Bmj Usa: Editor's Choice

Magic potions and pills

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E56

This article originally appeared in BMJ USA

For thousands of years, people have been searching for pills, ointments, elixirs, confections, and tinctures to preserve their health, cure their diseases, and relieve their pain. The Egyptian document Papyrus Ebers (1500 BC) described 800 prescriptions consisting of 700 drugs (mostly plants) in the form of gargles, snuffs, enemas, suppositories, inhalations, fumigations, and other preparations. Today Americans spend more than $125 billion annually on prescription drugs, and another $10 billion on megavitamins, herbal medicines, and commercial diet products. This issue of BMJ USA includes several items on the continued search for powerful potions and pills.

A pill that would have seemed magic to ancient populations—one that prevents pregnancy!—is appropriately called “the pill.” In an editorial, Drife reviews the continued controversy over third-generation oral contraceptives (BMJ USA p 430). He and the authors of a meta-analysis published recently in the BMJ conclude that third-generation oral contraceptives are associated with an increased risk of venous thrombosis compared with second-generation oral contraceptives. But he adds that prescribers are still awaiting a consensus on whether second-generation pills should be considered the preparation of first choice.

Purveyors of nostrums have always had a keen eye for those who suffer from rheumatic disease. The latest magic pill for arthritis is glucosamine, a sugar present in articular cartilage proteoglycans. In an editorial reviewing the meager evidence supporting the new treatment, Chard and Dieppe conclude that “there is more confusion and hype than magic about glucosamine” (BMJ USA p 429).

Conspiracy theorists who believe that the “medical industrial complex” suppresses inexpensive and widely available remedies (remember laetrile?) will be pleased to see the article in this issue about therapeutic cranberry juice (BMJ USA p 453). In a randomized controlled trial comparing cranberry-lingonberry juice and Lactobacillus GG drink for preventing urinary tract infections (UTIs) in women, Kontiokari et al found that those in the cranberry group had a 20% reduction in the risk of recurrence of UTI compared with the control group (the lactobacillus drink conferred no benefit).

Many medications work wonders, of course, but access to some of them is poor, and patients often do not take them as prescribed. In a Swiss study, Nuesch et al found no evidence to support the common assumption that patients who are unresponsive to antihypertensive drugs are more likely to be non-compliant than treatment-responsive patients (BMJ USA p 439). Grant and De Cock review the devastation of HIV infection and AIDS in the developing world (BMJ USA p 471), which is due in part to the low availability of antiretroviral therapy.

Finally, Schulz reviews a book devoted to a single medication—thalidomide (BMJ USA p 483). The authors of the book “bring thalidomide's shocking history to life and show how the infamous drug has made an astounding comeback.”

Drife (BMJ USA p 430)

Chard (BMJ USA p 429)

Kontiokari (BMJ USA p 453)

Nuesch (BMJ USA p 439)

Grant (BMJ USA p 471)

Schulz (BMJ USA p 483)

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