An old man lived alone in the country. He wanted to dig his potato garden but it was very hard as the ground was hard. His only son Fred, who used to help him, was in prison. The old man wrote a letter to his son and described his predicament.

Dear Fred, I am feeling pretty bad because it looks like I won't be able to plant my potato garden this year. I'm just getting too old to be digging up a garden plot. If you were here, all my troubles would be over. I know you would dig the plot for me. Love, Dad

A few days later he received a letter from his son.

Dear Dad, For heaven's sake, don't dig up that garden! That's where I buried the BODIES. Love, Fred

At 4:00 a.m. the next morning, FBI agents and local police arrived and dug up the entire area without finding any bodies. They apologized to the old man and left. The same day the old man received another letter from his son.

Dear Dad, Go ahead and plant the potatoes now. That's the best I could do under the circumstances. Love, Fred

The season of head lice is upon us especially in elementary school children. A recent review in the Medical Letter for drugs used in its treatment makes several salient points. Over the counter Permethrin 1% rinse (Nix and others) has residual activity for two weeks. It's also available in a 5% cream (Elimite, Acticin, and others) is FDA approved as a total body application in children over two months old and it requires a prescription. Resistance has been a problem with these products. For treatment failures they recommend Malathion an organophosphate which is the fastest killing and most ovicidal pediculicide marketed. It is available in a 0.5% lotion for human use. It has an objectionable odor and there has been some fear of flammability due to its alcohol vehicle. It is contraindicated in infants. It is expensive at $117.00 for a 2 fluid ounce bottle. Ivermectin, an FDA approved treatment for stronguloidiasis has also been used in head lice when all other therapies have failed and the Medical Letter recommends it may be worth trying. (The Medical Letter, Vol. 47, Issue 1215/1216, August 2005)

The season of the common cold is upon us and many remedies over the counter are used but unproven. Echinacea is perhaps one of the most popular herbal drugs. A recent trial supported by the NIH Center for Complimentary and Alternative Medicine provides compelling evidence that this medication does not prevent or alleviate symptoms of the common cold. A total of 437 healthy volunteers received nasal inoculations of rhinovirus and were randomized to seven groups. Three of the groups received active Echinacea one week before the virus challenge. Three groups started on the day of the virus challenge and one group received placebo. No significant differences were observed between the Echinacea and placebo groups in the incidence of serologically proven rhinovirus infection and the incidence of colds which was about 60% in each group. An accompanying editorial suggests that NIH could spend their money on more meaningful research. (Journal Watch, Vol. 25, Issue 17, September 2005)

DTCA is much in the news lately. There is abundant literature on this subject both pro and con. $3.2-billion dollars per year is spent with this type of advertising and not surprisingly retail sales of the drugs most heavily advertised to consumers increased an aggregate 32% from 1999 to 2000. More than 80% of physicians believe that DTCA does not provide balanced information and it encourages patients to seek treatments they do not need. Fewer than 10% of physicians consider DTCA a positive trend in healthcare. Senate Majority Leader Bill Frist, M.D. has asked pharmaceutical companies to voluntarily adopt a two-year waiting period before advertising new brand name drugs directly to consumers. A recent innovative randomized trial using trained actors as patients made 298 unannounced visits to 152 primary care physicians over several months. They portrayed people with adjustment disorders or major depressive disorder. They were trained to ask for a specific antidepressant Paroxatine (Paxil) which was being advertised heavily on television. Of a hundred standardized patients making brand specific requests for Paroxatine, 32 received it. Of 99 standardized patients making general requests only 6% received Paroxatine. When the condition was less severe with less clear indication for drug treatment i.e. adjustment disorder, physicians were more likely to prescribe an antidepressant in response to the brand name request rather than a general request. We will be hearing more on this subject now that Medicare will be paying for prescription drugs and anything which increases the cost of these drugs will likely come under scrutiny from the government. (American Medical News, July 2005 - JAMA, Vol. 293, No. 16, April 2005

John J. Mohr, M.D.