Dial-a-Doc is getting to be the American way, it would appear. We're not talking here about the kind of doc that tells you to take two aspirins and call him in the morning.
Now that the word's getting around about the insatiable curiosity about all things health-oriented, more and more medical organizations and sign-interest associations are getting their acts on tape. Some of these telephone medpals do nothing but speak a little piece for a minute or two, and then click off. Other provide real-live specialist at the other end of their hot lines.
Here's what's up on the tele-heath front:
CounselLine -- A mental-health spinoff from the people who brought you Tel Med -- is a new series of tapes on topics ranging from rage to non-assertiveness to death, dying and divorce. Developed at the University of Texas, CounselLine's tape library is marketed (as is Tel Med) by Teltronix, Inc. The folks there stopped counting Tel Med calls after 50 million or so in more than 200 cities.
The Washington, D.C., area will beamong the first half-dozen cities to institute CounselLine, a joint project of the D.C. Mental Health Association and the Psychiatric Institute. It is scheduled to begin operation Nov. 27, when its CoucilLine number will be listed.
Cancer Information Service -- Maintains a national, toll-free number (800-638-6694), which plugs the caller through to live, trained personnel who can answer questions for cancer patients and their families. And can refer them to cancer-information service in their own areas (17 states have comprehensive cancer centers). The national line is open seven days a week from 8 a.m. to midnight.
The theory behind this partially tax-supported system is simple: When patients hear a doctor say "cancer," they often freeze into a kind of protective shock, and as a result, absorb nothing else the doctor says. Later on when the shock lifts, they'll remember all the questions they forgot to ask. These operators will help them find answers.
Gutline -- A pilot demonstration project of the American Digestive Disease Society, about to be instituted in the Washington area. If it proves successful, it will be expanded to other cities. Under this program, a rotating team of volunteer gastroenterologists will be on tap two nights a week, from 7:30 to 9 p.m. The physicians will answer telephoned questions from people suffering from one or another of the 100 conditions that fall into the category of digestive disease. As society spokeman Mimi Ratner puts it, "anything that has to do with eating, swallowing, digesting and metabolizing food -- and eliminating wastes."
Ratner notes that one out of nine people in this country has a serious digestive disease and almost half will have episodes serious enough to consult a doctor. The Gutline has been established so that people with a problem or question -- the line will not deal with crisis situations -- can talk with a physician in a relaxed, leisurely way, and be referred to an appropriate specialist if necessary. Gutline will begin at 7:30 p.m. Nov. 27 at 652-5524. (Area code 301 for those outside the metro area.) Further information may be obtained from the Society, 7720 Wisconsin Ave., Suite 217, Bethesda, Md. 20014.
"Dysmenorrhea," Dr. Barbara Korberly, professor of clinical pharmacy at the Philadelphia College of Pharmacy and Science, was saying, "is to menstrual cramps what migraine is to headache."
The equation, as anyone who has been rendered non-functional by one or the other will tell you, is apt.
So recent studies showing that disabling menstrual cramps can be eliminated or greatly eased by some drugs used for other ailments for years, ought to have been ranked as one of the great medical advances of the decade.
They weren't, and one of the reasons why, says Dr. Penny Wise Budoff, a family practitioner in Woodbury, N.Y., is the failure of drug companies to update some old studies which had left a largely unjustified impression of the drugs' dangers and side effects.
Dr. Korberly, along with others, has expressed concern, especially about the use of mefenamic acid for dysmenorrhea. As the commercial drug Ponstel, mefenamic acid was the substance that offered significant relief from dysmenorrhea -- even that induced by IUD's -- for most of the subjects in Dr. Budoff's pioneering studies.
The drugs, like mefenamic acid, were designed for arthritis pain relief.
As it turns out, they are powerful inhibitors of natural substances in the body called prostaglandins. It has been theorized for some time that overproduction of prostaglandins caused some disabling mentrual cramps where no other physical problems (like endometriosis or uterine adhesions or fibroid tumors) existed. But no one in this country matched the drug to the disorder until Dr. Budoff stumbled upon some small studies in other countries, as Healthtalk has recounted.
The Medical Letter -- a highly respected, independent publication on drugs, which back in 1972 "emphasized the impressively large list of adverse effects . . ." of mefenamic acid, and suggested it probably shouldn't be used for anything -- has now described several new studies using it and similar drugs to relieve dysmenorrhea. It concludes they they "may prove to be more effective than aspirin for treatment of severe dysmenorrhea, but larger comparative trials than those published so far are needed to prove the point."
In addition to Dr. Budoff's experience -- she uses it, as do 300 of her patients, she says, with a minimum of reaction -- she has found studies which indicate that the drug's bad name is probably undeserved.
According to the world-respected Committee on the Safety of Medicine in the United Kingdom, of the Register of Diverse Reactions from the UK, the number of adverse reactions per million of prescriptions worked out to 36 for Ponstel, 50.9 for Motrin (a similar drug) and (for comparison) 12 for aspirin. Moreover, these figures are primarily based on use by arthritis victims who may take as many as 4 to 6 capsules a day. For dysmenorrhea, the use would be more like 4 to 6 capsules a month.
Mefenamic acid is available in Japan, without prescription, and 400 million capsules are sold there each year -- with no reports of adverse reactions.
Nevertheless, Budoff emphasizes that Ponstel or Mortin should be administered only after the menstrual period actually starts: First, to minimize the amount of the drug taken, but principally to "avoid any inadvertent use during pregnancy" as long as the effect of the drug on a fetus is not known.