Harvard Health Blog

As part of its 200th anniversary celebration, today’s New England Journal of Medicine carries an article called “The Past 200 Years in Diabetes.” It describes some of the advances made in understanding and treating this disease, like the discovery of insulin and the development of personal blood-sugar monitors. But it doesn’t tell much about how living with diabetes has changed. Just 50 years ago, checking blood sugar and administering insulin were big ordeals, and people with diabetes weren’t expected to live more than a few years after their diagnoses. today, it’s a cinch to check blood sugar with a quick finger prick, and pen-like devices almost painlessly deliver insulin, and people with diabetes who take care of themselves have almost normal life expectancies. Advances in protecting and treating the heart, eyes, kidneys, and limbs have helped reduce complications from diabetes.

Researchers at Kansas State University have developed a blood test that rapidly detects breast cancer (as well as non-small cell lung cancer) in very early stages, long before symptoms appear or the cancer can be seen by other methods. The experimental test identifies enzyme patterns that differ from one type of cancer to another. According to the researchers, the test can detect very early breast cancers (stages 0 and 1), as well as early lung cancers (stages 1 and 2), within an hour, with 95% accuracy. However, they tested only 32 participants with various stages of breast or lung cancer, as well as 12 people without cancer. Whether finding cancer that early makes a difference for treatment and survival remains to be seen.

In a car culture like ours, giving up the car keys can be a wrenching decision. Some see it as a loss of independence. For others, especially those who live in areas with poor public transportation, not driving makes it difficult to shop for groceries or see friends. But the fact is that some older people need to make that decision. Pleas from family members can sometimes do the trick. A special article in this week’s New England Journal of Medicine suggests that advice from a doctor can also help people who shouldn’t be behind the wheel any longer stop driving. There are no guidelines regarding who is fit to drive. Sadly, many people finally stop driving after they’ve crashed, or hurt someone. This is definitely a situation where “better safe than sorry” should rule.

Do you have unused or expired medications that you don’t know what to do with? Here’s a smart, safe, environmentally friendly solution: take part tomorrow (Saturday, September 29, 2012) in the fifth National Prescription Drug Take-Back Event, coordinated by the federal Drug Enforcement Administration (DEA). Between 10:00 am and 2:00 pm you can hand over old prescription and over-the-counter drugs at one of more than 5,000 sites across the country. During last spring’s take-back, the participating police stations, hospitals, and other sites collected more than 552,161 pounds of drugs. If you miss this fall’s take-back program, and need to clean out your medicine cabinet now, the FDA recommends taking it out of its original container, mixing it with used coffee grounds, kitty litter, or dirt, putting this unappetizing blend in a plastic container with a tight-fitting lid or in a sealable plastic bag, and placing the container or bag into your regular garbage.

The sleep-robbing condition known as restless legs syndrome (RLS) raises the risk of heart disease in older women about as much as smoking and obesity, according to a new Harvard-based study published online in the journal Circulation. The key sign of RLS is an irresistible urge to move the legs, often accompanied by an uncomfortable “creepy-crawly” sensation. It affects about 2% of adults and is twice as common in women as in men. Symptoms typically flare as people settle into bed, but may also arise when simply resting in a chair or sitting at a desk. Most people with RLS also experience periodic jerking leg motions during sleep. Uncovering this link could help people with RLS pay better attention to their cardiovascular health and potentially ward off a heart attack, stroke, or other cardiovascular condition.

It’s natural to assume that all OTC drugs are safe for just about everyone. But that’s a mistake. A recent report in JAMA by Harvard-affiliated physicians found that when a prescription drug moves to OTC status, balanced advertising tends to fly out the window. Of the four drugs randomly selected for the study—omeprazole (Prilosec, Nexium), orlistat (Alli), loratadine (Claritin), and cetirizine (Zyrtec), only Alli mentioned any potential harmful effects at all. One reason for this is that the Food and Drug Administration (FDA), which oversees the advertising of prescription drugs, insists that every side effect and interaction found in clinical trials of the medication be included in every ad. But OTC advertising is overseen by the Federal Trade Commission, which requires only that ads meet a “reasonable consumer” standard of truthfulness. Does this mean drugs should not be sold OTC? Of course not. But you can avoid potential pitfalls by asking a pharmacist whether the drug is okay for you to take.

For years researchers have been trying to weigh the benefits of finding early breast cancers against the risks related to false positives (the spots that turn out to be harmless). This work has sparked some bitter public debates and confusion for women over flip-flopping recommendations. The latest salvo comes from a review of the results of mammograms among more than 12 million women in 18 European countries. The results support the idea that routine mammograms can prevent deaths from breast cancer without causing undue harm. The findings support the U.S. Preventive Services Task Force’s recommendation that women between the ages of 50 and 74 have a mammogram every other year. Women at higher risk of developing breast cancer may need mammograms earlier than age 50, or more often than every other year.

Most people don’t think twice about taking Motrin, Advil, Aleve, or similar over-the-counter painkillers. A new study suggests that heart attack survivors should use these drugs, known as nonsteroidal anti-inflammatory drugs (NSAIDs), as little as possible. A team of Danish researchers found that among heart attack survivors, those who used an NSAID were about 60% more likely to have died during each year of the five-year study than those who didn’t use an NSAID. Of all the NSAIDs, diclofenac (Cataflam, Voltaren, generic) was linked to the largest increases in death or heart attack rates, while naproxen (Naprosyn, Aleve, generic) appeared to carry the lowest risk. The lower risk with naproxen confirms what has been seen in older studies. If you have heart disease and need pain relief, try acetaminophen first. If you need an NSAID, naproxen is probably the best choice for your heart. But whatever you and your doctor decide is best for you, use the lowest dose possible for the shortest period of time.

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).

What would you pay to keep from getting sick as you get older? How about a daily walk or other exercise? A new study suggests that’s exactly the right investment. In the study, people who were the most fit at midlife lived longer and spent less time being sick than middle-aged folks who weren’t fit. There are many benefits to staying physically active and exercising daily. One important effect of exercise that doesn’t get enough attention is that it improves fitness. Fitness is a measure of how well your heart, blood vessels, blood, and lungs work together to supply muscles with oxygen during sustained exercise. How do you improve your fitness? Increase the amount and the intensity of exercise over time. Don’t rush it. Improving fitness starts within weeks but will continue for months.

Based on data presented this week at the Union for International Cancer Control meeting in Montreal, a startling 40% of cancers may stem from modifiable causes, such as diet, exercise, tobacco and alcohol exposure, and appropriate screening. Although adapting a healthy lifestyle isn’t an ironclad guarantee against cancer, it can help lower a person’s individual risk.

This summer, Harvard Health Publishing hosted a group of mobile health startup companies, all part of the first Rock Health Boston class. I had the pleasure of attending their end-of-program demonstrations. It was 1) fun and 2) inspiring to see the future of medicine as told by young, savvy, energetic teams. All seven startups have similar goals—using the Web or apps to provide faster, better access to health care and to identify health issues before they become huge problems. Speaking before a standing-room-only crowd of potential investors, reviewers, and friends at the Broad Institute in Cambridge, the companies made polished pitches that had come a long way from those they offered upon their arrival at Harvard Health Publishing in June. The seven companies include (in alphabetic order): Home Team Therapy, NeuMitra, NeuroTrack, NoviMedicine, Podimetrics, Reify Health, and RxApps.

The United States is in the midst of the largest outbreak of West Nile virus since that virus was first discovered here in 1999. So far this year, more than 1,100 cases of human West Nile infection have been reported, about half of them in Texas, and at least 40 people have died from the virus. More cases are expected, since West Nile virus infections generally peak in late August and September. The virus is transmitted to humans by mosquitoes. Mosquitoes pick it up by feeding on birds carrying the virus. Very rarely, West Nile virus infection occurs due to transfusion of infected blood. It can’t spread from human to human by casual contact. None of the antiviral drugs currently available kill West Nile virus. And no vaccine is available. Prevention is best: stay inside when mosquitoes are most likely to bite, and use insect repellant when outside.

Compared to the pumping intensity of spin or Zumba, a tai chi class looks like it’s being performed in slow motion. But this exercise program is far more dynamic than it looks. As an aerobic workout, tai chi is roughly the equivalent of a brisk walk. And as a resistance training routine, some studies have found it similar to more vigorous forms of weight training. It is especially useful for improving balance and preventing falls—a major concern for older adults. Tai chi helps improve balance because it targets all the physical components needed to stay upright—leg strength, flexibility, range of motion, and reflexes—all of which tend to decline with age. It also offers an emotional boost to balance by removing the fear of falling that can make some people afraid to exercise.

You’ve probably heard the saying, “It takes a village to raise a child.” After reading about Rosie O’Donnell’s heart attack, I’d like to coin a new one: “It takes a celebrity to sound the alarm about important health issues.” The 50-year-old actress, comedienne, and talk show host suffered a surprise (aren’t they all) heart attack last week. Word got out when she wrote about it on her blog. O’Donnell brushed off some chest pain and arm pain as muscle aches related to some heavy lifting, ditto later feelings of nausea and clammy skin. When she went to the hospital the next day, a key artery in her heart was 99% blocked. At age 50, O’Donnell may have thought she was too young for those problems to signal a heart attack. She also wasn’t familiar with a heart attack’s sometimes sneaky signs and symptoms. O’Donnell urges “know the symptoms ladies/listen to the voice inside/the one we all so easily ignore/CALL 911/save urself.”

Taking care of yourself and your nuclear family is not always easy. Add the need to take care of an aging and ailing parent or family member and the stress can become overwhelming. According to some estimates, more than 40 million adults in the United States care for older or sick adult relatives or friends on a regular basis. AARP has estimated that these family and friends provide up to $450 billion worth of care. The responsibility often falls on family members, because long-term care outside the home can be very expensive and most Americans can’t afford private long-term care insurance that might cover these costs. Regular health insurance, or Medicare, does not pay for the kind of regular daily care many adults need later in life. A new ad campaign sponsored by AARP (formerly the American Association of Retired Persons) and the nonprofit Ad Council wants caregivers to know that they are not alone and that help is available. The goal of the ads is to raise awareness of the effects that family caregiving can have and to help people find the resources they need to reduce the stress.