Archive for 2012

Nancy Keating, M.D.

The Affordable Care Act—moving forward

Last week, Americans reelected President Obama and returned a Democratic majority to the Senate. How that will affect the economy, foreign policy, and other aspects of government remain to be seen. One thing we can say for certain—it pulls the Affordable Care Act (ACA) out of limbo. The President’s re-election means we can expect to see the ACA implemented. Some popular elements of the law are already in place: allowing children to stay on their parent’s health coverage until age 26, and allowing for cost-free preventive services. Other more complicated aspects of the ACA remain to be realized. These include the establishment of state-run exchanges through which the millions of uninsured Americans covered by the ACE can buy health insurance; extension of eligibility for Medicaid to Americans who earn less than 133% of the poverty level; and innovations to improve the how health care is paid for and delivered while improving care and lowering costs.

Map, the therapy dog: more than a best friend

Therapy dogs provide comfort and support. They must be social, gentle, and enjoy getting and giving physical affection. My therapy dog, Maps, has those qualities in spades. They also must be well behaved and respond to their handlers, neither of which applied to Map when I got him as a puppy. After many therapy dog classes and a lot of practice, we learned. After two years of training, Map became a certified therapy dog. He shines when he is in his blue training coat visiting a preschool. He loves to see the kids and to work with me. How does Map help kids? His presence somehow lets children open up to learning. He offers kids a way to feel more whole in the face of physical illness or disability. He can also help children heal from emotional pain. Like any great therapist, Map knows how to listen and how to help children help themselves.

Holly Strawbridge

Unlike death and taxes, cardiovascular disease may be avoided

If you take good care of yourself, you just might end up avoiding cardiovascular disease (CVD), the most common killer in this country. That’s the bottom line from a study published this week in JAMA. Researchers from Northwestern University’s Feinberg School of Medicine analyzed five long-term studies which documented cardiovascular risk factors for 120,000 individuals at ages 45, 55, 65, and 75. This time they cast a broader net and tallied up all cardiovascular events—nonfatal and fatal heart attack and stroke, angina, the need for angioplasty or bypass surgery, heart failure, and death due to cardiovascular disease. The percentages of people who experienced one of these “events” was huge, above 50% at all four ages. However, those with an optimal risk factor profile—non-smoker, no diabetes, blood pressure less than 120/80 mm Hg, and total cholesterol less than 180 mg/dL—had a much lower lifetime risk of cardiovascular disease. For example, men and women with optimal profiles at age 55 were 30% to almost 50% less likely to develop cardiovascular disease than those with two or more major risk factors. They also lived an average of 14 years longer free of cardiovascular disease.

Daniel Pendick

Mental strain helps maintain a healthy brain

When it comes to keeping healthy and fit, living a mentally active life is as important as regular physical exercise. Just as your muscles grow stronger with use, mental exercise keeps your mental skills and memory in tone. Although any brain exercise is better than being a total mental couch potato, some kinds of “brain work” are more effective than others. The activities with the most impact are those that require you to work beyond what is easy and comfortable. Try these four basic brain-health strategies: Be a lifelong learner. Strain your brain with mentally challenging tasks. Get out of your comfort zone from time to time to challenge your mental skills. Be social. And don’t forget your body—physical activity that gets your pulse thumping helps the mind as well as the heart.

Patrick J. Skerrett

New treatment for head lice effective with one dose and no combing

As a parent who has dutifully combed nits from my children’s hair, the promise of a no-comb treatment for head lice sounds mighty appealing. An article in today’s New England Journal of Medicine looks like a slam dunk for such a treatment, a medication called ivermectin (Sklice). In two trials, one dose of ivermectin and no nit-combing did vastly better than a placebo treatment. Side effects were also minimal. Keep in mind that the trials didn’t test ivermectin against the current standard treatment using lotions made with permethrin or pyrethrins. And they included under 800 people in carefully controlled situations. That means we don’t really know the true effectiveness, side effects, safety profile, and interactions with other drugs. Until more is known about side effects and how ivermectin stacks up against other treatments, it seems wise to follow the current guidelines from the American Academy of Pediatrics. They call for the use of an over-the-counter product containing permethrin or pyrethrins as a first salvo against head lice, along with combing wet hair with a fine-toothed comb to remove nits.

Stephanie Watson

Zombie apocalypse? Only in your dreams

It’s Halloween—a time when we’re preoccupied with witches, ghouls, and other frightful creatures. But this year, no creature is generating as much buzz as the zombie. Zombies have inspired movies and TV shows, video games—even a bloody Pride and Prejudice takeoff. Could all this talk of the undead be foreshadowing a real-life zombie apocalypse? In fiction, yes. But not in real life. A Harvard ethnobotanist once found that a neurotoxin was the cause of several cases of zombie-like living deaths in Haiti. Oddly shaped proteins called prions have also been linked to brain diseases that vaguely resemble zombieism. In his novel The Zombie Autopsies, Dr. Steven Schlozman, a zombie enthusiast and professor of psychiatry at Harvard Medical School, imagined an infection scenario that turns normal human beings into flesh-craving monsters. Although a pandemic that creates zombie-like symptoms is theoretically possible, a real-life zombie apocalypse shouldn’t be high up on our list of worries.

Howard LeWine, M.D.

Gene mutation key to aspirin’s benefit in people with colorectal cancer

Back in 2009, Dr. Andrew T. Chan and his colleagues at Harvard-affiliated Massachusetts General Hospital found that people diagnosed with colorectal cancer who took aspirin on a regular basis tended to live longer than those who didn’t take aspirin. Aspirin worked only for some people, though, so Chan and a larger team of researchers set out to learn why. Their latest work, published in the New England Journal of Medicine, indicates that people with colorectal cancer who have a mutation in a gene called PIK3CA are most likely to benefit from aspirin. (About 15% to 20% of people with colorectal cancer have this gene mutation.) The mutation permits colon cancer cells to thrive. Aspirin blocks this action. If confirmed, this work could lead to routine genetic testing for people with this common cancer, and aspirin therapy for those with the PIK3CA mutation.

Patrick J. Skerrett

World Stroke Day: Emphasize prevention, early detection

The term “stroke” conjures up a frightening bolt out of the blue. It certainly feels that way when it happens. But the sudden onset hides most strokes’ decades-long development stemming from slow but steady damage to blood vessels, the growth of artery-clogging plaque, or the erratic heart rhythm known as atrial fibrillation. This long gestation means it is often possible to avoid a stroke by fighting arterial corrosion. Today is World Stroke Day—a moment to pay close attention to stroke. Worldwide, this brain-damaging condition afflicts millions of people each year, and kills more than 6 million. In the United States, about 800,000 people have strokes each year, and about 140,000 die from them. There are two main messages of World Stroke Day: Stroke can be prevented. Stroke can be treated if detection and treatment happen quickly.

Michael Craig Miller, M.D.

Metacognitive therapy: a possible new approach for ADHD?

One treatment that can help relieve depression and other mental or emotional problems is cognitive behavioral therapy. It guides individuals to change what they think. A related approach, called metacognitive therapy, helps individuals change how they think. Some preliminary but promising research suggests that metacognitive therapy may be useful for people with attention deficit hyperactivity disorder (ADHD). One study of 88 adults with ADHD found that metacognitive therapy led to significant reduction in ADHD symptoms in 42% of participants, compared to 12% who received supportive therapy. Keep in mind that metacognitive therapy is not yet a proven therapy. More research is needed on its effectiveness in different settings. But that means it doesn’t yet stack up to its elder cousin, cognitive behavioral therapy. And metacognitive therapy can’t be considered as a first line treatment for ADHD.

Patrick J. Skerrett

Peripheral artery disease: often silent, sometimes deadly, potentially preventable

Better attention to four common health factors could go a long way to preventing a stealth condition known as peripheral artery disease (PAD). That’s the upshot of a Harvard-based study published today in JAMA. PAD usually refers to blockages in the arteries that supply blood to the legs and other body parts below the heart. Such blockages can cause widespread damage, limit activity, and sometimes lead to death. In the new study, the factors that most strongly influenced the development of PAD were the same “big four” that are largely responsible for heart disease and stroke: smoking, diabetes, high blood pressure, and high cholesterol. Prevention is the best medicine. Quitting smoking and keeping blood pressure, cholesterol, and blood sugar under control can prevent PAD from getting established, or slow the disease process and possibly improve symptoms. Also important are exercise, a healthy diet, and taking medications as needed to protect the heart and arteries.