Gym complaints soar

If your resolve to get fit has you headed to the nearest fancy fitness chain in your area, tread carefully: The Better Business Bureau has reported that complaints about fitness clubs are up by more than 90 percent in the past five years. In a recent release, the bureau notes that the most common gripes pertained to contract disputes (about 42 percent of complaints) and billing issues (about 32 percent). Another 15 percent of complaints came from consumers who joined a fitness center only to have it go out of business shortly after, leaving them to try to recoup their advanced payments.

The findings dovetail with the results of Consumer Reports’ first-ever fitness club survey More than 10,000 of our online subscribers who use a fitness facility answered questions about the staff, classes, crowds, equipment, cleanliness, locker rooms, billing issues, and other features at their respective gyms. We learned that consumers were happier with independent or nonprofit gym options—including private studios for yoga, dance, and Pilates, and gyms at community centers, schools, work, YMCAs, and Jewish Community Centers (JCCs)—than with most big health-club chains.

A common gripe was contract or fee issues (about 16 percent of respondents overall). At the two lowest-scoring chains (Bally Total Fitness and Town Sports International), a higher percentage of respondents had encountered problems, such as unexpected dues hikes or the inability to suspend a membership temporarily while away (34 and 28 percent, respectively).

Canceling was also problematic: Thirty-eight percent of respondents who’d left a big gym in the past three years reported at least one problem, such as continuing to get bills after cancellation or excessive time and effort needed to cancel.

Of course, large-chain gyms can offer certain extras that smaller outfits can’t, such as personal training packages, spa services, child care, and electronic tracking systems. If these extras are important to you, consider a big club but check out a company’s complaint history with the BBB’s free reliability reports.

In addition, both the CR and BBB reports offer useful tips for choosing a gym and avoiding common pitfalls, so you don’t get burned while you’re feeling the burn. Check out our Ratings (subscribers only) to see how your gym stacks up.

Happy sweating!

—Jamie Hirsh, associate editor

Put Vytorin back—way back—on the shelf

Last month, Merck/Schering Plough Pharmaceuticals finally released the disappointing results of a clinical trial, completed nearly two years ago, on the hoped-for ability of Vytorin to halt the progression of thickening in the carotid arteries (the two major blood vessels in the neck). In the interim, with the public totally unaware of those results, Vytorin continued to be heavily advertised to the public and widely prescribed by physicians.

That two-year study of 720 volunteers with inherited very high cholesterol levels, showed no significant differences between the carotid artery scans of those patient who took Vytorin (a combination of Zocor and Zetia) and those who took Zocor alone, despite the finding that the Vytorin takers had lower LDL cholesterol levels.

I think this study has two important implications, over and above the money wasted on purchases of Vytorin:

1. There’s no connection between the lowered LDL cholesterol levels and the lack of change in carotid artery thickening (actually the Vytorin group had more plaque formation which was not, however, statistically significant). This is unlikely in view of the overwhelming evidence that ties LDL cholesterol to cardiovascular disease. Perhaps the study was not long enough.

2. There is fallibility in clinical studies that use so-called intermediate end-points (imaging techniques, biochemical changes) instead of real events (heart attack, stroke, death). There are still many unknowns about the causes of heart attacks; fully half of coronary-disease deaths occur in people with no discernable risk factors.

And what about the patients and professionals who believed the TV ads and the hype of the drug reps and spent large sums of money on a drug that was very likely not helping them?
Here’s my advice:

Regard Zetia for what is—excessive and expensive baggage and a relatively weak LDL cholesterol lowerer. It should only be used by those who cannot tolerate statins or by the few patients who are already on high-dose statin therapy and are not achieving desirable LDL cholesterol levels. As for the combination product Vytorin? Put it back—way back—on the shelf and stick to a statin drug, preferably one available as a less-costly generic version. Read our CR Best Buy Drug report on statins to see which ones we recommend.
—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.

Drugs for nerve pain, bipolar disorder linked to thoughts of suicide

The Food and Drug Administration has warned that a group of drugs called anticonvulsants can cause some people to have thoughts of suicide and to attempt suicide.

This new advice is based on an analysis of 199 studies involving nearly 44,000 patients. The analysis found that the risk of suicidal thinking, behavior, and/or attempts was quite low—less than 1 percent in both people who took one of the drugs and in those who took a placebo pill. However, among those who took one of the drugs, the risk of suicidal thoughts and attempts was twice that of those who took placebos—0.43 percent compared with 0.22 percent. The FDA reported that four people who took one of the drugs died by committing suicide while none of the patients taking a placebo did.

The analysis is the latest to link drugs that affect the brain and nervous system to an increased risk of suicidal thinking and attempts. Most notably, the FDA has also warned of those possibilities for antidepressants.

While stating that patients and doctors should carefully weigh the benefits of the drugs against the risks, the agency is urging doctors to “closely monitor all patients currently taking or starting any antiepileptic drug for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.”

We recommend that patients who start taking any of the drugs in this class also be on the lookout for deepening depression or expressed suicidal thoughts, and immediately consult a physician.

To find out more about the uses and side effects of the drugs in this class, read our full Consumer Reports Best Buy Drugs report.

—Steve Findlay, managing editor, Consumer Reports Best Buy Drugs

The hook in hookahs

Just last month my 15-year-old son, Daniel, mentioned that some of his friends were smoking hookahs (also known as shisha, narghile, goza, and hubble bubble). Daniel ticked off its advantages: It’s not addictive (like alcohol), not illegal (like pot), and safe from the health hazards of cigarettes. His friends’ parents think that it’s cool, he said, and someone he knew even had her Sweet 16 party at a hookah bar (before they became illegal in New York City).

Daniel and his friends were parroting the myths that are being perpetuated by many other teens and young adults in the U.S. As our reporting of the recent research reveals, 15 percent of freshmen surveyed at my alma mater, Johns Hopkins, admit to smoking water pipes. Although many Hopkins students are future doctors, they’re ignoring the facts. Last year  the American Lung Association reported evidence that hookah smoking carries many of the same health hazards as cigarette smoking—heart disease, clogged arteries, and lung cancer. And because the mouthpieces are shared with others, users are also at risk for infectious diseases, such as TB, hepatitis, and herpes. 

Furthermore, evidence suggests that an average 45-minute hookah session raises levels of nicotine in the blood up to 250 percent. It also delivers the equivalent of 100 times the smoke of a cigarette (with its related toxic agents such as carbon monoxide), contributing to a growing concern in the medical community that the practice may lead to regular cravings and addiction to cigarettes. 

As the February 2008 journal Nicotine & Tobacco Research illustrates, it seems that hookah users don’t have a clue! Data analyzed from 201 hookah smokers revealed that 79 percent felt that cigarettes were more addictive than water pipes, 67 percent felt cigarettes were more harmful, and more than 65 percent believed that cigarettes have more nicotine. 

So far, the part about germs has been enough to deter Daniel. But the battle is far from over. When I told him that I was writing this, he insisted, “They wouldn’t make something legal if it were so unsafe.” —Orly Avitzur, M.D., medical adviser to Consumers Union

How Mediterranean is your diet?

The first U.S.-based study of the Mediterranean diet and longevity has confirmed the life-extending benefits seen in several European studies.

Researchers with the National Cancer Institute used a 9-point scale to score the diets of about 380,000 men and women ages 50 to 71. Those with scores above 6 were significantly less likely to die over 10 years of follow-up, particularly from heart disease or cancer, compared with those scoring below 4. (Though this study didn’t measure dairy intake, the Mediterranean diet also typically includes modest amounts of dairy products, such as yogurt and cheese.)

Now see how Mediterranean your diet is. Read each item below and give yourself 1 point for each of the guidelines you follow, 0 for each of those you do not follow.

• Vegetables (other than potatoes)—4 or more servings a day.
• Fruit—3 or more servings a day
• Whole grains—2 or more servings a day
• Alcohol—½  to 1 drink a day for women, 1 to 2 for men (but no more)
• Fish—4 or more servings a week
• Legumes—2 or more servings a week
• Nuts and seeds—2 or more servings a week
• Fat—More unsaturated fats, such as canola and olive oil, than saturated fats, such as butter, lard, and tropical oils
• Red and processed meat—Fewer than 2 servings a day

Now tally your score to see where it fits on the Mediterranean diet scale. If you score below 6, it may be time to adjust your eating habits.

Prevent medical identity theft

Financial identity theft can leave your wallet hurting and your credit history in chaos. Medical identify theft—someone using your personal information to get medical care—can do that and more. “Not only may you get bills for services you didn’t receive, but incorrect information can appear in your medical records, with devastating consequences,” says Pam Dixon, executive director of the World Privacy Forum.

The crime, which affects an estimated 250,000 Americans each year,may be on the rise. “There’s a huge demand, not only among criminals who sell prescription drugs on the black market or submit false health insurance claims, but also people who just can’t afford health care,”Dixon says.

Medical identity theft often starts with an employee in a hospital or doctor’s office who sells stolen information to organized crime rings. People might not find out that they’ve been victimized until they get a bill for care they never received or are denied health insurance coverage because of a medical problem they don’t have. To protect your medical identity:

• Share health insurance information only with trusted providers.
• Monitor the explanation of benefits you receive from insurers, and get a summary each year of all the benefits paid in your name. Contact the insurer and provider about charges for care you didn’t receive, even if you don’t owe any money.
• Keep copies of your health-care records in case of a dispute.
• Check your credit history for medical liens.
• Demand that your providers and insurance company correct errors or remove false information in your medical records.
• If you think you’ve been a victim, file a police report and send copies to insurers, providers, and credit bureaus.

Visit the World Privacy Forum for more information.

Hair removal: What’s best for you?

How you remove unwanted body hair—manual or electric shavers, creams, hot wax, epilators, electrolysis, or lasers—is mostly a matter of preference. But some methods make particular sense for certain individuals, and our tests show that not all products are created equal.

Blades tend to be easiest for most people, and they shave slightly closer than electrics. Two- or three-bladed razors may offer some advantage. If you develop razor bumps—caused by shaved hairs curling back into the skin—stop shaving for a few days, then apply a preshave lotion and shave with the grain, without stretching the skin. Or consider one of the options below.

Electric shavers rarely cause razor burn or cuts, a particular advantage if you take a blood thinner or have a bleeding disorder. But all models tested on women’s underarms—including some men’s shavers—caused skin irritation.

Electric epilators (with hundreds of tiny tweezers) and hot-wax treatments pull hair out. Most of the ones we tested performed well, though some women found them painful.

Depilatory creams dissolve hair just below the skin surface. But they produce an unpleasant smell and can cause skin reactions in some people, so test a small amount on your forearm first.

Lasers and electrolysis permanently remove hair by destroying the follicles. But they’re costly and time-consuming, and should be done only by licensed practitioners. Even then, they can sometimes darken, lighten, or scar the skin.

Tips for cleaner teeth

Whichever brand of toothbrush, toothpaste, or floss you choose, using proper brushing and flossing techniques is critical for adequately removing plaque, which causes cavities and gum disease.

Brush up on brushing
What to use: Choose a brush with soft or medium bristles, which are gentler on the gums and may clean better because they’re more flexible. The brush design does not appear to influence effectiveness, so choose any one you like.

How often: Brush twice a day, 2 minutes each time. And rinse your mouth after sugary or starchy snacks.

How to brush: Hold the brush with the bristles angled 45 degrees toward the gum line, so one row of bristle tips can slip slightly under the gums. Jiggle the brush head with a short, vibrating motion, then move on to the next spot. Finally, scrub the chewing surfaces.

Brush gently to avoid harming the gums; removing plaque doesn’t require much pressure. Brush both the outer and inner surfaces of your teeth and the tops of molars. Brush your tongue, too, to remove bacteria and freshen breath (or use a tongue scraper, sold at drugstores for about $1 each).

Flossing fundamenals
What to use: All flosses clean effectively. But if you find flossing uncomfortable, consider a slippery one like Glide.

How often: Floss once a day to remove plaque and food particles your brush can’t reach.

How to floss: Break off about 18 inches of floss and wind most of it around a finger; wind the rest around the same finger on your other hand. Use a careful sawing motion to slide the floss between your teeth down or up to the gum line; then gently move the thread slightly under the gums. Next, curve it into a “C” shape against the side of one tooth and sweep it up and down. Repeat for both sides of each tooth, unwinding clean floss from the first hand.

Find out more:

Our testers found a difference in how toothpastes clean, though, so look at our ratings to find out which toothpaste worked best (for subscribers only).

Brush up on your knowledge of toothpaste terms.

If you're pregnant, can the tuna

Many of us rely on the news to help us make decisions about what to buy and feed our families. But sometimes what seems to be good info from an authoritative-sounding source can be dead wrong. A recent advisory by the National Healthy Mothers, Healthy Babies Coalition encourages pregnant women not to cut back on fish, indicating that a little bit of mercury isn’t a problem because the benefits of eating omega-3 fatty acids for healthy brain development outweigh the risks of brain damage from mercury. But that advice counters what many doctors, government agencies, and consumer groups advise.

Hidden agenda?
So what’s up with the National Healthy Mothers, Healthy Babies Coalition? Turns out that the National Fisheries Institute, a fish-industry trade group, paid honoraria to an outside group of experts, who came up with the advice. Organizations that purport to serve the public but are backed by industry groups have been muddying the information pool for decades. The Center for Media and Democracy has been following these organizations.At Sourcewatch.org, its Web site, you’ll find lots of examples, like the Center for Consumer Freedom. Backed by the food industry, the group rails against any actions to combat obesity or smoking in public places.

What to do
While accepting industry money may not be proof positive of a hidden agenda, it’s a conflict of interest for a “consumer” group and should make you think twice about any advice.When it comes to eating fish, we recommend that pregnant women skip seafood with high levels of mercury like tuna and swordfish to lower risks to the developing fetus. And if you’re planning to become pregnant, cut back. For starters, don’t eat more than three cans of chunk light tuna a week. And avoid albacore, which tends to be even higher in mercury. Many women of childbearing age already have borderline high levels of mercury in their bodies so there’s no sense in adding to it, especially since you can get the nutrients you need without consuming mercury-laden fish. And the next time you hear any fishy advice, do some fishing around to find out whom it’s really benefiting; it may not be you.

—Urvashi Rangan, PhD., director of GreenerChoices.org.

Dr. Rangan's blog appears courtesy of ShopSmart magazine.

When you need extra water

As you ramp up your exercise routine this Spring, ensure you're staying hydrated with our advice based on a recent report from the American College of Sports Medicine.

For most moderate exercisers, drinking as much as thirst dictates during or after a workout will usually prevent dehydration. But if you are overweight, over age 65, tend to sweat heavily, or exercise intensely or for a long time, especially in the heat, staying well-hydrated may take extra effort.

A simple way to determine how much to drink is to weigh yourself before and after a typical workout. Water loss can be substantial: A 150-pound person can lose more than a pound of fluid during a brisk walk for just half an hour on a hot day. For each pound lost, plan to drink about two additional cups during or after your next session. If you gained weight during the workout, you drank too much. That can disturb your body’s sodium balance, potentially causing serious illness. After a few weigh-ins you’ll have a good idea of how much you need to stay well hydrated.

As an alternative or additional indicator, monitor your urine. If it’s dark yellow or amber after a night’s sleep, replenish your fluids by drinking a cup of water, particularly if you’ll be exercising that morning. But wait a while before working out, if possible, to let your body absorb the liquid. And drink extra fluid if your urine is dark or scant. If you’ve sweated heavily for a long time, you’ll also need something salty to replenish lost sodium.

For most recreational athletes, the main goal of staying hydrated is to avoid heat stress. So in addition to drinking on hot days, splash water on your face and wipe away sweat, which hinders evaporation. And watch for symptoms of dehydration: feeling sluggish, dizzy, faint, and weak.

Don't gamble with your heart during the Super Bowl

What is it about sporting events like the Super Bowl that turn even the most docile couch potato into a screaming, wildly gesticulating lunatic?  A subject that has long served as comedic fodder for sitcoms and hidden camera exposes has suddenly become deadly serious.  A new study released in the January 31st issue of the New England Journal of Medicine highlights the potential harm to the heart that can be caused by watching an intense and stressful sporting event.

Researchers in Germany analyzed the number of cardiovascular emergencies that occurred among German citizens during the World Cup soccer games in 2006 when their home team was playing and found that the fans experienced twice the number of heart attacks and other cardiac problems, especially within the first two hours of the soccer match.  Men with a history of heart disease were at highest risk.

As if that’s not bad enough, a University of Maryland study presented by Dr. David Jerrard at the American College of Emergency Physicians in 2006, found that there were 50 percent more visits to emergency rooms by men after professional football games than during the games over the three-year period examined.  This came on the heels of a previous study by the same investigator showing that men’s visits to emergency rooms declined during games. 

Not only are men at risk, they delay getting proper medical care so they can finish watching the fourth quarter!

Although triggers were not examined in these studies, Anthony G. Alessi, MD, ringside physician for the Connecticut State Boxing Commission points out that fans who don’t want to give up their seat at a match often skip the diuretic prescribed to control their blood pressure, to avoid having to take a bathroom break. This raises their risk for both heart attack and stroke enough to cause casinos, where boxing events are held, to keep large numbers of defibrillators throughout the house and have three teams of paramedics strategically placed and on alert at all times.

So, whether you’re rooting for the New England Patriots or the New York Giants, take heed:

• Avoid overeating, especially junk food
• Watch the alcohol
• Don’t smoke
• Take your prescribed medication
• Try to relax
• Reduce your stress…don’t bet on the games
• And above all else, don’t bet on your life—if you experience chest pain or shortness of breath, ACT IN TIME!

—Dr. Orly Avitzur, Medical Adviser, Consumer Reports

See how Super Bowl snacks stack up in our chip ratings.