BodBoss

Docs Sometimes Avoid the Truth: What You Can Do

2012-02-09T12:33:00.000-08:00

If a medical error occurred when you were getting health care, would you want your doctor to tell you?

If your chance of surviving a surgery or procedure was low, would you want to know?

If you're likely to die soon, would you want to be told?

If your physician stands to gain financially from a procedure, drug, medical device or surgery he or she is recommending to you, would you like to know?

It turns out that many doctors aren't telling you these things.

When almost 2,000 physicians were surveyed in 2009 about whether they think physicians should ever lie to a patient, only 83% said they should not. About a third did not agree that physicians should disclose "all significant medical errors to affected patients." Over a third don't agree that they should tell patients about their financial relationships with drug and medical device companies. More than half said they had described a patient's prognosis more positively than the data suggested was true. About 10% said they had lied to a patient in the last year.

Lisa Iezzoni, MD, the lead author of the study said these and similar findings from other studies "raise concerns that some patients may not receive complete and accurate information."

The study, published in the February, 2012 issue of Health Affairs, was conducted by researchers at Massachusetts General Hospital. The survey asked physicians questions related to the Charter on Medical Professionalism, a guideline endorsed by more than 100 professional groups internationally and the U.S. Accreditation Council for Graduate Medical Education.

What can you do about it?

First of all, understand that, for a variety of reasons, some physicians may not be fully forthcoming with you. So, you have to lay the groundwork. The relationship you have with a physician is partly your responsibility. Take the lead in establishing a disclosure policy with your physician.

You could say, for example, something like: "I want you to know that I am the kind of person who would like -- and expects -- full disclosure from my physician. I want to know all the pertinent facts related to my condition. Please tell me directly. If there's bad news, I don't want it sugar coated. If there's a medical error or a problem, I want to hear about it. Are you comfortable with that?"

You should also ask that you routinely receive all written copies of any reports related to surgeries, biopsies, lab work and procedures. Not only will this help keep you fully informed, it's handy to have these copies in your own medical file at home in case they're ever needed.

And frankly, if that conversation doesn't go well, you should find another doctor.

Flying? Why Window Seats May Be Bad for Your Health

2012-02-08T13:48:00.000-08:00

I love window seats on a long flight. There's nothing like getting a big-picture perspective on planet Earth when you're looking out at big, billowing clouds and the tiny ground below from 30,000 feet. But it turns out, sitting next to the window could actually be bad for you. Really? Yes.

That's because people who cuddle up against the window tend to get up less during a flight. You can't blame them. After all, who wants to climb over the people in the middle and aisle seats, especially if they're sound asleep or have their seat-back trays piled high with food or reading material? And it's not due entirely to shrinking leg room; this isn't just a problem for people traveling in coach. Even those in business and first class tend to avoid getting up if they're by the window.

The American College of Chest Physicians just released an advisory about the risks of getting blood clots in your legs, also called deep venous thrombosis or DVT, published in the February, 2012 issue of Chest.

These clots can develop when parts of your body, most typically your legs, are dependent, or lower, than the rest of you, and not moving much. They can cause swelling and pain locally, and if they travel through your veins to your lungs, they can spur a pulmonary embolism, which can be life threatening.

If you're healthy, your risk is still relatively low. People at greatest risk are on birth control pills or supplementary estrogen, have had a previous clot, have a disability that restricts their mobility, have problems with blood coagulation, are obese, have recently had surgery or trauma, or have cancer. Others at risk include people who are are pregnant and seniors. The longer the trip, the greater your risk.

There are some things you can do to reduce your risk of DVT:

Walk up and down the aisle every hour or two.
Stay hydrated. Drink water. Avoid alcohol. (I try to drink a glass of water every hour at least. That produces an additional benefit: you'll find you're forced out of your seat to go to the restroom!)
Don't take a sleeping pill. You'll find you sit virtually immobilized and get dehydrated when you're snoozing.
Don't take aspirin or anticoagulants with the intention of cutting your risk of DVT. If you're at high risk for DVT, talk with your healthcare provider before your trip.
If you're in a bus or a train for more than an hour or two, these tips apply. If you're in a car, pull over and get out to stretch and walk around a bit every couple of hours, too.
While you're seated, do occasional leg exercises (to the extent there's room), flexing your feet (lifting them up) and stretching.

The Trouble with Trust

2012-02-06T14:01:00.000-08:00

When you're in the air at 30,000 feet, you probably want to trust the pilot. I know I do.

But there's usually just one commonly-accepted way to fly the plane. With most healthcare decisions these days, there are at least a couple of different paths your treatment could take. Probably more.

When you're faced with a healthcare decision of some significance, you can't lie back in the seat and trust the pilot. You've got to do some homework, get educated about the options from which you can choose, and ask your doctor some tough questions. Based on what you hear, you may need to get a second or third opinion to ensure you have considered all the potential options.

It's not that your physician isn't trustworthy, smart, committed, experienced or caring. You're not expected to know more than your doctor does about medicine, either. No. But you have a crucial role in deciding in what direction you'll go.

I have a good friend with a chronic healthcare condition who has, over the last few years, required a series of invasive procedures that have not solved her problem. When I talk with her about the potential value of seeking a second opinion at a time when she's not in crisis -- just to be sure -- I see a wall come up between us. "I like my doctor," she says. "I have to trust him."

Should she? Should you? To which I say: It's not about trust.

Trust means "total confidence in the integrity, ability and good character of another." When you're faced with a healthcare issue, the question isn't the integrity, ability or character of your physician, but rather whether you have access to the most advanced and effective approaches to your condition. When you're making a decision about your health, your physician -- no matter how well intentioned -- may not be aware of other alternatives, or may have not seen all the research or be familiar with a new diagnostic approach or treatment. Your doctor may even have a blind spot, a preconceived notion that could go back to his or her experience years ago in medical school or residency.

It's not uncommon for two physicians to disagree with each other. Who is to say, if you have physician A, that physician B might not offer a better approach to your situation?

Which is why I say that when it comes to getting critical advice about your health, understand that physicians can vary greatly in how they would recommend treating your condition. Find out what's available for you, learn the pros and cons and explore why physicians disagree about which approach is better. Discover what evidence is available to suggest a particular approach is good, better or best.

Then, and only then, you can trust that you've done all you can. In consultation with your doctor or doctors, you're ready to make a decision.

5 Things to Say to a New Doctor

2012-02-02T10:56:00.000-08:00

It's always a little awkward getting to know a new physician. After the first hellos, and before the examination begins, it's smart to set the stage for an effective, 21st century relationship.

This approach would be unthinkable years ago. But, times have changed. As CEO of your own body, you should see your physician as a consultant to you, someone whom you have chosen to evaluate your situation and give you recommendations and options. You recognize that consultants often know more about something than you do; but you see yourself as the ultimate decision maker and you need to know all you can to be effective.

Physicians can read x-rays but they can't read your mind. They cannot know what role you'd like to play in your own health care. If you're like many people, you want to know everything necessary to make the decisions that will naturally and ultimately be yours to make. Here are five things you should say from the very start:

I'd like to be told the pros and cons of whatever you're suggesting I do.
I'd like a copy of all data and reports generated from my care. Ideally, I'd like to see the notes you write down about me at each visit and get a copy of any of my lab reports or test results.
If I should have an urgent question or issue between visits, how do I best get in touch with you, especially if the issue is not something that should require a visit to the emergency room? Is there a way I can communicate with you by email?
If you recommend I get a test or procedure, I'd like to know if there's an option to watch the problem for a few months and revisit my situation to re-evaluate. If it's urgent or critical, I'd like to know why.
If you recommend a drug, procedure or surgery, please let me know if you have any potential conflicts of interest, such as having an ownership interest in the facility, or receive benefits from a drug company.

Most physicians will welcome your involvement and interest since they know that it will help ensure your health and your confidence.

If your new physician balks at your questions or seems irritated or taken aback, unless he or she is the only doctor in town, this would be the perfect time to put your clothes back on and say goodbye. All you have to say is something like, "From our conversation, I see we're not a good fit. Thank you."

Time to Indulge a Little: Dark Chocolate Improves Sports Performance

2012-02-01T14:02:00.000-08:00

It sounds like a dream come true. After hearing, day after day, that just about everything is bad for you, finally a tasty treat is given a thumbs up. And it's chocolate, no less!

A recent study in the Journal of Physiology suggests that cocoa compounds can make you stronger. Researchers at the University of California San Diego (UCSD) gave mice two doses a day for 14 days of a chocolate flavonoid called epicatechin, and then put them on treadmills (mice love those wheels) to see if the chocolate could improve their athletic performance. The chocoholic mice had 30% more leg muscle capillary density (which delivers more oxygen to muscle), and 50% more muscle protein (which makes muscle cells more efficient) than the mice that were denied the cocoa treats. That means the chocolate-munching mice had more resistance to fatigue and greater muscle power.

This isn't the first study that has shown chocolate, in moderation, is good for you. Other research has revealed that dark chocolate can lower blood pressure, reduce the impact of stress and make arteries more flexible. But you have to remember that an average one ounce serving is about 170 calories, 34% of your daily saturated fat limit. (And of course, if you are a person with diabetes, your situation is different).

If you're taking a day hike, going cycling or out for a run, a few little chocolate treats might be just the reinforcement you need. Not only will they most likely make the exercise a little easier, but they could serve as a perfect reward, inspiring you to keep your exercise regimen going.

Sweet.

Think Twice Before Saying Yes to the HPV Vaccine

2012-01-31T14:16:00.000-08:00

Should you?

There's been a lot of controversy about the HPV vaccine since is was approved by the FDA in 2006. Parents, public health officials and politicians have been arguing about whether the vaccine might promote sexual activity in teenagers, is safe, or is just too expensive. Now an essay published online in the Annals of Medicine suggests that the vaccine has been promoted based on inaccurate information. If you're thinking about getting the vaccine for yourself or for your children, read on.

The HPV vaccine may not work. The clinical trials showed no evidence that HPV vaccination can protect against cervical cancer. It turns out that the efficacy of the vaccine (Gardasil, by Merck & Co and Cervarix by GlaxoSmithKline) has not been proven; the study period was too short. Although invasive cervical cancer can take 20 to 40 years to develop from the time of HPV infection, the follow-up in the phase 2 trials for Gardasil was only five years, and for Cervarix it was just 8.4 years. No one knows how long the vaccine will last. If the vaccine is given to 11-12 year olds, but lasts for only 10 years, then women who are in the early 20's would no longer be protected.
The HPV vaccine may not lower the rate of cervical cancer. With the level of Pap smear screening now done in the U.S., 8 out of 100,000 women get cervical cancer. Cervical cancer is rare in the U.S. Contrary to claims that cervical cancer is the second most common cancer in women worldwide, existing data show that this only applies to developing countries. With the vaccine -- assuming that it lasts a lifetime -- and without Pap smear screening, it's predicted that 9.5 out of 100,000 women will develop cervical cancer. In other words, the impact of the vaccine would be quite small.
The risks of the vaccine may exceed the benefits. The World Health Organization says there are about 1.7 deaths from cervical cancer out of 100,000 women. But that is 2.5 times lower than the rate of serious adverse reactions from Gardasil. Reported adverse reactions include death, paralysis, facial palsy, chronic fatigue syndrome, automimmune disorders, pancreatitis and pullmonary embolism, among others. Since the vaccine was approved in the U.S., there have been almost 19,000 adverse reactions reported to Vaccine Adverse Event Reporting System (VAERS), of which 8% were serious, and there have been 68 deaths.

One of the researchers, Lucija Tomljenovic, PhD, from the Neural Dynamics Research Group at the University of British Columbia, in Vancouver, puts it well in an article in Medscape Medical News: "We have to ask if it's worth receiving a vaccine that has been associated with a permanent debilitating disease, or death, in young girls" when the vaccines have only "a theoretical potential to prevent a disease that may or may not develop until decades later, and which can be easily prevented in another, safer way."

What's needed is independent evaluation of HPV vaccine safety and long-term data to evaluate how long the vaccines really last. The researches say pediatricians and other physicians need to be less enthusiastic about the vaccines when discussing their availability with parents and young adults, and base their recommendations on the actual evidence.

So much in health care depends on which risks you're more inclined to take. At this point, the push to get kids the HPV vaccine may be way ahead of the data we need.

Find the Hidden Costs in Your Doctor's Bill

2012-01-26T11:14:00.000-08:00

There's one thing about health care you must face: you've got to pay for it. Whether it's just a co-payment, a considerable percentage, or the whole bill, no matter how you're covered, you're increasingly likely to have to pull out your checkbook or your credit card. And healthcare billing is more confusing than any other service you'll ever pay for. What makes matters worse, it's intimidating to challenge a doctor's office about a bill. You know you'll need them someday. So it's often hard to know what to do.

The particulars will vary depending on what kind of health insurance coverage you have, but there are a few things that are almost universally applicable.

When you get a claim or "explanation of benefits" from your insurance company, read it carefully. Sometimes a physician's office uses a billing code that doesn't properly represent the service you received. For example, a short visit can sometimes be billed as an extended visit. A "free" physical can be coded as an office visit. A trip to the office to get a vaccination might be billed as a complete office visit. You get the picture. But the problem is that the codes (7 digit descriptors used to bill the service) are a big secret. So, if the dollar amount seems high, call the office and ask them to translate what the billing code stands for. If it doesn't describe the service you received, tell them.

The office will tell you that the physician decided the code based on what happened in the exam room, something that is private between you and the doc. Tell them that you would like to hear what was written in the physician's notes about your visit so you can understand why the encounter seems to have been billed wrong.

I'll give you an example. My husband got an annual physical exam, something our insurance company pays for. But when the "explanation of benefits" came, there was a charge. It turns out that in the course of having the 10 minute annual physical, the physician wrote down an ongoing and relatively unimportant diagnosis related to his cholesterol level. The staff said that he may have asked her a question, triggering the charge for what was supposed to be free. When I questioned whether that made any sense at all, the office staff talked to the physician and they revoked the charge.

Now you might say that isn't worth your time. Maybe it isn't. But you should get in the habit of doing this anyway.

Part of the reason healthcare costs are sky high is that people are getting billed inappropriately. This isn't necessarily the doctors' fault because the system is dreadfully complicated. But by paying attention to how you're billed, you're reducing the costs for everyone -- including yourself -- and hopefully mending the system, albeit in a small way. Perhaps more importantly, you're learning something about how the billing aspects of the system work.Then, should you end up (hopefully never) with a pile of complex medical bills, you'll be all the wiser.

But the biggest reason to mind your money when it comes to health care is very basic indeed: you are paying for it. And you'll undoubtedly be spending more as costs rise and you get older. So giving the system carte blanche to charge you inappropriately here and there will backfire.

By acting more like a consumer, you'll also get better at understanding why you need to be actively involved in making decisions about your health care. Your attitude will change. You'll find yourself asking more questions and probing a little more about the benefits and risks when you're asked to have a test or procedure.

I

Was It Something You Ate? How to Know and What to Do

2012-01-25T15:09:00.000-08:00

Salmonella, a bacteria that causes food poisoning.

You know the feeling.

It starts with a few twitches or cramping in your abdomen and ends up with weakness, loss of appetite, diarrhea, and sometimes vomiting and a fever.

What nobody ever seems to know is whether the illness was really caused by genuine food poisoning, or if it was a stomach virus that got you. It's tough even for healthcare providers to tell the difference. It seems to me that most people seem to tend to prefer to call it food poisoning. Some call it the stomach flu. Either way, most physicians will diagnose your problem as "gastroenteritis." That's a non-specific term for a range of abdominal troubles that are associated with diarrhea, nausea, vomiting and abdominal pain. The illnesses can range from inconvenient to life-threatening.

It's hard to know how many people get this sort of stomach trouble every year because many are not reported. It's estimated that there are 100 million cases a year, and that children alone account for 1.5 million outpatient visits because of stomach trouble.

Food poisoning happens when you eat or drink something contaminated with infectious organisms, bacteria, parasites or viruses passed on to you through food or water. Some of the most common carriers include raw oysters, contaminated water or ice cubes, lettuce, bagged spinach, alfalfa sprouts and cantaloupes. Bacteria-caused food poisoning typically hits you 12 to 36 hours after ingestion.

The majority of cases of gastritis are caused by the norovirus. It's quite contagious and very resistant to alcohol-based products, including hand sanitizers. You can get it by eating something people have prepared without properly washing their hands (fecal contamination); from the air (if you're in a bathroom, dorm, classroom or hostel when someone vomits and the virus is airborne); from water; from deli meats; and from touching contaminated surfaces.

So you see, you can get a food-borne illness that most people would call food poisoning just by touching the counter at a store or using the handrail when you're running down stairs. And because so many people attribute their troubles to something they ate, they may be less careful about taking the necessary precautions to prevent passing it on to roommates, friends and family.

If you've been infected by the norovirus, the incubation period is 12-48 hours and the onset of symptoms is sudden. The illness usually lasts between 12 hours and 2 or 3 days.

No matter how you've gotten a stomach virus, the recommendations are the same:

If your symptoms persist for more than a few days, see your healthcare provider.
If your symptoms suddenly get worse, or your fever goes above 102 degrees Fahrenheit, or you see blood in your stool or vomit, see your healthcare provider.
If you can't keep food or water down for more than 24 hours, see your healthcare provider.
Keep hydrated by drinking sips of water, chewing on ice chips, having a popsicle, and starting to have clear liquids and soft foods as soon as you feel you can.
Consider taking over-the-counter medications like Immodium for diarrhea, Emetrol for nausea.
Rest.

And the next time someone tells you they have food poisoning, you can tell them that whatever they call it -- stomach flu, stomach virus, food poisoning, or gastroenteritis -- you sympathize because you know it's no fun at all.

Healthy? At Low Risk For Heart Disease? Relax About Cholesterol.

2012-01-23T12:13:00.000-08:00

Do healthy people with high cholesterol gain anything from taking statins to prevent heart disease? Should you be treating your risk factors instead of your cholesterol?

In the back rooms of Medicine, doctors have been debating whether statins -- cholesterol and lipid-lowering prescription medications -- are being vastly overused. For several years most general practitioners and internists looked at your cholesterol and lipid levels, and if they were higher than they liked, they'd give you a few months to clean up your diet, recheck those levels, and then prescribe a statin like Lipitor, one of the biggest selling drugs of all time.

Now, a growing number of physicians are questioning this approach. Earlier this month a study came out showing that women on statins are at significant risk of getting type 2 diabetes, which is a considerable risk factor for heart disease. And now, as guidelines for physicians about how to manage cholesterol are in the works (from the National Cholesterol Education Program Adult Treatment Panel), a public debate has surfaced. Basically, many are arguing that physicians should be focusing on your overall risk factors for heart disease first. If they're high, then consider taking a statin. If they're not, don't.

If your risk of heart disease is low, some physicians say statins won't help you much. In fact, side effects and potential drug interactions could actually hurt you. In an opinion piece published online January 17, 2012 in Circulation: Cardiovascular Quality and Outcomes, Harlan Krumholz, MD, of Yale University School of Medicine and Rodney Haward, MD, of the University of Michigan argue that physicians should stop treating based on LDL-cholesterol targets and instead focus on a patient's risk of having a heart attack. They say if the risk is low, skip the drugs and avoid side effects and unnecessary costs.

In the Wall Street Journal today, Rita Redberg, MD, a professor of medicine and director of woman's cardiovascular services at the University of California, San Francisco, debates Roger Blumenthal, MD, arguing that statins don't help healthy people live longer or feel better. "For most healthy people, the data show that statins do not prevent heart disease...I can't in good conscience recommend them [for healthy people]."

How do you judge your own heart attack risk? You can plug your data into the Framingham Risk Score calculator, and you should talk with your healthcare provider about what cardiac health risks you may have. Factors include your blood pressure, weight, whether you smoke or have diabetes, whether you're male or female, your age, and your cholesterol levels. (One warning: the currently available calculators are based on the old guidelines from the National Cholesterol Education Adult Treatment Panel).

The debate continues. If you're healthy and you want to be sure to do all you can to prevent heart disease, look at what has been proven without a doubt to be effective: Exercise, eat well, don't smoke, watch your blood pressure and maintain a healthy weight. And until the debate about the benefits of anti-cholesterol medications is resolved, keep asking your healthcare provider for the facts as they pertain to you personally.

Many Breast Cancer Patients Aren't Told All Their Options: What You Should Know

2012-01-20T11:02:00.000-08:00

If you've got a red-hot appendix or a complete break of your femur (thigh bone), there typically doesn't have to be a lot of discussion about what to do next. But with many, many other surgeries and procedures, there are a range of options, each with their own pros and cons.

It turns out, according to a study published in the January, 2012 issue of the Journal of the American College of Surgeons, physicians aren't effectively informing women with early stage breast cancer about all the different kinds of surgery they could choose. And as a result, patients were less likely to have the surgery that was most in line with their goals.

For these patients, lumpectomy and complete mastectomy are both reasonable options. Local recurrence risk is higher after lumpectomy than after mastectomy, but survival rates are equivalent with both kinds of surgery. So women really have a choice that should be based completely on their personal preferences, says the study's lead author, Clara Lee, M.D., an associate professor of surgery and director of surgical research at the University of North Carolina School of Medicine in Chapel Hill. But many women are probably never told they have a choice to consider.

Out of 440 patients surveyed who had undergone surgery for stage one or stage two breast cancer, fewer than half (48.6%) recalled ever being asked what they preferred. Less than half (46%) knew that local recurrence risk is high after lumpectomy than mastectomy, while only 56% knew survival rates are equivalent for both types of surgeries.

The patients surveyed had surgery at one of four top medical centers: the Dana-Farber Cancer Institute and the Massachusettes General Hospital in Boston; the University of California, San Francisco, and the University of North Carolina, Chapel Hill.

While it may be that some of these women were offered options and don't remember it, the bottom line is the same: in order to get the best possible health care when there is more than one medically-appropriate choice, you should be prepared to ask questions about the benefits and risks associated with the options you've got.

You may want to take some time and talk with people who have chosen each of the options, and listen to their experiences and the rationale for the choices they made. You should then consider, based on what you've learned and heard, which option feels best to you and then talk with your surgeon about your decision.

Being told you need surgery is very stressful, and many people just want to get it all over with. But you almost always have the time to learn more about your options and think about what you think is best. You'll be living with the outcome a long time; it's worth asking more questions before you sign the consent form for surgery. Just say, "Could you tell me the pros and cons of all the options before I make my decision?" And, "Can I take a little time to think this through and get back to you?"

Conflict of Interest

2012-01-18T11:49:00.000-08:00

My physician walked into the exam room on a Monday morning looking particularly robust and rested. I told her so. And she responded, "Oh, I just came back from a wonderful, all-expenses-paid weekend at the Ventana Inn and Spa, [a high-end boutique resort in Big Sur on the California coast], thanks to a drug company!"

I smiled and asked teasingly, "So are you going to prescribe more of their drugs as a result?" And she answered, "Probably."

So a year or so later, when she was urging me to take hormones as I entered my early 50's, I couldn't help but wonder whether the perks from the drug companies could be having any influence -- conscious or unconscious -- on her decision making. When her explanation about the potential benefits versus risks didn't convince me, I opted to go cold turkey into menopause and leave the drug option on the back burner. And unlike the drug companies, I didn't offer to buy her lunch.

It turns out that, according to analyses by The New York Times and others, 25% of physicians accept cash payments from drug or device makers, and 66% accept routine gifts of food, including dinner out and lunch for all the office staff. Now, on the one hand, it's hard to believe that bagels and coffee delivered to the doctor's office would affect prescribing habits, but, honestly, if it didn't, why would drug companies keep funding fun vacations and meals?

Evidence suggests that doctors who take money and gifts from drug makers often prescribe in ways that are not approved or do not meet general guidelines for symptoms and conditions. A new rule is likely going to take effect soon (the public has until February 17, 2012 to comment on the payment-reporting procedures proposed under the new health care law) that will require companies that have even one product that is covered by Medicare or Medicaid to report all payments to physicians (other than those they employ) and make the data available on a website for all to see.

That's great, but it poses a problem. What do you say to your physician if you find out they're taking cash or benefits from a pharmaceutical company? It's awkward at best.

That's why I suggest that you should be aware that physicians are indeed influenced by rewards and positive reinforcement, just like the rest of us. Whenever your healthcare provider suggests a drug, a procedure, a significant test or surgery, you should -- as CEO of your own body -- be prepared to ask some tough questions:

Why is this the best approach to my problem?
What are the alternatives?
How will I benefit by doing this now, rather than waiting and re-checking my need for it in a few months?
What do you see as the downside risk if I don't do this now?
What is the medical evidence for your recommendation?
What do you see as the pros and cons to taking this approach?

With these questions and a curious mind, you'll be getting the information you need. And you won't ever have to ask, "How was that free luxury weekend at the resort?

Who is responsible for your health? Careful. Your answer could be life-threatening.

2012-01-17T13:55:00.000-08:00

Take this simple one-question quiz:

Who is responsible for your health?

My doctor.
My insurance company or other third-party payer.
The government.
I am.
The emergency room or hospital.

It turns out that people who choose #4, "I am," are more likely to be in better health than are others, regardless of income or other social factors.

A survey developed at the University of Oregon by Judith H. Hibbard and others shows how your commitment to taking charge of your own health care measurably affects your health.

Based on survey results from more than 25,000 patients enrolled in Fairview Health Services, in Minneapolis, looking at objective data such as blood pressure, body mass index (BMI), blood sugar and cholesterol levels, hospitalizations and emergency department use, the study showed that people who are more active in their health care and life style decisions are healthier. Period.

The survey includes a wide range of questions, such as:

How confident are you that you can tell your healthcare provider concerns you have even when he/she does not ask?
How confident are you that you can find trustworthy sources of information about your health condition and your health choices?
How confident are you that you can follow through on medical recommendations your health care provider makes such as changing your diet or doing regular exercise?
Do you believe that taking an active role in your own care is the most important factor in determining your health and ability to function?
If you're dissatisfied with your health care, are you willing to go to the trouble of changing healthcare providers?

The researchers say the survey measures how actively involved you are in your health care. To be involved, you need a combination of self-confidence and knowledge about how to get the information you need, they say. And the more you know about your health, the more likely you are to do what's good for you -- eat right, get exercise, take your medications, obtain the necessary screening tests -- and ask tough questions. You're also more likely to get a new healthcare provider when you're dissatisfied with the one you have.

So, being "the CEO of your own body," as I say, isn't just about knowing who is boss. Research shows it's ultimately critical to your health and well being. The way I see it, it starts with your attitude, with your belief that you're the one in charge of your health care. Then it involves getting more knowledgeable about what questions to ask healthcare providers and and where you can get information to inform your questions and your decisions. And ultimately it demands a level of self-confidence and commitment, a sense that even if you didn't go to medical or nursing school, you know enough to get the answers you need and to make sound choices.

Doc, what are you writing down about me?

2012-01-12T10:48:00.000-08:00

For some odd reason, I still remember this seemingly unimportant experience with the health care system. I was about 20, a nursing student at UCLA, and I was getting a mini-physical through the student health service. The doctor stepped out for a minute, and, accustomed as I was becoming to reading medical records, I leaned over and picked up my chart. The doctor had written down, "heavy abdomen." I weighed 112 pounds. I had no idea what he meant. And of course, when he came back in the room, I didn't ask. To this day, every once in a while I poke my abdomen and wonder what secret lies within.

A recent survey of physicians and patients about whether patients should be "invited" to read their charts was published in the Annals of Internal Medicine. Patients -- of every age, education and health status -- want to.

Some doctors aren't too sure about it. Physicians are concerned, according to the survey, about "worrying their patients," "getting more questions between visits," and "being at greater risk of lawsuits."

There's a status issue behind the "can I please read my chart?" issue. Information is power. The vast majority of physicians over the last 100 years have been trained to see themselves as the central authoritative source on matters of health. Most people in the health professions have not seen the patient's chart as something they would share with the patient. They have long felt that they -- the doctor's office, the clinic, the hospital -- owned it. To this day, in most hospitals, doctor's office and clinics, patients cannot go up to the nurses' station or desk and ask to read their charts. Try it some time.

Part of the problem with all of this is that patients are not getting the benefit of the information contained in the chart, aren't in a position to ensure their description of symptoms and problems is written down accurately, and can't see and discuss the written diagnosis, lab and diagnostic test data, and treatment plan in writing. The practice of not sharing the notes and data increases the risk of medical errors. Almost nothing is written down for the patient. Especially if you're nervous, less is retained when you only hear something. A written copy of the physician notes from every visit would be a very nice thing to review with the physician, take home, discuss with your family if you'd like to, and keep in your own "health history" file.

Some doctors and health systems are starting to do this. Kaiser Permanente in Northern California is one example, and patients really like it. Some physicians are now using a paperless system but have not begun to give you a copy of what they are writing down.

Whether you like it or not, you are indeed the CEO of your own body. No one else is. You are the ultimate decision maker of what tests will be done, what treatments you'll take and what recommendations you'll follow. Your healthcare providers are consultants to you. What CEO wouldn't be allowed to view his or her consultants' reports and notes? What CEO would make decisions without being able to review the data?

"I wouldn't understand all that anyway," you might think. But there is nothing in health care that can't be explained in basic terms. If you have questions, you should do what any CEO would do: a-s-k. All the abbreviations and terms can be translated for you. You can also look up medications, tests or diagnoses on the web or ask another health provider.

A lot has changed since 1912. This question of whether patients can read their charts should be a no brainer. Notes about your health care are all about YOU. Shouldn't you get to read them if you want to, right then, in the examining room, as you and your trusted healthcare provider are deciding what to do next?

Next time you see your healthcare provider, tell him or her that you'd like to go over the notes for the visit together and have a copy to take home. If they look shocked and worried, you'll realize your relationship with your physician needs some work. You may want to break it to them: the chart is legally yours. Or if you'd like to be more gentle, just say, "I'd really benefit from seeing your notes at each visit."

What do you think?

The Bottom Line on Women, Statins and Diabetes Risk

2012-01-10T14:50:00.000-08:00

My previous doctor told me the federal government should be putting statins in our water supply because they could save us all. I don't think so.

If you're a woman 50 or older and are either thinking about taking a statin to reduce your cholesterol or are already on one, yesterday's news about data published in the Archives of Internal Medicine may give you pause.

In short, researchers reported a 48% increased risk of diabetes among women taking statins. It's a much larger risk than has been identified in previous studies, and it raises a bunch of questions. There were 153,840 women in the study.

Statins weren't designed to be used in what is called "primary prevention," to prevent your first heart attack. They were created -- and approved by the FDA -- to help prevent a second heart attack after you've had your first. But gradually they have become a mainstay of middle age, used even by people with few of the risk factors associated with cardiovascular disease.

Statins lower just one risk factor -- high cholesterol -- out of several others. The truth is, if you don't smoke, if you don't have high blood pressure, if you're not overweight, if you don't have diabetes and you're not physically inactive, your cholesterol level is far less important than you might think.

Because diabetes raises your risk of heart disease, it's possible that you could be taking a drug that turns out to do little to decrease your chances of cardiovascular problems, and may even increase your risk.

Whether or not you continue on a statin or start taking one is something you really have to discuss with your healthcare provider based on your family history and risk factors.

But the bottom line on this research is clear:

Drugs have pros and cons, and there are clearly downsides to taking statins.
Lifestyle changes are critical to improving your risk of heart disease. That means exercising regularly, eating right, not smoking, managing your blood pressure and maintaining a healthy weight.
If you take a pill partly to avoid tackling the lifestyle changes you need to make, you can end up with other, bigger problems.

An editorial by Kirsten Johansen, MD, of the University of San francsico, editor of Archives, says that the increased risk of diabetes in women without cardiovascular disease has "important implications for the balance of risk and benefit of statins in the setting of primary prevention in which previous meta-analyses show no benefit on all-cause mortality."

Translated, that means if you're a woman and you don't already have heart disease, statins are likely to be of little or no benefit to you, and may actually increase your risk.

Diagnostic Tests Can Be Wrong: What You Should Know

2012-01-05T11:33:00.000-08:00

It's counter-intuitive, because it seems like a CAT scan, MRI or an x-ray provides a scientific view, something so objective that it's got to be accurate. But there's lots of room for error. Most people don't realize it, but diagnostic tests are sometimes wrong. Taking action based on a single test result can cause needless risk, hassles, cost, or create serious health issues.

A study reported in Health Imaging shows that out of 650 radiology mistakes reported to the Pennsylvania Patient Safety Authority, (who knows how many weren't reported?) 50% of the tests involved the wrong patient or wrong test; 30% were performed on the wrong patient, and 20% focused on the wrong site. Of the tests associated with errors, 45% were x-rays; 17.6% were CT scans; 15% were mammograms; and the remaining tests were MRIs, ultrasounds, PETs, DEXAScans, nuclear medicine or interventional radiology.

Physicians are well aware of the problem. In a piece in Diagnostic Imaging by Richard Woodcock, MD, in September, 2011, "Mistakes are unavoidable...We (in radiology) encounter this difficulty more frequently than virtually anyone else in medicine."

Contributing to the error rate is the fact that many diagnostic facilities don't have specialists who read the tests only within within their practice area or sub-specialty within radiology . The same is true, in fact, with pathology specimens, the examination of material taken from or off your body by a dermatologist or surgeon, for example.

The lack of specialization increases the chance of error. Some physicians are less qualified than others to determine whether or not the diagnostic image is normal or abnormal; and likewise, some are less qualified to identify whether a tumor is benign or malignant, or what sub-type of tumor it may be. These issues will have a role in what treatments are recommended to you and whether it will ultimately be successful.

I know of many, many examples in which a diagnostic test that first suggested big problems turned out to be fine. A CAT scan showed an enlarged pineal gland in the brain, a potentially troubling situation. On second examination a few months later, the gland was normal. In another case, a woman had an x-ray with an unusual spot on the lung; the physician immediately wanted to do a biopsy. The patient asked to have the x-ray re-done in a few months and it turned out to be normal.

So what does this mean for you?

Understand that every test, even if it is high-tech, it's still susceptible to error.
If the results of the test are troubling, ask to have a physician who specializes in that area of the body or that type of problem re-analyze the test results or scan.
Depending on your situation, it may be advisable to ask to have the test re-taken in a few months to confirm the results before taking aggressive action.
If you're having a biopsy taken, consider asking the physician to send one sample to one lab and another to a second lab to allow for two analyses (and to protect against having the sample lost).
Always ask for a written copy of the analysis of the test and read it carefully. Keep the test in a medical folder that you can access later if need by.
Consider getting a second opinion about your situation before proceeding with surgery or treatment.

Of course, this doesn't mean that you shouldn't have diagnostic tests when needed or that you should distrust your healthcare providers. But it does mean that it's important to realize that even the most sophisticated of diagnostic studies can be erroneous. Knowing how to balance your risk by seeking a second opinion or getting confirmation of your results can save you a lot of worry and help ensure your long-term health.

Skinny even after the holidays? Your risk of dying in surgery could be 40% higher

2012-01-03T11:02:00.000-08:00

If you're very thin, here's an excuse to grab that last piece of Christmas fudge from the pantry. It turns out that people with a BMI (body mass index) less than 23 have a 40% higher likelihood of dying in the month after having surgery.

The study, published recently in Archives of Surgery, drew from a national surgical database including 183 hospitals. Reviewing a sample size of 190,000 patients, the researchers found the skinny patients had a significantly greater post-operative risk.

Why? The authors say that, of course, some of the patients could have been thin due to protracted illness, but with the large sample size, that is probably not the whole story. Being underweight has risks, including nutritional deficiencies, compromised immunity, weakness, and complications in pregnancy.

Of course, being overweight has significant health risks associated with surgery. Fat can make it harder to detect problems through diagnostic scan, and can complicate surgery. Some studies also show obesity increases the risk of a post-surgical infection. If extra weight makes it harder to get up and around after surgery, the risk of getting blood clots goes up, too.

So, like so much in life, our best bet is a healthy balance. If your BMI is in the lowest quintile of body weight, make sure you're eating a healthy diet and getting plenty of sleep and exercise.

Wondering what your BMI is now? Find out here. Just plug in your height and weight and the tool automatically gives your your number and tells you whether it's in the healthy range. BMI does not measure body fat directly, but research has shown that it correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA). BMI is a free and easy way to screen for weight categories that may lead to health problems.

One Single Word that Will Help Ensure You Get Better Health Care

2011-12-21T14:40:00.000-08:00

There's one word that will virtually guarantee you better health care.

Time.

When you're first dealing with news about your body -- especially potentially bad news -- unless your situation is immediately life threatening, your first reflex should be to pause. Not react. Not immediately see a specialist or a surgeon. Your first and most important step is to do nothing.

Most people feel they need to act immediately: get another test, a biopsy, a procedure, or sign up for surgery just to stem the tide of what they picture as rapidly reproducing cancer cells, or the quick spread of infection, or the immediate and complete blockage of critical arteries. They want action. They want quick solutions. Fast remedies. They want the fear and the confusion to end. They want a plan.

Instead, sit back and consider what you're hearing from your healthcare provider. Try not to react emotionally. Take a few deep breaths. If you can compose yourself and think clearly, ask some questions. If you can't, ask if you can call or return in a few days with follow-up questions.

Then get fully briefed on your situation (as the CEO of your own body). Get a handle on your own data: learn exactly how your situation was diagnosed and what precise next steps are being suggested.

Do a little homework. See what the Internet offers. Talk with friends. Then go back to your healthcare provider with a set of well-informed questions.

Depending on your situation, you may want to get your blood test re-done by a different lab to confirm the situation, or have biopsy slides or test results reviewed by another pathologist or other physician. If surgery or an invasive procedure is being proposed, you may want to ask if there are alternatives such as medications or radiology. Get a second opinion or two. Talk to someone who advocates a traditional tried-and-true method and another who suggests using a proven new approach. Talk with others who have personally dealt with a diagnosis such as yours.

Think about which alternatives you've been offered are most palatable to you -- which ones feel like the right approach, given your personality and what you've heard from your consultants, the physicians. Talk with the people you love. And then, and only then, decide how you would like to move forward.

9 Easy Tips for Healthy Plane Travel

2011-12-19T17:10:00.000-08:00

For years, practically every single time I flew -- whether for business or pleasure -- I got a cold. I hate being sick. I especially hate being sick when I'm traveling. So I did a systematic analysis of why I was catching colds from plane travel, reviewed the latest research and developed a game plan that works.

The odds of catching a cold or flu when you fly are sky high. One study found that when a plane sat on the tarmac for three hours without circulating air, 72% of 54 people got sick within two days from a flu strain that was linked to a single passenger.

But, do not despair. There are some concrete things you can do to help avoid bringing home a fever-cough-and-sore-throat-souvenir. And honestly, once I started doing these things I haven't caught an airplane- or airport-induced cold since.

Boost your immune system before the trip. For a day or two before you plan to fly, get plenty of sleep and eat right. Get plenty of exercise. Take 500 mg to 1500 mg a day of Vitamin C. (You can't overdose on Vitamin C because your body eliminates what it doesn't need through your urine). Think of your flight almost as if you're planning to run a marathon.
There's no data about how often security bins are cleaned. I'd wager that most have never been wiped off. When you're done with security, step into a rest room and wash up. It also wouldn't hurt to wipe off your carry-ons and your purse with an antiseptic wipe.
Consider every airplane surface to be full of germs. The airlines say they thoroughly wipe the plane's inside surfaces -- like tray tables -- about once a month. Just imagine how many people have touched your armrest, seat belts, and tray tables before you sit down. Bring a slew of disinfectant packets with you and thoroughly wipe off these surfaces before you settle in.
Don't touch the seat-back pockets. They are virtually impossible to disinfect. Bring your own reading material and avoid the airline magazine catalogs such as SkyMall. Even the safety instructions card is probably gross. Watch the safety video.
Don't use airline blankets or pillows. Use your coat or jacket if you're cold and bring an inflatable soft pillow if you like.
Treat the onboard bathroom like a giant germ pool. If you need to lift or lower the toilet seat, use a tissue. Wash your hands thoroughly with soap and warm water even though the water keeps going off automatically. Use a paper towel to drain the sink (since the sinks in airport bathrooms typically don't drain on their own). Also use a paper towel to open the door as you exit. And when you get back to your seat, use a hand disinfectant (such as Purrell or a pre-packaged sanitizing wipe).
Use a hand disinfectant or sanitizing wipe before you eat or drink during the flight.
If you end up seated next to someone who is sick, talk with the flight attendant to see if you can change seats. Just explain to your seat neighbor that you don't mean to offend him or her, but you need to avoid getting sick.
Stay hydrated. Not only does this help prevent blood clots, it will help keep your nasal and throat passages moist. Some people also use saline sprays. Avoid alcohol because it will dehydrate you.

I've had people watch me carefully clean off my tray table, seat belt and arm rests with antiseptic wipes. They have laughed at me, cracked jokes, or just snickered. But I get over it and you should, too. Because three days later, when you're snowboarding in good health in Aspen, or acing a business meeting across the continent, or sitting around the fire talking with your family, you can just imagine the person who made fun of your prudent antics is now in stuck in bed, feeling miserable.

Do what you can to avoid getting sick from the masses.

Not So Wise to Remove Wisdom Teeth

2011-12-15T14:28:00.000-08:00

It's been almost a rite of passage in America. When you're 16-18, you're carted off to the oral surgeon to have your wisdom teeth (third molars) taken out. You typically spend a few days with ice packs, pain pills and salt water gargle, propped up in front of the TV.

Yesterday ABC News reported that the parents of a Maryland teenager who passed away this year during a wisdom tooth extraction are suing the oral surgeon and anesthetist. Jenny Olenick, 17, died when her heart rate and blood oxygen dropped to a critical level and she was not resuscitated.

About five million Americans have their wisdom teeth extracted every year (although the procedure is done far less often in many other countries). Wisdom teeth extraction costs more than $3 billion a year. In addition to the inherent risks of anesthesia, it's possible to have permanent nerve damage (which affects 11,000 people annually), jaw and tooth fractures, hypoxia, hemorrhage and infections of the brain.

Most dentists and oral surgeons, and the American Association of Oral and Maxillofacial Surgeons, say impacted wisdom teeth need to be removed because they can damage adjacent or nearby teeth and nerves, get infected, or crowd your other teeth.

But research argues against the routine removal of wisdom teeth. The American Public Health Association says it "subjects individuals and society to unnecessary costs, avoidable morbidity and the risks of permanent injury." A report by the National Institutes of Health says wisdom teeth should be extracted only when there is infection, cavities, cysts, tumors or damage to adjacent teeth and bone. It doesn't recommend taking out teeth that are not causing discomfort or pain, even if they are impacted. And an article in Science Daily says "no reliable studies exist to support removal of trouble-free impacted wisdom teeth." The study authors argue that "prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60 percent or more."

The lead author of that study, originally published in The Cochrane Library, a publication of The Cochrane Collaboration (an organization that reviews medical research) boils it down well. "The third molar controversy is still ongoing. As with all surgical procedures, the surgeon wants to do surgery; it is his or her profession. However, systematic prophylactic removal of impacted third molars is not evidence-based but only practice-based and usual care. From a patient point of view, nonsurgical treatment should be the first option in an asymptomatic environment."

Bottom line: if you or your teenagers are nominated for wisdom teeth extraction, explore with the dentist what indications specific to you or to your child lead to that suggestion. Buy some time: ask that the teeth be actively monitored at regular six-month appointments before you re-consider moving ahead with the decision.

(Full disclosure: I had my upper wisdom teeth out at 16. My husband had all four of his removed at 21. Our son had them out at about 17. None of us had any problems or symptoms precipitating the surgery. And our daughter is part of the roughly 30% of people who are born without third molars).

Women: It's Time to Kiss Your Annual Pelvic Exam Goodbye

2011-12-13T14:05:00.000-08:00

Most women absolutely hate the annual ritual of getting a pelvic exam. It's awkward and uncomfortable, and nothing makes you feel smaller and stranger than having a healthcare professional wearing surgical gloves and a clear plastic mask inserting himself or herself in and around your pelvic organs, looking for problems.

Well, it's time to stop. Pelvic exams are not supported by scientific evidence and are not recommended by any U.S. organization. But a survey of 1,250 U.S. internists, family practitioners, general practitioners and obstetrician/gynecologists showed that more than 98.4% of the ob/gyn docs still do them as part of a routine annual "wellwoman exam," as do 89.5% of family and general practitioners, and 54% of internists. The study is published online in the December 26, 2011 issue of the prestigious Archives of Internal Medicine.

Pelvic exams aren't harmless. They are not effective in early detection of ovarian cancer. What's worse is that there is a false-positive rate of 98%, which leads to over-testing and unnecessary anxiety and fear. They add to the cost of health care. And the reluctance to have the exam often deters women from getting contraceptives or having routine screening for sexually transmitted infections, the study authors say.

For years, pelvic exams and Pap smears have been done annually. But in 2003, the American College of Obstetricians and Gynecologist recommended that women only get a Pap smear only every three years, once they've had a negative Pap test.

Analia R Stormo and colleagues from the Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, in Atlanta, Georgia and researchers from the Soltera Center for Cancer Prevention Control Research in Tucson, Arizona conducted the study.

Next time you go in for your annual physical, this study suggests you would be wise to tell your doctor that you're skipping the pelvic exam. Use the time you save to discuss some other aspect of your health, an activity that is far more likely to truly benefit you and help you be healthier.

9 Things You Can Do Now to Help Avoid Breast Cancer

2011-12-12T12:02:00.000-08:00

The latest thinking about breast cancer says you may have a meaningful role to play in reducing your risks.

According to the Institute of Medicine of the National Academies, about 230,480 women will have found out they had breast cancer this year. While there is still much to learn about the disease, a consensus review by the Institute of Medicine -- sponsored by Susan G. Komen for the Cure -- offers specific things we can do to help cut our chances of getting breast cancer.

The report also says that a "life-course approach" to studying breast cancer is needed because new information suggests that women and girls may be more susceptible to some risk factors during specific life stages.

Here are nine things the Institute of Medicine report says you can do now:

Avoid inappropriate or unnecessary medical radiation exposure, such as CAT scans.
Avoid combination (estrogen-progestin) hormone treatment.
Stop smoking.
Avoid passive smoking.
Limit or eliminate alcohol consumption (but know that some alcohol consumption may decrease your risk of heart disease).
Maintain or increase your level of physical activity.
Maintain a healthy weight, or reduce your weight, to cut your postmenopausal risk.
Limit workplace, consumer, and environment exposure to chemicals.
If at high risk of breast cancer, consider use of chemoprevention.

In addition to considering how to adapt these recommendations to your lifestyle, be sure to check out the short, readable, very helpful Q & A booklet that explains common questions about risk and what the statistics really mean for you.
As 2011 comes to a close,consider how the report might might serve as a catalyst to some personal New Year's resolutions that can help ensure your health for years to come.

Antibiotics, Docs, and You

2011-12-08T13:32:00.000-08:00

There's a big lesson to learn from this piece of research: physicians often do things based on what other doctors in their area are doing, rather than what research or recommendations dictate. This has big implications for your health and for healthcare in general.

It turns out that a sore throat, ear infection or a cough in one part of the country will be quickly treated with an antibiotic, while in another section of the nation, it won't. For example, healthcare providers in Alaska, Oregon and California tend to be more reluctant to pop open the prescription pad without clear evidence antibiotics are needed. But if you live in North Dakota, North Carolina, Delaware or Pennsylvania, you're far more likely to score antibiotics.

Why is that? According to William Schaffner, MD, chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville, Tenn. (interviewed by American Medical News) the geographical disparity in prescription rates is due to the fact that physicians aren't using antibiotics properly. It seems that some physicians prescribe antibiotics just because their patients lobby for the drugs for themselves or for their children. The research was done by Extending the Cure, a project of the Washington-based nonprofit Center for Disease Dynamics, Economics & Policy.

In West Virginia, there were 1,222 dispensed antibiotic prescriptions for every 1,000 people, more than two times the antibiotic prescribing rate in Alaska (546 per 1,000 individuals). The national average was 858 antibiotic prescriptions per 1,000 residents.

Resistance to broad-spectrum drugs is on the rise in communities and hospitals, making lackadaisical antibiotic prescribing a national health issue. There are clearly situations in which broad spectrum drugs should be prescribed, but when it's overdone, it means the antibiotics we have available may not work when we really need them (individually or collectively). More research is needed to explain the vast differences in prescribing practices.

The data also showcase a problem that applies to almost every aspect of health care. Physicians differ widely in how they practice medicine and what drugs, procedures and surgeries they typically prescribe and recommend. Sometimes those decisions are based on local community practice or the "medical culture" of the area, rather than on research-proven guidelines.

As for your own antibiotics use, it's important to understand that they can't resolve a viral infection, like most colds or flu. Sometimes, if you've been sick for awhile, you develop what is called a secondary or "super" infection, meaning that you've now got a bacterial infection, often in your lungs or sinuses. If that's the case, antibiotics may be in order. But don't run to the doctor asking for antibiotics as a quick fix to an initial sore throat or the sniffles. Get some rest and drink a lot of fluids. If you experience high fever or don't start to feel better after five days or so, see your health provider. (As always, though, if you have any questions or concerns, seek medical attention). But don't push for antibiotics that you may not need.

Map source: Outpatient Antibiotic Use, Center for Disease Dynamics, Economics & Policy, Nov. 16, 2011; Published December 5, 2011, amednews.com

40% of All Cancers Are Caused by Things We Can Change

2011-12-07T14:09:00.000-08:00

The timing of this study is really bad. Just when we're poised to indulge a bit over the holidays, new research reminds us that the best bet for a long life -- and avoiding cancer -- amounts to living a very healthy lifestyle.

In the most comprehensive review of cancer and lifestyle ever undertaken, researchers have found that about 40% of all cancers are caused by things we generally have the power to change. Rather than luck, fate, or genetics, almost half of cancer cases can be attributed to smoking, unhealthy diets, alcohol and excess weight. The study was published in the December issue of the British Journal of Cancer.

The findings are too detailed to be fully reported here, but there were some especially notable discoveries. There were differences between how lifestyle habits affected men and women. For men, not eating enough fruits and vegetables was second to smoking in risk factors. For women, being overweight was in second place. Men were more affected by occupational expsoure (such as asbestos), while women experienced a larger impact from infections, (such as HPV and cervical cancer).

The researchers remind us that a healthy lifestyle is, of course, not a guarantee that we won't get cancer. "There is always a chance element," said Max Parkin, MD, professor of epidemiology at Queen Mary University, London, at a press conference announcing the study findings.

My advice? Go ahead and celebrate responsibly over the holidays. But be sure to take some time to consider your New Year's resolutions, and build in a do-able approach to exercise, healthier food, quitting smoking and reducing your alcohol intake. Make the new year -- and this research -- your catalysts to take on any necessary change with gusto and perseverance.

Taking an Antidepressant But Not Happy? Switch to a New Drug

2011-12-06T10:29:00.000-08:00

If you're taking an anti-depressant, you're in good company. About 27 million Americans have taken antidepressants as of 2005. But many people find that the drug they're taking doesn't seem effective, or they dislike the side effects they're experiencing.

You may just need a different drug. A study published online December 5 in the Annals of Internal Medicine found that today's SSRIs (selective serotonin reuptake inhibitors), SNRIs (norepipnephrine reputake inhibitors), and related antidepressants are virtually interchangeable. But depending on your unique characteristics, they do vary in how quickly they work, side effects you may experience and the impact on your quality of life.

The research, funded by the U.S. Agency for Healthcare Research and Quality, was what is called a "meta analysis," a full-scale review of multiple previously-done published studies to analyze collective conclusions. It looked at 234 research papers, all based on randomized trials that included at least 1,000 people in each.

For example, Remeron (mirtazapine) works more quickly than does Prozac, Paxil, Zoloft or Clexa. Wellbutrin (bupropion) has fewer side effects than does Zoloft, Paxil, Lexapro or Prozac. Some are more likely to help you sleep. Others tend to contribute to appetite and weight gain (a blessing if you've been losing weight but a curse if you tend to gain pounds when you're depressed). Some have to be taken more frequently than others, which makes it more likely you may skip a dose here and there and then find the medication to be less effective.Costs, too, vary from about $20 a month to $200 a month.

If you're taking an antidepressant with mixed results, don't assume you're getting the best that medicine can offer. Talk with your healthcare provider about trying another of the many newer antidepressants available, matching the drug's side effects and other characteristics to your needs. Finding the right match can take a little trial and error, but it's worth the time and effort.

Heartburn May Be Eased with Antibiotics

2011-12-05T15:44:00.000-08:00

If you've tried a low fat, low acid diet, exercise and stress reduction and still have heartburn or GERD (gastro esophogeal reflux disease), a new study published online in the November 28, 2011 issue of the Archives of Internal Medicine suggests you should try taking antibiotics along with your heartburn drug.

Why antibiotics? They can wipe out Helicobacter pylori (H. pylori), a bacterium previously found to be associated with chronic gastritis and gastric ulcers.The new research suggests that people who suffer from heartburn but don't have ulcers may also benefit from taking antibiotics such as amoxicillin and clarithromycin for 10 days. An accompanying editorial to the research says there is now strong evidence that eradicating H. pylori can help some patients.

The researchers randomly assigned 404 people with indigestion or heartburn to take just omeprazole (a protein-pump inhibitor), or to also take amoxicillin and clarithromycin for 10 days. A year later, 49% of the people who were taking the antibiotics reported their symptoms had improved by at least 50%, while only 37% of those just on the protein-pump inhibitor reported such reduction in symptoms. (Protein pump inhibitors reduce the amount of acid generated in the stomach).

Testing for H. pylori is simple; options include a blood antibody test, a stool antigen test and a urea breath test. But some healthcare providers may decide to simply prescribe the antibiotics without testing for the bacterium just to see if the drugs are effective.

Physicians and researchers don't fully understand the role of H. pylori in our gastro-intestinal systems, but the research now suggests that antibiotics may be worth a try for people who have been dealing with chronic heartburn.