Harvard Health Blog

Actress Angelina Jolie recently went public with her double mastectomy to prevent breast cancer. Governor Chris Christie told us his reasons for gastric bypass surgery. And now actor Michael Douglas is shining the spotlight on the human papilloma virus (HPV)—the number one cause of mouth and throat cancer. In an interview published in The Guardian newspaper in London, Douglas mentioned that his own throat cancer could have been brought on by oral sex, a common way to become infected with HPV. HPV transmitted by sexual contact often doesn’t become active enough to cause symptoms. When it does become active, it tends to invade mucous membranes, such as those covering the lining of the vagina, cervix, anus, mouth, tongue, and throat. An HPV infection can cause warts in and around these tissues. Most people sexually exposed to HPV never develop symptoms or health problems, and most HPV infections go away by themselves within two years. But the infection can persist and cause long-term problems. These include cervical cancer in women, penis cancer in men, and in both sexes some cancers of the anus and oropharyngeal cancer (cancer in the back of throat, including the base of the tongue and tonsils).

Sunday, June 2, is National Cancer Survivors Day. It was started 26 years ago as a way to recognize and support people living with cancer. The foundation that organizes the yearly event defines survivor as “anyone living with a history of cancer – from the moment of diagnosis through the remainder of life.” National Cancer Survivors Day offers survivors and their family members and friends a chance to acknowledge the hard work that goes into fighting cancer and to show the world that survivors can live fulfilling lives. The day is observed in many different ways. Around the U.S. and in 18 other countries, community groups, hospitals, and other organizations hold breakfasts, picnics, walks, fun runs, and other activities.

We are taught to share at an early age, and sharing is encouraged and praised across the life span. One area in which there has been a lack of sharing is medicine. Doctors have traditionally made decisions for their patients with little or no discussion about the preferences of the person who will ultimately have to live with the decision. That’s changing. More and more, doctors are trying to implement a model known as shared decision making or informed decision making. These terms refer to a process that includes a thoughtful, informed conversation between you and your doctor aimed at making a decision that’s right for you. Shared decision making is gaining acceptance as a medical “best practice.” Many studies suggest that it improves health outcomes, taking medications as directed and following other instructions, and satisfaction with a treatment or course of action.

A lot is known about diabetes. But a discovery that could change how this disease is treated shows just how much more there is to learn. A team of Harvard Medical School researchers has discovered a hormone called betatrophin made by liver and fat cells that signals the body to make more insulin-producing beta cells. A report of their work appears in this month’s issue of the prestigious scientific journal Cell. In mice with diabetes, experimentally turning on the production of betatrophin inside liver and fat cells caused an increase in beta cells and a dramatic improvement in blood sugar. It will, of course, take much more research in mice—and then in humans—to determine if this newly discovered hormone can serve as a treatment for diabetes. So it’s too soon to get excited that the discovery of betatrophin will translate directly into a new treatment for diabetes. But it is another example of the human body’s power to naturally repair itself.

My twice-daily walks with my border collie, Clair DeNoon, are the highlights of my day. A new report from the American Heart Association will put an extra spring in my steps on these walks. A panel of experts from the American Heart Association has weighed all the available evidence on pet ownership and cardiovascular disease. The verdict: Having a pet—a dog in particular—likely lowers the risk of heart disease. Some of the connection can be attributed to the extra walks dog owners take. Companionship also contributes. If dog ownership is heart healthy, should everyone who cares about heart health have a dog? No. According to the heart association panel, “the primary purpose of adopting, rescuing, or purchasing a pet should not be to achieve a reduction in cardiovascular risk.”

With the unofficial start of summer just a few days away, many people will soon be stocking up on sunscreen. The products they’ll be seeing in stores look different than they have in the past. That’s because new rules for sunscreen labels are now in effect. The changes are good ones for consumers. The new rules, mandated by the FDA, are making sunscreen more informative with less misleading information. For example, the term “sunblock” is banned because none of these products can block all of the sun’s ultraviolet rays. “Waterproof” is also banned, replaced by “water-resistant”—which must be accompanied by a set time for reapplication. Another big change has to do with SPF, or sun protection factor. The best protection comes from a sunscreen that provides broad spectrum protection, meaning it filters out much of the UVA and UVB. Under the new FDA rules, if a label says “broad spectrum,” the product must pass tests proving that it truly protects against both UVA and UVB rays. Sunscreen products that don’t meet an SPF of 15 or higher for both UVA and UVB must now carry a warning.

Beginning in March, 2013, reports started to come out of Eastern China that a new “bird flu” virus was loose and causing infections in humans. The new virus is called H7N9. Should we in the U.S. be worried? Neither I nor anyone I know can give a confident answer to that question. So far the news is reassuring. A report from the U.S. Centers for Disease Control and Prevention (CDC), and another from a team from China in this week’s New England Journal of Medicine, indicate that so far the new H7N9 virus has not clearly spread from one person to another, and has not spread outside of Eastern China. Even so, every public health agency around the world is keeping a close eye on China. That’s because a virus that cannot spread easily from one person to another can change or swap genes—and suddenly be capable of spreading easily.

• Fast-food restaurants deliver filling, inexpensive meals and snacks. But there’s usually a hidden added cost: a wallop of salt (sodium) that isn’t good for cardiovascular health. Even with the current clamor for reducing sodium in the American diet, and industry promising to do just that, the amount of sodium in prepared foods hasn’t changed much since 2005, according to a report published in the latest issue of JAMA Internal Medicine. The average sodium in chain restaurant items increased 2.6% between 2005 and 2011. In packaged foods, it fell on average 3.5%. While some are calling for tighter government regulation on the sodium content in processed and restaurant foods, you can take action now.

Angelina Jolie revealed yesterday in a New York Times op-ed article that she underwent a double mastectomy even though she doesn’t have breast cancer. She did that because she carries a gene (BRCA1) that substantially increases her chances of developing the disease. Her mother’s 10-year losing battle with ovarian cancer helped guide her decision. Women who carry BRCA1, BRCA2, or who have at least two close relatives—a mother, sister, or daughter—who have had breast or ovarian cancer are candidates for prophylactic mastectomy. Some women who develop cancer in one breast often have both breasts removed to avoid a recurrence of the disease. Taking time to make the decision, and talking it over with a trusted and knowledgeable expert, is an important part of the decision-making process. Having as much information as possible before choosing prophylactic mastectomy is as empowering as making the decision itself.

In the past decade, a remarkable series of experiments from laboratories all over the world has begun to show what causes aging—and how to slow it. In the latest example of such aging research, two of my Harvard Medical School colleagues, cardiologist Richard T. Lee (co-editor in chief of the Harvard Heart Letter) and stem cell biologist Amy Wagers and their teams have found a substance that rejuvenates aging hearts in mice. The researchers joined the circulation of an old mouse with a thick, stiffened heart to that of a young mouse. After four weeks, the heart muscle of the old mouse became dramatically thinner and more flexible. The team then identified a substance called growth differentiation factor 11 (GDF11) as the probable “anti-aging” substance. It’s too soon to tell if this discovery will ever help humans with heart failure. But it reveals that there are substances naturally present in all living things that cause aging and that retard it. By understanding them, we may someday be able to slow aging.

As wait times to see a doctor for simple problems like sinusitis and urinary tract infection lengthen, more and more Americans are turning to retail health clinics—walk-in medical facilities located in pharmacies, grocery stores, and retailers such as Wal-Mart and Target. The number of visits to such clinics quadrupled from 1.48 million in 2007 to 5.97 million in 2009, according to a study published in the journal Health Affairs, and topped 10 million last year. Convenience is driving this migration to retail health clinics, since you can walk into a retail health clinic without an appointment, and many are open nights and weekends. Although most retail clinics focus on immunizations and common ailments such as strep throat and sinus infections, some are beginning to manage chronic conditions such as high blood pressure, diabetes, high cholesterol, and asthma.

Most reputable companies that provide services tell you what you’ll get for your money. Hospitals are an exception. They haven’t traditionally made public the cost of operations and other procedures. This secrecy has let hospitals set widely different prices for the same procedure. It’s also made it impossible to do any comparison shopping. Yesterday’s release to the public of a once very private database shows just how big the differences can be from hospital to hospital. The database, released by the Centers for Medicare and Medicaid Services, details what 3,300 hospitals charged for the 100 most common treatments and procedures in 2011. It data reinforce the big differences in charges from one part of the U.S. to another. What’s new and surprising are the huge differences sometimes seen between hospitals in the same city, or even the same neighborhood.

New Jersey Governor Chris Christie’s revelation yesterday that he had secretly undergone weight-loss surgery back in February shouldn’t come as a big surprise. He has been publicly (and privately) struggling with his weight for years and fits the profile of a good candidate for this kind of operation. In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease, and sleep apnea, who had tried to lose weight other ways. Christie had a BMI of at least 41. He also acknowledged trying to lose weight many times, using different weight loss programs. He underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery, gastric bypass and the gastric sleeve procedure.

When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help. Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body. Yet a new survey from the Centers for Disease Control and Prevention shows that more than half of people with arthritis don’t walk at all for exercise, and only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function.

Two of every three Americans who reach age 65 will at some point need long-term care for up to three years. Yet the majority of those age 40 and older have done “little or no planning” for how they might pay for long-term care when they get older. That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover. And few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members. Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

It isn’t every day that an effective new treatment for some Parkinson’s disease symptoms comes along. Especially one that is safe, causes no adverse side effects, and may also benefit the rest of the body and the mind. That’s why a report in the New England Journal of Medicine showing that tai chi may improve balance and prevent falls among people with Parkinson’s disease is so exciting. This and earlier studies are significant because they suggest that tai chi can be used as an add-on to current physical therapies and medications to ease some of the key problems faced by people with Parkinson’s disease. Since the appearance of the New England Journal of Medicine study, tai chi classes specifically for Parkinson’s disease patients have sprung up across the country, and the benefits of tai chi for Parkinson’s disease have been endorsed by the National Parkinson’s Foundation.

Adding more protein to the diet and cutting back on carbohydrates, especially highly processed carbs, is an eating strategy adopted by a growing number of people. A new study in the Journal of Nutrition Education and Behavior found that 43% of women surveyed are using the practice of eating more protein to prevent weight gain, and this strategy was associated with weight loss. It isn’t necessary to eliminate all carbohydrates and focus only on protein. Such an eating strategy may have a short-term payoff for weight loss, but it may also come with some long-term risks. Tips for getting a healthful mix of nutrients include adding the healthful trio of fat, fiber, and protein to each meal; avoiding highly processed foods; and choosing the most healthful sources of protein, such as fish, poultry, eggs, beans, legumes, nuts, tofu, and low-fat or non-fat dairy products.

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Strength training is a popular term for exercises that build muscle by harnessing resistance against an opposing force. The resistance can come from your body, or from free weights, elasticized bands, or specialized machines. It makes muscles stronger. Another type of training, known as power training, is proving to be just as important as strength training in maintaining or restoring function. As the name suggests, power training is aimed at increasing power, which is the product of both strength and speed. Optimal power reflects how quickly you can exert force to produce the desired movement. Here’s an example: Faced with a four-lane intersection, you may have enough strength to walk across the street. But it’s power, not just strength, that can get you across all four lanes of traffic before the light changes. Likewise, power can prevent falls by helping you react swiftly if you start to trip or lose your balance. Some power moves are strength training exercises done at a faster speed. Others rely on the use of a weighted vest, which is worn while performing certain exercises that are typically aimed at improving functions such as bending, reaching, lifting, and rising from a seated position.

The bombs that exploded on Monday near the finish line of the Boston Marathon killed three people, physically injured nearly 200 others, and traumatized thousands more. Recovery and healing are beginning for the families of those who died, for the injured and their families, and for others touched by this tragedy. For some, healing will be swift. For others it will be measured in small steps over months, and possibly years. The Marathon explosions will leave a legacy of emotional scars along with the physical ones, even among those who weren’t anywhere near the blasts. Some people who were at the scene of the explosions will undoubtedly develop post-traumatic stress disorder (PTSD). But PTSD is not the only response to frightening events. In fact, most people exposed to a trauma do not develop this condition. They may develop an anxiety disorder, for example, or become depressed. Most people do have some emotional response, but the majority develop no illness at all.

Is red meat bad for your heart? A new study suggests it is, but not for the reasons you might expect—like the saturated fat or cholesterol in red meat. A team from a half dozen U.S. medical centers says the offending ingredient is L-carnitine, an amino acid that is abundant in red meat. Their work shows that eating red meat delivers L-carnitine to bacteria that live in the human gut. These bacteria digest L-carnitine and turn it into a compound called trimethylamine-N-oxide (TMAO), which has been shown to cause atherosclerosis, the disease process that leads to cholesterol-clogged arteries, in mice. There’s still a long way to go before we know the full story about L-carnitine and heart disease, but this work suggests that cutting back on L-carnitine (and avoiding L-carnitine supplements) may be good steps for heart health.

Salt is a cheap, easy way to turn on taste buds. That’s one reason why it’s in so many of the foods we eat. It’s so commonly used that most Americans consume more than double the recommended daily limit for it. Three new studies in BMJ (formerly the British Medical Journal) once again confirm the relationship between salt intake and health problems. They show that reducing salt intake can help lower blood pressure and lower the odds of having a heart attack or stroke or developing heart failure. They also show that consuming more potassium is also linked to lower blood pressure and lower risk of stroke. Current dietary guidelines recommend that Americans get no more than 1 teaspoon of salt a day. That’s the equivalent of 2,300 milligrams (mg) of sodium a day. Most Americans get much more than that. It’s possible to cut back by avoiding processed and packaged foods, using herbs and spices to season food instead of salt, and other strategies. It’s best to get potassium from food, especially fruits and vegetables. Green leafy vegetables, beans, and bananas have a lot of potassium.