Archive for January, 2013

Heidi Godman

Think fast when kids want fast food

An army of nutrition experts is constantly reminding us that most fast food is bad for health. But they’re not around to back you up when your children or grandchildren unleash powerful weapons of cuteness to convince you to stop at a fast-food chain. It’s hard not to give in when the ones you adore put on the pressure, even when they’re older. One new study links several weekly fast-food meals with increased risks of asthma, rhinitis, and eczema. Another shows that when kids eat out they take in up to 300 more calories than when eating at home. Stacey Nelson, a registered dietitian who is a clinical nutrition manager at Harvard-affiliated Massachusetts General Hospital, offers some advice for when fast food is the only option.

Howard LeWine, M.D.

For early breast cancer, lumpectomy is at least as good as mastectomy

When it comes to fighting cancer, “get it out” is a common and understandable response. It’s what prompts some women with early-stage breast cancer to choose mastectomy, an operation to remove the entire affected breast. Results from the largest-ever observational study offers reassurance to women who choose a more conservative approach—removal of just the tumor and some tissue around it (lumpectomy) followed by radiation therapy. In fact, the study showed that, as a group, women who chose lumpectomy plus radiation had lower death rates from breast cancer and all causes than women who chose mastectomy. The women who appeared to reap the biggest survival benefit from lumpectomy plus radiation therapy were those over age 50 with estrogen-positive breast cancer, with 13% lower mortality from breast cancer and 19% lower for all causes. The results were reported online today in the journal Cancer. For early-stage breast cancer, mastectomy has been proven to cure or at least retard the disease. It’s a reasonable and understandable choice, especially given how well breast surgeons today can reconstruct a breast. For women who choose to have lumpectomy plus radiation therapy, the new study provides yet more scientific reassurance that this approach is at least as good as mastectomy.

Stephanie Watson

The stigma of chronic migraine

At least once a week throughout my childhood, a migraine would force my mother to retreat into her bedroom. She’d shut the blinds and burrow under the covers, overwhelmed by a pain so severe it turned the faintest sound into an agonizing roar and launched waves of nausea with the slightest movement. Though my family and I tried to be sympathetic, it was hard for us to fully comprehend my mother’s migraines or understand why she had to miss so many events because of them. When you’re on the outside looking in, you can’t begin to appreciate how severely disabling—and life disrupting—chronic migraine can be. A study from Thomas Jefferson University in Philadelphia, released last week in PLoS One, found that chronic migraine sufferers experience as much social stigma as people with epilepsy—a disease that produces far more obvious and dramatic symptoms. Some of that stigma is external—for example, getting treated differently by friends or colleagues, and some is internal.

Howard LeWine, M.D.

Hearing loss may be linked to mental decline

Loss of hearing represents more than just difficulty hearing sounds. It can lead to social isolation and depression. A new study suggests that hearing loss may also be linked to loss of memory and thinking skills. In a study published online yesterday in JAMA Internal Medicine, Johns Hopkins researchers found that declines in thinking skills happened faster during a six-year period among people with hearing loss than among those without it. Among the nearly 2,000 volunteers, all over age 70, those with hearing loss we also likely to develop “cognitive impairment,” defined as a substantial reduction in the score on a key test called the Modified Mini-Mental State Examination. The researchers estimated that it would take a hearing-impaired older adult just under eight years, on average, to develop cognitive impairment compared with 11 years for those with normal hearing. This new study shows an association. It does not prove that hearing loss causes a decline in thinking skills. The work also raises a huge question: can treating hearing loss prevent or slow an age-related decline in brain function?

Daniel Pendick

Rub-on pain reliever can ease arthritis discomfort

When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers. These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness. The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs.

Anthony Komaroff, M.D.

Focusing on gun violence could pave the way to fewer firearm-related deaths

The gun control proposals that President Barack Obama unveiled yesterday highlight the intensely personal nature of this issue. What often gets lost in the debate is the public health dimension of firearm possession. In 2011, the last year for which we have complete statistics, 32,163 American men, women, and children were killed by firearms. Since 2000, the running total is more than 400,000. That’s a staggering loss of life. A few are accidents, some are suicides, and about one-third are homicides. One way to sidestep the contentious debate over gun control would be to focus more effort on preventing gun violence. In a compelling article, three Harvard-affiliated researchers make the case for approaching gun violence as we have tackled other serious public health issues. Writing in JAMA, Drs. Dariush Mozaffarian, David Hemenway, and David Ludwig summarize lessons learned from successful efforts at reducing deaths from smoking, motor vehicle accidents, and poisoning and suggest ways to apply similar approaches to stemming gun violence. By talking about gun violence as a public health issue, and treating it that way, we may be able to save thousands of lives that are now needlessly lost each year.

Daniel Pendick

Sleep drug dosage change aims to avoid daytime drowsiness

The FDA is urging doctors to lower the starting dose of zolpidem, a popular prescription sleep aid, due to concerns that the drug can linger too long in the body. This causes daytime drowsiness that has led to car accidents. Sleep aids affected by the FDA’s announcement includes generic zolpidem and brand names Ambien, Ambien CR, Edluar, and Zolpimist. The FDA lowered the starting dose for women from 10 milligrams (mg) to 5 mg; for men it is now 5 to 10 mg. The drug should be taken right before going to bed. Taking too much of a sleep drug can give you a “hangover” of daytime drowsiness the next morning that could raise the risk of accidents or falls. Because people respond to medications in their own ways, it’s safest to start taking a sleep drug on a weekend, and start with a dose lower than the maximum recommended starting dose. If you feel drowsy the next day, the dose can be reduced; if it didn’t work, the dose can be increased.

Patrick J. Skerrett

The trick to recognizing a good whole grain: Use carb-to-fiber ratio of 10-to-1

“Whole grain” has become a healthy eating buzzphrase, and food companies aren’t shy about using it to entice us to buy products. Browse the bread, cereal, or chip aisle of your favorite grocery store and you’ll see what I mean. Last year, nearly 3,400 new whole-grain products were launched, compared with just 264 in 2001. And a poll by the International Food Information Council showed that 75% of those surveyed said they were trying to eat more whole grains, while 67% said the presence of whole grains was important when buying packaged foods. But some of the products we buy may not deliver all the healthful whole-grain goodness we’re expecting. Identifying a healthful whole-grain food can be tricky. A new study from the Harvard School of Public Health says the best way is to choose foods that have at least one gram of fiber for every 10 grams of carbohydrate. Fiber and carbs are both listed on the nutrition label.

Dennis Rosen, M.D.

Why “sleeping in” on weekends isn’t good for teens

After getting too little sleep Monday through Friday, many teens try to catch up on weekends, sometimes straggling out of bed after noon. While they may feel like they are doing their bodies a favor, they actually aren’t. Sleeping late on Saturday and Sunday may fill a teen’s sleep deficit, but it creates a bigger problem. It allows his or her inner clock to further drift away from the external clock, worsening the shift begun by delaying bedtime on school nights. The result: the circadian sleep is thrown out of whack, which makes it much more difficult to get up at the usual wake time. In effect, by sleeping late on Saturday and Sunday, your teen is suffering from the equivalent of a five-hour jet lag when it’s time to get up on Monday morning. The alarm clock may be saying 6:00 am, but his or her inner clock is reading 1:00 am. This will make it much harder for your teen to concentrate and take in anything at school.

Patrick J. Skerrett

As flu cases spike, it isn’t too late to get the vaccine

It’s shaping up to be a banner year for the flu. The City of Boston just declared a public health emergency, with 700 cases of the flu reported so far this season, compared to just 70 cases last year. Four Boston residents, all elderly, have died. A similar spike in flu is happening all around the country. According to the federal Centers for Disease Control and Prevention, this year’s flu season is shaping up to be a bad one. By the end of December, the flu was widespread in 41 states. The CDC says that more than 2,000 people have been hospitalized so far; scores of adults have died, as well as 18 children. One way to keep from getting the flu is to get the flu vaccine. (Almost everyone age 6 months and older should be vaccinated.) If you haven’t already done this, it isn’t too late. For more information about the flu, visit Harvard Health Publication’s Flu Resource Center at www.health.harvard.edu/flu