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^Epidurals
don't result
in more
C-sections
By MARTHA RVINE
THE AMOClAreP PRESS
> . CHICAGO - Epidurals - a
'type of anesthesia administered
. through the spine during child
birth - do not greatly increase
.'the rate of Cesarean deliveries
*a$ previously suspected,
) researchers say.
vt An analysis of 10 clinical tri
'als, published in last Wednes
day's Journal of the American
'Medical Association, also found
^-epidurals were more effective
?pain relievers and had less
- impact on the health of new
borns than narcotic injections.
Dr. Stephen Halpern, coau
thor of the report, said he hopes
.lifce findings will put to rest
itQme concerns about the use of
'.-epidurals and the stigma some
{somen feel in asking for them.
>?- "Basically, if a woman needs
pain relief, she should feel free
to ask for it," said Halpern,
director of obstetrical anesthe
sia at Women's College Hospital
in Toronto and an associate
professor at the University of
Toronto.
? The clinical trials, conducted
in Europe, the United States
a'nd Canada, included a total of
2,369 patients. Of the 1,183 who
received epidurals, 97 women,
or 8.2 percent, had babies deliv
ered by Cesarean section./ Of
the 1,186 who received narcotic
pain injections, 67 women, or
5.6 percent, had C-sections.
Halpern said he and his col
leagues found epidurals are not
the cause of C-sections. Rather,
they are often used because
complicated deliveries that end
in C-sections are among the
. most painful, he said.
; Scott McGlothlen, a certi
- fied nurse anesthetist in Denver,
'said he and his colleagues at St.
'. Luke's Presbyterian Medical
: Center have actually found that
; epidurals decrease the number
?of C-sections.
"* "Some patients just can't
quite get over that hump
because of that pain and an
epidural can help them do that,'
said McGlothlen, a spokesman
for the American Association of
Nurse Anesthetists.
Women in the studies who
received epidurals also reported
less pain, although their labors
also were longer and they expe
rienced side effects such as
fevers more often. Newborns
whose mothers had epidurals
also were born less often with
acidosis, a disturbance of the
body's acid-base balance that
can cause breathing problems
and diarrhea.
McGlothlen said these find
ings reinforce what he'sknown
I for a lpng time.
"The beauty of this article ...
is that it points out that certain
ly there are a number of mecha
nisms for pain control for
women in labor," he said. "All of
'these things need to be made
readable to patients."
?% Either way, MargaretAnn
^Eross, a mother of two from
[;faertztown, Pa., says she's likely
?To go without an epidural or
other pain-relieving medica
tions in the future - just as she
did five months ago when she
had her second daughter in a
hot tub with the help of mid
wives.
?
; She said she had an epidural
; during the birth of her 4-year
old daughter and ended up with
a medication-related headache
' for two weeks.
"It was awful," Cross said.
"It was the worst time to be
bedridden, when you're a new
imom. Even though they say the
chances of that happening are
.~small, I wouldn't chance it
^taain."
? * ?
.a. ? ,
\
Equal access?
On Net, no doctor needed for powerful drugs
By LAURAN NEERGAARD
THE ASSOCIATED PRESS
WASHINGTON - With a
few computer keystrokes - and
without ever seeing a doctor -
Americans can buy powerful
prescription drugs including
some not approved for sale in
this country.
Supporters say consumers
are savvy enough to buy medi
cines over the Internet. But
health experts fear the growing
trend could endanger, even kill,
patients. Several states are
investigating Web sites, and the
Drug Enforcement Administra
tion has raided at least one
Internet doctor as the govern
ment struggles with how to con
trol drugs in cyberspace both
here and abroad.
"Consumers are taking a
huge risk. ... They may be risk
ing their lives," warns William
Hubbard of the Food and Drug
Administration. "We're very
concerned about this."
Yet some state regulators say
they've never heard of the myr
iad Web sites that post such ads
as: "Need Viagra? No prescrip
tion? No problem!"
How easy are such purchas
es? An Associated Press
reporter bought from a British
Web site a controversial diet
drug that the U.S. government
has not yet decided is safe. The
unmarked brown envelope
bearing a month's supply of
Xenical cleared U.S. Customs.
The unseen British pharmacist
had no way to know the
reporter had exaggerated her
weight by 30 pounds to qualify
for the drug.
A Viagra site promised to
ship the little blue impotence
pill after an AP reporter
answered just one health ques
tion _ and disclosed she was a
woman.
"That's very, very danger
ous," said consumer advocate
Dr. Sidney Wolfe of Public Cit
izen, saying both were drugs for
which the "patient" did not
medically qualify.
"There is a reason that some
of these drugs have to be pre
scribed," added Larry Lessly,
director of Nevada's Board of
Medical Examiners, which
recently barred over-the-Inter
net sales unless Nevada doctors
also see the patients. "People
shouldn't just willy-nilly take
them."
Colorado publicly repri
manded one doctor for selling
Viagra over the Internet; Con
necticut, Wyoming and Nevada
ordered one Web site to stop
selling in those states, and at
least eight other states are
investigating complaints.
North Carolina is probing
Web sales of a computer pro
gram that teaches patients to
diagnose their own problems
and then pick a medication
from foreign Web sites.
"Get self-prescribed medica
tions without a doctor's pre
scription" including "experi
mental ... or unapproved drugs
not yet available m the U.S.,"
the site promises. Patient testi
monials declare success at buy
ing controlled substances such
as narcotic painkillers.
"It's a do-it-yourself doc-in
a-bos," complained Dave Work
of North Carolina's Board of
Pharmacy* . .
The government determines
which drugs need prescriptions
- because they're for serious
medical problems and can
cause serious side effects.
Yet U.S. Web sites tout: Via
gra, highly risky for certain
men; Valtrex, which treats geni
tal herpes but can kill patients
with weak immune systems;
Meridia, a diet drug that
requires doctor monitoring
because it can raise blood pres
sure, and the diet drug phenter
mine, a controlled substance
considered too dangerous for
whole groups. "> ^
Spotted on foreign sites:
stimulants, tranquilizers, anti
depressants, antibiotics and
drugs for epilepsy, dementia,
diabetes and hypertension.
The Internet is making huge
inroads in medicine, as doctors
e-mail patients, online pharma
cies mail refills and patients
turn to medical journals now
available 24 hours a day.
But it also has opened a
Pandora's box; Almost anyone
can set up shop as an expert.
"'I'm not a doctor, but I'm
playing one on the Internet' is
probably our worst nightmare,"
said Mark Herr of New Jersey's
Division of Consumer Affairs.
Foreign drug sellers who
don't need prescriptions in their
own country can target Ameri
cans. And U.S. doctors and
pharmacists, too, are selling to
unseen Internet users across the
country.
It is illegal for doctors to
prescribe for patients in a state
where they're not licensed to
practice. Licensed doctors also
must meet standards of care
that in most states require a
patient relationship to prescribe
drugs. But the rules were writ
ten before the Internet, so states
aren't sure how to apply them in
cyberspace and how to police
ever-changing Web sites.
"It is a huge problem. We
just don't have the resources to
deal with all of them," said
Mark Stafford of the Kansas
Board of Healing Arts, which
last month sued two Web sites
to stop Internet Viagra sales in
Kansas.
On the other side is veteran
pharmacist William Stal
iknecht, who runs a popular
Web site from his Pill Box Phar
macy in San Antonio, Texas. He
iays patients should be free to
choose certain drugs without
the hassle or embarrassment of
in-person doctor visits.
"Patients have rights," said
Stallknecht, who sells Viagra,
the anti-baldness pill Propecia
and the antihistamine Claritin
over the Internet. "We take the
care necessary" by requiring
online health questionnaires
reviewed by staff doctors.
Stallknecht says he ships 30
to 40 Viagra Internet orders a
day and his doctors reject about
10 percent of applicants for
health risks.
But critics say online ques
tionnaires can't substitute for a
doctor's exam. Asks consumer
advocate Wolfe: How many
men refused Viagra by local
doctors turn to the Wbeb? How
many women wanting to lose a
quick five pounds exaggerate
their weight to buy a diet drug?
"The question we have is
whether ... you can believe what
a patient says in a question
naire," said Steven Davis,
Utah's chief licensing investiga
tor.
Photo illustration by Steven Moon
Tha food and Drug Administration It concomod with thm availabili
ty of proscription and iliogal drugs to consumart la tho Intornat.
?
Americans in country not exercising
f *
By RUSS BYNUM
THE ASSOCIATED PRESS
/
' ATLANTA - Americans in
rural areas spend even less of their
leisure time exercising than people
in metropolitan areas, the govern
nfcnt reported Wednesday. <
Nearly a third of Americans
may go at least a month without
exercise, according to a 1996 sur
vey by the Centers for Disease
Control and Prevention.
The nearly 119,000 people sur
?
veyed were asked if they had exer
cised outside work in the preced
ing month. Exercise was defined
as running, golfing, walking or
gardening. About 30 percent said
they had not exercised - the same
as in 1994.
In rural areas, 37 percent did
not exercise, compared with 27
percent in metropolitan areas.
Although the results make it
appear as if rural America is
slacking ofT, the survey did not
look at how much people sweat at
work. A suburbanite who sits
behind a desk all day might need
to jog more than a farmer tending
his crops.
"We don't want to disappoint
people who live in the country and
call them lazy," said Dr. Helena
Zabina, a CDC epidemiologist.
The study also found that col
lege graduates were apt to be more
active than high school dropouts,
and people who earned more than
$50,000 a year were more likely to
exercise than those who made less
than $10,000.
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