The authors of this study previously reported that epigallocatechin gallate (EGCG), a polyphenol in green tea, induced apoptotic cell death in leukemic B-cells from a majority of patients with chronic lymphocytic leukemia (CLL). After the publication of these findings, many patients with CLL and other low grade lymphomas began using over-the-counter products containing tea polyphenols. Four patients with low grade B-cell malignancies (three with CLL and one with B-cell lymphoma) were seen in the authors' clinical practice who began oral self-treatment with EGCG-containing products and subsequently appeared to have an objective clinical response. Three of the four patients met standard criteria for a partial response. Some of these patients had had steady clinical, laboratory, and/or radiographic evidence of progression prior to taking tea polyphenols and developed objective responses shortly after starting the treatment.

Comment: While the possibility of spontaneous remissions cannot be ruled out, such remissions are rare in patients with low grade B-cell malignancies. Although confirmatory studies are needed before this treatment can be considered proven, there seems to be little risk, and a great deal of potential benefit, from the use of tea polyphenols by patients with low-grade B-cell malignancies.

Shanafelt TD, et al. Clinical effects of oral green tea extracts in four patients with low grade B-cell malignancies. Leuk Res. 2006;30:707-712.

Twenty-five patients with grade 3 neuropathy during paclitaxel or cisplatin therapy, or grade 2 neuropathy persisting for at least 3 months after discontinuing these drugs, received acetyl-L-carnitine at a dose of 1 gram 3 times a day for eight weeks. All patients except one reported symptomatic relief. The sensory neuropathy grade improved in 15 of 25 patients (60%), and motor neuropathy improved in 11 of 14 patients (79%). Total neuropathy score improved in 92% of the patients. Symptomatic improvement persisted in 12 of 13 evaluable patients a median 13 months after acetyl-L-carnitine treatment. Side effects were mild nausea in two patients.

Comment: Certain chemotherapy drugs produce a neuropathy that can be disabling and persistent. Previous studies have shown that acetyl-L-carnitine is beneficial in the treatment of both diabetic neuropathy and the neuropathy induced by antiretroviral drugs such as stavudine, zalcitabine, and didanosine. The results of the present study suggest that acetyl-L-carnitine may also be effective for preventing or treating neuropathy induced by paclitaxel or cisplatin.

Bianchi G, et al. Symptomatic and neurophysiological responses of paclitaxel- or cisplatin-induced neuropathy to oral acetyl-L-carnitine. Eur J Cancer. 2005;41:1746-1750.

A survey was conducted to evaluate whether the prescribing of antibiotics influences the duration of doctors' visits for children presenting with colds or bronchitis. The mean duration of visits during which antibiotics were prescribed was 14.24 minutes, as compared with 14.18 minutes for visits during which antibiotics were not prescribed. Previous studies have shown that patient satisfaction and the likelihood of switching physicians are not affected by the receipt of an antibiotic.

Comment: The reason this study was performed is that many physicians fear that if they do not prescribe antibiotics their patients will go to other doctors or they will have to spend time explaining to patients why the antibiotic is unnecessary. While the results of the new study should allay such fears, the fact that these fears exist at all is disturbing. Are there doctors who would prescribe an antibiotic that is not indicated and that costs money and that might cause adverse effects and that might promote the development of resistant organisms, just because they don't want to spend time explaining why the drug is not necessary? Would some doctors rather practice bad medicine than risk losing their patients to other doctors? It has always seemed to me that doctors who look out for the welfare of their patients and respect their intelligence and judgment will have satisfied patients, regardless of whether or not the doctor agrees with the patients' preconceived notions about what treatments are appropriate.

Coco A, et al. Relation of time spent in an encounter with the use of antibiotics in pediatric office visits for viral respiratory infections. Arch Pediatr Adolesc Med. 2005;159:1145-1149.

Pregnant guinea pigs were treated with gentamicin (100 mg/kg/day intraperitoneally for seven days), with or without the addition of L-carnitine (1 mg/ml in drinking water, equivalent to approximately 100 mg/kg/day). L-carnitine was started two weeks before or simultaneously with gentamicin. Supplementation with L-carnitine at either time completely prevented gentamicin-induced hearing loss in both the mothers and the offspring.

Comment: Gentamicin-induced ototoxicity results from apoptosis of auditory and vestibular sensory cells and is irreversible. An increasing number of pregnant women are being treated with gentamicin during the perinatal period, and their offspring are therefore being exposed to this drug in utero. The results of the present study suggest that treatment with L-carnitine can prevent gentamicin-induced ototoxicity. A previous study in guinea pigs found that vitamin B12 also reduced the ototoxic effect of gentamicin (Acta Otolaryngol. 2001;121:351-354).

Kalinec GM, et al. Pivotal role of Harakiri in the induction and prevention of gentamicin-induced hearing loss. Proc Natl Acad Sci. 2005;102:16019-16024.

Sixty men with high-grade prostate intraepithelial neoplasia (the main pre-malignant lesion that leads to prostate cancer) were randomly assigned to receive, in double-blind fashion, 600 mg/day of green tea catechins (a type of polyphenols) or placebo for one year. After one year, prostate cancer had developed in 3.3% of the patients in the active-treatment group and in 30% of those in the placebo group (p < 0.01).

Comment: These results suggest that supplementing with green tea polyphenols can prevent the progression of high-grade prostate intraepithelial neoplasia to prostate cancer. The results of this study and of the study cited above are consistent with are large body of animal research and in vitro data that demonstrated an anticancer effect of green tea. While green tea and black tea are both derived from the same plant leaves (Camellia sinensis), the former contains a higher concentration of the polyphenols that are believed to inhibit cancer development. Other research suggests that green tea consumption can help prevent cardiovascular disease and dental caries.

Bettuzzi S, et al. Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from a one-year proof-of-principle study. Cancer Res. 2006;66:1234-1240.

A potential interaction between beta-carotene intake and smoking on the risk of tobacco-related cancers was investigated in 59,910 women participating in the French Etude Epidemiologique de Femmes de la Mutuelle Generale de l'Education Nationale. After a median follow-up period of 7.4 years, 700 women had developed cancers known to be associated with smoking (e.g., lung, head and neck, urinary tract, digestive tract, cervix, thyroid, and ovary). Among women who had never smoked, there was a significant inverse association between beta-carotene intake from both diet and supplements and the risk of all smoking-related cancers (p for trend = 0.03). Supplement users had a 56% lower risk of developing such cancers, compared with women in the lowest tertile of beta-carotene intake.

In contrast, among women who had ever smoked (including current and former smokers), increasing beta-carotene intake was associated with an increase in the incidence of smoking-related cancers (p for trend = 0.09). Smokers who took beta-carotene supplements had more than twice the risk of such cancers as did women in the lowest tertile of beta-carotene intake (hazard ratio = 2.14; 95% confidence interval, 1.16-3.97). Tests for interaction between beta-carotene intake and smoking were statistically significant (p for trend < 0.02).

Comment: Previous randomized controlled trials have shown that supplementation with synthetic beta-carotene (which differs somewhat from naturally occurring beta-carotene) increased the incidence of lung cancer in smokers. The results of the present study are consistent with those clinical trials, but also suggest that beta-carotene supplements reduce the risk of certain cancers in nonsmokers. It is possible that chemicals in cigarette smoke react with beta-carotene, causing the formation of compounds that have deleterious effects on human health. Such a toxic interaction has previously been demonstrated between beta-carotene and alcohol: supplementation with beta-carotene increased the severity of ethanol-induced liver disease in rats.

In most cases, the best way to consume beta-carotene is by eating fruits and vegetables, which contain a wide array of different carotenoids. Supplementation with beta-carotene by itself might deplete other carotenoids that have health benefits. There are a few instances in which beta-carotene supplementation is indicated, such as for the treatment of erythropoietic protoporphyria and oral leukoplakia. Beta-carotene supplements may also help prevent sunburn and slow the progression of HIV disease.

Touvier M, et al. Dual association of beta-carotene with risk of tobacco-related cancers in a cohort of French women. J Natl Cancer Inst. 2005;97:1338-1344.

Twenty-three children (aged 3-11 years) living in Seattle, WA, consumed a diet for five days in which most of their usual foods were substituted with organic food. Urine samples were collected twice a day. The median urinary concentrations of the specific metabolites for the organophosphorus pesticides malathion and chlorpyrifos decreased to undetectable levels immediately after the introduction of organic diets and remained undetectable until the normal diets were reintroduced. The median concentrations for other organophosphorus pesticide metabolites were also lower during consumption of organic foods; however, the detection of those metabolites was not frequent enough to show statistical significance.

Comment: Some people have argued that organic foods provide little advantage over pesticide-sprayed foods, because of the drift of pesticides from non-organic to organic farms through the air and water. They point out that traces of pesticides can be found even in remote areas far from civilization. However, the results of the present study strongly suggest that there is a major difference in the amount of pesticides present in organic and non-organic food. Consumption of an organic-foods diet appears to result in rapid clearance of recently consumed pesticides from the blood. Long-term use of such a diet would also presumably aid in the gradual removal of pesticides stored in organs and adipose tissue. While the debate continues about the safety of these neurotoxins in the human diet, more and more people are "just saying no" to pesticides, as evidenced by the fact that organic foods are now being sold at WalMart.

Lu C, Toepel K, Irish R, Fenske RA, Barr DB, Bravo R. Organic diets significantly lower children's dietary exposure to organophosphorus pesticides. Environ Health Perspect. 2006;114:260-263.

Sixty pregnant women with preterm premature rupture of membranes at 26 to 34 weeks' gestation were randomly assigned to receive, in double-blind fashion, 1) 500 mg/day of vitamin C and 400 IU/day of vitamin E or 2) placebo until delivery. All women received two doses of betamethasone in the first 24 hours after admission as well as broad-spectrum antibiotic prophylaxis. The mean time before delivery was 10.5 days in the active-treatment group and 3.5 days in the placebo group (p = 0.03).

Comment: These results indicate that supplementation with vitamins C and E after preterm premature rupture of membranes resulted in a longer latency before delivery. The additional week of gestation afforded by the administration of these vitamins would allow for better development of the lungs and other vital tissues, and could mean the difference between a positive and negative birth outcome. In a previous study, supplementation with 100 mg/day of vitamin C, beginning in the 20th week of gestation, reduced the incidence of premature rupture of membranes by 74% among women with borderline-low dietary vitamin C intake (approximately 60 mg/day).

Borna S, e al. Vitamins C and E in the latency period in women with preterm premature rupture of membranes. Int J Gynaecol Obstet. 2005;90:16-20.