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Science Tuesday - Pollution, Global Warming, Health Literacy, and BCP Weight Gain
Highway Exhaust Stunts Lung Growth, Study Finds
By NICHOLAS BAKALAR, The New York Times, January 30, 2007
A new study suggests that children who grow up within a third of a mile of a freeway may be sustaining permanent respiratory problems.
Researchers studied developing lung function in 1,445 children living in 12 Southern California communities for eight years, from age 10 to 18. They found that the closer the children lived to a freeway, the more likely they were to experience reduced growth in lung function as measured by the standard tests.
“That living near freeways is a health issue is something we’ve known about for a long time,” said Gennet Paauwe, a spokeswoman for the California Air Resources Board, which financed part of the research. “All of this points to the fact that California’s air pollution control program needs to continue with its aggressive reduction in air pollutants. But I think this would translate to any other part of the U.S. where people are living near heavily trafficked roadways.”
The findings were published online Friday by the British journal Lancet.
“Our finding of a larger impact on small lung airways is consistent with what is known about the types of pollutants that are emitted from the tailpipe,” said W. James Gauderman, the lead author and an associate professor of preventive medicine at the University of Southern California. These pollutants, he continued, “can be inhaled deeply into the lung and may have the largest impact on the smallest lung airways.”
The study was not restricted to the notoriously smoggy Los Angeles basin. “Our findings were observed in all of these children, including those living in areas of lower pollution,” Dr. Gauderman said, “so it suggests that in any urban area where children are living near busy roads, they are likely to have adverse respiratory effects. It’s not just L. A.”
The development of lung function was also lower in nonasthmatic and nonsmoking teenagers living near freeways, suggesting that the highways had an adverse effect on otherwise healthy children. Growth of lung strength and capacity, the researchers write, is largely complete by age 18, and this means that a child with a deficit at that age will probably suffer lifelong diminished lung function.
“The study is significant in the finding that it isn’t just regional air pollution, which policy makers have focused on,” said Frederica Perera, director of the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health in New York. “These results indicate that it’s also important to consider local variations in air pollution.”
The researchers started with a group of 3,600 children, using questionnaires to gather information on parental income, history of asthma, prenatal exposure to maternal smoking and household exposure to smoking and pets. Then, using yearly questionnaires, they tracked asthma status, personal smoking and exposure to secondhand smoke. They also recorded the distance of each child’s home from the nearest limited-access highway and from other major nonfreeway roads.
To determine lung function, the scientists used standard tests that measure how much air a child can exhale during a forced expiration and how forcefully he can do so. Normally, these numbers gradually increase as children grow. The children were tested an average of six times over the eight years of the study.
About 11 percent of subjects per year dropped out of the study for various reasons.
Although the authors controlled the study for socioeconomic status, an editorial with the paper points out that social factors are difficult to define and may affect lung capacity no matter where a child lives. Other studies, for example, have shown that poor children in the Los Angeles area are more likely to attend schools near freeways than those who are more affluent. Also, the study did not examine exposures at ages younger than 10.
World Scientists Near Consensus on Warming
By JAMES KANTER and ANDREW C. REVKIN, The New York Times, January 30, 2007
PARIS, Jan. 29 — Scientists from across the world gathered Monday to hammer out the final details of an authoritative report on climate change that is expected to project centuries of rising temperatures and sea levels unless there are curbs in emissions of carbon dioxide and other gases that trap heat in the atmosphere.
Scientists involved in writing or reviewing the report say it is nearly certain to conclude that there is at least a 90 percent chance that human-caused emissions are the main factor in warming since 1950. The report is the fourth since 1990 from the Intergovernmental Panel on Climate Change, which is overseen by the United Nations.
The report, several of the authors said, will describe a growing body of evidence that warming is likely to cause a profound transformation of the planet.
Three large sections of the report will be forthcoming during the year. The first will be a summary for policy makers and information on basic climate science, which is expected to be issued on Friday.
Among the findings in recent drafts:
“Concerns about climate change and public awareness on the subject are at an all-time high,” the chairman of the panel, Rajendra Pachauri, told delegates on Monday.
But scientists involved in the effort warned that squabbling among teams and government representatives from more than 100 countries — over how to portray the probable amount of sea-level rise during the 21st century — could distract from the basic finding that a warming world will be one in which shrinking coastlines are the new normal for centuries to come.
Jerry Mahlman, an emeritus researcher at the National Center for Atmospheric Research in Boulder, Colo., who was a reviewer of the report’s single-spaced, 1,644-page summary of climate science, said most of the leaks to the news media so far were from people eager to find elements that were the most frightening or the most reassuring.
He added in an interview that such efforts distracted from the basic, undisputed findings, saying that those point to trends that are very disturbing.
He noted recent disclosures that there is still uncertainty about the pace at which seas will rise because of warming and the melting of terrestrial ice over the next 100 years. That span, he said, is just the start of a rise in sea levels that will almost certainly continue for 1,000 years or so.
Many economists and energy experts long ago abandoned any expectation that it would be possible to avoid a doubling of preindustrial carbon dioxide concentrations, given the growth of human populations, use of fossil fuels, particularly coal, and destruction of forests in the tropics.
The report is likely to highlight the hazardous consequences of that shift by finding that reaching twice the preindustrial concentration of carbon dioxide will probably warm climate between 3.5 and 8 degrees Fahrenheit and by highlighting that there is a small but significant risk that such a buildup can produce even more warming.
One major point of debate in early drafts of the report is the projection of a smaller rise in sea level than the last report as scientists relying on computer models and field observations struggle to find a consensus. Some scientists say that the figures used in the coming report are not recent enough because they leave out recent observations of instability in some ice sheets in Antarctica and Greenland.
Another possible point of contention during the four days of closed sessions in Paris this week may be assertions in early drafts of the report that the recent warming rate was blunted by particle pollution and volcanic eruptions.
Some scientists say the final report should reflect the assumption that the rate of warming in coming years is likely to be more pronounced than that of previous decades.
Achim Steiner, the executive director of the United Nations Environment Program, said the findings presented Friday should lead decision makers to accelerate efforts to slash carbon emissions and to help people in vulnerable parts of the world prepare for climate change.
“These findings should strengthen the resolve of governments to act now to reduce greenhouse gas emissions and put in place the medium- to longer-term strategies necessary to avert dangerous climate change,” Mr. Steiner said.
In a new report issued Monday, his agency said the most recent evidence from mountain glaciers showed that they were melting faster than before.
In the past year, international concern over what to do about global warming has grown along with concrete signs of climate change. Even so, political leaders are still groping for ways to tackle the phenomenon. Europe has adopted a program that caps the amount of emissions from industrial plants.
But the world’s largest emitter, the United States, still is debating whether to adopt a similar policy, while developing countries like China are resisting caps on the ground that the industrialized countries contributed about 75 percent of the current volume of greenhouse gases and should make the deepest cuts.
Many experts involved in the intergovernmental panel’s process said there was hope that with a prompt start on slowing emissions, the chances of seeing much greater warmth and widespread disruption of ecosystems and societies could be reduced.
Outside experts agreed.
“We basically have three choices: mitigation, adaptation and suffering,” said John Holdren, the president of the American Association for the Advancement of Science and an energy and climate expert at Harvard. “We’re going to do some of each. The question is what the mix is going to be. The more mitigation we do, the less adaptation will be required and the less suffering there will be.”
Personal Health: The Importance of Knowing What the Doctor Is Talking About
By JANE E. BRODY, The New York Times, January 30, 2007
How often have you left a doctor’s office wondering just what you were told about your health, or what exactly you were supposed to be doing to relieve or prevent a problem? If you are a typical patient, you remember less than half of what your doctor tries to explain.
Whether you left school at 16 or have a doctorate; whether your annual income is in four figures or six; whether you are black, white, Hispanic, Asian or American Indian, chances are there have been many medical encounters that left you with less than optimal understanding about how you can improve or protect your health.
National studies have found that “health literacy” is remarkably low, with more than 90 million Americans unable to adequately understand basic health information. The studies show that this obstacle “affects people of all ages, races, income and education levels,” Dr. Richard H. Carmona, the United States surgeon general, wrote in the August issue of The Journal of General Internal Medicine, which was devoted to health literacy.
The fallout is anything but trivial. Researchers have found that poor health literacy, which is especially prevalent among the elderly, results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room and worse control of chronic diseases.
The consequences are poorer health and greater medical costs. All because doctors fail to speak to patients in plain English (or Spanish or Chinese or any other language) and fail to make sure that patients understand what they are told and what they are supposed to do and why.
In a study published in the internal medicine journal, conducted among 2,512 elderly men and women living on their own in Memphis and Pittsburgh, those with limited health literacy were nearly twice as likely to die in a five-year period as were those with adequate health literacy. That held true even when age, race, socioeconomic factors, current health conditions, health care access and health-related behaviors were taken into account.
Another study in the journal among 175 adult asthma patients treated by Cornell University doctors found that “less health literacy was associated with worse quality of life, worse physical function and more emergency department utilization for asthma over two years.”
Among the many problems resulting from limited health literacy are misinterpretations of warning labels on prescription drugs. For example, among 251 adults attending a primary care clinic in Shreveport, La., those with low literacy were three times more likely to misunderstand warnings than the more literate.
When the warning label read “Do Not Chew or Crush, Swallow Whole,” misinterpretations included “Chew it up, so it will dissolve” and “Don’t swallow whole or you might choke.”
When the warning read “Medication Should Be Taken With Plenty of Water,” the mistakes included “Don’t take when wet” and “Don’t drink hot water.”
When the warning was “For External Use Only,” the mistakes included “Medicine will make you feel dizzy” and “Use extreme caution in how you take it.”
Better Communication
Despite major reports on the need to improve health literacy issued in the last decade by organizations including the American Medical Association and the National Academy’s Institute of Medicine, little improvement has been noted in how much patients understand and remember about encounters with health care practitioners.
A main obstacle has been the decreased time patients can spend with their doctors, dictated largely by managed care and other medical reimbursement plans.
A second hurdle is the embarrassment that patients with limited health literacy experience when they do not understand what the doctor has said. And, of course, asking for clarification is seriously impeded by the imbalance in power between the white-coated physician and the paper-wrapped patient. Even when conversations are conducted in the doctor’s office with a fully clothed patient, patients are often reluctant to ask questions.
The tools for repairing this problem lie mainly within the realms of medical education and clinical practice. More medical schools, residency programs and continuing education programs for practicing physicians need to include training in clinical communication skills.
Dr. Sunil Kripalani of the Emory University School of Medicine in Atlanta and Dr. Barry D. Weiss of the University of Arizona College of Medicine in Tucson suggest these strategies:
Dr. Kripalani and Dr. Weiss say none of this should take more than a few minutes. And by tailoring information to a patient’s individual needs and limiting it to the most important points, the process can save time in the long run, result in better control of chronic illness and lead to shorter and less frequent office visits.
Experts on health literacy also encourage doctors to assess patients’ health literacy by asking them to read aloud a list of 66 medical terms, each within 5 seconds. Patients are scored on how many words they pronounce correctly.
Taking the Lead
Do not wait until doctors become better at communicating. If you want the best medical care, you have to take the initiative. If the doctor says something you do not understand, ask that it be repeated in simpler language. If you are given a new set of instructions, repeat them back to the doctor to confirm your understanding. If you are given a new device to use, demonstrate how you think you are to use it.
Insist that conversations about serious medical matters take place when you are dressed and in the doctor’s office. Take notes or take along an advocate who can take notes for you. Better yet, tape-record the conversation to replay it at home for you and your family or another doctor.
If you have received a diagnosis of a new problem and want to explore it further on the Internet, be sure to look up reputable sites. Two that can be relied on are www.nlm.nih.gov, produced by the National Library of Medicine, and www .healthfinder.gov, produced by the United States Department of Health and Human Services. Many major medical centers also provide useful, accurate information online.
Avoid anecdotal information posted by patients or patients’ relatives, as well as write-ups by commercial organizations that overtly or covertly sell products.
Really? The Claim: The Pill Can Make You Put On Weight
By ANAHAD O’CONNOR, The New York Times, January 30, 2007
THE FACTS Quick weight gain may be among the birth-control pill’s most dreaded side effects. But how much does it really add to your waistline?
Last year, a group of researchers carried out what may be the most extensive study on the subject to date. Their conclusion: In most women, neither the pill nor the patch seems to add any pounds at all.
Of 44 previous studies that the researchers combined and analyzed, 3 found no difference between women who took hormonal contraceptives and those who took a placebo. The other studies looked at women taking different types and doses of hormonal contraception, and came to the same overall conclusion.
The claim may have had some truth many years ago, when the pill contained high levels of estrogen, which can cause water retention and increased appetite. Nowadays, most versions of the pill have only half the amount found in early versions.
Some studies have shown that while the pill may add a couple of pounds at first from water retention, the added weight disappears as the body adjusts to the hormones.
Another factor has nothing to do with the pill: most women start birth control as teenagers and continue it through their 20s, a period when women naturally tend to gain weight.
THE BOTTOM LINE The link between the pill and weight gain is exaggerated at best.
By NICHOLAS BAKALAR, The New York Times, January 30, 2007
A new study suggests that children who grow up within a third of a mile of a freeway may be sustaining permanent respiratory problems.
Researchers studied developing lung function in 1,445 children living in 12 Southern California communities for eight years, from age 10 to 18. They found that the closer the children lived to a freeway, the more likely they were to experience reduced growth in lung function as measured by the standard tests.
“That living near freeways is a health issue is something we’ve known about for a long time,” said Gennet Paauwe, a spokeswoman for the California Air Resources Board, which financed part of the research. “All of this points to the fact that California’s air pollution control program needs to continue with its aggressive reduction in air pollutants. But I think this would translate to any other part of the U.S. where people are living near heavily trafficked roadways.”
The findings were published online Friday by the British journal Lancet.
“Our finding of a larger impact on small lung airways is consistent with what is known about the types of pollutants that are emitted from the tailpipe,” said W. James Gauderman, the lead author and an associate professor of preventive medicine at the University of Southern California. These pollutants, he continued, “can be inhaled deeply into the lung and may have the largest impact on the smallest lung airways.”
The study was not restricted to the notoriously smoggy Los Angeles basin. “Our findings were observed in all of these children, including those living in areas of lower pollution,” Dr. Gauderman said, “so it suggests that in any urban area where children are living near busy roads, they are likely to have adverse respiratory effects. It’s not just L. A.”
The development of lung function was also lower in nonasthmatic and nonsmoking teenagers living near freeways, suggesting that the highways had an adverse effect on otherwise healthy children. Growth of lung strength and capacity, the researchers write, is largely complete by age 18, and this means that a child with a deficit at that age will probably suffer lifelong diminished lung function.
“The study is significant in the finding that it isn’t just regional air pollution, which policy makers have focused on,” said Frederica Perera, director of the Columbia Center for Children’s Environmental Health at the Mailman School of Public Health in New York. “These results indicate that it’s also important to consider local variations in air pollution.”
The researchers started with a group of 3,600 children, using questionnaires to gather information on parental income, history of asthma, prenatal exposure to maternal smoking and household exposure to smoking and pets. Then, using yearly questionnaires, they tracked asthma status, personal smoking and exposure to secondhand smoke. They also recorded the distance of each child’s home from the nearest limited-access highway and from other major nonfreeway roads.
To determine lung function, the scientists used standard tests that measure how much air a child can exhale during a forced expiration and how forcefully he can do so. Normally, these numbers gradually increase as children grow. The children were tested an average of six times over the eight years of the study.
About 11 percent of subjects per year dropped out of the study for various reasons.
Although the authors controlled the study for socioeconomic status, an editorial with the paper points out that social factors are difficult to define and may affect lung capacity no matter where a child lives. Other studies, for example, have shown that poor children in the Los Angeles area are more likely to attend schools near freeways than those who are more affluent. Also, the study did not examine exposures at ages younger than 10.
World Scientists Near Consensus on Warming
By JAMES KANTER and ANDREW C. REVKIN, The New York Times, January 30, 2007
PARIS, Jan. 29 — Scientists from across the world gathered Monday to hammer out the final details of an authoritative report on climate change that is expected to project centuries of rising temperatures and sea levels unless there are curbs in emissions of carbon dioxide and other gases that trap heat in the atmosphere.
Scientists involved in writing or reviewing the report say it is nearly certain to conclude that there is at least a 90 percent chance that human-caused emissions are the main factor in warming since 1950. The report is the fourth since 1990 from the Intergovernmental Panel on Climate Change, which is overseen by the United Nations.
The report, several of the authors said, will describe a growing body of evidence that warming is likely to cause a profound transformation of the planet.
Three large sections of the report will be forthcoming during the year. The first will be a summary for policy makers and information on basic climate science, which is expected to be issued on Friday.
Among the findings in recent drafts:
- The Arctic Ocean could largely be devoid of sea ice during summer later in the century.
- Europe’s Mediterranean shores could become barely habitable in summers, while the Alps could shift from snowy winter destinations to summer havens from the heat.
- Growing seasons in temperate regions will expand, while droughts are likely to ravage further the semiarid regions of Africa and southern Asia.
“Concerns about climate change and public awareness on the subject are at an all-time high,” the chairman of the panel, Rajendra Pachauri, told delegates on Monday.
But scientists involved in the effort warned that squabbling among teams and government representatives from more than 100 countries — over how to portray the probable amount of sea-level rise during the 21st century — could distract from the basic finding that a warming world will be one in which shrinking coastlines are the new normal for centuries to come.
Jerry Mahlman, an emeritus researcher at the National Center for Atmospheric Research in Boulder, Colo., who was a reviewer of the report’s single-spaced, 1,644-page summary of climate science, said most of the leaks to the news media so far were from people eager to find elements that were the most frightening or the most reassuring.
He added in an interview that such efforts distracted from the basic, undisputed findings, saying that those point to trends that are very disturbing.
He noted recent disclosures that there is still uncertainty about the pace at which seas will rise because of warming and the melting of terrestrial ice over the next 100 years. That span, he said, is just the start of a rise in sea levels that will almost certainly continue for 1,000 years or so.
Many economists and energy experts long ago abandoned any expectation that it would be possible to avoid a doubling of preindustrial carbon dioxide concentrations, given the growth of human populations, use of fossil fuels, particularly coal, and destruction of forests in the tropics.
The report is likely to highlight the hazardous consequences of that shift by finding that reaching twice the preindustrial concentration of carbon dioxide will probably warm climate between 3.5 and 8 degrees Fahrenheit and by highlighting that there is a small but significant risk that such a buildup can produce even more warming.
One major point of debate in early drafts of the report is the projection of a smaller rise in sea level than the last report as scientists relying on computer models and field observations struggle to find a consensus. Some scientists say that the figures used in the coming report are not recent enough because they leave out recent observations of instability in some ice sheets in Antarctica and Greenland.
Another possible point of contention during the four days of closed sessions in Paris this week may be assertions in early drafts of the report that the recent warming rate was blunted by particle pollution and volcanic eruptions.
Some scientists say the final report should reflect the assumption that the rate of warming in coming years is likely to be more pronounced than that of previous decades.
Achim Steiner, the executive director of the United Nations Environment Program, said the findings presented Friday should lead decision makers to accelerate efforts to slash carbon emissions and to help people in vulnerable parts of the world prepare for climate change.
“These findings should strengthen the resolve of governments to act now to reduce greenhouse gas emissions and put in place the medium- to longer-term strategies necessary to avert dangerous climate change,” Mr. Steiner said.
In a new report issued Monday, his agency said the most recent evidence from mountain glaciers showed that they were melting faster than before.
In the past year, international concern over what to do about global warming has grown along with concrete signs of climate change. Even so, political leaders are still groping for ways to tackle the phenomenon. Europe has adopted a program that caps the amount of emissions from industrial plants.
But the world’s largest emitter, the United States, still is debating whether to adopt a similar policy, while developing countries like China are resisting caps on the ground that the industrialized countries contributed about 75 percent of the current volume of greenhouse gases and should make the deepest cuts.
Many experts involved in the intergovernmental panel’s process said there was hope that with a prompt start on slowing emissions, the chances of seeing much greater warmth and widespread disruption of ecosystems and societies could be reduced.
Outside experts agreed.
“We basically have three choices: mitigation, adaptation and suffering,” said John Holdren, the president of the American Association for the Advancement of Science and an energy and climate expert at Harvard. “We’re going to do some of each. The question is what the mix is going to be. The more mitigation we do, the less adaptation will be required and the less suffering there will be.”
Personal Health: The Importance of Knowing What the Doctor Is Talking About
By JANE E. BRODY, The New York Times, January 30, 2007
How often have you left a doctor’s office wondering just what you were told about your health, or what exactly you were supposed to be doing to relieve or prevent a problem? If you are a typical patient, you remember less than half of what your doctor tries to explain.
Whether you left school at 16 or have a doctorate; whether your annual income is in four figures or six; whether you are black, white, Hispanic, Asian or American Indian, chances are there have been many medical encounters that left you with less than optimal understanding about how you can improve or protect your health.
National studies have found that “health literacy” is remarkably low, with more than 90 million Americans unable to adequately understand basic health information. The studies show that this obstacle “affects people of all ages, races, income and education levels,” Dr. Richard H. Carmona, the United States surgeon general, wrote in the August issue of The Journal of General Internal Medicine, which was devoted to health literacy.
The fallout is anything but trivial. Researchers have found that poor health literacy, which is especially prevalent among the elderly, results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room and worse control of chronic diseases.
The consequences are poorer health and greater medical costs. All because doctors fail to speak to patients in plain English (or Spanish or Chinese or any other language) and fail to make sure that patients understand what they are told and what they are supposed to do and why.
In a study published in the internal medicine journal, conducted among 2,512 elderly men and women living on their own in Memphis and Pittsburgh, those with limited health literacy were nearly twice as likely to die in a five-year period as were those with adequate health literacy. That held true even when age, race, socioeconomic factors, current health conditions, health care access and health-related behaviors were taken into account.
Another study in the journal among 175 adult asthma patients treated by Cornell University doctors found that “less health literacy was associated with worse quality of life, worse physical function and more emergency department utilization for asthma over two years.”
Among the many problems resulting from limited health literacy are misinterpretations of warning labels on prescription drugs. For example, among 251 adults attending a primary care clinic in Shreveport, La., those with low literacy were three times more likely to misunderstand warnings than the more literate.
When the warning label read “Do Not Chew or Crush, Swallow Whole,” misinterpretations included “Chew it up, so it will dissolve” and “Don’t swallow whole or you might choke.”
When the warning read “Medication Should Be Taken With Plenty of Water,” the mistakes included “Don’t take when wet” and “Don’t drink hot water.”
When the warning was “For External Use Only,” the mistakes included “Medicine will make you feel dizzy” and “Use extreme caution in how you take it.”
Better Communication
Despite major reports on the need to improve health literacy issued in the last decade by organizations including the American Medical Association and the National Academy’s Institute of Medicine, little improvement has been noted in how much patients understand and remember about encounters with health care practitioners.
A main obstacle has been the decreased time patients can spend with their doctors, dictated largely by managed care and other medical reimbursement plans.
A second hurdle is the embarrassment that patients with limited health literacy experience when they do not understand what the doctor has said. And, of course, asking for clarification is seriously impeded by the imbalance in power between the white-coated physician and the paper-wrapped patient. Even when conversations are conducted in the doctor’s office with a fully clothed patient, patients are often reluctant to ask questions.
The tools for repairing this problem lie mainly within the realms of medical education and clinical practice. More medical schools, residency programs and continuing education programs for practicing physicians need to include training in clinical communication skills.
Dr. Sunil Kripalani of the Emory University School of Medicine in Atlanta and Dr. Barry D. Weiss of the University of Arizona College of Medicine in Tucson suggest these strategies:
- Doctors should assess the patient’s baseline understanding before providing extensive information: “Before we go on, could you tell me what you already know about high blood pressure?”
- Doctors should use plain language, not medical jargon, vague terms and words that may have different meanings to a lay person. They should say chest pain instead of angina, hamburger instead of red meat and, “You don’t have H.I.V.” instead of “Your H.I.V. test was negative.”
- To encourage patients to ask questions, doctors should ask, “What questions do you have?” rather than, “Do you have any questions?”
- Doctors should confirm the patient’s understanding by saying, “I always ask my patients to repeat things back to make sure I have explained them clearly.” Or, if a new skill like using an inhaler was taught, the doctor should have the patient demonstrate the action.
- Then, as fail-safe measures, the doctor should provide written instructions and educational material for the patient and family to review at home.
Dr. Kripalani and Dr. Weiss say none of this should take more than a few minutes. And by tailoring information to a patient’s individual needs and limiting it to the most important points, the process can save time in the long run, result in better control of chronic illness and lead to shorter and less frequent office visits.
Experts on health literacy also encourage doctors to assess patients’ health literacy by asking them to read aloud a list of 66 medical terms, each within 5 seconds. Patients are scored on how many words they pronounce correctly.
Taking the Lead
Do not wait until doctors become better at communicating. If you want the best medical care, you have to take the initiative. If the doctor says something you do not understand, ask that it be repeated in simpler language. If you are given a new set of instructions, repeat them back to the doctor to confirm your understanding. If you are given a new device to use, demonstrate how you think you are to use it.
Insist that conversations about serious medical matters take place when you are dressed and in the doctor’s office. Take notes or take along an advocate who can take notes for you. Better yet, tape-record the conversation to replay it at home for you and your family or another doctor.
If you have received a diagnosis of a new problem and want to explore it further on the Internet, be sure to look up reputable sites. Two that can be relied on are www.nlm.nih.gov, produced by the National Library of Medicine, and www .healthfinder.gov, produced by the United States Department of Health and Human Services. Many major medical centers also provide useful, accurate information online.
Avoid anecdotal information posted by patients or patients’ relatives, as well as write-ups by commercial organizations that overtly or covertly sell products.
Really? The Claim: The Pill Can Make You Put On Weight
By ANAHAD O’CONNOR, The New York Times, January 30, 2007
THE FACTS Quick weight gain may be among the birth-control pill’s most dreaded side effects. But how much does it really add to your waistline?
Last year, a group of researchers carried out what may be the most extensive study on the subject to date. Their conclusion: In most women, neither the pill nor the patch seems to add any pounds at all.
Of 44 previous studies that the researchers combined and analyzed, 3 found no difference between women who took hormonal contraceptives and those who took a placebo. The other studies looked at women taking different types and doses of hormonal contraception, and came to the same overall conclusion.
The claim may have had some truth many years ago, when the pill contained high levels of estrogen, which can cause water retention and increased appetite. Nowadays, most versions of the pill have only half the amount found in early versions.
Some studies have shown that while the pill may add a couple of pounds at first from water retention, the added weight disappears as the body adjusts to the hormones.
Another factor has nothing to do with the pill: most women start birth control as teenagers and continue it through their 20s, a period when women naturally tend to gain weight.
THE BOTTOM LINE The link between the pill and weight gain is exaggerated at best.