Take this, prevent that
A pill a day could cut your risk of heart disease and cancer, prevent breakouts and breakdowns, even help you avoid a stroke. The medicine of tomorrow has arrived, but should you take it?
By Shari Roan
Photo by Jim Jordan
Photo by Jim Jordan
In contrast, many pills intended for prevention are expensive prescription drugs, but the trip to the pharmacy may be worth the effort and the dollars. For example, Nolvadex (tamoxifen) and Evista (raloxifene) block estrogen receptors in breast-cancer cells and can cut the incidence of breast cancer by up to 48 percent in high-risk women, such as those with a family history of breast cancer or those who carry genetic mutations in the so-called breast-cancer genes (BRCA1 or BRCA2). Tamoxifen has been approved by the FDA for cancer prevention in high-risk women, and the two drugs are now being studied in a head-to-head trial.
Prevention strategies are being tested for cancers of the prostate and colon as well. Researchers recently discovered that Proscar (finasteride), currently prescribed for men with enlarged prostates, reduced prostate cancer in test subjects by nearly 25 percent; yet the patients who did develop prostate cancer seemed to have a more aggressive form of the disease, so it's uncertain as to who will most benefit from the drug's preventive effects. And the FDA has approved the use of Celebrex (celecoxib), a nonsteroidal anti-inflammatory drug commonly used for treating arthritis and pain, to help reduce the risk of colon cancer in men with a genetic disease called familial adenamatous polyposis. Additionally, Celebrex is being examined for its potential effectiveness in reducing the risk of lung cancer in smokers.
no magic medicine
These aren't magic pills, says Patricia Ganz, M.D., director of the division for cancer prevention and control research at Jonsson Cancer Center at the University of California, Los Angeles. "It's not voodoo or black magic. These prevention therapies are based on a real understanding of the biology of that particular disease." It can take 20 years for a wayward cancer cell to grow into a tumor, Ganz notes. Therefore, to prevent disease, doctors are shifting their focus to treating cancers when they're just abnormal cells and not fully developed malignancies. That's when we can use a "targeted drug therapy" to interrupt the disease process, she says. In another example of unanticipated benefits, using oral contraceptives to suppress ovulation may cut the risk of ovarian cancer in half. These drugs can also prevent acne in some women by decreasing levels of certain hormones. In fact, the FDA has approved the use of one contraceptive, Ortho Tricyclen, for acne treatment.
a dose of caution
A "polypill" might very well lower the risk of heart attack tremendously, but some say that the risk of side effects would be felt by up to 15 percent of people taking it. And while the idea of a pill that packs a huge preventive wallop is intriguing, keeping disease at bay isn't so simple. Even the widely used statins can produce muscle aches and, in very rare cases, kidney failure.
Mistakes have been made in the name of prevention. In the 1990s, doctors routinely recommended hormone-replacement therapy for postmenopausal women in order to prevent osteoporosis, heart disease, stroke and dementia. But recent data from the Women's Health Initiative trial showed that hormone therapy raises the risk of heart attack and stroke and doesn't appear helpful for dementia. Other medications can protect bone as well as hormone therapy without the risks involved, the researchers concluded.
HRT wasn't the only strategy that backfired. Beta-carotene, an antioxidant, was thought to prevent cancer, but studies showed that it had no effect and even slightly increased lung-cancer rates in smokers. And women who took two or more regular aspirin per week for 20 years were recently found to have an increased risk of pancreatic cancer.
These incidents are reminders that the best--and safest--way to prevent disease is through good lifestyle habits, such as regular exercise and healthy eating, says Hennekens. "Pill-taking should be viewed as an adjunct, not an alternative, to a healthy lifestyle. If taking a pill, such as the polypill, leads a person to believe they can eat two Big Macs every day, that would be very unfortunate."
Prevention strategies are being tested for cancers of the prostate and colon as well. Researchers recently discovered that Proscar (finasteride), currently prescribed for men with enlarged prostates, reduced prostate cancer in test subjects by nearly 25 percent; yet the patients who did develop prostate cancer seemed to have a more aggressive form of the disease, so it's uncertain as to who will most benefit from the drug's preventive effects. And the FDA has approved the use of Celebrex (celecoxib), a nonsteroidal anti-inflammatory drug commonly used for treating arthritis and pain, to help reduce the risk of colon cancer in men with a genetic disease called familial adenamatous polyposis. Additionally, Celebrex is being examined for its potential effectiveness in reducing the risk of lung cancer in smokers.
no magic medicine
These aren't magic pills, says Patricia Ganz, M.D., director of the division for cancer prevention and control research at Jonsson Cancer Center at the University of California, Los Angeles. "It's not voodoo or black magic. These prevention therapies are based on a real understanding of the biology of that particular disease." It can take 20 years for a wayward cancer cell to grow into a tumor, Ganz notes. Therefore, to prevent disease, doctors are shifting their focus to treating cancers when they're just abnormal cells and not fully developed malignancies. That's when we can use a "targeted drug therapy" to interrupt the disease process, she says. In another example of unanticipated benefits, using oral contraceptives to suppress ovulation may cut the risk of ovarian cancer in half. These drugs can also prevent acne in some women by decreasing levels of certain hormones. In fact, the FDA has approved the use of one contraceptive, Ortho Tricyclen, for acne treatment.
a dose of caution
A "polypill" might very well lower the risk of heart attack tremendously, but some say that the risk of side effects would be felt by up to 15 percent of people taking it. And while the idea of a pill that packs a huge preventive wallop is intriguing, keeping disease at bay isn't so simple. Even the widely used statins can produce muscle aches and, in very rare cases, kidney failure.
Mistakes have been made in the name of prevention. In the 1990s, doctors routinely recommended hormone-replacement therapy for postmenopausal women in order to prevent osteoporosis, heart disease, stroke and dementia. But recent data from the Women's Health Initiative trial showed that hormone therapy raises the risk of heart attack and stroke and doesn't appear helpful for dementia. Other medications can protect bone as well as hormone therapy without the risks involved, the researchers concluded.
HRT wasn't the only strategy that backfired. Beta-carotene, an antioxidant, was thought to prevent cancer, but studies showed that it had no effect and even slightly increased lung-cancer rates in smokers. And women who took two or more regular aspirin per week for 20 years were recently found to have an increased risk of pancreatic cancer.
These incidents are reminders that the best--and safest--way to prevent disease is through good lifestyle habits, such as regular exercise and healthy eating, says Hennekens. "Pill-taking should be viewed as an adjunct, not an alternative, to a healthy lifestyle. If taking a pill, such as the polypill, leads a person to believe they can eat two Big Macs every day, that would be very unfortunate."
