Good Health Information Can Save Lives

My colleagues at Harvard Health Publications and I have a mission: To provide accurate, reliable information that will help readers live healthier lives. We work hard to fulfill that mission, and the feedback we get from folks who read our newsletters, Special Health Reports, books, and online health information indicates we are on the right track. Every so often we hear something from a reader that makes me especially proud of the work we do.

This letter was recently sent to the editor of the Harvard Womena??s Health Watch:

One of your mailings undoubtedly saved me a lot of grief. (My kids, anyway.) I was aware of a womana??s heart attack symptoms being different from a mana??s, and your brochure contained a paragraph confirming that. Early in June I was packing for a trip to celebrate my brothera??s 90th birthday, at the same time a ditching project was being done in my back lot. Trying to deal with several matters at the same time is a talent Ia??ve outgrown, at 88, so didna??t think too much of the sudden fatigue and vague aches I felt in jaw & arms. I crashed for a nap in my recliner, felt OK afterwards, and figured it was just stress. The next day I was ready to leave, but got to thinking of those symptoms, and the fact the brochure had arrived at just that time, and wondered if it was more than coincidence and maybe I should pay attention? Didna??t much like the idea of something happening out in the middle of nowhere, so took myself to the fire hall where an EMT was on duty. He ushered me into the ambulance, did an EKG, and soon I was being helicoptered on doctora??s orders to St. Josepha??s Hospital. There I had 3 stents installed, and they apparently are doing their job. Thank you!

This echoes what a reader of the Harvard Heart Letter told us a couple years ago:

This past Friday the 13th, in the a.m., I attended mass at a nearby church and when I returned home I felt aches across my chest, on my back, and down both arms. I also felt a bit nauseous. I tried to shrug it off thinking that a visit to the gym a few days before was my problem. I sat down in a chair and on a nearby table I spied a copy of the Harvard Heart Letter. We subscribe to this for my wife who has a heart condition. The cover story cited 10 symptoms of a heart attack. I had 4. We called 911. A few hours later a stent was implanted. I was released on Sundaya??Fathera??s Daya??and the surgeona??s parting words were, a??Tim Russert had a 100% blockagea??yours was 98%a??. I believe very strongly in the Hand of God. Had I not sat down on that particular chaira??and had that particular issue not been therea??the outcome might have been decidedly different. My time had not yet come. Thank you.

In the new year and beyond, the Harvard Health Publications team will continue to bring you honest, practical, on-target information that we hope will make a difference in your life.

From Harvard Medical School and Harvard Health Publications, I wish you good health in 2011.

- Anthony Komaroff, M.D., Editor in Chief, Harvard Health Publications

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Echinacea For Colds: Does It Really Work?

Does echinacea, the popular natural cold remedy, really work?

It depends on what you mean by a??work.a????Results [recently] reported in??the??Annals of Internal Medicine found that echinacea??may reduce the length of a week-long cold by 7 to 10 hours and make symptoms a little less onerous. That cana??t be characterized as a major??effect, so many??people??may??figure that the trouble and expense of echinacea just??isna??t worth it (fortunately,??side effects from echinacea dona??t seem to be much of an issue.)

But others??may decide that some benefit is better than none, and these results??do fit??with others that have left the door slightly ajar for echinacea having some effect as a cold remedy — a modest effect, but an effect, nonetheless.

A summary for patients published by the Annals summed up the situation??nicely:

People who take echinacea to treat colds may experience a decrease in the length and severity of their cold symptoms but to such a small degree that they may not care about the difference. Although many studies of echinacea have been performed, researchers still disagree about its benefits in treating the common cold. This study is unlikely to change minds about whether to take this remedy.

Have you tried echinacea as a cold remedy? Has it worked???How do??research??findings, pro and con, affect your opinion of so-called alternative medicines?

Many of the echinacea studies, especially early on, were sponsored by companies making or selling the product. This study was supported by a grant from the National Center for Complementary and Alternative Medicine, which is part of??the National Institutes of Health.

- Peter Wehrwein, Editor, Harvard Health Letter

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Consider Medical Conditions Before Jumping On The New Year’s Resolution Diet-And-Exercise Bandwagon

The first week of January was full of news reports of giving advice on your new diet and exercise program to help you lose the weight you’ve always wanted to. In a previous post and video I talk about some do’s and don’ts when planning for your weight loss New Year’s resolution.

In the video below, I talk about some medical issues to keep in mind before starting your program. For example,??do you have??a family history of medical problems like high blood pressure or diabetes? If so, you may want to schedule an appointment with your personal physician before jumping on the diet and exercise bandwagon.

If you find??this video helpful, I invite you to check out other TV interviews at MikeSevilla.TV. Enjoy!

                       

Why Every Pregnant Woman Needs To Do A Background Check

The journey to a healthy pregnancy and delivery begins with the selection of a healthcare provider, and??the challenge is to find the right one. This is the person who will be in charge of your pregnancy up until the time of the delivery, so it certainly is not a casual date. For the next 280 days your life and the life of your unborn child will be in this persona??s hands. A background check is therefore in order.

One of the best ways to find the right healthcare provider is by word-of-mouth referral from neighbors, friends, or family members however please dona??t stop there. Labor and delivery nurses are also a great source of referral because they have seen physicians and midwives under their most vulnerable and challenging moments.

Don’t feel intimidated about checking a providera??s credentials — this is public information. You can find out whether the providera??s medical license is current or expired. You’ll also be able to obtain information on whether the provider has ever been disciplined by the board for medical malpractice or unprofessional behavior or misconduct. Healthcare providers are not exempt from problems with alcoholism, drug addiction, professional incompetence, and unprofessional or unethical behaviors. Although less than??five percent of healthcare??providers have egregious problems, you want to make certain that your provider is not one of them.

Once you have a name, you need to check the providera??s credentials. You can obtain this information from your local medical society or state medical board, and in many instances it can be verified online. In the appendix of The Smart Mothera??s Guide you will find the addresses, phone numbers, and websites of the state medical boards in all fifty states, as well as Puerto Rico and the Virgin Islands.

Knowing how to check a providera??s credentials becomes especially important if you have relocated to a new community and are not familiar with local healthcare providers.??It’s also helpful if you belong to a health maintenance organization (HMO)??that can provide you with a limited selection of providers. If you discover that someone on that list has a history of problems, you have leverage in negotiating for a different provider.

Be unapologetically proactive about checking the backgrounds of prospective healthcare providers. A healthy pregnancy doesna??t just happen. It takes a smart mother who knows what to do.

                       

The Forecast For Heart Disease: Gloomy With A Chance Of “Boomers”

As a youngster, I loved being part of the baby boom — it meant there were dozens of kids on my block who were ready to play hide-and-seek or join mysterious clubs. Now that Ia??m of an AARP age, therea??s one club I dona??t want to join: The one whose members have bypass scars, pacemakers, or other trappings of cardiovascular disease. The American Heart Associationa??s (AHA) gloomy new forecast on cardiovascular disease tells me it wona??t be easy to avoid.

The AHA foresees sizeable increases in all forms of cardiovascular disease (see table) between now and 2030, the year all of the boomers are age 65 and older. Those increases will translate into an additional 27 million people with high blood pressure,??eight million with coronary heart disease,??four million with stroke, and??three million with heart failure. That will push the number of adult Americans with some form of heart disease to 110 million.

(Percentages refer to the percentage of Americans aged 18 years and older.)

If the AHAa??s projections are accurate, the cost of treating cardiovascular disease would balloon from $272 billion today to $818 billion in 2030. Add in the cost of lost productivity, and it jumps to more than $1 trillion. Yikes!

Although obesity and inactivity are part of the problem, much of the increase comes from the graying of the baby boom. We cana??t stop boomers from aging, but we can fight cardiovascular disease, a condition the AHA calls a??largely preventable.a??

As I described in an article on the top five habits that harm the heart in the Harvard Heart Letter, healthy habits protect the heart (and the rest of the body). In a long-term study of thousands of female nurses, those who followed five healthy habits (not smoking, maintaining healthy weight, exercising regularly, eating a healthy diet, and having less than one alcoholic drink a day) were a whopping 83 percent??less likely to have had a heart attack or to have died of heart disease over the 14-year study period compared with all the other women in the study. Similar reductions were seen in a study of men.

So, fellow boomers: Leta??s pick up the pace of our personal prevention efforts and prove the AHA number-crunchers wrong!

- P.J. Skerrett, Editor, Harvard Heart Letter

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Treating The Common Cold

For the last week I have had a cold. I usually get one each winter. I have two kids in school and they bring home a lot of viruses. I also work in a hospital, which tends (for some reason) to have lots of sick people. Although this year I think I caught my cold while traveling.?? Ia??m almost over it now, but ita??s certainly a miserable interlude to my normal routine.

One thing we can say for certain about the common cold — ita??s common. It is therefore no surprise that there are lots of cold remedies, folk remedies, pharmaceuticals, and a??alternativea?? treatments. Finding a a??cure for the common colda?? has also become a journalistic cliche — reporters will jump on any chance to claim that some new research may one day lead to a cure for the common cold. Just about any research into viruses, no matter how basic or preliminary, seems to get tagged with this headline.??(Ita??s right up there with every fossil being a a??missing link.a??)

But despite the commonality of the cold, the overall success of modern medicine, and the many attempts to treat or prevent the cold — there are very few treatments that are actually of any benefit. The only certain treatment is tincture of time. Most colds will get better on their own in about a week. This also creates the impression that any treatment works — no matter what you do, your symptoms are likely to improve. It is also very common to get a mild cold that lasts just a day or so. Many people my feel a cold a??coming ona?? but then it never manifests. This is likely because there was already some partial immunity, so the infection was wiped out quickly by the immune system. But this can also create the impression that whatever treatment was taken at the onset of symptoms worked really well, and even prevented the cold altogether.

What Works

There is a short list of treatments that do seem to have some benefit. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen, can reduce many of the symptoms of a cold??– sore throat, inflamed mucosa, aches, and fever. Acetaminophen may help with the pain and fever, but it is not anti-inflammatory and so will not work as well. NSAIDs basically take the edge off, and may make it easier to sleep.

Decongestants may also be of mild benefit. Antihistamines have a mild benefit in adults, but not documented in children. There are also concerns about safety and side effect in children. Overall, other than some TLC and NSAIDS (although not aspirin) parents should probably not give their children anything for a cough or cold. The benefit of antihistamines in adults is very mild and of questionable value. There is better evidence for antihistamines in combination with a decongestant, but the benefits are still mild. Nasal sprays are probably better than oral medication, and overall use a much lower dose. These treatments do not seem to have any effect on the course of the cold, but may relieve symptoms. Perhaps the best use of nasal spray decongestants is just prior to going to sleep, to reduce a post nasal-drip cough that can be very disruptive to sleep.

There is weak evidence for the use of hot liquids. There does not seem to be any advantage to chicken soup over other hot liquids, like tea. They may provide a symptomatic benefit in clearing the sinuses and loosening phlegm so that it can be cleared easier. Since this is a low risk intervention (just make sure the liquids are not too hot for small children), if it makes you feel better, go for it. There also may not be any advantage over just humidified air to help keep the membranes moist. Honey may be soothing, but there is no evidence of real benefit.

A neti pot looks like a small teapot with a thin spout that is meant to pour hot liquids up your nose to irrigate your sinuses. The evidence for the use of neti pots is mixed. Briefly — there is no evidence for their routine or preventive use, and in fact they may be counterproductive. However, they may be useful for acute symptoms of sinus congestion. The concept is actually simple and well established — irrigating an infected space to help wash out the germs and prevent impaction. There is probably no benefit to using a neti pot for a regular cold — unless you have significant sinusitis and feel that your sinuses are clogged. And again, this is probably no better than just moist air or hot liquids.

What Doesn’t Work

In short — everything else.

Over-the-counter (OTC) cough suppressants simply do not work and are not safe in children. If you have a serious cough, the kind that can cause injury, you need prescription medication (basically narcotics, like codeine). Also, in most cases using a cough suppressant makes no sense, especially in combination with an expectorant. You want to cough up the mucus and phlegm. If your cough is caused by a sore throat, take an NSAID. If ita??s post nasal drip, treat the congestion as above. And if ita??s severe, see your doctor. But dona??t bother with OTC cough suppressants.

I have covered echinacea previously in detail — it does not work for the prevention or treatment of the cold or flu.

Vitamin C has been a favorite since Linus Pauling promoted in decades ago. But decades of research has not been kind to this claim. The research has failed to find a consistent and convincing effect for vitamin C in treating or preventing the common cold. For routine prevention, the evidence is dead negative. For treating an acute infection, there is mixed evidence for a possible very mild benefit, but this is likely just noise in the research.

What about homeopathic treatments? Since homeopathy is one big pseudoscientific scam, its products are nothing but water, and they dona??t work for anything — I dona??t need to go into more detail here.

Finally, there is some evidence that zinc or zinc oxide may reduce symptoms of a cold, but this evidence is mixed and unconvincing at present. At best the benefit is very mild (again, likely within the noise of such studies). Further, zinc comes with a nasty taste (something that also complicates blinding of studies) and many people may find this worse than symptoms it treats. Zinc oxide nasal sprays have been linked to anosmia (loss of smell, which can be permanent) and is certainly not worth the risk to treat a self-limited condition like the cold — even if they did work, which is unclear.

Conclusion

The common cold remains a difficult syndrome to treat effectively. In most cases it is best to just let the cold run its course. Limited use of NSAIDs and decongestants may be helpful. Otherwise, if there is an intervention that is risk free and makes you feel better, do it. We all need to feel comforted when wea??re sick. But dona??t waste your time or money on other medications, supplements, herbs, or other concoctions. There are also endless snake-oil products out there, too many to deal with here. A good default position is simply not to believe any product that claims to prevent or treat the common cold. And dona??t be compelled by the anecdotal evidence of your neighbora??s cousina??s boss. Everyone thinks they have the secret to treating the cold, but no one does. Ita??s all placebo effect and confirmation bias.

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The Patient: The Most Important Member Of The Healthcare Team

Do you feel patients are the most important part of the medical (healthcare) team?

In a recent post on Health in 30, a??When Doctors and Nurses Work Together,a?? I wrote about the team-based approach for caring and treating patients, and it addressed the relationship between nurses, doctors, patients and the importance of a multidisciplinary, team-based approach to patient care.

The healthcare team is comprised of a diverse group of specialized professionals, and the most important part of the medical team is the patient.

Subsequent to publishing this post, I received an email from an author and patient advocate stating that patients are not the most important member of the medical team. I value and respect this comment, however I politely and passionately disagree. As a registered nurse and consumer health advocate, I emphatically say that patients are the most important part of the medical team.

As healthcare professionals engage their patients with empathy, we can make them feel valued and respected, and by listening and communicating effectively with our patients we can develop a treatment plan specifically around their needs.??Patients are the center and the most valuable part of the team.??We need to involve them in their care and understand that they are the integral part of the healthcare team.??We need to encourage them to be a proponent of their own healthcare.??We need to let them know that it is okay to ask questions and to take charge of their health.

Patients may have some self-doubt about questioning healthcare professionals.??They may feel uneasy and perhaps they may have difficulty expressing themselves, but we can offer reassurance and continue to encourage them to be proactive.

My colleagues speak out

I asked a few of my colleagues to weigh in on this topic. They are:

• Elizabeth Cohen, CNN senior medical correspondent and author of “The Empowered Patient”


• Kevin Pho, MD, primary care physician and founder of KevinMD.com


• Donna Cryer, JD, patient advocate, known as a??DC Patienta?? and CEO of Cryer Health


• Carl R. Sullivan, MD, professor and vice-chair of the Department of Behavioral Medicine and Psychiatry at West Virginia School of Medicine, Medical Director of Substance Abuse Programs at the West Virginia University School of Medicine in Morgantown, WV

Elizabeth Cohen, CNN senior medical correspondent and author of “The Empowered Patient”:

a??Patients know their bodies and their illnesses, and know when somethinga??s gone wrong. Empowered patients can communicate changes and observations that can make a real difference in their medical care. To have their voices heard patients have to, first of all, speak up! This might sound obvious, but many times patients are intimidated, or sometimes bewildered, by the medical world around them. Also, it can be hard to speak up if the doctor or nurse if perceived to be rushed and ready to move on to the next patient. In a??The Empowered Patient,a?? I urge patients to realize there are times they absolutely have to advocate for themselves or their loved ones. Their lives, or the life of someone they love, may depend on it.a??

Kevin Pho, MD, primary care physician and founder of KevinMD.com:

a??Ita??s important for doctors and other medical providers to listen to the most important member of the healthcare team, the patient.??After all, there is no bigger stakeholder.??Involving the patient in the decision making process is essential, to both better the patient outcome and improve patient experience.a??

Donna Cryer, JD, CEO of CryerHealth and patient advocate, DC Patient:

a??Patients are the sine qua non of healthcare. Not without which there is no purpose of spending all this time, money, and effort.?? Patients are the most affected by the success or failure of the medical team.??Patients hold the ultimate responsibility of selecting the right team members, determining the primary objective based on their lifestyle and values, adhering to the treatment or recovery plan, and persisting, enduring until the team has reached the end of their work.a??

Carl R. Sullivan, MD, director of addictions programs at the West Virginia University School of Medicine in Morgantown, WV:

Patient care is at the heart of everything we do, says Dr. Sullivan. He refers to this quote from Norman Cousins-1989 that speaks volumes:

a??People go to doctors out of fear and hope –??fear that something may be wrong but hope that it can be set right. If these emotional needs dona??t figure in the physiciana??s approach, he may be treating half the patient. The question is not now — any more than it has ever been — whether physicians should attach less importance to their scientific training than to their relationships with patients, but rather whether enough importance is being attached to everything involved in effective patient care.a???? – Norman Cousins

Putting patients needs first and allowing them to be the focal point and at the center of the team will foster a better patient relationship and better outcomes.??By being empathetic, listening and communicating and understanding that patients are the most important part of the team. Healthcare professionals can create a treatment plan that correlates with patients’ needs.??Every patient is the most important member of the healthcare team.

Your turn

We would love to hear your insightful thoughts.??Do you feel that you are the most important part of the medical (healthcare) team???What are your experiences???Do you consider yourself an empowered patient? Do you take charge of your health???Have there been times when you were afraid to speak up???Are you involved in the decision-making process with your healthcare professionals? Please share your experiences so we can all learn to be better at what we do.

As always, thank you for your time.

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Germs, Kids, And School

Everyone knows that when it comes to germs and kids, it can sometimes??be difficult to limit the spread of infection — especially in??a school or daycare setting. In this video, I talked with local TV news last week about germs and kids, and about preventing infections in college students during finals week:

??

If you find??this video helpful, I invite you to check out my other videos at MikeSevilla.TV. Enjoy!

                       

Cancer Treatment With Fewer Side Effects

Treating Cancer Better with Reduced Side Effects from Patient Power?? on Vimeo.

                       

Decline In Stroke Deaths Reinforces “Brain Attack” Prevention

Stroke killed 2,000 fewer Americans in 2008 (the last year with complete numbers) than it did in 2007, the Centers for Disease Control and Prevention (CDC) said yesterday in its latest annual Deaths report. That dropped stroke from the third leading cause of death in the United States to the fourth.

Good news? Yes and no. Ita??s always good news when fewer people die. The reduction suggests a payoff for efforts to prevent stroke and improve the way doctors treat it.

Yet the drop from third to fourth place is due largely to an accounting change. The CDC reorganized another category, a??chronic lower respiratory diseasesa?? (mainly chronic bronchitis and emphysema), to include complications of these diseases such as pneumonia. The change substantially increased the number of deaths in this category, which had long trailed stroke as the fourth leading cause of death.

More worrisome is that the decline in deaths from stroke isna??t matched by a decline in the number of strokes. On the rise since 1988, stroke now strikes almost 800,000 Americans a year, and that is expected to grow.

Better recognition of stroke and better treatment mean more people survive this sudden cut-off of blood flow to part of the brain. The American Heart Association estimates that 6.4 million Americans are stroke survivors. Although some have no physical or mental reminders of the attack, many have long-lasting speech loss, paralysis, or other problems. In fact, stroke is a leading cause of disability a?? 20 percent??of survivors need some kind of institutional care after three months, and up to 30 percent??are permanently disabled. The financial cost of stroke, $73.7 billion per year, is staggering. The human toll is incalculable.

Treatment of stroke and rehabilitation following it have vastly improved over the last few decades, but they are still no match for prevention. Prevention isna??t complicated and it doesna??t require fancy tools or expensive medications a?? but it works. In fact, new guidelines on the prevention of stroke suggest that a healthy lifestyle can prevent up to 80 percent??of strokes. Here are the key steps:

Know your baseline. Things you cana??t change, like your age, sex, genes, and race or ethnicity influence your risk of stroke. The higher your so-called nonmodifiable risk, the more important it is to pay attention to things you can change.

Exercise and diet. Regular exercise and physical activity, along with a healthy diet, are the foundation for stroke prevention.

Smoking. Dona??t start. Try to quit if you do smoke. Avoid secondhand smoke when possible.

High blood pressure, high cholesterol, and diabetes. Each of these elevates your stroke risk. Controlling blood pressure, cholesterol, and blood sugar with diet and exercise, and medications if needed, can help prevent stroke.

Atrial fibrillation. The wild, erratic beating of the upper chambers of the heart known as atrial fibrillation is an important cause of stroke. Taking a medication such as warfarin or aspirin can help prevent stroke.

Sickle cell disease. Having this blood disorder, which mostly affects African Americans, strongly increases the chances of suffering a stroke. Managing sickle cell disease can significantly reduce the chances of having a stroke.

The 68-page report lists numerous other factors that may increase the risk of stroke, along with ways to minimize their impact, from obstructive sleep apnea to oral contraceptives, migraine, and drug abuse.

Ita??s best to start early a?? like childhood or young adulthood. That said, ita??s never too late to start. The beauty of these prevention strategies is that they have a ripple effect that extends far beyond stroke. They also work against heart disease, cancer, osteoporosis, and other chronic conditions. Ita??s an investment well worth making.