News 06/01/2544

News 06/01/2544

UNIVERSAL FLU VACCINATION COSTS LESS THAN TREATMENT
Administration of the trivalent influenza vaccine to all healthy adults saves money over treatment of those who develop influenza-like illnesses with the oral neuraminidase inhibitor oseltamivir or supportive care alone.

COMMON HERBAL REMEDIES HAVE UNCERTAIN RISK-BENEFIT PROFILES
While many people swear by the benefits of certain herbal therapies, a review of the medical literature provides only incomplete evidence of efficacy, making any risk benefit assessment unreliable.

OLD CHINESE REMEDY MAY BE USEFUL IN TREATMENT OF ASTHMA
Xiao-qing-long-tang (XQLT), a traditional Chinese medicine used to treat bronchial asthma, appears to reduce bronchoconstriction and eosinophil infiltration of the airway.

Universal Flu Vaccination Costs Less Than Treatment

NEW YORK (Reuters Health) Dec 31 - Administration of the trivalent influenza vaccine to all healthy adults saves money over treatment of those who develop influenza-like illnesses with the oral neuraminidase inhibitor oseltamivir or supportive care alone, report investigators from Cornell University and the New School University.

In Clinical Infectious Diseases for December 1, Drs. Peter A. Muennig and Kamran Khan define influenza-like illness as a fever of at least 37.7 degrees Centigrade along with a cough or sore throat. Supportive care would include rest, hydration, symptom relief and medical care as needed. Oral oseltamivir treatment would require 75 mg b.i.d. for 5 days.

They developed a decision-analysis model that included all healthy individuals between the ages of 15 and 65 years who lived in the US in 1997. The model assumed that no deaths would occur, that 10% of patients with flu-like illnesses would visit a clinician, that 95% of these would be prescribed oseltamivir, and that the risk of hospitalization due to influenza would be reduced by 50% among those taking oseltamivir.

The incidence of flu-like illnesses was the major predictor of cost savings. At more than 24.2 cases per 100 persons, "which is well below rates quoted in the medical literature," the authors write, vaccination would save money compared to providing supportive care alone.

Oseltamivir would be a cost-saving intervention relative to supportive care only if a 5-day course of the drug costs less than $15, Drs. Muennig and Khan calculate. Even if oseltamivir were free, vaccination would save costs overall.

Clin Infect Dis 2001;33:1879-1885.

Common Herbal Remedies Have Uncertain Risk-Benefit Profiles

NEW YORK (Reuters Health) Jan 01 - While many people swear by the benefits of certain herbal therapies, a review of the medical literature provides only incomplete evidence of efficacy, making any risk benefit assessment unreliable, a UK researcher reports in the Annals of Internal Medicine for January 1.

In a review of published studies of ginkgo, St. John's wort, ginseng, Echinacea, saw palmetto and kava, Dr. Edward Ernst from the University of Exeter, found that what clinical trials existed were too short, too small and too few.

Data from these studies showed that ginkgo had some positive effects on dementia and impaired circulation, but is of questionable value for memory loss and tinnitus. St. Johns wort was effective for mild to moderate depression, but adversely interacts with many common drugs, decreasing their effectiveness.

Echinacea may be of benefit in the prevention and treatment of upper respiratory infection, but the data are unconvincing. Saw palmetto did reduce symptoms of benign prostatic hyperplasia in the short-term, and kava appears effective in reducing anxiety in the short-term. Ginseng was of no proven benefit in treating any condition.

While there are books on these remedies, Dr. Ernst finds them for the most part useless. "According to our preliminary evaluation, these books represent more of a risk to the health of the reader than a helpful source of knowledge," he notes.

Dr. Ernst concludes that "dissemination of objective rather than promotional information, stimulation of rigorous research and provision of adequate funds are clearly the way ahead and should be of interest to all parties concerned. Rigorous and systematic evaluation of all herbal medicinal products is urgently needed."

Ann Intern Med 2002;136:42-35

Old Chinese Remedy May Be Useful in Treatment of Asthma

NEW YORK (Reuters Health) Jan 01 - Xiao-qing-long-tang (XQLT), a traditional Chinese medicine used to treat bronchial asthma, appears to reduce bronchoconstriction and eosinophil infiltration of the airway, according to the results of an animal study by Taiwanese researchers.

Dr. Shung-Te Kao, from China Medical College, and colleagues studied the effect of XQLT in ovalbumin-sensitized guinea pigs. Both antigen-induced immediate asthmatic response and late asthmatic response were significantly inhibited by XQLT, Dr. Kao's team found.

Also, XQLT produced relaxation of isolated guinea pig trachea that had been precontracted with carbachol. This effect was reversed by a selective beta-2 antagonist.

When the investigators analyzed bronchoalveolar lavage fluid they found that XQLT significantly suppressed the increase in eosinophils in the airway and slowed the increase of eosinophils for up to 72 hours after antigen challenge, according to their report in the December issue of Allergy.

Dr. Kao and colleagues conclude that "we show for the first time that XQLT is effective against early and late phase airflow obstruction in conscious sensitized guinea pigs...and we associated these changes with the number of eosinophils in bronchoalveolar lavage fluid."

"We suggest that there may be two antiasthmatic mechanisms of XQLT, a bronchodilator effect resulting from its stimulation of beta-2-receptors on bronchial smooth muscles, and an ability to inhibit the eosinophil infiltration into the airway."

Allergy 2001;56:1164-1171.