Always on the go? Don’t try drugs first. E2


Health CONSUMER REPORTS INSIGHTS


The Checkup 6voices.washingtonpost.com/checkup


t can be annoying if your blad- der seems to work overtime and you’re headed to the bath- room more often than you’d like, but that doesn’t necessarily mean you need medication or that you even have a medical problem. Yet if you’ve seen ads about this on TV or in magazines, you might think otherwise.


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Pharmaceutical companies spend millions on advertising to convince you that you need one of their drugs intended to treat a condition called overactive blad- der. But the truth, as detailed in Consumer Reports’ latest Best Buy Drugs report, is that lifestyle changes and bladder-training ex- ercises can often provide relief without the need for a drug. Why try to avoid medication? Because drugs for overactive blad- der — such as darifenacin (En- ablex), fesoterodine (Toviaz), oxy- butynin (generic, Ditropan, Ditro- pan XL, Oxytrol, Gelnique), solifenacin (Vesicare), tolterodine (Detrol, Detrol LA) and trospium (Sanctura, Sanctura XR) — are only moderately effective. And they can cause notable side ef- fects, including dry mouth, con- stipation, blurred vision and diz- ziness. Even so, heavy advertising has helped boost sales into the hun- dreds of millions of dollars for some of these drugs. Pharmaceu- tical companies spent a whopping $126.9 million on advertising last year for five of these drugs (De- trol, Detrol LA, Enablex, Toviaz and Vesicare), according to Kan- tar Media. The top three over- active bladder drugs — Detrol LA, Vesicare and Enablex — had com- bined sales of more than $1.6 bil- lion last year. It’s not a total surprise that ad-


vertising seems to work, when you consider that 20 percent of people currently taking a pre- scription drug report having asked their doctor for medication they learned about from an ad. And of those people, a majority (59 percent) said their doctor wrote a prescription for the re- quested drug, according to a new national survey by the Consumer Reports National Research Cen- ter. About half of the respondents also said they thought doctors reached too often for the prescrip- tion pad before considering al-


In partnership with


For further guidance, go to ConsumerReportsHealth.org. More-detailed information — including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products — is available to subscribers to that site.


Painkillers can push everyday people into risky addiction AnyBODY


Carolyn Butler P


rescription drug abuse is a staple of daily papers and gossip rags alike — from


high-profile celebrity overdoses and massive Oxycontin busts to teen “pharm parties” — but I never really gave the issue much thought. That is, until my doctor gave me a script for Percocet after my C-section surgery, along with a stern warning to taper off the opioid as soon as possible. The truth is, if I hadn’t broken out in a full-body allergic rash after a week’s worth of euphoric pill-popping, it’s not difficult to imagine myself developing a full-blown addiction. Clearly I’m not the only one who has experienced the allure of such medications, which are crucial and effective for the treatment of serious pain but can also be quite harmful when used inappropriately. For starters, several friends generously offered to relieve me of my leftover stash of pills, without a note of shame. And overall, 20.8 percent of Americans 12 and older — or nearly 52 million people — have taken prescription drugs for nonmedical reasons, according to the latest National Survey on Drug Use and Health, from 2008. When it comes to illicit drug use, only marijuana is more popular. While the problem isn’t new, the repercussions are mounting. One government study released last month found that the share of substance abuse treatment admissions involving


prescription narcotics increased more than fourfold between 1998 and 2008, from 2.2 to 9.8 percent. (The proportion of admissions tied to use of alcohol and such illicit drugs as cocaine, PCP and heroin declined.) A second study found that emergency room visits involving nonmedical use of these drugs jumped 111 percent over the same period, to 305,885. Nearly everyone, it seems, is at equal risk. “We’re not really talking about drug use that hits one group or another, because . . . there were increases across the


By the numbers: Prescription drug abuse


20.8 percent


Amount of Americans 12 and older who have taken prescription drugs for nonmedical reasons


Nearly 1 in 10


substance abuse treatment admissions in 2008 involved prescription narcotics


180 million


Number of prescriptions for opiate analgesics in U.S. (up from 40 million 20 years ago)


SOURCES: National Survey on Drug Use and Health; Substance Abuse and Mental Health Services Administration; National Institute on Drug Abuse


BIGSTOCK


board, with growth cutting across age, gender, region, race, education and employment status,” said Peter Delany, director of the Office of Applied Studies for Substance Abuse and Mental Health Services Administration, which published this latest research. Nonetheless, he said, young people are a particular concern, with 13.7 percent of those ages 18 to 24 and 13.5 percent of those ages 25 to 34 who sought treatment reporting pain reliever abuse in 2008, up from 1.5 and 2.1 percent, respectively, a decade before. So why are people like you and me turning to prescription medications in droves? For one thing, these narcotics are widely viewed as safer than street drugs such as cocaine or methamphetamines, said Washington-based interventional pain physician Damon Robinson. “Because you can obtain these drugs legally, from a doctor, there is this distorted perception that they are not as dangerous as other illicit substances, like IV


drugs,” he said. But potent medications such as Oxycontin and Vicodin “work on the same opiate receptor as heroin and are just as dangerous and just as addictive when they are abused outside of a medical context,” he said. In addition, these drugs are now more available than ever before, whether it is in doctors’ offices or on the street. “Over 20 years, the number of prescriptions for opiate analgesics in the U.S. has gone from 40 million to 180 million,” said Nora Volkow, director of the National Institute on Drug Abuse. She points out that research has shown that the majority of abusers obtain pain medications from friends or family members, although they also buy them from dealers and on the Internet, or get


prescriptions from one or more doctors. Experts lament the lack of a


centralized system for monitoring the distribution of controlled substances such as


opioids. Robinson believes this dearth of oversight allows patients to “doctor-shop” for physicians who will provide them additional or unnecessary medication. “Right now, there’s no way that


physicians and pharmacies can talk to each other,” said Robinson. He noted that while some states, including Virginia, have tracking databases for prescriptions, many other jurisdictions, Maryland and the District among them, do not. This makes it easy for savvy local patients to work the system and get narcotics they don’t really need.


Robinson said that some


doctors require patients who receive prescriptions for opioids to sign an agreement saying that they won’t lose the medication, take it too frequently or give it to anyone else. Others make certain patients subject to frequent monitoring visits and the occasional urine toxicity screen. Experts say there needs to be a happy medium that balances the needs of pain patients with concerns about the growing addiction and abuse problem. “We certainly want to cut down on prescription drug abuse, but we don’t want to prevent legitimate pain patients from getting the help and medications they need, in a safe way,” says the substance abuse administration’s Delany. He recommends better


training for doctors on the proper treatment of pain and


prescribing of narcotics, as well as more education for the public on the correct use of these medications and the dangers that come with their misuse. Perhaps most important is reminding patients of their responsibility to properly dispose of leftover pills — which means that my unused Percocet has now been flushed down the toilet, per FDA recommendations for certain painkillers. health-science@washpost.com


ERIC PALMA ternate treatments. At the same time, drug manu-


facturers spend heavily — more than $6.6 billion last year alone, according to IMS Health — in pro- motions to physicians and other health-care professionals. The public is wary of the amount of influence pharmaceu- tical companies may have over doctors’ prescribing habits. In the survey, which involved more than 1,150 nationally repre- sentative adults who currently take a prescription drug, 81 per- cent of the respondents said their greatest concern was the rewards given by pharmaceutical compa- nies to doctors who write a lot of prescriptions for a company’s


drugs. Sixty-one percent voiced concern about doctors’ receiving payments from pharmaceutical companies to speak at industry conferences. And 58 percent were concerned about big drug compa- nies’ buying meals for doctors and their staffs. In the end, consumers and their insurers foot the bill for these out- lays, in the form of high-priced brand-name medication. Certain overactive bladder drugs, for example, cost more than $200 a month. So before you shell out big bucks for any of these drugs, look beyond the slick ads and first con- sider whether you need a medica- tion at all. Here are a few points


worth considering:  Overactive bladder is charac- terized by sudden urges to uri- nate, by having to go more than 10 times a day and by episodes of in- continence (urine leakage). If you have these symptoms, it’s impor- tant to see a doctor to get an accu- rate diagnosis, because there are several other conditions that are treated differently but are some- times confused with overactive bladder. The symptoms of overactive bladder and related incontinence are very common. At least 11 mil- lion to 16 million U.S. women suf- fer from overactive bladder and incontinence, according to the Agency for Healthcare Research and Quality. Some estimates in- dicate that an equal number of men experience overactive blad- der, but exact numbers are diffi- cult to pin down because these symptoms can also be caused by prostate problems. The condition can develop in men or women of any age but is more likely to occur in older adults. Overactive bladder symptoms are not always permanent and may go away. Studies show that the condition resolves after a year in 23 to 35 percent of women who develop it. However, for the ma- jority of women, the condition persists for years.  If your symptoms are relatively mild and don’t interfere with your daily activities, you should try cut- ting back on caffeinated and alco- holic beverages, drink less before bedtime and learn bladder-train- ing exercises, including Kegel ex- ercises, to strengthen the pelvic muscles that help control urina- tion. These changes can often re- lieve your symptoms enough that a drug isn’t necessary.  If you and your doctor con- clude that a drug is worth trying, Consumer Reports Best Buy Drugs recommends Detrol or its extended-release version, Detrol LA, based on a systematic review of the evidence from 156 studies. These drugs can cost more than $200 a month, significantly more than oxybutynin, the only generic available to treat overactive blad- der. Consumer Reports selected them as “Best Buys” because they carry a lower risk of side effects. Copyright 2010. Consumers Union of United States Inc.


Teen hearing loss grows more common Hearing loss among teens has increased significantly in the


United States, according to a new study. Josef Shargorodsky of the Brigham and Women’s Hospital in Boston and colleagues examined data collected from more than 4,600 12- to 19-year-olds for two federal surveys; one covered 1988 to 1994, the other ran from 2005 to 2006. The prevalence of hearing loss increased from 14.9 percent in the 1988-94 period to 19.5 percent in the 2005-06 period, a rise of about 31 percent, the researchers reported in the Journal of the American Medical Association. The majority of hearing loss was slight, but the prevalence of mild or worse loss increased 77 percent. Girls were much less likely than boys to have lost some hearing. The authors noted that other studies have found that listening to music on portable stereo devices can play a role in hearing loss.


Long-term benefit found in chocolate A new study shows that eating chocolate can protect a


woman’s heart. Murray Mittleman of Harvard Medical School and his colleagues studied 31,823 middle-aged and elderly Swedish women, comparing how much chocolate they ate with their risk for heart failure over a nine-year period. Women who consumed one or two servings each week of high-quality chocolate, which contains a higher density of cocoa, had a 32 percent lower risk of developing heart failure than women who did not regularly eat any chocolate, the researchers reported in the journal Circulation: Heart Failure. Those who had one to three servings per month had a 26 percent lower risk. But women who treated themselves to at least one serving each day did not appear to benefit. The researchers speculate that the additional calories that result from eating that much chocolate might outweigh the benefits. Previous research has indicated that compounds in


chocolate known as flavanoids lower blood pressure. The new study is the first to show over the long term that chocolate appears to protect against heart failure. The researchers noted that in Sweden even milk chocolate has a higher cocoa concentration (30 percent) than dark chocolate sold in the United States (as little as 15 percent). So American chocolate may have fewer heart benefits and more calories and fat for equivalent servings.


—Rob Stein


HEALTH SCAN OBESITY


Reliving leaner times “THE DIETS THAT TIME FORGOT” (ACORN MEDIA, $39.99) The British reality-TV show “The Diets


That Time Forgot” is based on the premise that modern culture encourages obesity and if people lived more like their great-grand-


parents did, they would be slimmer. In this newly released two-DVD set, contestants on the show follow diets from one of three periods: Victorian, Edwardian and the Roaring ’20s. The Victorian diet consists mostly of meat; the Edwardians can eat whatever they want, provided they chew each bite 32 times; and the 1920s group is limited to a measly 1,200 calo- ries per day. Dieters wear period costumes and do era- appropriate exercises, including riding vintage bicycles and following an actual paper trail through the woods.


H2 O


Easy to swallow WOMAN’S DAY, AUGUST ISSUE The water aisle at the grocery store is an increasingly con- fusing place: Bottled water is available with electrolytes, arti- ficially sweetened, naturally sweetened, vitamin-enhanced or with a “hint” of flavor. What’s a thirsty gal to do? Woman’s Day magazine attempts to sort it out with a big feature called “Drink Me,” which centers on eight common hydration myths. It turns out that the diuretic effect of caffeine isn’t as drastic as once thought and that drinking cold water, rather than warm, is not an effective way to speed up one’s metabolism. The magazine pits various beverages against one another: Seltzer beats diet soda; milk and juice tie; a sports drink wins out over an energy drink, and regular water trumps vitamin- enhanced water. (“You’re better off taking a multivitamin and spending your money on fruits and vegetables,” according to the magazine.)


— Rachel Saslow QUICK STUDY WEIGHT LOSS


Limiting carbs rather than fat may have a heart benefit for those who are obese


THE QUESTION Over the long run, how do the results of low- fat and low-carbohydrate weight-loss efforts compare? THIS STUDY involved 307 adults, who averaged 45 years old and weighed an average of 227 pounds. All had body mass in- dex (BMI) ratings in the obese range, with an average of 36 (18 to 25 is normal, 30 or more is obese). They were randomly as- signed to consume a low-carbohydrate diet (with unrestricted consumption of fat and protein) or a low-fat/low-calorie diet. Everyone participated in periodic group sessions on behav- iors to enhance weight loss, and all were asked to exercise (mainly walk) regularly, increasing to more than three hours a week by five months. People in both groups lost weight, but the amount lost was virtually identical: about 24 pounds, on average, after one year and 15 pounds (7 percent of their start- ing weight) after two years. Changes in low-density lipopro- tein cholesterol and bone density did not differ between the groups after two years. However, levels of high-density li- poprotein cholesterol (the good kind) increased by more, and did so faster, for the low-carb diet group, reaching an increase of about 23 percent by the end of the study. WHO MAY BE AFFECTED? People who are obese and want to lose weight. Millions of Americans are obese: 34 percent of adults, about 20 percent of kids 6 years and older and 10 per- cent of younger children. The extra weight and fat makes an obese person more likely to have heart disease, high blood pressure, Type 2 diabetes and some types of cancer. CAVEATS People who had obesity-related diseases, such as diabetes, were excluded from the study, as were those taking cholesterol-lowering medication and people with high blood pressure; thus, the findings may not apply to them. Whether they apply to people who are overweight but not obese is un- clear.


FIND THIS STUDY Aug. 3 issue of Annals of Internal Medicine. LEARN MORE ABOUT losing weight at www.win.niddk.nih. gov/publications and www.mayoclinic.com (search for “weight loss”).


— Linda Searing


The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.


KLMNO


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TUESDAY, AUGUST 24, 2010


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