Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital.

On the South Side of Chicago, where I grew up, one hospital’s charge for implanting a pacemaker to keep the heart beating at a steady rhythm was $49,601, while another hospital charged $63,979 to do it. In Boston, a hospital not far from where I work charged $76,121 to implant a pacemaker while another hospital less than three miles away charged $55,687.

According to The New York Times, the Keck Hospital of the University of Southern California charged an average of $123,885 for a major artificial joint replacement (six times the average amount that Medicare reimbursed for the procedure) while Centinela Hospital Medical Center, also in Los Angeles, charged $220,881 for the same type of joint replacement surgery.

The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011.

The data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.

Keep in mind that these “charges” aren’t hard and fast. Medicare doesn’t pay the full charge. Insurers don’t either, as many of them negotiate lower charges. As NPR’s Robert Siegel said about the database, “it sounds like what you’ve got is a survey of the sticker prices in car lots all around America, but every deal is a special deal.”

At least for now, the database isn’t especially easy to use. It’s just an Excel spreadsheet listing the hospitals by state along their charges for the 100 procedures. The Washington Post created a nifty interactive tool that you can use to look at charges in your state for 10 conditions. Choose your state and the tool shows how its hospitals stack up against the national average, as well as the highest and lowest charges for these ten procedures. Expect other creative apps incorporating this information to be coming along soon.

If you decide to dive into the data, be aware—especially if you have private insurance (not Medicare)—that appearances can be deceiving. It may look like Hospital A charges more than Hospital B, but that may not be so. Your insurer and Hospital may have actually agreed on a lower payment. So the data don’t necessarily say what your insurance company is actually going to pay.

Reverberations

A few weeks ago, I finally finished reading “Bitter Pill,” Steven Brill’s extraordinary Time magazine article on the crazy cost of healthcare in America. I say “crazy” because, according to Brill, how hospitals set their prices has little rhyme or reason. The database from the Centers for Medicare and Medicaid Services reinforces that notion.

Publishing this information is one small step toward making the cost of healthcare more transparent. While it will be a long time before most of us will be able to figure out how much an operation or a hospital stay costs, the database could nudge hospitals with exorbitant charges to bring them in line.

Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body.

A national survey conducted by the federal Centers for Disease Control and Prevention showed that more than half of people with arthritis (53%) didn’t walk at all for exercise, and 66% stepped out for less than 90 minutes a week. Only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Delaware had the highest percentage of regular walkers (31%) while Louisiana had the lowest (16%). When the CDC tallied walking for less than 90 minutes a week, Tennessee led the list, with 76% not walking that much per week, compared to 59% in the  District of Columbia.

This map shows the percentage of adults with arthritis in each state who walked less than 90 minutes per week during 2011.

The findings were published in the journal Morbidity and Mortality Weekly Report, one of its contributions to Arthritis Awareness Month.

Beyond walking

Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function. “Swimming or bicycling tend to be better tolerated than other types of exercise among individuals with arthritis in the hips or knees,” says rheumatologist Dr. Robert H. Shmerling, associate professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center.

Exercise programs aim to help people with arthritis:

• increase the range of motion in the affected joint
• strengthen muscles
• build endurance
• improve balance

You can create an exercise program of your own, with help from a trusted doctor, nurse, or physical therapist. Or you can try one that’s been developed by arthritis experts. Examples include the Fit and Strong! program from the University of Illinois at Chicago, or one of several programs developed by the Arthritis Foundation: its Exercise Program, Walk with Ease program, or Aquatics program.

The fatigue, pain, and stiffness caused by many types of arthritis present a barrier to exercise—but these are the same symptoms that tend to improve with regular exercise.

If you have arthritis and don’t currently exercise, start slow. Take a five-minute stroll around your block, swim, or workout on an exercise bicycle. Do it every day, and then gradually increase the time spent exercising or how hard you exercise, but not both at once. If you have heart disease or other health issues, check with your doctor before embarking on an exercise program.

“If exercise was a newly developed medicine, it would be a blockbuster,” says Dr. Shmerling. “It has an excellent safety profile, and enormous benefits for people with arthritis, heart disease, and a long and growing list of other health problems.”

• Look everywhere you may store medications—medicine cabinet, bathroom counter, toiletry bag, refrigerator, purse, sock drawer, etc.
• Check the label for the name of the prescription and the dosage. Confirm that what you got from the pharmacy matches what your doctor prescribed. Contact your pharmacy if they don’t match exactly.

One reason the American College of Endocrinology recommends this kind of inventory is that insurance companies or pharmacies may substitute one brand-name or generic medication with another one without notifying you. Although this usually doesn’t make a difference, it’s good to know exactly what medication and what formulation of it you are taking. (If you aren’t 100% sure what a particular pill is, you can look it up at the Pill identifier on Drugs.com.)

Another reason is that it’s important to check expiration dates. For most medications, going a few months beyond the expiration date is okay. Beyond that, it’s time for a new prescription.

If you have expired medicines, don’t just toss them in the garbage. They could pose a safety hazard to children or animals if they somehow get out of the trash. Medicines in dumps and landfills are also making their way into our drinking water. Some pharmacies take back expired medications. The Boston Police Department and some other local law enforcement agencies offer collection boxes for out-of-date medications. If you can’t find a take-back program, here’s what the FDA recommends for most drugs:

• Take the medication out of its original container, mix it with used coffee grounds, kitty litter, or dirt, and put this unappetizing blend in a plastic container with a tight-fitting lid or in a sealable plastic bag. Put the container or bag into your regular garbage.
• Scratch off the prescription label and any identifying information from the original container to protect your identity and the privacy of your health record, and recycle or dispose of the container.

The FDA’s Web site provides a list of the 25 “flush-only” drugs as well as more information on disposing unwanted medications.

• Take a walk around the entire buffet to scope out your options before serving yourself.
• Put your food on a small plate instead of a big one.

Wansink, professor of consumer behavior at Cornell University, and colleague Mitsuru Shimizu led a team of 30 trained observers to watch more than 300 men and women in two dozen all-you-can-eat Chinese restaurant buffets and unobtrusively record six specific activities: how quickly the diners served themselves; choice of plate size; location of table; whether they faced the buffet; eating utensils used; and where they placed their napkin. Diners who surveyed the buffet before serving themselves and those who used smaller plates made fewer trips to the buffet, and so likely ate less.

“Consistent with the idea that small changes might lessen one’s tendency to overeat, deliberative thought about what to serve oneself, and using a smaller plate, may reduce overeating in buffets,” they write in the April 2013 American Journal of Preventive Medicine.

In an earlier study, the Cornell team showed that buffet diners with higher body-mass index (a measure of weight) tended to serve before surveying, used larger plates, sat facing the buffet, and used forks instead of chopsticks.

Behavior influences eating habits

Over the years, Wansink’s research has put a spotlight on how behavior and perception influence how much we eat. It’s important work.

“Many people aren’t aware of the multitude of factors that influence what and how much they eat,” says Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital.

When McManus and her team of dietitians advise people who are trying to lose weight or maintain a healthy weight, they cover four behavioral “buckets.”

People. For some people, eating with friends, eating alone, and even watching other people eat prompts them to eat more. For others, eating alone is a problem.

Emotions. Feeling bored, sad, nervous, anxious, or depressed can spark overeating. So can being happy.

Danger zones. Movie theaters, grocery stores (especially those that circulate air from the bakery or kitchen into the store), and vending machine areas nudge some people to eat even when they aren’t hungry. For some, sitting in a comfy chair watching TV can be a dietary danger zone.

Activities. It goes without saying that parties and celebrations can lead to overeating. Preparing food can do the same thing, as can shopping in a supermarket (blame the bakery smell).

Once an individual is aware of how these factors can shape eating behavior, he or she can take steps to change or avoid them. That may be especially useful in an all-you-can-eat buffet, where part of the attraction is being able to eat as much as you want. In that environment, many people go on autopilot. “Mindless eating can take over,” says McManus. “Doing a little thing like looking at all your choices first can put you in better control.”

In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery.

When the shock-absorbing cartilage in the knee is torn by injury or worn ragged by use, the result is called a meniscal tear. Stiffness and a vague sensation that the knee is not moving properly often result.

Surgeons at Harvard-affiliated Brigham and Women’s Hospital and six other large hospitals recruited 351 men and women with symptom-causing knee osteoarthritis and a meniscal tear. Half completed a six-week physical therapy program aimed at easing inflammation, strengthening muscles supporting the knee, and improving the knee’s range of motion. The other half underwent a procedure called arthroscopic partial meniscectomy, in which unstable pieces of the meniscus are removed and the remaining edges are smoothed, followed by the same physical therapy program.

Participants in both groups reported similar improvements in knee function and pain at six and 12 months. About one-third of those who received only physical therapy “crossed over” during the course of the trial and had surgery.

“We did this trial because surgeons really haven’t been sure what’s best for these patients,” said Dr. Jeffrey N. Katz, professor of medicine and orthopedic surgery at Harvard Medical School, who was one of the leaders of the trial. “Now we have a better picture, and can advise people with knee osteoarthritis and a torn meniscus that physical therapy and surgery are both good options.”

Keep in mind that the people participating in this trial had already had an MRI and been referred to a surgeon. For most people with knee osteoarthritis and a possible meniscus tear, conservative therapy is usually the place to start, especially when symptoms are mild, says Dr. Robert H. Shmerling, an associate professor of medicine at Harvard Medical School and rheumatologist at Beth Israel Deaconess Medical Center.

Making the choice

In younger people, it usually takes a strong twisting force to tear a meniscus. In people with osteoarthritis, the meniscus can tear without an injury, probably a result of ongoing degeneration of the cartilage.

Symptoms of a torn meniscus include:

• stiffness and swelling in the knee
• pain and tenderness along the joint line or general knee pain
• swelling in and around the knee
• catching or locking of the knee

As the NEJM report points out, not all meniscal tears need to be repaired. In fact, since even a torn meniscus can function as a shock absorber, it may sometimes be a better option to support it with physical therapy than surgically removing bits of it.

Next steps for the MeTeOR team include trying to determine if certain symptoms or psychosocial characteristics or other factors can identify individuals as better candidates for physical therapy or surgery.

The guidelines, released today by the American Academy of Neurology (AAN), replace a now-outdated set published in 1997.

“The new guidelines are a huge step forward,” said Dr. William P. Meehan III, director of the Sports Concussion Clinic at Harvard-affiliated Boston Children’s Hospital, who was not involved creating the new guidelines. “They summarize the best of what we now know about concussion.”

The guidelines step away from trying to “grade” concussions or diagnose them on the field or sidelines. Instead, they focus on immediately removing from play athletes who are suspected of having a concussion until they can be evaluated.

The AAN estimates that concussions cause between 1.6 million and 3.8 million mild brain injuries each year. Concussions happen when something makes the head and brain move quickly back and forth. This can be a jolt to the head, a fall, or a blow to the body. The injury changes how the brain functions. Many athletes don’t get medical attention for these injuries, often because they or their coaches don’t recognize the warning signs or take them seriously.

Here are some of the AAN’s findings and recommendations:

• Concussions are most common in males playing American football or rugby (Dr. Meehan says ice hockey also tops the list) and in females playing soccer or basketball. However, concussions can happen in any sport.
• Concussion is a clinical diagnosis. It isn’t something that can always be identified on the field using one of the numerous symptom checklists or scoring systems that are currently available.
• Athletes who seem to have suffered a concussion should be immediately removed from play and evaluated.
• Athletes who have sustained concussions should not return to play or activity that has a risk of contact activity until a licensed healthcare provider “had judged that the concussion has resolved.” Light exercise may be started beforehand as long as there is no contact risk. The AAN did not set a timeline for safe return to play.
• Athletes who have had one concussion are at greater risk of having another. The first 10 days after a concussion is a period of special danger.
• Athletes with multiple concussions and lingering symptoms should undergo testing. Some should be counseled to retire from play.

Spotting concussions

The new AAN guidelines differ from the old ones in a key way. “These are solid, evidence-based guidelines based on what we know about concussion, while the earlier ones were more a consensus statement of what we believed,” said Dr. Ross Zafonte, a member of the panel that developed the new guidelines and chair of the Department of Physical Medicine and Rehabilitation at Harvard Medical School.

That doesn’t mean the new guidelines are perfect. Rigorous research in concussion was scarce until a decade or so ago, and researchers still have a lot to learn about how concussions damage the brain, how best to prevent them, and how to treat them. But the AAN’s new effort is a good start.

Needed even more are clear guidelines for coaches and athletic trainers, the people who have ring-side seats to watching concussions happen and trying to deal with their aftermath. To make the guidelines truly useful, the next step for the AAN should be to translate the guidelines for coaches and trainers.

In the meantime, for any player with a suspected concussion or showing the symptoms below, “If in doubt, sit it out,” said Dr. Jeffrey S. Kutcher, co-leader of the AAN guidelines panel and associate professor of neurology at the University of Michigan Medical School. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”

The Centers for Disease Control and Prevention lists four categories of concussion signs and symptoms:

Physical: Headache; fuzzy or blurry vision; nausea or vomiting (early on); dizziness; sensitivity to noise or light; balance problems; feeling tired or lacking energy

Thinking/remembering: Difficulty thinking clearly; feeling slowed down; difficulty concentrating; difficulty remembering new information

Emotions/mood: Irritability; sadness; being more emotional than usual; nervousness or anxiety

Sleep: Sleeping more or less than usual; trouble falling asleep

Some symptoms appear right away, others may not be noticed for days or months after the injury.

Percentage of adults aged 18–64 years who reported that they had talked on their cell phone while driving regularly or fairly often, at least once, or never in the past 30 days

As you might expect, younger drivers were more likely to have reported talking on a cellphone or texting while driving.

Percentage of adults aged 18–64 years who reported that they had talked on their cell phone while driving at least once and read or sent text or e-mail messages while driving at least once in the past 30 days.

Driven to distraction

My family just launched a new driver, and we are starting the process for two more. It’s made me hyperaware of how much attention driving demands—especially in cities like Boston, which are known for their aggressive drivers.

Fiddling with the radio or heater is a distraction we all experience. It takes your mind off what you are doing—piloting two tons of metal and plastic at 30 miles an hour or more down a narrow lane—for a second or two, but usually doesn’t take your eyes off the road. Talking on a cellphone is different. In addition to finding the device and answering it, which means looking away from the road unless you have a hands-free setup, a conversation can distract you for minutes.

Texting is worse. According to distraction.gov, a website sponsored by the National Highway Traffic Safety Administration, sending or receiving a text takes a driver’s eyes from the road for an average of 4.6 seconds. At 55 miles per hour, that the equivalent of driving blind for more than the length of a football field.

The statistics are chilling. In 2011 (the last year with complete statistics), 3,331 people were killed in motor vehicle crashes involving a distracted driver, and nearly 400,000 were injured. The National Highway Traffic Safety Administration estimates that distracted driving accounts for about one in five crashes in which someone was injured.

Teens, who are just getting used to driving, tend to be more prone to distraction. It’s partly cultural, and partly developmental. Many teens are still developing the ability to regulate their attention and their emotions, making it more difficult for them to ignore distractions.

In the U.S., 33 states and the District of Columbia have laws prohibiting the use of electronic devices by some teen drivers. But they haven’t proven to reduce distracted driving in this age group.

Pediatricians and other physicians can help. An essay in the New England Journal of Medicine by Dr. Amy N. Ship urges her colleagues to ask their patients, especially teens, about distracted driving. Dr. Ship is a primary care physician at Beth Israel Deaconess Medical Center and an association professor of medicine at Harvard Medical School. Here essay is well worth reading.

Parents may be more effective. A campaign called Parents Are the Key by the Centers for Disease Control and Prevention (CDC) promotes safe driving and minimizing distracted driving. The first steps? Model safe driving behavior and talk with your teen about staying safe behind the wheel. The CDC and the National Highway Traffic Safety Administration also suggest that parents and their young drivers sign a pledge about safe driving, like the CDC’s Parent-Teen Driving Agreement or The Pledge on the NHTSA website.

One other strategy helps me: prayer.

That lost hour seems to be a big deal. A report in this month’s American Journal of Cardiology details the jump in heart attacks seen in a large Michigan hospital the first week after the start of Daylight Saving Time, and the small decline after it ends in the fall. A few years back, researchers showed a similar pattern in Sweden. The number of traffic accidents are similarly affected. In a Canadian study, there were more accidents on the Monday after the start of Daylight Saving Time than there were on the Monday the week before the change.

No one knows for sure why losing one hour of sleep might generate more heart attacks or accidents. It could be a disruption in the body’s circadian rhythm, which controls hormone levels and many other physiologic underpinnings of health, as well as alertness.

Catching up

If ever there was a perfect day for a nap, today would be it. A single nap won’t fully reset your body clock or make up for a lost hour of sleep, but it can help. It’s also a good way to stay sharp, especially in the afternoon.

A few years back, nap champion William A. Anthony, then professor of rehabilitation counseling at Boston University, proclaimed the Monday after the start of Daylight Saving Time as “National Napping Day.” It was part publicity stunt to promote The Napping Company, a business he founded with his wife, Camille Anthony to bring napping into business world to improve productivity.

But napping does make sense, not just today, but almost any day. Although the effects of napping on physical health are all over the map, it’s clear that napping can help improve learning and creativity.

Several leading researchers in this area, including Harvard’s Dr. Robert Stickgold, have suggested that the latest findings on napping should prompt employer policies that encourage napping. Stickgold directs the Center for Sleep and Cognition at Harvard-affiliated Beth Israel Deaconess Medical Center. A few companies have toyed with the idea—Google set up “nap pods” that block out light and sound—but napping on the job is still largely frowned upon, and few promote it.

Harvard Health Publications doesn’t have an explicit policy on napping. Since I have an office with a door that closes, and an extremely comfortable chair, this afternoon I plan to turn down the lights, sit quietly for a bit—and become more creative!

How to take a good nap

As described in an article on the potential benefits of napping in the Harvard Heart Letter, here are some tips for taking a refreshing nap:

Keep it short. A 20- to 30-minute nap may be the ideal pick-me-up. Even just napping for a few minutes has benefits. Longer naps can lead to sleep inertia — the post-sleep grogginess that can be difficult to shake off.

Find a dark, quiet, cool place. You don’t want to waste a lot of time getting to sleep. Reducing light and noise helps most people nod off faster. Cool temperatures are helpful, too.

Plan on it. Waiting till daytime sleepiness gets so bad that you have to take a nap can be uncomfortable and dangerous if, say, you’re driving. A regular nap time may also help you get to sleep faster and wake up quicker.

Time your caffeine. Caffeine takes some time to kick in. A small Japanese study published several years ago found that drinking a caffeinated beverage and then taking a short nap immediately afterward was the most restful combination because the sleep occurred just before the caffeine took effect. We’re not so sure about that approach — the mere suggestion of caffeine, in the form of coffee taste or smell, wakes us up. Regardless of the exact timing, you need to coordinate caffeine intake with your nap.

Don’t feel guilty! The well-timed nap can make you more productive at work and at home.

The safety of hospital stays and encounters with health-care providers got a boost today with the publication of 22 evidence-based “patient safety strategies.” Although most focus on care that takes place in hospitals, they extend to almost all interactions between individuals and their doctors, nurses, and other care providers. The top 10 strategies include:

•   The use of checklists before, during, and after surgery, in the same way that airline pilots use checklists before taking off—to be sure that every single important thing has been done, and nothing accidentally neglected

•   Institution of meticulous procedures, including the use of checklists, when putting a central line into a patient and caring for the line. (A central line, also called a central venous catheter, is a tube placed into a large vein in the neck, chest, or groin. It is used to deliver medication or fluids and conduct various tests.) Unless these lines are properly placed and maintained, they can become infected.

•   Finding ways to use fewer urinary catheters to help people urinate, because these catheters can cause urinary tract infections

•   Preventing pneumonia and other infections in people on ventilators by elevating the head of the bed, taking breaks from the use of sedating medication, and other strategies

•   Washing hands

•   Avoiding the use of abbreviations for medications or procedures

•   Putting in place simple strategies for preventing pressure ulcers in people confined to bed

•   The use of gloves, gowns, and other so-called barrier precautions to prevent healthcare-associated infections

•   Using ultrasound to guide the placement of central lines

•   More attention to treatment and prevention efforts for people who develop blood clots in a leg, arm, or lung (venous thromboembolism)

The recommendations were published online today in the Annals of Internal Medicine as part of a four-year effort by a national team of patient-safety experts and analysts supported by the federal Agency for Healthcare Quality and Research (AHRQ).

A dozen more safety efforts “encouraged” by the panel include greater attention to fall prevention, asking pharmacists to check for harmful medication interactions, reducing radiation exposure from CT scans and other imaging procedures, and documenting patient preferences for life-sustaining treatment.

Saving lives

To Err Is Human prompted the Agency for Health Care Policy and Research (now the AHRQ) to turn its attention to patient safety. Its 2001 report, Making Health Care Safer, identified some safety practices. Yet the agency concluded that there really wasn’t enough evidence about what worked and what didn’t to make solid, across-the-board recommendations. The new Annals of Internal Medicine report provides an evidence base upon which to build patient safety efforts that will make a difference.

One organization that has championed patient safety is the independent Institute for Healthcare Improvement, founded by Dr. Donald Berwick at Harvard Medical School. It instituted a 5 Million Lives Campaign in 2006. Participating hospitals and health care providers pledged to put into place 12 practices to prevent 5 million incidents of medical harm over a period of two years. Some of those practices are on the list published today.

Other organizations, like the Leapfrog Group, also focus on patient safety. It created an online Hospital Safety Score that you can use to see how your hospital stacks up in terms of safety. It ranks hospitals based on national performance measures from AHQR, the Centers for Medicare and Medicaid Services, and elsewhere.

Very few of the safety practices are expensive, high-tech interventions. Instead, they are almost old-fashioned efforts that aim to improve communication between health-care providers and their patients, and to improve the practice of medicine rather than the art of medicine. The theme of all of these interventions is to create systems that help caregivers follow every step that is known to improve patient care, and to avoid relying on fallible human memory. To err may be human, but it is also often preventable.

Parkinson’s disease occurs when nerve cells in the brain that make the chemical messenger dopamine begin wasting away. Dopamine helps coordinate movements. Without dopamine, hands tremble, arms and legs become stiff, movement slows and sometimes stops, balance and coordination fail. People with Parkinson’s may have trouble walking, talking, swallowing, and doing simple everyday tasks.

Drugs such as levodopa can fill in for natural dopamine and ease symptoms. But symptoms can reappear as the body breaks down the drug. And levodopa can cause side effects such as hand tremor or uncontrolled movements.

For more than a decade, a non-drug approach known as deep-brain stimulation has been used to help control Parkinson’s symptoms. As shown in the image to the right, it involves placing a tiny wire called a lead (pronounced leed) in the part of the brain that controls movement and a matchbook-sized stimulator under the skin below the collarbone. The lead and stimulator are connected to each other by a second wire that runs under the skin of the shoulder, neck, and head. The device emits small pulses of electricity that help coordinate movement.

Deep-brain stimulation traditionally isn’t used until a person has lived with Parkinson’s for a decade or more. French and German researchers wanted to know whether it might be appropriate earlier in the course of the disease, soon after the onset of troubling muscle symptoms. It is, they report in the NEJM. In a randomized trial that included 251 men and women with Parkinson’s disease, deep-brain stimulation plus state-of-the-art drug therapy was better than drug therapy alone at improving quality of life, mobility, muscle symptoms, and the ability to carry out daily tasks.

“I’m not surprised to see these results, but I and others who work with Parkinson’s patients are certainly glad to see them,” said Dr. Alice Flaherty, a specialist in movement disorders and associate professor of psychiatry at Harvard-affiliated Massachusetts General Hospital. “This trial gives us more leeway to use deep-brain stimulation earlier in appropriate patients.”

Although deep-brain stimulation can be an excellent option for some people with Parkinson’s disease, it isn’t a miracle worker, isn’t for everyone, and comes with some risks, points out Dr. Daniel Tarsy, professor of neurology at Harvard Medical School and director of the Parkinson’s Disease and Movement Disorders Center at Beth Israel Deaconess Medical Center.

“Sometimes just adjusting a person’s medications can make a big improvement,” said Dr. Tarsy. Writing last year in JAMA, he described how changing a man’s levodopa schedule from every four hours to every three hours helped reduce his involuntary movements and episodes of “freezing,” where he couldn’t walk.

That said, when state-of-the-art medical therapy isn’t enough to control symptoms, “deep-brain stimulation can be a very effective addition,” said Dr. Tarsy.