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‘Free’ lunch tab paid for at the pharmacy

Q. I sat in the waiting room at a local doctors’ office for hours while a relative was having tests. An amazing number of pharmaceutical reps waltzed in all day pushing dollies of samples. They waved to the front desk as they went back to restock the samples.

I also noticed a lot of food being delivered while I was there. The nurse said that pharmaceutical reps keep the staff well fed with cookies, brownies, pizza, barbecue, chicken and the like. It seems to me there is something wrong with this picture.

A. The pharmaceutical industry spends an extraordinary amount of money promoting medications to physicians. One way to get in good with the office staff is to provide lunch. We hear that in some doctors’ offices, the staff expects lunch to be provided for everyone and complains if the food doesn’t meet certain standards. These “Lunch and Learn” sessions are one way sales reps get face time with busy doctors, but the free lunches will ultimately be paid for at the pharmacy when patients pick up their prescriptions.

Q. How much ibuprofen can a person take and for how long before needing to talk to a doctor? I have read that stomach upset might indicate problems. I can’t really take any NSAID or aspirin unless I eat a “mini-meal” at the same time. Otherwise, my stomach hurts.

I was taking 1,600 to 2,400 mg per day of ibuprofen for weeks before surgery, and I expect to need some medicine to help with pain relief throughout my physical therapy.

As long as I eat with each dose, my stomach feels OK, but I’m trying to lose weight. I am also concerned about what the medicine could be doing to my insides. Any information you can provide on other approaches to pain relief would be greatly appreciated.

A. Ibuprofen, like all NSAIDs, can be irritating to the digestive tract. Stomach ulcers are always a risk. Other complications include high blood pressure, kidney damage, fluid retention, heart failure and toxic skin rash. The high doses you are using require medical supervision.

Topical NSAIDs might be a safer alternative. Canadian pharmacies sell Pennsaid (diclofenac and DMSO) if you have a prescription. You may also find fish oil or herbs like boswellia, ginger or turmeric beneficial.

We are sending you our Guide to Alternatives for Arthritis in which we discuss the complications of NSAIDs and options like Pennsaid and nondrug approaches. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (58 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. AA-2, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our Web site: Go to “Buy In Depth Guides.”

Q. I experience overwhelming anxiety and have problems flying and riding in elevators. This problem has gotten worse lately. My doctor prescribes an anti-anxiety drug when I occasionally fly. Is there an alternative to taking prescription drugs to get relief from the anxiety?

A. You might want to consult a therapist who uses cognitive-behavioral therapy to treat fear of flying. This approach can be very effective.

Anti-anxiety medicine can be helpful. However, if you take it on a regular basis to help you ride the elevator to your office, beware of stopping the medicine suddenly. Some people report withdrawal difficulties from medicines like Ativan (lorazepam) or Xanax (alprazolam).