When It Feels Like You’re Losing the Weight Loss Game

woman on scale
You know the drill.

You go in for your regular diabetes check and the nurse stands you on the scale. You’ve been avoiding the scale for some time now, and you’ve gained a few pounds. Inside your endocrinologist’s office, you feel – or imagine – her annoyance that you still haven’t taken yourself in hand. As you leave with her familiar instruction to cut the carbs and the number of a nutritionist in hand, you try not to get down.

You know you should lose the weight. If not for the sake of your diabetes, for how you feel. Your fat pants are tight, and you get winded going up the stairs. And then there are the complications from diabetes that you’ve read about online; you certainly don’t want to go there.

So, for the hundredth (or two hundredth time) in your life, you vow to slim down. Sitting behind the wheel of your car in the parking lot, you formulate a plan. Maybe you’ll try Weight Watchers. Or Paleo – a guy at work had good luck with that, losing 25 pounds.

And no matter how many times you’ve made this vow, you swear today will be different. On the back of your parking stub, you figure out how many pounds you can lose by June – 10, 20, maybe the complete 30? You carefully do the math. After all, you’ve been dieting most of your life and you know a lot of numbers – calories, carbs, and fats.

So why can’t you drop the pounds?

Well, you can. You actually lost weight last summer, almost ten pounds, but then you got annoyed. Watching everyone at the Labor Day picnic downing fried chicken didn’t seem fair, so you gave up on picking around the skin and ate the whole leg – skin and everything. It was only one time, and it was a holiday, so it seemed like no big deal. But then there was a birthday in the office, and though you debated for a moment, you allowed yourself a little piece of cake. Later, in the afternoon, you saw all that was left and you let yourself have a second slice -–no sense letting good cake go to waste. And then…

So what’s the answer? Do you give up?

No. But maybe, this time, you do it differently. For the first time, you walk away from diet plans and you figure out not what you need to subtract from your life, but what you need to add. Things that are doable. And enjoyable. That fit in with your twin goals: a lighter you and improved diabetes care.

How about exercise? A walk in the morning and a walk at night? How about vegetables? You know some have more carbs than others, so what kinds? Maybe you try a food tracking app, where you log everything you eat. Sure, you could eat a bag of M&M’s during break, but could you try a bag of baby carrots? If that doesn’t work, could you settle for half the M&M’s rather than an entire bag? How does that impact your sugar? Could you eat half the M&M’s two days a week and the carrots the rest of the time?

The problem with diets is that they often deprive, making you fixate on what you can’t have, which often makes you want that thing more. And when you begin to step outside the rigid rules of the diet, it can be hard to get back on track.

But what if you break down the imposed boundaries of the most popular diets and re-learn what to eat on your own? What if you thought of eating and exercise not as punishment, but a way to understand what you truly need and like and – to paraphrase Marie Kondo – what brings you joy?


Measuring BP the right way: the AHA issues a scientific statement


  • The American Heart Association (AHA) has issued a scientific statement on the measurement of BP, with a wide range of information on everything from technique, timing, and devices to best approaches in specific patient populations.

Why this matters

  • The statement is a timely update of a 2005 scientific statement and follows on the 2017 guidelines from the AHA and partner organizations.
  • The authors take a close look at oscillometric devices.

Key highlights

  • The statement takes a close look at appropriate cuff size, correct body position, and competence of the person doing the measurement.
  • It offers a table that breaks proper measurement technique into 6 steps:
    • Patient preparation: 3-5 minutes seated without talking, feet flat on floor, back supported; exam table is not appropriate.
    • Proper technique: validated device, correct cuff size and position.
    • Proper measurement: first record in both arms, use the arm with higher reading for future; separate repeats by 1-2 minutes.
    • Proper documentation: record systolic/diastolic values to nearest even number.
    • Average: average ≥2 readings on ≥2 occasions for proper BP estimation.
    • Tell the patient their readings.
  • Algorithms for distinguishing white-coat vs masked hypertension also provided.
  • Addresses specific populations, such as pediatrics, pregnancy, and technology (e.g., smartphone measurement).

5 Tips for Reducing Scanxiety

Irritability, sweaty palms, increased heart rate, and nausea are common symptoms many patients experience when preparing for an upcoming exam. This feeling of apprehension and discomfort is called scanxiety, which aptly refers to the anxiety or worry patients often feel before undergoing a scan or receiving the results of an examination.

“Anxiety often comes when people have to face things they can’t control,” says Karen Fasciano, PsyD, senior psychologist at Dana-Farber Cancer Institute and director of the Young Adult Program. “For someone who has—or has had—cancer, a common fear is that their body will betray them, or that cancer will eventually overcome them.”

The reason this fear is so common among patients, and even caregivers, is that many have already dealt with negative results from scans, Fasciano adds. This memory can fuel feelings of uncertainty and intensify fear and anxiety already present: that the next exam will bring about another upsetting or painful result.

For patients and caregivers experiencing scanxiety, Fasciano advises people to try different coping approaches until they find one that works for them, noting there isn’t a universal “right way” to deal with it.

1. Stay in the present

An upcoming exam can often lead patients to envision scenarios of what could happen, or what their results might indicate. They may fear they’ve run out of treatment options, or perhaps think back to difficult or painful times, dreading the idea of repeating them.

By trying to predict the future, Fasciano says patients can become fixated on all of the negative possibilities, so she advocates for patients to try to live in the present. Instead of getting attached to the idea of what could happen, take note of the world around you and be fully engaged in the activity you’re participating in—whether it be a conversation with a loved one or a walk around your neighborhood.

2. Know yourself

Everyone has a different response to stress, and nobody knows your body quite like you. You might be irritable or experience insomnia before an exam, or you may withdraw from family and friends. Rather than trying to fight your body and mind’s reaction, Fasciano encourages patients to acknowledge and accept it.

It’s important to take note of your response to anxiety. By recognizing trends, triggers, or an early onset of symptoms you can address your scanxiety early on, giving yourself enough time to try an effective coping mechanism.

3. Engage in distractions

Preventing scanxiety depends upon successfully decreasing your autonomic nervous system’s stress response, which, when fully engaged, may include bodily reactions like heavy breathing or an increased heart rate. One way to decrease this response is to distract yourself with a repetitive activity that requires your full focus.

Whether it’s meditating, playing video games, or simply knitting, the goal is to take your focus off of your upcoming exam. For those looking to try meditation, Fasciano suggests using an app like Headspace. That way you’re not required to try and generate peace of mind on your own, which can be hard if your already feeling stressed or anxious.

Meditation can be a helpful practice for patients.

4. Find your mantra

Like meditation, adopting a positive mindset can help alleviate the worries of scanxiety. Fasciano recommends compiling a list of quotes from people in your support system to increase feelings of support. Having words of encouragement from those who care about you can help not only put things into perspective, but also provide comfort during a difficult time.

Recently, Fasciano says she’s seen a rise in homemade inspirational videos. Patients create short videos in a variety of ways and formats from the quotes they’ve collected and watch them right before their exam.

5. Know that it’s OK to worry

While it might seem counterproductive, setting aside a limited amount of time to worry can be helpful. Fasciano explains that doing so allows patients and caregivers to validate their concerns and express them in a healthy way, whether that’s writing down notes in a journal or talking with someone they trust.

During this set time, she encourages patients to not only think about the potential outcomes—including the positive ones—but also create an action plan detailing how they will address each scenario.

It’s important to limit these scheduled sessions to just 10 to 15 minutes. Even the act of setting this time limit can help control scanxiety by allowing you to dictate how much time it will take up during your day.

Why Do We Crave Sweets When We’re Stressed?

A brain researcher explains our desire for chocolate and other carbs during tough tim

Why Do We Crave Sweets When We're Stressed?

Although our brain accounts for just 2 percent of our body weight, the organ consumes half of our daily carbohydrate requirements—and glucose is its most important fuel. Under acute stress the brain requires some 12 percent more energy, leading many to reach for sugary snacks.

Carbohydrates provide the body with the quickest source of energy. In fact, in cognitive tests subjects who were stressed performed poorly prior to eating. Their performance, however, went back to normal after consuming food.

When we are hungry, a whole network of brain regions activates. At the center are the ventromedial hypothalamus (VMH) and the lateral hypothalamus. These two regions in the upper brain stem are involved in regulating metabolism, feeding behavior and digestive functions. There is, however, an upstream gatekeeper, the nucleus arcuatus (ARH) in the hypothalamus. If it registers that the brain itself lacks glucose, this gatekeeper blocks information from the rest of the body. That’s why we resort to carbohydrates as soon as the brain indicates a need for energy, even if the rest of the body is well supplied.

To further understand the relationship between the brain and carbohydrates, we examined 40 subjects over two sessions. In one, we asked study participants to give a 10-minute speech in front of strangers. In the other session they were not required to give a speech. At the end of each session, we measured the concentrations of stress hormones cortisol and adrenaline in participants’ blood. We also provided them with a food buffet for an hour. When the participants gave a speech before the buffet, they were more stressed, and on average consumed an additional 34 grams of carbohydrates, than when they did not give a speech.

So what about that chocolate, then? If a person craves chocolate in the afternoon, I advise him or her to eat chocolate to stay fit and keep his or her spirits up. That’s because at work people are often stressed and the brain has an increased need for energy. If one doesn’t eat anything, it’s possible the brain will use glucose from the body, intended for fat and muscle cell use, and in turn secrete more stress hormones. Not only does this make one miserable, it can also increase the risk of heart attacks, stroke or depression in the long run. Alternatively, the brain can save on other functions, but that reduces concentration and performance.

In order to meet the increased needs of the brain, one can either eat more of everything, as the stressed subjects did in our experiment, or make it easy for the body and just consume sweet foods. Even babies have a pronounced preference for sweets. Because their brain is extremely large compared with their tiny bodies, babies require a lot of energy. They get that energy via breast milk, which contains a lot of sugar. Over time, our preference for sweets decreases but never completely disappears, even as we become adults. The extent to which that preference is preserved varies from person to person and seems to depend, among other things, on living conditions. Studies suggest people who experience a lot of stress in childhood have a stronger preference for sweets later in life.

For some, the brain cannot get its energy from the body’s reserves, even if there are enough fat deposits. The most important cause of this is chronic stress. To ensure their brains are not undersupplied, these people must always eat enough. Often the only way out of such eating habits is to leave a permanently stressful environment. So although many tend to be hard on themselves for eating too many sweets or carbs, the reasons behind such craving aren’t always due to a lack of self-control and might require a deeper look into lifestyle and stressful situations—past and present. Once the root cause of stress addressed, eating habits could ultimately resolve themselves.

Brainy Birds

Scientist Irene Pepperberg with African grey parrot, Griffin.

Irene Pepperberg, a research associate in Harvard’s Psychology Department, with African grey parrot Griffin.

Usually, calling someone a bird-brain is meant as an insult, but an African grey parrot named Griffin is rewriting the rules when it comes to avian intelligence.

A new study shows the African grey can perform some cognitive tasks at levels beyond that of 5-year-old humans. The results not only suggest that humans aren’t the only species capable of making complex inferences, but also point to flaws in a widely used test of animal intelligence. The study is described in a November paper published online in Behaviour.  

The paper arose from a collaboration among cognitive psychologists Irene Pepperberg, a research associate in Harvard’s Psychology Department; Francesca Cornero ’19; Suzanne Gray A.L.B. ’15, now the manager of the Alex Foundation at the Pepperberg Lab; and developmental psychologists Susan Carey, the Henry A. Morss Jr. and Elisabeth W. Morss Professor of Psychology, and Shilpa Mody, Ph.D. ’16.

The classic study uses a two-cup test. A reward is hidden in one of two cups; subjects are then shown that one cup is empty, and those that successfully choose the other cup are thought to employ a process known as “inference by exclusion” — reasoning that the reward is in cup A or B; if it is not in A, it must be in B.

For years, researchers have argued that young children, including infants as young as 17 months, and animals from a wide number of species, including grey parrots, understand this process.

“This is really about logic,” Pepperberg said. “In the wild, nonhumans must make these kinds of choices when they decide on things like, ‘Where should I forage? I saw other creatures eating food in this area. … If there’s nothing right here, I should deduce that something is nearby.’”

But what’s important about this study is not just that Griffin is, in some ways, as smart as a 5-year-old, but, said Pepperberg, “We also argue that this two-cup task, which has been the gold standard, only tells you about a certain level of ability. If you really want to study inference by exclusion, you have to go to the more complicated three- and four-cup tasks.”

Based on Carey and Mody’s notion that the two-cup task wasn’t an effective test of human cognition — that subjects could be choosing that B cup simply by default, not because they think the reward must be there — Pepperberg, Gray, and Cornero decided to put Griffin’s apparent smarts to the test.

Designed to add a wrinkle to the two-cup task, the more complex tests work like this: For the three-cup test, one reward is hidden in a single cup, and another is placed in one of two additional cups to one side of the first cup. When faced with a choice, participants should pick the single cup, as it is the only cup guaranteed to have a reward. This task doesn’t test inference by exclusion, but does test understanding of certainty versus mere possibility — a precursor to exclusion.

Tests have shown that, until they reach about 2 and a half years old, young children fail at similar tasks. The same goes for apes. But Griffin outperformed even 5-year-olds.

The four-cup test works similarly: Rewards are placed in one cup of each pair, then one cup in a pair is shown to be empty. Successful subjects will then pick the other cup in that pair, understanding that it must hold the reward, and that they have only a 50-50 chance of finding the reward in the other pair. Two-and-a-half-year-old children again fail, showing that they do not fully understand inference by exclusion.

Researchers in Harvard’s Psychology Department conduct a four-cup test on an African grey parrot.

Though Griffin passed both tests with flying colors, Pepperberg, Cornero, and Gray wanted to be sure he hadn’t simply learned to choose whichever cup was next to the empty one, so they designed a series of additional trials to test this possibility.

“Basically, we forced him to gamble,” Pepperberg said. “For a small percentage of trials, we would put nothing on one side and show him an empty cup on that side … so he if wanted a reward, and understood the system, he’d know that now he couldn’t go to the cup next to the empty one; instead he’d have to gamble on the 50-50 side. And he hated it, but he did it on all the trials in the subset.”

The trio even developed a test in which he had the choice between the guaranteed small reward of a nut or, in a small percentage of trials, gambling and potentially receiving one of his favorite treats — a Skittle.

“We wanted to make sure he wasn’t just avoiding the empty side completely … and, again, that he didn’t always pick the cup next to the one that was empty,” Pepperberg said. “If he wanted that very special candy, he’d have to go to the 50-50 side. A good-enough percentage of the time, he gambled. But what was interesting was that if he lost, he wouldn’t gamble on the next trial.”

Ultimately, Pepperberg said, tests like these don’t only reveal the intelligence of birds like Griffin, but also help shed light on the roots of human intelligence.

“Birds are separated from us by 300 million years of evolution, and their brains are organized differently than ours,” Pepperberg said. “That’s why this was so exciting — because we were able to show that Griffin was working at the level of a 5-year-old, on a task at which even apes would not likely succeed.”

10 Ways to Feel Better Now

You wake up with a sore throat. Then come the coughing, sneezing, and sniffling. There’s no denying it — you’re sick. Sadly, there’s no quick cure for the common cold or the flu. But you can find relief faster with these smart moves.

Take it easy. When you’re sick, your body works hard to fight off that infection. It needs more energy than usual. Make rest your top priority. Stay home from work or school, and put your daily routine on hold until you feel better.

Go to bed. Curling up on the couch helps, but don’t stay up late watching TV. Skimping on sleep makes your immune system weak, making it harder to fight germs. Head to bed early, and take naps during the day. Are your symptoms keeping you up at night? Try using an extra pillow to raise your head. It can ease sinus pressure and help you breathe easier.

Drink up. Getting plenty of fluids thins your mucus and breaks up congestion. It also prevents the headaches and fatigue that dehydration causes. Keep a glass or reusable bottle on hand, and refill it with water. Skip caffeinated sodas, coffee, and alcohol, which can dry you out.

Gargle with salt water. It’s a good way to soothe a throbbing throat. The salt water eases swelling and loosens mucus. Stir one-quarter to one-half teaspoon of salt into a cup of warm water until it’s dissolved, and gargle a few times a day.

Sip a hot beverage. It’s comforting to curl up with a mug of tea. Plus, research shows that the heat can also ease cold symptoms such as sore throat and fatigue. Try sipping non-caffeinated herbal tea, lemon water, or warm broth.

Have a spoonful of honey. This sticky stuff can coat your throat and soothe a cough. In one study, kids who ate about half a tablespoon of honey at bedtime slept more soundly and coughed less than those who got a placebo medicine. Stir it into a cup of decaf tea or lemon water. One warning: Don’t give honey to babies younger than 1 year old.

Take a hot shower. Breathing in steam may moisten a scratchy throat and nose, as well as loosen your congestion. Although the research is mixed on whether this remedy works, there’s no harm in trying it. The heat can also help relax any aching muscles.

Take an over-the-counter remedy. You may find relief with one of these medications. Take them as directed, and don’t give them to children under age 6 without your pediatrician’s OK.

  • Pain reliever for fever and aches. Doctors usually recommend acetaminophen. If you’re taking another cold medicine, though, check that it doesn’t already have the drug. It’s a common ingredient in many OTC remedies, but getting too much can be dangerous. So check the label and ask the pharmacist how much is safe to take at one time.
  • Lozenges for a sore throat. They have herbs and other ingredients that can soothe the stinging.
  • Decongestant for stuffiness. This medicine shrinks blood vessels in your nose so your airways can open up. But the liquid or pill form may make you feel jittery. Using decongestant sprays and drops too much can cause more congestion, so don’t use them for more than 3 days.
  • Expectorant to thin mucus. It can help loosen some of that thick discharge.
  • Antihistamine to dry up a runny nose. This drug blocks the chemical in your body that causes sneezes and sniffling.

Taking a decongestant and an antihistamine together may be more helpful than taking either one alone.

Use a saline spray or flush. Over-the-counter saltwater sprays make your nostrils moist, which makes it easier to blow your nose. You may also want to try nasal irrigation. That’s when you gently pour a saline solution into one nostril and let it flow out of the other. It washes away dried mucus so you can breathe easier. You can buy sinus rinses or use a bulb syringe or neti pot. If you do it yourself, always make the saltwater solution with distilled or cooled, boiled water.

Eat chicken soup. Mom was right: This sick-day staple really can make you feel better.  Research shows that chicken soup can calm inflammation in your body. This may ease some of your symptoms, such as aches and stuffiness. What’s more, this meal also has liquid and calories to give your body energy.

New Parents May Face Up to Six Years of Disrupted Sleep

It’s no secret that parents of new babies don’t get much sleep: infants have a wonky internal clock and frequent feeding needs, meaning that their moms and dads have to be available at all hours of the day and night. But as George Dvorsky reports for Gizmodo, an expansive new study has found that sleep deprivation may continue long after little ones come home from the hospital, with parents reporting less sleep and poorer sleep quality up to six years after the birth of their first child.


Published in the journal Sleep, the study drew on data collected between 2008 and 2015 by the German Socio-Economic Panel, an ongoing study of private households in the country. The participants—2,541 women and 2,118 men—reported the births of a first, second or third child during the study period. To track sleep patterns over time, parents were asked during annual interviews to rate their sleep satisfaction on a scale between 0 and 10. They were also asked how many hours they sleep during an average working week day and an average weekend day.

Perhaps unsurprisingly, the researchers found that sleep satisfaction and duration among women decreased sharply after childbirth. New moms’ rating of their sleep quality dropped by 1.53 points on the assessment scale. They also reported getting 41 minutes less sleep after the birth of their first child, and 39 and 44 minutes less sleep after the births of their second and third children, respectively. Dads were also sleeping less, though the drop wasn’t as marked as it was among moms; they reported decreases in sleep duration of 14, 9 and 12 minutes after the births of their first, second and third children. Breastfeeding was linked with slight decreases in sleep satisfaction and duration among mothers.

When researchers took a closer look at the data, they found that sleep deprivation reached its peak in the three months after a baby was born. Between the third trimester of pregnancy and the first three months postpartum, sleep duration was 87 minutes shorter in women and 27 minutes shorter in men.

“It is possible that children’s increased fussing and crying during the first 3 months after birth, along with their dependence on frequent nocturnal feedings and other caretaking, are important reasons for parental sleep disturbance after childbirth,” the study authors note. “Apart from infant crying and frequent nursing, other potential proximate causes of poor postpartum sleep may involve physical pain following delivery and distress related to the demands of a new role.”

Parents tended to get more sleep after the three month mark, but between four and six years after the birth of their first child, moms and dads still hadn’t bounced back to pre-pregnancy levels of sleep satisfaction and duration. Again, the discrepancy was more pronounced among women, who rated their sleep quality 0.95 scale points lower than they did before their baby arrived, and reported getting 22 minutes less sleep, on average. Four to six years postpartum, dads’ sleep satisfaction was down by 0.64 scale points and their sleep duration was reduced by 14 minutes.

“We didn’t expect to find that,” Sakari Lemola, study co-author and associate professor of psychology at the University of Warwick, tells Nicola Davis of the Guardian. But he notes that there are “certainly many changes in [parents’] responsibilities” that might affect how well they are sleeping. Even kids who sleep through the night get sick and have nightmares, which inevitably means that their parents will get less shut-eye. Parenthood may also come with new worries that inhibit sleep, Lemola adds.

Interestingly, the researchers found that factors like parental age, household income and single versus joint parenting had little influence on how well mothers and fathers were sleeping. But the fact that women are more affected by postpartum sleep deprivation than men is revelatory. “This may be associated with the observation that mothers, including working women, still have more household and child rearing responsibilities and spend more time on these tasks compared with fathers in most industrialized countries including Germany,” the study authors write.

Understanding the nuances of sleep patterns among parents is important because sleep is a vital contributor to overall health. This is especially true of new mothers, since sleep problems have been linked to higher postpartum depression symptoms. The researchers say that the results of their study highlight the importance of giving new parents advice and support on managing sleep. There are things that can be done to mitigate the effects of sleep loss, like ensuring that the parent who will be handling most of the nighttime care gets a chance to rest in the evening.

“Try not to worry about non-essential jobs around the house,” Cathy Finlay, an prenatal teacher with the U.K.’s National Childbirth Trust, adds in an interview with Davis, “and accept help from family and friends when it’s offered.”

How to Take Care of Your Eyes as You Age

An illustration of a man with a telescope in a pupil of an eye.

It’s natural to worry about losing your vision.

After all, three of the leading causes of blindness in the U.S.­—cataracts, glaucoma, and age-related macular degeneration—all become more common as we age.

But some drug, supplement, and lens makers, and even some doctors, take advantage of that fear, recommending treatments that are expensive, unnecessary, and even risky.

Here’s what you need to know.


The only way to cure cataracts­—a clouding of the lens of the eye that impairs vision­—is with surgery to replace the bad lens with an artificial one.

Though the procedure is very safe and effective, some doctors recommend needless tests or push newer types of lenses that pose risks.

Skip unneeded presurgery tests. Cataract surgery, usually performed as an outpatient procedure, requires only a local anesthetic to numb your eye.

Research shows that for most people the only pre-op requirements are that you be free of infection and have normal blood pressure and heart rate. Yet many doctors routinely order other tests, including blood counts and electrocardiograms, as would be necessary before a major procedure. That’s overkill, according to the American Academy of Ophthalmology.

Those tests can come with high co-pays and lead to false alarms that may delay surgery or force you to undergo additional tests, such as a chest X-ray or an ultrasound. So ask whether your doctor plans to recommend such tests and, if so, whether you can skip them.

Be wary of premium lenses. In standard cataract surgery, doctors remove the clouded lens and replace it with an artificial monofocal lens, which provides clear images at either near or far vision. There are multifocal lenses that do both, so you don’t also have to wear glasses.

But multifocal lenses cost up to $4,000—and usually aren’t covered by insurance. More worrisome, a 2012 review found that while the lenses provided better near vision, they also produced more complaints of halos and glare. Other research shows that people with multifocal lenses are also more likely to need repeat surgery.

One time you might consider a premium intraocular lens: if you have an astigmatism, or an irregularly shaped cornea.

Special lenses, called toric lenses, can correct that problem, says David Sholiton, M.D., an ophthalmologist at the Cleveland Clinic. And studies reveal that most people who get them are satisfied. But you will probably have to pay $1,000 or more out of your own pocket because insurance rarely covers them.


More than 2.2 million Americans have glaucoma, but only half know it. That makes screening important.

Treatment is key, too, because glaucoma can lead to permanent vision loss. But treatment, which often requires several different daily eye drops, can be expensive and complicated.

Get the right tests. Glaucoma often goes undiagnosed because it causes no symptoms until vision declines, at which point treatment no longer helps. So people ages 40 to 60 should consider being examined by an ophthalmologist or optometrist every three to five years; those older than 60 need an eye exam every one to two years.

Know you may need more than one test. Though many eye doctors screen for the disease with tonometry—a test that measures eye pressure—that’s not enough. Relying only on intraocular pressure when screening for glaucoma could miss up to half of all cases, research suggests, says ophthalmologist Andrew Iwach, M.D., executive director of the Glaucoma Center of San Francisco.

So the exam should also include an ophthalmoscopy, which involves examining your optic nerve. If you have elevated eye pressure but no other signs of glaucoma, you might not need to start treatment, which can be expensive. Instead, your doctor might screen you more often.

Go for generics. The most common treatment for glaucoma is eye drops known as prostaglandin analogs (PGAs), which lower eye pressure. Generic versions of most of those drugs are much cheaper than the brand-name versions. And per­haps because of the lower cost, patients taking them tend to do a better job of using the drops on schedule, which is important, according to an April 2015 study in the journal Ophthalmology.

Know you may need more than one drug. Many people need several drugs to control glaucoma, which usually means adding a beta-blocker drop. In that case, ask your doctor about drugs that combine medications, minimizing the number of drops.

Use proper eye drop technique. Tilt your head back and pull down the lower lid with your finger to form a pocket. Hold the dropper tip close to the eye without touching it, and squeeze one drop into the pocket. Close your eye for 2 to 3 minutes, tip your head down, and gently press on the inner corner of the eye. Try not to blink. If you need more than one drop in the same eye, wait at least 5 minutes between drops to let the first drop absorb.

Macular Degeneration

Age-related macular degeneration, a leading cause of vision loss in the U.S. for people 50 and older, damages the macula, the small area near the center of your retina, causing vision loss in the center of your visual field.

The advanced disease comes in two main forms: dry AMD, the more common variety, which is treated mainly with dietary supplements; and wet AMD, the more serious form, which requires monthly injections from an ophthalmologist with one of three drugs. There are controversies about both the supplements and the drugs.

Get the right supplement. Research funded by the National Institutes of Health has shown that a specific blend of vitamins and minerals known as AREDS (vitamins C and E, plus copper, lutein, zeaxanthin, and zinc) cuts the risk—by about 25 percent—that dry AMD will progress.

“It’s really the only treatment,” says Neil Bress­ler, M.D., chief of the retina division at Johns Hopkins University in Baltimore.

But not all eye supplements contain the proper formulation.

In January 2015, CVS was sued for incorrectly market­ing its Advanced Eye Health supplement as comparable to the formula used in published studies. And in an analysis of 11 eye-health supplements in the March 2015 issue of Ophthalmology, only four contained the right mix: PreserVision Eye Vitamin AREDS Formula, PreserVision Eye Vitamin Lutein Formula, PreserVision AREDS2 Formula, and ICAPS AREDS.

Be wary if your doctor suggests a genetic test to determine which supplement is best for you. Remember: The supplements have been shown to help treat only people diagnosed with AMD. Don’t bother taking any supplement with the hope that it will prevent the disease.

Consider inexpensive drugs. Each of the three drugs used to treat wet AMD—aflibercept (Eylea), bevacizumab (Avastin), and ranibizumab (Lucentis)—work equally well in slowing vision loss.

But Avastin costs just $50 per month, compared with $2,000 for the others. So experts recommend Avastin as the first choice for most people with wet AMD. But some doctors resist that advice.

First, Avastin is officially approved only as a cancer drug and doesn’t come in appropriate doses for AMD. So doctors need to get the medicine from a compounding pharmacy, which combines, alters, or—in this case—repackages ingredients. That poses some risk of contamination, and there have been reports of people being harmed by bacteria that got into Avastin. So some doctors, especially those without access to a reliable compounding pharmacy, may hesitate to prescribe the drug.

Some other physicians may have a financial reason for skipping Avastin: Medicare reimburses doctors less for it. That might help your doctor’s wallet, but it can hurt yours: People without supplemental Medicare may pay up to $400 out of pocket for Lucentis, compared with just $10 for Avastin.

Our advice: Consider Avastin, especially if you don’t have supplemental Medicare coverage. But ask whether your doctor’s compounding pharmacy is accredited by the Pharmacy Compounding Accreditation Board, which means it must adhere to quality standards.

Insights on Residency Training

My Primary Care Manifesto

Scott Hippe, MD

“She is meant for more than just primary care,” mused an attending on my internal medicine rotation in medical school. He was referring to a particularly adept resident with whom we were working. This resident was planning on practicing clinic-based general internal medicine. I wasn’t sure why this attending disclosed his thoughts regarding this resident to me, but the implication was clear: “primary care” — whatever is meant by the term — is an easy career path, meant for the mediocre clinician.

The comment left me scratching my head, because the general internist who said it worked in the outpatient setting almost exclusively. Something about the outpatient care he provided was apparently different than “primary care.”

A year later, I matched in a family medicine residency. I chose the field not because I had low test scores (I didn’t), but because I couldn’t find a single area of medicine that wasn’t interesting to me. I didn’t want to give anything up. I was attracted by the never-ending challenges afforded a generalist who is willing to push the boundaries of his or her knowledge. Asking “how much can I do [before reaching my limits] in the care of my patient?” is more compelling to me than saying “I know nothing about this particular organ system; this patient needs to go see another specialist.”

Medical education fails trainees interested in primary care

I did my medical training in the Northwest U.S., where the attitude towards primary care is generally favorable. My medical school actively encouraged students to consider primary care fields. But it isn’t that way everywhere. Trainees are frequently told explicitly or implicitly that primary care specialties are second-rate. Family medicine is seen as a convenient fall-back option for students who didn’t ace Step 1. General internal medicine and general pediatrics are the fields for residents who don’t match in their perfect fellowship.

A handful of medical schools even lack a department of family medicine. You might recognize just a few of them on the list mentioned in this article.

Rewriting a paradigm

The attending I mentioned in this post envisioned primary care as stuffy noses and pap smears. The way I see primary care is different. For the docs out there who look down on primary care fields and medical trainees who have received inadequate exposure to generalist medicine, I want to share this paradigm with you.

Primary care is the entirety of care that I provide for my patients as their first provider. This is far more than those stuffy noses and paps. My specialty’s broad scope of training incorporates services such as comprehensive obstetrics including cesarean section, reproductive health, addiction medicine, inpatient medicine, emergency medicine, screening colonoscopy, treadmill stress testing, treating hepatitis C, and end-of-life care. My domain encompasses the clinic, hospital, emergency room, delivery room, and nursing home. And I still visit patients in their homes.

To the undifferentiated medical trainee: staying general in medicine begets a land of huge opportunity and variety.

Generalists, and more of them, please

Image result for primary care physician graph

We’ve all heard about how the US has the highest health costs of any country in the world.

It takes a specially trained eye to focus on the big picture, to treat the whole person, and to be effective in varied care settings. There are 36 countries in the world that deliver better and cheaper healthcare than the U.S. What do they have in common? A strong base of generalists. I am grateful for the well-trained specialists who help me at the limits of my abilities. But the U.S. cannot specialize its way out of its poor-performing and exceedingly expensive health system.

Our hyper-specialized, fee-for-service health system deters many physicians from becoming generalists. Every medical trainee doesn’t need to choose a primary care specialty. But we need more than are

Although a bit out of date, this figure highlights the dearth of GPs in the US.

choosing primary specialties now. I advocate against the notion that generalist medicine is inferior to specialist medicine (partialist medicine? for some humor). Primary care is more stimulating and requires more clinical acumen than many realize. Until our medical community changes the way it thinks about generalists, I don’t see our health system improving — whatever political or policy “fixes” might be on the way.


Top trends that will define digital health in 2019

Government health workers in Zambia uses data visualization software to track malaria transmission in real time so that his team can treat, prevent, and eliminate cases before they spread further. Photo: PATH/Gabe Bienczycki.  

Zambian government health workers use real-time data updates from their region, and data visualization software, to track malaria cases and accelerate treatment and prevention.


PATH’s digital health team shares five trends that are likely to improve accessibility, affordability, and quality of health care for millions of people around the world.

Over the past decade, digital health has embedded itself in our daily lives. Wearables and smart devices keep track of everything from calories burned to heart rate to sleep cycles to stairs climbed, providing users a dashboard of data and insights about their health and well-being. Expert medical advice is no longer confined to a doctor’s office, as video consultations and messaging services connect people to medical professionals from the comfort of their own home.

But perhaps nowhere do developments in digital tools and services hold more promise to improve an individual’s health outcomes than in low-resource settings across Africa, South Asia, and elsewhere.

Here are five promising trends that PATH is optimistic will improve accessibility, affordability, and quality of treatment for millions of people around the world:

14750.jpeg A health care worker in Rwanda fills out paperwork. Photo: PATH/Doune Porter.

A healthcare worker in Rwanda works at the intersection of digital and paper records. PATH/Doune Porter.

  1. Health data privacy and security for all

People everywhere are calling for increased security to protect their personal data and for a greater understanding of the rights they have over this information. Because health information systems gather the most sensitive information about us, ensuring the privacy and security of these systems is vital. At the same time, researchers at universities and in the private sector rely on health data to inspire medical breakthroughs. As global health care systems undergo digital transformation, it is essential to get the balance between security and accessibility right.

In response, the global community is painting a more nuanced understanding of how anonymity, de-identification, and big data work together, and how consumers can benefit from digital health without feeling at risk. Inspired by the European Union’s General Data Protection Regulation, governments such as Kenya are writing new laws and guidelines to clarify the rights of individuals over their digital data. And organizations, including Understanding Patient Data, are exploring how to make sure patients are fully informed about their digital rights, giving them greater power over their health data. This year, the global conversation about privacy and security will be codified into new guidelines for governments, technology developers, and health workers.

2. AI is a powerful tool for the next-gen health worker

Artificial Intelligence (AI) and machine learning open up powerful avenues for digitally enabled health care. For example, computerized learning systems can free up frontline health workers’ time by automating tasks like supply management. By tracking which medicines and supplies are available and where they are running low, these systems will streamline inventory management with computer precision, enabling health workers to spend more time directly with patients.

In addition, machine learning tools can assist in the detection of and response to potential disease outbreaks, allowing global systems to respond quickly to prevent epidemics. Applying machine learning could help reduce errors in contact tracing—a method used to find and monitor individuals potentially exposed to serious infectious diseases like malaria or Ebola. AI can also use health care data collected through routine visits to assess treatment options, helping health workers treat common health problems within their communities. We believe that 2019 will be a year when AI is unleashed on large data sets and machine learning is applied to diseases that disproportionately affect communities in low-resource environments.

3. Can we harness social media as a social good?

Billions of people connect through Facebook, WhatsApp, Weibo, and other social media platforms. But the impact of social media is both good and bad.

While these platforms grant unprecedented access to health information, it’s not always accurate, and in some cases it’s misleading. Researchers are also studying the role of social media consumption in exacerbating mental health issues like anxiety and depression.

But social media has proven it can advance health equity. For example, a new mother living in rural Kenya can message a Facebook chatbot to receive information on infant care, saving her half a day’s travel to the nearest health outpost. Adolescents can avoid social stigma by anonymously chatting online with providers about sexual and reproductive health information. Rural health workers can ask their colleagues for advice through WhatsApp, making it easier to manage difficult cases even when they’re hundreds of kilometers apart. And pilot programs, like the World Health Organization’s partnership with Google Fit, are exploring how personalized social media can be used to influence or “nudge” people toward healthy behaviors and choices.

Individuals need more resources to navigate information they’re relying on to make health choices. Governments, social media platforms, and civil society are all looking for new ways to promote good sources of information and rebuild trust in social networks. In 2019, the conversation about how we can make social media a social good will continue with a greater focus on truth and trust.

4. Digital systems and products will talk to each other

The next era of digital health won’t be defined by cutting-edge technologies—instead it will be defined by the seemingly simple connections that enable digital health tools to work together. This includes interoperable software that allows individual programs and tools to “talk” to each other and share information. Guided by global standards, developers and data scientists are ensuring that interoperable systems can equip health workers and global experts with a complete picture of health services and opportunities for improvement in individual communities and entire countries alike.

We believe 2019 will be a year of great consolidation in digital health. Digital systems that used to function independently, or as standalone products, are being integrated into a network of tools. Communities of practice like OpenHIE are bringing together software developers and health care practitioners to define how systems can exchange health information. Private-sector companies are being encouraged to adopt the same global standards used by open source software so that health information systems around the world can speak the same language. Active government participation in groups like the Health Data Collaborative is ensuring that new tools work together and meet country needs from day one. The connections between systems will bring greater connections between people, growing a strong, vibrant global digital health community.

5. The digital health revolution will truly go global

The right conditions and environment are crucial to harnessing the latest and greatest health innovation. Work on the broader country “enabling environment” is underway to strengthen the governance and thoughtful application of digital health tools. This includes boosting frontline health workers’ digital literacy as well as improving the capability of data analytics in global health. It is not enough to collect data. It must be translated into information that helps decision-makers and health workers do their jobs. What’s more, governments are creating policies, strategies, and investment plans that guide digital health at both the global and national levels.

Technology, policy, and health systems are aligning at the global level, drawing upon decades of insights and lessons to transform digital health worldwide. Underpinning this effort is a collaboration between PATH and the World Health Organization, which focuses on developing a global digital health strategy. This will enable investors, governments, and technology developers to rally behind a shared set of principles and approaches for digital health, opening up new cross-sector collaboration. Pieces of this puzzle that were once scattered across the globe are now being assembled into a picture of revolutionary digital health systems.

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