We’ve said it before and we’ll say it again: Sleep is not an indulgence; the right amount is critical for your health. Yet another study confirms this truth by showing a link between insufficient sleep and a higher risk of heart disease.

NPR analyzed research published in the journal Arteriosclerosis, Thrombosis and Vascular Biology indicating that the right amount of good-quality sleep is key to good heart health and that poor sleep habits can raise your risk for heart disease at a relatively young age.

According to the data, adults who slept fewer than five hours a night had 50% more calcium in their coronary arteries than those who slept seven hours. But too much sleep also might not be a good idea: Adults who slept nine hours or more a night had 70% more coronary calcium compared with those who slept seven hours.

Calcification in your arteries signifies plaque buildup and coronary heart disease. The more calcium, the greater the risk.

The study showed that sleep quality is important, too. Adults who reported poor sleep quality also had 20% more calcium buildup in their arteries than those who said they slept well. Of course, that’s a subjective report, which describes the whole study, and therefore can’t be considered scientifically definitive. But the results reflect those of more objective research into sleep quality and effects.

The study involved more than 47,000 young and middle-aged men and women who answered questions about how long and how well they slept. They underwent tests to measure their cardiovascular health, including measuring the amount of calcium in the arteries of the heart. Stiffness of arteries, which also indicates heart health, was measured by the speed of blood coursing through the arteries in the upper arm and ankle.

The researchers found that the best heart health was among adults who slept, on average, about seven hours a night and reported good sleep quality.

NPR interviewed Dr. David Meyerson, a Johns Hopkins cardiologist and spokesman for the American Heart Association, who called the study results “profound.”

“You wouldn’t imagine that too little sleep, too much, or not sleeping well is going to influence your blood vessels so quickly or so early in life.”

The study does not prove that sleep problems cause heart problems. But it’s another reason to study the association more thoroughly.

Meyerson suggested that several factors potentially play a role in the sleep-heart connection, including hormones and chemical changes in the body during sleep that can increase blood pressure.

To learn more about slumbering well, read Patrick’s newsletter, “The Struggle to Sleep.”

Corporate wellness programs aren’t new, but their popularity is growing as companies seek ways to minimize spending on health care. But a lot of people within and outside of the health-care system question many of these programs in terms of their real health value, their financial benefit and their potential to invade employee privacy.

One recent commentary on the topic was penned by Al Lewis on the Huffington Post and repurposed on TheDoctorWeighsIn.com. Lewis is the author of “Why Nobody Believes the Numbers,” a critique of workplace wellness programs, and the CEO of a company he says is in a competitive industry. He wants his competitors to implement wellness programs because it will hurt them. As he wrote, “Those competitors will suffer increased healthcare costs, compounded by declines in productivity.”

“Best of all for me, these programs often have a negative impact on employee morale that may lead some of them to quit, thus facilitating our own recruiting efforts. This is especially true for overweight employees, whom wellness vendors really seem to dislike. We, on the other hand, find employee weight makes no difference in either productivity or health spending.”

Workplace wellness programs, Lewis said, are places where employees are subject to “pry, poke, prod and punish.”

The prying is about undergoing a “health risk assessment” (HRA) that identifies personal information about drinking/smoking/eating habits, marital relations and other things you should tell your primary care doctor but maybe not even a close relative.

Poking involves a “biometric screen.” That’s when technicians come to the workplace and administer tests, possibly involving needles, to identify diseases employees might have and that in many cases, according to Lewis, “the government’s clinical guidelines say they shouldn’t be tested for,” including, at some companies, DNA.

Prodding occurs when employees visit the doctor when they not sick “to see if the doctor can find anything wrong with them.”

The punishment, Lewis said, is for employees who refuse to submit. It might amount to financial penalties (they pay more from their paycheck for insurance coverage) or lost incentives.

A lot of these programs are “outcomes-based,” which means, for example, you get paid if you lose weight.

How much does Lewis object to this? “To maximize earnings at the expense of their long-term health,” he suggested, “employees can binge before the initial weigh-in and then crash-diet before the last. Is this a great country or what?”

More to the point here are Lewis’ three reasons why nobody should support company wellness programs:

  1. Health-care expenses will rise.

After investigating some programs, one major metropolitan newspaper called wellness programs a “scam,” and another wrote that they don’t save money. The nonprofit think tank RAND Corporation agreed that they don’t reduce costs.

Half of large employers offering health benefits, according to KaiserHealthNews.org (KHN), have wellness programs that ask workers to submit to medical tests, involve a trip to a doctor’s office, lab or workplace health fair.

Although RAND said most programs don’t save money for employers, the think tank did conclude that some can help employees to quit smoking, get more exercise and lose weight.

Lewis refers to the “treatment trap,” or additional costs for extra checkups, lab tests and anything the employee must endure when a wellness vendor “finds something.” Anyone receiving health care in this country knows well that vendors and providers love to find things. Our blogs regularly refer to the U.S. habit of overdiagnosing and overtreating.

  1. Productivity will decline.

Wellness programs are a time suck. On company time, workers must complete an HRA, and have a checkup; often, programs involve “health fairs” and other sounded-like-a-good-idea-at-the-time events that really only serve to separate people from their work.

“But that’s not the half of it,” Lewis reported. “Now add in the time employees spend telling one another what a stupid idea your wellness program is …”

  1. Morale will suffer.

In fact, Lewis said, the corporate wellness industry cops to this. “Morale impact,” he said, actually is a program cost listed in their consensus document. “Probably never before in history has an entire industry voluntarily admitted its worthlessness as thoroughly as the wellness industry did in this report,” he wrote.

As amusing and possibly as biased as Lewis is on the topic, KHN also looked at the efficacy of workplace wellness programs, and found that although asking employees about smoking or checking their blood pressure is not controversial among medical experts, making everyone submit to the same tests isn’t good medicine, because it’s a one-size-fits-all approach.

That never works for patients who might be 25 years old with no risk factors versus those who are 35 with a family history, say, of heart trouble. That’s where the overtesting comes in. “All screening tests carry the potential to give a false positive result,” according to KHN and many, many of our blogs. A false positive suggests someone has a problem who actually doesn’t. And what about a false negative, which provides reassurance that all’s well when it’s not?

Cholesterol screening is common in workplace wellness programs, and KHN said it’s probably the most contentious of these tests. It measures the levels of particular types of fats in the blood. But there’s no consensus among medical groups (the American Heart Association and the U.S. Preventive Services Task Force, to name two), on the best age to test people for cholesterol and the frequency of doing it. So it’s silly to think this test is a good idea for every employee in the company. (See Patrick’s newsletter on the topic of statins.)

That’s just one example of a common screening at a wellness program that is less about function than form. And it’s only one component — health — that might be important to workers. Privacy concerns loom large. Should any third party affiliated with your employer that isn’t your insurer know those details about you?

As patient advocates, we strongly recommend that people develop a strong, transparent relationship with their health-care provider. But that’s not their employer.

Research published in the Annals of Internal Medicine  showed that 2 or 3 in 10 prescriptions are never filled, and half of all patients don’t follow their drug instructions, even if doing so is necessary to keep them alive.

There’s a proper way to take medicine, whether it’s a prescription or over-the-counter remedy; all meds come with directions about when, how and how much to take. Doctors have a term for whether people follow those directions:  “compliance” or “adherence.”

A recent story in the Washington Post recounted just how difficult it can be for doctors, and pharmacists to get patients to follow medication instructions. Some patients resist because of cost, some because instructions are unclear or taking the meds properly is inconvenient. Some aren’t convinced the meds are helping, and some just can’t stand the side effects. Compliance can be challenging especially for elderly people, many of whom take multiple pills or other treatments a day, and get confused over the drill for each.

Still, as Meera Viswanathan told The Post, “the amount of nonadherence is staggering.” She’s director of the RTI-UNC Evidence-based Practice Center, a public-private institute that analyzes health care and health policy.

Decades ago a study pegged the number of annual deaths due to noncompliance at 125,000, which is about how many people die every year from strokes.

In addition to failing to address the underlying medical problem or, worse, harming the patient, noncompliance is expensive: According to The Post, as much as $289 billion is spent every year on needless hospitalizations, emergency room visits and other consequences of people not following their drug regimens.

So lots of things have been tried to solve the noncompliance problem. Even offering medicine for free, The Post said, hasn’t shown impressive results. But new funding as part of the Affordable Care Act (ACA) is subsidizing experiments that seem to offer hope in the intractable problem.

The experiments are part of the “health care innovation awards” granted by the ACA, and other efforts, by both public and private interests also are seeking solutions to the problem.

One project is about “behavioral economics.” About 1,000 people who were discharged from the hospital after having a heart attack were given “electronic pill bottles.” If they forgot to take their medicine, the cap on the bottle would illuminate and beep. If they remained noncompliant for a few more days, a person they had designated, as well as their doctor, would be notified, in the hope those folks would remind them to take the medicine.

If they did, they became eligible to win small cash prizes.

“I know $5 may not seem a lot to you, but it is thrilling to win a lottery,” one study subject, Melody Givison, told The Post. She had left the hospital with four medications she was supposed to take every day, at different times, in addition to the thyroid med she was already taking. She credited the program with keeping her on her medications for a year, and won two $50 prizes and a dozen $5 awards.

David Asch, director of the center that conducted the research, reported that the preliminary data suggest a big improvement in adherence when compared with other efforts involving similar patient populations.

“We designed it with the foibles of human nature in mind, not with the rational person in mind,” he told the newspaper. “Because the rational person would have been taking their meds in the first place.”

That’s a bit harsh — you don’t have to be irrational to forget to take your meds, or believe that because you’re feeling well you don’t need them — but reminders and incentives clearly have value in this application.

Other compliance-promoting projects include the “Pharm2Pharm” experiment, which seeks to connect doctors and pharmacists who dispense medication to patients being discharged from hospitals with community pharmacists who provide a continuum in dispensing them as those people resume their lives.

Community pharmacists, the story said, often don’t know which medications their patients are taking, especially when they leave the hospital with new ones, so they run the risk of missing a dangerous drug interaction, especially with patients who take tons of different meds, vitamins and supplements.

Another program involved pharmacists who took a training course, and 100,000 mostly poor or elderly people who appeared to be failing to refill their prescriptions or taking incorrect drugs based on data provided by insurers. After working with the patients, the pharmacists relayed their findings to prescribers, which included cost concerns and an inability to recognize the importance of taking the medicine.

But the trick is to keep patients following the drill once the outside programs or incentives have ended  making smart use of medications a habit, just like brushing your teeth or exercising regularly.

To become a better, more “adherent” consumer of medicine, read Patrick’s newsletter, “Becoming a Smarter Buyer of Prescription Drugs.”

For many people, autumn is the season for enrollment in a medical insurance plan. Everyone, whether you’re 25 or 85, whether you’re covered through an employer plan, a state insurance exchange, private insurance or Medicare, should review their current coverage and compare it with the available options.

Insurance companies rewrite some parts of their plans every year; they change premium amounts, the drugs they subsidize, the amount of the deductible … health-care coverage is a moving target, and absent certain major life events, you usually have one shot at renewing or revising your coverage each year.

The moving part we want to illuminate here is the drug coverage offered by Medicare, the federal government insurance for people 65 and older, the disabled and people with certain disorders. These patients tend to use a disproportionate amount of drugs, so Medicare Part D, which covers medicine, is a particularly important financial component of overall coverage.

The list of drugs that are covered or subsidized by insurers is called the formulary, and if you regularly take a certain med, or an usually expensive drug, you want to ensure it’s in your plan’s formulary, and you want to know how much of the cost is subsidized. Formularies change, so don’t assume because your med was covered last year it will be next year. Or if it is, that you’ll receive the same subsidy.

Click here to learn more about Medicare Part D, how it works with other insurance and how to choose a plan. Read Patrick’s newsletter, “How to Make the Most of Turning 65” to learn more about Medicare generally.

If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric descriptor/diagnosis for every problem they treat.

As of this month, doctors, hospitals and health insurers must use the ICD-10, the coding system that has been in the works for a long time and has been delayed due to its astonishing specificity. According to KaiserHealthNews.org (KHN) the number of codes doctors must use have increased from about 14,000 to nearly 70,000; hospital codes for medical procedures have boomed from about 4,000 to around 72,000.

Let’s say you’re boating in the San Juan Islands, get tossed into the water and slammed by a whale. Yep, we got that — W56.22xA (“struck by orca”). Let’s say you’re skating toward the net in your recreational hockey league game and some yahoo defender employs a weapon to stop you. Yep, we got that — Y08.01 (“assault by hockey stick”). Let’s say you were in the backyard coop, collecting eggs for breakfast and got attacked by an aggressive hen. Yep, we got that — W61.33 (“pecked by a chicken”).

The update from ICD-9, the previous set of codes, was necessary because the old ones have been used since 1979, and didn’t reflect the complexity of modern medicine. Lots of people think the new ones are more than a bit of an overreach. If you break your shinbone, it’s not a generic orthopedic event — your doctor must sort through dozens of codes for a fractured tibia to find the one that describes yours best. If you eat a toxic mushroom, there are 18 potential codes to describe that misadventure.

“Government and private insurers can reject claims that aren’t specific enough, use the wrong codes or have a mismatch between a diagnosis and procedure code,” KHN explained.

The code changeover is even more fraught in certain states because their billing systems were antiquated: California, Louisiana, Maryland and Montana got permission from the feds to use the old codes, at least for their Medicaid billing, until their systems can be upgraded, maybe a couple of years.

The ICD-10 codes are derived from the International Classification of Diseases, an initiative of the World Health Organization that includes codes for injuries, diseases, their causes and symptoms, as well as patient complaints and socioeconomic circumstances.

If most people and practitioners roll their eyes at what seems more like a comedy routine than medical record-keeping, public health officials, according to Marketplace.org, welcome the granular view the ICD-10 affords. They’re optimistic that they will help them track illnesses and patterns, and get a better sense of what’s working and what isn’t in the U.S. health-care system.

“For instance,” Sean Cavanaugh, director of the Center for Medicare, told Marketplace, “we recently had a … threat of a problem with ebola. And the [old set of codes] does not have a code that’s specific to ebola.”

But the American Medical Association (AMA) is concerned that although Medicare allows a one-year reimbursement grace period for doctors who made honest mistakes in coding, not all private health insurers and Medicaid necessarily do.

“Questions remain if physicians will be forced to follow patchwork of disparate coding standards for each payer. The resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care,” Steven J. Stack, AMA president, said in a written statement.

What’s the code for a prehistoric-looking, 8-foot reptile sinking its teeth into your leg? Depends — was it an alligator or crocodile? What’s the code for banging your elbow on a chair in a public venue? Depends — was it at the opera house or the library?



Good doctors have excellent clinical and science-based problem-solving skills, but there’s increasing pressure on these care providers to improve their people skills, too.

A recent report on KaiserHealthNews.org (KHN) explained that many medical centers, and private practices, are trying to relate better to patients partly because it delivers better health care, and partly because patients increasingly expect to be treated as partners, not patronized customers.

Also, as doctor pay increasingly is based at least partly on patient reports, it’s in their best interest to be better listeners and more sensitive to their patients’ needs, which are about medical care as much as they are medical treatment.

Part of the Affordable Care Act calls for Medicare to subsidize hospitals partly on the basis of patient satisfaction surveys. And as patients share more of the cost of their care, they’re pickier about the quality of the whole experience, not just the health outcome.

Most doctors are sinking under the weight of an out-of-control medical records system, insurance demands and shrinking insurance reimbursement that force them to maintain a crazy schedule just to remain in business. Sometimes, amid all that stress, they can be short, condescending and inconsiderate.

Martha Hayward, a patient engagement professional at the Institute for Healthcare Improvement, told KHN, “We train people to ask the question, ‘What’s the matter?’ We train toward diagnosis. We don’t train toward lifestyle understanding.”

KHN referred to a study from 2011 that found that only about half of recently hospitalized patients said they experienced compassion during their treatment, even though both doctors and patients involved in the research said that kindness in such settings is valuable and important.

Some medical facilities, such as those at the University of Michigan, the Cleveland Clinic and the Duke University School of Medicine are trying to encourage physicians to be more responsive, according to Tim Vogus, an associate professor of management at Vanderbilt University. He studies the relationship between compassion initiatives and patient satisfaction scores.

His research shows that hospitals that promote compassion, especially by rewarding those who embrace it, are more likely to have higher patient satisfaction scores.

We need research to confirm this? If you’re nice to a dog, she’s likely to lick your hand; if you abuse her, she’s more likely to bite it.

More medical schools, like Duke’s, require students to take courses to help them be empathetic, they offer training to practicing physicians. Some of these programs encourage providers to enter personal details about patients in their medical charts to enhance communication over common interests. Some suggest that doctors send handwritten to patients and their families as part of follow-up care.

Such small gestures, according to Matthew Taylor, who was interviewed by KHN, are quite meaningful. After his daughter was prescribed new medication for her anxiety and depression, the doctor called to check up on her. The doctor’s office, he said, “considered it important — even if it’s only taking 30 seconds or a minute of time to say, ‘Are things going well? Is there anything we need to be concerned about?’ — shows that they’re paying attention to things they need to be doing,” said Taylor.

Doctors working in hospitals are on the frontline of this patient-awareness initiative, generally because of the patient surveys’ influence on Medicare payments. But it’s not just doctors, it’s the whole health-care team that must know how patients perceive them. Cleveland Clinic employees get regular feedback from patients’ reviews, and if there’s a pattern of things they do that patients dislike, they can adjust.

At the University of Rochester Medical Center in New York, doctors who demonstrate compassion are called out in messages the department head sends out to the hospital’s faculty. The information often comes from patient evaluations, and includes practices such as spending extra time at a bedside and answering questions in ways the patient can understand.

It’s not that difficult to connect, and it often pays off in better health outcomes. “If patients feel their doctors genuinely care,” according to the KHN story, “they’re more likely to take medications and comply with recommendations.”

Stephen Post, who directs the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University in New York to KHN that when physicians listen more carefully, they can to pick up patient cues and details they might otherwise miss, and consequently prescribe better treatments.

And when they don’t, the opposite can occur. One woman in the KHN report thought her new doctor was condescending and dismissive during an office visit. It was so upsetting that she forgot to ask about the problem that brought her in, and wasn’t exactly enthusiastic about getting follow-up care.

“I was feeling obstinate,” she said. “It was almost a way to get back at him.”

Their hectic schedules and the pressure to see ever more patients just make ends meet can make doctors forget to listen, or even offer a greeting on entering the exam room.

“It’s not that they don’t care,” one KHN interviewee offered. “But they forget.”

You probably heard about the recent price hike for a drug critical to AIDS patients when the manufacturer sold it to an evil hedge fund manager who promptly marked it up 5,000%. This  prompted Los Angeles Times columnist Michael Hiltzik to revisit programs sponsored by pharmaceutical companies that purport to help people who can’t afford their costly meds.

Such patient-assistance programs, said Hiltzik, are a “sham.”

Drugmakers cover the patient’s co-pay or other costs in such programs, which involve about 300 drugs. Insurers, health-care economists and government agencies loathe the programs, according to Hiltzik, because “they’re often marketing schemes dressed up to look like altruism.”

One academic called the assistance programs “a triple boon for manufacturers,” because they increase demand for the product, allow companies to charge more for it and position themselves as the good guys for, basically, juicing a market, then exploiting it. “Manufacturers,” wrote Emory University’s David Howard last year, “can afford to pay a lot of $25 of $50 co-payments in return for even a small increase in sales of a $50,000 drug.”

Turing Pharmaceuticals makes Daraprim, which treats toxoplasmosis, an infection particularly threatening to people with AIDS. When the price jumped from $13.50 to $750 per pill, Turing said a patient-assistance program would cover low-income patients who can’t afford their share of the cost.

Is that “generosity”? Or just another example of a drugmaker using a patient-assistance program to pressure insurers into paying for its expensive drug? Hiltzik recalled how earlier this year, another member of the Big Pharma club, Gilead Sciences, limited its patient-assistance program for Sovaldi and Harvoni, drugs that treat hepatitis C for more money than most people make in a year. Although the drugs work well, they cost nearly $100,000 per treatment, so insurers were limiting them to only the sickest hep C patients, which is more than a little penny-wise, pound-foolish.

As Hiltzik wrote, “Gilead hoped that covering patient co-pays would pressure the insurers into allowing broader use of the drugs. When that didn’t happen, the firm shut down assistance for enrollees of insurers that were still applying restrictions; the hope plainly was that patients would scream at the insurers.”

So the descriptor “patient-assistance program” was not only a misnomer, it was a blatant falsehood. The AIDS Healthcare Foundation accused Gilead of “holding hepatitis C patients hostage as a negotiating strategy with health insurers for drugs that they ridiculously overpriced in the first place.”

That’s why private insurers and Medicare dislike the programs; “subsidizing the patients undermines what may be their most important tool for controlling health-care costs,” Hiltzik explained, “which is steering patients to low-cost alternative drugs or generics. The patients are immunized against their small share of the cost, but the insurers and government still have to pick up the rest.”

Even if patients get drug company assistance, it’s not necessarily good for them, either, if they get hooked on the high-priced product Big Pharma promotes when equally effective, less expensive options exist. Hiltzik referred to a survey in 2013 of coupon programs, which are a related kind of promotion. Downloaded from the manufacturers’ websites, the coupons limit or cover the patient’s co-pay for the first purchase of the drug. But, as Hiltzik reported, “Of the nearly 400 coupons for brand-name drugs examined by the authors, 62% were for products for which lower-cost alternatives were available.”

So you might get short-term savings but you’re locked into higher costs in the long term. By the time the discount ends, according to the survey, “patients may have developed loyalty to the particular brand or may be skeptical about switching away from a medication that they perceive as effective.”

Medicare prohibits co-pay patient-assistance programs that are affiliated directly with a drug manufacturer. Medicare’s overseer, the Dept. of Health and Human Services, warns that manufacturer subsidies to Medicare or Medicaid patients might run afoul of federal anti-kickback laws, which prohibit payments for the purpose of inducing people to choose a certain service.

Proven charities may provide assistance to low-income patients, but there have been problems, there, too. As Hiltzik recalled, a couple of years ago the Chronic Disease Fund (CDF) was accused of having an illegally close relationship with Questcor, the manufacturer of a multiple sclerosis drug that sold for $28,000 per vial, a cost CDF covered.

Even if these programs are not what they seem to be, the fundamental issue remains: How do people who can’t afford them get the drugs they need? Hiltzik didn’t see that as an insurmountable problem. “For one thing,” he wrote, “insurers don’t object so much to assistance programs for drugs that truly are uniquely effective, and at prices that are rational; their big problem is with expensive brand names that are just as effective as alternative treatments, or even inferior.”

But we still need policies that drive all prescription costs down, whether it’s a cap on patient co-pays, permission for foreign drugmakers to import less expensive drugs from overseas and/or allowing Medicare to negotiate with drugmakers for lower prices. In 2003, Congress forbade such commerce when it implemented the Medicare prescription drug program, known as Part D.

The latter idea might not lower prices that much anyway. Part D is required to offer a wide range of drugs, which limits Medicare’s bargaining power. Hiltzik noted that health economist Austin Frakt suggested tying Medicare’s required drug list to that of Veterans Affairs, which can negotiate with manufacturers and also can be more discriminating about the drugs it provides.

“The VA has used this authority to exclude many of the me-too drugs that drive health-care costs higher,” Hiltzik wrote. “Frakt calculated in 2011 that the VA paid 40% less for drugs than Medicare, while covering 59% of the most popular 200 drugs, compared with Medicare’s 85%. The change, he estimated, could save Medicare more than $14 billion a year. It might have a considerable multiplier effect nationwide by providing a truly effective benchmark for drug prices.”

Any conscientious, patient-centered effort to address the soaring rate of drugs would be better, Hiltzik concluded, than “the self-interested patient-assistance programs that cut prices for the few while keeping them bloated for everyone else. Drug companies shouldn’t be permitted to hide their fattening profits behind the shroud of philanthropy. That just costs everyone real money.”

To learn more, read Patrick’s newsletter, “Becoming a Smarter Buyer of Prescription Drugs.” 

Autumn marks the beginning of flu season. It takes a couple weeks after you get the flu vaccine before it’s completely effective, so get vaccinated now.

Last year was a notably rough flu season because a mutated strain of the virus developed after the vaccine, which generally is manufactured over several months, was distributed. As reported by the Associated Press (AP), the typical flu vaccine is effective in 5 or 6 out of 10 people, but last year, it worked in only about 13 in 100 people.

According to the Centers for Disease Control and Prevention (CDC), there are two main types of influenza (flu) virus, A and B. Over the course of a flu season, different types of A and B, and different subtypes of A (H3N2 and the H1N1) circulate and cause illness. The late-developing H3N2 subtype last year caused the highest flu-related hospitalizations of seniors in a decade.

So if the vaccine isn’t that great anyway, and if it can be overrun by newcomer strains, why even get vaccinated?

Because if you’ve ever had the flu, you know how miserable it can be — your body aches as if hit by a truck, your respiratory system is in full revolt, you have fever and headaches, you can barely move out of bed … and you shouldn’t.

These symptoms aren’t just difficult to live with for several days (or more), for some people they’re life-threatening, especially the elderly, young children, pregnant women and people with chronic health conditions such as asthma or heart disease. But healthy young people also can get seriously ill, and they can contaminate others.

According to the CDC, last year at least 145 children died of flu (the average is 100), and every year about 24,000 people in the U.S. die from it.

This year, authorities are confident that the vaccine developed over the last few months is a good match for the circulating strains. Dr. William Schaffner of Vanderbilt University and the National Foundation for Infectious Diseases told AP that even if one strain mutates, vaccination is still “the best defense against flu.”

There’s a choice of delivery systems, so if you’re afraid of needles, you might be able to get protection via a nasal spray or a needle-free option called a jet injector that forces the vaccine into a stream of fluid that penetrates the skin. It’s recommended only for adults 18 to 64, but it still might cause some of the same soreness as a traditional shot.

The nasal spray is appropriate for healthy people ages 2 to 49. There’s also “intradermal” or skin-deep shots that use tiny needles; a shot for people who are allergic to the chicken eggs in which most flu vaccine is developed; and a high-dose version for people 65 and older, whose immune systems need extra help.

“It doesn’t matter which flu vaccine you get, just get one,” advised Dr. Tom Frieden, director of the CDC, who got his shot a couple of weeks ago.

The flu vaccine is recommended for everybody who’s older than 6 months, the CDC says. But only about half of U.S. residents get immunized every year. And those rates vary according to age bracket. CDC data show the highest vaccination rates last year were among children 6 months to 23 months, 3 in 4 of whom were immunized. Almost 7 in 10 kids 2 to 4 years old were immunized, as were a bit more than 6 in 10 5- to 12-year-olds.

About 2 in 3 seniors were vaccinated, but only 1 in 3 adults 18 to 49 were. And only about half of pregnant women usually get immunized, and those numbers should be far higher — the vaccine protects not only the woman, but the baby for its first six months.

AP said that about 40 million of this year’s anticipated 171 million doses have been shipped to providers — doctors’ offices, pharmacies, clinics, etc. Flu generally peaks between December and February, but it’s unpredictable — there’s no reason, including cost, to wait to get protection. Most health plans must provide free flu vaccinations as a preventive health service under the Affordable Care Act; people who must pay out of pocket generally pay around $30 to $40.

The CDC and vaccine manufacturers are trying to figure how to cut vaccine production time so that if mutations develop, they can respond quicker with an effective vaccine. They also hope one day to offer a “universal vaccine” that addresses many flu strains, but according to Friedan, that’s “a few years away at best.”

To learn more about the flu, see our blogs “Get a Flu Shot, Protect Your Heart” and “The Trouble with Tamiflu.“

Here’s another device you probably don’t need. Or do you?

That’s the question Austin Frakt, who writes for the New York Times, tried to answer for himself when his cardiologist told him that one of his heart’s chambers sometimes pumped when it shouldn’t. The doctor had been “99.9% certain” that it wasn’t worrisome, and doctor advised against additional tests and visits.

But even though he’s a health economist, and knows that many commonly prescribed tests aren’t necessary, Frakt is only human. “As a patient,” he acknowledged in his story in The Times, “I’m not confident I know which ones.”

His heart palpitations persisted, and so did his concern. “Was I the patient for whom additional tests would be beneficial or wasteful?” he wondered.

He opted to try the monitor. That involved attaching electrodes to his chest so that his heart’s rhythm could be relayed over wires to a recorder on his belt. It wirelessly communicated the heart data to his physician, continuously monitoring for electrical signals of a heart attack.

As Frakt wrote in The Times, “Some [technologies] are valuable for some people but are used in a great many more for whom it is wasteful. When applied to the population with the right risk factors, various tests of the heart can save lives. When applied to a population at very low risk, a great deal of it does little but add to our health care bill, waste patients’ time and lead to unnecessary procedures, which carry their own risks.”

Although Frakt was amazed by his hear monitor’s wizardry, that didn’t overcome the unpleasantness of wearing it. The wires tickled his torso and made his clothing look bulky. The belt recorder poked him in the waist and impaired his range of motion. Not to mention the weird looks he got when somebody noticed the monitor.

“It was hard to forget I was a patient,” he wrote. “I felt tethered to, not freed by, technology. These inconveniences were like small physical and psychological co-payments, increasing the cost of the test to me, the patient.”

If you have an increased risk of heart problems, if you have a history that demands you carefully monitor your heart’s health, these are minor inconveniences, and maybe the monitor is a useful health-care tool. But if you’re not a heart patient or strong potential patient, really, is this something you want to pay for, be inconvenienced by and possibly stress out over its presence?

For Frakt, although the financial cost of the device wasn’t a concern, the psychological cost was too high, given that he wasn’t sure that he needed monitoring around the clock. “Within a day,” he wrote, “I unplugged and immediately felt liberated.”

As it turns out, his condition was benign.

But as the physical, mental and financial burden of collecting data about the human body declines, more people will use technologies like the heart monitor. Some are curious, some just like new gadgets and some are the “worried well,” people with no reason to suspect illness lurks, but still worry about it anyway.

The popularity of fitness monitors  attests to our cultural embrace of little tools that are all about me me me, even when there’s no medical reason for constant monitoring. And even though a lot of health data trackers now on the market aren’t always reliable, Frakt said that widespread monitoring eventually might enhance researchers’ ability to understand the early cues to potential problems. “It might save lives,” he said.

Today, wearable heart monitors for stroke patients are useful in diagnosing irregular heartbeats and alerting doctors to the need to intervene. Implantable defibrillators are proven tools to decrease risk of mortality for some patients with heart failure by shocking their hearts back into normal rhythm.

“But,” Frakt wrote “[t]hese examples are for technology targeted to specific groups with significant heart problems, the people we know will benefit most. What happens when millions of healthy people start recording their hearts’ rhythms just because they can? Even though the devices that enable this may be cheap, collectively we may pay a lot if doing so leads to over-diagnosis and unnecessary procedures. People who need wearable health monitors the least may be among those most likely to use them.”

Frakt isn’t just an economist, he’s a bit of a poet. Regarding our attraction to new technology, he concluded in his story, “Each time it feels right, but so often it doesn’t last. It’s like falling in love.”

In the last couple of years, the class of medications known as statins has gotten a lot of attention, most recently this month when NPR reported concern over the popularity of prescribing statins for the elderly.

Statins are cholesterol-lowering drugs with “statin” somewhere in the generic name; brand names include Crestor, Lipitor and Zocor. People with elevated blood cholesterol levels are at greater risk for heart disease  and stroke.

The NPR story said that a lot of doctors prescribe them almost as a default treatment, a better-safe-than-sorry way to prevent heart trouble in their very elderly patients. That’s problematic, because there’s a lack of science to show the wisdom of such a broad-brush approach for this age group.

A few years ago, the American Journal of Cardiology noted that there’s little research among people older than 79 showing that statins’ preventive heart benefits outweigh the possible risks, including muscle pain and diabetes. A more recent study in JAMA showed that seniors with no history of heart trouble are about four times likelier to be prescribed those drugs than they were in 1999.

The authors of that study wrote that “the very elderly have the highest rate of statin use in the United States.”

The American Heart Association and the American College of Cardiology issued guidelines a couple of years ago for using statins as a preventive measure for people with high cholesterol but no diagnosed heart disease if their 10-year risk of suffering a heart attack or stroke is 7.5% or higher.

Some scientists have questioned the risk calculator developed in concert with that guideline because they believe it might overestimate risk.

And the calculator applies only to patients younger than 75 precisely because of the lack of clinical trial data for the very elderly. So doctors have to decide whether statins as preventive medicine is good for the elderly given the potential harms and the patient’s life expectancy. And they seem to be tilting toward overuse.

Lots of luminaries in the medical community are concerned about the general overuse of statins, including Dr. Harlan Krumholz (see our blog, “A Wise Man Analyzes the Renewed Attention on Statins.”)

Referring to the Heart Association guidelines, last month, cardiologists at Johns Hopkins and the Mayo Clinic concluded that “overreliance on such algorithms can lead to unnecessary treatment with statins,” and called for updates to heart disease prevention guidelines.

Statins often are a good idea to reduce the risks of a heart attack or stroke for people who have suffered those conditions, and maybe to prevent an episode for people who have high cholesterol. But, as NPR pointed out, even though the average life expectancy in the U.S. is 76 for men and 81 for women, drug company research, including statin research, focuses on younger people.

Dr. Steven Nissen, department chair of cardiovascular medicine at the Cleveland Clinic, wants Congress to legislate incentives for drug manufacturers to conduct research into the effects on the elderly of a wide array of drugs, because statins aren’t the only meds in which that demographic has been underrepresented in clinical trials.

Dr. Michael Johansen, one of the authors of the recent statins study, told NPR that he hoped doctors would be more cautious about which elderly patients take them for prevention. Muscle pains that some seniors experience while taking the drugs might cause them to fall, he noted to NPR, and that could cause other life-threatening injuries.

“We just don’t know,” he said.

Learn more about statins in Patrick’s newsletter, “Should a Statin Drug Be in Your Medicine Cabinet?”


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