Harvard Health Blog

Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms. 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. Both therapies led to similar improvements in knee function and pain at six and 12 months.

New guidelines for recognizing and managing sports-related concussions could help protect the brains of millions of athletes at all levels of play, from professional football to youth soccer. The guidelines, released today by the American Academy of Neurology (AAN), replace a now-outdated set published in 1997. 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. “When in doubt, sit it out.” The AAN estimates that concussions cause between 1.6 million and 3.8 million mild brain injuries each year. 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. The new guidelines should help better identify athletes who have suffered concussions and improve how concussions are managed and treated.

Americans drive while talking on a cellphone or texting more than their counterparts in seven European countries. A report published yesterday showed that 69% of American drivers surveyed said they had talked on a cellphone while driving at least once in the previous month (31% said they did it “regularly or fairly often”), and 31% said they had read or sent text messages while driving. The least distracted drivers were in the United Kingdom. Not surprisingly, younger drivers were more likely to have reported talking on a cellphone or texting while driving. The statistics on distracted driving 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.

If you or a loved one has a latex allergy or sensitivity, think twice before reaching for a product that says “latex free” or “does not contain latex.” That’s the latest advice from the FDA, which says no existing tests can show that a product is completely free from latex. Labeling that suggests a product doesn’t contain the substance could cause trouble for individuals with a latex allergy or sensitivity. Natural latex is used to make a host of stretchy products, including adhesive bandages, condoms, gloves used in health care and dishwashing, balloons, rubber band, elastic used in waistbands and socks, baby bottle nipples, pillows, and more. This kind of latex contains proteins that set off some people’s immune systems, leading to an allergic reaction. The FDA’s warning highlights that products advertised as “latex-free” may not always live up to the claim. That’s because products that are made without latex can be contaminated with latex proteins during the manufacturing or packaging process.

It always takes me a few days to get used to Daylight Saving Time. While I love the extra hour of light at the end of the day, I’m not so wild about the extra hour of darkness in the morning or waking up an hour earlier than I need to. And I sure miss the hour of sleep I lost yesterday. 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. 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.

Americans are a diverse lot, so it’s no surprise they give different answers when asked about their well-being. But it seems that well-being differs from state to state, too. In the latest Gallup-Healthways Well-Being Index, which gauges the physical and emotional health of people in all 50 states, residents of Hawaii reported the best sense of overall well-being while West Virginia residents reported the worst. The index calculates overall well-being based on six quality of life categories, each of which is made up of several components. Poll respondents in Hawaii had the highest scores in the emotional health and work environment indexes, and were most likely to say they were thriving. People in West Virginia were most likely to say they were not thriving, and had the worst emotional health, the worst health habits, the most diagnoses of depression, and high rates of obesity. People in the other 50 states fell in between. It’s possible to change both emotional and physical well-being, and improve happiness.

The toll taken by medical mistakes burst into public attention with a 1999 report called To Err Is Human from the U.S. Institute of Medicine. The report estimated that between 44,000 and 98,000 people die each year as a result of preventable medical errors. Such errors can be headline grabbers, like the death of Boston Globe columnist Betsy Lehman from an overdose during chemotherapy. 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. 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.

Five seemingly different mental health disorders—major depression, bipolar disorder, schizophrenia, autism, and attention-deficit hyperactivity disorder—may be more alike than we think. A ground-breaking new study has identified four regions of the genetic code that carry same variations in people with these disorders. Two of the affected genes help control the movement of calcium in and out of brain cells. That might not sound like much, but this movement provides a key way that brain cells communicate. Subtle differences in calcium flow could cause problems that, depending on other genes or environmental factors, could eventually lead to a full-blown mental illness. But this work offers tantalizing hints that bipolar disorder, major depression, and schizophrenia—and possibly autism and attention-deficit hyperactivity disorder—may not be so distinct after all, but could be different manifestations of the same underlying disorder. This could change the way we view mental illness and open the door to more effective therapies.

People tend to think that the telltale sign of depression is sadness—a pervasive down, dragging feeling that won’t let up, day after day. But depression often manifests itself as something else entirely—like aches and pains or memory lapses. These “unusual” symptoms are actually quite common. They can mask depression—and delay an important diagnosis—especially in older people, who often display their depression in ways other than sadness. These include trouble sleeping, lack of energy, fatigue, trouble concentrating or remembering, loss of appetite, and aches and pains that don’t go away. If you have one or more of these symptoms that can’t be traced to an illness or ailment, a frank talk with a trusted doctor about the possibility of depression might be a good step forward.

The results of a new trial being made public today should get everyone interested in following a Mediterranean-style diet. What makes these new results so important is that they come from a randomized controlled trial, what many consider to be the gold standard of medical research. In the five-year trial, there were fewer heart attacks, strokes, and deaths from cardiovascular disease among participants who followed a Mediterranean-type diet than among those following a low-fat diet. A Mediterranean-style approach to food represents a diet of abundance, not restriction. Add not smoking and daily physical activity to this flexible eating strategy and you have a blueprint for protecting, and perhaps even improving, health.

Memory slips are aggravating, frustrating, and sometimes worrisome. When they happen more than they should, they can trigger fears of looming dementia or Alzheimer’s disease. But there are some treatable causes of forgetfulness.

The message that drinking a little alcohol is good for the heart has gotten plenty of attention. A new study linking alcohol with increased risk of dying from various cancers may temper that message a bit. About 4% of cancer deaths worldwide are related to alcohol use. A new study shows the in the United States, alcohol causes 3.5% of cancer deaths, or about 20,000 cancer-related deaths each year. The most common alcohol-related cancers were mouth, throat, and esophageal cancer in men, and breast cancer in women. At the same time, drinking alcohol in moderation (no more than two alcoholic drinks a day for men and no more than one a day for women) has been linked to lower rates of heart disease and deaths related to it. Advances in genetics may one day let us predict more accurately who can use alcohol in moderation and who should avoid it completely. Until then, it’s best to personally weigh the benefits and risks, ideally with a trusted health care provider.

The term “chocoholic,” usually said with a smile, actually nods to a potentially serious question: can a person become addicted to food? There are three essential components of addiction: intense craving, loss of control over the object of that craving, and continued use or engagement despite bad consequences. People can exhibit all three of these in their relationships with food. It’s most common with foods that deliver a lot of sugar and fat — like chocolate — because they trigger reward pathways in the brain. In some animal studies, restricting these foods induced a stress-like response consistent with the “withdrawal” response seen in addiction. Much of the scientific discussion about food addiction has been sparked by the epidemic of obesity sweeping the U.S. and many other countries. Many people who are overweight crave food, lose control over eating, and experience negative health effects that should, but don’t, serve as a deterrent. The influence of stress on eating provides another link between food and addictive behavior.

A pacemaker-like device that stimulates the brain can help control some of the muscular problems brought on by Parkinson’s disease, the second most common neurodegenerative problem in America. A report in tomorrow’s New England Journal of Medicine may prompt doctors to recommend its use sooner rather than later. For more than a decade, deep-brain stimulation has been used to help control Parkinson’s symptoms. 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. The new report in the NEJM will give doctors more leeway to use this therapy earlier in people with Parkinson’s.

To get or stay healthy, many people focus on exercising more, eating better, or quitting smoking. Getting recommended vaccinations is another relatively simple strategy for health that an alarming number of Americans overlook. Vaccination isn’t just for kids. Adults should get immunized against infectious agents that cause the flu, pneumonia, whooping cough (pertussis), shingles (herpes zoster), and more. The latest schedule for adult immunization has been published in the Annals of Internal Medicine. It now recommends adding a second anti-pneumonia vaccine for people with compromised immune systems. It also says that all adults age 65 and older should get the tetanus, diphtheria, and pertussis (Tdap) vaccine, as should pregnant women with each pregnancy. When it comes to adult immunization, Americans aren’t doing very well. One-third of older Americans don’t get the pneumococcal vaccine, 84% don’t get the shingles vaccine, and 87% don’t get the tetanus, diphtheria, and pertussis vaccine. In addition to protecting yourself from an infectious disease, immunization also protects others.

Getting extra calcium from supplements is supposed to be good for your bones. The latest in a string of studies heightens concern that this simple practice could end up being bad for your heart. The results support growing recommendations to get calcium from food, not pills. The latest evidence comes from the NIH-AARP Diet and Health Study, which has followed the health of nearly 400,000 men and women since 1995. Over 12 years of follow-up, men who took more than 1,000 milligrams (mg) of daily supplemental calcium were 20% more likely to succumb to heart disease than those who didn’t take calcium supplements. There was no connection between calcium supplements and heart disease in women (which has been seen in earlier studies), and no connection with calcium from food. This one study isn’t enough to find calcium guilty of heart disease in the first degree. But it’s not the only research to point the accusing finger. This line of research has some experts placing greater emphasis on a nutritious, calcium-rich diet and weight bearing exercise than on calcium supplements for keeping bones strong.

File this under “if a little bit is good, a lot isn’t necessarily better:” taking high-dose vitamin C appears to double a man’s risk of developing painful kidney stones. In an article published yesterday in JAMA Internal Medicine, Swedish researchers detail a connection between kidney stone formation and vitamin C supplements among more than 23,000 Swedish men. Over an 11-year period, about 2% of the men developed kidney stones. Men who reported taking vitamin C supplements were twice as likely to have experienced the misery of kidney stones. Use of a standard multivitamin didn’t seem to up the risk. Many people believe that extra vitamin C can prevent colds, supercharge the immune system, detoxify the body, protect the heart, fight cancer, and more. To date, though, the evidence doesn’t support claims that extra vitamin C is helpful. If high-dose vitamin C doesn’t improve health, then any hazard from it, even a small one, is too much.

An army of nutrition experts is constantly reminding us that most fast food is bad for health. But they’re not around to back you up when your children or grandchildren unleash powerful weapons of cuteness to convince you to stop at a fast-food chain. It’s hard not to give in when the ones you adore put on the pressure, even when they’re older. One new study links several weekly fast-food meals with increased risks of asthma, rhinitis, and eczema. Another shows that when kids eat out they take in up to 300 more calories than when eating at home. Stacey Nelson, a registered dietitian who is a clinical nutrition manager at Harvard-affiliated Massachusetts General Hospital, offers some advice for when fast food is the only option.

When it comes to fighting cancer, “get it out” is a common and understandable response. It’s what prompts some women with early-stage breast cancer to choose mastectomy, an operation to remove the entire affected breast. Results from the largest-ever observational study offers reassurance to women who choose a more conservative approach—removal of just the tumor and some tissue around it (lumpectomy) followed by radiation therapy. In fact, the study showed that, as a group, women who chose lumpectomy plus radiation had lower death rates from breast cancer and all causes than women who chose mastectomy. The women who appeared to reap the biggest survival benefit from lumpectomy plus radiation therapy were those over age 50 with estrogen-positive breast cancer, with 13% lower mortality from breast cancer and 19% lower for all causes. The results were reported online today in the journal Cancer. For early-stage breast cancer, mastectomy has been proven to cure or at least retard the disease. It’s a reasonable and understandable choice, especially given how well breast surgeons today can reconstruct a breast. For women who choose to have lumpectomy plus radiation therapy, the new study provides yet more scientific reassurance that this approach is at least as good as mastectomy.

At least once a week throughout my childhood, a migraine would force my mother to retreat into her bedroom. She’d shut the blinds and burrow under the covers, overwhelmed by a pain so severe it turned the faintest sound into an agonizing roar and launched waves of nausea with the slightest movement. Though my family and I tried to be sympathetic, it was hard for us to fully comprehend my mother’s migraines or understand why she had to miss so many events because of them. When you’re on the outside looking in, you can’t begin to appreciate how severely disabling—and life disrupting—chronic migraine can be. A study from Thomas Jefferson University in Philadelphia, released last week in PLoS One, found that chronic migraine sufferers experience as much social stigma as people with epilepsy—a disease that produces far more obvious and dramatic symptoms. Some of that stigma is external—for example, getting treated differently by friends or colleagues, and some is internal.

Loss of hearing represents more than just difficulty hearing sounds. It can lead to social isolation and depression. A new study suggests that hearing loss may also be linked to loss of memory and thinking skills. In a study published online yesterday in JAMA Internal Medicine, Johns Hopkins researchers found that declines in thinking skills happened faster during a six-year period among people with hearing loss than among those without it. Among the nearly 2,000 volunteers, all over age 70, those with hearing loss we also likely to develop “cognitive impairment,” defined as a substantial reduction in the score on a key test called the Modified Mini-Mental State Examination. The researchers estimated that it would take a hearing-impaired older adult just under eight years, on average, to develop cognitive impairment compared with 11 years for those with normal hearing. This new study shows an association. It does not prove that hearing loss causes a decline in thinking skills. The work also raises a huge question: can treating hearing loss prevent or slow an age-related decline in brain function?

When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers. These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness. The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs.

The FDA is urging doctors to lower the starting dose of zolpidem, a popular prescription sleep aid, due to concerns that the drug can linger too long in the body. This causes daytime drowsiness that has led to car accidents. Sleep aids affected by the FDA’s announcement includes generic zolpidem and brand names Ambien, Ambien CR, Edluar, and Zolpimist. The FDA lowered the starting dose for women from 10 milligrams (mg) to 5 mg; for men it is now 5 to 10 mg. The drug should be taken right before going to bed. Taking too much of a sleep drug can give you a “hangover” of daytime drowsiness the next morning that could raise the risk of accidents or falls. Because people respond to medications in their own ways, it’s safest to start taking a sleep drug on a weekend, and start with a dose lower than the maximum recommended starting dose. If you feel drowsy the next day, the dose can be reduced; if it didn’t work, the dose can be increased.