When Evidence Says No, but Doctors Say Yes
The Self-Medicating Animal
Published by The Atlantic on February 22, 2017
By David Epstein and Propublica
Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.
First listen to the story with the happy ending: At 61, the executive was in excellent health. His blood pressure was a bit high, but everything else looked good, and he exercised regularly. Then he had a scare. He went for a brisk post-lunch walk on a cool winter day, and his chest began to hurt. Back inside his office, he sat down, and the pain disappeared as quickly as it had come.
That night, he thought more about it: middle-aged man, high blood pressure, stressful job, chest discomfort. The next day, he went to a local emergency department.
Pill Pushers in White Coats
Published by the New York Times May 18, 2017
By Moises Velasquez-Manoff
Chausiku was clearly sick. The chimpanzee was in her 30s, a chimp’s prime. She was usually a gentle, doting mother. But one day she built a nest in a tree, climbed in and lay down, letting her infant, a male named Chopin, roam unsupervised. Another female chimp began looking after Chopin while Chausiku rested.
Later that day, after Chausiku descended from the tree, a scientist named Michael Huffman noted that she could barely walk. Huffman wasn’t there to watch Chausiku specifically; he was studying older chimps, researching their social relationships in the troop. But Chausiku did something so out of the ordinary that it captured his attention: She sat down in front of a leafy plant, began pulling off branches, chewing their tips, spitting out the fibrous pulp and swallowing only the juice.
How Many Pills Are Too Many?
Published by Undark on February 12, 2017
By Abigail Zuger, M.D.
It was in 2011 that the Centers for Disease Control first drew public attention to the ongoing nationwide opioid crisis. Much earnest commentary has explored the roots of this new killer epidemic since then, focusing on the broad highway between heroin and pain pills, and the online pharmacies, pill mills, and bad-apple doctors who fueled the two-way traffic and enabled catastrophe.
Forgive me for rolling my eyes. Anyone with a prescription pad and a shred of common sense saw this whole thing coming down the pike decades ago, a speeding 18-wheeler, tires squealing, no brakes. Furthermore, it has long been clear that while the bad medical apples certainly did their share of damage, there is not a health policy guru or medical school dean in the country whose sins of omission and commission are not also partly responsible. Call it an epidemic of unconscious collusion or, as Dr. Anna Lembke bluntly states, a nation’s doctors “trapped in a system gone mad.”
An Hour of Running May Add 7 Hours to Your Life
Published by the New York Times April 10, 2017
By Austin Frakt
The point of prescription drugs is to help us get or feel well. Yet so many Americans take multiple medications that doctors are being encouraged to pause before prescribing and think about “deprescribing” as well.
The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.
Deprescribing will work only if patients also get involved in the process. Only they can report adverse effects that they sense but that are not apparent to clinicians. And they need to be comfortable weaning from or dropping drugs that they are accustomed to and believe to be helpful.
Yet an increasing number of Americans — typically older ones with multiple chronic conditions — are taking drugs and supplements they don’t need, or so many of them that those substances are interacting with one another in harmful ways. Studies show that some patients can improve their health with fewer drugs.
Why Are So Many People Popping Vitamin D?
Published by the New York Times April 12, 2017
By Gretchen Reynolds
Running may be the single most effective exercise to increase life expectancy, according to a new review and analysis of past research about exercise and premature death. The new study found that, compared to nonrunners, runners tended to live about three additional years, even if they run slowly or sporadically and smoke, drink or are overweight. No other form of exercise that researchers looked at showed comparable impacts on life span.
The findings come as a follow-up to a study done three years ago, in which a group of distinguished exercise scientists scrutinized data from a large trove of medical and fitness tests conducted at the Cooper Institute in Dallas. That analysis found that as little as five minutes of daily running was associated with prolonged life spans.
Pop a Pill for Heartburn? Try Diet and Exercise Instead
Published by the New York Times April 10, 2017
By Gina Kolata
There was no reason for the patients to receive vitamin D tests. They did not have osteoporosis; their bones were not cracking from a lack of the vitamin. They did not have diseases that interfere with vitamin D absorption.
Yet in a recent sample of 800,000 patients in Maine, nearly one in five had had at least one test for blood levels of the vitamin over a three-year period. More than a third got two or more tests, often to evaluate such ill-defined complaints as malaise or fatigue.
The researchers who gathered the data, Dr. Kathleen Fairfield and Kim Murray of the Maine Medical Center, were surprised. Perhaps they shouldn’t have been.
Millions of people are popping supplements in the belief that vitamin D can help turn back depression, fatigue, muscle weakness, even heart disease or cancer. In fact, there has never been widely accepted evidence that vitamin D is helpful in preventing or treating any of those conditions.
Running as the Thinking Person’s Sport
Published by the New York Times March 20th, 2017
By Jane E. Brody
Many Americans would rather take a drug than change their habits to control a persistent ailment. Yet, every medication has side effects, some of which can be worse than the disease they are meant to treat. Drugs considered safe when first marketed can turn out to have hazards, both bothersome and severe, that become apparent only after millions of people take them for a long enough time.
Such is the case with a popular class of drugs called proton pump inhibitors, or P.P.I.s, now used by more than 15 million Americans and many more people worldwide to counter an increasingly common ailment: acid reflux, which many people refer to as heartburn or indigestion.
These medications are now linked to a growing number of complications, ranging in seriousness from nutrient deficiencies, joint pain and infections to bone fractures, heart attacks and dementia. While definitive evidence for most of the risks identified thus far is lacking, consumers plagued by acid reflux would be wise to consider an alternative approach, namely diet and lifestyle changes that can minimize symptoms and even heal damage already done.
Insomniacs Are Helped by Online Therapy, Study Finds
Published by the New York Times December 14, 2016
By Gretchen Reynolds
Running seems to require a greater amount of high-level thinking than most of us might imagine. The sport seems to change how the brain works in surprising ways, according to a new report.
The study, published this month in Frontiers in Human Neuroscience, found that the brains of competitive distance runners had different connections in areas known to aid in sophisticated cognition than the brains of healthy but sedentary people. The discovery suggests that there is more to running than mindlessly placing one foot in front of another.
Scientists have known for some time that mastering certain activities demands considerable thought and consequently can alter the workings of the brain. Playing a musical instrument, for instance, requires refining a variety of fine motor skills, while also engaging memory, attention, forward planning and many other executive functions of the brain. So it’s not surprising that past brain-scanning studies have found that expert musicians tend to have greater coordination between areas of the brain associated with different kinds of thinking, as well as sensory processing and motor control, than do people who have never picked up a bassoon or other instrument.
How Exercise Might Keep Depression at Bay
Published by the New York Times November 30, 2016
By Benedict Carey
The same digital screens that have helped nurture a generation of insomniacs can also help restore regular sleep, researchers reported on Wednesday. In a new study, more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.
The new report, published in the journal JAMA Psychiatry, is the most comprehensive to date suggesting that many garden-variety insomniacs could benefit from the gold standard treatment — cognitive behavior therapy — without ever having to talk to a therapist. At least one in 10 adults has diagnosable insomnia, which is defined as broken, irregular, inadequate slumber at least three nights a week for three months running or longer.
“I’ve been an insomniac all my life, I’ve tried about everything,” said Dale Love-Callon, 70, a math tutor living in Rancho Palos Verdes, Calif., who recently used the software. “I don’t have it 100 percent conquered, but I’m sleeping much better now.”
Really, Really Short Workouts
Published by the New York Times November 16, 2016
By Gretchen Reynolds
Exercise may be an effective treatment for depression and might even help prevent us from becoming depressed in the first place, according to three timely new studies. The studies pool outcomes from past research involving more than a million men and women and, taken together, strongly suggest that regular exercise alters our bodies and brains in ways that make us resistant to despair.
Posture Affects Standing, and Not Just the Physical Kind
Published by the New York Times
By Tara Parker-Pope
Think you’re too busy to work out? We have the workout for you. In minutes, high-intensity interval training (H.I.I.T.) will have you sweating, breathing hard and maximizing the health benefits of exercise without the time commitment. Best of all, it’s scientifically proven to work.
What Is H.I.I.T.?
SHORT WORKOUTS 101
High-intensity interval training — referred to as H.I.I.T. — is based on the idea that short bursts of strenuous exercise can have a big impact on the body. If moderate exercise — like a 20-minute jog — is good for your heart, lungs and metabolism, H.I.I.T. packs the benefits of that workout and more into a few minutes. It may sound too good to be true, but learning this exercise technique and adapting it to your life can mean saving hours at the gym. If you think you don’t have time to exercise, H.I.I.T. may be the workout for you.
A New Therapy for Insomnia: No More Negative Thoughts
Published by the New York Times December 28, 2015
By Jane E. Brody
A distraught wife begged me to write about the importance of good posture. “My husband sits for many hours a day slouched over his computer,” she said. “I’ve told him repeatedly this is bad for his body — he should sit up straight — but he pays no attention to me. He reads you every week. Maybe he’ll listen to you.”
So here goes: Yes, dear sir, listen to your wife. Slouching is bad. It’s bad not only for your physical health, but also for your emotional and social well-being. More about this in a bit.
Without delay, get that computer on a proper surface (laps can encourage slouching) and get a supportive chair that enables you to sit up straight with your head aligned directly over your shoulders and hips when your eyes are on the screen.
As a short person who is prone to back pain, I have long been aware of the value of good posture, and seating that minimizes the stress on my spine and the muscles and ligaments that support it.
Closest Thing to a Wonder Drug? Try Exercise
Published by the New York Times August 16, 2016
By Roni Caryn Rabin
We’ve all heard about the power of positive thinking. But will it help me sleep?
My problem isn’t falling asleep – it’s staying asleep. This particular form of torture has been dubbed “sleep-maintenance” insomnia. Call me a high-functioning sufferer: I’m usually O.K. once I’ve had my morning coffee. But I worry about the long-term health ramifications of losing sleep.
Now several medical organizations have endorsed a treatment known as cognitive behavioral therapy for insomnia or C.B.T.-I. In May the American College of Physicians advised its members that C.B.T.-I. was the first treatment they should offer patients with insomnia.
Why Swearing Off the Snooze Button Is the Secret to Better Sleep
Published by the New York Times June 20, 2016
By Aaron E. Carroll
After I wrote last year that diet, not exercise, was the key to weight loss, I was troubled by how some readers took this to mean that exercise therefore had no value.
Nothing could be further from the truth. Of all the things we as physicians can recommend for health, few provide as much benefit as physical activity.
In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a “miracle cure.” This isn’t a conclusion based simply on some cohort or case-control studies. There are many, many randomized controlled trials. A huge meta-analysis examined the effect of exercise therapy on outcomes in people with chronic diseases.
Running 5 Minutes a Day Has Long-Lasting Benefits
Published by Vogue January 22nd 2016
By Laura Regensdorf
For as long as I can remember, I have said the same three words upon waking: “Five more minutes.” No matter if it was Christmas morning and Santa had come. Eyes closed, I told my older sister the presents would still be there when we woke up—at a kinder, later hour. That the habit carried over into the sluggish teenage years and the sleep-deprived working ones is not much of a surprise. I’m at my most optimistic when I setthe alarm each night (morning yoga? A civilized breakfast?). Yet in reality, it plays out as more of a suggested wake-up time, like pay-what-you-wish admission at the Met. Maybe an hour slides by, the electronic cacophony punctuating the fog every nine minutes.
How Exercise May Lower Cancer Risk
Published by The New York Times July 30, 2014
By Gretchen Reynolds
Running for as little as five minutes a day could significantly lower a person’s risk of dying prematurely, according to a large-scale new study of exercise and mortality. The findings suggest that the benefits of even small amounts of vigorous exercise may be much greater than experts had assumed.
In recent years, moderate exercise, such as brisk walking, has been the focus of a great deal of exercise science and most exercise recommendations. The government’s formal 2008 exercise guidelines, for instance, suggest that people should engage in about 30 minutes of moderate exercise on most days of the week. Almost as an afterthought, the recommendations point out that half as much, or about 15 minutes a day of vigorous exercise, should be equally beneficial.
Dietary Supplements Lead to 20,000 E.R. Visits Yearly, Study Finds
Published by The New York Times February 24, 2016
By Gretchen Reynolds
The relationship between exercise and cancer has long both intrigued and puzzled oncologists and exercise physiologists.
Exercise is strongly associated with lowered risks for many types of cancer. In epidemiological studies, people who regularly exercise generally prove to be much less likely to develop or die from the disease than people who do not. At the same time, exercise involves biological stress, which typically leads to a short-term increase in inflammation throughout the body. Inflammation can contribute toelevated risks for many cancers.
Now, a new study in mice may offer some clues into the exercise-cancer paradox. It suggests that exercise may change how the immune system deals with cancer by boosting adrenaline, certain immune cells and other chemicals that, together, can reduce the severity of cancer or fight it off altogether.
Inuit Study Adds Twist to Omega-3 Fatty Acids’ Health Story
Published by The New York Times October 14, 2015
By Anahad O'Connor
A large new study by the federal government found that injuries caused by dietary supplements lead to more than 20,000 emergency room visits a year, many involving young adults with cardiovascular problems after taking supplements marketed for weight loss and energy enhancement.
The study is the first to document the extent of severe injuries and hospitalizations tied to dietary supplements, a rapidly growing $32 billion a year industry that has attracted increased scrutiny in the past year and prompted calls for tougher regulation of herbal products.
Published by the New York Times September 17, 2015
By Carl Zimmer
As the Inuit people spread across the Arctic, they developed one of the most extreme diets on Earth. They didn’t farm fruits, vegetables or grains. There weren’t many wild plants to forage, aside from the occasional patch of berries on the tundra.
For the most part, the Inuit ate what they could hunt, and they mostly hunted at sea, catching whales, seals and fish. Western scientists have long been fascinated by their distinctly un-Western diet. Despite eating so much fatty meat and fish, the Inuit didn’t have a lot of heart attacks.