Harvard Health Blog

How do people make decisions about their health and medical treatment? Husband and wife doctor team Jerome Groopman and Pamela Hartzband, both faculty members at Harvard Medical School and physicians at Beth Israel Deaconess Medical Center, explore this topic in a new book called Your Medical Mind. They say three basic influences drive our medical decisions: our mindset or general approach to medical matters, numbers (medical data and how they are presented), and stories. Groopman and Hartzband interviewed scores of patients to arrive at general mindsets that shape medical decisions: maximalists and minimalists, naturalists and technologists, believers and doubters. These mindsets can change in the face of new numbers, well-framed advice from physicians, compelling stories from friends and family, and direct-to-consumer advertising.

For neck and shoulder pain, doctors once recommended rest, maybe the use of a neck brace, and waiting until the pain had ebbed away. Today there are recommending movement instead of rest. As described in Neck and Shoulder Pain, a newly updated Special Health Report from Harvard Health Publishing, there is mounting scientific evidence for the role of stretching and muscle strengthening in treating people with neck and shoulder pain. After a whiplash injury, for example, people heal sooner and are less likely to develop chronic pain if they start gentle exercise as soon as possible. For those with long-term pain (called chronic pain) results from controlled studies show that exercise provides some relief. Exactly how much exercise to do, what types are best, and how often it should be done have yet to be completely hashed out.

Type 1 diabetes, once called juvenile-onset diabetes, takes a toll on health and longevity. Some people, though, have managed to live with the disease for decades. Since 1970, almost 3,500 men and women who have lived with type 12 diabetes for a half century have been recognized by the Joslin Diabetes Center in Boston with bronze 50-year medals. Forty-five of them have passed the 75-year mark. A study that includes several hundred 50-year Medalists is changing experts’ understanding of type 1 diabetes. Many of the 50-year Medalists have no signs of diabetes-induced eye or kidney damage, and some still continue to make small amounts of insulin. This work may uncover new ways to protect people from the damage diabetes can cause and point ways to new treatments for it.

Many prostate cancers grow very slowly and never escape the prostate. They cause no symptoms, and never threaten health or life. Yet almost 90% of men told they have prostate cancer opt for immediate treatment with surgery or radiation therapy—which often cause trouble getting or keeping an erection and an assortment of urinary problems. Yesterday, a panel of experts convened by the National Institutes of Health recommended that many men with localized, low-risk prostate cancer be closely monitored, and that treatment be delayed until there was evidence that the disease was progressing.

At least for men, being more fit may have a bigger health payoff than losing weight, according to a new study of more than 14,000 well-off middle-aged men who are participating in the Aerobics Center Longitudinal Study. Researchers followed their health, weight, and exercise habits for 11 years. Compared with men whose fitness declined over the course of the study, those who maintained their fitness levels reduced their odds of dying from cardiovascular disease or any other cause by about 30%, even if they didn’t lose any excess weight. Those who improved their fitness levels saw a 40% reduction. For optimal health, being fit and maintaining a healthy weight are best. But if you are overweight and inactive, this study and others suggest that getting more activity is the best place to start to improve your health.

It’s more than just a few flecks. President Barack Obama, who turned 50 in August, is definitely going gray. He’s said the color change runs in his family and has mentioned a grandfather who turned gray at 29. Dr. Michael Roizen, of RealAge.com fame, says presidents age twice as fast as normal when they’re in office. Not so, says new study of presidential longevity. According to an article in the Journal of the American Medical Association, there’s no evidence that American presidents die sooner than other American men of their time. In fact, quite the opposite: most of them lived long lives and beat the longevity expectations for their time. Seven of the first eight presidents lived to a ripe old age, with average life spans of 81.5 years. These men probably had some inborn hardiness, as well as fortunate circumstances.

Most men with advanced prostate cancer are at high risk for developing bone metastases, the process by which cancer spreads to and weakens the bones. A serious health and financial concern, bone metastases can lead to fractures, spinal cord compression, pain and a need for radiation therapy or bone surgery. These complications are referred to […]

On the 13th annual World AIDS Day, there’s cause for hope. The epidemic seems to have peaked. Drug therapy has turned HIV/AIDS into a manageable chronic disease. Drug therapy appears to prevent transmission of HIV from infected to uninfected individuals. And HIV cures are under investigation. Yet there is also cause for continued alarm. The AIDS epidemic is far from over, and the downward trends in infection rates could plateau or head up if prevention and treatment efforts slack off. The overalI trends don’t apply to everybody. In the United States, new HIV infections are still increasing among young black men, both gay and bisexual. And despite all the research into HIV and over two dozen ongoing trials of candidate agents, there’s still no HIV/AIDS vaccine.

The patent on Lipitor, the world’s best-selling brand name prescription drug, expired on November 30th. That opens the door for less expensive generic versions of the drug, called atorvastatin, which are now available. In addition to atorvastatin, six other statins are currently available in the United States. Generic drugs are chemical clones of their brand-name counterparts. By law, generic drugs must contain the same active ingredients as the brand-name drug, work the same way in the body, and meet the same standards the FDA has set for the brand-name drug. One big difference is cost. Generic atorvastatin should be less expensive than brand-name Lipitor, although Pfizer, the company that makes Lipitor, is striking deals with insurers and pharmacy benefit managers to price brand-name Lipitor at or under the generic alternatives in order to keep sales of Lipitor as strong as possible for as long as possible.

Today, the only reliable way to check blood sugar is by pricking a finger, squeezing out a drop of blood, and placing it on a small test strip attached to a meter. For some people, this means five to ten finger sticks a day. Researchers across the country are exploring pain-free ways to measure blood sugar. University of California, San Diego researchers have developed a titanium sensor the diameter of a quarter that would be implanted under the skin and wirelessly send blood sugar readings to an external monitor. At Northeastern University in Boston, researchers are working on a blood sugar “tattoo” by injecting glucose-detecting nanosensors under the skin. Arizona State University researchers are working to perfect a device that measures blood sugar using tears instead of blood.

Some medications are well known for being risky, especially for older people. Certain antihistamines, barbiturates, muscle relaxants—take too much of them, or take them with certain other medications, and you can wind up in serious trouble (and possibly in the back of ambulance). But researchers from the federal Centers for Disease Control and Prevention (CDC) […]

If exercise is good medicine, then yoga is, too. Research published recently suggests that yoga can be a useful therapy for lower back pain. An article in the November 2011 Harvard Health Letter indicates that yoga may also be a good way to keep feet strong and flexible, and so prevent falls. It can also help people who suffer from migraines. In The Migraine Solution, which will be published in January by Harvard Health Publishing and St. Martin’s Press, coauthor Paul B. Rizzoli, M.D., says that yoga can be a useful treatment for migraine because it is widely available, affordable, and very likely has benefits beyond migraine.

Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones. Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.

Many older people develop delirium when they are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. Hospital delirium is especially common among older people who’ve had surgeries such as hip replacement or heart surgery, or those who are in intensive care. Inflammation, infection, and medications can trigger hospital delirium as can potentially disorienting changes common to hospital stays, including sleep interruptions, unfamiliar surroundings, disruption of usual routines, separation from family and pets, and being without eyeglasses or dentures. Although delirium often recedes, it may have long-lasting aftereffects, including premature death and poorer outcomes, such as dementia and institutionalization.

One of the challenges faced by many servicemen and servicewomen returning from war is post-traumatic stress disorder, or PTSD. This a lasting and exaggerated reaction to a terrifying or life-threatening event. It makes a person feel like he or she is living through the event over and over again. PTSD shows itself in three main ways: re-experiencing, avoidance, and arousal. Traumatic events can create memories that are stronger, more vivid, and more easily recalled than normal events. These haunting memories activate brain circuits that are responsible for instantly responding to potentially life-threatening situations. Good treatments are available for PTSD. A type of talk therapy known as cognitive-behavioral therapy appears to be the most effective. Antidepressants and other medications can also help.

The manslaughter trial of Michael Jackson’s personal physician, Dr. Conrad Murray, focused a lot of attention on a powerful anesthetic agent called propofol. Propofol is sometimes called the “milk of anesthesia” because it comes in a white, oily solution. Propofol is used as an induction agent—the drug that causes loss of consciousness— for general anesthesia in major surgery. Propofol is also a very good anesthetic for milder sedation used for outpatient surgery because it puts people in a semi-conscious, drowsy state. It starts acting quickly, but also wears off quickly. Like many sedating anesthetics, propofol lowers blood pressure and suppresses breathing, so the heart function and breathing of patients need to be constantly monitored. With a lot of propofol around, opportunities exist for abuse, with possibly fatal consequences.

As many as 32 million American women and men have some degree of incontinence—the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. The most common causes of incontinence are childbirth and aging in women; prostate disorders and their treatment in men. Treatments include exercises to strengthen the pelvic floor, fluid management, medications, and surgery. For people with urinary incontinence, fluid management is an easy place to start, explains Better Bladder and Bowel Control, a new Special Health Report from Harvard Medical School. This involves drinking only when you are thirsty, limiting your fluid intake from all sources to six to eight 8-ounce cups of fluid per day from all sources, and minimizing caffeinated and carbonated drinks, as well as alcohol.

Most Americans fall back from daylight savings 2011 during the wee hours of Sunday morning, November 6. Although the time change can be discombobulating, our hearts like it better than springing ahead. One study showed fewer heart attacks on the Monday after the end of daylight savings time in the fall; the opposite happens in the spring. Getting, or losing, that extra hour of sleep may explain the differences. Ways to ease into the time change include going to bed and waking up at the same time as usual, and getting some sunlight on Sunday as soon as you get out of bed.

It was once thought that taking vitamin E could reduce the risk of prostate cancer. However, recent research suggests this is not the case. Back in 2008 one large study, known as the Selenium and Vitamin E Cancer Prevention Trial (SELECT), showed that not only did vitamin E fail to decrease the risk of prostate […]

A 28-year study of 106,000 women found that moderate alcohol slightly increases a woman’s risk of developing breast cancer. Women who had the equivalent of three to six drinks a week had a modest increase in their risk of breast cancer (15%) compared to women who never drank alcohol. That would translate into an extra 3 cases of breast cancer per 1,000 women per year. The risks were the same for wine, beer, and spirits. Because moderate drinking appears to prevent some types of heart disease—which affects more women than breast cancer does—it’s important for women to think about alcohol in light of their own personal health situation.

Although current recommendations call for pediatricians to ask their adolescent patients about alcohol and drug use at every visit, many don’t. To make it easier for doctors and nurses to do this, the American Academy of Pediatrics has just published a set of questions to guide the confidential conversation, along with advice on what to do with the answers. The first question is a simple one about drug or alcohol use. If the answer is no, the health care provider should praise the teen and encourage him or her to continue making good decisions about health and safety. If the answer is yes, six follow-up questions called the CRAFFT questions) can help separate those who are experimenting from those who may be headed for serious trouble and need more in-depth help.