Howard LeWine, M.D.

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications.

Posts by Howard LeWine, M.D.

Howard LeWine, M.D.

Want to live to age 120? Most Americans say no

As medical research and healthy living continues to extend life, the Pew Research Center asked more than 2,000 Americans if they would take advantage of medical treatments to slow the aging process and let them live to age 120. More than half (56%) said they would not, but 65% thought that other people would want it. The Pew survey did not ask why most adults would not want life extending treatment. Previous work has identified what people fear about getting too old. These include loss of independence, running out of money, not being able to live at home, pain, and more. But there are ways to minimize the problems that come with age. The strategies, like exercising and not smoking aren’t sexy, nor do they rely on medical breakthroughs. But they can maximize one’s “healthspan” as well as lifespan.

Howard LeWine, M.D.

Expert panel proposes annual lung cancer test for some

Proposed recommendations from the influential U.S. Preventive Services Task Force call for annual CT scans for some current and former smokers. Implementing these recommendations could prevent an estimated 20,000 deaths per year from lung cancer. The task force suggests annual testing for men and women between the ages of 55 and 79 years who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years or three packs a day for 10 years. This includes current smokers and those who quit within the previous 15 years. According to the draft recommendations, which were published today in the Annals of Internal Medicine, the benefits of annual checks in this group outweighs the risks. According to the Task Force recommendations, not all smokers or former smokers should undergo yearly CT scans. This group includes smokers or former smokers who are younger than 55 or older than 79, who smoked less or less often than a pack of cigarettes a day for 30 years or the equivalent, who quit smoking 15 or more years ago, or who are too sick or frail to undergo treatment for lung cancer. These draft recommendations have been posted for public comment until August 26, 2013.

Howard LeWine, M.D.

Taking aspirin linked to lower risk of colorectal cancer

Aspirin has many uses, from easing a headache or cooling a fever to preventing heart attacks and the most common kind of stroke. It may be time to add “preventing colorectal cancer” to the list. New results from the Women’s Health Study, a clinical trial that evaluated the benefits and risks of low-dose aspirin and vitamin E among nearly 40,000 women, show that aspirin reduces the risk of developing colorectal cancer by 20%. The effect isn’t immediate, but instead takes ten to 20 years to be seen. Aspirin isn’t without its drawbacks, including gastrointestinal bleeding and ulcer formation. Both occurred slightly more often among women taking aspirin. Although the Women’s Health Study results sound promising, don’t go reaching for the aspirin bottle just yet. Taking aspirin—and any other drug—is really a balancing act between benefits and risks.

Howard LeWine, M.D.

Fish oil: friend or foe?

News out of Seattle is sure to fuel confusion about fish oil supplements. A study by scientists at the Fred Hutchinson Cancer Research Center in Seattle linked eating a lot of oily fish or taking potent fish oil supplements to a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer. Fish oil loaded with omega-3 fatty acids, which play important roles in health. Deficiencies in them have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention. Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. Twice a week is a good goal.

Howard LeWine, M.D.

Medical crises don’t take vacations

The sudden hospitalization yesterday of Teresa Heinz Kerry, wife of U.S. Secretary of State John Kerry, while vacationing on Nantucket Island is high-profile testimony that illness can happen at any time—even during a vacation. Heinz Kerry was taken by ambulance on Sunday afternoon to Nantucket Cottage Hospital. She was accompanied by her husband. After being stabilized, she and the Secretary of State were flown to Massachusetts General Hospital in Boston. Neither the hospital nor Heinz Kerry’s family has commented on the nature of her illness. News reports say she is in critical but stable condition. Heinz Kerry’s situation highlights the value of electronic medical records, and the hazards of not having, or being able to access, medical information when you are travelling or on vacation.

Howard LeWine, M.D.

New trial muddies the water about diet, exercise, and diabetes

Long-awaited results from a nearly 10-year trial exploring the effect of changes in diet and exercise among people with diabetes weren’t what most people expected. The Look AHEAD trial found that intensive efforts to lose weight by eating less and exercising more didn’t provide any more protection against heart disease—a common co-traveler with diabetes—than standard diabetes support and education. The spin from some media reports is that weight loss doesn’t reduce heart disease risk among people with type 2 diabetes, but I think that’s the wrong interpretation. The results of the Look AHEAD trial don’t contradict the value of lifestyle changes. People in the intensive change group improved their blood sugar with fewer drugs, saving an estimated $600 per year, they were also less likely to have developed chronic kidney disease and less self-reported vision problems. The Look AHEAD results reinforce for me that diabetes care needs to be tailored to the individual.

Howard LeWine, M.D.

Better use of medicines could save billions

Wiser use of prescription medications by everyone—doctors and their patients—could save the U.S. health care system more than $200 billion a year. That’s the conclusion of a new report, Avoidable Costs in U.S. Healthcare, from the IMS Institute for Healthcare Informatics. Inefficient or ineffective use of medications lead to six million hospitalizations, four million trips to the emergency room and 78 million visits to doctors and other care providers each year, according to the report. Those are huge numbers. Although $213 billion represents less than 8% of what Americans spend on health care each year, it’s still a staggering sum. It also exacts human costs that aren’t reflected in the estimates. The report identifies 6 things that can be improved to address the problem: 1) not taking medications as directed, 2) taking too many medications, 3) delayed treatment, 4) overuse of antibiotics, 5) medication errors, and 6) underuse of generic medications.

Howard LeWine, M.D.

HPV transmission during oral sex a growing cause of mouth and throat cancer

Actress Angelina Jolie recently went public with her double mastectomy to prevent breast cancer. Governor Chris Christie told us his reasons for gastric bypass surgery. And now actor Michael Douglas is shining the spotlight on the human papilloma virus (HPV)—the number one cause of mouth and throat cancer. In an interview published in The Guardian newspaper in London, Douglas mentioned that his own throat cancer could have been brought on by oral sex, a common way to become infected with HPV. HPV transmitted by sexual contact often doesn’t become active enough to cause symptoms. When it does become active, it tends to invade mucous membranes, such as those covering the lining of the vagina, cervix, anus, mouth, tongue, and throat. An HPV infection can cause warts in and around these tissues. Most people sexually exposed to HPV never develop symptoms or health problems, and most HPV infections go away by themselves within two years. But the infection can persist and cause long-term problems. These include cervical cancer in women, penis cancer in men, and in both sexes some cancers of the anus and oropharyngeal cancer (cancer in the back of throat, including the base of the tongue and tonsils).

Howard LeWine, M.D.

Base shared decision making on good information, personal preferences

We are taught to share at an early age, and sharing is encouraged and praised across the life span. One area in which there has been a lack of sharing is medicine. Doctors have traditionally made decisions for their patients with little or no discussion about the preferences of the person who will ultimately have to live with the decision. That’s changing. More and more, doctors are trying to implement a model known as shared decision making or informed decision making. These terms refer to a process that includes a thoughtful, informed conversation between you and your doctor aimed at making a decision that’s right for you. Shared decision making is gaining acceptance as a medical “best practice.” Many studies suggest that it improves health outcomes, taking medications as directed and following other instructions, and satisfaction with a treatment or course of action.

Howard LeWine, M.D.

New sunscreen labels offer clearer sunburn, skin cancer information

With the unofficial start of summer just a few days away, many people will soon be stocking up on sunscreen. The products they’ll be seeing in stores look different than they have in the past. That’s because new rules for sunscreen labels are now in effect. The changes are good ones for consumers. The new rules, mandated by the FDA, are making sunscreen more informative with less misleading information. For example, the term “sunblock” is banned because none of these products can block all of the sun’s ultraviolet rays. “Waterproof” is also banned, replaced by “water-resistant”—which must be accompanied by a set time for reapplication. Another big change has to do with SPF, or sun protection factor. The best protection comes from a sunscreen that provides broad spectrum protection, meaning it filters out much of the UVA and UVB. Under the new FDA rules, if a label says “broad spectrum,” the product must pass tests proving that it truly protects against both UVA and UVB rays. Sunscreen products that don’t meet an SPF of 15 or higher for both UVA and UVB must now carry a warning.