DEAR DR. ROACH: My mother died of lung cancer at 62. For 12-18 months afterward, a sibling passed of a cancer or an unusual disease. Here’s the list: lung cancer, uterine cancer, kidney cancer, pancreatic cancer, and Lou Gehrig’s disease. All but the last sibling drank and smoked. Two sisters (nonsmokers) lived to the age of 90. So, I’m curious if this is familial or just related to them being smokers. — B.A.

ANSWER: I am sorry to read this list, which I’m sure doesn’t adequately express the pain of losing your family members.

Most cancers are sporadic, meaning that there isn’t a clear underlying cause. However, there are medical conditions that predispose individuals to cancers. For example, Lynch syndrome predisposes people to uterine, kidney and pancreatic cancer, but the hallmark cancer of Lynch syndrome is non-polyposis colon cancer, which you haven’t reported in your family.

Lung cancer is not a Lynch-associated cancer, and amyotropic lateral sclerosis (ALS, also called Lou Gehrig’s disease) is not a cancer. So, they’re not related to any familial cancer syndromes. I don’t know of any familial cancer syndrome that is likely to explain these cancers.

Smoking, on the other hand, is strongly related to many cancers. Although I see far too many cases of nonsmokers with lung cancer, especially in women, smoking is the cause of 90% of lung cancers. Smoking also increases the risk of kidney cancer by 36% and pancreatic cancer by 2.5 times the risk. Smoking increases the risk of ALS, although this isn’t an issue in your last family member’s case. Smoking is not a risk factor for uterine cancer, which is mostly related to excess estrogen.

If the population were to quit smoking entirely, there would be a whole lot less cancer, but it wouldn’t completely stop cancer. Better treatments and possibly better preventive and screening maneuvers will still be necessary.

DEAR DR. ROACH: I am a male, age 66, and often have hard stools and/or constipation. I have been a runner for over 40 years. I realize I don’t drink enough fluids in the day. I have been taking one stool softener daily (100 mg of docusate sodium) with my vitamins. This routine seems to help.

Is it safe to do this every day, or should I reduce this to a few days a week? — G.P.

ANSWER: The usual first-line treatment for constipation is to increase fluid and fiber in the diet. I rarely see people whose water intake is so low that they get constipation, but an extra glass of water might be beneficial for you, especially if you increase your fiber intake. You can get fiber easily through fruits, vegetables and cereals. Fruits have additional benefits due to nondigestible sugars, especially apples, peaches, pears, cherries, raisins and grapes. You can also use a fiber supplement, such as psyllium.

Docusate is a stool softener, and it works by allowing more water into the bowel movements. It is very safe, even for daily use. It has almost no side effects. It may not be as effective as fiber, but if it is working for you, there is no reason to change it.

Let me give a quick reminder that people over 45 are recommended to have a screening test, such as a colonoscopy, on a regular basis. Many people did not get this done during the pandemic, so be sure you are up-to-date.

DEAR DR. ROACH: My sister has a real problem with alcohol. I have tried to get her into a rehab program, but she is resistant. I have read that medications like Ozempic might have some benefit in getting people to stop drinking alcohol. Is there an answer? — W.A.

ANSWER: Alcohol use disorder is a huge problem worldwide, and basic and clinical scientists are constantly searching for new treatments. I found several trials showing initial promise with GLP-1 inhibitors helping to curb cravings, not only for alcohol but for nicotine and opioids as well. Most of these trials use the older drugs: liraglutide, dulaglutide and exenatide. But I found potential benefit for semaglutide (Ozempic) and tirzepatide as well.

However, these are preliminary studies. I can’t recommend these as initial treatment, based on the limited data. Furthermore, they are extremely expensive and subject to drug shortages. There are other medications that are much less expensive, more available, and better tested when it comes to alcohol use disorder. Natrexone and acamprosate both have strong evidence of benefit, and neither are used as often as they should be. There are second-line treatments available as well. By themselves, though, medicines are not the answer.

As it sounds like it might be the case with your sister, a major barrier is when a person isn’t ready to change. A skilled clinician, such as an expert in addiction medicine, sees this frequently and helps get a person motivated to change. Without motivation, treatment is unlikely to succeed.

DEAR DR. ROACH: My wife and I contracted COVID recently. All those expired COVID tests worked fine. I called my doctor to get a script for Paxlovid and uploaded all of the positive test results. Last year, we both had COVID, and Paxlovid worked extremely well for us. Still, our doctor said he did not believe in Paxlovid and sent scripts to my pharmacy for azithromycin and dexamethasone instead.

I called back and said I did not want an antibiotic for a viral infection. He reluctantly agreed, but said that because of a new law in Florida, we would have to drive to his office and wait in the parking lot for the nurse to have us sign release forms of some sort.

Do you know why it’s so hard to get Paxlovid now? You don’t even need to sign release forms for narcotics, as far as I know. — K.C.

ANSWER: The data are abundantly clear that Paxlovid reduces the risk of hospitalization and death in people with risk factors. In young, healthy people with no risk factors, Paxlovid really doesn’t have much benefit. However, the data are pretty strong that azithromycin is of no help, and dexamethasone is only appropriate for those who have severe COVID with low oxygen levels.

I couldn’t find any requirement in Florida (or anywhere else) to have patients sign a release form. I am very uncomfortable with your doctor’s behavior.

According to new guidance from the Food and Drug Administration, state-licensed pharmacists can prescribe Paxlovid as long as they have the necessary information, including recent health records, which are often available on smartphones now.

EDITOR’S NOTE: Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475.