Should I go to one of these new "retail health clinics" in shopping malls and drug stores?
Yes, if you're positive that you have a relatively minor problem - such as a sore throat, ear ache or bladder infection.
You should also follow some common sense guidelines from physician groups such as the American Medical Association (ama-assn.org), the American Academy of Family Physicians (aafp.org) and the American Geriatrics Society (www.americangeri atrics.org).
These little clinics are springing up all over, with names such as Take Care Health Centers, MinuteClinic, RediClinic, MiniMedCare and the like. They offer quick diagnoses and treatment for simple problems and often have ties to nearby drug stores. They're typically staffed by nurse practitioners.
Some clinics can do simple blood tests, but they usually do not have X-ray machines. Do NOT use one of these clinics if you have new major symptoms such as chest pain, shortness of breath or leg swelling (a possible sign of a blood clot in the leg or heart failure), or if there's a change in a long-standing medical problem for which you're already seeing a regular doctor.
"Retail clinics are probably a good option for certain types of health care problems," said Dr. Jane Potter, president of the American Geriatrics Society. "But this is not a substitute, for people with chronic health conditions, for seeing a doctor.
Dr. Lawrence Earl, president of MiniMedCare, a convenience care provider based in Chester, N.J., which will open its first clinic this spring, said services are limited to minor problems such as bladder infections, ear aches and sore throats.
"Pharmacies create the hosts," he said. "We need only a small space, and typical retail spaces available are too large," he said. Some retail health shops take insurance and some don't, with typical visits costing $50 to $60.
An article last week in the New England Journal of Medicine wrote of the potential benefits of retail health shops, including the observation that many patients seem able to diagnose the simple kind of problems that the clinics are designed to treat. Some doctors, however, worry about the lack of follow-up and the potential competition with their own practices.
My take on this? If you are extremely sure that all you have is a sore throat or bladder infection and have few serious health problems, try a retail health shop. But if you have any doubts about what ails you or if you have a complicated medical situation, see a regular doctor.
Does the herbal product black cohosh alleviate hot flashes in menopausal women?
No, unfortunately for millions of women seeking alternatives to hormone replacement therapy.
In a study published in December in the Annals of Internal Medicine, researchers from Washington state concluded that black cohosh does not work for menopausal symptoms such as hot flashes. The only thing that did, as has been shown repeatedly, was estrogen, either alone or with another hormone called progestin.
In the randomized, double-blind clinical trial, epidemiologist Katherine M. Newton, associate director for external research at Group Health, a large, integrated health plan headquartered in Seattle, assigned 351 women to one of five groups.
One group got a placebo, or dummy medication. One group got hormone replacement therapy. The other three groups got either black cohosh alone, black cohosh in combination with other herbs, or the combination plus phone counseling to increase consumption of soy products. (Studies are mixed on whether soy effectively combats hot flashes.)
Decreases in hot flashes were no different between the placebo and black cohosh groups, said Newton. Black cohosh, she said, "had no promise for relieving" these symptoms in menopausal women.
That's no surprise, said Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston and author of the book Hot Flashes, Hormones and Your Health.
"When subjected to rigorous testing in clinical trials, black cohosh and other botanicals have been disappointing for hot flashes," she said. "What's more, even though black cohosh is 'natural' and seems to be safe, it has actually been linked to liver damage. Estrogen does have risks, but it is well-established as the most effective treatment available for hot flashes."
For women with bad hot flashes that disrupt their quality of life, it's back to trying to balance the benefits of hormone therapy (symptom management, bone protection) against the risks (including a slightly higher risk of breast cancer, blood clots and stroke). Use the lowest dose possible for the shortest possible amount of time.
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