Dear Dr. Roach: In all the warnings you see for prescription drugs on TV and in print, it seems like a disproportionally high number of them have some tie-in to tuberculosis.
They say to get tested for it and don’t take the medicine if you’ve had it or if you know someone who had it. Regular over-the-counter drugs don’t seem to have this connection to tuberculosis, at least from the labels. Why is it true for prescription drugs?
C.W.
Despite the feeling you’re getting from TV ads, only a handful of prescription drugs increase risk for tuberculosis, but among those that do are some of the best-selling drugs (by total amount of money, not by number of prescriptions) and thus they are advertised heavily.
These include adalimumab (Humira) and other tumor necrosis factor inhibitors (Remicade, Cimzia, Simponi and Enbrel).
These drugs increase risk of developing tuberculosis by between 50 and 100 per cent, but that is still only about one person in 200 who takes these medications.
Steroid medications like prednisone also increase risk for tuberculosis, but you won’t see those advertised on television.
I hear the ads as well, and am puzzled when they say “if you live in an area where certain fungal infections are common.”
I bet that even people who do live in those areas might not realize it.
They are referring (mostly) to histoplasmosis, which occurs in the Ohio and Mississippi River Valleys.
Other fungal infections are possible, including coccidioidomycosis in the Southeastern states and blastomycosis, which in addition to the Ohio and Mississippi Valleys occurs in the St. Lawrence River area and the Great Lakes.
Only the northwest and northeast U.S. are really at low risk for any fungal infections.
Symptoms of fungal infection with histoplasmosis are similar to a mild pneumonia: Fever and chills, cough and chest discomfort are common, but some people have more vague symptoms, such as weight loss and just not feeling well.
People on these drugs with these symptoms should discuss them with the prescriber.
Dear Dr. Roach: I grew up with two boys who were identical twins. I say “were,” because growing up, the brothers were mirror images of each other with the exception that one brother needed glasses; that was the only way you could tell them apart.
They even had the same voice and were indistinguishable from one another on the phone unless you knew their mannerisms very, very well.
I also say they “were” identical because they’re in their late 30s now and the brother with the perfect eyesight has been diagnosed with male pattern baldness, yet his twin has not and still has a full head of hair.
How is this possible? Is it possible they’re actually fraternal twins who are eerily similar to one another?
Or can identical twins have different genetically inherited conditions?
N.E.
I believe you that they are identical twins. But some conditions we think of as genetic may not express themselves the same way, even in genetically identical people like twins.
We should think of them as having a genetic predisposition. There are environmental factors, which affect the way the condition shows up.
It is clear that smoking, sun exposure and low exercise all increase hair loss. I suspect the twin with full hair now will eventually lose his in a male pattern, but it may be that differences in the environment led to premature hair loss. Vision change also may be related to environmental factors.
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
