Medicinal Claims Research Articles

Hemingway's Early Illness Narratives and the Lyric Dimensions of "Now I Lay Me"

I want to begin with a claim so basic it scarcely needs to be made: Heming way's early stories?those of In Our Time and Men Without Women?are full of sick and injured characters, from the laboring woman of Indian Camp to bullfighter Manuel Garcia Maera, drowning from pneumonia in A Banal Story; from boyish Nick with his shin barked, his eye banged, and his heart broken to war-wounded Nick, propped bleeding against a church wall or working his damaged leg every af ternoon at the hospital or lying awake at night in a state that can only be called post traumatic stress. There are more ill bodies than sexual ones in these stories, more characters in attitudes of suffering than in virtually any other state, of body or soul. There is Ole Andreson stretched on his bed in The Killers and Jack Brennan all busted inside at the end of Fifty Grand; there is William Campbell, concealed by a self-made shroud and talking through his rising nausea in A Pursuit Race, and Joe Butler's father, white and gone by the side of the track in My Old Man. There are boys holding their heads in their hands as though they were sick in one bar after another, and of course there is Nick himself, laid low in war. Treatment of ill ness also figures importantly in the development of plot and character. Doctoring is one way Nick knows his father. Like hunting?with which it is elided under the sign of the pocket knife and the arrowhead?it signifies power, responsibility, unsenti mentality, even a necessary cruelty. Doctoring is the turf, if not terrain, of Nick's parents' conflict?he's a doctor, she's a Christian Scientist?where medicine's claims to power are always vitally at stake. Through recurrent stories of illness and suffering, Hemingway marks several transformations. In the stories of Nick's boyhood, Nick believes that illness belongs to, even stigmatizes, the racially and socially other?the Indians in states of pneu

Gerald N Grob, The deadly truth: a history of disease in America, Cambridge, MA, and London, Harvard University Press, 2002, pp. x, 349, £23.00 (0-674-00881-2).

At the end of the nineteenth century Charles Creighton wrote a monumental, erudite and still widely cited study of the history of epidemics in Britain. Relying on an exceptionally wide range of primary sources, he chronicled the emergence of the great killing diseases, their gradual replacement by new or hitherto subterranean infections and processes accounting for differentials in mortality and morbidity in town and country. However, in the aftermath of the publication of his great A history of epidemics in Britain (1891), the subject entered a kind of twilight zone. Mainstream medical historians concerned themselves with the achievements of the great men of the profession and what then appeared to be the non-problematic emergence of the major twentieth-century sub-specialisms. Demographic studies, reaching a new level of maturity with the mid-century and paradigm-busting work of Thomas McKeown, grappled with the processes underlying the “modern rise of population”. Only with the publication of William McNeill's erudite but flawed overview of Plagues and peoples in 1976 and Emmanuel Le Roy Ladurie's astonishingly original article on the unification of the microbiological world which appeared in English in 1981, did scholars once again begin to engage with the larger epidemiological picture. Thereafter, writers as diverse as Fernand Braudel, Charles Rosenberg and Alfred Crosby made substantial contributions to a genuinely non-anecdotal study of disease in history. There has long been a need for a single-volume overview of the epidemiological history of America. Gerald Grob covers an immense field—the indigenous reaction to hitherto unknown European infections, the colonial period, the era of the young republic, embryonic urban-industrialism, and the complex socio-medical problems which confront the nation in the new millennium. A cursory glance at the endnotes to The deadly truth confirms that the author has read and absorbed nearly everything of value in what has developed into a heavily documented and intimidatingly interdisciplinary field. In addition to this large secondary literature, Grob has made exemplary use of official and unofficial reports, journals, diaries, poetry and fiction. Some of the contemporary accounts reproduced here of the massive depredations of smallpox—and measles—among uncomprehending indigenous populations from a wide range of ethnic backgrounds are terrifyingly vivid. Moving from the pre-Columbian era to early twenty-first-century prognostication based on the imminent discovery of a genetic super-bullet, the author adopts a consistently sceptical attitude towards the claims of modern medicine. Here his arguments have something in common with the classic work of McKeown, though not, it should be noted, with the wilder iatrogenic shores of Ivan Illich's Medical nemesis. The deadly truth presents the epidemiological universe as inherently random. Changes in environment, culture, and the autonomous micro-organic world itself repeatedly ensure that each waning epidemic threat is replaced by another and equally heavily politically and morally loaded crisis. Grob is particularly revealing on the regionally specific process of accommodation—what the early colonists aptly termed “seasoning”—to alien infection. His synopsis of the quality of life during the teething-period of early American urban-industrialism complements and confirms the broadly pessimistic conclusions of recent anthropometric scholarship. Following a chapter on the now much debated early-twentieth-century discovery of chronic illness, Grob insists that there can only rarely be absolute medical “victory”. Indeed, The deadly truth ends with a dystopian vision of mid-twenty-first-century America as an epidemiologically unstable society. The affluent and ethnically privileged will enjoy continuing improvements in life expectancy but also form the core of what could develop into an economically under-achieving “disability society”. According to Grob, the search for the magic bullet is misguided and futile, not least since the great majority of fatal and debilitating conditions that continue to afflict contemporary America have their origins in complexes of genetic interaction rather than the behaviour of a single gene. Biologists and medical scientists have pieced together the road-map and located the sign-posts. However, they are still only rarely able to direct drivers from one place to another. The only detectable weakness in Grob's exemplary overview of the state of the nation's health in the contemporary world is a failure to devote sufficient space to the massive scale of death and injury on America's roads. Otherwise, this is a comprehensive, wise and timely survey which effortlessly moves from state to state, hamlet to city and past to present. It certainly deserves an unusually wide readership. As for specialists, they will long be in Gerald Grob's debt for having so assiduously trawled an ever-expanding secondary literature.

Regulatory issues concerning the safety, efficacy and quality of herbal remedies.

Herbal remedies and alternative medicines are used throughout the world, and in the past herbs were often the original sources of most drugs. Today we are witnessing an increase in herbal remedy use throughout the Western world raising the question as to how safe are these preparations for the unborn fetus? Many women use herbal products during pregnancy. The dilemma facing most regulatory authorities is that the public considers these products as either traditional medicines or natural food supplements. The user sees no reason for regulation. Most countries have laws concerning foods, drugs, and cosmetics, the details of which seldom clearly define to what section of the law and regulations alternative remedies belong. In most countries alternative remedies are regulated as foods, provided that no medicinal claim is made on the label. The global regulatory sector, however, is changing rapidly. The Therapeutic Goods Administration (TGA) in Australia created a Complimentary Medicines Evaluation Committee in late 1997 to address this issue, and Canada has created a new Natural Health Products Directorate in the realigned Therapeutic Products and Foods Branch in 2000. In parallel, the European Agency for the Evaluation of Medicinal Products has drafted test procedures and acceptance criteria for herbal drug preparations and herbal medicinal products. In the US, the Food and Drug Administration classifies these natural products as dietary supplements. Manufacturers must label a dietary supplement thus: "this statement has not been evaluated by the FDA [, and] this product is not intended to diagnose, treat, cure or prevent any disease." Whether these products are foods or drugs is undecided. To add complexity to this issue, most of the potential deleterious effects of natural products on the unborn may be related to hormonal effects (e.g., phytoestrogens) and nutriceutical drug interactions (e.g., St. John's Wort and antidepressants), rather than direct embryotoxicity per se. We suggest that ensuring quality of herbal products should receive immediate attention by regulatory authorities, before embarking on the more arduous tasks of safety and efficacy.

The Essential Oils of Chamaebatiaria millefolium, Chamabatia australis, and Chamaebatia foliolosa (Rosaceae) and Comments on “Chamaebatiaria multiflorium” and “Chamaebatiaria nelleae” as Medicinal Plants

The essential oil ofChamaebatiaria millefolium from California is dominated by 24.90 ± 4.46% camphor, 17.36 ± 4.23% borneol, 11.17 ± 4.26% camphene, and 10.95 ± 4.59% α-pinene. The essential oil ofChamaebatia australis from California is dominated by no constituent greater than 10% but contains 7.07 ± 0.97% δ-cadinene, 6.84 ± 1.47% terpinen-4-ol, and 5.46 ± 1.50% linalool. The essential oil ofChamaebatia foliolosa from California is dominated by 12.90 ± 3.67% unidentified sesquiterpene alcohol and 15.96 ± 6.61% viridiflorol. No scientific literature exists to substantiate the medicinal claims for “Chamae Rose.” Neither Chamaebatiaria multiflorium norChamabatiaria nelleae exist in the scientific literature.

Good Noise? Infrasound May Be Beneficial

Infrasound normally results in pessimistic responses, describing it as a complicated problem, bringing great misery to those exposed, whose difficulties arise from adverse subjective effects, compounded by inadequate assessment methods. But Chinese traditional medicine claims therapeutic uses for infrasound, produced from the hands of the “Qigong Masters”, using an oriental system which many in the west, nurtured in experimental science and cause-and-effect medicine, find difficult to understand, and even more difficult to accept. There have been recent changes in the UK, following a report on Complementary and Alternative Medicine (CAM) by the House of Lords Select Committee on Science and Technology.1 It was estimated that the growth of CAM in the UK results in use by about 20% of the population, with an annual expenditure in excess of £1.5 billion. A result of the report has been the acceptance that CAM has a place in the health care of the UK and that more should be available on, or at least recommended by, the National Health Service. A directory of CAM practitioners is being developed for use by NHS healthcare professionals ( www.nhsdirectory.org ).

When is a Food a Medicine?

There is an upsurge of interest in functional foods (‘nutraceuticals’), but is their use to replace real medicines justified? Before we can address this issue we must question why people appear more interested in these potential remedies than they did a decade or two ago. An idealist’s answer might be that they cure ills without the adverse effects of conventional medicines and the need to visit the doctor. This hypothesis is almost certainly wrong! My cynical viewpoint is far more likely to explain their popularity, namely that advertising is making people think that functional foods work and that they are worth buying. All of this is just about to change as legislation around the world places anything with a medicinal claim firmly into the medicines camp. So if preparations of Echinacea purpurea (Purple Cone Flower from the American prairies) have the merest sniff of a claim to treat colds and influenza they will be considered medicines and not foods. At the moment in New Zealand there is a successful industry producing these, and other plants and their extracts. They are used to enhance the functionality of foods, or for export to other countries as components of herbal remedies which might be classified as either foods or medicines according to the regulations of the particular country. Echinacea is a good example because it contains numerous phenolics that might well have pharmacological activity. Indeed, the purified phenolics have been shown to have effects in isolated cells and in in vitro systems. However, simple randomised placebo-controlled clinical trials have shown equivocal efficacy with respect to an enhanced phagocytosis endpoint; three of the five studies showed no efficacy.[1] This might simply be a dose effect, but it points to the need for dose relationship efficacy studies with standardised test material. Preparations of the herb are said to stimulate the immune system (possibly by enhancing phagocytosis) and so prevent cold, flu and minor infections. Yoghurt containing Echinacea is available in supermarkets in New Zealand (and elsewhere), it is claimed to ‘enhance the body’s ability to resist infection’ and to be ‘prized for its antibiotic properties’. But are these claims true? The honest answer is that we don’t know because they have not been tested in proper clinical trials, because Echinacea is regarded as a food and foods do not need to undergo clinical trials before they are marketed. But surely these are medicinal claims. The New Zealand Medicines Act 1981 defines a medicine as something having a ‘therapeutic purpose’ and for use in ‘treating or preventing disease’. In my opinion, the Echinacea yoghurt pot labels fall within the Medicines Act definition. The world is waking up to this conundrum and Regulatory Authorities are grappling with the problems of medicinal claims and unconventional medicines. This will have a major impact on the nutraceutical and functional food industries. I suspect that either the foods (or are they medicines?) will disappear, or the medicinal claims will be removed from their labels because of the enormous cost of generating toxicological and efficacy data. New Zealand has introduced an Advertisement Pre-Vetting Service run by the Advertising Standards Authority and Medsafe, through which all advertisements for ‘fringe’ medicines must pass before the media will publish them. This is an excellent quality assurance system that helps to protect the consumer of these products. Despite this, advertisement vetting cannot replace toxicological and efficacy assessment. Surely the time is right for the manufacturers of ALL medicines, even if they prefer to call them foods, to have to support their claims with real science. And if they are not prepared to test their claims they should withdraw them.

‘Anti-aging’ medicine: does it exist? A critical discussion of ‘anti-aging health products’

‘Anti-aging’ medicine has become a popular topic, in the lay press, the (semi-) scientific literature and the Internet. 1 1 Searching with anti-aging medicine yielded 139,000 hits in Google.com; please also visit www.quackwatch.com In almost all instances, claims of drugs, health supplements and other types of intervention are not based on any evidence supported by sound scientific knowledge. Specifically, the aging process itself, in contrast to age-related diseases, has so far neither been fully understood, nor significantly influenced in higher species, notably humans. In addition to the ill-defined effects, claims of anti-aging medicine also pose a considerable economic burden on the usually poorly informed older segment of the population. The present paper is based on a recent report by the United States General Accounting Office (GAO) on the questionable and even harmful effects of anti-aging health products for seniors.

The Case against Assisted Suicide Reexamined

This Review Article examines the dominant legal and ethical arguments for and against assisted suicide. The Article argues that common practice of medicine and conceptual claims against assisted suicide do not withstand philosophical scrutiny.

Antiinflammatory screening of the medicinal plant Gynura procumbens.

Gynura procumbens is used in Thai folk medicine to treat topical inflammation, rheumatism, and viral ailments. In the present work, attempts were made to verify the folk medicinal claim that the crude ethanolic extract of G. procumbens has antiinflammatory action and to relate the activity to particular fractions using a croton oil-induced mouse ear inflammation model. The original ethanolic extract of G. procumbens was partitioned between water and ethyl acetate. The residues were subjected to antiinflammatory evaluation. While the water extract did not show any antiinflammatory activity, the administration of the original organic extract significantly inhibited the increase in ear thickness in response to croton oil (n = 5). The activity of 0.75 mg/ear original organic extract showed similar antiinflammatory activity (inhibition 65.2%) to that of 6 mg/ear hydrocortisone 21-hemisuccinate sodium salt (inhibition 64.8%). The organic extract was then fractionated with a series of solvents in order of increasing polarity. Each fraction was dried, dissolved in acetone and monitored using the same bioassay. These experiments showed that the hexane and toluene fractions showed significant inhibitions of 44.6% and 34.8%, respectively. These two fractions had similar activities to 4 mg/ear of hydrocortisone (inhibition 35.0%). The possible chemical constituents in the extracts and fractions were investigated using thin layer chromatography and specific color reagents. These tests showed that steroids might be one class of antiinflammatory compounds in this plant.

Keeping company: ethics and the talk in the commons.

The field of bioethics is by definition based on the presupposition that questioning, arguing, interruption, and response are the means by which we evaluate the truth claims of medicine and healthcare policy. The field began with the premise that another voice, one of at least critique, if not dissension, was just what was needed in any arena in which hegemonic expertise held sway. The field of the humanities is similarly based on the idea that both the literary and cultural canon—and the disputation and resistance to the canon—are acknowledged, taught, and honored. In situ in the clinic, on national boards, or in the literature, when a philosopher perceives a unanimity, she begins to be uneasy and begins to do the very thing she is trained for: to raise the questions of definition, method, data, motive, and goal.

Herbal Ethnomedicine Of The Gwalior Forest Division In Madhya Pradesh, India

Ethnomedicinal studies carried out in the Gwalior Forest Division, Madhya Pradesh, India, led to interesting therapeutic applications of 102 plant species. Information on medicinal claims was collected from the tribal people called ‘Sahariya’ and the traditional healers who had knowledge of the traditional uses of medicinal plants. This study describes details of botanical identity, local name, parts of the plants used, mode of preparation, administration of the drug, and diseases for which the given plants are used.

Chemical composition and medicinal properties of Nigella sativa Linn.

The black cumin or Nigella sativa L. seeds have many acclaimed medicinal properties such as bronchodilatory, hypotensive, antibacterial, antifungal, analgesic, anti-inflammatory and immunopotentiating and are universally accepted as a panacea. This review article has surveyed the relevant literature on Nigella sativa from 1960-1998 and examines the scientific evidence for these medicinal claims and highlights areas in need of research.

Pediatric elbow trauma

Acute pediatric elbow trauma is commonly seen in the emergency department (ED). Reports confirm that, compared to other fractures, children's elbow fractures are commonly misdiagnosed in the ED. In addition, missed orthopedic injuries are one of the leading causes of malpractice claims in emergency medicine. Radiologic diagnosis of these injuries is challenging, as a large portion of the pediatric elbow is composed of radiolucent cartilage. Knowledge of the normal anatomy and ossification centers around the elbow is essential for correct diagnosis. Acute neurovascular injury is frequently associated with these injuries, but is often difficult to assess in an apprehensive child. Immediate orthopedic consultation is indicated for any child with an elbow injury in whom neurologic or vascular compromise is suspected. Consultation should be strongly considered for children with displaced supracondylar fractures and/or significant echymosis and swelling about the cubital fossa.

The evolving health care market… Exploring alternatives

The growth in the scope and costs of health-care markets has largely overshadowed an explosive rise in alternative medical therapies, practices, and providers. However, one U.S. survey from 1993 suggested that expenditures on ‘Lunconventional medicine” (defined to include interventions that were not taught in medical schools and not available in hospitals) amounted to $13.7 billion! ’ This phenomenon is not a strictly American one; in Germany the expenditures on plant-based medicines was $1.9 billion in that same year. Although these figures represent only a few percent of overall health-care expenditures, their growth has been phenomenal. One estimate suggests that expenditures on unconventional medicine are rising at rates of 15% per year, 2 three times that of the medical consumer price index. Not surprisingly, the growth of alternative (a.k.a. unconventional or complementary) medicine has caught the attention of policymakers throughout the Western world. Two of the major foci of concern have been the regulation of nutritional supplements and the evaluation of alternative therapies. Unlike their European counterparts, U.S. botanical manufacturers had been precluded from making specific healthrelated claims regarding the efficacy of their products but were otherwise unregulated. Because the avoidance of such claims has allowed the manufacturers of these products (which range from kitchen-based mail-order businesses to huge international drug manufacturers) to work outside the Food and Drug Administration regulatory framework, the growing use of these supplements and the lack of quality control in their manufacture have prompted greater scrutiny. In the United States, recent problems with a few “natural agents” including the outbreak of eosinophilic myalgia syndrome eventually traced to L-tryptophan supplementation and rare fatal cases of poisoning due to “natural” abortifacients have prompted a re-examination of “dietary supplements” and their labeling. In 1994, the U.S. Congress passed the Dietary Supplement Health and Education Act allowing manufacturers to market their products more explicitly while introducing some regulatory mechanisms to protect the public. The text of that act noted “national surveys have revealed that almost 50 percent of the 260,000,OOO Americans regularly consume dietary supplements of vitamins, minerals, or herbs as a means of improving their nutrition, . . nearly all consumers indicate that dietary supplements should not be regulated as drugs, . . and the nutritional supplement industry is an integral part of the economy of the United States.” Like their European counterparts who have a long history of limited governmental control over the altemative-medicine industry (for example, Germany allows a nutritional supplement to make medicinal claims with only “reasonable’ ’ evidence of effectiveness), Americans have made some inroads into establishing the “4 R’s” (recognition, respectability, and reasonable regulation) for nutritional supplements and “natural” remedies with this act.* The act requires manufacturers to submit materials supporting the safety of their products. In return, manufacturers can advertise the “structure and function’ ’ of their products more explicitly as long as specific health claims are avoided. More recent Congressional action on the Food Regulatory Reform Act of 1996 further liberalizes such advertising by noting circumstances under which a label claim may be made characterizing the relation-

Evidence in consultations: interpreted and individualised

Proponents of an evidence-based approach to medicine claim that because doctors do not keep up with the latest research,1 well-founded medical advances do not find their way into the decision-making processes of the consultation. Opponents claim, however, that by emphasising the importance of this kind of evidence we may disregard the many uncertain, grey zones of clinical practice.

Scientific method and raw data should be considered

EDITOR,—Proponents of evidence based medicine claim that it is the conscientious, explicit, and judicious use of current best available external evidence about medical care.1 What about scientific method and raw data? Scientific method—the fundamental intellectual activity of obtaining data, assessing them by a series of valid arguments, and obtaining a series of conclusions in descending order of likelihood in all subjects—does not seem to merit consideration. Paradoxically, evidence based medicine seems to avoid all contact with the first hand evidence by replacing original findings with subjectively …

Training needed to deal with A&E deaths says new report

Nurses need more training in dealing with the death of patients in accident and emergency departments, a report from the Royal College of Nursing and the British Association for Accident and Emergency Medicine claims.

For Every Dollar Spent -- The Cost-Savings Argument for Prenatal Care

Public spending for prenatal care in the United States has been justified in recent years primarily by the cost-savings argument. Prenatal care, it is argued, can prevent the costs and medical complications associated with low birth weight; it is public health spending that pays for itself. This proposition seems intuitively reasonable and supports a popular public policy. Moreover, the findings of the body of research we consider here have given this assertion considerable weight and remarkable precision. Few other claims in medicine or in public health can be encapsulated into the statement that for every $1.00 spent, $1.701 (or $2.57 . . .

The gap between legal rules and practice in advertising non-registered pharmaceutical products: A new method of analysis

The market of non-registered pharmaceutical products is growing fast in number and overall costs, not only in the Netherlands, but also in other European countries. These products often give the impression that the consumer may expect ‘an effect as from a drug’. Legally, there is a clear distinction between ‘drugs’ and ‘commodities’ in the Netherlands; the question is whether legislation and practice concur. In an investigation we analyzed texts of advertisements for non-registered pharmaceutical products published in a popular magazine. A method was developed, based on the legal definition of a drug and jurisprudence, to determine in a qualitative and quantitative way the application of medicinal claims. It transpired that in 65% of the analysed advertisements explicit or implicit claims were made. These products should therefore be subject to drugs legislation. Thus, in the Netherlands there is a gap between legislation and practice in advertising non-registered pharmaceutical products.

Preventability of malpractice claims in emergency medicine: A closed claims study

We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. One hundred eighty-four of these cases were included in the following eight diagnostic categories: chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, aortic aneurysm, central nervous system bleeding, and epiglottitis. These eight categories accounted for 66.44% of the total dollars spent for the 262 claims. Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.