Robert Shmerling, M.D., Harvard Medical School's Comments

Medical Myths: Where do they come from? by Robert Shmerling, M.D., Harvard Medical School

May 11, 2009 | comments: 4

Robert Shmerling, M.D., Harvard Medical School May 11, 2009, 8:40pm EDT

To Peter Joseph Swanson -
You're right - the claim that vaccinations cause autism has been around for quite awhile. While I'm no expert on the subject, my understanding is that high quality research has found nothing to support this claim.

Medical Myths: Where do they come from? by Robert Shmerling, M.D., Harvard Medical School

May 11, 2009 | comments: 4

Robert Shmerling, M.D., Harvard Medical School May 11, 2009, 3:56pm EDT

Have you heard something you suspect is a medical myth? Why do you think there are so many misconceptions when it comes to health and disease?

Harnessing the placebo effect by Robert Shmerling, M.D., Harvard Medical School

Mar 9, 2009 | comments: 6

Robert Shmerling, M.D., Harvard Medical School Mar 10, 2009, 6:35pm EDT

Kathryn - I've never heard of anyone actually prescribing a sugar pill. Most placebo pills are created for research, not "real life" practice of medicine. And I strongly doubt anyone is charging for sugar pills as if they were an expensive, active prescription medication - if that is happening, I agree with you it shouldn't!

But do you think recommending tonic water (which contains quinine) for muscle cramps as described above should be illegal? Some would consider quinine a placebo in this situation - others would not.

I also agree with you, by the way, that doctors sometimes take the ''easy" way out by prescribing something when no medication is clearly needed. For the patient who expects (or requests or even demands) a prescription, doctors may want to keep the patient happy and avoid confrontation rather than take the time to explain why a medicine isn't a good idea and also review non-medication options for treatment. Such doctors may worry about losing these patients (to doctors who will provide the prescription they seek). Not good!

Harnessing the placebo effect by Robert Shmerling, M.D., Harvard Medical School

Mar 9, 2009 | comments: 6

Robert Shmerling, M.D., Harvard Medical School Mar 10, 2009, 6:25pm EDT

Paul - great point about the cost! I don't think most pharmacists will compound true placebo pills (although I'm told it was done in the past), so I don't think one can actually purchase them the way you would a prescription. The bigger issue now, I think, is prescribing supplements or other medications (over the counter or by prescription) in a way that might be considered placebos.

I think doctors often prescribe medicines that they don't know will work or aren't fairly sure will work, but they are safe treatments that some (not all) patients have found useful - I'm thinking of quinine for muscle cramps as an example. There's no good evidence it works but many people are completely convinced - so if a doctor recommends it (knowing that the evidence is just not there), is he or she doing something unethical? Is that a placebo? You mention a vitamin for low energy as acceptable but that was considered a placebo in the study I described. The more I think about this issue, the trickier it seems! But I completely agree, it's unethical for a doctor to intentionally deceive his or her patient.

Harnessing the placebo effect by Robert Shmerling, M.D., Harvard Medical School

Mar 9, 2009 | comments: 6

Robert Shmerling, M.D., Harvard Medical School Mar 10, 2009, 6:16pm EDT

Tom - there are many examples of an apparent physiologic effect noted among placebo-treated study subjects. Here are just a couple:

Macklin EA, et al. Stop Hypertension With the Acupuncture Research Program (SHARP) Results of a Randomized, Controlled Clinical Trial Hypertension. 2006;48:838.
(http://hyper.ahajournals.org/cgi/content/full/48/5/838#R39-069898)

Meaningful improvement criteria sets in a rheumatoid arthritis clinical trial. MIRA Trial Group. Minocycline in Rheumatoid Arthritis Pillemer et al. Arthritis Rheum 1997 Mar;40(3):419.

The acupuncture trial looked at whether acupuncture treatment could treat high blood pressure; the study was negative but not because acupuncture failed - it was negative because blood pressure fell in BOTH groups - acupuncture and "sham" acupuncture - one could argue that the insertion of needles in the "wrong" sites is not a true placebo treatment.

The other study is an old one but one I remember well because of the huge placebo response - while the antibiotic minocycline seemed to improve arthritis in about half the patients, nearly half (41%) improved in the placebo group with reduction in joint swelling. This one's too old to provide a link, sorry!

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 9:01pm EST

Thanks to all of you for your great questions! I wish you the best of health.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 9:00pm EST

I believe when modern medicine does not have ideal treatments (as is often true for aches and pains) we ought to be open-minded about safe and potentially effective treatments such as acupuncture.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:59pm EST

Aunt Shanny - the cost of medicines & supplements are out of control in my view. Among the least expensive options are exercise, acetaminophen and generic ibuprofen or naproxen. I mentioned acupuncture and massage earlier - also expensive!

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:56pm EST

Dan R. asked about treatment for fibrosis in the back - I'm not sure what condition you are referring to but fibrosis usually means scar tissue; if you've had an injury and have chronic back pain, imaging studies (such as MRI) could have shown scar tissue from the injury. If it's pressing on a nerve, steroid injections or surgery could help (assuming medications and physical therapy have not been helpful). Many people find acupuncture or massage helpful for back pain - if they work, I encourage my patients to stick with them.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:52pm EST

Jan S. - you mention a wintergreen-scented spray - it's interesting that a number of topical therapies (those you can apply to the skin) seem to be able to interrupt pain signals from the sore area to the brain. At least that's one theory about how they work - because it's unlikely these treatments are actually getting into the joint or reversing the painful condition. Capsaicin is a topical treatment that's often recommended for osteoarthritis of the hands - it's made from chili peppers so you have to be careful not to get it in your eye!

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:47pm EST

Heat is great for sore muscles - we usually recommend cold (or ice) for actual injuries, but only for the first day or two. There's not alot of science to my recommendations about heat and cold beyond that - if heat helps, stick with it (being careful not to burn the skin); if it's not helpful, try cold.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:45pm EST

Cecilia B. - it sounds like osteoarthritis is causing most of your problems - in this condition, extra bone forms and when that happens in the spine, it can pinch nerves - there are other possibilities, though, such as nerve compression near the elbow or wrist. We don't have great medicines for osteoarthritis in the spine, especially when a nerve is compressed. Pain medicines, steroid injections, physical therapy and, in some select cases, surgery are the usual treatments.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:42pm EST

Many of you, including April H. have asked about exercise. The most important thing to say is that moving is better than not moving. A physical therapist or trainer or other care providers can individualize an exercise program for people with joint problems - but there isn't a single exercise that is best. Walking, swimming, and exercise bikes tend to be the best tolerated exercises by people with back pain or joint pains.

I'm often asked if execise will cause harm - let your symptoms be your guide but for the most part the answer is no.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:38pm EST

Mariana T. asks about a medicine that caused hearing loss - since it was started after a bone density test was done, I assume it was an osteoporosis medication (such as Fosamax, Actonel or Boniva) - no, I've never heard of that side effect from these medicines. Perhaps it was a coincidence. Aspirin in high doses can cause hearing loss and ringing in the ears.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:36pm EST

I wanted to address the questions about glucosamine/chondroitin - there is some limited evidence that glucosamine may have a mild pain relieving effect (similar to Aleve) - but claims about its ability to heal damaged cartilage or prevent arthritis are unproven in my view. There is even less evidence to support the use of chondroitin. But these are fairly safe supplements and some people do seem to get benefit from taking them so I never object to their use if they seem helpful.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:31pm EST

Several folks have asked about fish oil - there was alot of enthusiasm for fish oil several years ago when studies were published suggesting a benefit for rheumatoid arthritis. I think interest has waned because the amount of fish oil taken by study subjects was higher than most people can tolerate (and they come with lots of calories!). There's little evidence fish oil helps other common causes of joint pain, such as osteoarthritis, bursitis, tendonitis or fibromyalgia.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:28pm EST

It's true that bananas are a great source of potassium - but I know of no connection between low potassium and joint or muscle pain.

Connie C asks about over-the-counter medicines for joint pain - there are many - the most common are acetaminophen (as in Tylenol), ibuprofen, naproxen, and the many creams and ointments (capsaicin, aspercreme, icy-hot to name a few). I think it's fair to say they are "supportive" treatments - that is, they treat symptoms, not the condition that is causing the pain. While these treatments may "mask the pain" that's not such a bad thing in many cases; some relief is a good thing until the body heals the problem or it passes with time.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:24pm EST

Mark R. asked about the connection between inflammation and fatigue - great question - they are strongly linked and for many people with inflammatory forms of arthritis (such as rheumatoid arthritis), the fatigue can be more bothersome than the joint pain. Effective treatment of inflammation tends to improve the fatigue.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:22pm EST

Trish A. asked a while ago about bananas and leg aching - I have to say I've never heard of that and can't think of a reason it should work, but if it does that's great since bananas are safer than medications! There is some evidence that cherries or cherry juice can be helpful for gout. I wonder if anyone else has had experience with fruit or other foods that are helpful for joint problems.

Aching Joint Pain - Learn how to relieve it! TRANSCRIPT – Join the Discussion and Win a Gather Points™! by Stefanie Plum, Gather Partner Team

Mar 3, 2009 | comments: 109

Robert Shmerling, M.D., Harvard Medical School Mar 3, 2009, 8:19pm EST

Cortney R. asks about cracking her elbows and fingers and whether that might contribute to joint pain - probably not. There is good evidence that cracking your knuckles does not cause arthritis or joint disease. It's harder to be sure about the elbows (since they are not so easy to crack...at least for me!) but most noises associated with the joints that are not associated with pain are of no importance to your joint health.