A pharmacist who sells antibiotics without a prescription violates Health Ministry regulations. Fortunately, this is rare. Needless use of antibiotics not only endangers patients by masking symptoms and causing adverse reactions, but it also builds up the resistance of bacteria to these drugs, creating "super bugs" and making medications in general much less effective. But there is a great deal of "self-medication" with antibiotics, according to researchers at Ha'emek Hospital in Afula and the Technion-Israel Institute of Technology's Rappaport Faculty of Medicine. Writing in the November issue of IMAJ (the Israel Medical Association Journal), Dr. Raul Raz, Hana Edelstein and Dr. Larissa Grigoryan, working with colleagues from the University of Gronigen in the Netherlands, worry about the reportedly major amounts of antibiotics and other medications stored in Israeli homes. Sometimes physicians give patients a prescription "just in case" an infection turns out to be bacterial. Many patients buy the drugs anyway, and if it turns out they don't need to take the pills, they store them for a "rainy day." Other patients who genuinely need antibiotics dangerously stop taking them when they feel better, and keep the leftovers in the medicine cabinet. In addition, the authors note, people borrow antibiotics from friends or relatives. The authors sent questionnaires to 2,615 members of Clalit Health Services in the north, half of them Jews and half of them Arabs. Although only 18% (mostly Jews) returned the questionnaire, a quarter of those admitted to storing antibiotics at home and taking them (or giving them to their children) without consulting a physician. These rates are similar to those in other developed countries. Although the results can't be regarded as absolutely representative because of the low response rate, the authors suggest that every time a pharmacist dispenses antibiotics (it is hoped, only by prescription), he or she should hand out a printed page explaining why self-medication is harmful to the individual and to society at large. The authors recommend that the leaflet encourage customers who have unused antibiotics to return them to the pharmacy. HAVE A HEART-TO-HEART TALK WITH YOUR DENTIST Dentists have a "unique opportunity" to help fight heart attacks, according to a study published in the November issue of The Journal of the American Dental Association . The report, written by Journal editor Dr. Michael Glick and colleagues at the New Jersey School of Dentistry, says people may be more likely to see their dentist regularly than they are to see their physician (this may not be so in Israel, where many go to a dentist only when they have pain, and accessibility to doctors is very high). "This could place dentists in the frontlines for identifying patients at risk of coronary heart disease," wrote Glick. Conducting medical history reviews and measuring patients' blood pressure are "common practices" for today's dentists. Together with simple chairside screenings, this could help dentists identify underlying medical conditions and risk factors for heart disease. "Our study clearly suggests that dentists can play an important role in primary prevention of cardiovascular disease." The researchers note that some patients may resist having their dentist screen for conditions not related directly to dental health, but since cardiovascular disease is the leading cause of death in the West, by collecting histories and conducting a few simple tests, dentists may be able to help reduce the enormous personal and financial costs. NO EARLY TO BED If your teenagers seem unable to fall asleep until late at night, they may not be to blame. A new sleep study has found that the "sleep pressure" rate - the biological trigger that causes sleepiness - slows down in adolescence. Published in the November issue of Sleep, the study suggests that as children mature, their internal, chemically-driven pressure to sleep builds more slowly, so teens generally aren't sleepy until later in the evening. "We've found another part of the story - the mechanism in the brain that builds up sleep pressure is working at a different rate in adolescents than in pre-pubescent children," says coauthor Dr. Mary Carskadon, a psychiatrist and director of the sleep lab at Brown University Medical School. Previously, studies have found that as children go through puberty, they struggle against going to bed early - a phenomenon attributed to changes in their brains' internal clock. This new finding indicates that, in addition to the changes in their internal clocks, adolescents experience a slower buildup of sleep pressure, which may contribute to an overall shift in sleep cycles. The results show that the adage "early to bed, early to rise" presents a real challenge for adolescents. The authors suggest that the shift in sleep cycles is simply one more way to prepare teenagers for performing tasks in spite of sleep deficits - a common requirement for adults in modern societies.