Healthcare Archive

24-hour health monitoring is high tech. But is it helpful?

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The day has arrived when doctors can remotely monitor your health every moment, if you (and they) choose. Increasing numbers of wireless digital sensors — some implanted in or on the body, some ingested, and some worn like clothing — are making the leap from patents to patients. In 2017, the FDA cleared dozens of devices for continuous health monitoring. "The hope is that people heading toward serious problems — such as high blood sugar or heart rhythm abnormalities — can be headed off at the pass," explains Dr. Anthony Komaroff, editor in chief of the Harvard Health Letter.

Not necessarily new

We've had portable gadgets that monitor health for decades. One early example is the kind of heart pacemaker that detects irregular heartbeats and shocks them back to a normal rhythm. Today we also have devices that sense and respond to many other health problems, such as Parkinson's disease tremors or pauses in breathing during sleep.

Liquid biopsies may offer a less invasive alternative than a traditional biopsy.

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A tissue biopsy is the standard test for identifying cancer. Your medical team will use needles or other devices to capture pieces of actual tumor to see if it's malignant or benign. But another approach, called a liquid biopsy, is less invasive and may provide a diagnosis when a biopsy doesn't.

This test uses a person's blood to look for signs of cells or mutated DNA that a tumor has shed into the bloodstream. "By sampling DNA or circulating tumor cells in the blood, we can predict and monitor responses to cancer treatments without subjecting patients to invasive biopsy procedures — and perhaps detect cancer early, before it has had a chance to spread," says Dr. David Miyamoto, assistant professor of radiation oncology at Harvard Medical School.

Here's what Harvard physicians advise you to do at your next appointment.

You know the routine: you're waiting in the exam room, and your doctor comes in for what seems like a very quick visit before leaving to see the next person. You're left feeling that you didn't ask all of your questions or get a good understanding of your treatment plan. What happened?

"We're under incredible pressure, and we're scrutinized to be sure we're seeing enough patients," explains geriatrician Dr. Suzanne Salamon, an assistant professor at Harvard Medical School. "We don't have many minutes, and yet we have to go over each person's medical issues, medications, and even end-of-life issues. That doesn't leave a lot of time to talk."

If you decide to change something in your living will or health care power of attorney, the best thing to do is create a new one. Once the new document is signed and dated in front of appropriate witnesses — and notarized, if necessary — it supersedes your old directive.

The American Bar Association Commission on Law and Aging suggests that you re-examine your health care wishes whenever any of the following "five d's" occurs:

Keep important information handy, such as an advance directive, a list of medications, and your emergency contacts.

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We spend a lot of time trying to stay healthy. We exercise, eat right, and get check-ups and screenings. But how many of us take the time to prepare for a medical emergency, with the right information and equipment handy? "Most patients I see are not prepared to come to the emergency department [ED]. They don't know their medical problems. We're lucky if they carry their medications list," says Dr. Kei Ouchi, an emergency medicine physician at Harvard-affiliated Brigham and Women's Hospital.

Maybe we're unprepared because of a natural tendency to think that medical emergencies may happen to others but not to us. But consider the numbers: in 2009–2010, about half of all adults ages 65 or older went to an emergency department, according to the CDC. "The number of older adults coming into the ED is increasing, especially near the end of life — 75% of older adults come to the ED at least once in their last six months," Dr. Ouchi says. Those odds may make you want to think twice about preparing for the unexpected.

It's called "weight bias," and even health care providers aren't immune.

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If you've ever delayed a doctor's appointment so you could lose a few pounds before your annual weigh-in, or hesitated to exercise in public because you felt self-conscious among a sea of hard-bodied gym goers, your weight may be affecting your health — but not in the way you might think.

Even if you're otherwise healthy, sometimes excess pounds bring increased health risks, especially if they keep you from following recommended health practices that offer protection over the long term.

Research we're watching

Good news on the cancer front: The cancer death rate dropped 35% between 1991 and 2014 among children and 25% in adults, according to the annual American Association for Cancer Research Cancer Progress Report. And more treatments for the disease are on the horizon. The FDA has recently approved nine new cancer treatments and signed off on expanding the uses of eight existing therapies to treat different types of cancer. Among the new treatments are innovative immunotherapeutics, which help some people with cancer live longer with a better quality of life; an imaging agent that will let surgeons more precisely remove brain tumors; and molecularly targeted agents, which take aim at specific molecules that help cancers grow and spread to other areas of the body. It is hoped that these new treatments will further reduce cancer deaths. To read the full report, go to cancerprogressreport.org.

Medicare is the federal health insurance program for people who are age 65 or older and those younger than 65 with a disability,
The definition of disabilities used to determine Medicare eligibility is the same as that used for Social Security benefits.

Medicare can be a maze all by itself. It has various components, designated by the letters A through D. Each one provides different benefits. In general, out-of-pocket costs are lower in Medicare than in commercial health plans. Here is a summary of what each part covers: