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Few of us like being patients, but there are ways to take charge of the situation
It’s no fun being a patient.You’re sick or bringing a family member or friend along. pills, but researchers are propos-
worried about being so. There’s the loss
It’s helpful to them to have friends or family
ing a “Polypill” of generics thateveryone over 55 would take. . 3
members of the patient who can listen care-
ness (and the health care system) seems to
take over. Even normally assertive and intelli-
gent people find themselves “shutting down,”
calmer patients that way. And doctors often
so they can’t understand new information
pick up some insights into the people they’re
taking care of by meeting family and friends.
sions. Others become irritable or downright
Old eyes sans spectacles
hostile — not a great mind-set for making
Talk to a nurse.
Even if we know better,
some of us are a little too eager to be good
patients, so we don’t complain or admit to
more rights than ever before. Most doctors
today neither want nor expect patients to
rassed at repeatedly asking, “What does that
The color and consistency ofstool may be a tip-off to health
passively follow orders. And the Internet
mean?” Some find themselves clamming up
problems. . . . . . . . . . . . . . . . . . 6
provides vast resources to help you under-
around authority figures. If you don’t feel
stand your condition and make choices.
comfortable talking to a doctor, seek out
Earlier this year, Harvard Medical School
one of the doctor’s nurses or some other
sponsored a forum titled “Taking Charge:
staff member. It’s no secret that patients con-
Patient Advocacy for Yourself or a Loved One.”
fide in nurses and other staff. Many doctors
is best for you? . . . . . . . . . . . . . 7
Dr. Nancy Keating, an internist at Brigham
and Women’s Hospital, and Dr. George De-
from nurses than they’d ever find out on
By the way, doctor
metri, director of the Center for Sarcoma and
What do coronary stents accomplish?. . . . . . . . . . . . . . . . 8
Institute, led the discussion. Here are nine sug-
Know your options.
Most medical jour-
neys have several crucial forks in the
road. If a doctor presents only one choice,
Bring along a family member or close
chances are you’re not getting the full story.
This is perhaps the single most
Of course doctors often do — and should —
important piece of advice anyone can give.
Patients need a second pair of eyes to look
immune system. Get the facts.
Harvard Health Publications
out for them and a second set of ears both to
must decide whether that doctor can still
hear their concerns and to listen to the doc-
tors and nurses. If you don’t have anybody
close by who can accompany you in person,
Set the terms of the relationship.
more information, or go towww.health.harvard.edu/YI.
ask the doctor to list someone in the medical
published several years ago showed that
record who should be called before crucial
most patients want a collaborative relationship
decisions are made or after something im-
with their doctor. But people’s preferences
vary. The researchers found that roughly 1 in 4
people prefer an active, take-charge role,
continued from page 1
Editor in Chief Anthony L. Komaroff, M.D.
also gives you the right to ask for chan-
Board members are associated with Harvard Medical School
and affiliated institutions. They review all published articles.
get copies of their medical records.
Dental Medicine R. Bruce Donoff, D.M.D., M.D.
Emergency Medicine John Tobias Nagurney, M.D.
Gastroenterology Stephen E. Goldfinger, M.D.
his or her relationship with a doctor.
Gerontology Kenneth L. Minaker, M.D.
Bring a tape recorder to your
or too deferential, make that known.
This may seem intru-
Nutrition Bruce Bistrian, M.D., Ph.D.
Ophthalmology B. Thomas Hutchinson, M.D.
Think through your priorities.
Orthopedics Donald T. Reilly, M.D., Ph.D.
Treatments often involve trade- an audiotape after your visit may help
Preventive Medicine JoAnn E. Manson, M.D., Dr.P.H.
freshing your memory can be helpful.
Women’s Health Soheyla Gharib, M.D.
the Journal of Clinical Oncology.
Online www.health.harvard.edu/subinfoLetters Harvard Health Letter
had significantly better recall of having
tients who didn’t listen to a tape.
Use the Internet.
Sure, the In-
Bulk Subscriptions Consumer Health Publishing Group
ternet is full of half-baked hokum Find a doctor you like and re-
This can be hard. Your
health insurer may limit your choices.
Corporate Sales & Licensing Consumer Health Publishing Group
information, so much so that it’s real-
1100 Summer St., 2nd Fl.
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ly a missed opportunity not
to get on-
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with your doctor is hard to overrate.
Published monthly by Harvard Health Publications,
…and don’t feel obligated to stick
Editor in Chief Anthony L. Komaroff, M.D.
with one you don’t.
It’s important to
2004 President and Fellows of Harvard College. (ISSN 1052-1577)
Proceeds support the research efforts of Harvard Medical School.
database of all the medical journals.
10 Shattuck St., Suite 612, Boston, MA 02115
don’t like or trust. It may not feel like
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| Harvard Health Letter
All-in-one pills for heart diseaseA polypill may make sense, but drug companies are coming up with their own combinations.
Taking your medicine these days Extrapolating from existing research re- What’s next?
sults, they estimated that their Polypill
Some critics say that a Polypill is a bad
may make sense for the “average” per-
lar conditions (heart attack, stroke, un-
might be an increase in the likelihood of
in it may not be healthy for a given per-
that all-in-one needn’t mean one for all.
of pills a person has to take, increase the
The hypothetical Polypill
Recipe for heart attack
and stroke prevention
Poly wants a pill
sive prevention and treatment is great.
this familiar approach a step further. In
an article in the British Medical Journal
tor, its best-selling statin, and Norvasc, a
university’s hospital after a heart at-
age 55 and over should take
Mukherjee reported that,
and other cardiovascular conditions.
may be a great idea. But there’s a dan-
terol-lowering statin, half doses of three
inhibitor, a beta blocker, and a diuretic),
aspirin, and the vitamin folic acid.
Harvard Health Letter | 3
Fainting Simple maneuvers could keep you from losing consciousness if you’re feeling faint.
The most common causes of syncope (SIN-co-pee) are the most blood pressure can make people vul-
the heartbeat (beta blockers, nitrates) or
of the blood it needs. No organ “likes”
also had some success “retraining” the
legs and the lower part of your body.
Cross your legs to stay on your feet
If you feel a fainting spell coming on, a
more blood is pushed into the brain.
off a full loss of consciousness — pro-
are another potential cause of fainting.
you’re getting blood into the brain.
faint. No one is sure why. The “wires”
Be sure to talk to your doctor
his or her side to prevent choking. It’s
temporary drops in blood pressure heart problem, they’ll usually start by
| Harvard Health Letter
The end of glasses? First came LASIK. Now there’s a procedure for baby boomers who don’t want to wear reading glasses.
But does it work?
Behind your pupil and iris is a ple who wore regular lenses, those
than twice as likely to suffer falls.
easily back and forth between seeingobjects in the distance and those right
Eyes that see things differently
getting stuck in a certain position.
cornea so the eye can see things up close.
inputs into a single, clear field of vision.
eyes. Those who’ve worn glasses for see-
it’s a good answer to the hassle of read-
ing in the distance (they’re nearsighted
tients don’t really like monovision and
certain people never get used to it.
less “contrast sensitivity” — the ability
to distinguish between light and dark.
them does take some getting used to.
eye is either uncorrected (because big question marks. How many people
it already sees well up close) or has are going to be happy with monovision?
a contact lens that boosts that near And how long before the treatment
tients will need reading glasses again six
half will need them after a year, accord-
glasses or contact lenses, involves using
a laser to reshape the cornea, the clear,
erated on if the goal is monovision.
Initially, CK is cheaper than LASIK.
New kid on the block
$1,000 less. But over the long run — if
Harvard Health Letter | 5
What is a healthy bowel movement?The characteristics of feces can offer clues to health problems, digestive and otherwise.
Australian colorectal surgeon from the esophagus,stomach,or small the stool is hard. One reason older
called melena that has a very bad odor.
Bowel Book: A Self-Help Guide for Suf-
that the “human gastrointestinal
berries and beets can change the color.
In Western societies, people
agents in imaging studies lighten it.
day, but it’s an individual matter. All
Normal stool is about 1%
that fiber is really a very mild laxative.
fat. Passing stool that is 7% fat is called
once a week and are perfectly healthy.
ally smelly, and stick to the side of the
to flow into, rather than out of, the in-
gastrocolic reflex is the reason manypeople, and especially children, need
Feces are normally about
The normal unpleasant scent
water, they’re soft; if they contain too
little, they’re hard. Soft feces can lead
to incontinence and passive soiling.
whenever possible because a more functions of the large intestine. A
intense urge makes it easier to start healthy large intestine takes 11/2 quarts
therefore, strong-smelling, feces. Sulfur
like beer and bread as preservatives.
Feces are normally brown be-
digestive system from the liver. Bleeding
| Harvard Health Letter
Almonds, oh joy! But peanuts better?They’re good for us, but which nut is the best?
Health-conscious people are enough of the mineral,with average amount ofalpha-linolenic acid,the only
lead in the folate category. Cashews have
they lag behind in vitamin E. If it’s sele-
some protection against diabetes, too.
in 12 ounces of many brands of soda.
If it’s clear that nuts are nutritionally
into regular meals as a protein source.
hard to beat: They’re almost buttery.
fat. Much of the fat, though, is “good”
ed fat, not the “bad” saturated variety
are a major selling point. So the associ-
terol-lowering effect of nuts. But citing
individual studies, the authors of an al-
mond study published in Circulation
that sheds a little light on the subject.
noncompetitive approach: mixed nuts.
Vitamin E (milligrams)
Omega-3 fats (grams)**
* Values are for the Virginia peanut, the variety used most often for roasted and in-the-shell peanuts.
** Amounts may include a small amount of omega-6 fats.
Source: United States Department of Agriculture National Nutrient Database
Harvard Health Letter | 7
Lp(a) levels, but we still don’t know whether that
Q I’m 70 and recently heard about a new blood
test for something called lipoprotein(a) that
reduction actually translates into a lower risk for
might help determine if I’ll get heart disease.
Testing for Lp(a) might be warranted if you
have diseased arteries (atherosclerosis) and none
A Lipoprotein(a),which is often abbreviated as of the conventional risk factors.I might also con-
Lp(a), is a molecule of “bad” LDL cholesterol
sider ordering this test for a patient whose high
with an extra protein attached. High levels may be
cholesterol level isn’t responding to a statin (Lipi-
harmful because Lp(a) interferes with the blood’s
tor, Mevacor, other brands) or to one of the bile-
natural clot busters. Over the past several years,
acid binders (LoCholest, Colestid, other brands).
some studies have shown that people with high
Talk to your doctor about the value of Lp(a)
Lp(a) levels are more likely to have a stroke or suf-
testing for you. Don’t be disappointed if he or she
fer a heart attack. The risk seems to be more pro-
says, “I’m not sure.” I’m afraid this is an area
where doctors need to know more before they can
But that doesn’t mean you should get an Lp(a)
test. Conventional risk factors like high blood pres-sure, high cholesterol, and smoking are far morereliable predictors of future cardiovascular risk.
And we know that lowering high blood pressureand cholesterol levels — and, of course, quittingsmoking — pays off by lowering cardiovascular
risk. There is medicine that reduces elevated
Harvard Health Letter
Editor in Chief
Q I read in the newspaper that angioplasty and people in this situation is no. Why? Because
stents don’t do any good because narrowed
crushing a big, scary-looking atherosclerotic
arteries aren’t the cause of most heart attacks. Is
plaque won’t do anything about all the smaller,
less obvious plaques in the artery. Yes, people withsignificant coronary narrowing are at higher risk
A Before patients get angioplasty or stents,they of dying from a heart attack than others are, but
(and their doctors) need to be clear about
it’s not so much because of obvious plaque — it’s
their goals. Are they trying to relieve symptoms
the many smaller ones that go along with it.
When these small plaques rupture, they can cause
Patients who feel fine and have no symptoms
just as much trouble as the larger ones, and there
of coronary disease will not feel any better after
are plenty of them left after an angioplasty has
an angioplasty. If, on the other hand, their lives
are being limited by angina from relatively mild
The good news is that the small plaques can
activity, then opening up a coronary artery could
be stabilized with cholesterol-lowering therapy,
really help because angina is caused by low blood
good blood pressure control, and other risk factor
flow to the heart. Angioplasty and stents restore
interventions. And those treatments can help you
But let’s turn to people who have some evi-
dence of coronary disease — say, a positive stresstest — but no symptoms. For them, the questionis not relief from angina but whether angioplasty
will help them live longer. The answer for most
Harvard Health Letter
By the Way, Doctor
we receive, we can’t answer every
letter. Nor can we provide personal
| Harvard Health Letter
Hier zeige ich eine der wichtigsten aktuellen Anwendungen des Satzes von Bayes: denBayes-Filter zur Selektion von Spam aus der Email-Box. Im Gegensatz zu klassischen,auf ”Schwarze” und ”Weiße Listen” beruhenden Spamfiltern geht der Bayes Filter alleinvon der statistischen Wahrscheinlichkeit aus, mit der die in einer Email vorkommendenWorte bisher in Spam-Mails bzw. in erw¨unschten Mails
Black, Green Tea May Slow Alzheimer's Disease Adapted from WebMD Medical News, Oct. 27, 2004 A study from England's University of Newcastle upon Tyne shows that green and black teas may inhibit certain brain enzymes linked to Alzheimer's disease. The study's findings may lead to new therapeutic developments for dementia and Alzheimer's disease, which is estimated to affect 10 million people w