Pain-killers: The power of a pill

Pain-killers: The power of a pill

Scientists keep discovering new benefits of this common painkiller

“Take two aspirin and call me in the morning” has long been doctors’ advice for headaches and minor pains. But a profusion of recent research shows that the painkiller that’s been used for more than 80 years may be good for more than headaches. The new findings suggest that aspirin may also help prevent heart attacks, certain types of cancers, and pregnancy-induced hypertension.

In its regular form, aspirin is an analgesic – a painkilling drug – available without a prescription to treat headaches, menstrual cramps, and muscle aches. It works by reducing the production of certain hormon-like chemicals, called prostoglandins, that can be responsible for inflammation, pain, fever or clumping of blood platelets. Because of its anti-inflammatory effects, aspirin is also effective in treating joint pain and muscle stiffness caused by certain types of arthritis. The non-narcotic drug can be used as well to reduce fever, so it is often an ingredient in cold medicines.

Of all of aspirin’s prophylactic powers, its role in combating heart attacks has received the most attention. Bu preventing platelets in the blood from sticking together, aspirin has been shown to decrease the chance of having a heart attack. And, by preventing clots from forming in the blood-stream, it can reduce the severity of a heart attack once it’s under way. Indeed, in a recent Harvard University study, healthy middle-aged male doctors who took as aspirin every other day on a continuing bases were 44 percent less likely to have a first heart attack than doctors who took a sugar pill as a placebo. But the aspirin takers showed no decline in overall cardiovascular deaths and only a slight increase in the risk of hemorrhagic strikes. The benefits of low-dose aspirin for women’s cardiovascular health are not yet known.

When taken within hours after a heart attack, aspirin can be a life-saving treatment. Heart attack sufferers who took aspirin after the attack began decreased their chance of dying in the following weeks by nearly 25 percent, a recent study found. Based on these findings, a group of doctors recently petitioned the Food and Drug Administration to approve aspirin as standard treatment for patients suffering from the acute stages of a heart attack. The FDA’s Office of Drug Evaluation has recommended approval, but a final decision is pending.

When aspirin is taken in small doses on a daily basis, it has also been shown to reduce a pregnant woman’s risk of suffering from high blood pressure and of delivering a premature baby of low birth weight. However, there is no evidence that aspirin can reduce high blood pressure among people who aren’t pregnant. For reasons not yet understood, it is only when a woman is pregnant that the drug appears to help keep blood pressure down. All these findings are still preliminary, however, and no pregnant woman should take aspirin without consulting her doctor first.

Migraine sufferers not only use aspirin to relieve headaches, but according to a large-scale study of middle-aged men who took aspirin every other day, aspirin can also reduce the frequency of migraines. That study found the men who took the aspirin reduced by 20 percent their chances of getting a migraine episode. When blood platelets clump together in the brain, they may release serotonin, a neurochemical linked to triggering migraines. Aspirin may stop the clumping, and, in turn, diminish the frequency of migraines.

Researchers have also found that those who take an aspirin tablet daily are less likely to contract colon, rectum and possibly stomach cancer. Some tumors produce prostaglandins, which scientists believe are required for a cancer to grow. Aspirin works by stopping the production of prostaglandins, preventing tumors from growing.

Where tumors do exist, aspirin may cause them to bleed, leading to earlier diagnoses.

For those who suffer from certain types of senility, such as senile dementia, doctors sometimes prescribe daily doses of aspirin because it helps prevent blockage of blood vessels in the brain. When aspirin is given to those suffering from dementia, it appears to reduce the chances of having mini-strokes, which in turn can cause dementia. This research is very preliminary, however.

Always consult a doctor before taking aspirin as a preventive measure; aspirin’s benefits many be many, but there are side effects to take into account. Hearing impairment, stomach problems, excessive bleeding, and complications of pregnancy may occur in those who take aspirin too heavily. Aspirin may also increase the risk of stroke caused by bleeding in the brain.

When a such child is involved, never give aspirin except under close medical supervision, because there is a slight risk of contracting Reye’s Syndrome, a rare brain and liver disorder. Instead, children should be given aspirin alternatives such as Tylenol.

Pain-killers help. Photo by Elena

What to Take When Aspirin Is Off-Limits

Acetaminophin: Tylenol is the most common brand name for this organic compound. The drug reduces pain and fever without the stomach irritation, bleeding, indigestion, and nausea that can occur with aspirin. It is also a more effective fever-fighter than aspirin for children. Since it doesn’t slow blood clotting, acetaminophen is also the best nonprescription painkiller for patients before and after surgery women who are pregnant, and people who have an allergy to aspirin. Acetaminophen does not, however, reduce inflammation or possess any of the powers of aspirin to fight heart attacks and strokes. Keep in mind also that it is dangerous to mix acetaminophen with alcohol and that high doses can cause liver damage.

Aleve: Also called naproxen sodium, Aleve is an anti-inflammatory effective in reducing pain and fever. Gentler on the stomach than aspirin, it became popular as a treatment for menstrual cramps. Because Aleve provides relief for 8 to 12 hours, longer than most over-the-counter pain-killers, it may be a good choice for arthritis sufferers. Precautions are the same as for aspirin and ibuprofen.

Ibuprofen: Found in over-the-counter medicines such as Advil and Motrin, it is stronger than aspirin and acetaminophen, yet easier on the stomach than aspirin. It relieves pain, fever, and inflammation, and is often taken to relieve the discomfort of menstrual cramps. It lacks aspirin’s bloodclot-fighting cardiovascular benefits, however, and should be avoided by people susceptible to asthma, high bllod pressure, heart or kidney disease, and cirrhosis, as well as those taking lithium or diuretics. If you have a cold, take ibuprofen with a decongestant instead of an over-the-counter cold medicine, which generally contains fewer pain relief ingredients and costs more.

Buffered Pills: Many pain relievers come in buffered form. The coating makes pills easier to swallow and easier on the stomach than tablets, but it slows down the absorption of the pain-killer, so relief takes longer. Time-released capsules of Aleve are best suited for low-level continuing pain, such as muscle soreness. Never take more than one type of pain reliever at a time, unless instructed by your doctor.

A Primer On Clinical Trials

A Primer On Clinical Trials

How to join one, and how to keep their purpose in perspective

Participating in a medical experiment isn’t for everything. Hopefully, you’ll never need to join one. Ut if you or a family member is sick with a life-threatening disease, a clinical trial program may be well worth considering. As experimental programs, the approaches being tested may not work and may even cause further medical problems. But agreeing to be a guinea pig for the latest medical technics or medications could also add many good years to your life.

Clinical trial research is generally federally funded and federally regulated, but conducted by private researchers at medical schools, drug companies, and hospitals, as well as by government scientists.

Research runs the disease gamut. To fight cancer, for instance, a new form of treatment, called biological therapy is being studied in clinical trials sponsored by the National Institutes of Health. This technique uses substances produced by the body’s own cells and substances that affect the body’s immune system to induce the body to fight the disease. In the AIDS area, one closely watched trial currently under way involves testing two experimental drugs to see if they can prevent the HIV virus from reproducing itself by interfering with the enzymes that reproduce the virus.

Other trials deal with chronic diseases that are not necessarily life-threatening. The NIH is currently conducting a clinical trial on herpes vaccines to determine if a person who is already infected with herpes can stave off further outbreaks by taking the vaccine. The vaccine is also being studied to see, if by taking it, a person who has been exposed to the virus can still be immunized.

Ideal candidates for clinical trial. Photo by Elena

Since the purpose of such trials is to answer a set of research questions, you have to fit the guidelines in order to be eligible. Be sure to discuss the suitability of a clinical trial with your personal physician, comparing the case for joining a trial with the arguments for following a more standard treatment. If you do decide to pursue an experimental program, be sure to ask:

•     What is the study’s scientific purpose?
•     What does the treatment involve?
•     Who will oversee your treatment?
•     What, if anything, will it cost you?
•     Does participation require relocation?
•     What type of follow-up care in involved?
•     How will the study’s results be used?

Participating in a trial means that you will probably be examined and tested more frequently than usual. If, during the study, it turns out that the trial is not in your best interest, you will be asked to drop out. If you decide not to continue, that, too, is fine.

The cost of trials varies from program to program. Virtually all NIH-sponsored experiments are free of charge to participants. Other clinical trials generally provide drugs for free, but in some cases patients may be charged for lab tests or doctor’s visits. Health insurance usually covers such expenses. In some cases, especially those involving an invasive procedure such as a spinal tap, patients may even receive minimal fees.

Detecting Prostate Cancer

If You Are a Man Over 40, Listen Up

Detecting prostate cancer is becoming easier, thanks to the PSA test

Nearly a quarter million men develop prostate cancer each year, making it one of the most common cancers in men. The disease claims 40,000 lives annually because of difficulties in detecting the illness early. But that could change thanks thanks to a blood test, known as the PSA test. It measures the amount of a protein in the blood called prostatic specific antigen, which is produced exclusively by the prostate.

The PSA test has been available for about eight years, but it is only now being widely recommended. Here we highlight what men need to know about the disease and the test.

All men – especially African-American and men with a family history of prostate cancer – are at risk of developing prostate cancer. Having a vasectomy does not raise the risk. It is uncertain why the disease develops, but a high-fat diet may be a contributing factor.

There are no symptoms in men who are in the early stages of the disease when it is curable. But there will be urinary difficulties and bone pain as the disease progresses.

All men aged 40 and above should have an annual digital rectal exam as a safeguard against prostate cancer. African American men and those with a family history should also have an annual PSA test beginning at age 40. After age 50 all men should have an annual digital rectal exam and PSA test.

The PSA test is available in most doctors’ offices and in hospital labs. It costs about $50, and takes a few days to a week for results to be reported. It is better in detecting prostate cancer than a mammography is in detecting breast cancer.

Monument to the king Edward VII in Toronto. Photo by Elena

American Hospitals: When Your Life Depends On It

American Hospitals: When Your Life Depends On It

Where you are treated is often critical to recovery from an illness

Whether it’s fine clothes or a new car, a great kitchen or where your child attends college, “only the best” is a standard that many aspire to but few can afford. Fortunately, there are plenty of perfectly fine alternatives to driving a new Mercedes or eating from a set of Belleek china that won’t bankrupt you. But what if the consumer decision you are confronted with is where to get open-heart surgery or have an injured hip repaired? Considering how high the stales might be then, “only the best” might not seem such an unreasonable standard to apply.

Indeed, recent research supports what many will have figured out on their own: When it comes to specialized medical procedures requiring hospitalization, where you go for treatment is often critical to whether you are treated successfully. In on study published in the Journal of the American Medical Association, for instance, researchers Harold S. Luft and Patrick S. Romano of the University of California found that death rates from high-risk heart bypass operations could be significantly reduced if the procedures were done at hospitals with consistently low death rates for the surgery.

Using the records of 115 California hospitals that had performed five or more coronary artery bypass operations annually in any year between 1983 and 1989, the researchers developed a methodology for determining when a hospital’s death rates for the procedure were higher – or lower – than would originally be expected, given the severity of the disease.

If death rates were merely a function of chance or the difficulty of measuring differences in the seriousness of the patients’ conditions, then a hospital that performed well one year would not necessarily excel in a later period, the researchers reasoned.

What they discovered, however, was that hospitals that had significantly lower death rates for the first years later, while hospitals that compared poorly the first time around continued to do poorly two years later.

The researcher’s general thrust was bolstered by a second study published recently in the journal Annals of Surgery. There, researchers found that patients were six times more likely to die of a complex pancreatic cancer surgery at hospitals that only attempt the operation a few times a year than at a large regional medical center that performs the procedure on a regular basis.

Healthy life allows you to avoid hospitals. Photo by Elena

This is not to say that you need to seek out treatment at a major regional medical center in all cases. There are many conditions that a local hospital or doctor is likely to be fully capable of handling and where postoperative care may be more effectively handled. The quality of a hospital’s nursing staff is often critical to the success of the patient’s recovery, for instance.

Some community hospitals are comparable to regional medical centers with major teaching programs in their expertise in performing certain procedures and are able to deliver their care at significantly lower prices. But if you or a family member needs treatment for a condition that could jeopardize your long-term health – or even your life – it might well be a good idea to explore with your doctor treatment alternatives by a team that is more specialized and experienced than what is available closer to home.

One excellent source of information about specialty medical centers in the United States is the annual survey, America’s Best Hospitals, published by the magazine U.S. News and World Report. The study assesses the quality of care at major medical centers for 16 specialty fields, from AIDS to urology. Highlights of that survey appear in many publications. The magazine’s rating system was designed by the National Opinion Research Center, a social science research group at the University of Chicago. The model combines three years’ worth of reputational surveys conducted by the magazine with nine categories of statistics bearing on quality of care. The reputational ratings were compiled by asking board-certified physicians from around the country to identify the hospitals they deemed to be the five best in their specialty, without regard to cost or location. Only major academic hospitals providing comprehensive, state-of-the-art, care, were eligible for consideration. Among the objective measures also factored in were everything from the ratio of nurses and board certified specialists to hospital beds to the availibility of advanced technology in various specialties, to death rates in fields where that is relevant.

Doctors and Medicine: Health Care in a New Age

Doctors and Medicine: Health Care in a New Age

Expect more information, more choices, and more tough decisions

Efforts to remake the health care system may seem to have filtered in Washington, but beyond the Beltway there is a fundamental shift occurring in the way in which Americans get their health care. For the average consumer the financial pressures to enroll in a health management organization or other managed-care plan will continue to intensify, but the employers and insurers most affected by the tab will hold health care providers to much greater accountability for cost increases and the quality of care.

“Report cards” prepared by large health care buyers such as companies, pension funds, and the government, as well as studies by public interest groups, universities, and foundations will provide consumers with far more information with which to compare fee structures and quality of care at hundreds of managed-care organizations nationwide. The report card are likely to include data on everything from waiting times to get an appointment to what the success rates have been for procedures such as open-heart surgery to how a particular plan is judged by its patients on overall “customer satisfaction.”

One study, commissioned by the Federal Office of Personnel Management to help government employees choose a health care plan wisely, gathered extensive data on the experience of federal workers at over 250 prepaid health plans or options across the country. The plans involved enroll approximately 65 percent of all persons currently covered by HMOs in the United States. The data should make it easier for both federal employees and other consumers to compare the quality of health care options available to them.

Ramsden Park in Toronto. Photo by Elena

One major corporation, American Express, has not only asked employees to rate their health plans, but, after using this information to develop a consumer satisfaction index for 52 HMOs around the country, offered discounts to workers who enrolled in the top-ranked plans – and charged higher plans to those who chose the low-scoring programs.

Some states, such as California, New York, and Pennsylvania, are even beginning to require that hospitals publish statistics on the medical outcomes and expense of particular surgeries. One of the most important efforts to provide accountability has been launched by the National Committee for Quality Assurance, a nonprofit group established by a consortium of managed-care companies to develop reporting standards and oversee accreditation of plans within their industry.

The organization has been devising report cards that it hopes will enable health care consumers to reliably compare the performance of managed-care plans nationwide on such things as enrollee satisfaction with access to and quality of care; the plan’s record in providing preventive services such as childhood immunizations, cholesterol screenings, and mammograms; the frequency with which the plan performed certain medical procedures such as bypass surgeries and angioplasties; the extent of the plan’s physician turnover; and its overall financial health. Twenty-one major managed-care plans recently participated in a pilot test of the report card’s effectiveness, and the committee hopes to make such report cards an industry standard within the next several years.

The accountability movement is sure to boost the dramatic growth that has occurred in HMOs and managed-care plans in recent years. According to the newsletter Health Trends, dozens of millions are enrolled in traditional HMO plans, and the newsletter predicts that many more may be enrolled in the near future.

HMO deserve much of the credit for the gradual easing of health care cost increases over the last several years. While those cost increases still exceed the general rate of inflation, for several years now the Labor Department’s index of medical price inflation has been declining. The Congressional Budget Office recently estimated that the best-run HMOs can reduce a patient’s use of services by 12 percent over what would have occurred in non-managed-care programs. Much of these savings comes from reducing the length of hospital stays. Because of such efficiencies, insurance premiums for managed-care plans can sometimes be as much as 15 to 20 percent lower than traditional fee-for-service plans.

The new health-care landscape

Fee-for-service: Private care where the patient chooses any doctor he or she wants to see. The patient pays according to the service rendered.

Health Maintenance Organization (HMO): Managed care where the patient is limited to seeing doctors employed by the HMO, and there is a set fee for the visit, no matter what service is performed.

Preferred Provider Organization (PPO): Managed care where the patient chooses from a list of specific doctors in his or her area, and pays a set fee for the consultation, no matter what service is performed.

Point-of-Service: Managed care where the patient chooses from a list of doctors a primary care physician who coordinates all of his or her care. Patients who want to see a specialist must obtain the primary care physician’s approval first.