How well do you score on brain health?

Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, 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

Beyond the usual suspects for healthy resolutions

Early in the new year, promises to reboot your health typically focus on diet, exercise, and weight loss. And by now you may have begun making changes — or at least plans — to reach those goals. But consider going beyond the big three.

Below are 10 often-overlooked, simple ideas to step up personal health and safety. And most won’t make you break a sweat.

Review your health portals

Your medical information is kept in electronic records. You have access to them through the patient portal associated with your doctor’s office. Set aside time to update portal passwords and peruse recent records of appointments, test results, and notes your doctor took during your visits.

“Many studies have shown that when patients review the notes, they remember far better what went on during interactions with their clinicians, take their medicines more effectively, and pick up on errors — whether it’s an appointment they forgot to make or something their doctor, nurse, or therapist got wrong in documenting an encounter,” says Dr. Tom Delbanco, the John F. Keane & Family Professor of Medicine at Harvard Medical School and cofounder of the OpenNotes initiative, which led shared clinician notes to become the new standard of care.

Doing this can help you become more engaged in your care. “We know from numerous studies that engaged patients who share decisions with those caring for them have better outcomes,” he adds.

Ask about health insurance freebies

Your insurance plan may offer perks that can lead to better health, such as:

• weight loss cessation programs
• quit-smoking programs
• free or reduced gym memberships.

Some insurers even offer breastfeeding counseling and equipment. Call your insurance company or take a close look at their website to find out if there’s anything that would help you.

Get rid of expired medications

Scour your cabinets for expired or unneeded drugs, which pose dangers for you and others. Look for prescription and over-the-counter medications (pills, potions, creams, lotions, droppers, or aerosol cans) as well as supplements (vitamins, minerals, herbs).

Bring your finds to a drug take-back site, such as a drugstore or law enforcement office, or a medical waste collection site such as the local landfill.

As a last resort, toss medications into the trash, but only after mixing them with unappealing substances (such as cat litter or used coffee grounds) and placing the mixture in a sealable plastic bag or container.

Invest in new sneakers

The wrong equipment can sabotage any exercise routine, and for many people the culprit is a worn pair of sneakers. Inspect yours for holes, flattened arch support, and worn treads. New sneakers could motivate you to jazz up your walking or running routine.

For example, if it’s in the budget, buy a new pair of walking shoes with a wide toe box, cushy insoles, good arch support, a sturdy heel counter (the part that goes around your heel), stretchy uppers, and the right length — at least half an inch longer than your longest toe.

Cue up a new health app

There are more than 350,000 health apps geared toward consumer health. They can help you with everything from managing your medications or chronic disease to providing instruction and prompts for improving diet, sleep, or exercise routines, enhancing mental health, easing stress, practicing mindfulness, and more.

Hunt for apps that are free or offer a free trial period for a test drive. Look for good reviews, strong privacy guardrails, apps that don’t collect too much information from you, and those that are popular — with hundreds of thousands or millions of downloads.

Make a schedule for health screenings and visits

Is it time for a colonoscopy, mammogram, hearing test, prostate check, or comprehensive eye exam? Has it been a while since you had a dermatologist examine the skin on your whole body? Should you have a cholesterol test or other blood work — and when is a bone density test helpful?

If you’re not sure, call your primary care provider or any specialists on your health team to get answers.

Four more simple healthy steps

The list of steps you can take this year to benefit your health can be as long as you’d like it to be. Jot down goals any time you think of them.

Here are four solid steps to start you off:

• Take some deep breaths each day. A few minutes of daily slow, deep breathing can help lower your blood pressure and ease stress.
• Get a new pair of sunglasses if your old ones have worn lenses. Make sure the new pair has UV protection (a special coating) to block the sun’s ultraviolet (UV) light, which can cause eye damage and lead to permanent vision loss.
• Make a few lunch dates or phone dates with friends you haven’t seen in a while. Being socially connected wards off loneliness and isolation, which can help lower certain health risks.
• Do a deep cleaning on one room in your home per week. Dust and mold can trigger allergies, asthma, and even illness.

You don’t have to do all of these activities at once. Just put them on your to-do list, along with the larger resolutions you’re working on. Now you’ll have a curated list of goals of varying sizes. The more goals you reach, the better you’ll feel. And that will make for a very healthy year, indeed.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, 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

Can watching sports be bad for your health?

As the new year rolls on, sports fans rejoice! You’ve had the excitement of the college football bowl games and the national championship game, the NFL playoff games are winnowing teams down to the Super Bowl contestants, and basketball and hockey seasons are in full swing. Spring training for the upcoming Major League Baseball season is around the corner.

But hold these thoughts a moment. Watching sports — not just playing them — can be hazardous to your health. I’ve seen it firsthand while working in a walk-in clinic near Fenway Park, where people would show up bleeding from cuts that needed stitches (from trips and falls at the stadium), broken bones (from trying to catch a foul ball or an altercation with another fan), and dehydration.

Most of these injuries weren’t life-threatening. But there’s evidence that the health impact of sports spectatorship can be far more serious for some of us — and, perhaps, underappreciated.

What are the health risks of watching live sports?

When you’re watching games in person, some risks are related to the weather and other fans. For example:

• Watching a baseball game in the summer for hours may lead to heat stroke or dehydration.
• Live winter football games may raise the risk of hypothermia, frostbite, or other cold-related problems.
• Stampedes, riots, and brawls between rival fans watching soccer matches are not rare and may actually be on the rise.
• And, as mentioned, spectators of live sports can be injured by balls hit into the stands or other flying objects such as bats, pucks, or golf balls.

How could watching sports on TV boost health risks?

Doctors and nurses often describe how quiet things get in the emergency room during a World Series game or the Super Bowl. But once the game ends, it tends to get much busier. One theory is that people with chest pain, trouble breathing, or other symptoms of a potentially serious problem who ordinarily would have reported to the emergency room right away may delay seeking care until after the game.

Of course, there’s another possibility: the game itself — especially if a game is close and particularly exciting — might cause enough stress on the body that heart attacks, strokes, or other dangerous conditions develop.

Research supporting the idea that watching sports can negatively affect your health includes:

• Older studies have linked hospital admissions for heart failure and cardiac arrest with watching sporting events.
• A 2017 study found that spectators of Montreal Canadiens hockey games experienced a doubling of their heart rate during games. The effect was more pronounced for live games than televised games, but even the latter experience led to faster heart rates similar to the effect of moderate exercise.
• A 2022 study found that hospital admissions for cardiovascular problems jumped 15% during and just after World Cup soccer games.

Together, these studies suggest that watching sports can be stressful enough to trigger dangerous cardiovascular events.

It’s worth emphasizing that most people watching sports enjoy it and do not experience any health problems related to the game. But these studies suggest that spectating may carry some small risk, similar to what might accompany moderate or vigorous exercise. This may be most relevant for people who are older or who already have cardiovascular disease.

What’s a sports fan to do?

One common recommendation is to remember that it’s only a game. Of course, if you care a lot about sports or a particular team, that advice is unlikely to help. A second is to get regular exercise. Staying physically active strengthens the heart and lowers blood pressure, which could help ward off some of the health risks described above.

Five additional game-day precautions are:

• Avoid overeating, especially salty junk food. For some, overindulging in food, drink, and salt can stress the heart or trigger heart failure.
• Be prepared for the weather. Check the forecast. If you’re planning to watch a game in the cold, dress in layers, use hand warmers, and drink warm fluids. If you’re going to be out in the sun, use sunscreen liberally, wear a hat, and hydrate well.
• If you have cardiovascular disease, don’t forget to take your medications, especially if there’s a big game coming up. And if you develop worrisome symptoms, such as chest pain or trouble breathing, seek medical attention right away. Don’t wait till the game ends!
• Stay hydrated and moderate your alcohol intake. Stay well-hydrated by drinking water, especially if you’re out in the heat for hours. Although beer is a liquid, it’s also a diuretic, meaning it can make you urinate more and lose more fluids than other beverages.
• Stay alert at live events. Give yourself a fighting chance of getting out of the way of a line-drive foul ball or an errant bat that’s slipped out of the batter’s hands during a swing.

The bottom line

I can attest to many upsides of watching sports: the excitement of competition and the bonding and camaraderie with likeminded friends, family, and other fans. And perhaps watching sports might improve your health if sports spectatorship sparks sports participation.

While watching sports has been linked to certain health risks, the overall risk is likely low for most people. And you can take steps to reduce this. The health risks of spectatorship only rarely require giving up watching a favorite team. So, put on your team jersey, cheer your team on to victory, and stay healthy while you’re at it. Oh, and watch out for outraged fans or flying bats.

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

What is a tongue-tie? What parents need to know

The tongue is secured to the front of the mouth partly by a band of tissue called the lingual frenulum. If the frenulum is short, it can restrict the movement of the tongue. This is commonly called a tongue-tie.

Children with a tongue-tie can’t stick their tongue out past their lower lip, or touch their tongue to the top of their upper teeth when their mouth is open. When they stick out their tongue, it looks notched or heart-shaped. Since babies don’t routinely stick out their tongues, a baby’s tongue may be tied if you can’t get a finger underneath the tongue.

How common are tongue-ties?

Tongue-ties are common. It’s hard to say exactly how common, as people define this condition differently. About 8% of babies under age one may have at least a mild tongue-tie.

Is it a problem if the tongue is tied?

This is really important: tongue-ties are not necessarily a problem. Many babies, children, and adults have tongue-ties that cause them no difficulties whatsoever.

There are two main ways that tongue-ties can cause problems:

• They can cause problems with breastfeeding by making it hard for some babies to latch on well to the mother’s nipple. This causes difficulty with feeding for the baby and sore nipples for the mother. It doesn’t happen to all babies with a tongue-tie; many of them can breastfeed successfully. Tongue-ties are not to blame for gassiness or fussiness in a breastfed baby who is gaining weight well. Babies with tongue-ties do not have problems with bottle-feeding.
• They can cause problems with speech. Some children with tongue-ties may have difficulty pronouncing certain sounds, such as t, d, z, s, th, n, and l. Tongue-ties do not cause speech delay.

What should you do if think your baby or child has a tongue-tie?

If you think that your newborn is not latching well because of a tongue-tie, talk to your doctor. There are many, many reasons why a baby might not latch onto the breast well. Your doctor should take a careful history of what has been going on, and do a careful examination of your baby to better understand the situation.

You should also have a visit with a lactation specialist to get help with breastfeeding — both because there are lots of reasons why babies have trouble with latching on, and also because many babies with a tongue-tie can nurse successfully with the right techniques and support.

Talk to your doctor if you think that a tongue-tie could be causing problems with how your child pronounces words. Many children just take some time to learn to pronounce certain sounds. It is also a good idea to have an evaluation by a speech therapist before concluding that a tongue-tie is the problem.

What can be done about a tongue-tie?

When necessary, a doctor can release a tongue-tie using a procedure called a frenotomy. A frenotomy can be done by simply snipping the frenulum, or it can be done with a laser.

However, nothing should be done about a tongue-tie that isn’t causing problems. While a frenotomy is a relatively minor procedure, complications such as bleeding, infection, or feeding difficulty sometimes occur. So it’s never a good idea to do it just to prevent problems in the future. The procedure should only be considered if the tongue-tie is clearly causing trouble.

It’s also important to know that clipping a tongue-tie doesn’t always solve the problem, especially with breastfeeding. Studies do not show a clear benefit for all babies or mothers. That’s why it’s important to work with a lactation expert before even considering a frenotomy.

If a newborn with a tongue-tie isn’t latching well despite strong support from a lactation expert, then a frenotomy should be considered, especially if the baby is not gaining weight. If it is done, it should be done early on and by someone with training and experience in the procedure.

What else should parents know about tongue-tie procedures?

Despite the fact that the evidence for the benefits of frenotomy is murky, many providers are quick to recommend them. If one is being recommended for your child, ask questions:

• Make sure you know exactly why it is being recommended.
• Ask whether there are any other options, including waiting.
• Talk to other health care providers on your child’s care team, or get a second opinion.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

A fresh look at risks for developing young-onset dementia

Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as “other.” Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

• High C-reactive protein is a sign of inflammation.
• Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD

Why do your prescription drugs cost so much?

I was in line at a pharmacy recently as the customer ahead of me was picking up her prescription. The pharmacist matter-of-factly said: “that’ll be $850.” All she could say was “really?” She left without her prescription, telling the pharmacist she’d have to call her doctor about a less costly alternative.

Many of us routinely experience sticker shock over drug costs. And ever more dramatic examples suggest there’s no limit. So, let’s talk about ways to minimize what we spend on prescription drugs; how we got to this juncture where some medicines cost more than a million dollars per dose; and what changes are needed in our pricey medication-industrial-complex.

7 ways to minimize your spending on prescription drugs

Consider these seven strategies to pare drug costs. Savings will vary depending on insurance, donut holes, deductibles, and cost-sharing.

• Ask your healthcare provider three questions: Is every medicine you take truly necessary? Is it safe to reduce the dose of any medicines you take? Could a lower-cost or generic drug be substituted?
• If you have health insurance, check the list of preferred medications (the formulary), which tend to cost less than other similar medicines.
• Split pills: In some cases, a prescription will cost less if each pill contains more than your needed dose and can be divided. For example, if you usually take a 25-mg pill, taking half of a 50-mg pill may help you save on drug costs and copays. Ask your pharmacist if the math works for you.
• Ask if a 90-day supply rather than a 30-day supply would reduce copays.
• Look for prescription drug discount programs that offer savings. Restrictions apply and availability varies by location. Also, paying through a discount program might not count toward your insurance deductible or maximum out-of-pocket costs, so it isn’t always less expensive to use these programs.
• Compare prices at different pharmacies and review your options with a pharmacist. Sometimes the price is lower if you don’t use your insurance.
• Consider using an online mail-order service (such as Blink Health or Cost Plus Drug Company). However, spending through these sites may not count toward your insurance deductible. And the prices are not always lower online.

These measures will help some people more than others and can take up a lot of time. The sad truth is that even if you did everything you could, the impact on your wallet might be small.

Why are medicine costs so high in the US?

My top five contenders are:

Drug makers’ profit motive. Pharmaceutical companies routinely reject this idea. They say it’s expensive to develop new drugs and run the required clinical trials to prove safety and effectiveness. Many promising drugs fail, and the FDA drug approval process is difficult and costly.

Yet one recent study published in JAMA Network Open found no connection between how much a drug company spends on research and development (R&D) for a drug and the drug’s price. Even after accounting for R&D spending, most of the top 30 pharmaceutical companies make billions of dollars in profit. And in Europe, where drug prices are negotiated, the very same drugs made by the same companies for the same health problems typically cost far less than in the US.

Pharmacy benefit managers (PBMs) handle drug benefits for large employers, Medicare, and health insurance companies. PBMs negotiate prices with health insurers and pharmacies. They help decide which drugs to cover and how much patients pay. Their fees and incentives — often a share of total spending on medicines, which might encourage approval of higher-priced drugs — contribute to the costs health consumers wind up paying. A flurry of state and federal legislation is intended to limit what PBMs can do and the transparency of their operations.

Cost-sharing. In recent years, insurers have increasingly shifted costs to patients through higher copays, deductibles, and premiums. Sometimes this is justified by the notion that this incentivizes patients to seek care only when truly necessary; of course, it could also discourage people from seeking care even when warranted.

Legal maneuvers. Many drug makers file numerous patents and sue potential competitors to extend their time holding a monopoly on a particular drug (see example). Or they create “me too” drugs by slightly tweaking an existing drug so they can patent it as a brand-new drug. Some pharmaceutical companies acquire patents for older drugs and then jack up the price. Others have bought or merged with another drugmaker to avoid price competition.

Direct-to-consumer advertising. Drug companies spend billions on ads (nearly $8.1 billion in 2022). Marketing costs raise the price of drugs while boosting demand for newer, heavily promoted drugs. Advertised drugs tend to be far more expensive (and not always better) than older drugs. Perhaps this is why such advertising is banned in most other countries.

What might slow rising drug costs?

Although prescription drug prices are likely to remain high for the foreseeable future, three developments could help slow rising drug prices in the coming years:

• The Inflation Reduction Act of 2022 allows the US government to negotiate drug prices for Medicare, which is expected to lower drug costs. The first 10 price-protected drugs — including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia) — take effect in 2026. More drugs will be added to this list each year. If you’re on one of these drugs, the impact could be large. But with more than 20,000 approved drugs on the market, it’s not a solution that will help everyone.
• Recent FDA action allowing Florida to import drugs from Canada, and other proposed federal and state legislation aiming to protect people from high prescription drug prices.
• Organizations advocating for lower prescription drug prices, including AARP, Consumers Union, and Patients for Affordable Drugs, appear to have the attention of lawmakers as never before.

The bottom line

Let’s face it: our complex, broken healthcare system incentivizes those who develop and distribute drugs to set the prices well above what many can afford. And the amount you can chip away on your own is limited. What we really need is an overhaul to remove middlemen who contribute to added cost without always adding value.

Until we get there, do what you can, even if the impact is small. Trying your best to stay healthy could be the most important step you take. After all, the best way to limit how much you spend on prescription drugs is to have no reason to take them.

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

Plyometrics: Three explosive exercises even beginners can try

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, 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

A mindful way to help manage type 2 diabetes?

Lifestyle changes like regular exercise, a healthy diet, and sufficient sleep are cornerstones of self-care for people with type 2 diabetes.

But what about mind-body practices? Can they also help people manage or even treat type 2 diabetes? An analysis of multiple studies, published in the Journal of Integrative and Complementary Medicine, suggests they might.

Which mindfulness practices did the study look at?

Researchers analyzed 28 studies that explored the effect of mind-body practices on people with type 2 diabetes. Those participating in the studies did not need insulin to control their diabetes, or have certain health conditions such as heart or kidney disease. The mind-body activities used in the research were:

• yoga
• qigong, a slow-moving martial art similar to tai chi
• mindfulness-based stress reduction, a training program designed to help people manage stress and anxiety
• meditation
• guided imagery, visualizing positive images to relax the mind.

How often and over what time period people engaged in the activities varied, ranging from daily to several times a week, and from four weeks to six months.

What did the study find about people with diabetes who practiced mindfulness?

Those who participated in any of the mind-body activities for any length of time lowered their levels of hemoglobin A1C, a key marker for diabetes. On average, A1C levels dropped by 0.84%. This is similar to the effect of taking metformin (Glucophage), a first-line medication for treating type 2 diabetes, according to the researchers.

A1C levels are determined by a blood test that shows a person’s average blood sugar levels over the past two to three months. Levels below 5.7% are deemed normal, levels from 5.7% to less than 6.5% are considered prediabetes, and levels 6.5% and higher are in the diabetes range.

How can mind-body practices help control blood sugar?

Their ability to reduce stress may play a big part. “Yoga and other mindfulness practices elicit a relaxation response — the opposite of the stress response,” says Dr. Shalu Ramchandani, a health coach and internist at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. “A relaxation response can lower levels of the stress hormone cortisol. This improves insulin resistance and keeps blood sugar levels in check, thus lowering A1C levels.”

A relaxation response can help people with diabetes in other ways, such as by improving blood flow and lowering blood pressure, which protects against heart attacks and strokes.

What else should you know about this study?

The results of studies like this suggest a link between various mind-body practices and lower A1C levels, but do not offer firm proof of it. Levels of participation varied widely. But because all mindfulness practices studied had a modest positive effect, the researchers suggested that these types of activities could become part of diabetes therapy along with standard lifestyle treatments.

Could mind-body practices protect people against developing type 2 diabetes, especially for those at high risk? While this study wasn’t designed to look at this, Dr. Ramchandani again points to the long-range benefits of the relaxation response.

“Reducing and managing stress leads to improved moods, and greater self-awareness and self-regulation,” she says. “This can lead to more mindful eating, such as fighting cravings for unhealthy foods, adhering to a good diet, and committing to regular exercise, all of which can help reduce one’s risk for type 2 diabetes.”

Trying mind-body practices

There are many ways to adopt mind-body practices that can create relaxation responses. Here are some suggestions from Dr. Ramchandani:

• Do a daily 10-minute or longer meditation using an app like Insight Timer, Calm, or Headspace.
• Attend a gentle yoga, qigong, or tai chi class at a local yoga studio or community center.
• Try videos and exercises to help reduce stress and initiate relaxation responses.
• Practice slow controlled breathing. Lie on your back with one or both of your hands on your abdomen. Inhale slowly and deeply, drawing air into the lowest part of your lungs so your hand rises. Your belly should expand and rise as you inhale, then contract and lower as you exhale. Repeat for several minutes.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, 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