Harvard Health Blog

This week’s inaugural April Fool’s Day edition of JAMA Internal Medicine carried a report entitled “Association Between Apple Consumption and Physician Visits: Appealing the Conventional Wisdom That an Apple a Day Keeps the Doctor Away.” Based on actual national nutrition data collected from nearly 8,400 men and women it concludes, “Evidence does not support that an apple a day keeps the doctor away; however, the small fraction of US adults who eat an apple a day do appear to use fewer prescription medications.” Apples may have failed this critical scientific test, but they are still an excellent choice as a snack, pick-me-up, or dessert.

Hospitals across America are merging. In 2014 alone, there were 95 mergers, acquisitions, and joint ventures among U.S. hospitals, down only slightly from 98 in 2013. What is fueling this trend toward hospital consolidation — and why should you, as a consumer of health care, be concerned about it? Hospital administrators who create the mergers believe that hospital consolidation improves efficiency, access to care, and quality of care, and may lower costs. In contrast to hospital administrators, many health economists are wary about the growing number of these mergers. When individual hospitals merge into larger systems, they gain a larger share of the consumer health market. That puts them in a position to ask health insurance companies to pay more for medical care and procedures. These higher prices are not borne by the insurers, but by consumers in the form of greater premiums. Thus, some economists argue, mergers drive up health care costs and place added financial pressure on consumers.

President Obama’s announcement of a Precision Medicine Initiative was one of the few items in this year’s State of the Union address to garner bipartisan support. And for good reason. Precision medicine, also known as personalized medicine, offers the promise of health care based on your unique DNA profile and the profiles of a million other individuals. Getting to precision care will require new diagnostic tests. It will also need a new regulatory framework to make sure that technologies aren’t launched before they’ve been proven to be safe and effective, according to a Perspective article in The New England Journal of Medicine. It may take a few years to design this new vetting system and put it in place. In other words, precision medicine is on the horizon, but it isn’t around the corner.

Is brain damage an inevitable consequence of American football, an avoidable risk of it, or neither? An editorial published yesterday in the medical journal BMJ poses those provocative questions. Chad Asplund, director of sports medicine at Georgia Regents University, and Thomas Best, professor and chair of sports medicine at Ohio State University, offer an overview of the unresolved connection between playing football and chronic traumatic encephalopathy, a type of gradually worsening brain damage caused by repeated mild brain injuries or concussions. The big question is whether playing football causes chronic traumatic encephalopathy or whether some people who play football already at higher risk for developing it. The Football Players Health Study at Harvard University hopes to provide a solid answer to that and other health issues that affect professional football players.

Older adults with new back pain usually end up getting a CT scan or MRI. That’s often a waste of time and money and has little or no effect on the outcome, according to a new study from the University of Washington. The results of the study contradict current guidelines from the American College of Radiology. The guidelines say that it’s “appropriate” for doctors to order early MRIs for people ages 70 and older with new-onset back pain, and many doctors do just that. The study, which followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain, found that people who got early back scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit.

If you or a loved one is age 65 or older, getting vaccinated against pneumonia is a good idea — so good that the Centers for Disease Control (CDC) now recommends that everyone in this age group get vaccinated against pneumonia twice. For the past 30 years or so, the CDC has recommended that everyone ages 65 and older get a single-dose pneumonia vaccine called pneumococcal polysaccharide vaccine 23 (PPSV23). This vaccine is also recommended for those between the ages of two and 64 who are at high risk of getting pneumonia. Findings from a large clinical trial called CAPiTA, published today in The New England Journal of Medicine, show that a second vaccine, called pneumococcal conjugate vaccine 13 (PCV13), provides further protection against pneumonia and related infections. When it comes to preventing pneumonia, the bottom line for older individuals is clear: Get vaccinated twice.

If you’re among the one in three American adults with high blood pressure, be sure you’re getting plenty of the B vitamin known as folate. Doing so may lower your odds of having a stroke, an often disabling or deadly event linked to high blood pressure. That’s the conclusion of a large trial conducted in China, where many people don’t get enough folate. Most Americans get plenty of folate or its synthetic version, folic acid. That’s largely because grain folic acid is added to most grain products, including wheat flour, cornmeal, pasta, and rice. It’s a good idea for everyone to do a diet check to make sure it delivers enough folate. Good sources include green leafy vegetables, beans, and citrus fruits.

Here is a table that contains the many different radiation therapy options for prostate cancer. It includes who the ideal candidates are, recovery time, possible side effects, and the advantages/disadvantages for each.

Every so often, a medical advance comes along that rewrites the script for treating a disease or condition. After today’s announcement of impressive results of a new type of cholesterol-lowering drug, that scenario just might happen in the next few years. The results of three clinical trials presented today at the annual meeting of the American College of Cardiology, and simultaneously published in the New England Journal of Medicine, suggest that a class of new drugs called PCSK9 inhibitors can dramatically reduce the amount of harmful LDL cholesterol circulating in the bloodstream and prevent heart attacks, strokes, and other problems related to cholesterol-clogged arteries. The drawbacks are that PCSK9 inhibitors must be given by injection every 2 to 4 weeks, may cause mental confusion or trouble paying attention, and, if approved, will likely be expensive.

Marijuana-laced brownies have long been a way to get high. Now a new generation of “food companies” is taking the concept of edible marijuana in a somewhat scary new direction: marijuana-laced foods that mimic popular candies. These sweets could pose a danger to children, warns a Perspective article in today’s New England Journal of Medicine. From a marketing perspective, it’s a cute concept to sell Buddahfingers that look like Butterfingers, Rasta Reese’s that mimic Reese’s Peanut Butter Cups, or Pot Tarts that resemble Pop-Tarts. But the availability of edible marijuana products has led to an increase in emergency visits to hospitals because of kids accidentally eating edible marijuana products and in marijuana-related calls to poison and drug hotlines.

Looking for ways to ward off colorectal cancer? According to a new study, a pescovegetarian diet — that’s a vegetarian diet that includes fish — was linked to a 43% reduction in the risk of developing colorectal cancer. The study, published in JAMA Internal Medicine, adds more support to the notion that something in red meat, or the way it is cooked, encourages the growth of colorectal cancer. It’s also possible that eating more plant foods provides extra beneficial nutrients such as folate, calcium, and fiber that may protect against colorectal cancer. Fish contain healthful omega-3 fats and vitamin D. Another good strategy for preventing harm from colorectal cancer, the second leading cause of cancer death in the United States? Have colonoscopies as needed.

A woman’s use of a testosterone-based vaginal cream may have contributed to a spike in her husband’s prostate-specific antigen and testosterone levels after he had his prostate removed to fight advanced prostate cancer.

Nuts have been gaining traction as an all-natural health food. Tree nuts like almonds, pecans, and walnuts are especially prized for their rich cargo of vitamins, minerals, and mono- and polyunsaturated fats. The downside is that tree nuts tend to be pricey. But a study published online this week in JAMA Internal Medicine puts the humble peanut squarely in the same nutritional league as its upscale cousins. This work makes the health benefits of nuts more accessible to lower-income shoppers. An international team of researchers found that in more than 200,000 people from Savannah to Shanghai, those who regularly ate peanuts and other nuts were substantially less likely to have died of any cause — particularly heart disease — over the study period than those who rarely ate nuts. A key take-home message from this study is that eating peanuts appears to be just as potent for preventing heart disease as eating other nuts.

The Supreme Court heard arguments this morning in a case that could threaten the viability of the Affordable Care Act, President Obama’s signature health care law. The law, also known as Obamacare, survived a previous Supreme Court challenge in 2012. But this new case, called King vs. Burwell, has many people worried, and rightfully so. At issue in the case are the financial subsidies provided to millions of Americans to buy health insurance through the insurance marketplaces, called exchanges. Without these subsidies, many people of lower income would not be able to afford coverage. Stopping these subsidies would put a big dent in the “affordable” part of the law’s name. The plaintiffs argue that the Affordable Care Act allows for subsidies to be provided when insurance is purchased on exchanges “established by the State” (there are 17 of these), but not on the exchange established by the federal government for the other states. The outcome of the case may hinge on how the justices interpret those four words in the health law.

Some years the flu vaccine works quite well. Other years it doesn’t. It has done a particularly poor job this year against the main flu virus. The CDC reported yesterday that this year’s flu vaccine has been just 18% effective. The estimate for children is even lower. And it looks like the nasal spray vaccine may not have worked at all among children. One reason for this year’s mismatch between virus and vaccine is that experts must decide months in advance which of the hundreds of flu viruses to include in the vaccine. What became the dominant flu virus this year, a new strain of H3N2 influenza A, wasn’t around last year when experts were determining this year’s vaccine.

Sitting in a sauna is one way to chase away the cold. A new report in JAMA Internal Medicine makes this pastime even more appealing: regularly spending time in a sauna may help keep the heart healthy and extend life. Among 2,300 middle-aged Finnish men, those who took a sauna bath four or more times a week were less likely to have died over a 20-year period than those who took a sauna once a week or less. Frequent visits to a sauna were also associated with lower death rates from cardiovascular disease and stroke. Sauna baths are generally safe and likely beneficial for people with well-controlled coronary artery disease or mild heart failure, but may not be so hot for those with unstable angina or a recent heart attack. The high temperature in a sauna can boost the heart rate to a level often achieved by moderate-intensity physical exercise. Is sitting in a sauna the equivalent of exercising? No. But exercising and then taking a sauna seems like a very healthy routine.

Peanut allergies can cause severe and sometimes deadly allergic reactions. A new study holds out the possibility that peanuts themselves may prevent peanut allergies. An international team asked parents of infants who were prone to a peanut allergy to give their children a peanut-based snack called Bamba or peanut butter three times a week until age five. The parents of another group of peanut allergy-prone infants were asked to make sure their children didn’t eat any peanuts, peanut butter, or other peanut-based products until age five. The results were surprising and dramatic. A peanut allergy developed in 1.9% of children who ate Bamba or peanut butter, compared with 13.7% of those who didn’t eat peanuts. This new work suggests that preventing peanut allergies may be a possibility in the near future.

If you knew that a vaccine could prevent your daughter or son from developing a relatively common and potentially deadly cancer later in life, would you have her or him get it? Such a vaccine is available, and it’s about to get even better than it is now — but fewer than half of all teens have gotten it. The vaccine helps prevent infection with the human papilloma virus (HPV). It is responsible for cervical cancer, which strikes 12,000 women each year in the United States and kills 4,000. HPV also causes cancer of the vulva, vagina, penis, anus, mouth, and throat. The vaccine, approved in 2006, attacks four types of HPV. The new one attacks nine types, and can help prevent most types of cervical cancer. Some parents worry that having their pre-teen daughters and sons vaccinated against HPV will nudge them into becoming sexually active or becoming sexually promiscuous. Studies, including a new one from Harvard, show that doesn’t happen.

Warnings against eating foods high in cholesterol, like eggs or shrimp, have been a mainstay of dietary recommendations for decades. That could change if the scientific advisory panel for the 2015 iteration of the Dietary Guidelines for Americans has its say. A summary of the committee’s December 2014 meeting says “Cholesterol is not considered a nutrient of concern for overconsumption.” Translation: You don’t need to worry about cholesterol in your food. Why not? There’s a growing consensus among nutrition scientists that cholesterol in food has little effect on the amount of cholesterol in the bloodstream. And that’s the cholesterol that matters. Doing away with the beware-cholesterol-in-food warning would simplify the art of choosing healthy foods. And it would let people enjoy foods that contain higher amounts of cholesterol, such as eggs, shrimp, and lobster, without worrying about it. A better focus is on reducing saturated fat and trans fat in the diet, which play greater roles in damaging blood vessels than dietary cholesterol.