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Mental Illness And The Tucson Shooting

When reports arrived that accused gunman Jared Lee Loughner had opened fire in Tucson, Arizona on January 7, journalistic first responders linked the incident to the fierceness of political rhetoric in the United States. Upon reflection, some of the discussion has turned to questions about mental illness, guns, and violence.

And plenty of reflection is required, because the connections are not at all simple. To get a sense of just how complicated they are, we invite you to read the lead article in this month’s Harvard Mental Health Letter entitled, “Mental Illness and Violence.” Strangely (for us) it was prepared for publication a month before the tragedy in Tucson. In light of the shooting, we are making the article available to non-subscribers.

I am not surprised at the outrage expressed in the news or at the impulse to blame. A quick scan of the news, however, shows there is not much agreement about whom to blame. In addition to the alleged perpetrator, one can find explicit and implicit criticisms of politicians for playing to our baser instincts; of media figures, various men and women of zeal, for their disingenuous or manipulative partisanship; of the various community bystanders (police, teachers, doctors, family members, neighbors, friends), whom we imagine could have intervened to prevent tragedy.

The political debate flowing from this incident will continue, as will the endless cycle of blame and defensiveness. But I caution all of us — and especially mental health professionals — not to make clinical judgments about Mr. Loughner. Very few people will or should have access to the kind of information that would allow such judgments. From a public health perspective, however, we should make careful judgments about policies that could reduce risk. Read more »

*This blog post was originally published at Harvard Health Blog*

“Just In Case” Heart Tests: Can They Do More Harm Than Good?

Here’s an important equation that all of us — doctors include — should know about healthcare, but don’t:

More ≠ Better

“More does not equal better” applies to diagnostic procedures, screening tests meant to identify problems before they appear, medications, dietary supplements, and just about every aspect of medicine.

That scenario is spelled out in alarming detail in the Archives of Internal Medicine. Clinicians at the Cleveland Clinic describe the case of a 52-year-old woman who went to her community hospital because she had been having chest pain for two days. She wasn’t having symptoms of a heart attack, such as shortness of breath, unexplained nausea, or a cold sweat, and her electrocardiogram and other tests were fine. The woman’s doctors concluded that her chest pain was probably due to a muscle she had pulled or strained during her recently begun exercise program to lose weight.

To “reassure her” that she wasn’t having a heart attack, the emergency department team recommended she have a CT scan of her heart. This noninvasive procedure can spot narrowings in coronary arteries and other problems that can interfere with blood flow to the heart. When it showed a suspicious area in her left anterior descending artery (a key artery nourishing the heart), she underwent a coronary angiogram. This involves inserting a thin wire called a catheter into a blood vessel in the groin and deftly maneuvering it into the heart. Once in place, equipment on the catheter is used to make pictures of blood flow through the coronary arteries. Read more »

*This blog post was originally published at Harvard Health Blog*

Echinacea For Colds: Does It Really Work?

Does echinacea, the popular natural cold remedy, really work?

It depends on what you mean by “work.” Results [recently] reported in the Annals of Internal Medicine found that echinacea may reduce the length of a week-long cold by 7 to 10 hours and make symptoms a little less onerous. That can’t be characterized as a major effect, so many people may figure that the trouble and expense of echinacea just isn’t worth it (fortunately, side effects from echinacea don’t seem to be much of an issue.)

But others may decide that some benefit is better than none, and these results do fit with others that have left the door slightly ajar for echinacea having some effect as a cold remedy — a modest effect, but an effect, nonetheless.

A summary for patients published by the Annals summed up the situation nicely:

People who take echinacea to treat colds may experience a decrease in the length and severity of their cold symptoms but to such a small degree that they may not care about the difference. Although many studies of echinacea have been performed, researchers still disagree about its benefits in treating the common cold. This study is unlikely to change minds about whether to take this remedy.

Have you tried echinacea as a cold remedy? Has it worked? How do research findings, pro and con, affect your opinion of so-called alternative medicines?

Many of the echinacea studies, especially early on, were sponsored by companies making or selling the product. This study was supported by a grant from the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health.

– Peter Wehrwein, Editor, Harvard Health Letter

*This blog post was originally published at Harvard Health Blog*

Good Health Information Can Save Lives

My colleagues at Harvard Health Publications and I have a mission: To provide accurate, reliable information that will help readers live healthier lives. We work hard to fulfill that mission, and the feedback we get from folks who read our newsletters, Special Health Reports, books, and online health information indicates we are on the right track. Every so often we hear something from a reader that makes me especially proud of the work we do.

This letter was recently sent to the editor of the Harvard Women’s Health Watch:

One of your mailings undoubtedly saved me a lot of grief. (My kids, anyway.) I was aware of a woman’s heart attack symptoms being different from a man’s, and your brochure contained a paragraph confirming that. Early in June I was packing for a trip to celebrate my brother’s 90th birthday, at the same time a ditching project was being done in my back lot. Trying to deal with several matters at the same time is a talent I’ve outgrown, at 88, so didn’t think too much of the sudden fatigue and vague aches I felt in jaw & arms. I crashed for a nap in my recliner, felt OK afterwards, and figured it was just stress. The next day I was ready to leave, but got to thinking of those symptoms, and the fact the brochure had arrived at just that time, and wondered if it was more than coincidence and maybe I should pay attention? Didn’t much like the idea of something happening out in the middle of nowhere, so took myself to the fire hall where an EMT was on duty. He ushered me into the ambulance, did an EKG, and soon I was being helicoptered on doctor’s orders to St. Joseph’s Hospital. There I had 3 stents installed, and they apparently are doing their job. Thank you! Read more »

*This blog post was originally published at Harvard Health Blog*

Painkiller Safety

Perhaps as many as one in every five American adults will get a prescription for a painkiller this year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders — getting rid of pain can seem like a miracle — but sometimes there’s a high price to be paid.

Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, and valdecoxib, sold as Bextra, were taken off the market in 2004 and 2005, respectively, after studies linked them to an increased risk of heart attack and stroke.

The nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen (sold as Advil and Motrin), and naproxen (sold as Aleve) seem like safe bets. But taken over long periods, they have potentially dangerous gastrointestinal side effects, including ulcers and bleeding. Kidney and liver damage are possible, too. More recently, some of the NSAIDs have been linked to an increased risk of cardiovascular disease. Low doses of aspirin (usually defined as 81 mg) is an exception and is often prescribed to lower the risk of heart and stroke.

Even acetaminophen, which is often viewed as the safest pain drug and a low-risk alternative to the NSAIDs because it doesn’t have their gastrointestinal side effects, comes with a caution about high doses possibly causing liver failure. Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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