Month: November 2020

In all aspects of our lives, we rely on experts, from home repairs to weather forecasting to food safety, and just about everything else that’s part of modern society. There’s just no way to know everything about everything. Yet when it comes to medicine, people seem to be taking their health in their hands in ways they’d never consider if, say, their car brakes needed repairs and they weren’t auto mechanics.

What if your brakes were shot?

Suppose a well-recommended car mechanic tells you your brakes need repair. Hopefully, they explain why this is necessary and review the pros and cons of your options, including no repairs. You certainly could get additional opinions and estimates. But to make a decision, you’d have to accept that a mechanic has specialized knowledge and that their advice is sound. Quite likely, you’d get the brakes fixed rather than risk injury.

Would you berate the mechanic personally because they told you something you didn’t want to hear about your beloved car? Let's hope not. And unless you knew a lot about cars, you probably wouldn’t tinker with the brakes yourself, or take the advice of a neighbor to spray the tires with vegetable oil because a friend of his cousin said it worked for his car. And you wouldn’t take your car to a veterinarian — it just wouldn’t make sense, right?

Yet hundreds of thousands of people in the US are rejecting advice on getting a COVID vaccine from well-respected health authorities like the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). Healthcare providers have somehow become the target of taunts, hostility, and even death threats for encouraging people to protect themselves and others.

Fear of the proven and an embrace of the unproven

What’s driving this? It seems to be some combination of distrust ("these so-called experts don’t know what they’re talking about"; "they rushed the vaccines just to help the drug companies") and unfounded suspicion ("they’re trying to control us, experiment on us, inject microchips in us"). Some people see recommendations regarding COVID-19 as attacks on American values ("mask and vaccine mandates infringe on my personal freedom").

At the same time, many who dismiss the advice of true experts are embracing unproven and potentially dangerous remedies, such as ivermectin pills and betadine gargles.

How did we get here?

Some reasons we’ve seen erosion in trust placed in public health experts are

• Politics. COVID-19 quickly became a political issue in the US. For example, trust in the CDC varies markedly by political affiliation, with Democrats giving much higher marks to the CDC, FDA, and NIH than Republicans.
• Social media. Misinformation spread through social media is rampant, and much of it has been linked to a small number of people.
• "Pseudo-experts." Even impressive credentials don’t automatically qualify everyone to be experts in a pandemic disease. Recent examples include radiologists, cardiologists, and chiropractors who have made headlines with their controversial views.
• Personal gain. Some have profited financially, politically, or otherwise by deliberately spreading health disinformation and denouncing expert advice.

Confusing changes in message

Public health messaging about protecting ourselves from COVID-19 also affects trust. For example, recommendations around wearing masks were inconsistent early on, and have continued to change since then.

While some confusing, seemingly contradictory messages were true missteps, most are simply changes in recommendations based on a change in circumstances, such as spiking virus cases or a more easily spread variant causing severe illness, hospitalizations, and deaths.

Particularly in the early months, no one had all the answers. But as we have accumulated information from research and real-world experience, changes in recommendations should not only be expected but embraced. It’s usually a reflection of the close attention experts are paying to changing circumstances.

Doing your own research?

A wait-and-see policy can be risky — and not just when it comes to fixing your car brakes. The virus that causes COVID-19 was only discovered 18 months ago, and vaccines have been in use for less than a year. Yet already we have an enormous amount of data from research and real-world experience from many millions of people.

So, when someone says they want to "wait and see" or "do their own research" rather than accept the advice of their own doctors or public health experts, what exactly does that mean? Are they waiting to see if something bad will happen to those who were vaccinated? How long is long enough?

Unless you’re a cutting-edge virologist, immunologist, epidemiologist, or public health expert, doing your own research isn’t likely to provide more reliable data than studies published in peer-reviewed medical journals that guide the CDC and FDA. Of course, most people "doing their own research" are relying on others who are also not doing actual research, yet they discount the findings and recommendations of true experts.

It’s important to ask questions. But pose them to your doctor. Rely less on people who tell you what you want to hear, and more on those who trained in science and whose careers have been devoted to improving health.

If your fingers or toes ever turn pale (or even ghostly white) and go numb when exposed to cold, you might assume you just have poor circulation. That’s what I used to think when I first started noticing this problem with my own hands many years ago. It usually happened near the end of a long hike on a spring or fall afternoon, when the temperature dropped and I didn’t have any gloves handy. My pinkie, third, and middle fingers would turn white, and the fingernails took on a bluish tinge. As I soon discovered, I have Raynaud’s phenomenon, an exaggeration of normal blood vessel constriction.

Raynaud’s phenomenon: Not just poor circulation

When you’re exposed to a cold environment, your body reacts by trying to preserve your core temperature. Blood vessels near the surface of your skin constrict, redirecting blood flow deeper into the body. If you have Raynaud’s phenomenon, this process is more extreme, and even slight changes in air temperature can trigger an episode, says rheumatologist Dr. Robert H. Shmerling, senior faculty editor at Harvard Health Publishing and corresponding faculty in medicine at Harvard Medical School.

"Cold weather is the classic trigger for Raynaud’s phenomenon. But it can occur any time of year — for example, when you come out of a heated pool, walk into an air-conditioned building, or reach into the freezer section at the supermarket," he says. In addition to the hands, Raynaud’s can also affect the feet and, less often, the nose, lips, and ears. During an episode, the small arteries supplying the fingers and toes contract spasmodically, hampering the flow of oxygen-rich blood to the skin. Some of these vessels even temporarily collapse, and the skin becomes pale and cool, sometimes blanching to a stark white color.

Technically, Raynaud’s phenomenon is a circulation problem, but it’s very different than what doctors mean by poor circulation, says Dr. Shmerling. Limited or poor circulation usually affects older people whose arteries are narrowed with fatty plaque (known as atherosclerosis), which is often caused by high cholesterol, high blood pressure, and smoking. In contrast, Raynaud’s usually affects younger people (mostly women) without those issues — and the circulation glitch is generally temporary and completely reversible, he adds.

Preventing and treating Raynaud’s phenomenon

As I can attest, the best treatment for this condition is to prevent episodes in the first place, mainly by avoiding sudden or unprotected exposure to cold temperatures. I’ve always bundled up in the winter before heading outside, but now I bring extra layers and gloves even when the temperature might dip even slightly, or the weather may turn rainy or windy. Other tips include preheating your car in winter before getting in, and wearing gloves in chilly grocery store aisles.

In general, it’s best to avoid behavior and medicines that cause blood vessels to constrict. This includes not smoking and not taking certain medications, such as cold and allergy formulas that contain phenylephrine or pseudoephedrine and migraine drugs that contain ergotamine. Emotional stress may also provoke an episode of Raynaud’s, so consider tools and techniques that can help you ease stress.

If necessary, your doctor may prescribe a medication that relaxes the blood vessels, usually a calcium-channel blocker such as nifedipine (Adalat, Procardia). If that’s not effective, drugs to treat erectile dysfunction such as sildenafil (Viagra) may help somewhat. You may not need to take these drugs all the time, but only during the cold season, when Raynaud’s tends to be worse.

Warm up affected areas quickly

Once an episode starts, it’s important to warm up the affected extremities as quickly as possible. For me, placing my hands under warm running water does the trick. When that’s not possible, you can put them under your armpits or next to another warm part of your body. When the blood vessels finally relax and blood flow resumes, the skin becomes warm and flushed — and very red. The fingers or toes may throb or tingle.

What else is important to know?

Some people with Raynaud’s phenomenon have other health problems, usually connective tissue disorders such as scleroderma or lupus. Your doctor can determine this by doing a physical exam, asking you about your symptoms, and taking a few blood tests. But most of the time, there is no underlying medical problem.

When a child starts to stutter, it can be alarming for parents. But most of the time, it’s nothing to worry about.

Stuttering is very common. In fact, according to the National Institute on Deafness and other Communication Disorders (NIDCD), 5% to 10% of all children stutter at some point, usually between 2 and 6 years of age.

Stuttering takes different forms

Children who stutter know what they want to say; they simply run into trouble when saying it. There are three different kinds of stuttering:

• Repetitions, when children repeat a word or parts of a word (“Can I pet your d-d-d-d-dog?”)
• Prolongations, when they stretch a sound for a long period of time (“Sssssssssstop it!”)
• Blocks, when they have a hard time getting words out.

Stuttering is more common in boys than girls and can run in families. We do not understand exactly what causes it. Most likely, it occurs due to a combination of factors, which may differ in each child who stutters.

Developmental stuttering, the most common form of this speech disorder, happens as children are learning speech and language skills. Stuttering can be caused by a brain injury, but that’s far less common. Contrary to what many people believe, it is rare for stuttering to be caused by psychological factors.

Helping your child manage stuttering

Nonetheless, stuttering can cause distress and stress for children and parents alike. That’s why the best way to manage stuttering is not to focus on it, but rather to be patient and supportive. For example, the NIDCD suggests that parents of children who stutter should

• create relaxed environments for conversation: set aside time each day to catch up with your child
• speak in a slow and relaxed way yourself
• resist the temptation to finish your child’s words or sentences yourself; let them finish
• focus on the content of the message rather than how it is delivered.

To the extent that you can, ignore the stuttering — but if your child brings it up or seems bothered by it, be open and accepting. Acknowledge that it is happening, but tell your child that it is fine and they shouldn’t worry. Also see additional tips from the American Academy of Pediatrics on ways parents can help toddlers and preschoolers with stuttering.

When to get more help with stuttering

Most stuttering goes away by itself within about six months; overall, 75% of children who stutter stop completely. You should talk to your pediatrician or a speech-language pathologist if

• the stuttering has continued for more than 6 to 12 months
• the stuttering started after ages 3 to 4 years, as this may make it more likely to continue
• the stuttering has increased in severity or frequency
• there is a family history of stuttering that continued past early childhood
• your child is upset or frustrated by the stuttering.

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