Are the Health Risks of Smoking Reversible?

by Mark A. Kelley

This blog originally appeared on HealthWeb Navigator.

As a lung specialist, I am often asked whether the body can recover from many years of smoking. Based on decades of research, the answer is a resounding “Yes” … but only if you quit smoking — completely.

 

What Are The Risks of Smoking?

Cigarette smoking kills over 480,000 Americans each year — more than the combined deaths from alcohol, illegal drug use, homicide, suicide, car accidents, and AIDS combined.

Cancer – Before cigarette smoking became widespread in the twentieth century, lung cancer was a rare disease. However, as smoking became popular, lung cancer rose to become a leading cause of death. Scientific research demonstrated that the toxic chemicals in cigarette smoke are carcinogenic. Smoking is also associated with cancers of the throat and digestive tract.

Heart and Vascular Disease – There is a strong association between smoking and the development of atherosclerosis, the “hardening of the arteries” that causes heart attacks, strokes and aneurysms. These conditions are among the major causes of death in smokers. A heart attack is 2-4 times more likely in a smoker than a non-smoker. Quitting smoking is the single most effective way to reduce the risk of a future heart attack.

Lung Injury and COPD  – A person’s first puff from a cigarette invariably causes coughing. This is the body’s warning sign that inhaled smoke is damaging the lungs. Cigarette smoke irritates the lung’s bronchial tubes, causing mucus production. The smoke also paralyzes the cells that clear mucus and debris out of the lung. Over time, cigarette smoke causes mucus plugging, swelling and, sometimes, destruction of the bronchial tubes. This makes the lung more vulnerable to infections. When bronchial tubes are blocked or distorted, it is also much harder to move air in and out of the lung. This condition, called chronic obstructive pulmonary disease (COPD), is a leading cause of death and disability.

Nicotine Addiction – Nicotine is one of the most addictive substances known — often compared to heroin. Nicotine withdrawal produces symptoms similar to opiates, which is why is it so difficult to quit smoking. Cigarette smoke delivers nicotine immediately to brain areas associated with pleasurable sensations. Nicotine also increases heart rate and blood pressure, and constricts blood vessels.  This puts strain on the heart and promotes vascular disease.

 

If You Quit Smoking, Health Risks Fall Dramatically.

Cancer – Smoking cessation for 10 years cuts the risk of lung cancer in half. The reason is that the lung is no longer exposed to the carcinogens in cigarette smoke. With continued abstinence from smoking, the risk continues to decline. Similar results have been seen with laryngeal and other forms of cancer.

Heart and Vascular Disease – For someone with known coronary artery disease (CAD), smoking cessation reduces the risk of a future cardiac event by 50%. For someone without CAD, quitting smoking for one year reduces the risk of CAD by 50%. If abstinence continues for 15 years, the risk of future heart events is almost the same as a lifetime non-smoker. The same is true for the risk of stroke.

COPD – Smokers expose their lungs to the constant irritation of cigarette smoke, and have a faster decline in lung function than non-smokers. This decline occurs slowly and is not noticeable until the lung function is so low that it affects everyday activity. At that point, smoking cessation will reduce lung irritation but the chronically diseased lung cannot repair years of damage. The best strategy is to stop smoking before significant damage has occurred. The good news is smoking cessation can halt the rapid decline in lung function before more damage occurs.

Nicotine Addiction – Most smokers want to quit smoking but nicotine withdrawal is a major obstacle. As the old saying goes, “if it were easy, everyone would do it.” Most smokers who try to quit fail multiple times. However, the encouraging statistic is that millions of Americans have kicked the habit. The best results come from planned programs to break the nicotine addiction and eliminate lifestyle habits associated with smoking.

 

In summary, smoking has life-threatening health care risks.  Once a person stops smoking, these risks decline significantly over time. While kicking the habit is challenging, the health benefits are enormous. It is never too late to quit.

For more information about smoking and health risks,  see the Centers for Disease Control (CDC) and the American Lung Association.

Meeting the Medicine Information Needs of Americans with Vision Loss  

The Facts

Photo by Nathan Dumlao

More than 3.4 million (3%) Americans aged 40 years and older are either legally blind (having visual acuity [VA] of 20/200 or worse or a visual field of less than 20 degrees) or are visually impaired (having VA of 20/40 or less). The Federal Interagency Forum on Aging Related Statistics estimates that 17% of the age 65 and older population report “vision trouble.” Twenty-one million Americans report functional vision problems or eye conditions that may compromise vision. Older people are more likely to experience vision loss because of age-related eye diseases.

Prevalence of Visual Disability

The following estimates (for adult’s age 16 and older reporting significant vision loss, who were in the non-institutionalized, civilian population) are derived from the American Community Survey results for 2016, as interpreted by Cornell University’s Employment and Disability Institute (EDI), unless otherwise credited.  

The number of non-institutionalized, male or female, ages 16 through 75 +, all races, regardless of ethnicity, with all education levels in the United States reported to have a visual disability in 2016:

  • Total (all ages): 7,675,600 (2.4%)
    • Total (16 to 75+): 7,208,700 (2.83%)
      • Women: 3,946,300 (3.01%)
      • Men: 3,262,300 (2.65%)
      • Age 16 to 64: 4,037,600 (2.0%)
      • Age 65 and older: 3,171,100 (6.6%)

According to the American Foundation for the Blind (AFB), a rapidly increasing proportion of the aging adult population experiences eye problems that make simple daily tasks difficult or impossible, even when wearing glasses or contact lenses.  The risk of severe eye problems has been found to increase significantly with age, particularly in those over age 65. More alarmingly, the trend is expected to continue to grow significantly as the baby boom generation continues to age. Experts predict that by 2030, rates of vision loss will double along with the country’s aging population.

The leading cause of vision impairment and blindness among older adults in the U.S. is age-related eye disease, including macular degeneration, cataracts, diabetic retinopathy, and glaucoma. Physiologic changes in vision that occur with age, such as loss of near focus, reduced contrast sensitivity, decreased color vision and some loss of peripheral (side) vision compound a reduction in visual acuity.

 

There are many medication safety issues associated with vision loss.  Low vision and blindness affect a person’s ability to read prescription labels and information sheets about medications, determine the color and markings distinguishing a medication, and see gauges on testing devices. People who cannot read prescription labels or distinguish among different medications must rely on memory or depend on someone else for help, and may not take their medications correctly or at all.  Not all vision loss is the same and the issues differ depending on the nature of the visual impairment. For example, the needs of people with glaucoma who have tunnel vision are different from those with macular degeneration who have central vision loss. Also, individuals who are blind have different issues from individuals with low vision. Individuals who are blind may need audible devices, tactile devices, or Braille.

 

Addressing a Growing Problem

In response to a federally-mandated effort to increase access to medications for all populations, in 2013, the U.S. Access Board created a series of recommendations focusing on adults who are blind or visually impaired and especially older adults many of whom are older than 60 years and may be more likely to take multiple medications and have caregivers or family members helping administer their prescriptions. The recommendations are contained in a report, “Best Practices for Making Prescription Drug Container Label Information Accessible to Persons Who are Blind or Visually-Impaired or Who are Elderly.” This guidance is advisory only and not mandatory. Pharmacies are not obligated to follow the best practice recommendations.

  • Here are a few other tips to share:
    • Safely dispose of medication once it is expired. This will help reduce the number of bottles sitting around unnecessarily and can help cut down on drug diversion.
    • Use dark trays, as they provide the best contrast against most medications. 
    • Keep a light or magnifying glass near where you take your medicines each day.  

 

 

(With permission from the American Pharmacists Association, this blog was adapted from “Counseling patients who are blind or visually impaired,” Pharmacy Today, Page 26, March 1, 2014)

BeMedWise

BeMedWise was launched in 2017 by the National Council on Patient Information and Education (NCPIE). NCPIE was established in 1982 in Washington, D.C. as one of the original patient safety coalitions. It became recognized as a trusted source of educational resources for patients, caregivers, healthcare professionals and the general public.

In July 2018, the operation of NCPIE and its programs, including ground-breaking research on patient-healthcare provider engagement and medicine communication, were assumed by NeedyMeds. Harnessing the expertise and reach of the BeMedWise partners, committed stakeholder groups and program sponsors, BeMedWise will sustain the NCPIE mission to improve health and stimulate high-quality medicine safe use conversations between healthcare professionals, patients, and caregivers.   

Doctors Prescribe Too Many Medications

This blog post originally appeared on Zaggocare.org

Medications save lives and make life more bearable for millions of people. No doubt about it. But medications can also cause harm. Logically, the more medications a patient takes, the higher the risk of side effects and dangerous interactions between medications. Did you know many patients take inappropriate or unnecessary medications? Unfortunately, over-prescribing is a widespread, dangerous problem in the US, especially for older patients (categorized as those 65+ years old). Why do doctors prescribe too many medications? What harm does it cause? And what can patients do?

An extensive report by the Lown Institute examines the impact of over-prescribing in older patients. Their report states that the US “is in the grips of an unseen epidemic of harm from the excessive prescribing of medications.” This important, often overlooked issue may impact your health, or the health of a loved one.

 

What are the dangers associated with medications?

Although medications are designed to help patients, they can also cause health issues. All medications have side effects. Some are potentially serious, while others are minor. But it’s important to understand that all medications carry some degree of risk. There are two major issues of concern – side effects and adverse drug reactions.

Adverse drug reactions (ADR) involve an unexpected or dangerous reaction to a medication. You can develop an ADR after one dose of medication, from prolonged use of a drug, or from a negative interaction between 2 or more medications.

The more medications you take, the higher your risk of problems, an issue called medication overload.

 

What is Medication Overload?

According to the Lown Institute report, medication overload is “the use of multiple medications for which the harm to the patient outweighs the benefit. There is no strict cutoff for when the number of medications becomes harmful, but the greater number of medications a person is taking, the greater their likelihood of experiencing harm, including serious adverse drug events.”

 

It’s as serious as the opioid crisis!

The Lown Institute reports that “medication overload is causing widespread yet unseen harm to our parents and our grandparents. It is every bit as serious as the opioid crisis, yet its scope remains invisible to many patients and health care professionals.”

 

How many medications are older Americans taking?

Older Americans, as a group, are taking a lot of medication:

  • More than 40% of older adults take 5 or more prescription medications a day, an increase of 300% over the past two decades!
  • Almost 20% of older adults take at least ten medications.

 

What is the impact of medication overload?

Health issues from medication overload can range from mild to life threatening. And the economic ramifications are staggering.

The Lown Institute report found that in 2018, in the US:

  • Medication issues led older adults to seek medical care nearly 5 million times.
  • Every day approximately 750 older people end up hospitalized due to medications, for a total of over 250,000 hospitalized patients/year.
  • These hospitalizations cost an estimated $3.8 billion.

 

Over the last decade:

  • There were over 35 million cases of older people seeking medical treatment for adverse drug events.
  • Medication issues led to 2 million hospital admissions.

 

The Lown Institute estimates that if changes are not made, in the next 10 years medication overload will lead to premature deaths for 150,000 older Americans and reduce the quality of life for millions more. Furthermore, the report estimates that reducing inappropriate or unnecessary medications could save as much as $62 billion over the next 10 years. And that’s only for money saved by avoiding unnecessary hospitalization for older adults. Certainly, there could be huge additional savings by keeping all patients, of all ages, healthier by reducing medication overload across the board.

 

What factors lead to medication overload?

Although many factors influence medication overload, the Lown Institute report identifies 3 overarching issues:

Culture of Prescribing

The culture of prescribing is shifting. Doctors and patients feel the need to “do something” to improve patient health. Ads for prescription medications encourage patients to seek medications for improved happiness and health. The practice of medicine is fast paced, with doctors often seeing patients in time-limited slots. Additionally, we have adopted a medical approach to normal aging. All these factors have led to a shared expectation among doctors and patients that there is a “pill for every ill.”

Information & Knowledge Gaps

Doctors and other clinicians, as well as patients, don’t always have the critical information and skills they need to evaluate the circumstances and make informed decisions regarding medications.

Fragmented Care

There is a widespread lack of communication among a patient’s various doctors and other healthcare providers. As a result, patients can suffer. One common scenario: one doctor writes prescriptions for what seems like a new health condition but is actually a side effect from another medication prescribed by another doctor. This practice, referred to as “prescribing cascade”, can lead to a cycle of debilitating health and even death.

 

A story of a devastating prescription cascade.

The story below illustrates how medication overload, due to a prescription cascade, killed Joe Esposito.

Joe Esposito was remarkably healthy, running half-marathons in his 50s. Unfortunately, a slew of medications left him on the brink of death in just a few years. Joe suffered from mild to moderate Crohn’s disease, an annoying, but rarely fatal condition. Through the process of seeking treatment, his list of medications cascaded from 1 to 6 to 20. Unfortunately, each new medication led to new side effects.

The cascade started with steroids for Crohn’s leading to bone loss and anal fistulas. Doctors prescribed antibiotics for the fistulas, which led to peripheral neuropathy in his feet. Since the pain made it difficult to sleep, doctors gave him benzodiazepines and Ambien for sleep, along with Lyrica for the nerve damage and Tramadol for the pain. And then he developed severe diarrhea from several of the medications. Doctors gave him medications for the diarrhea, including opium drops. Furthermore, drugs weakened his kidneys, which in turn raised his blood pressure, so doctors prescribed 4 blood pressure medications. And, doctors gave him an experimental anti-inflammatory drug which led to pericardial tuberculosis, which almost killed him.

At the end of his life, Joe took over 20 different medications each day, but not one of his doctors considered this a problem worth addressing. Moreover, no one stopped to consider that all of these medications caused his symptoms, not the Crohn’s disease.

 

What are doctors, hospitals and the government doing about this?

Not as much as we would hope and deserve! Although some doctors strive to minimize medication overload among their patients, there is no professional group, public organization, or government agency to date has formally taken responsibility for addressing this problem. The Lown Institute “calls for the development of a national strategy to address medication overload and help older people avoid its devastating effects on the quality and length of their lives.” Hopefully government agencies, non-profit organizations, hospitals and doctors will unite to address this serious issue.

 

What can you do?

While we wait for a national strategy to reduce medication overload, there are some steps you can take to reduce your own risk of medication issues. I suggest the following:

  1. Carry a list of all medications with you – on your phone, or in your wallet – and keep this list updated as you add and remove medications. Be sure to include over-the-counter medications.
  2. Make sure all your doctors have an accurate list of all your medications, including over-the-counter. At every appointment, your doctor (or a staff member) should ask you to confirm your medications. Listen carefully, check the doctor’s list against your own list, and make any corrections needed. Do NOT assume that each one of your doctors has access to your medication list via your Electronic Health Records (EHR). Many EHRs do not connect to each other.
  3. When a doctor recommends a new medication, ask these questions:
    • Is the medication absolutely necessary?
    • What will happen if you don’t take it?
    • Is there a chance your doctor is giving you this new medication to treat side effects from other medications you are taking? If so, what other options do you have?
    • Are there lifestyle changes you can try first?
    • Is the doctor giving you the smallest dose possible for your condition?
    • Will this new medication interact negatively with other medications you’re already taking?
    • Exactly how and when should you take it?
  4. Ask each doctor on your medical team if you can eliminate, or reduce, any of the medications you take.
  5. Don’t push your doctor to prescribe medication. Push aside the temptation to get “a pill for every ill”. And just because you saw an ad for a medication on TV, or a friend told you how much it helps her, it doesn’t mean it’s right for you.

 

About Zaggo:

Roberta Carson started Zaggo, a non-profit organization to help patients and family caregivers manage illnesses and injuries, after her experience as caregiver for her teenage son Zachary during his 27-month battle with terminal brain cancer. Roberta realized patients and families urgently need practical, easy-to-use information and tools. Zaggo’s mission is to provide patients and families with the educational information, tools, and resources they need to become empowered, engaged, effective members of their medical teams for the best possible care. With an easy-to-use guide book and organizational tools, the ZaggoCare System is the only product to offer the comprehensive advice and tools needed to help patients and caregivers manage illness or injury. As a charitable organization, 100% of the profits from the sale of ZaggoCare are donated to innovative brain tumor research in memory of Zachary.

National Women’s Health Week 2019

This past Mother’s Day launched the 20th annual National Women’s Health Week. Led by the U.S. Department of Health and Human Services Office on Women’s Health, the goal is to empower women to make their health a priority and raise awareness of the steps one can take to improve their health.

The Centers for Disease Control and Prevention (CDC) recommends many common measures, such as proper health screenings, staying physically active, eating healthy, and promoting other healthy behaviors. Healthy behaviors include getting enough sleep, being tobacco-free, washing your hands, not texting while driving, and wearing a seatbelt, a bicycle helmet, and sunscreen when appropriate. The Office on Women’s Health website has specific suggestions for women through their 20s to their 90s.

The Affordable Care Act (ACA; aka Obamacare) established Essential Health Benefits that insurers are required to cover, including maternity care. Following the Trump administration’s failed attempts to repeal the ACA in 2017, the Department of Health and Human Services (HHS) announced a year later that insurers will be allowed to omit these Essential Health Benefits from their insurance offerings, leaving the state of health insurance to pre-ACA standards when women were often charged inordinate fees for “extra” maternity coverage. This is compounded by the Trump-approved short-term insurance plans, that are held to much lighter standards than Obama-era insurance offerings. “Trumpcare” plans have low premiums but high out-of-pocket costs and poor benefit coverage — they’re not required to cover pre-existing conditions or healthcare situations such as pregnancy — and lack provider networks which leads to large unexpected hospital bills.

In 2018, The HHS-operated Office for Women’s Health (OWH) website had removed the “lesbian and bisexual health” page and other related links; then later, the OWH Breast Cancer websites were removed before being replaced days later with a single page featuring less comprehensive information. Earlier last year, the HHS announced it would form the new Conscience and Religious Freedom Division that would allow doctors to refuse treatment for those that go against their religious beliefs. The rule has recently been finalized — limiting access to care and undermining the civil rights, health, and well-being of women seeking reproductive health services, LGBT people, their children, and others.

 

A bill was signed into law last week criminalizing abortion in the state of Georgia. The law, which is set to go into effect in 2020, prohibits doctors from terminating any pregnancy after they are able to detect a heartbeat, which typically occurs at six weeks’ gestation. At this stage of pregnancy, the embryo is the size of a sweet-pea or the head of a nail and is more than 30 weeks away from being able to survive without intensive neonatal care; 20 weeks from having even a 50% chance of survival. Many women may not experience symptoms or know they are pregnant this early.

Women who seek an abortion in Georgia would be a party to murder, punishable by up to life in prison. Women who miscarry could be deemed guilty of second-degree murder and sentenced to 10 to 30 years imprisonment. Even residents who travel out-of-state to procure legal abortions would be punished by the Georgia law, as would anyone who helped or supported them in planning transport to a family planning clinic — charged with conspiracy to commit murder.

Similar laws are being pushed in Alabama and Texas, where murder charges stemming from abortions could carry the death penalty. These laws are dangerously detrimental to women’s health, not only in restricting access to important healthcare services but by doing immense harm to the mental health of women. Even women who do not live under these state laws can experience profound emotional trauma from knowing their bodily autonomy is not guaranteed or respected throughout the country.

 

Despite the harm being done to women’s access to healthcare and over the past two years, there are still resources for women in need. In a previous blog post, we detailed the National Breast Cancer and Cervical Cancer Early Detection Program; a program that has provided low-income, uninsured, and underserved women access to timely breast and cervical cancer screening and diagnostic services for over 25 years. Information for the local offerings from the program can be found in the NeedyMeds State Sponsored Programs database. There are other government programs for women’s health to be found on our site, including WISEWOMAN, a program that provides low-income, uninsured/under-insured women with blood pressure, cholesterol, and diabetes screenings.

NeedyMeds has a database of over 17,000 free, low cost, or sliding scale clinics, more than 6000 of which offer women’s health services including nearly 500 Planned Parenthood locations. Search your ZIP code for clinics in your area, and find Women’s Health in Services under the Details heading to find free or low-cost medical attention. Assistance for women’s health can also be found in our Diagnosis-Based Assistance database by searching for conditions that affect the women in our lives, including many that offer various forms of assistance for women seeking an abortion. For more resources, check our website at Needymeds.org or call our toll-free helpline at 1-800-503-6897 9am to 5pm Eastern Time Monday through Friday.

Mental Health Month 2019

May has been observed as Mental Health Month since 1949. One in five Americans are affected by a mental health condition in their lifetime — as many as 43.8 million — and everyone is impacted through family or loved ones. A main objective of mental health awareness is to fight the stigma surrounding those living with sometimes serious conditions through education and support and to improve the chance of recovery for those in need.

 

Everyone has stress and difficult emotions on occasion, and this is completely normal. Mental illness, however, is any condition that makes it difficult to function in daily life. It can affect relationships or job performance, and is caused by any number of complex interactions within the human brain. Mental illness can range from anxiety or mood disorders like depression, psychotic disorders like schizophrenia, eating disorders, or addictive behaviors.

 

Mental illness is prevalent in homeless populations, with 25% living with serious mental health conditions and an estimated 46% with any mental illness. Sixty-four percent of jail inmates, 54% of state prisoners, and 45% of federal prisoners report mental health concerns. LGBT individuals often deal with body dysmorphia, physical or emotional abuse, or feeling unsafe at school or work which can deeply affect their mental health. Adopted children are almost twice as likely as children brought up with their biological parents to suffer from some form of mental illness. Thousands of immigrant children have been separated from their parents/families under the Trump administration’s “zero tolerance” policy, and now face an increased risk of profound physical and mental health problems. Psychologists who have visited detention centers worry that the living conditions in these facilities will add to the trauma families have already endured, though the impact is difficult to predict as no research has been done on children who have been forcibly separated from their families due to the inherent ethical concerns.

 

The United States is facing a growing shortage of mental health professionals trained to work with youth — at a time when depression and anxiety are on the rise. Suicide was the second greatest cause of death for children from age 10-24 in 2017, after accidents. Mood disorders such as depression or bipolar disorder are the third most common cause of hospitalizations in the U.S. across ages 18-44. Serious mental illness costs America $193.2 billion in lost earnings per year.  

A new study shows the economic costs of untreated mood and anxiety disorders among moms exceeds $14 billion dollars through the first five years of a child’s life alone. Fewer adults experiencing psychological distress are being treated by a mental health professional. Of those reporting foregoing mental health care, 13% said they could not afford the cost of care, 12% reported that their insurance would not cover it, 10% indicated that fear or embarrassment kept them from seeking care, and 8% reported that they did not know where to get care.

 

Last year we wrote about Medicaid work requirements waivers promoted by the Trump administration being implemented around the country and the impact work requirements may have on Medicaid recipients. Seven states have since approved work requirements for those receiving Medicaid benefits, and six more are pending. Two states have had their work requirements overturned by the courts.

The growing concern is that people who work could potentially lose Medicaid coverage by not meeting the specific requirements set differently in each state or by getting lost in administrative obstacles to verifying work status or documenting exemption. Work requirement exemptions are based on “medical frailty,” which is defined differently state-to-state and does not always include mental illness in their consideration of frailty. Many mental illnesses can be accompanied by cognitive difficulties affecting executive function, processing speed, and ability to collaborate and communicate which can impact a person’s ability to navigate the complex bureaucratic systems necessary to verify their work status or exemption. Over 18,000 people have lost Medicaid coverage in Arkansas alone due to the work requirement.

 

NeedyMeds has Diagnosis Information Pages for various mental illnesses including depression, obsessive-compulsive disorder, and schizophrenia. We also have information for over 5,000 free, low-cost, or sliding-scale clinics throughout the country that offer counseling or mental health services. Search your ZIP Code for mental health clinics near you, or call our toll-free helpline for information at 1-800-503-6897 (open Monday through Friday, 9am to 5pm ET).

 

We encourage everyone to educate themselves, strive to understand the difficulties people around us live with, and to replace stigma with hope and support. If you or someone you know is suffering from a mental health condition, it is important to know that no one is alone in their struggle. Call for assistance, whether help is needed immediately or long-term.

Samaritans 24/7 Crisis Services via call or text: (877) 870-HOPE (4673)

The Trevor Project (LGBTQ+ crisis support): 1-866-488-7386 or Text “Trevor” to 1-202-304-1200

Trans Lifeline: (877) 565-8860