Question: I'm taking Synthroid for a slow thyroid due to Hashimoto's thyroiditis. I read about how a low dose of naltrexone of just 1 mg has been proven to reverse the symptoms of Hashimoto's thyroiditis. My doctor is unwilling to prescribe it for me. Why wouldn't my doctor recommend something that can cure my slow thyroid? - A.M., Atlanta

Answer: Even if low-dose naltrexone works as well as the hype surrounding it, it cannot cure hypothyroidism and would need to be continued for life. At its purported best, it will get you on a reduced dosage of thyroid replacement hormone or possibly no thyroid replacement, forever substituting it with a compounded low dose of the opioid receptor blocker drug naltrexone. A pill for a pill.

Naltrexone was approved by the FDA for the treatment of alcohol and opioid addiction, blocking the effects of those drugs in the brain. In 1985, Dr. Bernard Bihari, discovered lower doses of the drug may be helpful in boosting the immune systems of persons with AIDS. Since then, low dose naltrexone has been purported to be useful in both suppressing an overactive immune system and revving up a dampened immune system, depending upon the disease. Diseases low-dose naltrexone has been purported to help by anecdotal evidence include: HIV, cancer, fibromyalgia, multiple sclerosis, an overactive thyroid, an underactive thyroid, inflammatory bowel disease, lupus and more. The myriad of disease states this "wonder drug" can supposedly help should immediately arouse skepticism.

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Missing are double-blinded randomized placebo-controlled trials that put the claims to the test. For reasons that aren't clear, your body is destroying thyroid hormone-producing as though it were invading tissue. Even if this "miracle" drug could somehow modulate that activity, no claim has ever been made that it can cure Hashimoto's thyroiditis and put things back to a pre-disease state. I'd stay on thyroid replacement hormone, since that's proven to work.

Question: I was reading a story in the newspaper that the British Medical Journal has accused Roche Pharmaceuticals of failing to provide full access to the research data on Tamiflu. The article said that there's really no evidence Tamiflu can actually stop the flu. Do you agree? Do you recommend people still take it if they have the flu? - M.S., West Chester, Pa.

Answer: Even if the anti-viral treatment for flu works as stated, it only reduces the duration of flu symptoms in adults (ages 18 to 65) by an average of 1.3 days; by just one day in folks older than the age of 65; and by roughly 36 hours in children. So the benefit of a five-day course of Tamiflu is modest at best.

For some time, investigators have been concerned about Tamiflu for two reasons: 1) Tamiflu's manufacturer, Roche, claims there are 10 studies that show Tamiflu's effectiveness. However, only two studies showing its superiority over placebo were actually published in scientific journals. Further, the original data from those studies is "lost" and unable to be independently verified, reviewed and critiqued in the usual peer-reviewed fashion; and 2) Roche has been unwilling to provide all requested data that supports the effectiveness of Tamiflu.

The FDA still currently approves Tamiflu for the treatment of uncomplicated influenza A and B in persons age 1 and older who have been symptomatic for no more than two days. However, they also acknowledge the benefit of such treatment is modest at best. Tamiflu has not been shown in any clinical trials to reduce the rate of hospitalization, flu complications or death compared to folks receiving a placebo dummy pill. Until the FDA makes a decision to pull the drug off the market, I will prescribe it with a great deal of skepticism, lots of fluids, rest and Tylenol/Advil.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," P.O. Box 767787, Atlanta, GA 30076

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