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Healthy people often say they would never want to be subjected to "extraordinary" medical procedures just to be kept alive. But their tune can change if they actually get sick.

A U.S. study found that elderly people with a terminal illness become increasingly willing to undergo life-extending treatments, even if it means accepting more pain and disability. (One thing most reject, however, is a decline in their mental functions.)

"Medical conditions . . . that may look intolerable to a healthier person don't seem so bad once a person has had a chance to experience them, and to see that they can still lead a life from which they can obtain pleasure," said the lead researcher, Terri Fried, at Yale University in New Haven, Conn.

The findings, based on numerous interview with 226 patients, "pose a serious challenge" to a rigid interpretation of living wills or so-called advanced directives. In these documents, people can state preferences for medical care should they become disabled and unable to speak for themselves.

But, as the new study suggests, attitudes can change. That's why it's good to review the content of such documents if circumstances change, said Dr. Fried, whose study is published in Archives of Internal Medicine.

He said it's important for patients to appoint a family member, or surrogate, who can make decisions on their behalf -- and that person should have a certain amount of leeway in the interpretation of advanced directives.

Dr. Fried noted it's usually not difficult to make a decision in "extreme circumstances," such as keeping an unconscious patient alive on a machine. A bigger challenge is selecting treatments that may extend life, but the patient becomes more disabled over time.

Herbals to the rescue

Several herbal remedies appear to be better at easing low-back pain than a prescription drug.

Canadian researchers reviewed 10 studies that examined a variety of different herbal treatments, including devil's claw, white willow bark and topical cayenne. The remedies were compared with placebos. A few of the trials also tested the remedies against Vioxx, a prescription medication that has since been removed from the market because of health concerns.

The results suggest the treatments work better than placebos and, in some cases, beat out Vioxx. "White willow bark was the most effective," lead researcher Dr. Joel Gagnier, of the University of Toronto, said in an e-mail interview.

The patients in the trials suffered from "non-specific" low-back pain. That means the pain did not result from a serious underlying medical condition such as arthritis, infection, sciatica or a herniated disc.

Dr. Gagnier noted side effects, such as gastrointestinal upset, were generally mild. But extended studies are needed to determine the long-term effectiveness and safety of the treatments. The existing studies lasted only six weeks.

The findings appeared in The Cochrane Library, a publication of an international organization that evaluates medical research.

Chamomile's dark side

Chamomile should be added to the growing list of herbal remedies that might react with other medications. Montreal doctors tell of a 70-year-old who checked into a local hospital, suffering from severe internal bleeding. The woman had a heart condition and had been prescribed warfarin, a blood-thinning medication. Doctors in the emergency room soon discovered the woman was also treating herself with chamomile. She was drinking copious amounts of chamomile tea for a sore throat and slathering the herbal remedy on her body for a skin condition.

It seems the chamomile "acted synergistically" with the warfarin to cause the internal bleeding, Dr. Louise Pilote of McGill University Health Centre, reports in this week's edition of the Canadian Medical Association Journal. Warfarin is derived from coumarin, a chemical compound with anti-coagulant properties found in many plants, including chamomile.

"I would say that if consumed in small amounts -- i.e. one cup a day -- there is probably no interaction," Dr. Pilote said in an e-mail interview. But, she added, the case serves as a reminder seemingly innocuous remedies can trigger serious reactions.

Hope for Alzheimer's

An international research team says it has discovered a natural protein that stops the buildup of harmful neurotoxins that leads to Alzheimer's disease.

"This is the starting block of something that could be tremendous," said University of Toronto Professor Peter St George-Hyslop, who led the study published in the journal Nature.

What has the researchers really excited is the fact the protein does not interfere with the brain's normal activities. So, it is potentially free of side effects. "This could be the blueprint for the development of a drug to treat the disease," Dr. St George-Hyslop said in a statement. However, many years of research lie ahead.