.S. in the 1970s, when the relationship between China and the U.S. opened up. The columnist James Reston had an appendectomy while in China and wrote a column about how acupuncture relieved his postoperative pain, which helped make it popular.

What does modern science say?
The evidence is pretty clear that acupuncture can stimulate the production of endorphins, natural painkillers from your own brain. It can also send signals along the hypothalamus-pituitary-adrenal axis, producing glucocorticoids, compounds that suppress inflammation. MRI studies show that acupuncture stimulates brain activity. Our own research has found that acupuncture reduces pain from knee arthritis. In my practice I treat people with back and neck pain, sports injuries, muscle strains, headaches, menstrual cramps, and the nausea and pain associated with cancer and chemotherapy. And don’t worry, it doesn’t hurt. In the past, we used thick needles that had to be inserted by hand. But now everybody uses very, very thin disposable needles that come with guiding tubes; you just tap them and the needle shoots into the skin. You can hardly feel it. Plan on coming in twice a week for the first two or three weeks, and then less often if you’re doing better.

How do I find an acupuncturist?
Look for an experienced practitioner who has a state license or registration as well as certification from the National Certification Commission for Acupuncture and Oriental Medicine.

Editor's Note, December 26th: In hindsight, the title of this blog (What does the science say about acupuncture?) does not accurately reflect the blog post itself. Thanks for your comments, and based on them we have changed the title.

Avandia - Our Take on the Controversial Diabetes Drug

The diabetes drug Avandia has been the subject of intense focus and debate - and confusion - in recent months. A study published in a leading medical journal in May 2007 indicated the drug may be associated with a higher risk of heart attack compared to a placebo or other diabetes medicines. Since then, several analyses of existing data on tens of thousands of patients have confirmed this observation.

But none of the studies offered hard proof of Avandia's link to a higher heart attack risk. And Avandia's maker, GlaxoSmithKline, has pointed to several older studies that did not seem to find such a problem. Based largely on this uncertainty and lingering questions about the methodology of the studies finding the link, an expert advisory panel to the Food and Drug Administration voted in July to keep the drug on the market.

After what press accounts characterized as a fierce internal debate - and a very close 8 to 7 vote in favor of Avandia by the agency's Drug Safety Oversight Board - the FDA in November formally concurred with the outside panel's advice to keep Avandia on the market. But the agency announced at the same time that GlaxoSmithKline had agreed to warn doctors and patients about the possible heart attack risk (on the drug's labels and in patient information), and to undertake a new long-term study on its safety.

The agency acted deliberatively and responsibly but should have gone farther. The new patient information material advises people with type 2 diabetes who also have diagnosed heart disease, or risk factors for heart disease, to talk to their doctors about the benefits and risks before taking Avandia.

We believe that people with type 2 diabetes who have been diagnosed with heart disease or have any other risk factors should not take Avandia under any circumstances until future studies, including the one GlaxoSmithKline will now initiate, fully exonerate the drug.

The rationale for this advice is two fold: (a) people with type 2 diabetes are already at considerably higher risk for heart disease and heart attack and taking a drug that possibly elevates that risk simply makes no sense; and (b) there are several alternative diabetes drugs which have quite good, and better known, safety track records. Several of those are low-cost generic drugs. Another is a drug named Actos which is in the same class as Avandia. To date, no studies have suggested Actos elevates heart attack risk and two studies have indicated it is associated with a significantly lower risk.

Since the majority of people with type 2 diabetes have other risk factors for heart disease (such as high blood pressure, high cholesterol, kidney disease, overweight or obesity) in addition to diabetes, we urge people with the condition who are currently taking Avandia to talk with their doctor about switching to another oral diabetes drug.

Our advice is consistent with the recommendations of health authorities in Canada, who urged doctors to use Avandia only in rare circumstances.

For more details, read our detailed report on all the oral diabetes medicines - from Consumer Reports Best Buy Drugs, a Consumers Union public education project.

Haemophilus Vaccines Recalled

Merck is recalling over a million doses of its Haemophilus influenzae Type B vaccine because of improper sterilization during manufacturing, according to the New York Times. Centers for Disease Control and Food and Drug Administration officials said there was no public health threat, although the recall may lead to a shortage of the vaccine this year.

The recall affects Pedvaxhib and the combination Haemophilus/hepatitis B vaccine Comvax  that were distributed as early as April 2007.

Merck says that physicians should not administer vaccines from the recalled lots. Patients who have already received the recalled vaccines should finish their series with an Hib conjugate-containing vaccine not part of this recall. Revaccination is not necessary, Merck says, because the vaccine's efficacy was not affected.

For further information, read the CDC's frequently asked questions on the recall.