Archive for 2014
The expression that something is “a hard pill to swallow” isn’t just a metaphor. Swallowing pills can be difficult and downright unpleasant. It causes one in three people to gag, vomit, or choke. That may keep people from sticking to their medication routines, which can make them sicker. A new study by researchers from the University of Heidelberg in Germany may help people with pill swallowing difficulties. They suggest two techniques — the pop-bottle method and the lean-forward method — that can help people swallow pills more easily. Both methods were tested among people with self-professed difficulty swallowing medicine, and offered improvements of 60% to 90%.
Last spring, an advisory panel for the Center for Medicare and Medicaid Services (CMS) recommended that Medicare not cover low-dose CT scans for smokers or former smokers. These scans can double the proportion of lung cancers found at an early stage, while they are still treatable. Yesterday, CMS announced that it would cover the cost of these scans for people between the ages of 55 and 74 who smoke, or who quit within the last 15 years, and who have a smoking history of 30 pack-years. (That means a pack a day for 30 years, two packs a day for 15 years, etc.) The new Medicare plan would cover scans for an estimated 4 million older Americans, at a cost estimated to be more than $9 billion over five years. In a wise addition, Medicare will require smokers to get counseling on quitting or the importance of staying smoke-free before having the annual scan.
The best test for finding hidden lung cancer in smokers is a low-dose CT scan. Its use has been endorsed by the U.S. Preventive Services Task Force (USPSTF), an independent panel that makes recommendations for screening tests. Most insurers follow the recommendations of the task force, and pay for those services. But some opposition to this by Medicare may mean that the test isn’t covered for some of the people who could benefit from it the most. A new report in the New England Journal of Medicine showed that the cost of adding one good year to a person’s life through CT screening is around $80,000. Tests or procedures that cost less than $100,000 per year added are considered cost effective. The analysis identified two groups for whom screening is the most cost-effective—current smokers and people ages 60-74. People with private insurance will have low-dose CT scans covered. But those with Medicare may not, thanks to the decision of a Medicare advisory committee. The CMS is expected to publish a draft of its decision within the next few days and come to a final decision in early 2015.
The FDA’s approval in 2010 of the blood-thinner dabigatran (Pradaxa) got many doctors excited. It was at least as effective as warfarin for preventing stroke-causing blood clots, and possibly caused fewer bleeding side effects. In addition, it is easier to use. Since then, studies of Pradaxa have slightly dampened the enthusiasm for the new drug. For example, a new study from the University of Pittsburgh showed that Pradaxa cause more episodes of serious bleeding (9%) than warfarin (6%). The bleeding sites tended to differ. Bleeding in the stomach and intestines was slightly higher among Pradaxa users. Bleeding in the head was slightly higher among warfarin users. Black patients and those with chronic kidney disease were more likely to bleed from Pradaxa.
More and more experts now recommend that people with high blood pressure regularly check their blood pressure at home. Doing this gives people an idea where their blood pressure stands in between office visits, and can motivate them to care more about their health. It also helps doctors make quick medication adjustments to keep blood pressure in the healthy zone. But according to a new study, up to 15% of home blood pressure monitors as accurate as they should be. Readings can be off by as much as 20 points. If you check your blood pressure at home, bring your monitor and cuff to your doctor’s office and compare the reading you get with the doctor’s known, accurate instrument.
Getting a flu shot can help ward off the flu. It also works to prevent pneumonia, a leading cause of hospitalization (about one million a year) and death (about 50,000) in the United States. Pneumonia can be especially dangerous in young children and older people. For these groups, as well as others who face a high risk of pneumonia, two different vaccines can help prevent pneumonia caused by the bacterium known as Streptococcus pneumoniae. One, called PPSV23 or Pneumovax, is derived from 23 different types of pneumococcal bacteria. A newer vaccine, called PCV13, features parts of 13 different pneumococcal bacteria linked to a protein that helps the vaccine work better. PCV13 is recommended for all children younger than 5 years old, all adults 65 years or older, and anyone age 6 or older with risk factors for pneumonia. PPSV23 is recommended for all adults 65 years or older and anyone age 2 years through 64 years are at high risk of pneumonia.
Smells and tastes are often sources of great pleasure. They can also spark wonderful memories. But like memories, these senses can fade, or even disappear, with age. A new study suggests that loss of smell may be a canary in the coal mine—an early warning that something else is wrong in the body. In the study, published in PLoS ONE, older people who lost their sense of smell were more likely to have died over a five-year period. Previous research has linked loss of smell to the onset of neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. What to do If your sense of smell has faded? Don’t jump to conclusions. Diminished smell function is usually caused by problems in the nose, not in the brain.
Combining a chemotherapy drug called docetaxel with hormone therapy (androgen-deprivation therapy) to treat advanced prostate cancer appears to work better than starting with hormone therapy and adding docetaxel later.
Prostate cancer tends to be more aggressive in men with low levels of vitamin D. Among African American men, low vitamin D is also linked to a higher risk of developing prostate cancer.
The New York Times has described Thomas Eric Duncan, the first person to die of Ebola virus infection in the United States, as “the Liberian man at the center of a widening health scare.” Use of the term “health scare” about Ebola in the U.S. just isn’t warranted, according to a consensus of several Harvard experts who have looked at Ebola through different lenses. They give four main reasons why an epidemic of Ebola virus disease isn’t likely to happen here: 1) the virus is relatively difficult to spread; 2) we have an effective emergency-response infrastructure; 3) Most hospitals are equipped to treat Ebola safely; and 4) new treatments are in the works.