Health Weekender: The good, the bad, and the 'P' in the pool

Swimming is my exercise of choice, which apparently puts me in good company—it’s the second most popular workout in the country. And you know it’s a great workout. Lap swimming is about as effective as jogging at burning calories, building strength, and provides a similar aerobic workout. And it’s easier on the hips and knees, helping those with joint problems work out longer and with less stress.

But lap swimming isn’t the only way to get a good water workout. Walking, running, or lifting weights in a pool is a different kind of workout than on land—and it can be safer too, especially for those who may be frail, overweight, pregnant, or with back or joint problems. One of my colleagues and fellow blogger was required to take a water aerobics class in college. She wasn’t excited about it at first, but says she thoroughly enjoyed it, and lost nearly ten pounds in one semester.

Like some exercise machines, water provides a natural form of resistance—roughly ten times greater than air—forcing you to work harder to move through it, which burns calories faster while building strength and aerobic fitness. And because water surrounds you, it provides resistance in any direction you move. Straight leg lifts on land, for example, tone the muscles in your front thigh, but the same exercise in water has the added benefit of strengthening the hamstring when you push your leg back down.

The ‘P’ in Pool

OK, so that’s the good news. Now for the bad news: your fellow swimmers may not be models of aquatic hygiene. A recent survey by the Water Quality and Health Council found that 47 percent of Americans admit to one or more behaviors that contribute to an unhealthy pool. Notably, one in five pee in the pool, and 35 percent skip the pre-swimming shower.

Breaking the piggy bank for Rx drugs? Apply for patient assistance

If you’re among the growing number of uninsured or underinsured Americans, you could probably use some help paying for your medications. A patient assistance program* (PAP) might be able to help you pay for your prescriptions. Also called indigent drug programs, charitable drug programs, or medication assistance programs, PAPs are set up by drug companies, and you can find one relevant to you by searching the Web, or via online directories like RxAssist.

I’m a firm believer that if it sounds too good to be true, there must be a catch. So I checked out RxAssist, and to my surprise, not only was it easy to find several programs that could cover my specific medications, there wasn’t loads of confusing paperwork (many forms are one-pagers). You just click on the patient section, type in the name of the drug in the database search box, and you’ll get a list of PAPs that offer the drug at a low cost or for free. The forms will ask for your annual household income, your prescription information, and whether or not you qualify for health insurance, and some forms will need your doctor’s signature. If you’re eligible, the medication will be sent to your doctor’s office, your local pharmacy, or your front door.

Overtreatment: The lesson of McAllen, Texas

McAllen, Texas, in the impoverished Mexican border region of Hidalgo County, is an unlikely place to find the nation’s most expensive health care. But that’s exactly what Dr. Atul Gawande did, and wrote about in a fascinating article in the current issue of New Yorker magazine. In McAllen, he found doctors and hospitals who had discovered a guaranteed path to riches: give unsuspecting patients many expensive and profitable tests and treatments, whether they need them or not. Here’s a quote from the article that highlights the issue:

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly.

If this theme sounds familiar to Consumer Reports readers, that’s because we’ve been writing about it for years. We’ve warned people away from treatment traps that do nothing except run up your bills. We’ve investigated how too much treatment can paradoxically make people less healthy by exposing them to poorly coordinated care, side effects of unneeded tests and medications, and hospital infections.

Q&A: Is spinal surgery for back pain worth trying?

My doctor suggested minimally invasive surgery for my back pain. Is it worth trying? —J.M.K., Brown Deer, Wis.

Only as a last resort. Minimally invasive decompression surgery uses smaller incisions than the standard operation, which involves slicing through the muscles and bones of the lower back to relieve pressure on nerves from slipped disks or other causes. But in a 2008 Consumer Reports survey of some 1,000 readers who underwent back surgery, nearly half said that recovery was longer and more painful than expected. And most back pain resolves on its own in about six weeks. When it doesn’t, acupuncture, chiropractic care, or exercise often help. So consider surgery only if other options have failed and you’ve received a second opinion.

Read more on what to consider when considering back surgery, and see our Treatment Ratings (subscribers only) for a comparison of 23 lower-back treatments, including spinal manipulation, massage, and drug therapies.

FDA wants new labels on acetaminophen

You may already be aware that the widely-used painkiller acetaminophen (Tylenol or generic) can cause liver damage that may lead to liver failure, if you take more than the recommended dose. Despite steps by the FDA from the last decade to warn consumers of the risks, recent studies indicate that overdosing leading to liver damage continues to occur. In response, the FDA working group is now recommending* several safety measures–mostly to changes on the label–that amount to prominently displaying that an over-the-counter drug contains acetaminophen and to warn people about the risk of severe liver damage. The FDA also wants manufacturers to reduce the maximum adult and child doses to avoid an overdose.

While these changes from the FDA may take months or longer to appear on your drugstore shelves, in the meantime, we think it is worth a reminder to:

• Carefully read the list of active ingredients that is on the package and label of any over-the-counter drugs you take, and be aware that acetaminophen is a common drug that appears in many combination products. Avoid doubling up on combination products as well.
• Don’t exceed the maximum dosage. Recognize that even doubling the maximum allowable dose for an adult for a few days can be toxic and even deadly.
• Avoid acetaminophen if you are a heavy drinker.

Can folic acid reduce the risk of heart defects, too?

From the moment that + sign appears on a pregnancy test, expectant mothers (and fathers) have plenty of planning, nesting, and stressing to do before their baby's arrival. Although tasks like picking a name can wait, making sure you get enough folic acid cannot. In fact, doctors advise women to make sure they get enough of this nutrient before they even become pregnant, as this can reduce the risk of spina bifida and related birth defects.

Now, a new study suggests another reason to be vigilant about getting enough of this vitamin: a lower risk of serious heart defects.

Folic acid (also known as folate) is a B vitamin that is important for the healthy development of the neural tubes, which eventually become a baby's brain and spinal cord. If these tubes don't develop properly in early pregnancy, a baby can be born with neural tube defects such as spina bifida, in which the bones of the spine do not come together properly. Animal studies have suggested folic acid may also play a role in preventing heart defects, although little research has been done in people.

Eat at home, cut costs and pounds

I’m always on the go, so eating out is a convenient, and often, the only, solution to the "what’s for dinner" dilemma. But this weekend I got a fiscal wake-up call when I took a close look at how much I’ve spent on restaurant and delivery meals in the past month. Twenty bucks here, another $30 there, and before I knew it, I’d spent over $500 on dine-out meals in a month’s time.

But you can easily cut costs and lose weight by trading a couple of those dine-out days for your own home-cooked meals. And if saving money isn’t an incentive enough, a recent Consumer Reports National Research Center survey showed that restaurant and take-out meals can really pile on the pounds. And since many restaurant meals are drenched in salt, eating at home can cut your sodium intake and your risk of high blood pressure.

Healthy habits on the decline in the U.S.

Exercise regularly. Eat five or more servings of fruits and vegetables a day. Maintain a healthy weight. Don't smoke. Drink alcohol in moderation.

How often have you heard these health messages? Hundreds of times, I'd wager. Now, how often have you heard these messages and actually made changes to your life? If you're like most Americans, probably not too often. According to a new study published in the June 2009 issue of the American Journal of Medicine, few adults ages 40 to 74 have adopted these basic health-promoting habits—and their numbers are dropping.

Researchers gathered data on people's health behaviors from a large survey called NHANES (short for National Health and Nutrition Examination Survey). NHANES regularly polls thousands of Americans about their eating habits, levels of exercise, history of smoking and many other health markers. Participants also have a physical exam.

Using this data, researchers compared people's adherence to these five healthy habits during two time periods: 1988 to 1994, and 2001 to 2006. Overall, adherence was far from stellar. But perhaps most alarming was the drop in healthy habits over the study's 18-year span. Here's a summary:

Mike Tyson’s daughter in preventable treadmill accident

The latest headlines on Mike Tyson’s 4-year-old daughter are deeply troubling, and unfortunately are a reminder that treadmill-related injuries are far too common. Hospital-treated treadmill injuries are on the rise, and the greatest percentage of injuries have been among toddlers who were hurt while a parent using the machine didn't see the child playing behind or beneath it. A report from the Consumer Product Safety Commission estimated that more than 25,000 children under age 14 are injured by exercise equipment, including stationary bikes, treadmills, and stair climbers, each year.

Follow these safety tips to help prevent injuries from treadmills and any exercise equipment:

• Keep your child away from the treadmill while it is in use.

• When the treadmill is not in use, unplug it, and if possible, lock it up to keep out of your child’s reach. If it’s not possible to lock it away in another room in your home, consider surrounding it with a safety gate. An unsupervised child should never be left near exercise equipment.

The latest headlines on Mike Tyson’s 4-year-old daughter are deeply troubling, and unfortunately are a reminder that treadmill-related injuries are far too common. Hospital-treated treadmill injuries are on the rise, and the greatest percentage of injuries have been among toddlers who were hurt while a parent using the machine didn't see the child playing behind or beneath it. A report from the Consumer Product Safety Commission estimated that more than 25,000 children under age 14 are injured by exercise equipment, including stationary bikes, treadmills, and stair climbers, each year.

Follow these safety tips to help prevent injuries from treadmills and any exercise equipment:

• Keep your child away from the treadmill while it is in use.

You deserve answers about the risks, benefits of medical care

Patients who come to my office for lower-back pain are often seeking a second opinion because they’ve been told they need surgery. And as it turns out, many get better by waiting it out, which may explain why 35 percent of our Consumer Reports Health Ratings Center survey of more than 14,000 people with lower-back pain said they never consulted a professional at all.

Others improve with a variety of treatments, especially hands-on therapies. Patient preference plays a big role in healing, regardless of the treatment chosen. If a person is not keen on taking medications, the drugs are not likely to be effective (and prescriptions may not even be filled), and likewise, if someone doesn’t want to make the time for regular physical therapy, its benefits are bound to be limited. The decision that will often work best depends on the patient's own beliefs and values. And the choice that is best for one person may not be best for another under exactly the same circumstances.

Enlisting the preferences of patients is part of helping patients reach an informed medical decision. Shared decision making involves a conversation in which patients communicate their values and the relative importance they place on benefits and harms. It also means doctors make sure that patients understand their therapeutic options. This includes explaining the medical uncertainties.

Cut costs, question medical tests and treatments

You’ve likely heard it said that more isn’t better when it comes to health care. And when it comes to unnecessary and overused tests and treatments, more can cost you a bundle that you could spend on essential preventive care. According to a Progressive Policy Institute report, $700 billion per year goes to unnecessary tests and procedures. And in a 2007 Consumer Reports National Research Center survey, thirty-four percent of a national sample of 300 primary-care physicians said their patients "very frequently" or "quite often" requested unnecessary or duplicative medical tests. And 66 percent said they had acceded to at least one such request within the previous month.

What can you do to make sure you’re only getting the essential tests? Designate one doctor, typically your primary-care physician, to coordinate your care. If your doctor suggests a tests or procedure you’re uncertain about, ask:

Health Weekender: Real men should wear sunscreen

I made my husband go to the dermatologist—and probably saved his life. He has always had a crazy pattern of moles on his back, so I make sure he goes in for an annual checkup.

But on the day of his appointment two years ago he objected, saying he didn’t have time. So I made a deal with him: He could switch with me and take my earlier appointment that morning. He went, and it was a good thing he did—he found out that he had a melanoma on his back, right below his shoulder blade. Our dermatologist cut out the offending mole but told my husband he had to have follow-up surgery to make sure it hadn’t spread.

The mortality rate for melanoma among middle-aged white men in the U.S. increased by nearly 65 percent from 1973 to 2002, according to a study in the April 2009 issue of the Archives of Dermatology. This could be in part because they’re less likely than women to go to the doctor to have their moles checked out. Plus they’re less likely to wear sunscreen in the first place, according to a Consumer Reports National Research Center survey of 1,000 adults taken last month. It found that only about one-third of men reported regularly wearing sunscreen if they knew they would be in the sun for more than four hours. They were a little better about putting on sunscreen for sunbathing (53 percent) or swimming (44 percent).

Swine Flu Update: Moving toward a vaccine

The Secretary of the Department of Health and Human Services, Kathleen Sebelius, announced today that the agency would be moving forward in its preparations for vaccine development. HHS is directing $1 billion in funds to be used to conduct clinical studies over the summer and to prepare for large-scale commercial production of a swine (H1N1) flu vaccine.

Also today, the CDC announced that a new study has found that the virus likely emerged from pigs, and that the influenza genes that make up the new virus had probably been circulating unnoticed in swine populations for at least a decade. The study concludes that hog operations will likely need increased monitoring for flu viruses in the future, and to prevent this swine flu virus from reemerging from pigs.

The good news from the study is that most of the new swine flu viruses in humans show a very similar genetic makeup. That means that it may be somewhat easier to develop  a vaccine that will be effective against the new H1N1 viruses now circulating. The CDC does note, however, that now that the virus is being transmitted in humans, they expect it to evolve more quickly than it had in pig populations.

Manufacturers have been speeding up development of the seasonal flu vaccine, to allow for the production of a potential swine flu vaccine for the fall. Government health agencies are also planning to augment the development of a traditional vaccine—which can take months to produce in chicken eggs—with a technology that uses mammal cells to develop a vaccine in weeks. Researchers are also studying the possibility of using reverse genetic technologies to produce a vaccine, according to a CDC spokesman.

—Kevin McCarthy, associate editor

Blood pressure drugs for everyone over age 60? Not so fast

A study getting a lot of attention this morning suggests that everyone over age 60 or so should take a blood pressure lowering drug, even if their blood pressure is normal (of 140 mm Hg over 80 mm Hg). We don’t think it’s clear yet that the benefits of that aggressive approach—in heart attacks and strokes prevented—really outweigh the potential risks of drug therapy, especially in older people, a subset of the population already burdened with illness and drugs.

What is apparent, however, is that millions of Americans with high blood pressure remain undiagnosed, and many of those who know they have the problem aren’t being adequately treated. That’s a scandal. Every adult should get his or her blood pressure measured at every doctor visit. And people with high blood pressure should take steps to treat it, starting with losing excess weight, cutting back on sodium, exercising more and, if necessary, taking medications. That would be more in line with what is proven to be effective—and certainly safer than putting millions of older people on yet another drug for what, at this point, is little more than conjecture.

—Joel Keehn, senior editor

96,000 pounds of ground beef recalled due to E. coli contamination

Before you fire up the grill, check your the beef burgers in your freezer to make sure they're not part of the 95,898 pounds of ground beef products recalled this week by an Illinois company. Valley Meats is recalling beef patties that may be contaminated with E. coli O157:H7, according to the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS).

Several brands were involved in the recall, including 3S, Grillmaster, J & B, Klub, Thick 'N Savory and Ultimate. The frozen beef patties bear the establishment number "EST. 5712" inside the USDA mark of inspection as well as an individual case code, which can be found on the recall notice. The products were produced on March 10, 2009, and distributed nationwide.

Read more on the recall on our Safety blog and see more from the USDA on safely preparing ground beef.