Sound Medicine -- January 18, 2003

Hosts Barbara Lewis, Dr. Kathy Miller, & Dr. Ora Pescovitz talk to experts about:

Botanical hormone replacement therapy

Genetics of alcoholism

Drugs for treating alcoholism

Botanical hormone replacement therapy

Natural products such as St. John's wort and echinacea have been on the market for some time now, but not until recently have they been scientifically studied. We talk about current research into "botanicals" with Connie Weaver, PhD, head of foods and nutrition at Purdue University and researcher with the Purdue University and the University of Alabama Botanicals Research Center for Age Related Diseases, an NIH-funded center comprised of six collaborative research groups .

Dr. Weaver hopes to determine whether or not the natural estrogen-like compounds found in plants such as soy or red clover can reduce post-menopausal bone loss without producing negative effects like those that come from taking estrogen supplements long-term.

Weaver also talks about the current craze over botanical supplements and stresses the importance of exercising caution when choosing them. She points out that manufacturers are not motivated to test supplements for effectiveness or quality because they are not regulated like prescription or over-the-counter drugs. She recommends selecting products from larger companies who often have better resources available to them and are more concerned about upholding a reputation.

Resources:

Purdue University's Botanical Center for Age Related Diseases.

Purdue's Department of Horticulture's Guide to Medicinal and Aromatic Plants includes descriptions, databases, and links to botanical companies. (Note: site loads slowly.)

The FDA's Center for Food Safety & Applied Nutrition and the NIH Office of Dietary Supplements provide links to scientific resources, consumer advisories and information on current research.

Check out other NIH-funded Botanical Research Centers.

Genetics of alcoholism

The idea that alcoholism is inherited has long been suspected and past studies have shown a likely genetic link. One recent study looked at two groups of people -- one with a family history of the disease and one without -- to see if they differed in alcohol toleration. The results showed a significant difference. Dr. Sean O'Connor, professor of psychiatry and neurobiology at the Indiana University School of Medicine, discusses his recent research in the area of alcoholism.

Dr. O'Connor describes the many factors of alcoholism that make research a tremendous and time-consuming task. His study found that individuals identified as high risk for alcoholism have a greater, and possibly more pleasurable, initial response to alcohol than those identified as being at low risk. In addition, the results suggested that high-risk individuals adapt more quickly to alcohol, requiring them to drink more to maintain the effect.

Finding genetic causes of alcoholism is only the beginning. In the future, researchers will study individuals with genetic predispositions in different environments and examine interactions between environmental and genetic factors. The outcome may lead to drugs able to halt alcoholism years before a potential alcoholic takes his first sip of beer.

Resources:

Dr. O'Connor refers to several recent studies. Click here to read the abstracts.

Drugs for treating alcoholism

Dr. Thomas McLellan of the University of Pennsylvania's Center for Studies of Addiction developed the "alcoholism severity index," a test given at many alcohol treatment centers. It helps determine the level of someone's alcohol dependence, along with other physical, psychological, or social issues that need addressing. But Dr. McLellan thinks the field of alcohol treatment now needs is its own version of Viagra.

According to Dr. McLellan, to treat alcoholism successfully, anti-alcohol drugs must be similar to Viagra. They should be easy and appealing to take, inexpensive, have few side effects, work effectively, and fit into a patient's lifestyle. Lack of pleasant treatment methods has led society to view alcohol abuse primarily as a law-enforcement issue rather than a medical condition and addiction. Further study is needed to find an effective and appealing treatment for alcoholism, he says.

Dr. McLellan describes differences between drugs currently used to control alcohol intake, including antabuse, naltrexone, and acamprosate. These medications are not effective unless coupled with behavioral changes. He also says that there are different combinations of problems that lead to alcoholism, which implies that there are different paths to effective recovery.

Resources:

Dr. McLellan was recently interviewed for a PBS special about addiction. Read a transcript of the interview.

Read Dr. McLellan's paper, "Dependence as a Chronic Medical Illness." (PDF format)

Read the Naltrexone FAQ from the University of Pennsylvania.

Get more information on antabuse and acamprosate.

Our Genes, Our Choices
This month, WFYI TV 20 presents three timely and provocative programs in a series designed to foster dialogue about the complex implications of advances in human genetics. Find program details and schedules at WFYI.

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When the weather turns cold, make sure your skin takes cover. Which term correctly describes the condition where the skin and the tissue underneath it are frozen?

a. frostnip
b. trench foot
c. frostbite
d. hypothermia

Find out!

Medical mystery — Got those black circles?

We call them shiners, bags or dark circles, and we usually blame it on fatigue when they appear under our eyes. But fatigue isn't the culprit. What's really the cause for these annoying under-eye blemishes?

Find out!

Glaucoma is a group of diseases that causes damage to the optic nerve, eventually leading to irreversible blindness. A common misconception is that glaucoma is caused by fluid buildup that will eventually cause pain. However, in many cases, there are no symptoms until serious damage occurs, making fluid buildup only a risk indicator for, rather than a cause of, glaucoma. In fact, of the nearly 3 million Americans who have glaucoma, only about half actually know that they have it. The best form of prevention is early detection through regular eye exams. Although there is no cure for glaucoma, medication or surgery can successfully prevent loss of vision.

You are at higher risk for developing glaucoma if you:

• are over 60 years old and Caucasian
• are over 40 years old and African-American
• have a family history of glaucoma
• are near-sighted or far-sighted; these conditions put you at higher risk for developing either open-angle or closed angle glaucoma, respectively
• have diabetes or a family history of diabetes
• have injured your eye in the past

Sources: Glaucoma Research Foundation and WebMD