Debating the use of Guiafenesin in Fibromyalgia.

clipped from stuff.mit.edu Dr. Robert Bennett, a recognized expert in the fibromyalgia field, agreed to do a study on guaifenesin, with Dr. St. Amand The results of this long term study showed that guaifenesin had no effect on fibromyalgia. much of Dr. St. Amand's success with guaifenesin, could be attributed to the placebo effect. Additionally, any worsening of fibromyalgia symptoms during the treatment, is also a good sign, since these symptoms are attributed to guaifenesin's reversal process, that rids the body of "metabolic debris". Not to mention, that guaifenesin often causes a change of smell or color in the urine. Many people attribute these changes to toxins being released from the body, when in all likelihood, this is simply due to the fact that the guaifenesin is metabolized by the liver, resulting in a form of lactic acid, that is then excreted in the urine. guaifenesin has a skeletal muscle relaxant property, It likely also has an analgesic, or pain relieving capability

Amongst the many "alternative" treatments in existence today, is the use of guiafenesin, a common over-the-counter mucolytic, in the treatment of fibromyalgia. The most influential proponent of this treatment, one Dr. St. Armond, has written a book on the topic entitled, "What Your Doctor May Not Tell You About Fibromyalgia : The Revolutionary Treatment That Can Reverse The Disease."

Reading the book, as a new physician, several aspects of Dr. St. Armond's case raised immediate red flags in my mind. First, Dr. St, Armond has (admittedly) failed to show any clinical evidence that the treatment works, relying instead on extensive anecdotal evidence. Second, the proposed mechanism of action in the treatment of the fibromyalgia simplifies for the laymen to the all-to-common "ridding the body of metabolic toxins." Third, fibromyalgia itself, and this treatment regimen in particular, lends itself to significant percentages of placebo affected patients. And finally, his line follows the all-to-common theme of the underdog treatment, conspired against by the likes of Big Medical and Big Pharm.

A wonderful response to this theory has been written by Mark London (presumably) at MIT. His response addresses all of the aforementioned points, but most extensively covers the dubious mechanism of action. Some of the basic points in his article are quoted below.

A rare textual blog of the scriptures

clipped from www.slate.com Like many lax but well-educated Jews (and Christians), I have long assumed I knew what was in the Bible—more or less. I absorbed other bits of Bible everywhere—from stories I heard in churches and synagogues, movies and TV shows, tidbits my parents and teachers told me. All this left me with a general sense that I knew the Good Book well enough, and that it was a font of crackling stories, Jewish heroes, and moral lessons. o, the tale of Dinah unsettled me, to say the least. If this story was strutting cheerfully through the back half of Genesis, what else had I forgotten or never learned? I decided I would, for the first time as an adult, read the Bible. And I would blog about it as I went along. My goal is pretty simple. I want to find out what happens when an ignorant person actually reads the book on which his religion is based.

David Katz, a writer for Slate magazine, has undertaken a surprisingly rare task in the blogosphere. He has decided to actually read the bible and engage his readers in a discussion of the text. As a believer in the pursuit of truth and wisdom, as well as a believer in the scriptures as a source of truth, I had assumed that this type of blog would be easy to come by. Alas, I was mistaken. The longer one searches the blogosphere, and for that matter, the internet at large, the more obvious it becomes what many of us had suspected all along. Almost nobody actually reads that thing. For all the preachers waving their bibles around in church, and all the thousands of people listening intently every week, no one's actually doing their homework.

So leave it to the newly invigorated liberal media to get some religion and fill the gap. The fellows over at Slate may fill volumes with their mockery of the religious right, but in this column they're also one-uping them by studying what the other side claims to own. Keep up this honest search for truth, and the liberals might win over some converts. One thing though, they've certainly captured a reader.

Daily Show IQ?

clipped from thezeroboss.com A study by the Pew Research Center for the People and the Press found that viewers of Jon Stewart and Steven Colbert are among the most politically savvy news watchers. Shit, we even beat out those robo-geeks who watch Jim Lehrer on PBS! The average Fox News viewer, by contrast, bombed the political pop quiz, placing that audience just slightly above the early morning talk show crowd. it seems safe to conclude that my so-called “slacker” generation takes more of an explicit interest in politics than our ancestors. The other thing to note about this segment of the population is that it skews decidedly liberal. I think it’s quite simple. My generation (*cough*) grew very wary at an early age with propagandist style lies about everything from the War on Drugs to sex education; with racism, homophobia, immigrant paranoia; and with blind faith in both God and country.

Interesting post. I disagree with his analysis of the data though. Our (*cough*) generation is likely left-leaning just because they're twenty-something, not because we've been alienated by the right. That feeling of alienation we might feel from the right may be predominantly because we're not their target audience. Young people typically seem to be more liberal, and as they age, swing more toward the right. I don't have sources to sight on that, it just seems self-evident.

I would speculate that this age gap also explains why the Daily Show viewers did better on the quiz. My father, for example, used to watch McNeal-Lehr religiously, and as a Mayo clinic physician and information junkie, I suspect he was pretty well informed on things. Now, in his 60's, he leaves the TV on FoxNews "because PBS just got too damn-liberal nowadays."

Greenspan needs to shut up.

Ever known someone who knew everything, but didn't know when to keep quiet about it? Alan Greenspan was that guy this month. It's true when he says that increased competition in any industry invariably leads to innovation and progress. It's true that competition leads to lower costs, and a healthier economy. But as an aspiring doctor with 10's of thousands of dollars of debt, I'm not too happy about him pointing out the inflated salaries of my medical colleagues.

As members of a civilized society however, we cannot draw lines when it affects us personally. We cannot condemn the moral incongruity of other protectionists while at the same time defending our own turf. Still, it would be nice if some truths took a little longer to come to light.

Perhaps while he's on the subject of perceived income inequality, he might suggest some international competition for the Christmas bonuses of friends at Goldman's Sachs. Or better yet, stop by Cato and check how much incomes are really diverging. Or best, next time he has an epiphany like this one, keep it to himself...

clipped from www.usnews.com Greenspan's solution to America's wage disparity is thus: "Our skilled wages are higher than anywhere in the world. If we open up a significant window for skilled workers, that would suppress the skilled-wage level and end the concentration of income." After all, less-skilled and less-educated workers, primarily in the manufacturing industry, have been subjected to direct competition with lower-paid workers overseas. In return, the United States has received less-expensive goods at big box stores like Wal-Mart and Costco. In 1997, Congress tightened the licensing rules for foreign doctors entering the country because of concerns by the American Medical Association and other doctors' organizations that the inflow of foreign doctors was driving down their salaries. As a result, the number of foreign medical residents allowed to enter the country each year was cut in half.

Multiple options available for treatment of MRSA

Management of Staphylococcus aureus Infections - December 15, 2005 -- American Family Physician

More than half of all patients who develop S. aureus infections while in the hospital are found to have MRSA (methicillin resistant Staph. aureus). Vancomycin is the drug of choice in the treatment of MRSA. With the development of vancomycin resistant strains, it is important for physicians and patients to be aware of alternatives to vancomycin. Luckily, there are several alternatives available.

A fairly recent review article from American Family Physician (AFP), summarizes these alternatives. Linezolid (Zyvox) can be used for all types of MRSA infections, but is especially useful in treating hospital acquired MRSA pneumonia. One article found that it was actually superior to Vancomycin in this setting. Daptomycin (Cubicin) can be used for all complicated MRSA infections EXCEPT pneumonia.

Patients who develop simple MRSA skin infections outside of the hospital can usually be treated with trimethoprim/sulfamethoxazole (Bactrim), doxycycline, or possibly a fluoroquinolone such as gati- or levofloxicin.

In patients found to have methacillin susceptible S. aureus (MSSA), the treatment should be easier. Oral dicloxacillin or IV nafcillin or oxacillin (known as semi-synthetic penicillins) are preferred. Oral cephalexin (Keflex) or IV cefazolin (Ancef) (known as 1st generation cephalosporins) are a good alternative. In this setting, Vancomycin should be reserved for patients who are allergic to penicillins.

The article goes on to describe aspects of treatment specific to the various body systems that may be infected by S. aureus. ...very good reading.

Multifactorial approach effective for treatment of IBS

Treatment of Irritable Bowel Syndrome - December 15, 2005 -- American Family Physician

Using an algorithm adapted from a New England Journal of Medicine article, a recent review in AFP promotes a multi factorial approach to the treatment of Irritable Bowel Syndrome (IBS). In addition to relaxation, stress reduction, education, and exercise, patients with mild IBS usually respond to dicyclomine (an antispasmodic) and peppermint. Patients with constipation do especially well with the addition of guar gum, fiber, exercise, and/or laxatives. Those who suffer from diarrhea or pain usually respond to the addition of immodium and TCAs (tricyclic antidepressants). Other treatments, including, 5-HT3 antagonists (Alosetron), 5-HT4 agonists (Tegaserod, or Zelnorm), Cisapride, probiotics, or cognitive-behavioral therapy, can be tried if other therapies fail.

Peppermint is especially interesting because it works well in several ways. It is an antispasmodic, anesthetic, and relieves nausea. As an herbal, it can be given over the counter or as a tea. Importantly, it may be acceptable to many patients who are hesitant to start a new 'medication'.

For those with constipation, guar gum is interesting for much the same reason as pepperment. It too can be given over the counter, and, importantly, patients tend to actually like it better than fiber.

Patients with diarrhea have two very good choices. We all know immodium, but it is important to know that it does suprisingly well in the treatment of IBS. In addition, TCAs such as desipramine (my favorate), amitryptyline, and clomipramine, work very well in low doses. Patients should know that the mechanism of action for TCA's is likely seperate from that which is involved in the antidepressant quality of the drugs (and thus you are NOT saying that they are crazy when prescribing the medication).

In short, patients with IBS have no reason to go untreated. There exist multiple good therapies, and good understanding and treatment of the illness is achievable.

Dipstick sufficient, no imaging necessary for uncomplicated childhood UTI's

Urinary Tract Infection in Children - December 15, 2005 -- American Family Physician

A review article in American Family Physician reports that children with uncomplicated UTI's show no benefit from imaging work-ups. While it may be true that imaging may reveal relatively common vesicourethral reflux or, less commonly, subsequent renal scarring leading to potential adult hypertension, effective treatments for these conditions are wonting, and clinical efficacy for the tests has not been shown. Older children with classic symptoms of UTI were best served by initial urine cultures and empiric antibiotics, while infants with unexplained fever and older children with nonclassic symptoms did best with initial dipstick testing.

A negative dipstick result can effectively rule out UTI. Physicians are free to treat positive cultures for as long as they want, as long as it lasts more than one day. Cranberry juice has not been shown to be effective in preventing UTI's. Although circumcision has been shown to reduce the incidence of UTI's, the benefit (from this aspect alone) is clearly insufficient to warrant the procedure.