Health Headlines - October 28

Doctors Ask Government About Tamiflu

Worried that bird flu in Asia could morph into a human flu pandemic, healthy patients, schools and even some doctors are asking if they should stock up on Tamiflu -— the one medicine experts believe might help fight the virus.

Although some doctors' groups say no, the agency in charge of the nation's public health has no answer. That has frustrated local health officials who want to know how to advise people.

"Those are questions that are under discussion," Christina Pearson, spokeswoman for the U.S. Department of Health and Human Services, said this week. "Right now we're focused on the seasonal flu."

HHS includes the federal Centers for Disease Control and Prevention, whose job includes dispensing public health recommendations.

"A lot of people have asked the CDC to provide some guidance about this, with patients asking doctors for prescriptions," said Dr. Craig Conover, medical director for the Illinois Department of Public Health.

Personal hoarding isn't fair, he said, "but on the other hand, I have heard people say that the more this gets used, the more manufacturing ability they'll develop. We've chosen to wait for CDC guidance on this."

Tamiflu is a prescription pill designed to treat regular flu. But it also seems to offer some protection to people against the type of flu that has devastated Asian poultry flocks and is spreading to birds in Europe. Bird flu has killed more than 60 people over the past two years.

On Thursday, Tamiflu's Swiss maker, Roche Holding AG, said it was temporarily suspending shipment to private U.S. suppliers because of increased global demand.

"We've seen recently some very large purchases at the wholesale level, companies or large entities who are possibly hoarding Tamiflu right now," said Darien Wilson, spokeswoman at Roche's U.S. offices in Nutley, N.J.

Prescriptions for the drug last week were nearly quadruple what they were a year before, according to Verispan, a Pennsylvania-based company that monitors pharmacy sales.

And this winter's flu season hasn't even started yet.

Maura Robbins of Chicago said she and her husband have discussed whether to seek prescriptions for their two young children as a precaution against a pandemic. They won't for now, because they "didn't want to buy into the hysteria or overreact," she said.

Dr. Bennett Kaye, a pediatrician affiliated with Chicago's Children's Memorial Hospital, said he tells patients that stocking up on Tamiflu "is definitely a bad, bad idea."

The virus circulating among Asian birds is not spreading between people and is not even very easy for people to catch from birds.

"Parents should not be worried about their kids catching bird flu this year unless they're planning on visiting a chicken farm in Vietnam," Kaye said.

Published reports suggest that some doctors are keeping supplies of Tamiflu to give to family and friends in case the bird flu mutates into a bigger threat, but no doctors reached for this story acknowledged that.

The American Medical Association is against personal stockpiling and says the misuse of Tamiflu could lead to drug-resistant flu strains.

The American Academy of Pediatrics is preparing a statement urging pediatricians "not to do personal or organizational stockpiles," said Dr. John Bradley, a member of the American Academy of Pediatrics' infectious disease committee. "The last sentence of the statement is that no pediatrician on this committee has a personal stockpile or is prescribing the drug" for healthy people.

Dr. Deborah Yokoe, an infectious disease specialist at Boston's Brigham and Women's Hospital, said, "Doctors are human, too. They have the same sorts of anxieties themselves. I'm sure some are keeping supplies, too."

Last week, the Massachusetts Department of Public Health issued a notice advising against personal stockpiling, prompted by patients' questions, and Yokoe said such messages will discourage some doctors from writing advance prescriptions for a potential flu pandemic.

Tamiflu isn't the only hot commodity being sought because of pandemic worries.

Kimberly-Clark Health Care says it has "ramped up to full capacity" face mask production to keep up with bird flu-linked demand from governments, hospitals and individuals. Surgical N-95 masks protect against airborne disease transmission.

Company spokesman David Parks declined to specify numbers but said some orders have been 50 times higher than usual.

3M spokeswoman Jacqueline Berry also reported a rise in face-mask orders but said reasons for demand include hurricane-related mold problems.

Cough and Cold Medicine Abuse

Although it's been all over the news lately, chugging cough medicine for an instant high certainly isn't a new practice for teens. They've been raiding the medicine cabinet for a quick, cheap, and - more importantly - legal high for decades. But recent coverage of the dangerous, potentially deadly practice of intentionally overdosing on cough and cold medicine has put parents, educators, and emergency departments on the alert.

Why Are Kids Abusing Cough and Cold Remedies?
Before the Food and Drug Administration (FDA) replaced the narcotic codeine with dextromethorphan as an over-the-counter (OTC) cough suppressant in the 1970s, teens were simply guzzling down cough syrup for a quick buzz. Over the years, teens have made the unsettling discovery that they could get high by taking mass quantities of any of the multitude of over-the-counter medicines containing dextromethorphan (also called DXM). Found in tablets, capsules, gel caps, and lozenges, as well as syrups, dextromethorphan-containing products are labeled DM, cough, cough suppressant, or Tuss (or contain "tuss" in the title).

Medicines containing dextromethorphan are easy to find, affordable for cash-strapped teens, and perfectly legal. Getting access to the dangerous drug is often as easy as walking into the local drugstore with a few dollars or raiding the family medicine cabinet. And because it's found in over-the-counter medicines, many teens are naively assuming that DXM can't be that dangerous.

Then and Now
Despite the recent media coverage, there's been "no significant change" in the number of emergency department visits from DXM abuse since 1994, according to the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), which monitors trends in drug-related emergency department visits and deaths nationwide.

The major difference between abuse of cough and cold medicines from past years is that teens are using the Internet to not only buy DXM in pure powder form, but to learn how to abuse it. Because drinking large volumes of cough syrup causes vomiting, the drug is being extracted from cough syrups and sold on the Internet in a tablet that can be swallowed or a powder that can be snorted. Online dosing calculators even teach abusers how much they'll need to take for their weight to get high.

One major way teens are getting their DXM fixes is by taking "triple C" - Coricidin HBP Cough and Cold, which contains 30 mg of DXM in little red tablets. Users taking large volumes of triple C run additional health risks because triple C contains an antihistamine as well. The list of other ingredients - decongestants, expectorants, and pain relievers - contained in other Coricidin products and OTC cough and cold preparations compound the risks associated with DXM and could lead to a serious drug overdose.

In addition to Triple C, other street names for DXM include: Candy, C-C-C, Dex, DM, Drex, Red Devils, Robo, Rojo, Skittles, Tussin, Velvet, and Vitamin D. Users are sometimes called "syrup heads," and the act of abusing DXM is often called "dexing," "robotripping," or "robodosing" (because users chug Robitussin or another cough syrup to achieve their desired high).

What Happens When Teens Abuse DXM?
Although DXM can be safely taken in 15- to 30-milligram doses to effectively suppress a cough, users tend to consume as much as 360 milligrams or more. Taking mass quantities of products containing DXM can cause hallucinations, loss of motor control, and "out-of-body" (disassociative) sensations.

Other possible side effects of DXM abuse include: confusion, impaired judgment, blurred vision, dizziness, paranoia, excessive sweating, slurred speech, nausea, vomiting, abdominal pain, irregular heartbeat, high blood pressure, headache, lethargy, numbness of fingers and toes, redness of face, dry and itchy skin, loss of consciousness, seizures, brain damage, and even death.

When consumed in large quantities, DXM can also cause hyperthermia, or high fever. This is a real concern for teens who take DXM while in a hot environment or while exerting themselves at a rave or dance club, where DXM is often sold and passed off as similar-looking drugs like PCP.

Being on the Lookout
If you suspect that your child may be abusing over-the-counter medicines or if your teen often attends raves or dance clubs where DXM can likely be found in abundance, it might be a good idea to:

Lock your medicine cabinet, or keep those OTC medicines that could potentially be abused in a less accessible place.
Avoid stockpiling OTC medicines. Having too many OTC medications at your teen's disposal could make abusing them more tempting.
Keep track of how much is in each bottle or container in your medicine cabinet.
Keep an eye out for not only traditional-looking cough and cold remedies in your teen's room, but also strange-looking tablets (DXM is often sold on the Internet and at raves in its pure form in various shapes and colors).
Look for possible warning signs of DXM abuse listed above.
Monitor your child's Internet usage. Be on the lookout for suspicious websites and emails that seem to be promoting the abuse of DXM or other drugs, both legal and illegal.
Above all, talk to your kids about drug abuse and explain that even though taking lots of a cough or cold medicine seems harmless, it's not. Whether it comes from inside the family medicine cabinet or the corner drugstore, when taken in large amounts dextromethorphan is still a drug that can be just as deadly as those sold by drug dealers on a seedy street corner. And even if you don't think your teen is doing it, chances are they know someone who is.

China Rules Out Bird Flu in Girl's Death

China on Friday ruled out bird flu in the death of a 12-year-old girl whose village suffered an outbreak, while Indonesia was testing dead chickens on Bali for the virus.

Highlighting the region's growing anxiety, Australia's health minister said the country would have to isolate itself in the event of a bird flu epidemic among humans. A Hong Kong lawmaker proposed arming the public to shoot all migratory birds.

The Thai government said three French tourists who became ill after visiting Thailand were found not to have bird flu.

The cases caused alarm when initial tests conducted on the Indian Ocean island of Reunion suggested the three might be carrying the virus. But more sophisticated tests in Paris found no virus, the Thai Health Ministry announced.

The World Health Organization said it wanted to see test results on the Chinese girl before it could confirm that the world's most populous nation hadn't suffered its first bird flu fatality.

Chinese authorities went on national television to assure the nation they could control the disease. They said they would quarantine any human cases and threatened to punish anyone who tries to hide an outbreak.

Scientists say China is a potentially a huge incubator for the disease because of its large poultry industry and vast territory. The country has reported three outbreaks since Oct. 19, the latest in the village where the girl died.

"Prevention and control of bird outbreaks is of chief importance," said Jia Youling, China's chief veterinary officer. "If we fail to do that well, then sooner or later there will be transmission from birds to human."

Bird flu has killed at least 62 people since it surfaced in 2003, according to the WHO. Most had contact with sick poultry. But health experts have warned that the virus could mutate into a form that can be easily transmitted between humans and trigger a global pandemic.

Chen Xianyi, vice director of the Health Ministry's department of disease control said tests on the girl, who died last week in the central province of Hunan, showed she died of pneumonia.

"The test results were negative" for bird flu, Chen said.

Still, a WHO spokeswoman said the U.N. agency was still waiting for official word from Beijing.

"We'd like to know what tests were conducted," said spokeswoman Aphaluck Bhatiasevi.

The girl lived in Wantang, a village where the government says 545 chickens and ducks died of bird flu last week. She died three days after developing a high fever on Oct. 13.

In Indonesia, authorities were waiting for test results on chickens that have died recently in Padang Sambian, a village on the outskirts of Bali's capital, Denpasar. Bird flu has killed four people and decimated poultry stocks across the sprawling archipelago.

Also Friday, Australia's health minister said the island continent of 20 million people would shut itself off from the rest of the world if a human flu pandemic breaks out.

"The best way of ensuring that you don't get infected with something like this, in the absence of an effective vaccine, would be isolation," Health Minister Tony Abbott told Australian Broadcasting Corp. radio after returning from a bird flu conference in Canada.

Abbott's announcement came as Australia warned its people to avoid travel to 15 Asian countries at risk for possible outbreaks.

In Hong Kong, a lawmaker proposed allowing the public to carry guns and shoot migratory birds suspected of carrying the virus.

"Perhaps what we should do is give each person a gun," said lawmaker Tommy Cheung, who has a reputation for making unusual proposals, "and when we see a migrating bird, we can just shoot it down, so Hong Kong would be a much safer place."

Food Fact:
Broccoli vs. cancer.

The veggie's green pigment makes it a potent disease-fighter. Substances called isothiocyanates, found in cruciferous vegetables such as broccoli, stimulate our bodies to break down potential carcinogens. Plus, ounce for ounce, broccoli contains as much calcium as milk. Vegetables in the crucifer family range widely in color, shape and flavor, from squat purple turnips to lanky, leafy nappa cabbage. Most crucifers are strong-flavored and require an assertive seasoning to bring out their best.

Fitness Tip of the day:
Find the right activity.

Answers to three questions will tell you if your exercise program is right for you. Try different activities, and ask yourself : Do I look forward to this? Do I enjoy doing it? Do I feel good afterward? If you answer yes to all three, it's an activity you'll probably keep doing. Remember, no exercise program will work for long if you have to force yourself to do it.

FAQ of the day:
Will carbs make me fat?

It certainly hasn't worked that way for traditional Asian societies, where carbohydrates can make up as much as 80% of the diet and obesity is rare. Excess calories from any source will lead to weight gain. As for carbohydrates, the key for weight control is to limit consumption of refined grains and sugars, which pack a lot of calories in a portion, and emphasize whole grains rich in fiber, and whole fruits and vegetables, which are very low in calories.