At the peak of its popularity, the viewpoint of some was that Prozac (fluoxetine) could make well people feel “better than well”. This was a concept that not many people could resist. Mark Epstein, a psychiatrist, was drawn to the promise of the drug. His report was as follows.

“One evening, I decided to try a little myself. I was well, but I could be better, I wanted to be. I soon noticed my stomach becoming queasy and a quickening of my pulse. Maybe this was the price I would have to pay, I thought. But that night, I did not sleep. I struggled through the next day feeling worse than ever and resolved to put the Prozac away. Better to leave well enough alone.”

He concludes that the selective serotonin-reuptake inhibitors are interesting drugs, but their muting of sexuality, their tendency to produce agitation, and their occasional association with suicidal thoughts and behavior will forever limit their appeal. The vast number of people who take Prozac for common unhappiness will notice nothing but side effects.

So, maybe not better than well.

Tamoxifen has been a marvellous adjuvant treatment for breast cancer over the last 2 decades. But the hot flushes, increased risk for endometrial cancer and its thromboembolic risk have limited its use.

Recently anastrazole (an aromatase inhibitor) has been shown in a large randomised trial (over 9000 postmenopausal women followed for 5 years) to be superior in all respects (longer disease-free survival, longer time to relapse, and reduced distant metastases). And less limiting adverse effects. Good news for patients.

ALLHAT, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, indicated that diuretics were equal or superior to other antihypertensive agents as first-line therapy. However, most patients with hypertension require more than 1 drug class to control hypertension.

But what combination is best? In a recent study involving over 90,000 American women aged between 50 and 79 years, some interesting data has been reported.

After 5.6 years of follow-up, monotherapy with diuretics was superior to monotherapy with other agents in preventing cardiovascular complications. Combination therapy with a calcium channel blocker plus diuretic was associated with a higher risk of cardiovascular mortality than the combination of a β-blocker plus diuretic. Risks were similar for combined therapy with either an angiotensin-converting enzyme inhibitor plus diuretic or a β-blocker plus diuretic.

The first report on silicone breast implants appeared in 1963. In addition to occasionally leaking, they have been the subject of reports associating them with adverse health outcomes, including connective tissue diseases, especially systemic sclerosis, and other autoimmune diseases.

A recent retrospective report compares symptoms in a cohort of women who had silicone implants and a cohort who had non-silicone involved plastic surgery. It appears that both groups included patients with night sweats, lethargy, breast pain, impaired mentation, reflux, paraesthesiae, hand muscle weakness and myalgia.

The symptoms were significantly more common in the silicone cohort. The authors concluded that silicone implant patients were not suffering from “silicone-osis”. Really? The study was funded by Dow Corning (who make silicone implants).

“Water is now everywhere. It has become a modern fashion and health accessory, as ubiquitous as the mobile phone. Students have a bottle in their bags or in front of them during lectures, people are jogging with water, and office workers have a bottle within easy reach of their desk.”

This is from a recent BMJ editorial. The authors go on to point out that sales figures confirm that bottled water is the world’s fastest selling drink. In the United Kingdom, consumers spent ₤1bn (NZ$2.7bn) on bottled water last year, a 70-fold increase from 20 years ago.

In the United States, consumption of bottled water has risen from 2.5bn gallons (9.5bn litres) in 1992 to almost 6bn gallons in 2002. Water is good for you and bottled water is very, very good for its purveyors. The gullibility of the junior members of the human race never ceases to amaze.