Archive for January, 2015
Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression. But medications don’t work if they aren’t taken. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects. A new report from the National Center for Health Statistics shines the light on another reason: nearly 1 in 10 people skip medications because they can’t pay for them. Other strategies for saving money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies. Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed. Safe money-saving options include using generic drugs when possible, pill splitting, shopping around, and making lifestyle changes such as exercising more and following a healthier diet, which can sometimes decrease the number and dose of drugs needed.
A new report from the University of Washington links long-term use of anticholinergic medications and dementia. Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinson’s disease. The study found that people who used anticholinergic drugs were more likely to have developed dementia as those who didn’t use them. Dementia risk increased with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less. Safer alternatives to anticholinergic drugs exist.
If you are a sociable soul, here’s some interesting news about exercising with others: A study published online in the British Journal of Sports Medicine shows that being part of an outdoor walking group can improve health in many ways, including improvements in blood pressure, resting heart rate, total cholesterol, body weight, body fat, physical functioning, and risk of depression. In addition, people who were part of a walking group tended to keep exercising and not slack off. The findings are interesting because walking group participants reaped health benefits even though many of the groups did not meet international guidelines for moderate activity. This supports the idea that any activity is better than none.
The standard recommendation for exercise is at least 150 minutes of moderate-intensity activity each week. But that may not be the best recommendation for everyone, especially those who are older and have trouble exercising, or those who don’t exercise at all. If we think of exercise as a spectrum, with no activity on one end and 150 minutes or more a week on the other end, there’s a continuum in between. Getting individuals to move along that continuum, from no exercise to a little, a little to more, and so on, is an important goal. New research on the hazards of sitting for prolonged periods should get all of us to sit less and stand or move more.
More than half of the average person’s waking hours are spent sitting: watching television, working at a computer, commuting, or doing other physically inactive pursuits. But all that sitting could be sending some to an early grave. That’s the conclusion of a Canadian study published in this week’s Annals of Internal Medicine. People in the study who sat for prolonged periods of time had a higher risk of dying from all causes — even those who exercised regularly. The negative effects were even more pronounced in people who did little or no exercise. In addition to premature death, the study documented higher rates of type 2 diabetes, cancer, and cancer-related deaths in very sedentary people. If you sit for work, try standing or moving around for one to three minutes every half hour. Better yet, think about working at a standing desk. At home, stand when watching TV or talking on the phone.
Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. Thanks to the introduction of insulin therapy in 1922, and numerous advances since then, many people with type 1 diabetes now live into their 50s and beyond. But survival in this group still falls short of that among people without diabetes. A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control.