Harvard Health Blog

In an effort to halt the spread of AIDS, health officials in New York City recommended yesterday that treatment with anti-AIDS drugs should begin as soon as an individual is diagnosed with the human immunodeficiency virus (HIV), the virus that causes AIDS, rather than waiting for it to begin harming the immune system. Early treatment also lessens the likelihood of passing HIV to someone else.

On the 13th annual World AIDS Day, there’s cause for hope. The epidemic seems to have peaked. Drug therapy has turned HIV/AIDS into a manageable chronic disease. Drug therapy appears to prevent transmission of HIV from infected to uninfected individuals. And HIV cures are under investigation. Yet there is also cause for continued alarm. The AIDS epidemic is far from over, and the downward trends in infection rates could plateau or head up if prevention and treatment efforts slack off. The overalI trends don’t apply to everybody. In the United States, new HIV infections are still increasing among young black men, both gay and bisexual. And despite all the research into HIV and over two dozen ongoing trials of candidate agents, there’s still no HIV/AIDS vaccine.

The patent on Lipitor, the world’s best-selling brand name prescription drug, expired on November 30th. That opens the door for less expensive generic versions of the drug, called atorvastatin, which are now available. In addition to atorvastatin, six other statins are currently available in the United States. Generic drugs are chemical clones of their brand-name counterparts. By law, generic drugs must contain the same active ingredients as the brand-name drug, work the same way in the body, and meet the same standards the FDA has set for the brand-name drug. One big difference is cost. Generic atorvastatin should be less expensive than brand-name Lipitor, although Pfizer, the company that makes Lipitor, is striking deals with insurers and pharmacy benefit managers to price brand-name Lipitor at or under the generic alternatives in order to keep sales of Lipitor as strong as possible for as long as possible.

The FDA has approved a nonsurgical alternative to open-heart surgery for replacing a failing aortic valve. For now, though, it is only available for people who can’t, or shouldn’t, have open-heart surgery.

Today, the only reliable way to check blood sugar is by pricking a finger, squeezing out a drop of blood, and placing it on a small test strip attached to a meter. For some people, this means five to ten finger sticks a day. Researchers across the country are exploring pain-free ways to measure blood sugar. University of California, San Diego researchers have developed a titanium sensor the diameter of a quarter that would be implanted under the skin and wirelessly send blood sugar readings to an external monitor. At Northeastern University in Boston, researchers are working on a blood sugar “tattoo” by injecting glucose-detecting nanosensors under the skin. Arizona State University researchers are working to perfect a device that measures blood sugar using tears instead of blood.

Some medications are well known for being risky, especially for older people. Certain antihistamines, barbiturates, muscle relaxants—take too much of them, or take them with certain other medications, and you can wind up in serious trouble (and possibly in the back of ambulance). But researchers from the federal Centers for Disease Control and Prevention (CDC) […]

If exercise is good medicine, then yoga is, too. Research published recently suggests that yoga can be a useful therapy for lower back pain. An article in the November 2011 Harvard Health Letter indicates that yoga may also be a good way to keep feet strong and flexible, and so prevent falls. It can also help people who suffer from migraines. In The Migraine Solution, which will be published in January by Harvard Health Publishing and St. Martin’s Press, coauthor Paul B. Rizzoli, M.D., says that yoga can be a useful treatment for migraine because it is widely available, affordable, and very likely has benefits beyond migraine.

The FDA today revoked its 2008 approval of the drug Avastin to treat breast cancer, concluding that the drug does little to help women with breast cancer while putting them at risk for potentially life-threatening side effects. Avastin will remain on the market (and so be potentially available to women with breast cancer) because it has also been approved to treat other types of cancer.

Good vibrations may work for dancing on the beach or for romance, but they don’t seem to do much to strengthen bones. Results of a clinical trial published in the Annals of Internal Medicine showed that older women who stood on a vibrating platform for 20 minutes a day experienced just as much bone loss over the course of the year-long trial as women who didn’t use the platform.

Many older people develop delirium when they are hospitalized. Delirium is a sudden change in mental status characterized by confusion, disorientation, altered states of consciousness (from hyperalert to unrousable), an inability to focus, and sometimes hallucinations. Hospital delirium is especially common among older people who’ve had surgeries such as hip replacement or heart surgery, or those who are in intensive care. Inflammation, infection, and medications can trigger hospital delirium as can potentially disorienting changes common to hospital stays, including sleep interruptions, unfamiliar surroundings, disruption of usual routines, separation from family and pets, and being without eyeglasses or dentures. Although delirium often recedes, it may have long-lasting aftereffects, including premature death and poorer outcomes, such as dementia and institutionalization.

With Veterans Day and Halloween behind us, we are moving full steam ahead to the holidays, the stretch from Thanksgiving to New Year’s Day (or Super Bowl Sunday, depending on your perspective). The holidays can be a wonderful time, full of friends, family, and fun. But they can also generate pressures and situations that undermine health. To help you enjoy a healthy and happy holiday season, Harvard Health Publishing is offering three Special Health Reports that focus on common holiday challenges: depression, overuse of alcohol, and healthy eating.

One of the challenges faced by many servicemen and servicewomen returning from war is post-traumatic stress disorder, or PTSD. This a lasting and exaggerated reaction to a terrifying or life-threatening event. It makes a person feel like he or she is living through the event over and over again. PTSD shows itself in three main ways: re-experiencing, avoidance, and arousal. Traumatic events can create memories that are stronger, more vivid, and more easily recalled than normal events. These haunting memories activate brain circuits that are responsible for instantly responding to potentially life-threatening situations. Good treatments are available for PTSD. A type of talk therapy known as cognitive-behavioral therapy appears to be the most effective. Antidepressants and other medications can also help.

The manslaughter trial of Michael Jackson’s personal physician, Dr. Conrad Murray, focused a lot of attention on a powerful anesthetic agent called propofol. Propofol is sometimes called the “milk of anesthesia” because it comes in a white, oily solution. Propofol is used as an induction agent—the drug that causes loss of consciousness— for general anesthesia in major surgery. Propofol is also a very good anesthetic for milder sedation used for outpatient surgery because it puts people in a semi-conscious, drowsy state. It starts acting quickly, but also wears off quickly. Like many sedating anesthetics, propofol lowers blood pressure and suppresses breathing, so the heart function and breathing of patients need to be constantly monitored. With a lot of propofol around, opportunities exist for abuse, with possibly fatal consequences.

As many as 32 million American women and men have some degree of incontinence—the unintended loss of urine or feces that is significant enough to make it difficult to do ordinary activities without frequent trips to the restroom. The most common causes of incontinence are childbirth and aging in women; prostate disorders and their treatment in men. Treatments include exercises to strengthen the pelvic floor, fluid management, medications, and surgery. For people with urinary incontinence, fluid management is an easy place to start, explains Better Bladder and Bowel Control, a new Special Health Report from Harvard Medical School. This involves drinking only when you are thirsty, limiting your fluid intake from all sources to six to eight 8-ounce cups of fluid per day from all sources, and minimizing caffeinated and carbonated drinks, as well as alcohol.

Most Americans fall back from daylight savings 2011 during the wee hours of Sunday morning, November 6. Although the time change can be discombobulating, our hearts like it better than springing ahead. One study showed fewer heart attacks on the Monday after the end of daylight savings time in the fall; the opposite happens in the spring. Getting, or losing, that extra hour of sleep may explain the differences. Ways to ease into the time change include going to bed and waking up at the same time as usual, and getting some sunlight on Sunday as soon as you get out of bed.

It was once thought that taking vitamin E could reduce the risk of prostate cancer. However, recent research suggests this is not the case. Back in 2008 one large study, known as the Selenium and Vitamin E Cancer Prevention Trial (SELECT), showed that not only did vitamin E fail to decrease the risk of prostate […]

A 28-year study of 106,000 women found that moderate alcohol slightly increases a woman’s risk of developing breast cancer. Women who had the equivalent of three to six drinks a week had a modest increase in their risk of breast cancer (15%) compared to women who never drank alcohol. That would translate into an extra 3 cases of breast cancer per 1,000 women per year. The risks were the same for wine, beer, and spirits. Because moderate drinking appears to prevent some types of heart disease—which affects more women than breast cancer does—it’s important for women to think about alcohol in light of their own personal health situation.

A new study involving 1.2 million children and young adults provided reassuring evidence that the drugs used to treat ADHD do not increase the risk of death from heart disease. Researchers analyzed medical records from a nationwide private insurance plan along with health plans based in Tennessee, California, and Washington State. They compared children taking stimulant drugs (like Ritalin and Adderall) that are commonly used to treat ADHD to children not taking these drugs. Cardiac problems were no more common among children using a stimulant as among those not taking one.

Although current recommendations call for pediatricians to ask their adolescent patients about alcohol and drug use at every visit, many don’t. To make it easier for doctors and nurses to do this, the American Academy of Pediatrics has just published a set of questions to guide the confidential conversation, along with advice on what to do with the answers. The first question is a simple one about drug or alcohol use. If the answer is no, the health care provider should praise the teen and encourage him or her to continue making good decisions about health and safety. If the answer is yes, six follow-up questions called the CRAFFT questions) can help separate those who are experimenting from those who may be headed for serious trouble and need more in-depth help.

Two new studies, one from the United Kingdom and one from Seattle, show that people with lower back pain may get some relief by regularly doing yoga. In the British study, yoga classes were more effective than standard care at improving “back function,” meaning it reduced back-related problems that interfered with everyday activities like walking, standing, climbing stairs, and so on. In the Seattle study, yoga was just as good as special stretching classes designed for people with low back pain. In the real world, it’s probably easier to find a yoga class than a stretching class designed specifically for low back pain. While yoga is generally safe, if you want to use it to treat something like low back pain, talk it over with your doctor first—in both studies, yoga made back pain worse for a small percentage of people.

The new fields of pharmacoepidemiology and pharmacoeconomics aim to understand how people use medications and how effective—or ineffective—medications are. A leader in this area is Dr. Jerry Avorn, chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. In a recent issue of the Harvard Health Letter, editor Peter Wehrwein spoke with Avorn about generic drugs, the pharmaceutical industry, the high cost of cancer drugs, and more.

For the past five years, the Centers for Disease Control and Prevention (CDC) has recommended that all girls and young women be vaccinated against the human papillomavirus (HPV), a sexually transmitted virus that is a key cause of cervical cancer. Members of a CDC advisory panel have now voted unanimously that boys and young men should also get the vaccine. Vaccinating boys and young men against the virus will help prevent its transmission to women, and will also help prevent some of the 7,000 HPV-related cancers that occur in men each year, including cancers of the penis, anus, head, neck, and throat. HPV also causes genital warts in both men and women. The vaccine works best when a child gets it before he or she becomes sexually active.