Harvard Health Blog
Each year, an alarming number of babies born in the United States spend their first few days withdrawing from drugs, often prescription painkillers their mothers took during their pregnancies. This problem, called neonatal abstinence syndrome (NAS), has increased fourfold since 2004, according to a report published online yesterday in The New England Journal of Medicine. NAS occurs in many babies whose mothers took a type of medication called an opioid during pregnancy. (Two commonly used opioids are OxyContin and Vicodin.) These drugs easily pass from the mother’s bloodstream to the baby’s. In effect, NAS is a baby’s withdrawal from opioids. With medication and time, babies with NAS get better, but they have to spend time in the hospital. In short, they get a rough start on life that can set them back and possibly have long-term repercussions. With so many safe options for pain control, women who are pregnant should use opioids only if these medications are absolutely necessary.
Fibroids are noncancerous tumors that grow in the uterus. They may be smaller than a seed or bigger than a grapefruit. Depending on their size, number, and location, fibroids can cause heavy bleeding and long menstrual periods (which can, in turn, cause anemia), pelvic pain, frequent urination, or constipation. Fibroids can also cause infertility and repeated miscarriages. About 7 in 10 women will develop this condition at some point. Given how common uterine fibroids are, it’s surprising how few randomized trials have been done to compare treatment options. A clinical practice article in today’s New England Journal of Medicine lays out the options for treating uterine fibroids and discusses the factors women and their doctors should consider when making treatment decisions.
Fainting can be alarming. Sometimes it’s a signal of a heart or other problem that needs to be fixed. But sometimes it is nothing to worry about, caused by not eating, having blood drawn, or even laughing too hard. Up to one-third of people at low risk for serious short-term problems after fainting end up being hospitalized. A research letter in this week’s JAMA Internal Medicine points out that hospitalization for low-risk fainting can do more harm than good. Just because you’re in the emergency department after fainting doesn’t mean you need to be admitted to the hospital. Ask your physician if you’re at risk for a worse event if you go home, and make sure that if you’re admitted it’s because there’s a potential serious cause for your fainting that can’t be fully assessed in the emergency department.
On Marathon Monday, thousands of runners will start in Hopkinton, Mass., and finish in Copley Square. Some will glide along, some will lope, and others will shuffle. No matter how they run, or how fast they run, running the Boston Marathon is something special. Here are a few tips to make the Boston Marathon your marathon. 1) Never wear something on marathon day you haven’t worn for a distance run before. 2) If family or friends will be watching you along the route, try to know in advance where they will be. 3. “The wall” is real so have a plan. 4. Try to take in the atmosphere. 5. Enjoy the camaraderie.
Yoga is good for the muscles and the mind. New research suggests that it may also be good for the heart. A review of yoga and cardiovascular disease published in the European Journal of Preventive Cardiology indicates that yoga may help lower heart disease risk as much as conventional exercise, such as brisk walking. It can help people lose weight, lower blood pressure and cholesterol, and ease stress. Each of those changes works to prevent heart disease, and can help people who already have cardiovascular problems.
One type of lower back pain, called lumbar spinal stenosis, can be painful and potentially disabling. An operation known as laminectomy or decompression is sometimes done to ease the pain of lumbar spinal stenosis. Physical therapy can also help. Researchers compared the results of laminectomy to those of a special physical therapy program among nearly 170 Pittsburgh-area men and women with lumbar spinal stenosis. The two approaches worked equally well — pain declined and physical function improved. There were more complications in the surgery group. Since there are no hard and fast rules for choosing the right treatment for lumbar spinal stenosis, the results of this study offer some guidance — try a well-designed physical therapy program first.
The tragic story of copilot Andreas Lubitz, the man who apparently crashed Germanwings flight 9525 into the Alps in an act of suicide and murder, demonstrates the opaqueness of mental illness. It is difficult to know when a person is struggling with private psychological and emotional pain that might lead to dangerous or destructive behavior. All of us tend to keep our thoughts, especially our most disturbing ones, to ourselves. Even when encouraged to speak those thoughts aloud — to a mental health professional, for example — it is very difficult to do so. This tragedy will likely spark calls for increased scrutiny of pilots. That’s not necessarily a bad thing, but it could lead to the unintended and undesirable consequence that pilots will become even more wary of seeking help. To honor the lives lost will require policies that protect the public while not being punitive to pilots.
This week’s inaugural April Fool’s Day edition of JAMA Internal Medicine carried a report entitled “Association Between Apple Consumption and Physician Visits: Appealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away.” Based on actual national nutrition data collected from nearly 8,400 men and women it concludes, “Evidence does not support that an apple a day keeps the doctor away; however, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.” Apples may have failed this critical scientific test, but they are still an excellent choice as a snack, pick-me-up, or dessert.
Hospitals across America are merging. In 2014 alone, there were 95 mergers, acquisitions, and joint ventures among U.S. hospitals, down only slightly from 98 in 2013. What is fueling this trend toward hospital consolidation — and why should you, as a consumer of health care, be concerned about it? Hospital administrators who create the mergers believe that hospital consolidation improves efficiency, access to care, and quality of care, and may lower costs. In contrast to hospital administrators, many health economists are wary about the growing number of these mergers. When individual hospitals merge into larger systems, they gain a larger share of the consumer health market. That puts them in a position to ask health insurance companies to pay more for medical care and procedures. These higher prices are not borne by the insurers, but by consumers in the form of greater premiums. Thus, some economists argue, mergers drive up health care costs and place added financial pressure on consumers.
President Obama’s announcement of a Precision Medicine Initiative was one of the few items in this year’s State of the Union address to garner bipartisan support. And for good reason. Precision medicine, also known as personalized medicine, offers the promise of health care based on your unique DNA profile and the profiles of a million other individuals. Getting to precision care will require new diagnostic tests. It will also need a new regulatory framework to make sure that technologies aren’t launched before they’ve been proven to be safe and effective, according to a Perspective article in The New England Journal of Medicine. It may take a few years to design this new vetting system and put it in place. In other words, precision medicine is on the horizon, but it isn’t around the corner.