Dear Dr. Roach: I read in your column recently that you suggested saw palmetto to a male reader who was having difficulty with his blood pressure dropping due to medications prescribed for his enlarged prostate. That was causing frequent trips to the bathroom and a weak urine stream. I have read a number of articles, both pro and con, about the effectiveness of saw palmetto for enlarged prostate. Further, there is the question of the consistency of over-the-counter supplements and whether they actually contain the ingredients in the amounts listed. Could you please offer some insight as to the effectiveness of saw palmetto for enlarged prostate, either from experience with patients or from actual research? Also, is there any good way to determine which brands of supplements are more likely to contain the ingredients as labeled?
Dear A.R.: I believe I noted that the studies were conflicting; some studies show a benefit over placebo, but others — including a National Institutes of Health-funded study (not drug company-funded) and one from a respected group (the Cochrane collaborative), which was an evaluation of multiple studies — showed no benefit over placebo.
As you note, there is a high degree of variability of the active ingredients in saw palmetto from one brand to another. I am very cautious about recommending a particular brand. A 2004 study from UCLA showed tremendous variation between brands (which were not disclosed). A 2011 study in JAMA used a German product, but the study showed no benefit over placebo. A 2006 study in the New England Journal of Medicine used a proprietary blend, which also showed no benefit over placebo. Despite my best efforts, I cannot recommend any particular brand that is available in North America.
Dear Dr. Roach: My daughter is in a college where there is an outbreak of mumps. She was vaccinated as a small child. The school is offering a free booster. Is it necessary to get this?
Dear D.L.G.: Outbreaks of mumps happen periodically, even in highly vaccinated populations. The vaccine is thought to be about 95 percent effective. In a 2009-2010 outbreak, the attack rate was 4.9 percent among students. The students were offered a booster vaccine, which 80 percent received. Following vaccination, the attack rate was 0.13 percent, suggesting that the booster vaccine was effective.
Mumps can have serious side effects. In males, the virus can cause inflammation of the testicles, rarely causing sterility. It also rarely causes inflammation of the brain, leading to death or permanent disability in a few. Although most people have only fever and swollen salivary glands, it requires staying home for two to four weeks in addition to the risk of complications. Since the risk of a booster MMR vaccine (there is not a mumps-only vaccine available) is negligible, I would recommend getting the booster vaccine during an outbreak in an environment where people live close together, such as a college. However, the vaccine should not be given to pregnant women, immunosuppressed people or those with active cancer.
Email questions to ToYourGoodHealth@med.cornell.edu.