Placebo response may be at work on reader’s leg cramps
DEAR DR. ROACH: I was a bit surprised that in your response to a question about coping with nighttime leg cramps some time ago, you made no mention of vitamin E.
was troubled with these painful cramps increasingly often and tried both calcium and magnesium supplements without evident improvement. I then saw mention of using vitamin E ( a long time ago so I don’t recall where), and tried 400 IU at bedtime with some improvement, then 800 IU, which soon resulted in complete cessation of the cramps.
This has continued now for several years. I mentioned this to my doctor, who said that many of his patients benefit from using vitamin E for cramps. Vitamin E is so benign that I hope you will consider mentioning this in your column. -- E. H.
ANSWER: A well- done trial back in the 1990s showed no benefit in using vitamin E to reduce leg cramp frequency, severity or sleep disturbance, despite a benefit having been seen in a trial from the 1970s.
Still, you saw improvement, and your doctor has said he has also.
There may be two possibilities for this. The first, I have often discussed: the placebo response. Placebos are very powerful at improving symptoms.
Up to a third of people in many trials across many types of medical problems will have improvement when taking a placebo tablet, and strangely, placebos can also work even if the person knows they are taking a placebo.
Physicians benefit from the placebo response every day. We prescribe a medication to help relieve a symptom, our patients ( sometimes) get better and we take the credit. Sometimes, the apparent benefit is a placebo response, and our patient would have gotten better with an inactive pill.
Another possibility is that vitamin E helps some people, but not enough to show a benefit in a medical trial. In that case, identifying who would be likely to benefit is the key to successful prescribing.
Two trials showed benefit in people on hemodialysis, for example. Of course, even a well- done trial may be inadequate to show a relatively small benefit.
While vitamin E is mostly benign, it does increase the risk of prostate cancer, at least at an 800 IU per day dose. I recommend against high doses of vitamin E in men at risk for prostate cancer. Otherwise, vitamin E is certainly worth a try.
The most effective preventive therapies for nocturnal leg cramps remain moderate exercise, daily stretching, proper foot gear and avoiding dehydration.
Many people have written that keeping blankets and sheets untucked or loosely tucked has made a big difference.
DR. ROACH WRITES: A recent column on dosing of over- the- counter drugs used aspirin as an example of dosing by weight and age.
A pediatric nurse practitioner wrote with the concern that aspirin should be avoided in children under 16 due to the risk of Reye’s syndrome.
I would add that the risk of Reye’s syndrome is highest in children and teens with influenza or chickenpox. I recommend against aspirin for children, except under orders of the child’s pediatrician.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med. cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
ROME ( AP) — Italy’s main teachers’ union is balking at plans for educators under age 55 to receive the AstraZeneca vaccine rather than jabs it believes provide better protection, evidence that lobbying groups are vying to get specific shots as the virus and its variants spread across Europe.
The CISL School union said in a statement Monday that it wanted a meeting with Italy’s government scientific committee. It complained that it hadn’t been consulted about the decision to start up the vaccine drive for teachers ahead of schedule, with some of the first 250,000 AstraZeneca doses that arrived over the weekend.
The Italian government rejiggered its vaccination plans last week after Pfizer-BioNTech and Moderna reduced vaccine deliveries and Italy’s pharmaceutical agency gave “preferential use” for AstraZeneca shots for people aged 18 to 55. The government is now directing its Pfizer and Moderna shots to inoculate people over age 80 while designating the AstraZeneca jabs for younger, at-risk workers.
Interim analysis from late- stage human trials showed the AstraZeneca vaccine was 70.4% effective at preventing symptomatic COVID-19 after two doses. Pfizer and Moderna reported preliminary results from late-stage trials showing their vaccines were almost 95% effective.
Over the weekend, South Africa suspended plans to inoculate its front- line health care workers with AstraZeneca after a small clinical trial suggested that it isn’t effective in preventing mild to moderate illness from the variant dominant in the country.
To date, Italy has identified one person who tested positive with the variant from South Africa who arrived on a flight from the continent, though it has had more cases of the variants identified in Britain and Brazil. But on Monday, the Austrian government issued a warning against travel to its Tyrol province, which borders northern Italy, after 293 infections of the variant identified in South Africa were confirmed there.
Northern Italy has been the hardest-hit part of the country ever since the first locally transmitted case was confirmed on Feb. 21 in Lombardy and became Europe’s one- time epicenter. While infections nationwide have held steady for several weeks — around 8,000 new con
firmed cases were reported Monday and 307 new deaths — northern regions continue to see the highest numbers of infections and deaths. With more than 90,000 dead, Italy has the second-highest confirmed COVID-19 death toll in Europe after Britain.
The union said school workers were questioning whether to accept the AstraZeneca vaccine given its “claimed lower vaccination coverage compared to the more effective Pfizer and Moderna vaccines.”
Italy’s virus czar, Domenico Arcuri, has defended the decision to direct the AstraZeneca vaccines to younger workers, saying the dual aim of Italy’s campaign is to reduce mortality overall among the elderly who are most at risk of fatal complications, and reduce the spread of the virus among younger people.
“We have a new weapon that allows us to amplify the categories to vacci
nate,” Arcuri told reporters Friday.
Originally, Italy’s national vaccine plan prioritized health care workers and residents of nursing homes with the first doses of vaccines that arrived, followed by people over age 80.
But the new “preferential use” designation for AstraZeneca shots means a parallel campaign begins this week for under- 55 teachers, law enforcement personnel, armed forces, prisoners and prison officials as well as essential workers and residents of communities.
To date, Italy has administered more than 2.5 million doses. On Monday in Rome, the first doses for people over age 80 and not living in nursing homes got underway at local hospitals.
“I have seven grandchildren waiting for a hug,” a pleased Abramo Abrusca said as he got his Pfizer shot.