Robert Shmerling, M.D.
Posts by Robert Shmerling, M.D.
Neck pain is a common, and often frustrating, condition. Although there are many causes of neck pain, in many cases, it can be hard to know the exact reason for the pain. There is no one treatment that is reliably helpful, and treatments can take a long time to work. But a new study suggests that two complementary therapies — acupuncture and the Alexander Technique — may offer a way for neck pain sufferers to find genuine and lasting relief.
Many people believe that the placebo effect is solely a psychological phenomenon. But for some people, a placebo can have real, measurable therapeutic benefits. The power of the placebo effect is significant enough that it can actually skew study results. Additional research is needed to better understand how to leverage the placebo effect and when doing so might offer real benefits to patients.
If arthritis in your knee means you can’t do everything you want, whether that’s walking the dog or playing a game of tennis, you may be considering a knee replacement. But are the benefits “as advertised”? A study published in The New England Journal of Medicine suggests that they may be, but it’s more important to weigh the risks and benefits with your personal preferences in mind.
It’s a common belief that all physicians swear to uphold the Hippocratic Oath and its critical dictum, “first, do no harm.” In fact, the Hippocratic Oath doesn’t include this promise — and many fledgling doctors do not take this oath (or any oath). What’s more, “do no harm” isn’t always a realistic goal in the day-to-day practice of medicine. However, it is an important reminder that we need to learn more about the risks and benefits of any treatment, and to use this information wisely.
We often look to science to solve life’s difficult questions. But sometimes it hands us more uncertainty. Take three reports in today’s New England Journal of Medicine. One shows that eating less sodium (a main component of salt) could save more than a million lives a year worldwide. A second came to a nearly opposite conclusion — that current average sodium intake is okay for cardiovascular health while getting either too little or too much is a problem. The third study essentially agreed with the second, but found that getting too little potassium may be as bad as getting too much sodium. The findings are certain to fuel the already heated debate on sodium and the international efforts to get people to take in less of it. But until there are good answers to the questions raised by the studies, it’s too soon to throw out recommendations to reduce sodium intake, especially in high-risk groups. Another lesson from the three New England Journal articles worth keeping in mind: getting more potassium from fruits, vegetables, and other foods is a good way to help keep your heart and arteries healthy.
Checking seemingly healthy people for cancer—what doctors call screening—seems like a simple process: Perform a test and either find cancer early and cure it or don’t find it and breathe easy. It works for colon, breast, and cervical cancers, but not for others. For colon cancer, there are several effective screening tests: colonoscopy, sigmoidoscopy, and stool testing. Two new studies in yesterday’s New England Journal of Medicine help further quantify their benefits. In the studies, all three types of test reduced the risk of developing or dying from colon cancer. Colonoscopy worked best, followed by sigmoidoscopy and then stool testing. The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening.
A new report suggests that skin cancer can sometimes hide in a tattoo. Writing in JAMA Dermatology, three German clinicians describe the case of a young man who wanted to remove large, multicolored tattoos on his arms and chest. During the removal process, his doctors discovered a suspicious mole inside the tattoo. It turned out to be cancerous—stage II melanoma. Tattoos may make it difficult to evaluate moles. Laser removal therapy is also problematic when moles are present. If you are considering getting a tattoo, either make sure it will be applied to skin that is free or moles or birthmarks, or have your doctor check any moles in the to-be-tattooed area beforehand. If you are planning to have a tattoo removed, check for moles within the tattoo. If you see any, ask your doctor or dermatologist to check them out before starting laser therapy.
How’s this for a mind-bender: Lou Gehrig may not have had Lou Gehrig’s disease. Instead, the disease that ended his life may have been chronic traumatic encephalopathy (CTE). This brain disease is caused by repeated concussions—Gehrig sustained at least four during his baseball career—or other head injuries. It can cause symptoms very similar to those of amyotrophic lateral sclerosis (ALS), now commonly called Lou Gehrig’s disease. More evidence of a connection between CTE and ALS comes from a new study of almost 3,500 retired professional football players, all of whom had played for at least five years in the National Football League. Among the 334 who died during the course of the study, the risk of death from Alzheimer’s disease or ALS was nearly four times higher than expected. Players who manned a “speed” position (such as quarterbacks or receivers) had a risk of dying from Alzheimer’s disease or ALS that was more than three times higher than those playing “non-speed” positions (such as linemen).
There are several good reasons to have cataracts fixed. Restoring clear, colorful vision certainly tops the list. A study published today in the Journal of the American Medical Association (JAMA) adds another benefit—a lower risk of breaking a hip. Researchers analyzed the effect of cataract surgery on the frequency of hip fracture in the following year. Among more than a million adults ages 65 and older who had cataracts, the frequency of hip fracture was 16% lower among those who had cataract surgery compared with those who didn’t have it, and the reduction in risk was even greater (23%) if the cataract was severe. Besides the immediate benefit of improved vision on everyday activities, and the longer-term one of preventing broken hips, cataract surgery may have other, less obvious benefits. These include more independence, better physical fitness, and better mental health.
As Benjamin Franklin once wrote, “nothing is certain but death and taxes.” A new study suggests that death and taxes are more than just unrelated “certainties,” and that one (paying taxes) could lead to the other. Over the last 30 years, an average of 226 Americans died in motor vehicle accidents on the day taxes were due (usually April 15th), compared to 213 on other days. The authors speculated that the increase may be due to distracted driving because of the added stress of tax day, more alcohol drinking, or less sleep. If the JAMA findings are real, staying off the road on tax day could ever so slightly reduce your chances of getting into an accident on the road. But there are other, better ways to keep yourself and others safe while driving every day of the year.