Category: Drugs & Medicine

Having trouble finding reliable health information? Our medical professionals can do it for you.

By Nathan Blake | 11/14/18
Project Manager, HealthWeb Navigator

Readers sometimes ask what a typical day looks like here at HealthWeb Navigator.

Mostly we spend a lot of time browsing the web. Whether it’s groundbreaking medical research, user reviews of a diabetes smartphone app, or a new website that helps you understand your health insurance plan, we try to stay on top of everything health-related the internet has to offer.

Our tireless web browsing has helped us become one of the internet’s leading resources for finding and evaluating reliable healthcare websites. We are, to date, the only place that publishes in-depth reviews of health websites written by actual health experts. Yet we’re still on the lookout for innovative and helpful ways to meet your healthcare research needs.

That’s why we’re excited to announce a new service that gathers the web’s best health information specific to your needs or interests. Yep — we’ll check every nook and cranny to give you personalized resources from the internet’s most trusted sources. No more wondering if what you’re reading is credible. We pre-screen every resource for reliability and only send you the cream of the crop.

Start by shooting us an email at info@healthwebnav.org. Fill us in on the details — what topic you want to learn about, your preferred language and medium, the level of detail you’re comfortable with, etc. — and we’ll respond with relevant, trustworthy resources that specifically meet your preferences.

Maybe you want a Spanish-language video that introduces type 1 diabetes. Or perhaps you’re looking for clinical trials for new a Parkinson’s disease drug treatment. You might even like to know the side effects of your wife’s chemotherapy, or if there’s a support group for teens with cystic fibrosis, or where to download a podcast for caregivers. Whatever the case, we’ll see what’s out there.

We can’t guarantee that we’ll find something you haven’t seen already. And nothing we send you can substitute for medical advice. But no matter what, you’ll walk away with credible and up-to-date information that has been verified by at least one medical professional.

So what are you waiting for? Send us an email and get started today!

Free Health Research Worksheet for Patients

By Nathan Blake | 7/27/18
Project Manager, HealthWeb Navigator

Our team of medical reviewers talk with countless patients about health information on the internet. But many more patients don’t mention what they read online. Either they’re afraid the doctor will ignore them, or will think they’re being “difficult” for talking about what they learned, or they just don’t have time to bring it up.

Doctors and patients need to talk openly about what patients are reading. Browsing the web before and after a doctor’s appointment is something most of us do, as it lets us participate in healthcare decisions. But a doctor’s medical training can help us avoid dangerous or irrelevant advice. And if doctors refuse to listen to what patients have read, or if patients are afraid to speak up, then everyone misses out on valuable insights.

That’s why we’re providing this free resource to help you collect your thoughts before meeting with a healthcare professional. As you research health topics on the internet, use this worksheet to write down what you want to talk about with your doctor.

Make sure you’re clear from the start of your next appointment what you want to discuss and why it’s important to you. Then, let your doctor respond, and write down their thoughts too. Together, you can come to a decision about what to do next.

And don’t forget to browse our collection of reviews to find the most reliable health websites available today!

Download file: Health Research Worksheet

HealthWeb-Navigator-Health-Research-Worksheet

 

Vitamin Supplements — Cure-All, or Snake Oil?

By Mark A. Kelley, MD |2/15/18
Founder, HealthWeb Navigator

Vitamins and other over-the-counter supplements are extremely popular in the United States. In fact, it’s estimated that Americans spend $21 billion on these products every year—a few billion dollars more than NASA’s entire annual budget.

Over the last century, there has been extensive research to understand the importance of vitamins and minerals in maintaining good health. Essential vitamins and minerals are chemicals that our bodies cannot manufacture on their own. Usually they’re introduced to our bodies by the food we eat.

There are some great stories surrounding the discovery of certain vitamins and minerals. Three centuries ago, sailors on long voyages often became very ill, many of whom died. The cause was lack of vitamin C in their diet, a condition known as scurvy. To provide vitamin C, these sailors were given limes to eat on the voyage. Miraculously the condition disappeared.

Another example comes from the early twentieth century, when patients were mysteriously dying from anemia despite an adequate diet. Studies showed that they lacked a protein that is necessary to absorb vitamin B12. When the patients were given vitamin B12 by injection, their anemia vanished.

Over time medical science has learned much more about how vitamins and minerals keep us healthy. Yet even in this era of health supplements, the average person still wonders, “What should I be doing to maintain good health?”

Below, we’ll look at a few of the consensus recommendations for vitamin use based on clinical studies to date.

Are Vitamins and Supplements Necessary?

For a healthy person, a well-balanced diet will supply the necessary minerals and vitamins. A balanced diet should include fruits, grains, vegetables, protein, and some dairy products. These foods have the right nutrients that our bodies are designed to absorb to keep us healthy.

Folic acid supplement during pregnancy has been shown to reduce neural tube (spinal) defects in infants. This major advance may save many infants from a lifetime of disability.

Strict vegans may need vitamin supplements. A completely vegetarian diet may lack vitamins B12 and D, and the patient may require oral supplements to correct these deficiencies. The same approach applies to anyone on a poor or restricted diet.

Vitamin D may require some supplement. Vitamin D is necessary for bone growth and strength and comes from two sources. The first is from food, and the second from our skin, which produces vitamin D in response to sunlight. Low vitamin D levels can be seen in patients whose diets are poor or who rarely go out in the sun. For this reason, many experts advise oral vitamin D supplements for older patients who may be at risk for osteoporosis or bone fracture.

Multivitamins are safe, but usually aren’t necessary. Patients with poor diets or digestion may benefit from multivitamins or other supplements. However, for an average person, the consensus is that these products are unnecessary. Nonetheless, multivitamin doses are generally modest and likely won’t harm healthy patients who want to use them within the usual recommended doses.

Beware of high doses of certain vitamins. High doses of the following vitamins can cause lasting damage to your health:

• Vitamin A: Birth defects, osteoporosis, increased cardiac mortality

• Beta-Carotene: Lung cancer

• Vitamin C: Kidney stones

Based on current research, there is no evidence that supplemental vitamins or antioxidants prevent or improve the outcomes of cancer or cardiac disease.

Vitamin and mineral supplements can sometimes be helpful. But for those of us who take prescription medications, they can also cause dangerous interferences. This field is complex, and the science behind it is constantly evolving. Before taking any supplements, it is wise to consult your physician and discuss what is best for you.

A Permanent Vaccine for the Flu?

By Mark A. Kelley, MD |2/5/18
Founder, HealthWeb Navigator

The current flu season is the most severe in nearly a decade. In a typical year, influenza causes 3 to 5 million cases of severe illness, and anywhere from 290,000 to 650,000 deaths around the globe.

But this year may be even more worse because the flu vaccine has been only 10-20% effective in preventing the flu—less than half its usual protection.

The flu virus mutates rapidly, so creating an effective vaccine is largely a game of chance. The process requires scientists to decide in advance which strains they think will be the most prevalent each flu season. That decision determines how the flu vaccine is manufactured, a process that takes about six months.

This year the H3N2 virus emerged unexpectedly. It is particularly nasty and tends to be more resistant to flu vaccines.

The flu virus, particularly type A, can also blend its genes with other viruses, including those infecting animals like pigs and birds. These changes produce new surface coatings on the virus, which pose a major challenge for our body’s defenses. If our immune system recognizes a virus from a previous infection or vaccine, it can quickly kill it. However, new forms of the virus are hard to recognize and can make it difficult for the immune system to react quickly. Such a delay can be deadly if it allows the infection to gain a foothold.

Compared to vaccines for polio, smallpox, and measles, the current flu vaccine falls considerably short:

• It offers limited protection that changes year to year.

• It does not provide lifelong immunity.

• It is unlikely to protect against more dangerous strains of flu like the 1918 pandemic that killed 50–100 million of the world’s population.

Can we produce a better and more effective flu vaccine? The short answer is yes—but only if we have the will to do it.

Scientists have known that certain parts of the flu virus do not change their genetic profile. These areas hide from our immune system. A more effective vaccine would expose and target those areas so that our immune system can always recognize the virus and eliminate it. Other approaches include reengineering some of our own cells to look like the flu virus and making the immune system better prepared to reject it.

These and other innovations are aimed at developing more effective and predictable protection against the influenza virus. Although it will likely take years and considerable funding to develop, the costs are paltry compared to the estimated $8.4 billion in lost productivity every year in the U.S. resulting from the flu. A new vaccine that uses modern technology and offers better protection would be a bargain.

Influenza has plagued mankind for centuries. Every winter, this disease reappears around the world. It may spread even more rapidly with population growth, international travel, and urbanization.

There are reasons to be optimistic about a new vaccine. In this era of “precision medicine,” the science of virus biology has advanced far beyond the 70-year-old technology used for the current vaccine. If the nations of the world choose to accept this challenge, we may be able to protect millions of people who suffer or die from influenza every year.

Hospitals Take Aim at Generic Drug Companies

By Mark A. Kelley, MD |1/22/18
Founder, HealthWeb Navigator

In a previous blog, I mentioned how the prices of many generic drugs have skyrocketed. In some cases the price of a single pill has increased over 500%.

But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer.

Why has the price of generics skyrocketed?

Some large drug companies have purchased (or outcompeted) generic drug manufacturers. This has created a monopoly for some widely used and long-standing products, such as the EpiPen and the albuterol inhaler. In effect, the companies can set whatever price the market will bear. In many cases, the market (i.e patients) has no choice but to accept these prices since no one else makes the drugs.

As if that strategy were not enough, some analysts have suggested another motive. By raising the price of generics and controlling the supply, monopolies could also introduce new “copycat” drugs that resemble the generics and are protected by patents. Both of these maneuvers could improve the stock market value of these drug manufacturers.

The issue is that prescription drugs operate in a market that does not include the patient. Health insurance companies negotiate drug prices and then pass them on to employers and their employees. Compared to hospital costs, most generic drugs are minor costs for the employer. Furthermore, through deductibles, any new drug costs can be passed on to the patient.

Federal regulation might seem like be a good way to solve this problem. Most other developed countries set drug prices for their national health programs. However, Congress has historically forbidden the federal government to set drug prices for Medicare. Regulating the pharmaceutical industry seems unlikely.

What can a hospital consortium do? The hospital industry spends billions of dollars on drugs to treat patients in the hospital and in ambulatory practice. Most insurance plans pay hospitals a fixed price per hospital admission. If drug prices rise, either the insurance company must pay more or the hospital loses money. Lately the drug prices have jumped, especially for generics.

On the ambulatory side, the scenario is no different. Hospitals with outpatient practices are under increased pressure to reduce costs. Among the largest is prescribed drugs.

Another problem for hospitals is the shortage of many commonly used drugs whose patents have expired. Companies simply are not interested in keeping high inventories to meet the challenges of demand.

A nationwide hospital consortium could have tremendous market leverage since these facilities care for millions of patients. Currently, the consortium has enrolled 300 hospitals. That market power could be used to negotiate reasonable prices with the pharmaceutical industry. However, such a plan is complicated and might face legal and regulatory challenges.

The other option is for the consortium to create a nonprofit company that makes generic drugs and sets fair and reasonable prices. That is bold move that would create a true free market. Generic drugs account for almost 80% of all prescribed medications.

Rather than rely on for-profit manufacturers, hospital systems and their patients would have access to the same drugs at lower prices. In effect the providers would eliminate the middleman by controlling the supply of most drug products.

It is unclear how this proposal will evolve because it threatens the status quo. There is sure to be opposition—but not from patients. They will root for any plan that protects them from more out-of-pocket spending.

We need to reduce health care costs and, for once, here is an approach that offers an innovative and sensible solution for patients everywhere.

It’s an idea whose time has come.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Should I Get the Shingles Vaccine?

By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator

I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.

Fortunately, this condition can be prevented.

What Causes Shingles?

Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.

In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.

However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.

For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.

With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.

Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.

In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.

What Are My Options?

Currently there are two injectable vaccines that can prevent shingles.

Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.

Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.

Is the Shingles Vaccine Right for Me?

The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.

These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.

The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.

I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.

Consult your physician to see if and when the shingles immunization is right for you.

Why Prescription Drugs are Expensive and What We Can Do About It

By Mark A. Kelley, MD |11/28/17
Founder, HealthWeb Navigator

As the healthcare debate drags on in Congress, prescription drug costs continue to rise by almost 10% annually. It is the rare patient who is spared this expense.

Over the years, I have seen how these costs have affected my patients. At first, most patients had little in the way of co-pays. However, once the local economy deteriorated, co-pays skyrocketed as employers tried to curb their healthcare expenses. Now, monstrous co-pays are the norm for health insurance plans across the nation.

The solution to this problem appeared simple. Drugs with expired patents are usually much cheaper for patients. Insurance companies encouraged physicians to prescribe these “generics” and used this practice as a metric to measure quality.

That strategy has indeed worked. Generic drugs now account for 89% of all prescriptions but only 26% of all drug expenditures.

Unfortunately, this success has not prevented drug inflation. Countless new drugs have emerged over the last thirty years. Some have been “blockbusters” that substantially change medical practice, but the rest have had much less impact. All of these new drugs, blockbusters or not, are protected by patents and promoted by aggressive marketing. They command high prices and subsequently drive up the average cost of prescribed drugs.

Recently, several events have given me a deeper appreciation of the reality experienced by our patients.

The first “surprise” was witnessing a 400 percent increase in the cost of the albuterol inhaler, an asthma product that has been around for decades. Because the inhaler propellant was changed, the manufacturer sold this product as a newly patented “delivery system.” This patent loophole is a common tactic in the drug industry. In this case, the FDA predicted that the loophole would cost consumers $8 billion before the patent expired in 2017.

The second revelation was a variation of the same theme. One of my patients watched the market price of a skin medication double in just four years. The reason was that the company’s drug patent was about to expire. The final price tag for the drug was $300 — for a six-week supply. This is another common industry tactic.

But the most surprising outcome has been the emergence of “competitive” generic drugs. Most generics have a low price point. However, if a large generic manufacturer has little competition, it can act like a monopoly and raise prices on its own terms.

A well-publicized example was the dramatic rise in the price of the “Epipen.” This pre-loaded injector of epinephrine can be life saving during severe allergic attacks. In 2007, one injection cost $50. By 2016 the price was $300 — for the same drug and injector. This tactic, termed “price gouging,” is now illegal in the state of Maryland. Other states may soon follow.

These pricing maneuvers have made drug prescribing more complicated for both patients and their physicians. Generics may no longer be “safe bets” for low costs. New and more expensive drugs may not be any better than generics. And drugs may have different co-pays, depending on the insurance plan.

How is one to know? The answer is simple: the patient and the doctor need to communicate.

I learned that lesson with my own new prescription. My doctor explained carefully why she preferred this brand-name product. When I picked up the prescription, the price tag was $420 for a 75-day supply!

When I mentioned this cost to my physician, she was even more astounded than me. She quickly changed the prescription to a generic product that cost $29 for the same duration of treatment. She felt the advantage of the first medication was minor compared to its overwhelming cost, which was 14 times more expensive.

Pharmacists have told me that this “sticker shock” is becoming more common among patients picking up their meds. But that situation is preventable. Doctors should know the prices and efficacy of the drugs they commonly prescribe, and patients should ask for the drug prices up front. In my case, both my physician and I should have done that homework. Thankfully, all that was needed to solve the problem was a painless follow-up discussion.

Drug price information is easy to find online, since pharmacies compete fiercely for business. The market price for most drugs is available via a simple Google search of the specific drug name with the term “price.” Here on HealthWeb Navigator, you can find several websites that help patients locate and compare drug prices.

If the drug is expensive (e.g. three digits for a typical 30 day prescription), the out-of-pocket cost (co-pay or deductible) is likely to be significant. If the local pharmacist has the patient’s insurance information, s/he can quickly quote how much the patient must pay. If the out-of-pocket cost is high, a less expensive yet effective drug may be preferable. If the patient cannot afford the drug, there are organizations such as NeedyMeds that can help with discounts.

Healthcare economics may be complicated, but drug cost is where patients and their doctors can team up. Patients want to be healthy but don’t want to go broke in the process. Informed doctors are in the best position to advise patients of the trade-offs between cost and benefit. Working together, doctor and patient can make an informed choice.

There is a lot of room for improvement. In a recent poll, 60% of patients feel their doctor is unaware of how much they pay for drugs. Doctors need to be better informed about drug costs and help patients deal with this challenge. 

If you are looking for a perfect model of patient-centered care, this is it. After all, as my own story illustrates, when doctors become patients, we face the same reality as everyone else.

How to Effectively Manage Appointments with Your Doctor

By Mark A. Kelley, MD |7/12/17

Everyone in health care is busy these days. Most doctors have full schedules and patients often can’t afford to take time off from work.

Neither patients nor doctors are satisfied with this situation. However, once you and your doctor get together, there are ways you can make the visit more valuable.

Doctor appointments fall into two different categories:

• Urgent visits: For true emergencies, you should seek immediate medical attention. For a problem that is not an emergency but worries you,  the best approach is to contact your doctor’s office. Your doctor may be able to solve the problem by phone or work you quickly into the office schedule.

• Routine planned visits: These visits are usually for a new consultation or a follow-up for a known condition. You can get more from these scheduled visits if you do some preparation.

The New Consultation

You can take a few steps to ensure a new consultation goes as smoothly as possible.

Educate yourself beforehand: Understand the reason for the consultation from your referring doctor. Have you read up on your particular problem? Have you checked the credentials and experience of the new doctor? Is this new doctor affiliated with a hospital that you like? Does the doctor accept your insurance?

Bring your medical records, drug list, and results of any lab/radiology studies: This step can make a major difference in your first visit. Medical records provide a clear picture of your health history. The doctor can read faster than you can talk, and this written information frees up time for the doctor to have a better conversation with you. The information may also reduce the need for more tests, allowing the doctor to focus on a diagnosis and treatment plan.

Prepare a list of questions in advance: Make a list that you can share with the doctor. This conversation will help you to understand the medical issues involved, as well as help the doctor understand your concerns.

Ask a close relative or friend to accompany you on the visit: This has several advantages. Your relative may remember something about your medical history that you forgot to mention. They may also be helpful in remembering specific details that the doctor mentions. Additionally, it is always comforting to have a close companion with you to provide support.

Ask the doctor to summarize their findings and recommendations for you: Then, in your own words, repeat the summary back to the doctor. This will help you remember details and ensure that you and your doctor are on the same page regarding your problem and action plan. Don’t be shy about asking questions. Doctors want their patients to be well informed.

Understand the plan and goals before the next visit: These may include any new medications, tests, procedures, or therapies. For each one, consider asking the following questions: How does this test or therapy work? Why do I need it? How long will I need it? What are its benefits? What are its risks? For a new medication, what side effects should I look for? Will it interfere with my current medication? If I have a problem, who should I contact?

Ask for a printout: Request hardcopies of any diagnosis, medications (especially new ones), or tests before you leave the office. You can also ask the doctor to send you a written summary of the visit for your records. By law, you are entitled to this information, and physicians are usually glad to provide it.

Learn more about your condition: Although you may have read about the subject beforehand, your doctor may direct you to other helpful resources. The information may come in the form of written materials or online resources. HealthWeb Navigator can direct you to the most trustworthy, independently reviewed health websites online today.

The Follow-Up

Follow-up visits are scheduled so that the doctor and patient can monitor progress together. You should expect to discuss the following issues with your doctor:

• Are you feeling better or worse?

• Are there any problems to report? If so, let the doctor know early in the visit. They can evaluate whether this issue is serious and/or related to other conditions.

• Are you taking your medicines as prescribed?

• Have you had any new tests or other doctor visits recently? The doctor may not have the results but should be able to get them quickly.

• Do you have any questions about your condition?

• Do you understand the treatment plan? Before you leave the appointment, be sure you receive written summaries and instructions.

Based on my decades of practice, this preparation makes the office visit more productive for doctor and patient alike.

Final Tip

Sometimes routine follow-up visits become “too routine.” Physicians know that patients spend a lot of time and money on medications and doctor visits. If you are doing well and everything has been under control, you may want to pose the following questions to your doctor:

• Can I cut back on any of my medicines (or even stop them)?

• Can I reduce the number of routine follow-up visits?

• Can some of these follow-ups be done by phone or email?

Physicians are modernizing their practices to suit your needs. I suspect that most are more than willing to discuss these requests.

What Does Medical Science Say About Fish Oil Supplements?

By Nathan Blake |11/23/16

A recent survey of over 11,000 consumers revealed that fish oil is currently the second most popular nutritional supplement on the American market today, with annual spending exceeding $1.2 billion for over-the-counter fish oil pills and related supplements.

Fish oil has long been touted for its supposedly positive effects on a variety of bodily functions including lowering blood pressure, triglycerides, and cholesterol levels; preventing heart disease; inhibiting the formation of cancer cells; combatting depression and mood disorders; reversing the effects of macular degeneration; and countless others.

But what does medical science have to say about these claims? Is fish oil the cure-all it’s advertised to be, or would consumers be better off spending their money elsewhere?

Fish Oil’s (Not So) Secret Ingredient

Fish oil capsules contain concentrated amounts of omega-3 polyunsaturated fatty acids. Omega-3 fatty acids are necessary for human health, playing a crucial role in brain health and the regulation of inflammatory responses. There are three main types of omega-3 fatty acids, two of which can be found in fish oil capsules.

Eicosapentaenoic acid (EPA) is absorbed into the body by eating oily, coldwater fish like salmon, menhaden, sardines, mackerel, albacore tuna, halibut, and herring. EPA is also found in edible strains of seaweed as well as human breast milk.

Docosahexaenoic acid (DHA) is an important structural component of the human brain and is essential for its proper functioning. It also plays a primary role in maintaining the health of the eye, cerebral cortex, skin, sperm, and testicles. The human body can produce a small amount of DHA on its own, but like EPA, we get the majority of our DHA from cold-water ocean foods. DHA can also be found in organ meat, poultry, and egg yolks, though in small amounts.

Cardiovascular Health

The positive effects of fish oil on the human cardiovascular system have well been established, but that’s not to say no controversy exists. After evaluating the potential benefits of fish oil supplements for patients with multiple pre-existing cardiovascular disease factors, scientists concluded that DHA and EPA had neither a positive nor a negative effect on cardiovascular health. However, an early meta-analysis of fish oil studies revealed a possible correlation between fish oil supplementation and lower blood pressure. Further, scientific data indicates that fish oil consumption can reduce the risk of coronary heart disease, decrease mild hypertension, and prevent certain cardiac arrhythmias. Other studies show that fish oil capsules can be effective in the prevention of primary and secondary cardiovascular disease. In multiple clinical trials, fish oil supplements have been linked to the suppression of major coronary events. The most conclusive benefit of fish oil supplements seems to be that fish oil capsules are effective in lowering triglycerides in the blood. One study found that a prescription dose of EPA + DHA (2x the normal amount) lowered patients’ triglycerides by 27%.

Mood Disorders

Fish oil is not considered to be an effective replacement for mental health treatments, but when used in conjunction with other therapies, fish oil seems to provide beneficial effects to patients diagnosed with borderline personality disorder, unresponsive depression, and schizophrenia. EPA in particular has been studied for its possible use in regulating mood disorders, and researchers found that EPA-heavy omega-3 supplements appear to be effective against primary depression when used alongside prescription medications and other treatment. There is some evidence, however, that fish oil supplementation does not improve mood when tested against a placebo.

Alzheimer’s Disease

In a double-blind study spanning 26 weeks, researchers found that neither high nor low doses of fish oil had an observable effect on cognitive performance in patients age 65 and older. A much longer study, however, found that fish oil intake is associated with lower rates of Alzheimer’s disease. That being said, in a study of 174 Alzheimer’s patients, fish oil supplementation was not shown to reduce cognitive decline in patients with mild or moderate Alzheimer’s disease, though some positive effects were shown in a small group of patients with very mild Alzheimer’s. Other trials confirmed these finding that omega-3 supplementation is beneficial only for patients with mild cognitive impairment. While it’s still too early to make firm recommendations regarding the potential benefits of fish oil intake, daily DHA supplementation in excess of 180 mg is associated with a 50% decrease in dementia risk.

Eye Health

Regular consumption of EPA and DHA fatty acids significantly reduces the risk of developing age-related macular degeneration in women. Other findings suggest that increased omega-3 intake via fish oil capsules can prevent age-related macular degeneration in all subjects, sometimes by an estimated 22%. While the precise role of omega-3 fatty acids in eye health is unclear, there is some evidence that suggests DHA supplements can prevent cell damage and eye stroke injury in the retina.

Inflammation

A study of 250 patients with neck or back pain revealed that fish oil supplements are an equally effective but safer treatment for reducing arthritic pain compared to NSAIDs like ibuprofen and aspirin. Some studies suggest that EPA, independent from DHA, is a potential therapeutic treatment for arthritis-related inflammation in mice, and that EPA has a stronger anti-inflammatory effect than DHA. While another study’s findings suggest that fish oil supplements are not as effective in reducing chronic low-grade inflammation in obese men compared to weight reduction, multiple studies seem to suggest that omega-3 fatty acid supplements can decrease inflammation in patients, particularly those diagnosed with rheumatoid arthritis or ulcerative colitis.

Cancer

Some evidence points to the benefit of fish oil’s anti-inflammatory effects on reducing the overall number of cancer cells in the colon. Another investigation found that EPA + DHA are good candidates for primary and secondary breast cancer prevention due to their abilities to reduce inflammation. Strangely enough, one recent study has shown a correlation between elevated levels of omega-3 fatty acids and an increased risk for developing aggressive prostate cancer; men with the highest DHA levels were 2.5x more likely to develop high-risk prostate cancer, though similar studies proved inconclusive. Further, other studies revealed opposite findings, that fish oils are actually helpful in reducing the risk of prostate cancer in healthy individuals, as well as preventing colorectal and breast cancer formation.

The Last Word

Ultimately, the health benefits of fish oil supplements are still unclear. Studies surrounding omega-3 supplements, as we have seen, are conflicting at best, contradictory at worst. That being said, multiple organizations agree that the potential benefits of fish oil capsules outweigh the potential risks for generally healthy people, though more evidence is needed before making a definitive claim.

Continue taking fish oil capsules if they have been prescribed to you by a physician. If you are planning to begin a fish oil regimen, consult with your primary care physician beforehand to make sure you are healthy enough and that they will benefit you. General consumers should be aware that while many of the findings referenced above are interesting, it’s entirely possible you may not be receiving the benefits you’ve been paying for.

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