The Challenge of Doctor-Patient Relations in the Internet Age
Published by the New York Times March 1, 2018
By Doris Iarovici, M.D.
“Let me do some research, and I’ll get back to you,” my patient said.
My patient, a 19-year-old undergraduate, had already taken time off from school because of her anxiety. I was her psychiatrist, with over two decades of experience treating university students, and had just explained my diagnostic impressions based on a lengthy evaluation. I’d recommended that she try a medicine I expected would help. I’d also laid out the risks and benefits of other treatment options.
“Do you have additional questions I can answer?” I asked. I wanted to let her know that’s why I was there, to cull the research, to help make sense of it.
“No, I like to go online and look for myself,” she said.
More and more, I see students turning away from the expertise that a live person can offer and instead turning to the vast and somehow more objective-seeming “expertise” of the digital world.
Fiber Is Good for You. Now Scientists May Know Why.
Published by the New York Times February 24, 2018
By Rich Joseph
Boston — The 96-year-old patient with pneumonia in Bed 11 was angry. “Do you really need to check my vital signs every four hours?” he asked.
Checking things like temperature, blood pressure and respiratory rate every four hours on hospitalized patients has been the standard of care since the 1890s, yet scant data indicates that it helps. In fact, data shows that close to half of patients are unnecessarily awakened for such checks, perhaps to the detriment of their recovery. My patient wanted to know how, with all that poking and prodding, he was supposed to rest and get better.
“I understand your frustration,” I replied, “and wish I could help to change the situation.”
I may have been a lowly intern, but it was a feeble reply. And he knew it. “Understanding is not enough,” he said. “You should be doing something to help fix this system.”
Gut Microbiome Affects Salt-Sensitive Hypertension in Mice and Humans
Published by the New York Times January 1, 2018
By Carl Zimmer
A diet of fiber-rich foods, such as fruits and vegetables, reduces the risk of developing diabetes, heart disease and arthritis. Indeed, the evidence for fiber’s benefits extends beyond any particular ailment: Eating more fiber seems to lower people’s mortality rate, whatever the cause.
That’s why experts are always saying how good dietary fiber is for us. But while the benefits are clear, it’s not so clear why fiber is so great. “It’s an easy question to ask and a hard one to really answer,” said Fredrik Bäckhed, a biologist at the University of Gothenburg in Sweden.
He and other scientists are running experiments that are yielding some important new clues about fiber’s role in human health. Their research indicates that fiber doesn’t deliver many of its benefits directly to our bodies.
Prescription Drugs May Cost More With Insurance Than Without It
Published on January 2, 2018
by Anthony L. Komaroff, MD reviewing Wilck N et al. Nature 2017 Nov 30 Relman DA. Nature 2017 Nov 30
When dietary salt intake increases, lactobacilli are lost and blood pressure rises.
Salt-sensitive hypertension is caused, at least in part, by expansion of intravascular volume due to a high-salt diet. In a new study, researchers investigated an additional mechanism: the gut microbiome's response to a high-salt diet.
In mice, a high-salt diet led to depletion of Lactobacillus species, particularly of one Lactobacillusspecies, L. murinus. This was followed by an increase in the number of particular lymphocytes (T-helper [TH]17) that drive many autoimmune diseases and then by a rise in blood pressure. When researchers supplemented the mouse feed with the depleted species of lactobacilli, these changes were reversed.
Coffee's Numerous Health Benefits Detailed in New Analysis
Published December 9th 2017 by the New York Times
By Charles Ornstein and Katie Thomas
Having health insurance is supposed to save you money on your prescriptions. But increasingly, consumers are finding that isn’t the case.
Patrik Swanljung found this out when he went to fill a prescription for a generic cholesterol drug. In May, Mr. Swanljung handed his Medicare prescription card to the pharmacist at his local Walgreens and was told that he owed $83.94 for a three-month supply.
Alarmed at that price, Mr. Swanljung went online and found Blink Health, a start-up, offering the same drug — generic Crestor — for $45.89.
How to Start Running
Published November 27, 2017 by New England Journal of Medicine JOURNAL WATCH
By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Coffee consumption — in particular, several cups daily — is associated with a wide range of health benefits, according to an umbrella review of meta-analyses in The BMJ.
The review included over 200 meta-analyses of observational or interventional research into coffee consumption and health outcomes in adults. Among the benefits:
Antibiotic-resistant gonorrhoea on the rise, new drugs needed
Published by the New York Times
By Tara Parker-Pope
Running is a great way to get fit, feel better and even form new relationships with other runners. Starting a new running habit doesn’t have to be hard — all it takes is a comfortable pair of shoes and a willingness to move a little or a lot, all at your own pace. The Well Guide makes it easy to get started, get inspired and stay on track. Are you ready? Let’s go!
When Evidence Says No, but Doctors Say Yes
Published July 7, 2017 by the World Health Organization
Data from 77 countries show that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat.
"The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them," said Dr Teodora Wi, Medical Officer, Human Reproduction, at WHO.
WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is best – are finding cases of the infection that are untreatable by all known antibiotics.
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.
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.