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1 January 2002 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

ACP-ASIM: Pharmacists Not Qualified to Initiate Drug Therapy

(See news release on new ACP-ASIM position paper.)

Six Popular Herbal Therapies Have Mixed Risk-Benefit Profiles

A review of published data on the effectiveness and safety of six herbal therapies finds:

Accurate assessment is difficult, the author says, because existing clinical trials are "too few, too small, and too short"; lack of standardization and quality control make it hard to know what the herbal products contain or if they are free of contamination, and a plethora of books on herbal medicines "represent more of a risk to the health of the reader than a helpful source of knowledge." The author identifies and ranks some newer books on herbal medicines. Although the growing popularity of herbal medicines probably reflects the public perception that they have no negative side effects, the author stresses that all herbal products have some risks (Academia and Clinic, p. 42).

Steroids Lessened Arthritis Symptoms but Increased Risk for Bone Fractures

Prednisone, a glucocorticoid, reduced swelling and progression of damage to joints for up to six months in patients with early active rheumatoid arthritis, according to a recent study (Article, p. 1). Prednisone is not often used today as a long-term treatment for arthritis because of its severe side effects. In this study, a daily pill with 10 milligrams of prednisone was compared to a placebo, or dummy pill. Prednisone was not used in combination with the newer disease-modifying antirheumatic drugs (DMARDs) that are known to reduce symptoms and the risk of permanent joint damage. Prednisone causes osteoporosis. Thus, of the 41 patients who took prednisone, five experienced a fracture of the body of one of the vertebrae in their spine, compared to two patients who received the placebo. Authors conclude that prednisone may be useful to treat arthritis when combined with DMARDs. An editorial praises the authors of the study for re-evaluating an 'old' therapy and showing that it may have found a new application (Editorial, p. 76). But the editorial writer cautions that the 10 milligram dose, called a low dose in the study, may still be higher than necessary to achieve the desired results.

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