Harvard Health Blog

The new fields of pharmacoepidemiology and pharmacoeconomics aim to understand how people use medications and how effective—or ineffective—medications are. A leader in this area is Dr. Jerry Avorn, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. In a recent issue of the Harvard Health Letter, editor Peter Wehrwein spoke with Avorn about generic drugs, the pharmaceutical industry, the high cost of cancer drugs, and more.

For the past five years, the Centers for Disease Control and Prevention (CDC) has recommended that all girls and young women be vaccinated against the human papillomavirus (HPV), a sexually transmitted virus that is a key cause of cervical cancer. Members of a CDC advisory panel have now voted unanimously that boys and young men should also get the vaccine. Vaccinating boys and young men against the virus will help prevent its transmission to women, and will also help prevent some of the 7,000 HPV-related cancers that occur in men each year, including cancers of the penis, anus, head, neck, and throat. HPV also causes genital warts in both men and women. The vaccine works best when a child gets it before he or she becomes sexually active.

Heart disease, stroke, diabetes, asthma, osteoporosis and other common chronic diseases are often blamed on genes, pollution, or the wear and tear caused by personal choices like a poor diet, smoking, or too little exercise. An intriguing hypothesis is that these and other conditions stem from a developing baby’s environment, mainly the womb and the placenta. During the first thousand days of development, from conception to age 2, the body’s tissues, organs, and systems are exquisitely sensitive to conditions in their environment during various windows of time. A lack of nutrients or an overabundance of them during these windows, so the thinking goes, programs a child’s development and sets the stage for health or disease.

Americans are taking antidepressants in astounding numbers. According to a report released yesterday by the National Center for Health Statistics (NCHS), the rate of antidepressant use in this country among teens and adults (people ages 12 and older) increased by almost 400% from the early 1990s to the mid 2000s. The federal government’s health statisticians figure that about one in every 10 Americans takes an antidepressant. Antidepressants were the third most common prescription medication taken by Americans in the study period. Antidepressant use was higher in women than men, and in whites than blacks or Hispanics.

Your kitchen cabinets—along with your pantry, refrigerator, and grocery list—are probably more important than your medicine cabinet for maintaining or improving your heart’s health. That’s because what you eat influences many of the things that contribute to heart disease, including high blood pressure, high cholesterol, diabetes, inflammation, and electrical instability and function of the heart. The foods you choose can make these factors better, or worse. Healthy Eating for a Healthy Heart, a newly revised Special Health Report from Harvard Health Publishing, details a heart-healthy eating plan that you can follow for the rest of your life—while still enjoying the foods you eat. Some of the best choices include fish, vegetables, and whole grains. Healthy Eating for a Healthy Heart also includes 39 recipes of healthy, delicious, and easy-to-make foods.

Thirty-five years ago, Dr. Herbert Benson defined and tested the relaxation response. This simple method for quieting brain activity slows the body’s processes and induces a feeling of well-being. Both have measurably positive effects on disorders caused by stress or made worse by it, including high blood pressure, abnormal heart rhythms, and many digestive disorders. In a recent lecture at Harvard Medical School, Dr. Benson described the technique and talked a crowd through it. Inducing the relaxation response is simple: Sit in a quiet place with your eyes closed. Relax your muscles and silently repeat a word, phrase, sound, or short prayer of your choosing over and over. When stray thoughts interfere (as they will), let them come and go and return to your word, phrase, or sound. Doing this daily can help ease stress.

For the first time, the U.S. Preventive Services Task Force recommends that healthy men avoid getting regular prostate cancer screening tests.  The new recommendation, which conflicts with existing recommendations from the American Urological Association, has sparked controversy among experts and confusion among patients. Harvard’s Ann MacDonald, Editor of the Annual Report on Prostate Diseases, offers […]

The U.S. Preventive Services Task Force is expected soon to release an updated statement on PSA (prostate-specific antigen) testing for men, recommending for the first time that healthy men avoid getting regular PSA tests. This is big news, as the PSA test is one of the most common prostate cancer screening tests around.

Alzheimer’s disease is a “disease of behaviors” that can wear down family and loved ones. In a talk called “Dementia and Cognitive Decline (Aging Gracefully)” Barbara Moscowitz, coordinator of geriatric social work for the Geriatric Medicine Unit at Harvard-affiliated Massachusetts General Hospital, offered helpful insights and tips into caring for people with Alzheimer’s disease. Moscowitz drew not only her 30 years of professional experience, but also on the personal experience of helping take care of her mother, who suffered from dementia the last several years of her life.

Many people try to tune out stress. A healthier approach may be to tune in to it. Paying more attention to what is going on around you, not less, is the first step toward cultivating mindfulness, an excellent technique to help you cope with a range of mental and physical problems, including stress. Mindfulness teaches people to be present in each moment. The idea is to focus attention on what is happening now and accepting it without judgment. Mindfulness techniques have been shown to ease stress, prevent major depression from reappearing, alleviate anxiety, and even reduce physical symptoms such as pain or hot flashes.

People with pacemakers and implantable cardioverter-defibrillators (ICDs) are often told that they can’t get an MRI scan. The worry is that the powerful magnetic fields and radio waves MRI scanners use might “fry” the devices, induce current so hearts would beat wildly or, in the case of ICDs, cause an unnecessary shock. A new study suggests that with the proper monitoring, MRIs can be safe for many people with pacemakers and ICDs. One of the biggest obstacles will be cost, since a specially trained nurse or a doctor would need to be present to reprogram the device and to respond in case of an emergency.

Replacing unhealthy behaviors with healthier ones usually isn’t easy, and many ambitious attempts often fall short. But you’re more likely to succeed if you start by choosing the right goal—the one you are most likely to accomplish—rather than the goal you think you should make. Breaking a goal into bite-sized pieces also helps. So does making your goal a SMART one (specific, measurable, achievable, realistic, and time-based).

A few years back, my colleague Michael Miller wrote an interesting article about the adolescent brain in the Harvard Mental Health Letter. I had only a passing interest in the topic at the time, being far more focused on raising a 9-year old and a pair of 8-year-olds. Fast-forward six years, and I now have […]

A new study published in The Journal of the American Medical Association finds that saw palmetto, a fruit extract commonly taken to treat urinary tract symptoms caused by an enlarged prostate (technically termed benign prostatic hyperplasia, or BPH), is no more effective in relieving symptoms than placebo, even at high doses. The federally funded study […]

For years, Dr. Anthony Komaroff has answered his patients’ questions one-on-one. With the launch of Ask Doctor K, a daily newspaper column that appears in 450 newspapers, he will be answering questions from people across the U.S and beyond via daily newspaper and the Internet (at AskDoctorK.com). Dr. Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of Harvard Health Publishing. In the column, he will offer clear answers and straight advice to readers’ questions, talk about new treatments that are available today or will be soon, and focus on proven changes in lifestyle that can keep readers healthy, help them cope with chronic diseases, and improve their quality of life.

About 10% of women who have heart attacks seem to have clear, unblocked arteries. They don’t, really. Instead, they have a problem inside tiny arteries supplying the heart muscle, called microvessels. Traditional diagnostic tests can’t “see” into microvessels. In larger coronary arteries, the buildup of cholesterol-filled plaque creates distinct bulges that narrow the vessel at a particular spot, reducing blood flow. In microvessels, plaque uniformly coats the inner layer. This reduces the space for blood flow and makes the arteries stiff and less able to expand in response to exercise or other stress. Researchers are still trying to determine the best ways to diagnose and treat microvessel disease. Talking to cardiologists at Harvard-affiliated Brigham and Women’s Hospital, Dr. C. Noel Bairey Merz said that the erectile dysfunction drug Viagra (sildenafil), which was originally developed to improve blood flow to the heart, is being tested as one possible therapy.

Sometimes chronic tinnitus can be fixed by taking care of the underlying cause, like grinding your teeth at night or taking aspirin. Otherwise, one of the simplest approaches is masking the noise by listening to music or having a radio, fan, or white-noise machine going in the background. Some companies make devices worn like hearing aids that generate low-level white noise. Hearing experts often recommend masking before turning to more expensive options such as cognitive behavioral therapy, tinnitus retraining therapy, biofeedback and stress management, and transcutaneous electrical stimulation of parts of the inner ear.

Smokers who want to quit can turn to a nicotine replacement products, prescription medications, and counseling. What about the newest stop-smoking aid, the electronic cigarette? Despite its appeal, we don’t know enough about the safety or effectiveness of electronic cigarettes to give them the green light. Preliminary studies from the FDA, New Zealand, and Greece raise some concerns about the dose of nicotine delivered and potentially harmful chemicals that might be in the vapor. Until good studies have been done on electronic cigarettes, the best way to quit involves using nicotine replacement or a medication along with some sort of counseling or support, either in person, by telephone, or even by text message.

Gluten, an umbrella term for proteins found in wheat, rye, and barley, makes dough resilient and stretchy. Some people can’t eat foods made with these grains because gluten triggers an immune reaction and causes inflammation of the lining of the small intestine. This can eventually interfere with the absorption of nutrients from food. This condition, called celiac disease, can cause symptoms like gas, bloating, and abdominal cramps. A growing number of people who don’t have celiac disease suffer many of its symptoms. They are classified as “gluten sensitive” or “gluten intolerant.” A new Special Health Report from Harvard Health Publishing called “Food Allergy, Intolerance, and Sensitivity” covers how to cope with gluten sensitivity, lactose intolerance, and other food allergies and sensitivities.

The death of Kara Kennedy, the only daughter of the late Senator Edward M. Kennedy, at age 51 from an apparent heart attack while exercising offers a reminder of the possible long-term effects of cancer and its treatment. In 2002, Kennedy was diagnosed with lung cancer. After having part of her lung removed, she underwent chemotherapy and radiation therapy. She lived for another nine years, in apparently good health. One of the hazards of some cancer survivors face is that the treatments used to fight cancer—drugs, radiation, and hormones—sometimes damage the heart and arteries.

Many people have trouble telling whether they are having heartburn or a heart attack. “Many people” includes doctors. A personal story from a Harvard physician describes how he treated himself with strong acid-suppressing pills until a near heart attack made him realize he had heart disease. His story appears in an updated Special Health Report from Harvard Medical School called “Heart Disease: A guide to preventing and treating coronary artery disease.”

Perfectionism has a dark side—it is often seen as obsessive and sometimes pathological. But it has a bright side, too. Desirable aspects of this personality trait include conscientiousness, endurance, satisfaction with life, and the ability to cope with adversity. This helps explain why some perfectionists become corporate leaders, skilled surgeons, or Olympic champions. In his new book, The Perfectionist’s Handbook, Dr. Jeff Szymanski describes how to become a better perfectionist—by building on the strengths of this quality and learning to minimize its drawbacks. A key step in becoming a better perfectionist is to learn how to turn mistakes into strategic experiments, says Szymanski, a clinical instructor of psychology at Harvard Medical School and executive director of the International OCD Foundation.