Youth mental illness costs U.S. billions

WASHINGTON (Reuters) – Mental illness, substance abuse and behavioral problems among children and young adults, costs the United States $247 billion a year in treatment and lost productivity alone, an expert panel said on Friday.

The panel set up by the National Research Council and Institute of Medicine which advise U.S. policymakers urged the White House to set prevention goals and coordinate government action to attack the problem.

The panel looked at the financial toll from mental illnesses including depression, anxiety disorders and schizophrenia, as well as drug and alcohol abuse and behavioral problems by people up to age 24.

It concluded that treatment and lost productivity costs alone reached an estimated $247 billion annually. That figure excluded criminal justice and education, workplace disruption and social welfare spending which would certainly add many billions more to the price tag.

"It's a lot of money," said Kenneth Warner, dean of the University of Michigan School of Public Health, who headed the panel.

The estimate came as the Obama administration and many lawmakers look for ways to improve U.S. healthcare, which is the world's most expensive but lags many other countries in some quality measures.

Some school-based and other programs have effectively reduced mental health, substance abuse and behavioral problems but federal leadership has been lacking, the panel said.

"We really can prevent a lot of mental, emotional and behavioral disorders," Warner said.

FDA seeks to reduce misuse of painkillers

WASHINGTON - Federal health regulators in the United States are requiring more than a dozen drugmakers to develop plans to reduce the misuse of their painkillers, which cause hundreds of deaths each year.

The Food and Drug Administration said this week it has issued letters to companies that make 24 opioid drugs, including morphine, oxycodone and methadone. Opioids are drugs that simulate the effects of natural opiates, such as opium poppy.

The products targeted by FDA, which come in both pill and patch forms, generally feature extended-release formulas designed to give long-lasting effects. But regulators warned that potency carries serious risks.

"We're focusing on these products because they generally contain very high doses of the drugs and need to be used very carefully," said Dr. John Jenkins, FDA's chief of new drugs.

The drugs are typically used by people already taking narcotics, such as cancer patients, to treat severe flare-ups of pain. Despite their ability to relieve chronic pain the drugs can be highly addictive and are often abused for their euphoric effects.

The FDA has issued a number of warnings on prescription pain relievers in recent years and some companies already have plans to manage the drugs' risks.

"Despite these efforts, the rates of misuse and abuse, and of accidental overdose of opioids, have risen over the past decade," said Jenkins.

According to FDA, about 3.7 million patients were taking the drugs under scrutiny in 2007. A federal survey conducted that year found 5.2 million people in the U.S. reported using prescription pain drugs inappropriately.

FDA said it will meet with 16 drugmakers March 3 to discuss risk-management plans for the medications.

Former Polk Doctor Sentenced for Internet Drug Sales

TAMPA | A physician who once practiced in Haines City and Central Polk was sentenced in federal court Thursday to 51 months in prison for illegally distributing pain medicine nationwide through Internet Web clinics.
Related Links:

* Board to Vote On Doctor's License Over Hydrocodone

Juan Antonio Ibanez, 60, pleaded guilty in late October to multiple charges, according to the Department of Justice in Tampa.

His organization grossed more than $85 million between 2003 and December 2007 by distributing more than 50 million hydrocone pills to customers who placed orders on various Internet sites, according to a plea agreement.

Hydrocone is sold either generically or under brand names such as Vicodin, Vicoprofin, Lortab, Lorcet and Norco, court documents said.

Ibanez, who lives in the Orlando area, also practiced in Tampa, according to the U.S. Attorney’s office in Tampa.

“This is an ongoing investigation and part of the plea agreement requires that Ibanez cooperate with our office,” said Steve Cole, public affairs specialist with the U.S. Attorney’s office.

“As for its size, I don’t know that it’s the largest, but is certainly one of the largest online prescription cases we have prosecuted.

Ibanez pleaded guilty to:

Illegally distributing hydrocone, a powerful and addictive drug, to undercover investigators in Tampa.

Conspiracy to illegally distribute hydrocodone.

Illegally using other doctors’ federal drug registration numbers to do that.

Conspiracy to use pharmacies for illegally distributing hydrocone and to use communication facilities as part of the conspiracy.

Engaging in a monetary transaction, greater than $10,000, in property received criminally from the drug conspiracy.

Call us today to discuss how the V.I.P. Way can free you from your opiate dependency and get your life back. Call today: (800)276-7021 or (702)308-6353 Email: info@rapiddetoxlasvegas.com Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine. Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine.

Pill mills contribute to deaths, officials say

Before Larry Plunk got wise to them, he used to watch people who had just come into his pharmacy go out into the parking lot and divide up the pills he had just dispensed to them.

"What comes in our front door are kids 25 to 30 years old with prescriptions for muscle relaxers and pain pills," the Port Arthur pharmacist said. "People are addicted and selling half the prescription and taking the other half. We don't know, but that's what we suspect."

It's a trend that Plunk and others think is leading to deaths.

In 2008, in fact, exactly 61 deaths.

That's the number of Jefferson County deaths in which prescription drugs were a factor, according to statistics from the Southeast Texas Forensic Center.

Doctors, pharmacists and law enforcement officials all believe that illegal prescription drug use and the pain management clinics that illegally supply such drugs are behind much of the problem.

"Narcotic medicines have surpassed all others as the second leading drug of abuse only behind marijuana," said Dr. Daniel Harris, a trained pain management specialist with Coastal Pain Care in Beaumont. "In the long run, people with legitimate pain are going to get short-changed because the situation calls for some more stringent rules."

In the past two years, opiate narcotics commonly prescribed for pain have become a leading drug of choice for abusers.

"Without a doubt, it's our fastest growing narcotics problem," said Maj. Jim Singletary with the Jefferson County Narcotics Unit. "The majority of our operations involve pain management drugs in some form or fashion."

Jefferson County Sheriff Mitch Woods calls the three-drug cocktail commonly prescribed at so-called pain management clinics - Soma, Xanax and hydrocodone, usually sold as Lorcet, Lortab and Vicodin - "three of the most highly abused drugs out there."

A recent problem

Woods said local law enforcement didn't realize there was a problem until the deaths in which prescription drugs were a factor suddenly jumped from nine in 2005 to 56 in 2006.

"We had that increase, and it wasn't amazing to anyone, and the reason was because it was prescription drugs," Woods said.

People have a prescription from a doctor, so many people think taking the drugs are okay, he added, even if someone is taking 10 times the amount prescribed.

"Just because it's a prescription drug doesn't mean it isn't dangerous," said Resident Agent-in-Charge Ray Troy of the U.S. Drug Enforcement Agency office in Beaumont.

In 2007, there were 41 deaths, but law enforcement officials attribute the decline to two major pain management clinics that were closed in June of that year.

Last year, the number shot back up to 61.

"People are dying more from these drugs than from methamphetamine and crack cocaine combined," Singletary said.

At the pain management clinics, also known as "pill mills," patients typically pay cash for the visit and walk out the door with a prescription for the three-drug cocktail, he said.

Minus wait time, a typical visit to a local pill mill might last five minutes, and one or even two other people might be in the exam room at the same time, said Sheriff Mitch Woods.

An undercover officer for the Jefferson Co. Narcotics Unit recently paid $130 cash and waited five hours to be seen at a local pill mill. Once in an examining room, the officer was seen by a physician's assistant who conducted "virtually no" exam, said Singletary.

After visiting the connected pharmacy, the officer walked out with a three-month supply, 270 tablets, of Soma, Xanax and hydrocodone.

"It's called 'non-therapeutic prescribing,' and it's illegal," Singletary said. "They're dispensing prescriptions to patients with no medical need."

The problem has become so big that a diversion agent, who concentrates solely on such issues, recently was assigned to the DEA office in Beaumont.

Pain management clinics vs. pill mills

A visit to a legitimate pain management clinic might mean a drug test, a 45-minute consultation and treatment options that include injections and physical therapy as well as, and sometimes instead of, prescription medications.

"You don't have to go to a pill mill if you have pain, but you don't have to live with the pain either. It's not all narcotics," said Harris.

For he and his partner, Dr. Craig Charleston, who have trained specifically in pain management, the pill mills are hindering sufferers from getting the treatment they need.

"Pain management is not just prescribing by any means," Harris said. "It's medications, physical therapy, psychotherapy, intervention procedures…"

The two see themselves as patient advocates.

"Being an advocate does not mean we're going to write a prescription and everyone'll be happily ever after," Harris said.

Instead, they create a treatment plan that includes all aspects of pain, from the physical to the psychological.

Many times, Charleston said, patients walk in the door afraid they will be put on an addictive drug.

"I think there should be a genuine fear of narcotics," he said. "There's overdoses everyday and it's not something that happens to someone else."

A typical initial consultation session at Coastal lasts about 45 minutes, the doctors said, and a follow-up session averages about 25 minutes.

Often, treatment at Coastal includes injections that combat the patient's pain and make pills unnecessary. And, at some point, Harris and Charleston say that surgery can be needed.

"If you're continuing to write 'scripts and not sending to surgery, you are doing a disservice to patients," Harris said. "A lot of patients lose that opportunity to have further treatment."

Filling the 'script

The other side of the problem, officials say, are the pharmacies that fill the drug-cocktail prescriptions.

Larry Plunk, pharmacist and owner of King's Pharmacy in Port Arthur, is one who does not.

That means he has, on a peak day soon after Hurricane Ike, turned away 70 people in one day.

"I asked one of them where they had been getting these filled and they said the pharmacy was down because of the hurricane," Plunk said.

On a regular day, he says he turns away at least 10 people.

Plunk broke his own rules, however, when a woman in her 80s came in with the drug cocktail prescription from what Plunk suspects is a pill mill.

"Her insurance called and said they had assigned her to that clinic and she really did need the medication," he said. "There are some people who actually need these things, and those people are falling through the cracks."

When someone comes in with a prescription, pharmacists have to make a judgement call on whether or not to fill it, Plunk said.

"It puts us in the position of being judge and jury," he said. "There's some little old lady who's falling through the cracks."

Plunk advocates for stiffer laws for doctors who write such prescriptions and pharmacists who are asked to fill them.

"Pharmacists are going to have to recognize their ethical professional responsibilities and stop it at that point," he added.

Fixing the problem

Law enforcement officers, doctors, pharmacists and law makers all agree that the only way to fix the problem is legislation.

"We're not going to get a handle on it until we get some laws passed," said Sheriff Mitch Woods.

Assistant U.S. Attorney Brit Featherston said that cases against pain management clinics are "very delicate."

"We're trying to make sure that what they're doing is within the realm of normal medical practice," he said. "Once it's outside that norm, they start going into the same function as a drug dealer."

Such cases are document and resource intensive and even then, it is hard to get a solid case unless doctors are straight-out selling prescriptions or trading them for sex, Featherston said.

In Louisiana, laws penalizing so-called "doctor-shopping," have been passed. The term refers not to picking your doctor, but to going from doctor to doctor trying to get prescriptions for drugs.

A similar bill is being drafted in the Texas Senate, said Sen. Tommy Williams (R-Woodlands).

A second bill, also in the draft-stage, would license pain management clinics, making them submit to an annual review and renew the license every two to three years, Williams said.

"This is not unique to Southeast Texas. It's happening all over the state," he said. "I think we have a particular problem because of some of the changes in regulations in Louisiana pushed people over here."

The bills won't be filed for at least a month, Williams said, and might not be voted on until the end of the session in April or May.

Local law enforcement officials are hoping the bills become law as soon as possible.

"It's hard to dedicate a lot of time and effort to this when the laws aren't there," said Commander Ron Hobb of the Jefferson Co. Narcotics Unit.

Southwest Council warns of dangerous trend of prescription drug abuse among children

Parents are becoming aware of the growing trend of prescription drug abuse in our nation's middle and high schools. Many of these teens are overdosing on narcotic pain relievers such as Oxycontin, Percocet and Vicodin, according to The Southwest Council, Inc.

What parents may not know is that even young children and toddlers are becoming accidental victims of these drugs.

New research in the 2008 Annals Of Emergency Medicine suggests that “increased availability of prescription opiates is responsible for a surge of accidental overdose deaths and injuries among young children under the age of 6.” Between January 2003 and June 2006, 9,179 children in this age range were sickened by prescription opiates, with eight of these children dying. According to the report's co-author Richard Dart of the Rocky Mountain Poison and Drug Center, prescription drugs have become a leading cause of child poisonings, with only carbon monoxide poisoning being more prevalent.

More than 157 million prescriptions for opiates were written in the United States in 2007. Most of the children who were poisoned accidentally ingested medication belonging to an adult living in the same home.

In an effort to reduce the number of prescriptions being written, physicians should be suspect of patients who offer “textbook symptoms,” or who ask for specific medicines by name in an effort to obtain opiate prescriptions. Patients who claim loss or theft of opiate prescriptions or who ask for refills before they are due should also be viewed with concern.

According to Dr. Leonard Paulozzi of the Centers for Disease Control and Prevention, in a March 12, 2008, report before the Senate Judiciary Subcommittee on Crime and Drugs, roughly 40 percent of opioids are dispensed in emergency departments. He suggests that hospitals start requiring their emergency departments to screen patients for a history of substance abuse before dispensing opiates.

Parents and adult caregivers are on the front line when it comes to protecting children from accidental poisonings. One way to do that is to make sure all prescriptions are kept out of reach of children. Disposing of outdated or unnecessary medications is also recommended.

Grandparents should be encouraged to secure medications in homes where children might be visiting. While prescription pain relievers offer relief to many patients, it must be remembered that these are very powerful drugs and they need to be treated as potential poisons for children.

For more information on prescription drugs, contact the Southwest Council, Inc. at 856-935-0182 ext. 11. The Southwest Council is an alcohol, tobacco and other drug prevention agency serving Salem, Gloucester and Cumberland counties.

Call us today to discuss how the V.I.P. Way can free you from your opiate dependency and get your life back. Call today: (800)276-7021 or (702)308-6353 Email: info@rapiddetoxlasvegas.com Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine. Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine.

Ex-Somerset postal worker pleads guilty to stealing drugs

Crump stole prescription drugs from mail of Kentucky residents

By TRICIA NEAL CJ Staff Writer
Commonwealth Journal

A former Russell Springs postmaster who could be facing jail time has ties to Pulaski County.

Phillip Thomas Crump, 49, of Nancy, pleaded guilty in federal court to stealing prescription drugs from the mail while he was serving as postmaster in Russell Springs.

Crump admitted that he took more than 45 pieces of mail sent from the Veterans Administration to residents in Kentucky from January 2004 to December 2005, the U.S. Attorney’s office in Louisville said.

The mail contained prescription drugs, including Lortab — a pain medication, which Crump took for his own use.

Crump was a former employee of the Somerset Post Office. He served as the officer in charge of the North Maple Street post office following long-time postmaster John Perkins’ retirement in 2003. While he was employed at the Somerset Post Office, he wrote a column for the Commonwealth Journal. He is also reportedly a former radio personality for ClearChannel Communications.

Crump is scheduled to be sentenced on Jan. 3 in federal court in Bowling Green.

If he is convicted, he could face up to 5 years in prison and a $250,000 fine.

FDA To Place Limits On Narcotics Prescriptions

The FDA plans to place new limits on prescriptions of two dozen popular narcotics.
It is part of an effort to reduce the deaths and injuries caused by abuse of drugs like Oxycontin.
We talked to a man who says he became an expert at fooling doctors into writing prescriptions he did not need.

Daniel Natter says he abused narcotics for years.

Natter says, "Oxycontin, heroin, and basically every opiate that's available."

His arm was severed as a child, causing permanent nerve damage. After his addiction started through experimentation, Natter used his childhood injury as a reason for doctors to prescribe more powerful drugs.

Natter says, "I was actually able to go to a pain clinic and just report pain in my arm, and it really didn't exist."

Oxycontin was at the top of his agenda.

Natter says, "Every month I would go in and say, 'No this isn't working for me, I need something stronger,' you know whatever I had to say."

But a new program known as REMS - Risk Evaluation and Mitigation Strategies - will allow the FDA to place strong restrictions on the distribution of oxycontin and 23 other drugs. Proponents of the legislation that made REMS possible say it's long overdue.

Operation UNITE Director Karen Engle says, "This should have happened years ago, and maybe we wouldn't be where we are today."

Rep. Hal Rogers says, "I even went to the FDA in 2003 and testified requesting that the FDA change the rules by which Oxycontin can be prescribed."

No immediate changes are planned, but next month the FDA will begin meetings with manufacturers, patient and consumer advocates, and health care professionals to develop guidelines.

The FDA is planning a public meeting in late spring or early summer for broader input.
Daniel Natter is currently in recovery at Chad's Hope center in Clay County.

Addicted to Pain-Killers?

Monday, Feb 16 (Psych Central) --

Addiction to prescription medications, especially prescribed painkillers, is a growing problem. A new study will evaluate if individuals addicted to opioid painkillers, such as Vicodin and OxyContin, can effectively be treated with drug treatments currently used for heroin addiction.

The addiction has become a national concern as authorities estimate 2.2 million Americans, per year, will begin to use prescription pain relievers for non-medical uses. This incidence rate surpasses the number of new marijuana users (2.1 million), according to the 2005 National Survey on Drug Use and Health.

In that survey, more than 6 million Americans reported using prescription drugs for non-medical uses in the previous month, which is more than the number abusing cocaine, heroin, hallucinogens and inhalants, combined.

The new study is part of a national effort involving 11 clinical research centers to evaluate treatment strategies. Known as the Prescription Opiate Addiction Treatment Study, or POATS, it is being led by the National Drug Abuse Treatment Clinical Trials Network, under the National Institute of Drug Abuse (NIDA).

The research is in response to the growing national problem of prescription drug abuse that has resulted in higher emergency room admissions and potentially devastating impacts on millions of Americans and their families, according to Stephen Dominy, MD, director of the Division of Substance Abuse and Addiction Medicine at San Francisco General Hospital Medical Center, who is co-leading the U.C.S.F. portion of the study.

The abuse of prescription opiates has become a very serious problem in our society, but until now, there have been no large-scale studies to evaluate how to treat those addictions, Dominy said.This study hopes to assess whether current opiate dependence therapies are effective, as well as the role of counseling in treatment outcomes.

Abusers of prescribed opiates seem to fit a very different profile from traditional patients in heroin dependence programs, according to Yong Song, PhD, co-principal investigator for the U.C.S.F. site study. These users tend to be younger, he said, with fewer other dependency issues, such as alcohol or cocaine, and often come from a middle-class background.

Opiate addiction is well studied in heroin dependence, but very little is known about what treatments are effective with this group of people, Song said.`We think this is a different demographic, but it's not well studied. This trial will confirm whether they really do look different.

Source: University of California - San Francisco

Call us today to discuss how the V.I.P. Way can free you from your opiate dependency and get your life back. Call today: (800)276-7021 or (702)308-6353 Email: info@rapiddetoxlasvegas.com Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine. Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine.

Sampson Regional puts an end to dispensing of narcotic pain meds

In an effort to reduce the epidemic of prescription drug abuse being felt in Sampson and across the country, emergency physicians at Sampson Regional Medical Center are no longer refilling narcotic pain and sedative medications. Instead of dispensing narcotic pills, they are instead doling out referrals to primary care physicians so patients may receive the proper treatment.

Sampson Regional is another in the growing number of emergency departments taking such measures to reduce the increasing overuse of narcotic and sedative medications used to treat chronic pain.

Medications such as Codeine, Hydrocodone (Lortab and Vicodin), Oxycodone (Percocet), Morphine, Darvocet, Oxycontin, Xanax and Valium are just some that will no longer be dispensed by emergency physicians. A full list is provided by hospital officials.

“We are trying to limit the amount of narcotics being given out,” said Dr. Steven D. Kelley, chief of emergency medicine at Sampson Regional.

He pointed to the increasing abuse of the medications.

“It seems as though that has become more of a problem,” said Kelley. “What they were doing previous to this policy was (patients) were given four or five pills to get them through.”

Those pre-packs of narcotic pills were given out after pharmacy hours so pain could be eased in the meantime.

“What’s happening is people are getting narcotics from multiple providers,” said Kelley. “People have implemented other policies to limit the use and abuse of narcotics. It is becoming sort of an epidemic.”

Under the new policy, implemented Feb. 1, patients who have chronic pain will only receive non-narcotic pain medication as a temporary treatment. Patients who frequently visit the emergency room seeking relief from pain — more than two visits in one month, six visits per year — will be deemed to have chronic pain syndrome.

The policy makes exceptions for terminal conditions, such as cancer. However, all patients will be responsible for maintaining an active prescription with their primary care provider.

“The goal is to get them back to a primary care physician,” said Kelley. “Our goal is to get these folks who frequent our ER the proper care. We need to get them to someone to manage that care and that’s not what the ER is there to do. We manage emergency care.”

Wanda Boyette, chief operating officer at Sampson Regional, said the SRMC emergency room remains inundated with patients receiving all levels of care, estimating well in excess of 30,000 patients a year.

“It’s increasing, it’s definitely not decreasing,” Boyette noted.

She said there may be some backlash as a result of the new policy, but patients are urged not to take it up with emergency physicians. They are all required to follow the policy, which has been adopted after consideration by the Emergency Department Staff, as well as endorsements by the hospital’s medical staff and the hospital administration.

“We’ll have more complaints,” said Boyette. “They’ll be angry and take it out on providers. It will not be without a lot of gnashing of teeth. We want to take care of their pain, but we will not be dispensing narcotics, so they know what to expect. You just don’t come to the ER to get narcotics and get refills. We want to give them the proper care.”

Boyette said, once confronted with the policy, patients may show hostility and then seek the narcotic medications from elsewhere. She said she is hoping they will grow to accept the change and form a closer relationship with their primary care provider so that plans to treat chronic pain can be developed.

Laurie Smith, director for emergency services at SRMC, said the policy must be followed and all nurses have been instructed to do so.

“We probably will be in the hot seat,” said Smith. “On behalf of the nursing staff, I just want to make sure the policy is followed. We don’t want to add to the epidemic.”

In the past, some patients have gone so far as to return to the emergency room under fictitious names, in an effort to get more narcotic medications.

“As a nurse, you know this patient is being dishonest but there’s not much you can do,” said Smith. “(The new policy) standardizes the care.”

Kelley said the most important thing everyone should know is that if they are experiencing pain, doctors at Sampson Regional will do their best to ease it — in a responsible way. Patient safety is at the forefront, Boyette said.

Boyette noted two recent deaths at Sampson Regional from patients taking narcotic medications. They were not given the meds at the Clinton hospital, but died as a result of them.

“That should hit home with people around here that these narcotics can be dangerous,” said Kelley. “You see people getting excess amounts and people taking too much narcotics for chronic pain. Obviously, these medicines are important and needed, but there’s a better way to address chronic pain.

“It’s much easier to write (the prescription) and move on,” Kelley attests, “but it’s not the responsible thing to do.”

Chris Berendt can be reached at 910-592-8137, ext. 121, or by email at sicrime@intrstar.net.

Call us today to discuss how the V.I.P. Way can free you from your opiate dependency and get your life back. Call today: (800)276-7021 or (702)308-6353 Email: info@rapiddetoxlasvegas.com Medical Director: Board-Certified by American Board of Anesthesiology 1994, former chief of cardiac anesthesia, University of Nevada School of Medicine. Board-Certified by American Board of Pain Medicine 1997, Clinical Assistant Professor University Nevada School of Medicine.

Are You Wasting Money on Multivitamins?

Advertisements with tantalizing promises of improved health, prevention of cancer and heart disease, and greater energy have lured millions of Americans to spend billions of dollars on the purchase of multivitamins.

An article in the February 9 issue of Archives of Internal Medicine reported that multivitamin use did not protect the 161,808 postmenopausal women enrolled in the Women's Health Initiative Study from common forms of cancer, heart attacks, or strokes. And the numbers of deaths during the 8 years of the study were the same in vitamin users as in non-users. Still, it is important to recognize that this was an observational study, not a more meaningful clinical trial. Although these findings apply only to women, other studies have failed to show benefits of multivitamins in older men.

These results are not at all surprising for several reasons. No large study has shown that multivitamins significantly benefit healthy men and women. In addition, for some years physicians prescribed folic acid and vitamins B12 and B6 in the hopes of preventing heart attacks and strokes by lowering blood levels of homocysteine. (High blood levels of homocysteine are associated with an increased risk of coronary and other vascular diseases.) A number of recent studies, however, have shown that, while these vitamins do lower homocysteine levels, they do not prevent heart attacks or strokes.

Many doctors have also prescribed the antioxidants vitamin E and beta-carotene to reduce the risk of cardiovascular diseases and cancer. Alas, studies have now proven that these supplements are not protective--and may even be harmful.

No one denies that an adequate intake of vitamins is essential; however, vitamins can and should be obtained from eating enough healthy foods rather than from swallowing vitamin supplements.

Then what about vitamins being a great source of energy? Some multivitamin ads do indeed claim that their supplements boost energy; and some professional athletes gobble handfuls of vitamin pills to increase their energy and strength. But researchers proved long ago that energy comes from calories, not vitamins. The highly touted cholesterol-lowering effects of substances added to some multivitamin supplements? Still unproven.

All this is not to say that specific vitamins supplements are never desirable. Vitamins can be valuable in certain situations:

* Folic acid supplements in women who are pregnant or plan to become pregnant can help to prevent serious neural-tube defects that affect the baby's brain and spine.
* Supplements that contain more vitamin D and calcium than is present in regular multivitamin pills can help older men, and especially women, avoid osteoporosis and bone fractures.
* Supplements of vitamins C and E, beta-carotene, zinc, and copper may slow the progression of vision loss in people with early macular degeneration.

And multivitamins are beneficial for some entire groups of people:

* those on a very-low-calorie weight-loss diet
* strict vegetarians
* heavy alcohol drinkers
* individuals who are not getting an adequate diet because they are too sick or too poor--or live by themselves and are unable to prepare proper meals for themselves

I also agree with a comment made by one of the coauthors of the Archives of Internal Medicine article about postmenopausal women mentioned above. An 8-year follow-up period may not be long enough to show that multivitamins protect against cancers that take many years to develop.

All the same, the results of the studies on vitamins so far point to one conclusion: Healthy people who eat enough calories from a varied diet do not benefit from multivitamin supplements.