In the British study, people suffering from
facial pain and a runny nose with greenish or yellowish mucous
generally improved within about two weeks — whether they
took the standard antibiotic amoxicillin, steroid nose spray
or fake medicine.
The results, based on patients' reporting whether
their symptoms had improved, echo previous findings in children.
Antibiotics, particularly the penicillin-like
drug amoxicillin, are among the most commonly prescribed medicines
for sinus infections.
Steroid sprays sometimes are used, but the study
found they also were no better than dummy drugs, although they
appeared to provide some relief for patients with only minor
symptoms.
The study should lead to a "reconsideration
of antibiotic use for acute sinusitis. The current view that
antibiotics are effective can now be challenged, particularly
for the routine cases which physicians treat," said lead
author Dr. Ian Williamson of the University of Southampton in
England.
"Physicians can focus on effective remedies
that improve symptom control," which include ibuprofen
and other over-the-counter painkillers, Williamson said.
Inhaling steam and squirting salt water into
the nose to flush out thick mucous are among other methods that
sometimes provide relief, he said.
The study appears in Wednesday's Journal of
the American Medical Association.
Researchers randomly assigned 240 adults to
receive one of four treatments: 500 milligrams of amoxicillin
three times daily for seven days and 400 units of steroid spray
for 10 days; only amoxicillin; only steroid spray; or fake medicine.
Patients on the drugs didn't get better quicker
than those using the placebo.
Sinus infections are diagnosed in about 31 million
Americans each year and are among the most common reasons for
doctor visits. In the United Kingdom, primary care doctors see
50 or more cases a year, the study authors said.
The infections affect air spaces called sinuses
around the nose and in the lower forehead. Inflammation and
excess mucous can cause nose congestion, headaches and eye and
face pain. Causes include bacteria, viruses, fungal infections
and allergies.
Despite a long-held notion, recent studies have
found that yellowish or greenish mucous doesn't always mean
the infections are bacterial, said Dr. Vincenza Snow, a Philadelphia
internist and director of clinical programs and quality of care
at the American College of Physicians.
Moreover, while antibiotics are designed to
treat bacteria, these drugs aren't always very effective at
treating bacterial sinus infections because the medicine has
a tough time reaching the sinuses, she said.
The U.S. physicians' group issued guidelines
in 2001 advising against using antibiotics for most sinus infections
in otherwise healthy people, blaming overuse for contributing
to the growing problem of bacteria resistant to drugs.
The group is considering updating the guidelines
to say recent evidence reaffirms the drugs "don't really
change the course of the illness," Snow said.
Dr. Marvin Fried, otolaryngology chairman at
Montefiore Medical Center in New York, questioned whether all
the patients in the study had true sinus infections. While patients
were recruited by family doctors, the results were based on
patients' self-reported symptoms rather than medical exams,
he noted.
Still, Fried said the conclusions are in line
with September guidelines from a group of head and neck doctors,
whose treatment options included observation without antibiotics
for mild sinus infections.
Chinese Apple
Juice Imports Causing Concern
by KAREN ROBINSON-JACOBS / The Dallas Morning
News
While it may seem as American as apple
pie, much of the apple juice filling those juice boxes and
jugs on U.S. grocery shelves comes from China.
Over the past 10 years, China, which produces
up to 65 percent of the world's apples, has become the top
supplier of concentrate used in apple juice sold in the U.S.,
contributing more than 40 percent of the juice consumed here,
compared with 22 percent from domestically produced apples,
according to the U.S. Apple Association trade group.
Both U.S. producers who use the foreign concentrate
and fruit trade groups say the individual companies and the
federal government insist that suppliers follow strict safety
standards. Several firms said they also have auditors test
the imported juice as well as conducting their own tests.
No warnings
It's important to note that there have been
no major warnings about China-produced juice as there were
earlier this year about toys from China, tainted toothpaste
and pet food.
Still, some consumers are registering concern
with juice makers and on Web sites. And others simply do not
know that the juice they're giving their families comes from
China.
"Do most consumers know? Right now, probably
not," said Michael Hansen, senior scientist for food
safety with Consumers Union, the nonprofit publisher of Consumer
Reports magazine. "It would probably surprise people."
Count among the unaware Garland resident Kathleen
Brooks, who was taken aback when a Dallas Morning News reporter
pointed out the "concentrate from China" stamp on
the Kroger brand juice she had put in her cart.
"It would definitely make a difference
knowing that," said Ms. Brooks, who was buying juice
for her 16-month-old granddaughter. "I'll probably just
buy a different flavor, like white grape or peach," she
said as she placed the apple juice back on the shelf.
As a matter of fact, American consumers, especially
those with young children, have been drinking juice from Chinese
concentrate for years.
The amount of apple juice concentrate pouring
in from China skyrocketed from only 4.5 million gallons in
1996 to 249.54 million gallons in 2005 – 55 times as
much – according to figures from the Apple Association.
Last year, the U.S. imported 225.54 million gallons from that
country.
The juice is most often shipped to the U.S.
as concentrate, with water and packaging added here.
Some consumers became wary of Chinese goods
this summer, after a steady stream of news reports ranging
from toothpaste tainted with diethylene glycol (or DEG), a
poisonous chemical used in antifreeze, to lead paint on toys,
to pet food containing melamine, an industrial chemical.
Thursday, consumers were told to avoid still
more Chinese toys because of lead-based paint.
There have been no such warnings related to
juice, but nervous consumers began phoning some of the top
U.S. juice makers this summer, representatives said.
Many store brands use apple juice concentrate
from China, as do well-known names such as Motts, Tree Top,
Welch's and Tropicana.
(Both Tropicana and Plano-based Frito-Lay
Inc. are owned by PepsiCo Inc., of Purchase, N.Y.)
Tropicana received calls from consumers this
summer asking about juice from China, said spokesman Peter
Brace. He put the number at "less than 1 percent of total
calls."
The "key driver" for sourcing juice
from outside the states is "seasonality and availability,"
he said. He declined to discuss the relative costs of Chinese-
vs. American-produced concentrate.
In August, blogger S. Neil Vineberg, who runs
a public relations firm in West Hampton, N.Y., took his thoughts
about Tropicana's use of Chinese juice into cyberspace, launching
an e-dialogue with like-minded consumers.
Mr. Vineberg said he wrote to Tropicana asking
them to discontinue the use of Chinese apple juice concentrate
and "suggested ... consumers might stage a boycott of
Tropicana products."
His blog has generated dozens of postings,
but there has been no boycott, and Tropicana remains one of
the top-selling brands.
Kimberly Rawlings, a spokeswoman for the U.S.
Food and Drug Administration, cautioned consumers against
guilt by association.
"You can't make the assumption that just
because a country has one thing that's problematic that every
product that country has is problematic," she said, adding,
"China is not the only country we've issued import alerts
from."
'Heavily regulated'
Carol Freysinger, executive director of the
Washington, D.C.-based Juice Products Association, called
fruit and vegetable juices some of the "most heavily
regulated foods in the U.S., subject to many levels of quality
control by both individual processors and the federal government."
Production of juice to be sold in the U.S.,
whether foreign or domestic, must adhere to strict regulations
referred to as "HACCP" ( Hazard Analysis and Critical
Control Point), one of the FDA's most stringent set of rules.
Some shoppers try to avoid foreign-made foods
for reasons beyond safety, such as concern about "food
miles," said Mr. Hansen of Consumers Union, referring
to concerns about the energy used and environmental impact
of shipping food long distances.
And, he said, "they want to be supportive
of American products."
America is still home to acres of apple orchards.
But growers, seeking top dollar, most often bypass the juice
market, choosing instead to sell their fruit to the fresh
and processed markets, which pay more.
U.S. growers, for the most part, "don't
go out with the intent of growing juice apples," said
Jim Cranney Jr., vice president of the U.S. Apple Association
based in Vienna, Va. "If you're looking at things from
a grower's perspective, you want to produce the things that
will produce the most revenue for you."
Between 1991 and 2006 the price growers received
for juice apples fell by 41 percent, to $96.40 a ton, according
to the USDA.
"Juice apples have really been a salvage
market for domestic producers," Mr. Cranney said, explaining
that discolored or misshapen fruit winds up there.
Many apple industry insiders argue that U.S.
juice prices fell so far because of the flow of concentrate
from China.
In the 1990s, the U.S. apple industry launched
an anti-dumping case against Chinese suppliers before the
U.S. International Trade Commission and the Department of
Commerce.
Ultimately, duties up to almost 52 percent
were assessed on some Chinese producers, while no duties were
imposed on others.
As a result, the juice from China continued
to flow, eclipsing all other sources. Now, there is no longer
enough U.S.-made juice available to supply American bottlers,
even if tomorrow they decided to forgo Chinese shipments.
Reading the labels
There are U.S. juices and ciders without foreign
concentrate – but determining the contents in a brand
of juice can be challenging.
Since a 1986 court case, federal law has required
U.S. companies that add only water to foreign concentrate
to list the concentrate's country of origin.
But, for example, the printed labels on bottles
of Tree Top apple juice, marketed by Tree Top Inc., in Selah,
Wash., boasts of "fruit we've grown ourselves,"
and "sharing the pure taste of our Washington orchards."
In less-obvious type, on the plastic bottle,
is the phrase "Conc from USA China."
A spokeswoman for Tree Top declined to comment,
and company executives did not respond to e-mailed requests
for information.
Likewise, apple juice labels from Motts LLP,
part of Plano-based Cadbury Schweppes Americas Beverages,
speak of "our apples" that are "hand-picked
... putting little between the orchards and you, the way you
trust us to."
A careful observer might also see "Conc.
From USA, China and Argentina" stamped on the side of
the plastic bottle.
The country of origin information is "inkjeted
on the bottle because we can change it more quickly when the
countries of origin change," said spokesman Greg Artkop,
explaining why it is not printed on the label.
He also noted that the company uses a mixture
of foreign concentrates and "millions of cases of apples
each year from U.S. apple producers."
There is no requirement for where on the package
the information must be placed, only that it be legible and
in English.
That can lead to a "Where's Waldo?"-type
search – contributing to some consumers' frustration.
"I think it's an important issue and
at least consumers should be informed," said Mr. Vineberg.
"And then they can make their own personal choices."
.
