mans.1 He presents evidence of the destruction of vitamin B12 by large amounts of ascorbic acid (vitamin C),2 hyperbilirubinemia and liver damage produced by large doses of nicotinic acid, liver damage by vitamin Be, and of vitamin Bi and its degradation products possibly destroying vitamin B12. Is this only the beginning? If there were some objective evidence that megavitamin therapy or orthomolecular psychiatry produced beneficial results, one would then use the rule of reason in evaluating the risk-benefit ratio. For the present, we can only conclude that there is no benefit to massive daily doses of the vi¬ tamins and that only one aspect can be evaluated, namely, the risk. Subjective evidence and testimonials do not con¬ stitute adequate evaluation of effectiveness of either a drug or nutritional compound. Thus the cry, "Fight for your freedom to take vitamins," raised by the NHF seems hardly to be in the public interest. We have not touched on the safety of mineral elements, and certainly the margin of safety is far less than for the vitamins. The trace elements—fluorine, chromium, manga¬ nese, iron, cobalt, copper, zinc, selenium, molybdenum, and iodine—are so named because they are required in minute quantities. Because the effects of their deficiency are so devastating and the results of therapy so dramatic, the folk medicine adage of "if a little helps, more will do wonders," could lead many to potentially dangerous ex¬
perimentation.
Philip L. White, ScD AMA Department of Foods and Nutrition
Chicago 1. Herbert V: The rationale of massive-dose vitamin therapy, in Proceedings, Western Hemisphere Nutrition Congress IV. Acton, Mass, Publishing Sciences Group, Inc., to be published. 2. Herbert V, Jacob E: Destruction of vitamin B12 by ascorbic acid. JAMA 230:241-242, 1974.
chronic conditions, was an effort made to detect complications of increased calcium excretion or phosphate depletion ? 4. Were antacids administered along with other drugs with which they would interact? 5. Was there an appropriate indication for the use of an
anticholinergic drug? 6. In patients who received
anticholinergic drug, had (glaucoma, prostatic hypertrophy, gastric retention, or esophageal re¬ flux) ? an
effort been made
to
an
rule out contraindications
7. Was the dose and time of administration of anti-
cholinergics appropriate ? George N.
Aagaard, MD Chairman, Subcommittee on Hospital-Based Education in Therapeutics Seattle
Athlete's Foot
Physicians usually see athlete's foot when it is at a stage characterized by white, soggy, malodorous, itching lesions between the toes. Since it is assumed that the lesions are caused by a fungus, a fungicidal agent is therefore prescribed, to little or no avail. In the current issue of the Archives of Dermatology (111:1004-1010, 1975), Leyden and Kligman explain the reasons for this failure. Pure tinea pedis is a dry, scaling, asymptomatic lesion that will respond readily to an antifungal agent. However, when the feet sweat, as in hyperhydrosis or during the summer, resident bacteria take over and produce the symptomatic form described above. The fungi originally present are suppressed or may entirely disappear for a time. Symptomatic athlete's foot, therefore, is a fungal-bacterial complex, a collaborative
enterprise. Realizing
that wetness is basic to the symptomatic form foot, the authors tested several aluminum comnotable for their astringency and possibly for bacpounds teriostatic or bactericidal action. Aluminum chloride in 30% solution proved to be most effective. Applied twice daily with a cotton-tipped applicator, the solution brought about relief of pruritus and disappearance of malodor with¬ in two or three days. Within a week, all symptoms had greatly abated. It is evident from this experience that aluminum chloride is a satisfactory substitute for the time-tried carbol-fuchsin solution (Castellani paint), which has the disadvantage of its color. When the symptomatic form has been cleared, the asymptomatic form of tinea pedis will remain and can be treated with a fungicidal agent. However, it is likely to recur, perhaps indicating an individual susceptibility to this form of dermatophytosis. of athlete's
Drug Spotlight on Anticholinergics The
DRUG SPOTLIGHT
Antacids and
(p 540)
Since these
is focused
on
antacids and
anticholinergic drugs. commonly agents peptic ulcer disease, our questions will relate primarily to their use in that clinical situation. These questions are offered to hospital pharmacy and therapeutics commitin an effort to suggest one or more points that they tees might wish to review in the study of drug therapy in the are
most
used in
local
hospital.
1. What was the antacid dosage in relationship to meals? 2. Were the buffering capacity and sodium content of the
antacids 3. In
appropriate to the individual patient? patients who had received antacid therapy for
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/22/2015
Hugh H. Hussey, MD
perimentation.
Philip L. White, ScD AMA Department of Foods and Nutrition
Chicago 1. Herbert V: The rationale of massive-dose vitamin therapy, in Proceedings, Western Hemisphere Nutrition Congress IV. Acton, Mass, Publishing Sciences Group, Inc., to be published. 2. Herbert V, Jacob E: Destruction of vitamin B12 by ascorbic acid. JAMA 230:241-242, 1974.
chronic conditions, was an effort made to detect complications of increased calcium excretion or phosphate depletion ? 4. Were antacids administered along with other drugs with which they would interact? 5. Was there an appropriate indication for the use of an
anticholinergic drug? 6. In patients who received
anticholinergic drug, had (glaucoma, prostatic hypertrophy, gastric retention, or esophageal re¬ flux) ? an
effort been made
to
an
rule out contraindications
7. Was the dose and time of administration of anti-
cholinergics appropriate ? George N.
Aagaard, MD Chairman, Subcommittee on Hospital-Based Education in Therapeutics Seattle
Athlete's Foot
Physicians usually see athlete's foot when it is at a stage characterized by white, soggy, malodorous, itching lesions between the toes. Since it is assumed that the lesions are caused by a fungus, a fungicidal agent is therefore prescribed, to little or no avail. In the current issue of the Archives of Dermatology (111:1004-1010, 1975), Leyden and Kligman explain the reasons for this failure. Pure tinea pedis is a dry, scaling, asymptomatic lesion that will respond readily to an antifungal agent. However, when the feet sweat, as in hyperhydrosis or during the summer, resident bacteria take over and produce the symptomatic form described above. The fungi originally present are suppressed or may entirely disappear for a time. Symptomatic athlete's foot, therefore, is a fungal-bacterial complex, a collaborative
enterprise. Realizing
that wetness is basic to the symptomatic form foot, the authors tested several aluminum comnotable for their astringency and possibly for bacpounds teriostatic or bactericidal action. Aluminum chloride in 30% solution proved to be most effective. Applied twice daily with a cotton-tipped applicator, the solution brought about relief of pruritus and disappearance of malodor with¬ in two or three days. Within a week, all symptoms had greatly abated. It is evident from this experience that aluminum chloride is a satisfactory substitute for the time-tried carbol-fuchsin solution (Castellani paint), which has the disadvantage of its color. When the symptomatic form has been cleared, the asymptomatic form of tinea pedis will remain and can be treated with a fungicidal agent. However, it is likely to recur, perhaps indicating an individual susceptibility to this form of dermatophytosis. of athlete's
Drug Spotlight on Anticholinergics The
DRUG SPOTLIGHT
Antacids and
(p 540)
Since these
is focused
on
antacids and
anticholinergic drugs. commonly agents peptic ulcer disease, our questions will relate primarily to their use in that clinical situation. These questions are offered to hospital pharmacy and therapeutics commitin an effort to suggest one or more points that they tees might wish to review in the study of drug therapy in the are
most
used in
local
hospital.
1. What was the antacid dosage in relationship to meals? 2. Were the buffering capacity and sodium content of the
antacids 3. In
appropriate to the individual patient? patients who had received antacid therapy for
Downloaded From: http://jama.jamanetwork.com/ by a Karolinska Institutet University Library User on 05/22/2015
Hugh H. Hussey, MD
