Category: POWER

Alzheimer's disease (AD) is a devastating disease. Despite decades of research, science has not pinned down causes or discovered highly effective treatments. And while a healthy diet, regular exercise, and other measures can help people slow or avoid AD, we badly need more routes for preventing it.

That’s why a new study is so intriguing — and potentially game-changing. Researchers have found that the risk of death due to AD is markedly lower in taxi and ambulance drivers compared with hundreds of other occupations. And the reason could be that these drivers develop structural changes in their brains as they work.

Drawing a connection between Alzheimer’s disease and work

In the past two decades, small studies demonstrated that London taxi drivers tend to have an enlargement in one area of the hippocampus, a part of the brain involved with developing spatial memory. Interestingly, that part of the brain is one area that’s commonly damaged by AD.

These observations led to speculation that taxi drivers might be less prone to AD than people with jobs that don’t require similar navigation and spatial processing skills.

A recent study explores this possibility by analyzing data from nearly nine million people who died over a three-year period and had occupation information on their death certificates. After accounting for age of death, researchers tallied Alzheimer’s-related death rates for more than 443 different jobs. The results were dramatic.

What did the study find?

• Taxi and ambulance drivers were much less likely to die an AD-related death than people in other occupations. AD accounted for 0.91% of deaths of taxi drivers and 1.03% of deaths of ambulance drivers. Among chief executives, AD accounted for 1.82% of deaths, which is close to the average for the general population. While these differences may seem small, they translate to more than 40% fewer deaths related to Alzheimer’s among taxi and ambulance drivers.
• This benefit did not seem to extend to others with jobs involving navigation. For example, aircraft pilots (2.34%) and ship captains (2.12%) had some of the highest rates of death due to AD. Bus drivers (1.65%) were closer to the population average but still not nearly as low as taxi and ambulance drivers.
• Other types of dementia did not follow this pattern. Rates of death due to dementia other than AD were not lower among taxi and ambulance drivers.

Why would driving a taxi or ambulance affect the risk of AD-related death?

One possible explanation is that jobs requiring frequent real-time spatial and navigational skills change both structure and function in the hippocampus. If these jobs help keep the hippocampus healthy, that could explain why AD-related deaths — but not deaths due to other types of dementia — are lower in taxi and ambulance drivers. It could also explain the older studies that found enlargement in parts of the hippocampus in people with these jobs.

And why aren’t bus drivers, pilots, and ship captains similarly protected? The study authors suggest these other jobs involve predetermined routes with less real-time navigational demands. Thus, they may not change the hippocampus as much.

What are the limitations of this study?

A single research study is rarely definitive, especially an observational study like this one. Observational studies can only identify a relationship — not establish a firm cause — between a protective factor and a condition like AD. There could be other explanations for the findings. For example:

• Information on death certificates. Researchers in this study used “usual occupation at the time of death” as provided by a survivor presumed to know that information. But that might not be accurate. And many people have more than one job over the course of their lives.
• Self-selection. Perhaps people who are prone to AD find navigation more challenging than others, and so tend to avoid these occupations. Similarly, it’s possible that people who are less prone to AD tend to have better navigational skills and are more likely to pursue jobs for which that’s an advantage. In this way, self-selection, rather than the occupation itself, could have contributed to the study’s results.
• Confounders. The study’s findings could be due to factors other than those assessed by the study (confounders). For example, it’s possible that people whose lifelong occupation is driving a taxi or ambulance are less likely than others to smoke. Since smoking is a risk factor for AD, the lower rate of smoking, rather than the occupation, could contribute to fewer AD-related deaths among these drivers.
• Chance. The findings could be due to chance, especially because there were just 10 AD-related deaths among taxi drivers. Even a small number of overlooked deaths due to AD could sway the results.

And even if driving a taxi or ambulance could lower your risk of AD-related death, what’s the impact of GPS technology now in widespread use? If these jobs now require less navigational demand due to GPS, will the protective effect of these jobs evaporate?

How might this new study help you reduce your risk of AD?

You might wonder if these findings can be applied to anyone who wants to lower their risk of AD. For example, could outdoor treasure-hunting activities that require complex navigational skills, such as orienteering and geocaching, help stave off AD? At least one small study found that orienteering experts had better spatial memory than orienteering novices.

Could puzzles, video games, or even board games designed to build spatial skills reduce the risk of AD? Think Rubik’s Cubes and jigsaw puzzles, Minecraft and Tetris, chess and Labyrinth. A round of Battleship, anyone? And if these activities are actually helpful, how often would you need to play?

I look forward to the results of studies exploring these questions. Until then, it’s best to rely on experts’ recommendations to reduce your risk of AD, including high-quality sleep, diet, and regular exercise.

The bottom line

I find this new research about taxi and ambulance drivers having lower rates of AD-related death fascinating. Considering how often we hear about the risks of certain jobs, it’s encouraging to hear about occupations that might actually protect you from disease.

If confirmed by other research, the results of this study could lead to a better understanding of Alzheimer’s disease — and, more importantly, how to prevent it.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share

Have you met your step goals today? If so, well done! Monitoring your step count can inspire you to bump up activity over time.

But when it comes to assessing fitness or cardiovascular disease risk, counting steps might not be enough. Combining steps and average heart rate (as measured by a smart device) could be a better way for you to assess fitness and gain insights into your risk for major illnesses like heart attack or diabetes. Read on to learn how many steps you need for better health, and why tagging on heart rate matters.

Steps alone versus steps plus heart rate

First, how many steps should you aim for daily? There’s nothing special about the 10,000-steps number often touted: sure, it sounds impressive, and it’s a nice round number that has been linked to certain health benefits. But fewer daily steps — 4,000 to 7,000 — might be enough to help you become healthier. And taking more than 10,000 steps a day might be even better.

Second, people walking briskly up and down hills are getting a lot more exercise than those walking slowly on flat terrain, even if they take the same number of steps.

So, at a time when millions of people are carrying around smartphones or wearing watches that monitor physical activity and body functions, might there be a better way than just a step count to assess our fitness and risk of developing major disease?

According to a new study, the answer is yes.

Get out your calculator: A new measure of health risks and fitness

Researchers publishing in the Journal of the American Heart Association found that a simple ratio that includes both heart rate and step count is better than just counting steps. It’s called the DHRPS, which stands for daily heart rate per step. To calculate it, take your average daily heart rate and divide it by your average daily step count. Yes, to determine your DHRPS you’ll need a way to continuously monitor your heart rate, such as a smartwatch or Fitbit. And you’ll need to do some simple math to arrive at your DHRPS ratio, as explained below.

The study enrolled nearly 7,000 people (average age: 55). Each wore a Fitbit, a device that straps onto the wrist and is programmed to monitor steps taken and average heart rate each day. (Fitbits also have other features such as reminders to be active, a tracker of how far you’ve walked, and sleep quality, but these weren’t part of this study.)

Over the five years of the study, volunteers took more than 50 billion steps. When each individual’s DHRPS was calculated and compared with their other health information, researchers found that higher scores were linked to an increased risk of

• type 2 diabetes
• high blood pressure (hypertension)
• coronary atherosclerosis, heart attack, and heart failure
• stroke.

The DHRPS had stronger associations with these diseases than either heart rate or step count alone. In addition, people with higher DHRPS scores were less likely to report good health than those who had the lowest scores. And among the 21 study subjects who had exercise stress testing, those with the highest DHRPS scores had the lowest capacity for exercise.

What counts as a higher score in this study?

In this study, DHRPS scores were divided into three groups:

• Low: 0.0081 or lower
• Medium: higher than 0.0081 but lower than 0.0147
• High: 0.0147 or higher.

How to make daily heart rate per step calculations

Here's how it works. Let’s say that over a one-month period your average daily heart rate is 80 and your average step count is 4,000. That means your DHRPS equals 80/4,000, or 0.0200. If the next month your average heart rate is still 80 but you take about 6,000 steps a day, your DHRPS is 80/6,000, or 0.0133. Since lower scores are better, this is a positive trend.

Should you start calculating your DHRPS?

Do the results described in this study tempt you to begin monitoring your DHRPS? You may decide to hold off until further research confirms actual health benefits from knowing that ratio.

This study merely explored the relationship between DHRPS and risk of diabetes or cardiovascular disease like heart attack or stroke. This type of study can only establish a link between the DHRPS and disease. It can’t determine whether a higher score actually causes them.

Here are four other limitations of this research to keep in mind:

• Participants in this study were likely more willing to monitor their activity and health than the average person. And more than 70% of the study subjects were female and more than 80% were white. The results could have been quite different outside of a research setting and if a more diverse group had been included.
• The findings were not compared to standard risk factors for cardiovascular disease, such as having a strong family history of cardiovascular disease or smoking cigarettes. Nor were DHRPS scores compared with standard risk calculators for cardiovascular disease. So the value of DHRPS compared with other readily available (and free) risk assessments isn’t clear.
• The exercise stress testing findings were based on only 21 people. That’s far too few to make definitive conclusions.
• The cost of a device to continuously monitor heart rate and steps can run in the hundreds of dollars; for many this may be prohibitive, especially since the benefits of calculating the DHRPS are unproven.

The bottom line

Tracking DHRPS or daily activity and other health measures might be a way to improve your health if the results prompt you to make positive changes in behavior, such as becoming more active. Or perhaps DHRPS could one day help your health care provider monitor your fitness, better assess your health risks, and recommend preventive approaches. But we don’t yet know if this new measure will actually lead to improved health because the study didn’t explore that.

If you already have a device that continuously monitors your daily heart rate and step count, feel free to do the math! Maybe knowing your DHRPS will motivate you to do more to lower your risk of diabetes and cardiovascular disease. Or maybe it won’t. We need more research and experience with this measure to know whether it can deliver on its potential to improve health.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share

Not such good news for butter lovers like myself: seesawing research on how healthy or unhealthy butter might be received a firm push from a recent Harvard study published in JAMA Internal Medicine. Drawing on decades of data gathered through long-term observational studies, the researchers investigated whether butter and plant oils affect mortality.

One basic takeaway? “A higher intake of butter increases mortality risk, while a higher intake of plant-based oil will lower it,” says Yu Zhang, lead author of the study. And importantly, choosing to substitute certain plant oils for butter might help people live longer.

What did the study find about butter versus plant oils?

The researchers divided participants into four groups based on how much butter and plant oils they reported using on dietary questionnaires. They compared deaths among those consuming the highest amounts of butter or plant oils with those consuming the least, over a period of up to 33 years.

Plant oils won out handily. A 15% higher risk of death was seen among those who ate the most butter compared with those who ate the least. A 16% lower risk of death was seen among those who consumed the highest amount of plant oils compared with those who consumed the least.

Higher butter intake also raised risk for cancer deaths. And higher plant oil intake cut the risk for dying from cancer or cardiovascular disease like stroke or heart attack.

While the study looked at five plant oils, only soybean, canola, and olive oil were linked with survival benefits. Swapping out a small amount of butter in the daily diet — about 10 grams, which is slightly less than a tablespoon — for an equivalent amount of those plant-based oils was linked with fewer total deaths and fewer cancer deaths, according to a modeling analysis.

How could substituting plant oils for butter improve health?

“Butter has almost no essential fatty acids and a modest amount of trans fat — the worst type of fat for cardiovascular disease,” Dr. Walter C. Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health and professor of medicine at Harvard Medical School, noted by email.

By contrast, the plant oils highlighted in this study are rich in antioxidants, essential fatty acids, and unsaturated fats, which research has linked to healthier levels of cholesterol and triglycerides and lower insulin resistance.

Especially when substituted for a saturated fat like butter, plant oils also may help lower chronic inflammation within the body. Making such substitutions aligns with American Heart Association recommendations and current Dietary Guidelines for Americans for healthful eating that lower risk for chronic disease.

And for the butter lovers? “A little butter occasionally for its flavor would not be a problem,” says Dr. Willett. “But for better health, use liquid plant oils whenever possible instead of butter for cooking and at the table.” Try sampling a variety of plant oils, like different olive oils, mustard oil, and sesame oil, to learn which ones you enjoy for different purposes, he suggests. Additionally, a blend or mix of butter with oils — or sometimes a bit of butter on its own — can satisfy taste buds.

What about study limitations and strengths?

The study crunched data collected through a questionnaire answered every four years by more than 221,000 adults participating in the Nurses’ Health Study, Nurses’ Health Study II, and Health Professionals Follow-Up Study. As is true of all observational studies, this type of research can’t prove cause and effect, although it adds to the body of evidence. Because most participants were white health care professionals, the findings may not apply to a wider population.

The researchers adjusted for many variables that can affect health, including age, physical activity, smoking status, and family history of illnesses like cancer and diabetes. The size of the study, the length of follow-up, and multiple adjustments like these are all strengths.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and associate editor of multimedia content for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast Cancer … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD Share

Prostatitis, or inflammation of the prostate, is more common than you might think — it accounts for roughly two million doctor visits every year. The troubling symptoms include burning or painful urination, an urgent need to go (especially at night), painful ejaculations, and also pain in the lower back and perineum (the space between the scrotum and anus).

Prostatitis overview

There are four general categories of prostatitis:

Acute bacterial prostatitis comes on suddenly and is often caused by infections with bacteria such as Escherichia coli that normally live in the colon. Men can suffer muscle aches, fever, and blood in semen or urine, as well as urogenital symptoms. Acute inflammation can cause the prostate to swell and block urinary outflow from the bladder. A complete blockage is a medical emergency that requires immediate treatment. Depending on symptom severity, hospitalization may be necessary.

Chronic bacterial prostatitis results from milder infections that sometimes linger for months. It occurs more often in older men and the symptoms typically wax and wane in severity, sometimes becoming barely noticeable.

Chronic nonbacterial prostatitis, also called chronic pelvic pain syndrome (CPPS), is the most common type. CPPS can be triggered by stress, urinary tract infections, or physical trauma causing inflammation or nerve damage in the genitourinary area. In some men, the cause is never identified. CPPS can affect the entire pelvic floor, meaning all the muscles, nerves, and tissues that support organs involved in bowel, bladder, and sexual functioning.

Asymptomatic inflammatory prostatitis is diagnosed when doctors detect white blood cells in prostate tissues or secretions in men being evaluated for other conditions. It generally requires no treatment.

Both acute and chronic bacterial prostatitis can cause blood levels of prostate-specific antigen (PSA) to spike. This can be alarming, since high PSA is also indicative of prostate cancer. But if a man has prostatitis, then that condition — and not prostate cancer — may very well be the reason for the rise in PSA.

Prostatitis treatments

Fortunately, research advances are leading to some encouraging developments for men suffering from this condition.

Antibiotics called fluoroquinolones are effective treatments for acute and chronic bacterial prostatitis. A four-to six-week course of the drugs typically does the trick. However, bacterial resistance to fluoroquinolones is a growing problem. An older drug called fosfomycin can help if other drugs stop working. PSA levels will decline with treatment, although that process may take three to six months.

CPPS is treated in other ways. Since it is not caused by a bacterial infection, CPPS will not respond to antibiotics. Medical treatments include nonsteroidal anti-inflammatory drugs such as ibuprofen, alpha blockers including tamsulosin (Flomax) that loosen tight muscles in the prostate and bladder neck, and drugs called PDEF inhibitors such as tadalafil (Cialis) that improve blood flow to the prostate.

Specialized types of physical therapy can provide some relief. One method called trigger point therapy, for instance, targets tender areas in muscles that tighten up and spasm. With another method called myofascial release, physical therapists can reduce tension in the connective tissues surrounding muscles and organs. Men should avoid Kegel exercises, however, which can tighten the pelvic floor and cause worsening symptoms.

Acupuncture has shown promise in clinical trials. One study published in 2023 showed significant improvements in CPPS symptoms lasting up to six months after the acupuncture treatments were finished. Mounting evidence suggest that CPPS should be treated with holistic strategies that also consider psychological factors.

Men with CPPS often suffer from depression, anxiety, and other mental health issues that can exacerbate pain perception. Techniques such as mindfulness and cognitive behavioral therapy for CPPS can help CPPS sufferers develop effective coping strategies.

Comment

“An accurate diagnosis is important given differences in how each of the four categories of prostatitis is treated,” said Dr. Boris Gershman, a urologist at Beth Israel Deaconess Medical Center and assistant professor of surgery at Harvard Medical School. PSA should also be retested after treating bacterial forms of prostatitis, Dr. Gershman added, to ensure that the levels go back to normal. If the PSA stays elevated after antibiotic treatment, or if abnormal levels are detected in men with nonbacterial prostatitis, then the PSA “should be evaluated in accordance with standard diagnostic approaches,” Dr. Gershman said.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

C.W. Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, he has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by C.W. Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD Share

It’s fairly common for a medical treatment to cause side effects: think headache, upset stomach, sleepiness, and occasionally more severe side effects. Far more rarely, a side effect provides an unexpected benefit. This might be the case for the shingles vaccine.

Shingles is a painful, blistering skin rash caused by the varicella zoster virus responsible for chickenpox. The virus lies dormant in nerve tissue and can reactivate to cause shingles in anyone who has had chickenpox in the past. A vaccine to prevent shingles is recommended for adults ages 50 and older, and for people 19 and older who have an impaired immune system.

While we know the shingles vaccine is effective at preventing shingles, evidence is mounting that it might also reduce the risk of dementia. Yes, a vaccination to prevent shingles may lessen your risk of dementia.

Dementia is on the rise

Dementia is a devastating condition for those affected and their families. Currently, an estimated nine million people in the US have dementia. The number is expected to double by 2060, primarily because of the aging population. In most cases, no highly effective treatments are available. An effective preventive measure could have an enormous impact, especially if it’s safe, inexpensive, and already available.

Can shingles vaccination prevent dementia?

Some (though not all) studies have found that having shingles increases your risk of dementia in the future. And that’s led researchers to explore the possibility that preventing shingles through vaccination might reduce dementia risk.

Several studies suggest this is true. For example:

• A study of more than 300,000 adults found that among those 70 and older, dementia was less common among those who had received shingles vaccination than among those who did not.
• A study of more than 200,000 older adults compared rates of dementia between those receiving a newer (recombinant) shingles vaccine and those who had an older (live) vaccine that is no longer approved in the US. Researchers found that the risk of dementia was lower six years after receiving either vaccine. But the effect was larger for the newer vaccine: those given the recombinant vaccine spent more time living dementia-free (164 days longer) compared with those given the older vaccine.

What is a natural experiment?

Perhaps the best evidence suggesting that shingles vaccination prevents dementia comes from a natural experiment recently published in the journal Nature.

A natural experiment takes advantage of real-world circumstances by dividing people into an exposed group and an unexposed group and then comparing specific outcomes.

• Examples of exposures might be an illness (like the COVID pandemic), a policy (like a smoking ban in one state), or a vaccination (like the shingles vaccine).
• Outcomes might include virtual versus in-person learning during the pandemic, smoking-related illnesses in a state with a smoking ban compared to a state without that ban, or dementia rates among people who did or didn’t receive a vaccine.

Natural experiment studies bypass the challenges of having to recruit hundreds or thousands of study subjects who might differ from one another in important ways, or who might alter their behavior because they know they’re in a study. The results can be even more valuable than — and as credible as — standard randomized trials.

What did this natural experiment study look at?

In 2013, Wales made the shingles vaccination available to individuals based on their date of birth: anyone born after September 2, 1933, was eligible, while anyone born before that date was not. Researchers took this opportunity to analyze health records of nearly 300,000 people: half were two weeks older than the cutoff date and half were two weeks younger. The study looked at whether people developed dementia over a seven-year period.

Researchers found that compared to those who didn’t get the shingles vaccination, those who received it

• developed shingles less often
• were 3.5% less likely to develop dementia over seven years (a 20% reduction)
• were more likely to be protected from dementia if female.

A study of this type cannot prove that shingles vaccination prevents dementia. But along with the studies cited above, there’s a strong suggestion that it does. We’ll need additional studies to confirm the benefit. We also want to understand other details of the vaccine’s effect, such as whether protection applies more to some types of dementia (such as Alzheimer’s disease) than others, and whether the effect of vaccination changes over time.

Why might the shingles vaccine prevent dementia?

With any unexpected finding in science, it’s a good idea to ask whether there is a reasonable explanation behind it. Scientists call this biologic plausibility. In general, the more plausible a result is, the more likely it is to hold up in later research.

In this case, several lines of reasoning explain how a shingles vaccine might reduce the risk of dementia, including:

• Reduced inflammation: Preventing shingles may prevent harmful inflammation in the body, especially in the nervous system.
• Impact on immune function: Vaccination might alter immune function in a way that protects against dementia.
• Reducing stroke risk: Some evidence shows that shingles may increase the risk of stroke. A stroke can contribute to or cause dementia, so perhaps vaccination leads to less dementia by reducing shingles-related strokes.

The observation that women had more protection from dementia than men after shingles vaccination is unexplained. It’s possible that the immune response to vaccination is different in women, or that dementia develops differently in women compared with men.

The bottom line

All of us can take steps to lower dementia risk, mostly through healthy behaviors such as being active regularly and choosing a healthy diet. Evidence is mounting that shingles vaccination should be added to the list. It’s a story worth following. Future studies of the shingles vaccine could even provide insights into how dementia develops, and how to better prevent and treat it.

Until then, get your shingles vaccination if you’re eligible for it. It can prevent painful episodes of shingles — and may do much more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share

Ever wonder if every medical test or treatment you've taken was truly necessary? Or are you inclined to get every bit of health care you can? Maybe you feel good about getting the most out of your health insurance. Perhaps a neighborhood imaging center is advertising discounted screening tests, your employer offers health screens as a perk, or you're intrigued by ads touting supplements for a seemingly endless number of conditions.

But keep in mind: just because you could get a particular test or treatment or take a supplement doesn't mean you should. One study suggests that as much as 20% of all health care in the US is unneeded. In short: when it comes to health care, more is not always better.

Isn't it better to be proactive about your health?

We're all taught that knowledge is power. So it might seem reasonable to want to know as much as possible about how your body is working. And isn't it better to take action before there's a problem rather than waiting for one to develop? What's the harm of erring on the side of more rather than less?

The truth is that knowledge is not always power: if the information is irrelevant to your specific situation, redundant, or inaccurate, the knowledge gained through unnecessary health care can be unhelpful or even harmful. Unnecessary tests, treatments, and supplements come with risks, even when they seem harmless. And, of course, unnecessary care is not free — even if you're not paying a cent out of pocket, it drives up costs across health systems.

Screening tests, wellness strategies, and treatments to reconsider

Recommended screening tests, treatments, and supplements can be essential to good health. But when risks of harm outweigh benefits — or if proof of any benefit is lacking — think twice. Save your time, money, and effort for health care that is focused on the most important health threats and backed by evidence.

Cancer screening: When to stop?

Screening tests for some cancers are routinely recommended and can be lifesaving. But there's a reason they come with a recommended stop age. For instance, guidelines recommend that a person at average risk of colorectal cancer with previously normal colonoscopies stop having them once they turn 75. Similar limits apply to Pap smears (age 65) and mammograms (age 75). Studies suggest that beyond those ages, there is little benefit to continuing these screens.

Watch out for wellness marketing

Dietary supplements are a multibillion-dollar industry. And a whopping 70% or more of US adults take at least one, such as vitamin D, fish oil, or a multivitamin. People often consider them as insurance in case vital elements are missing from their diet, or they believe supplements can prevent dementia, heart disease, or another condition.

Yet little evidence supports a benefit of routine supplement use for everyone. While recent studies suggest a daily multivitamin might slow cognitive decline in older adults, there's no medical consensus that everyone should be taking a multivitamin. Fish oil (omega-3) supplements haven't proven to be as healthful as simply eating servings of fatty fish and other seafood low in toxic chemicals like mercury and PCBs. And the benefits of routinely taking vitamin D supplements remain unproven as well.

It's worth emphasizing that dietary supplements clearly provide significant benefit for some people, and may be recommended by your doctor accordingly. For example, if you have a vitamin or mineral deficiency or a condition like age-related macular degeneration, good evidence supports taking specific supplements.

Reconsider daily aspirin

Who should be taking low-dose aspirin regularly? Recommendations have changed in recent years, so this is worth revisiting with your health care team.

• Older recommendations favored daily low-dose aspirin to help prevent cardiovascular disease, including first instances of heart attack and stroke.
• New recommendations favor low-dose aspirin for people who've already experienced a heart attack, stroke, or other cardiovascular disease. Adults ages 40 to 59 who are at a high risk for these conditions and low risk for bleeding also may consider it.

Yet according to a recent study, nearly one-third of adults 60 and older without past cardiovascular disease take aspirin, despite evidence that it provides little benefit for those at average or low risk. Aspirin can cause stomach bleeding and raise risk for a certain type of stroke.

Weigh in on prostate cancer screening

Men hear about prostate cancer often. It's common, and the second leading cause of cancer deaths among men. But PSA blood tests and rectal exams to identify evidence of cancer in the prostate are no longer routinely recommended for men ages 55 to 69 by the United States Preventative Services Task Force.

The reason? Studies suggest that performing these tests does not reliably reduce suffering or prolong life. Nor do possible benefits offset downsides like false positives (test results that are abnormal despite the absence of cancer). That can lead to additional testing, some of which is invasive.

Current guidelines suggest making a shared decision with your doctor about whether to have PSA testing after reviewing the pros and cons. For men over age 70, no screening is recommended. Despite this, millions of men have PSA tests and rectal examinations routinely.

Not everyone needs heart tests

There are now more ways than ever to evaluate the health of your heart. But none are routinely recommended if you're at low risk and have no signs or symptoms of cardiovascular disease. That's right: in the absence of symptoms or a high risk of cardiovascular disease, it's generally safe to skip EKGs, stress tests, and other cardiac tests.

Yet many people have these tests as part of their routine care. Why is this a problem? Having these tests without a compelling reason comes with risks, especially false positive results that can lead to invasive testing and unneeded treatment.

Four more reasons to avoid unnecessary care

Besides the concerns mentioned already, there are other reasons to avoid unnecessary care, including:

• The discomfort or complications of testing. If you're needle-phobic, getting a blood test is a big deal. And while complications of noninvasive testing are rare (such as a skin infection from a blood test), they can occur.
• The anxiety associated with waiting to find out test results
• False reassurance that comes with false negatives (results that are normal or nearly so, suggesting no disease when disease is actually present)
• All treatments have side effects. Even minor reactions — like occasional nausea or constipation — seem unacceptable if there's no reason to expect benefit from treatment.

The bottom line

You may believe your doctor wants you to continue with your current schedule of tests and treatments, while they might think this is your preference! It's worth discussing if you haven't already, especially if you suspect you may be taking pills or getting tests you don't truly need.

If your doctor says you can safely skip certain tests, treatments, and supplements, it doesn't mean that he or she is neglecting your health or that you don't deserve great health care! It's likely that the balance of risks and benefits simply doesn't support doing these things.

Less unnecessary care could free up resources for those who need it most. And it could save you time, money, and unnecessary risks or side effects, thus improving your health. It's a good example of how less can truly be more.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share

Everything is connected. You’ve probably heard that before, but it bears repeating. Below are five ways to boost both your individual health and the health of our planet — a combination that environmentalists call co-benefits.

How your health and planetary health intersect

Back in 1970, Earth Day was founded as a day of awareness about environmental issues. Never has awareness of our environment seemed more important than now. The impacts of climate change on Earth — fires, storms, floods, droughts, heat waves, rising sea levels, species extinction, and more — directly or indirectly threaten our well-being, especially for those most vulnerable. For example, air pollution from fossil fuels and wildfires contributes to lung problems and hospitalizations. Geographic and seasonal boundaries for ticks and mosquitoes, which are carriers of infectious diseases, expand as regions warm.

The concept of planetary health acknowledges that the ecosystem and our health are inextricably intertwined. Actions and events have complex downstream effects: some are expected, others are surprising, and many are likely unrecognized. While individual efforts may seem small, collectively they can move the needle — even ever so slightly — in the right direction.

Five ways to improve personal and planetary health

Adopt plant-forward eating.

This means increasing plant-based foods in your diet while minimizing meat. Making these types of choices lowers the risks of heart disease, stroke, obesity, high blood pressure, type 2 diabetes, and many cancers. Compared to meat-based meals, plant-based meals also have many beneficial effects for the planet. For example, for the same amount of protein, plant-based meals have a lower carbon footprint and use fewer natural resources like land and water.

Remember, not all plants are equal.

Plant foods also vary greatly, both in terms of their nutritional content and in their environmental impact. Learning to read labels can help you determine the nutritional value of foods. It’s a bit harder to learn about the environmental impact of specific foods, since there are regional factors. But to get a general sense, Our World in Data has a collection of eye-opening interactive graphs about various environmental impacts of different foods.

Favor active transportation.

Choose an alternative to driving such as walking, biking, or using public transportation when possible. Current health recommendations encourage adults to get 150 minutes each week of moderate-intensity physical activity, and two sessions of muscle strengthening activity. Regular physical activity improves mental health, bone health, and weight management. It also reduces risks of heart disease, some cancers, and falls in older adults. Fewer miles driven in gas-powered vehicles means cleaner air, decreased carbon emissions contributing to climate change, and less air pollution (known to cause asthma exacerbations and many other diseases).

Start where you are and work up to your level of discomfort.

Changes that work for one person may not work for another. Maybe you will pledge to eat one vegan meal each week, or maybe you will pledge to limit beef to once a week. Maybe you will try out taking the bus to work, or maybe you will bike to work when it’s not winter. Set goals for yourself that are achievable but are also a challenge.

Talk about it.

It might feel as though these actions are small, and it might feel daunting for any one individual trying to make a difference. Sharing your thoughts about what matters to you and about what you are doing might make you feel less isolated and help build community. Building community contributes to well-being and resilience.

Plus, if you share your pledges and aims with one person, and that person does the same, then your actions are amplified. Who knows, maybe one of those folks along the way might be the employee who decides what our children eat from school menus, or a city planner for pedestrian walkways and bike lanes!

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD Share

Looking after a loved one who has prostate cancer can be overwhelming. Caregivers — usually partners, family members, or close friends — play crucial roles in supporting a patient's physical and psychological well-being. But what does that entail? You as a caregiver might not know what to say or how to help.

"Patients diagnosed with advanced cancer are facing their own mortality," says Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. "And they each process that in different ways."

Dr. Garnick emphasizes the need provide patients and families with the best information possible about the specifics of the diagnosis, symptoms, and available treatments. Some patients have near-miraculous responses to treatment, he says, even when they have very advanced cancer. "We let patients know that there are reasons to be optimistic, as treatments are improving on a regular basis," he says.

Communication

Dr. Garnick points out that clinicians should avoid words or phrases that can leave cancer patients feeling unempowered. A phrase like "Let's not worry about that now," for instance, is dismissive and doesn't respond to a patient's legitimate concerns. Saying "You're lucky your cancer is only stage 2" doesn't allow for the fear and anxiety a patient may have over his disease.

Along similar lines, "It's important for caregivers to be receptive to what their loved ones are saying," Dr. Garnick says. "Instead of minimizing or questioning what your loved one is telling you, try asking 'What do you need? Tell me what you think is going to help you feel better.'"

While it's natural to offer reassurance, you should also give your loved one space to express himself openly without offering quick solutions. Be aware that treatment can lead to emotional ups and downs, so expect mood fluctuations.

One of the most valuable tools you have as a caregiver is the relationship you've built with your loved one over the years. During this challenging time, remind yourself of the bonds you've created together. Shared memories, inside jokes, and mutual interests can provide strength and comfort.

Day-to-day practical support

Managing medications can be challenging. Cancer patients can take a dozen or more pills per day on varying schedules. You can help your loved one stay on track by setting up a pill organizer (available at most drugstores) that sorts medications according to when they're needed.

Patients with advanced prostate cancer are now being treated more often with drug combinations that include chemotherapy as well as hormonal therapies. Chemotherapy can leave patients feeling unusually cold, and patients may also get cold after experiencing hot flashes from hormonal therapy. So keep lots of blankets and warm hats on hand.

Collaborate on a journal where you and your loved one keep health information in one place. It should contain the names and contacts of clinicians on his team, as well as details of his treatment plan. The journal can also double as a diary where you both record treatment experiences.

You might be tasked with coordinating medical appointments. It's important to keep lists of questions you may have. Take notes so you have a record of what doctors and other people on his care team have told you. Also, you should take some time to familiarize yourself with your loved one's insurance policies or Medicare plans so you have a better understanding of what's covered.

Don't forget to take care of yourself!

As a caregiver, it's easy to get lost in your loved one's needs. But caring for someone with cancer while managing household responsibilities can also leave you feeling isolated, burned out, and even depressed. It's essential to also prioritize your own health and well-being.

Make sure that you get enough sleep and exercise. Keep up with your own checkups and screening. Try to eat well, and prepare meals ahead of time to reduce stress and save time on busy days. Take breaks! Caregiving can be intense, so take time to recharge by taking a walk, reading a book, or spending time with friends.

Here are some valuable resources that can help.

Help for Cancer Caregivers provides support on managing feelings and emotions, keeping healthy, day-to-day needs, working together, and long-distance caregiving.

The Prostate Cancer Foundation provides an array of educational materials, including a "caregiver's toolkit" that helps caregivers understand treatment options, side effects, and ways to be actively involved in the decision-making process.

The Patient Advocate Foundation offers case management services to help caregivers and patients understand insurance coverage, financial assistance programs, and other resources that can reduce the financial burden of cancer treatment.

About the Author

C.W. Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

C.W. Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, he has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by C.W. Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD Share

Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. “Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood,” says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don’t have these symptoms.

What’s more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don’t have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.

Myth # 1: Celiac disease is usually diagnosed at a young age

Not typically. While celiac disease can develop any time after a baby’s first exposure to gluten, it’s usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.

Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto’s thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).

“We don’t know why some people go from being susceptible to actually having celiac disease,” says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may “flip the switch” and cause the disease to appear, he says. “Increasing numbers of people are being diagnosed at midlife and older, often after they’re found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies,” says Dr. Kelly.

Myth #2: Celiac disease only affects the gut

When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.

While gastrointestinal problems can occur, they aren’t always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.

Myth # 3: Celiac disease versus gluten intolerance

If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.

• Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
• Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.

“Non-celiac gluten sensitivity appears to be a real phenomenon, but it’s not well defined,” says Dr. Kelly. It’s unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.

• One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
• Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.

Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease

The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn’t always help. This problem is known as nonresponsive celiac disease.

“About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet,” says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.

Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:

• Enzymes that break down gluten, which people could take alongside gluten-containing foods. “It’s a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products,” says Dr. Kelly.
• Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
• Reprogramming the immune response to prevent the body from reacting to gluten.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD Share

Has the recent news about measles outbreaks in the US surprised you? Didn’t it seem like we were done with measles?

In the US, widespread vaccination halted the ongoing spread of measles more than 20 years ago, a major public health achievement. Before an effective vaccine was developed in the 1960s, nearly every child in the US got measles. Complications like measles-related pneumonia or hearing loss were common, and 400 to 500 people died each year.

As I write this, there have been 1,288 confirmed cases in 38 states, mostly among children. This is the largest number of cases in a year since 2000, when the disease was declared eliminated in the U.S.

The biggest outbreak is in west Texas, where 98 people have been hospitalized and two unvaccinated school-age children recently died, the first measles deaths in the US since 2015. Officials in New Mexico have also reported a measles-related death.

Can we prevent these tragedies?

Measles outbreaks are highly preventable. It’s estimated that when 95% of people in a community are vaccinated, both those individuals and others in their community are protected against measles.

But nationally, measles vaccination rates among school-age kids fell from 95% in 2019 to 92% in 2023. Within Texas, the kindergarten vaccination rates have dipped below 95% in about half of all state counties. In the community at the center of the west Texas outbreak, the reported rate is 82%. Declining vaccination rates are common in other parts of the US, too, and that leaves many people vulnerable to measles infections.

Only 4% of the recent cases in the US involved people known to be fully vaccinated. The rest were either unvaccinated or had unknown vaccine status (92%), or they had received only one of the two vaccine doses (4%).

What to know about measles

As measles outbreaks occur within more communities, it’s important to understand why this happens — and how to stop it. Here are seven things to know about measles.

The measles virus is highly contagious

Several communities have suffered outbreaks in recent years. The measles virus readily spreads from person to person through the air we breathe. It can linger in the air for hours after a sneeze or cough. Estimates suggest nine out of 10 nonimmune people exposed to measles will become infected. Measles is far more contagious than the flu, COVID-19, or even Ebola.

Early diagnosis is challenging

It usually takes seven to 14 days for symptoms to show up once a person gets infected. Common early symptoms — fever, cough, runny nose — are similar to other viral infections such as colds or flu. A few days into the illness, painless, tiny white spots in the mouth (called Koplik spots) appear. But they’re easy to miss, and are absent in many cases. A day or two later, a distinctive skin rash develops.

Unfortunately, a person with measles is highly contagious for days before the Koplik spots or skin rash appear. Very often, others have been exposed by the time measles is diagnosed and precautions are taken.

Measles can be serious and even fatal

Measles is not just another cold. A host of complications can develop, including

• brain inflammation (encephalitis), which can lead to seizures, hearing loss, or intellectual disability
• pneumonia
• eye inflammation (and occasionally, vision loss)
• poor pregnancy outcomes, such as miscarriage
• subacute sclerosing panencephalitis (SSPE), a rare and lethal disease of the brain that can develop years after the initial measles infection.

Complications are most common among children under age 5, adults over age 20, pregnant women, and people with an impaired immune system. Measles is fatal in up to three of every 1,000 cases.

During the latest outbreaks, 162 cases — about one in eight — have required hospitalization.

Getting measles may suppress your immune system

When you get sick from a viral or bacterial infection, antibodies created by your immune system will later recognize and help mount a defense against these intruders. In 2019, a study at Harvard Medical School (HMS) found that the measles virus may wipe out up to three-quarters of antibodies protecting against viruses or bacteria that a child was previously immune to — anything from strains of the flu to herpesvirus to bacteria that cause pneumonia and skin infections.

“If your child gets the measles and then gets pneumonia two years later, you wouldn’t necessarily tie the two together. The symptoms of measles itself may be only the tip of the iceberg,” said the study’s first author, Dr. Michael Mina, who was a postdoctoral researcher in the laboratory of geneticist Stephen Elledge at HMS and Brigham and Women’s Hospital at the time of the study.

In this video, Mina and Elledge discuss their findings.

Vaccination is highly effective

Two doses of the current vaccine provide 97% protection — much higher than most other vaccines.  Rarely, a person gets measles despite being fully vaccinated. When that happens, the disease tends to be milder and less likely to spread to others.

The measles vaccine is safe

 The safety profile of the measles vaccine is excellent. Common side effects include temporary soreness in the arm, low-grade fever, and muscle pain, as is true for most vaccinations. A suggestion that measles or other vaccines cause autism has been convincingly discredited. However, this often-repeated misinformation has contributed to significant vaccine hesitancy and falling rates of vaccination.

Ways to protect yourself from measles infection

• Vaccination. Usually, children are given the first dose around age 1 and the second between ages 4 and 6 as part of the Measles-Mumps-Rubella (MMR) vaccine. If a child — or adult — hasn’t been vaccinated, they can have these doses later.

  If you were born after 1957 and received a measles vaccination before 1968, consider getting revaccinated or tested for measles antibodies (see below). The vaccine given before 1968 was less effective than later versions. And before 1957, most people became immune after having measles, although this immunity can wane.

• Isolation. To limit spread, everyone diagnosed with measles and anyone who might be infected should avoid close contact with others until four days after the rash resolves.
• Mask-wearing by people with measles can help prevent spread to others. Household members or other close contacts should also wear a mask to avoid getting it.
• Frequent handwashing helps keep the virus from spreading.
• Testing. If you aren’t sure about your measles vaccination history or whether you may be vulnerable to infection, consider having a blood test to find out if you’re immune to measles. Memories about past vaccinations can be unreliable, especially if decades have gone by, and immunity can wane.
• Pre-travel planning. If you are headed to a place where measles is common, make sure you are up to date with vaccinations.

The bottom line

While news about measles in recent months may have been a surprise, it’s also alarming. Experts warn that the number of cases (and possibly deaths) are likely to increase. And due to falling vaccination rates, outbreaks are bound to keep occurring. One study estimates that between nine and 15 million children in the US could be susceptible to measles.

But there’s also good news: we know that measles outbreaks can be contained and the disease itself can be eliminated. Learn how to protect yourself and your family. Engage respectfully with people who are vaccine hesitant: share what you’ve learned from reliable sources about the disease, especially about the well-established safety of vaccination.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD Share