Harvard Health Blog

In a new essay entitled “Big Med,” physician-author Atul Gawande muses in The New Yorker if The Cheesecake Factory and other successful chain restaurants could serve as a model for improving health care. He wondered how a large restaurant could deliver “a range of services to millions of people at a reasonable cost and with a consistent level of quality,” while hospitals and other parts of the U.S. health care system can’t. The experience prompted Dr. Gawande to meet with managers, cooks, and other workers at a Boston-area Cheesecake Factory to see how it delivers good food and a good dining experience time after time. He then goes on to compare the restaurant’s procedures with what goes on in hospitals.

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.

A recent study in the Archives of Internal Medicine indicates that the risk of having a heart attack is up to 31 times higher immediately following joint replacement surgery. Those relative risk numbers could be terrifying for someone who needs to have a knee or hip replaced. The absolute risk numbers offer some reassurance. In the six weeks following surgery, one in 200 people in the study who got a new hip and one in 500 who had a knee replaced suffered a heart attack. One new point the study underscored is that the elevated risk may last longer than previously thought. Though earlier research had suggested a danger zone lasting four to five days after joint replacement—coincidentally, the period in which many people are discharged from the hospital—the elevated heart attack risk may persist for two to six weeks.

Thanks to medical advances in detecting and treating stroke, the risk of dying from one is now lower than it used to be. Unfortunately, many stroke survivors are left with a disability. In fact, stroke is the leading cause of serious long-term disability in the United States. A new study from Indianapolis suggests that yoga may benefit some stroke survivors. In this study, 47 stroke survivors were divided into three groups. Some took part in a twice weekly group yoga session for eight weeks, and others received standard follow-up but no yoga. There were several benefits in the yoga group, including improved balance, improved quality of life, reduced fear of falling, and better independence with daily activities. Although small, this study adds to findings from other research that yoga may help stroke survivors in several ways.

For some people with depression that isn’t alleviated by medication or talk therapy, a relatively new option that uses magnetic fields to stimulate part of the brain may help. Called repetitive transcranial magnetic stimulation (rTMS), it was approved by the FDA in 2008. Although more and more centers are beginning to use transcranial magnetic stimulation, it still isn’t widely available. Transcranial magnetic stimulation directs a series of strong magnetic pulses into the brain. These pulses create a weak electrical current that can increase or decrease activity in specific parts of the brain. In two large studies, rTMS improved depression in 14% of people who underwent it, compared to 5% who underwent sham, treatment. The cost can range from $6,000 to $10,000, depending on the clinic and how many sessions are needed. Insurance may not cover the cost of treatment.

New guidelines now urge adults who have been infected with HIV to start taking HIV-fighting drugs as soon as possible, ideally within two weeks of being diagnosed with the infection, rather than waiting to see what happens with white blood cell counts. By preventing the virus from multiplying in the body, this strategy can maintain health and slow—or even stop—the progression to AIDS. Equally important, taking anti-HIV drugs early can decrease the odds that a person will spread HIV to someone else as much as 96%. The new guidelines, from the International Antiviral Society—USA Panel, were presented at the 19th International AIDS Conference, now going on in Washington DC. The new guidelines aren’t without their challenges. Patients must be “ready and willing” to stick with drug therapy, which can be complicated. Another hurdle is cost. An effective anti-HIV drug strategy costs more than $1,000 a month.

Is there a spring in your step—or a wobble in your walk? The speed and stability of your stride could offer important clues about the state of your brain’s health. According to new research, an unsteady gait is one early warning sign that you might be headed for memory problems down the road. A group of studies reported last week at the Alzheimer’s Association International Conference in Vancouver, Canada, revealed a strong link between walking ability and mental function. What’s behind this connection? Walking is a complex task that requires more than just moving the leg muscles. Walking requires scanning the environment for obstacles and safely navigating around them, all while talking and carrying out various other tasks. The studies found that walking rhythm was related to information processing speed; walking variations and speed were associated with executive function (the mental processes we use to plan and organize); and walking speed became significantly slower as mental decline grew more severe.

Controlling high blood pressure is a good thing—unless you are a frail older person. Then it might be harmful. That’s the surprising finding of a study of more than 2,000 seniors published online in the Archives of Internal Medicine. In the study, high blood pressure was linked to an increased risk of dying only among older adults who were relatively fit. Among those who couldn’t walk 20 feet, those with high blood pressure were less likely to have died. It’s possible that frail older adults benefit from having higher blood pressure. It’s also possible that using multiple medications drive down blood pressure in older, frail adults may do more harm than good.

If you start an exercise program, it only seems fair that you should see your hard work reflected in lower numbers on the scale. If it isn’t, don’t despair—or quit exercising. You are still helping your heart, lungs, and every other part of your body. A study in the Journal of the American College of Cardiology looked at the effects of exercise and/or weight loss on cardiovascular health among more than 3,000 men and women who were initially overweight. As I write in the July issue of the Harvard Health Letter, those who exercised consistently and lost weight had the biggest reduction in heart attack risk over six years of follow-up. Exercising without losing weight and losing weight without exercising offered smaller benefits. Although exercise and weight don’t always move in the same direction, they are both important for health.

Although dying is a fact of life, few people want to think about it. One group that must think about dying are people with advanced cancer who are told they have just a few months to live. What helps them end their days as peacefully as possible? A new study from Harvard-affiliated Dana-Farber Cancer Center and Brigham and Women’s Hospital found that being at home instead of in the hospital, talking with a chaplain or other minister, and spending time in private religious activity helped achieve this. When it’s clear that there’s no stopping cancer, heart failure, or other conditions, palliative care can help create a situation that maintains quality of life and leads to a “good death.”

After a hospitalization, being discharged is a key step on the road to recovery. But that road can take a dangerous turn—namely, a serious problem with one or more medications. It’s a common problem that many people experience within a few weeks of leaving the hospital. Researchers at Brigham and Women’s Hospital reported in the […]

Daily exercise appears to reduce a woman’s risk of developing breast cancer, according to a study published online in the journal Cancer. The type or intensity of the exercise didn’t seem to matter, as long as it was done often. How much exercise is needed to lower breast cancer risk? In this study of 3,000 women, 10 to 19 hours a week (about two hours a day) had the greatest benefit. Age didn’t seem to matter—physical activity reduced breast cancer risk in younger women during their reproductive years and older women after menopause. What did make a difference in the effect of exercise was weight gain—especially after menopause. Gaining a significant amount of weight essentially wiped out the benefits of exercise on breast cancer risk in older women.

The FDA has approved a new kind of PSA test for prostate cancer that its maker claims can help doctors do a better job of telling the difference between prostate cancer and less worrisome conditions such as prostate infection or benign prostate enlargement. The test, called the Prostate Health Index (PHI), should become available in the U.S. later this summer. The PHI combines measurements of three kinds of prostate specific antigen (PSA), a protein produced by the prostate gland. In theory, the combination could help reduce the number of men who undergo prostate biopsies when their PSA levels are slightly above normal, in the 4 to 10 nanogram per milliliter range. But doctors must take care not to allow use of the PHI test to worsen the existing overdiagnosis and overtreatment of low-risk cancers, according to Dr. Marc B. Garnick, an expert in prostate cancer at Harvard Medical School and editor in chief of HarvardProstateKnowledge.org.

A new book from First Lady Michelle Obama, “American Grown: The Story of the White House Kitchen Garden and Gardens Across America,” details the challenges and joys the First Lady has experienced with her now-famous White House garden. It also looks at community gardens all across America, and how they can improve health. The book contains helpful hints for starting your own vegetable garden, as well as a school or community garden. This effort dovetails with Mrs. Obama’s “Let’s Move” initiative. In addition to getting more physical activity, so the thinking goes, eating more food harvested from the ground and less from packages can help kids — and adults — become healthy or stay that way. The health benefits of growing your own food range from helping you eat more fresh fruits and vegetables to deciding what kinds of fertilizers and pesticides come in contact with your food.

Today’s ruling by the Supreme Court that largely upholds the Patient Protection and Affordable Care Act should be viewed as a landmark event—whether one agrees with it or not. The Supreme Court’s ruling means that many more people will have health insurance; that health care will continue to be provided largely by the private sector; and that insurance companies won’t be able to deny an individual coverage because he or she has a chronic medical condition, drop coverage if an individual becomes sick, or put limits on the amount of lifetime coverage a person can get. It also means that individuals without health insurance will have to pay for it, and that many employers who do not currently offer health insurance as a benefit will be required to do so, or pay a stiff penalty.

The U.S. Preventive Services Task Force (USPSTF) has stirred up a maelstrom of debate by proposing that healthy postmenopausal women lay off daily calcium and vitamin D supplements, which the task force says may do more harm than good. The USPSTF concluded that, based on the available evidence, supplements containing up to 400 IU of vitamin D and 1,000 milligrams (mg) of calcium don’t reduce fractures in postmenopausal women. Plus, these supplements may slightly increase the risk of kidney stones. As a result, the USPSTF says that postmenopausal women who aren’t at risk for osteoporosis shouldn’t be taking these supplements to prevent fractures. The jury is still out on whether it’s worth it for women and men to take higher doses of calcium and vitamin D to prevent fractures, or to take vitamin D to prevent cancer. Our experts say that most of your daily calcium should come from your kitchen, not your medicine chest.

We usually think of post-traumatic stress disorder (PTSD) as an aftermath of military combat or terrible trauma. It can also strike heart attack survivors. By the latest account, 1 in 8 people who live through a heart attack experiences a PTSD-like reaction that might be called post-traumatic stress disorder (PTSD). They experience the same key symptoms: flashbacks that occur as nightmares or intrusive thoughts. They try to avoid being reminded of the event and become hypervigilant worrying that it will happen again. As treatments for heart attack continue to improve, 1.4 million people a year are now surviving the event long enough to be discharged home. If the study is correct, 168,000 of them will be diagnosed with PTSD every year. It’s a grim reminder that as we get better at fixing the body, we must recognize the need to treat the mind.

Drinking alcohol during pregnancy has been taboo for some time, largely because drinking too much can cause fetal alcohol syndrome (FAS). Because no one has been able to identify a clear threshold for “safe” drinking during pregnancy, doctors tell women to steer away from alcohol entirely. A series of five studies from Denmark published in BJOG An International Journal of Obstetrics and Gynaecology found that “low” (1-4 drinks per week) to “moderate” (5-8 drinks per week) alcohol consumption in early pregnancy did not harm the neuropsychological development of children evaluated at age five. Drinking more appears to be a different story. In one of the studies, five-year-olds whose mothers consumed higher levels of alcohol (9 or more drinks per week) during pregnancy were significantly more likely to have lower attention spans. The authors of the study do not argue that drinking alcohol during pregnancy is wise or to be encouraged. In fact, most doctors will continue to advise pregnant women not to drink alcohol. is there a middle ground? Perhaps. Deciding to have a sip (or glass) of champagne at a special occasion during pregnancy may not be an unreasonable or unsafe choice–one that each woman has to make for herself, ideally after talking with her obstetrician or midwife about this issue.

Why is it so incredibly hard to quit smoking—even when you are desperate to do so? For some people, the answer may be in their genes. In a report published online in the American Journal of Psychiatry, a team led by Dr Li-Shiun Chen of the Washington University School of Medicine identified a “high risk” version of a nicotine receptor gene that is more common in heavy smokers. Those with the high-risk gene took two years longer to quit smoking. But there was a silver lining: smokers with the high-risk gene were three times more likely to respond to smoking cessation therapies. The study provides hope for even hardcore smokers. However long it takes, quitting is beneficial. In a study published in the Archives of Internal Medicine, quitting smoking reduced the risk of dying—even in people in their 80s. “Even older people who smoked for a lifetime without negative health consequences should be encouraged and supported to quit,” the researchers wrote.

For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse. In a presentation at yesterday’s annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers reported that almost 11% of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7% drank too much before the operation, representing a 50% increase. This finding shouldn’t steer people who could benefit from gastric bypass surgery away from the procedure. But it should prompt them—and their doctors—to be on the lookout for changes in alcohol use or abuse afterward.