FDA Limits Cough, Cold Medicines
Consumers shopping for over-the-counter cough and cold medicine may have fewer choices in the next 12 months.
On Monday, the Food and Drug Administration announced it will allow only one expectorant, guaifenesin, to remain in non-perscription cough and cold medications.
Manufacturers have one year to reformulate or withdraw their products, FDA spokeswoman Susan Cruzan said. Among the ingredients found ineffective in the FDA’s review of over-the-counter cough medications were ammonium chloride, horehound, pine tar and spirits of turpentine, she said.
Guaifenesin is found in many products, according to the FDA, including Robitussin, Sudafed Cough Syrup and Vicks Formula 44 Multi-Symptom Cough Mixture.
Expectorants work by stimulating the movement of phlegm, said Arthur Kibbe, director of scientific affairs for the American Pharmaceutical Assn. in Washington. “They do this by increasing the movement of the cilia (tiny hair-like outgrowths on bronchial tree cells) or by thinning the phlegm.â€
Kibbe predicted the FDA ruling will make little difference to consumers. “A very low percentage of products on the market will be affected,†he said.
Although guaifenesin was the FDA’s expectorant of choice, it’s not a miracle drug, he added. “It’s effective, but you can get as much relief by inhaling steam from a vaporizer with plain water.â€
Eye Warning for Skiers
Sunny slopes may be a ski buff’s idea of heaven, but lack of proper eye protection can lead to snow blindness, doctors warn.
A painful inflammation of the cornea due to overexposure to ultraviolet sunlight, snow blindness can sneak up on skiers after as little as two hours outdoors, depending on clouds and other conditions, said Dr. Peter McDonnell, assistant professor of ophthalmology at the USC/Doheny Eye Institute.
It often strikes suddenly, eight or more hours after exposure to bright sunlight. Symptoms include pain, sensitivity to light and swelling of the eyelids. Some victims say the condition feels as if sandpaper had been rubbed against the outside of the eye.
If pain is severe, take aspirin and visit the emergency room or eye doctor as soon as possible, McDonnell advised. Drops, stronger than those routinely given to dilate the eyes during examinations, can help ease the discomfort, he added, noting the condition usually improves in a few days.
Wraparound sunglasses that filter out 100% of ultraviolet radiation and polarized lenses are the best preventive measure against snow blindness, McDonnell said. “Studies show even the best traditional style sunglasses only block out about two-thirds of UV light,†he noted. “Light can still get in (to the eye) around the sides.â€
Home Asthma Treatment
Treating asthmatic children at home with nebulizer systems can reduce the number of emergency room visits, Chicago researchers report in this month’s American Journal of Diseases of Children.
Clinicians agree that the trend to using home nebulizers--a relatively inexpensive medication delivery system--can be beneficial for children with asthma, a chronic disorder marked by wheezing, coughing and difficulty in breathing.
“Our patients who use it hardly ever show up in the emergency room,†said Dr. Eugene Kenigsberg, chief of allergy and clinical immunology at Kaiser Permanente-Woodland Hills and a USC clinical professor of pediatrics.
“Home nebulizer treatment is nothing more than an improved delivery system of the same medications (given in the hospital),†Kenigsberg explained. The system includes a small air compressor connected to a plastic nebulizer, in turn attached to a mouthpiece or a face mask. Liquid medicine added to the nebulizer vaporizes into a fine mist, which is inhaled slowly for about 10 minutes.
In the Chicago study, 22 children were evaluated by Dr. Deborah A. Zimo, an assistant professor of clinical pediatrics at the University of Chicago Pritzker School of Medicine who’s on staff at La Rabida Children’s Hospital and Research Center, and her colleagues. They compared two 12-month periods before and after the children, ages 3-17, began home nebulizer therapy. Fewer emergency trips to the hospital, Zimo speculated, may also make it psychologically easier for children to cope with the illness.
Studies on HMO Benefits
Are health maintenance organizations more prevention-minded than traditional or “fee-for-service†health plans?
Three recent studies yield conflicting conclusions.
A San Diego study found traditional doctors more prevention-oriented than those employed by HMOs. Dr. F. Douglas Scutchfield, professor and director of the Graduate School of Public Health at San Diego State University, polled 64 HMO physicians and 104 fee-for-service doctors.
“It appears the (fee-for-service) physicians . . . have a stronger set of beliefs, attitudes and positive practices related to health promotion and disease prevention,†he reported in the current Western Journal of Medicine. Traditional doctors surveyed were more likely to ask patients about behavior risk factors, such as smoking and alcohol use, and were more likely to consider them important than their HMO counterparts, he wrote.
Scutchfield also found traditional doctors more likely than their HMO peers to use continuing education courses to upgrade their skills in helping patients modify behavioral risks. But Scutchfield conceded his study may have some methodological problems because doctors, not patients, were interviewed about practice habits.
But another study by researchers at UCLA and the Rand Corp. in Santa Monica found that children in certain fee-for-service health plans had fewer medical contacts and received fewer preventive services than their counterparts in HMOs. Compared were 693 Seattle children ranging in age from newborn to 13 years. Children in some traditional plans were perceived by their parents to be in better overall health than those in HMO care. But the researchers, reporting their findings in the current issue of Pediatrics, discovered no physiologic differences between the groups.
A third study by Dr. Martin F. Shapiro, a UCLA associate professor of medicine, found that “being older, uninsured and having lower socioeconomic status were risk factors for receiving less preventive care.â€
When it comes to preventive care, consumers are their own best advocates, the researchers agreed. Said Scutchfield: “Physicians may have a positive attitude (toward preventive care), but they can forget in the process of taking care of a patient’s illness.â€
Dress Code for Doctors
How a doctor is dressed is probably the last thing on a patient’s mind when rushed to the emergency room. Yet a survey reported in this month’s Annals of Emergency Medicine asked 190 patients just that: What mode of dress they prefer for their ER doctors? The results: Nearly half voted for white coats. And more than three-quarters also gave a thumbs up to scrub suits. Unpopular attire: excessive jewelry, prominent ruffles, long fingernails, jeans and sandals.
The pollsters found 129 doctors even less tolerant of casual physician attire: 73% of the doctors, but only 43% of patients, said physical appearance influences a patient’s opinion of medical care.
