But Dr. Pieter Cohen’s astute resident at the Somerville Hospital primary care clinic, Dr. Rachael Bedard, had her suspicions, and she brought the patient to his attention. Dr. Cohen, a general internist at Cambridge Health Alliance and a frequent medical mythbuster, sent the pill out to be tested.

“The lab not only found Viagra in it,” he recalled. “They also found Cialis, another erectile dysfunction drug, as well as a brand new designer drug, as well as caffeine.” So in all, “You’ve got two prescription drugs that we would never prescribe together, a brand new drug, and caffeine, all in one pill. And that’s what our patient was consuming when he thought he was taking a natural sex enhancer.” In fact, the supplement, Sex Plus, was “chock full of pharmaceuticals that had nothing to do with nature.”

Dr. Bedard sent the findings to the FDA, which did its own testing and ended up issuing this alert late last month. And Dr. Cohen has just co-authored a paper in the Journal of the American Medical Association Internal Medicine — “Adulterated Sexual Enhancement Supplements,” subtitled “More Than Mojo” — spreading the word that sex-enhancement supplements advertised as natural may in fact be nothing of the kind. And they may contain brand new designer erectile-dysfunction drugs whose potential dangers are anyone’s guess.

His bottom line: “If you want a natural sex enhancer, talk to your doctor about prescription ‘yohimbe,’ but it may have side effects and it’s not very effective. Still, if you want to avoid Viagra, that’s the way to go. When it comes to any supplement sold for sexual enhancement, it should be avoided because it’s either going to be useless or potentially harmful.”

What might be the danger of, say, the drug that Somerville patient was taking?

Viagra is very safe, Dr. Cohen said, “but it’s important to know that you’re taking it so you can avoid common medications used for heart disease that can cause dangerous drops in blood pressure.” Even more alarming, he said, the supplement the patient was taking contained “an entirely new compound, and we have no idea what the potential side effects might be, because it affects the body in ways that are completely unstudied. So that’s what I’m most concerned about — an outbreak of a completely novel side effect from these new drugs, and how hard it’s going to be for doctors to identify what the culprit is.”

If a patient is taking a sex supplement and his blood pressure suddenly drops, the doctor will likely quickly figure out that the supplement must have Viagra in it, he said. “But imagine a situation in which people are getting a particular illness that would never suggest to a doctor that it’s from a prescription, so you wouldn’t even ask about it and it wouldn’t come up.”

Just a word of background. I’ve long had a general “buyer beware” impression that the tens of thousands of substances sold as supplements are surprisingly unregulated compared to pharmaceuticals, but I asked Dr. Cohen to explain how it could be that cocktails like Sex Plus could be freely sold to unsuspecting buyers.

“Basically, when it comes to supplements, everything is assumed to be safe until the FDA proves otherwise,” he said. “And not only is everything assumed to be safe, it can be sold to do just about anything as long as it’s not sold to ‘treat’ or ‘cure’ disease. So this means countless supplements are out there, presumed safe, telling us that they can treat anything under the sun, and the FDA is in the position of needing to remove the most dangerous supplements but can’t even get to a small fraction of them.”

So, I asked, they can’t claim to treat or cure but they can claim anything else? Quite a loophole…

“To call it a loophole would be a gross understatement,” he said. “It’s more like swiss cheese. In the law, it’s called the ‘structure/function’ claim, and what that means is that if you’re saying this improves a function — improves your sexual function — that’s perfectly fine, whereas if you said, ‘This treats erectile dysfunction,’ using the medical words and ‘treats,’ that would be illegal. So that creates a huge market and expectations that natural products can improve our sex lives, in the case of these types of products, which they can’t.”

Well, I pointed out, they can if they contain Viagra analogues — not that that’s a good thing.

Recent analyses have found not just Viagra-like drugs, Dr. Cohen said. They’ve also found drugs that have nothing to do with sexual health, such as diabetes drugs and painkillers. And most worrisome of all, he said, “We have over 45 different, entirely brand new chemicals being introduced here, where the consumer is the human guinea pig and we don’t even have early clinical trial data to know if it’s safe.”

Dr. Cohen’s full paper, co-authored with Dr. Bastiaan Venhuis, a leading European expert on spiked supplements, is here.

So would three Harvard experts who argue in the Journal of the American Medical Association today that the best way to curb gun violence is to treat it as a public health challenge not unlike smoking or car accidents.

From the press release:

They offer more than a dozen recommendations, based on successful strategies used in other public health crises. For example, they suggest a new, substantial national tax on all firearms and ammunition, to more accurately reflect the true societal costs of gun ownership and to provide a stable revenue source to target gun violence prevention. Such a tax would function like the tobacco tax, which provides crucial funding for smoking prevention efforts.

Other “off-the-shelf” approaches to preventing gun violence can be borrowed from efforts used in the 1970s to prevent accidental poisonings, the authors say. In the case of potentially harmful drugs, child safety packaging was introduced. In the case of guns, a similar strategy would be the manufacture of “smart guns” with security codes or locking devices. Also, routine education and counseling by physicians and national networks for education and prevention helped significantly reduce childhood poisoning deaths; similar efforts could help curb gun-related deaths.

Public health efforts to reduce motor vehicle deaths also offer ideas that could help prevent gun violence. Strategies included systematic safety standards for the driver (like driver education and licensing and drunk-driving legislation) and the vehicle (like safety glass and air bags). Similarly, strategies to reduce gun violence might include things like mandatory gun safety classes, penalties for violators of gun safety laws, reduced magazine clip sizes, and restrictions on rapid-fire firearms.

“Changing social norms is a fundamental public health strategy,” said Hemenway. “For common products like cigarettes, cars, and guns, many individuals, groups, and institutions need to become involved. As ‘friends don’t let friends drive drunk,’ similarly friends should help ensure that a friend going through a psychological crisis doesn’t have ready access to a firearm until the crisis is over.”

The authors also propose “de-glorifying” guns. “In much the same way that media, celebrities, peers, teachers, and physicians worked together in the latter decades of the 20th century to “de-glorify” cigarettes — previously seen as symbols of power, modernity, and sexuality — an analogous campaign ‘could justifiably equate gun violence with weakness, irrationality, and cowardice’ and reduce its glorification in movies, television, and video games.”

Listen to WBUR’s All Things Considered today for an interview with one of the JAMA piece’s authors, David Hemenway. And for further background that may make your blood boil, check out this other recent JAMA piece: Silencing The Science On Gun Research.

On a perfect, sunny winter day, I watched helplessly as my son was slammed to the ground by a girl hurtling down our local sledding hill on a giant inner tube. She was moving at such velocity that she barely slowed even after knocking him down. Remarkably, other than a bruised ankle and a bruised ego, my son was fine.

But the girl, splayed on her back and unable to steer, was spun around by the collision. The impact sent her spinning and bouncing crazily, and then she flew off the tube like a rag doll. She barely missed a tree and landed with an ugly thud, slamming her head on the icy snow. I was the first to reach her and she was initially unresponsive, awake but staring blankly at the sky. Eventually her parents ran over and she stumbled to her feet. Then she began crying hysterically.

If her parents took her for a hospital evaluation (and I hope they did), they’d have found that her collision wasn’t a rare occurrence. There are a limited number of sledding days even in frosty winters like this one, yet an estimated 23,000 people are treated annually in the United States for sledding injuries, with the highest percentage being children between ages 10-14.

“Sledding injuries are common,” acknowledges Dr. Eric Glissmeyer, a fellow in Pediatric Emergency Medicine at the University of Utah. “They range from inconvenient and painful, like broken arms or collar-bones, to serious and life-threatening, such as skull fractures, and neck and brain injuries. As one would expect, the steeper the hill and the faster the speed and the more crowded the sledding day, the more likely injuries are to occur.”

And those dastardly, unsteerable, oversized inner tubes rank at the top of the sledding danger list. A study in the journal Pediatrics evaluated sledding injuries from 1997-2007, and found: “Traumatic brain injuries were more likely to occur with snow tubes than with other sled types.”

“The inner tubes are bouncy and you literally have no control,” explains Dr. David Mooney, director of the Trauma Program and an assistant professor of surgery at Boston Children’s Hospital. “Most of the real injuries we see are when people hit something. We’ve had horrible head injuries with kids hitting trees. With tubes they spin around and even if a kid is trying to be a good citizen (and travel feet first) it could spin when they’re halfway down the hill.”

Tubes are unpredictable, and bouncy, which makes them fun, and very popular. While helmets have become standard (if not required) equipment for many kids’ sports – bicycling, hockey, skiing, lacrosse, baseball – sledding has remained something of a Wild West. And although sledding is essentially the process of throwing a child (or yourself) onto a slippery piece of plastic on a slippery slope that generally has trees and other obstacles on it, helmets are largely absent.

“The big question always comes out with helmets,” admits Dr. Mooney. “It’s a tough one.” Like many other people, he doesn’t want to legislate a sport that’s defined by its sense of freedom, but he wants people to understand the risks. “If you’re going feet first down an appropriate hill that doesn’t have trees on it or objects like walls, the chance of getting a severe head injury is very, very low.”

But then there’s the variable of the tubes. “I think tubes can not be controlled. They go really fast and the likelihood of being bounced off is much higher than a sled. If someone puts their kid on that they need to recognize the kid will not be able to control it. They’re taking a higher risk, and they might wear a helmet.”

Or, better yet, float on the tube during summer vacation and bring a steerable sled to the local hill.

Moments after Dr. Mooney and I spoke, he admitted a new trauma patient. A child with a head injury from a sledding accident.

(Below: A bit of dark Canadian sledding humor to make up for the frightening cautions above.) 

But for that very reason, I found this warning about the dangers that champagne corks pose to our eyes oddly soothing. I may not be able to protect my children while they’re in school, but I can make darned sure my champagne is served chilled and opened in a way that it doesn’t take out anybody’s eye…

BOSTON, Mass. — Warm bottles of champagne and improper cork-removal techniques cause serious, potentially blinding eye injuries each year, according to the Massachusetts Society of Eye Physicians and Surgeons and the American Academy of Ophthalmology. Champagne bottles contain pressure as high as 90 pounds per square inch – more than the pressure found inside a typical car tire. This pressure can launch a champagne cork at 50 miles per hour as it leaves the bottle, which is fast enough to shatter glass. Unfortunately, this is also fast enough to permanently damage vision.

Advice from the American Academy of Ophthalmology:

• Chill sparkling wine and champagne to 45 degrees Fahrenheit or colder before opening. The cork of a warm bottle is more likely to pop unexpectedly.
• Don’t shake the bottle. Shaking increases the speed at which the cork leaves the bottle thereby increasing your chances of severe eye injury.
• Point the bottle at a 45-degree angle away from yourself and any bystanders and hold down the cork with the palm of your hand while removing the wire hood on the bottle.
• Place a towel over the entire top of the bottle and grasp the cork.
• Twist the bottle while holding the cork at a 45 degree angle to break the seal. Counter the force of the cork using downward pressure as the cork breaks free from the bottle.

Readers, any additional wisdom?

Tanya Connolly, 37, crushed under a tractor-trailer in South Boston last Monday. Doan Bui, 63, killed by a speeding pickup truck on a busy Dorchester thoroughfare the Friday before. Alexander Motsenigos, 41, victim of a hit-and-run in surburban Wellesley late last month.

In major metropolitan areas like Boston, it often seems as if every week brings news of another bicycling death — or, as in this past week, more than one — usually in an unequal clash between vehicle and rider. Biking experts say that as more people take to two-wheel travel — surely a good thing — more accidents are also likely. Below, writer David C. Holzman describes his own bike crash, and shares a key safety technique that many riders ignore: Helmets save lives, but they have to be worn right.

By David C. Holzman
Guest contributor

The treetops seemed far away, as if through the wrong end of a telescope. They were all green, leafy, and dreamlike — like my memory of Seattle before I moved away at age eight.

The dream quickly soured as it began to dawn on me that I might have had a bicycle crash. But that didn’t make sense. Even in my stupor, I remembered that I was a very experienced cyclist, and very safety-conscious.

I began trying to wake myself up, as I’d done so easily in the lucid dreams of my early childhood. But it wasn’t working, and I couldn’t even shift the scene. Shock was cushioning me, like emotional Novocaine; nonetheless, I could feel the fear growing ominously more perceptible.