heart disease

The phrase "high quality, low cost health care" gets thrown around quite a lot these days. Unfortunately, no one seems to be able to agree on what it means. Are there really ways to cut costs and improve the quality of healthcare at the same time, and how do we find them?

A group of doctors from the National Physicians Alliance (NPA) recently listed several common patient problems for which medical care could be improved and costs lowered. Hear are five of the most frequently mentioned areas where less may truly be more:

Sinus Infections
People with mild to moderate acute sinus infection do not generally require antibiotics unless symptoms have lasted more than a week (or if there is worsening after initial improvement).

This one is near to my heart as an infectious disease specialist. Fellow healthcare workers often seem annoyed or hurt when I fail to give them antibiotics in hospital hallways for this problem. (I suspect they quickly slip off to descend on another unsuspecting colleague.) Most new sinusitis episodes are viral infections, and antibiotics are not helpful, though they are prescribed in a clear majority of cases.

EKGs and Heart Disease
Annual electrocardiographs on low risk patients without any symptoms of heart disease are unnecessary. This is another classic case of more is not always better. Routine EKGs are very unlikely to improve health outcomes in such patients, and they can lead to an "off to the races" series of more invasive tests, often with possible serious complications as well as significant costs.

Pap Tests
Screening Pap tests are not necessary in women younger than 21 or in women after hysterectomy performed for reasons other than cancer. Most abnormal tests in adolescent women return to normal spontaneously over time, and such abnormal tests can lead to unnecessary further testing as well as needless anxiety.

Sore Throats
Patients with sore throat (pharyngitis) do not require antibiotics unless they test positive for Strep. Once again, most upper respiratory tract infections are viral, but physicians prescribe antibiotics in a majority of patients with these complaints.

Furthermore, most people with sore throat and no fever, no tender neck lymph nodes, and no white patches on the tonsils should not even be tested for Strep throat. Strep is very unlikely without any of these present.

Low Back Pain
Finally, people with low back pain of less than six weeks' duration should not have routine x-ray or other imaging performed unless they complain of neurological deficits such as weakness or if serious underlying conditions such as cancer or bone infection are suspected. Early screening increases costs without improving outcomes.

Always remember that general rules don't apply to every individual or situation. Be sure to discuss with your physician any unusual details of your problem that may require additional testing.

Each of the scenarios above, however, does offer an opportunity to improve care and control costs. We all can hope that the NPA and other physician groups will continue to look for opportunities to lead in health care reform, keeping patients' welfare first while improving care in this era of limited resources.

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There's nothing like a study touting the health benefits of drinking alcohol to put people in a celebratory mood. No doubt moderate drinkers are tipping their glasses to one such study published in the September issue of the journal Alcoholism: Clinical and Experimental Research.

The study found that drinkers aged 55 to 65 have lower mortality rates than non-drinkers. That's right: Subjects who did not drink had twice the risk of death as moderate drinkers (defined as someone who drinks two to three drinks a day). Even compared to heavy drinkers, who average more than three drinks a day, the mortality risk for non-drinkers in the study was still higher.

The study adds to other research that's been pointing to the benefits of drinking a little alcohol--mostly in the form of red wine.

But before you break out the champagne, it's important to note that most of the non-drinkers in the study were less healthy than the drinkers to begin with.

According to the authors, the abstainers were more likely to have "prior drinking problems, to be obese and to smoke cigarettes" than their drinking counterparts. They also were less affluent, less likely to be physically active, less likely to be married and less likely to socialize—factors associated with shorter lifespans.

Once researchers controlled for those factors, subjects in the study died in rates similar to heavy drinkers, but still higher than moderate drinkers.

Good news for the cocktail crowd? Maybe not. It's hard for scientists to effectively control for that many factors, and this kind of study—one where subjects self report their behavior—doesn't produce the most reliable results.

Some people may interpret the findings as an open invitation to belly up to the bar. And that's a problem. As the researchers in the study point out, moderate drinking can increase the risk of falls, lead to alcohol abuse and interfere with certain medications in older people.

Plus, there are other things people in this age group can do that are proven to have a bigger impact on mortality rates than consuming alcohol—such as losing weight, quitting smoking and socializing more. And those are definitely worth toasting.

When I was diagnosed with diabetes 10 years ago, there weren't many places to turn to for help. I tried a support group, but I was the youngest person in the class by 20 years; the other recently-diagnosed patients faced different challenges than I did.

The few people I knew my age with diabetes had type 1, a disease that seemed at the time as different from type 2 as arthritis. I could find no one, it seemed, who was dealing with the same disease and circumstances that I was.

What a difference a decade makes. Thanks to social networks, bloggers, FaceBook and Twitter, rich communities exist that allow the afflicted to connect with one another and share information.

A lot of people might have scoffed at the benefit of such sites just a few years ago; really, who in their right mind would turn to a chat room or bulletin board for medical information? And who would publicly share details of their disease?

Count me among those initial skeptics. But I've come around. I like connecting with other diabetics--especially as my disease has progressed and become more complicated to manage. Now I use Twitter to share blood sugar readings, read blogs by other writers with diabetes and share interesting articles on my Facebook profile. While I still distrust much of the medical information I find, I feel more connected to people suffering from the same chronic illness as me--and I feel as though I have a community of support.

And it turns out I'm not alone: Studies show that such online activity helps mute the loneliness, stress and depression symptoms that attend chronic conditions like heart disease, arthritis, celiac disease and diabetes.

In one study, for example, women who participated in breast cancer groups online boosted their quality of life and decreased depression.

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We all know that a good laugh can help you feel better. But can humor also improve your health?

The late Norman Cousins thought so. When the writer and editor was diagnosed with an autoimmune disease in the 1970's, his self-prescribed treatment included humorous TV shows and films, which he credited for helping him recover. He called laughter "internal jogging."

Three decades later, there's new research that may support Cousins' belief. In a study of 20 diabetic patients, half of whom were exposed to humor as part of their treatment, those in the laughter group had higher levels of good cholesterol (HDL) and fewer signs of inflammation in their blood vessels (a possible risk for heart disease) than those not exposed to humor.

To be sure, a study with only 20 subjects is far from conclusive, and it has yet to be published. Still, it follows other research suggesting that laughter may help increase blood flow, reduce levels of stress hormones, and enhance immune function.

By itself, laughter therapy won't cure cancer or keep you from getting sick. But it certainly can't hurt. At the very least, it may make your pursuit of better health more enjoyable. Watch, for example, how some yoga practitioners are incorporating laugher into their routines.

One physician, Dr. Brad Nieder, has gone so far as to become a stand-up comedian. If further research corroborates that, as the Bible says, a "merry heart doeth good like a medicine," then the good doctor may indeed be on to something by keeping people in stitches.

It's become a frustratingly familiar tale: A vitamin or mineral is hailed for its power to ward off disease. Sales of the supplement soar. But then studies suggest that the claims may have been overblown. Eventually, more definitive research--in the form of large, randomized trials--confirms that the supplement is ineffective and possibly even harmful.

Such is the disappointing story of vitamin E, an antioxidant that previous research has suggested may help ward off cancer and heart disease. But several recent studies have cast doubt on the idea. And now two large trials are putting some final nails in the coffin.

One is a massive study, funded by the National Cancer Institute, that involves 35,000 men age 50 and older. Known as SELECT, it was designed to determine whether vitamin E and the mineral selenium, taken either alone or together, prevent prostate cancer. The answer is no, according to an initial review of the data. What's more, those who took vitamin E had a slightly higher risk of prostate cancer, though it's possible the finding was due to chance. As a precaution, researchers recently decided to halt the trial early and advised participants to stop taking their supplements.

Another large randomized trial, involving more than 14,000 male physicians age 50 and older, recently found that subjects who took vitamin E supplements had no fewer heart attacks, strokes, or cardiovascular-related deaths than those who got a placebo.

When vitamin E fails tests such as these, proponents are sometimes quick to blame the research. One common complaint is that studies used synthetic vitamin E rather than the "natural" form. (You can tell which is which by looking at the label; dl-alpha-tocopherol means it's synthetic, while a "d" instead of "dl" indicates it's natural.) Though some vitamin users and sellers believe that natural vitamin E is more effective, there's no compelling evidence to support such assertions.

Other possible explanations are that the dose (400 IUs daily in both studies) wasn't optimal or that the follow-up periods (an average of five years in SELECT and eight in the heart disease trial) were too short.

Perhaps. But the information yielded by health studies is rarely perfect. We have to make decisions based on what's known--not what we hope is true. And multiple studies--involving different doses and different populations, using different forms of vitamin E--have now shown that it does not live up to its earlier billing.

The take-home message is that we need to be careful not to swallow supplement claims prematurely. First, do some homework. Databases provided by the Mayo Clinic and Consumer Reports, which objectively review the scientific evidence for a host of dietary supplements, are two good places to start.

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