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Tuesday, June 18, 2013
Cancer is one of our scariest diseases. That’s because it is the second-leading cause of death in the U.S., killing nearly 600,000 people each year.
It is not surprising that many Americans do everything in their power to avoid exposure to toxins that might increase their chances of getting cancer. Millions have quit smoking. Others buy organic food to reduce exposure to herbicides and pesticides.
Despite such proactive steps, there may be cancer-causing chemicals in one of the least-suspected places — medications. Few people realize that many of the medicines they swallow every day may contain compounds that are under a cancer cloud.
The Food and Drug Administration often requires pharmaceutical companies to test their compounds for carcinogenicity in animal models. Not infrequently, medications come back positive for an elevated risk of tumors. That rarely disqualifies them from the drugstore.
Hormone replacement therapy (HRT) is a classic example. Studies have clearly linked estrogen plus progestin with breast cancer (Journal of the National Cancer Institute online, March 29, 2013). The FDA even has a black-box warning about this risk.
Most of the time, however, the FDA doesn’t seem to know what to do about cancer concerns. The popular diabetes drug Actos (pioglitazone) has been banned in France and Germany because of research suggesting an increased risk of bladder cancer.
The official U.S. prescribing information describes reports of bladder tumors in rat studies and bladder cancer in humans, but leaves patients and doctors confused about whether the risk is worth worrying about. Other diabetes drugs (Byetta, Januvia, Onglyza and Victoza) have been linked to pancreatitis and pre-cancerous cellular changes in the pancreas.
Sometimes FDA staffers fight amongst themselves about cancer risks. Thomas Marciniak, M.D., is a patient-safety expert within the FDA. He recently raised a red flag about a potential cancer risk linked to popular blood pressure medications called ARBs (angiotensin receptor blockers). This includes medications such as Benicar (olmesartan), Cozaar (losartan) and Diovan (valsartan).
According to a May 30, 2013, Wall Street Journal report, Dr. Marciniak sent a message to high-ranking FDA officials stating: “The FDA needs to inform patients and physicians about the ARB lung-cancer risks. The FDA must act now.” A 2011 analysis by the agency found no increase in cancer. Dr. Marciniak’s boss told the Journal, “We have no reason to tell the public anything new.”
If the FDA cannot agree about drugs and cancer, it is hardly any wonder that physicians and patients get confused. Even when the agency requires cancer warnings, most people don’t know what to make of these cautions.
The popular heartburn medicine omeprazole (Prilosec) carries a notice about abnormal cell growth and stomach tumors (carcinoids) in rats. Does that pose a problem for people?
Dozens of other drugs carry some sort of cancer warning. They include skin creams for eczema (Elidel and Protopic) and powerful biotech drugs for rheumatoid arthritis (Cimzia, Enbrel, Humira and Remicade).
When the FDA requires a cancer warning in the prescribing information, it leaves everyone in a quandary. If there is a real hazard, such drugs should be restricted. If the danger is trivial, we should be told the risks are not relevant to people so patients won’t worry needlessly.
Q: A friend recently told me that she used a vaginal cream as her facial moisturizer. Is this dangerous?
A: If the vaginal cream contains estrogen, she could be getting a much higher hormone dose than her doctor intended. Premarin cream, for example, is absorbed from the vagina into the bloodstream (JAMA, Dec. 14, 1979). Other hormonal creams also can raise blood levels of estrogen (Annals of Oncology, April 2006; Menopause, January 2009). Smearing such a cream on the face, neck, arms or upper chest is likely to add significantly to the dose.
Q: My doctor tells me that I can no longer take anti-inflammatory pain relievers for my arthritis because I have had stomach problems and my kidney function is not as good as it should be. I have given up ibuprofen, but now my knees, hips and fingers are aching.
What else can I do to ease this pain? Not being able to exercise really affects my quality of life.
A: When NSAIDs (nonsteroidal anti-inflammatory drugs) such as diclofenac, ibuprofen and naproxen are not appropriate, doctors have few other pharmaceutical options. Acetaminophen is less likely to cause ulcers, but it is no friend to the kidneys.
That is why we sometimes suggest supplements or home remedies even though the evidence for them may be weak. Many readers report relief by using turmeric, tart cherries, boswellia, ginger, Certo and grape juice, fish oil, gelatin or gin-soaked raisins. A combination may be better than any one alone.
We are sending you our Guide to Alternatives for Arthritis so that you can get more details about such approaches. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. AA-2, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: I had a hemorrhagic stroke a few years ago. I have low cholesterol (155), with an HDL of 58 and an LDL of 86.
I have never taken cholesterol-lowering drugs. I have read on your website that there is a connection between low cholesterol and a risk of bleeding stroke, but the references were old. Is there more recent evidence that low cholesterol could be a risk factor for a stroke like mine?
A: A recent review in the journal Stroke (online, May 23, 2013) analyzed data from 23 studies with more than 1 million participants. The analysis revealed a connection between lower cholesterol levels and a greater risk of hemorrhagic stroke.
This seems contrary to popular belief that the lower your cholesterol, the healthier you are. In addition, a study from Japan involving more than 80,000 adults found that the more saturated fat people consumed, the lower their risk for bleeding stroke (European Heart Journal online, April 21, 2013).
Q: I just wanted to share my cure for toenail fungus. I clipped the toenail as far back as I could and applied Monistat 7 to the nail. After a few days, the damaged nail bed sloughed away.
I kept applying the Monistat 7 and trimming the toenail until I couldn’t see any more damaged nail. The nail is growing out, and I don’t see any signs of the fungus or thickening of the nail.
A: Monistat 7 contains the anti-fungal ingredient miconazole. It sounds as though your regular use has gotten the better of the nail fungus.
“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.
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