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More information, please
In the article, diclofenac gel (Solaraze) is re-
You left us hanging! After reading the article by
ferred to as a “newer topical chemotherapy”
Mark E. Meijer, MD, “An unusual approach to
when it is actually considered by most to be a
glycemic control” (March 2005), I felt that the
nonsteroidal anti-inflammatory drug. In the
actual approach was not outlined. His article
current Solaraze prescribing information, the
marked his successes and his “study” results but
mechanism of action in the treatment of actinic
never actually told us what his approach was.
keratoses (AK) is unknown. And while the au-
The example of Dr. Meijer’s patient handout on
thors state that Solaraze is “gaining widespread
page 34 was a teaser.What else does he teach the
acceptance,” it is currently the third most com-
patient? There was no address except his city to
monly prescribed topical product for AK in both
Likewise, the article recommends treating AK
with imiquimod (Aldara) three times per weekfor eight weeks. However, in the drug’s prescrib-
Dr. Meijer responds:
ing information, the recommended dosage is
If simple problems have simple solutions, then complex
two times per week for 16 weeks. Additionally,
problems do not. The fact that the well-funded
no safety information associated with Aldara is
United Kingdom Prospective Diabetes Study could
presented (i.e., application-site reactions/disor-
not achieve weight control while achieving intensive
ders, including treatment-site infections), yet in-
glycemic control suggests that treating “diabesity”(both
flammation as an effect with 5-fluorouracil is
diabetes and obesity) is not as simple as writing a
prominently noted in the article. The Aldara
prescription. Nevertheless, noted psychologist, B.F.
prescribing information notes: “Most patients
Skinner, MD, showed that simple behavior modifica-
using Aldara Cream for the treatment of AK
tion could achieve very complex behavior changes ( but
experience erythema, flaking/scaling/dryness
only at one small step at a time ).Complex changes can
and scabbing/crusting at the application site
require many steps, and unfortunately, there was just
not enough room in the article to provide these details.
However, I do have a DVD, “The Prevention and
Treatment of Diabetes,” that better explains my results
and how they were achieved. ( Editor’s note: For a free
copy of Dr.Meijer’s DVD,e-mail a request to email@example.com)
A complete copy of my patient information
handouts has been published in my book,
Ten Stepsto Control Diabetes, which can be purchased atwww.diabetesbook.com. A detailed tutorial is avail-able at no additional charge to health-care providers. Ifyou would like personal assistance, you may also con-tact me through my Web site.
Ultimately, my success in treating patients with di-
abesity is the result of my ability to simplify theproblems (diet, diabetes, obesity, etc.) and their corre-sponding solutions.
Diclofenac for actinic keratoses
I would like to comment on a few statements in
“A quick guide to five common skin diseases”
by Robert Norman, DO, MPH, and Kenneth
Wallace,MD (March 2005).
High Prevalence of Multidrug-Tolerant Bacteria andAssociated Antimicrobial Resistance Genes Isolated fromOrnamental Fish and Their Carriage WaterDavid W. Verner-Jeffreys1*, Timothy J. Welch2, Tamar Schwarz1,3, Michelle J. Pond1, Martin J. Woodward4, Sarah J. Haig1,3, Georgina S. E. Rimmer1, Edward Roberts1, Victoria Morrison4, Craig1 Centre for Environment, Fisheries and Aquaculture Sciences,
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