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July 13, 2007
Public reporting campaign meets surgical caution on Running a Hospital today.
In this week's New England Journal of Medicine three Harvard doctors argue that making mortality rates public for individual cardiac surgeons could end up harming patients if the rankings push surgeons to avoid operating on high-risk patients.
Today Paul Levy responds in detail to the White Coat Notes post about the opinion piece in the journal, written by Dr. Thomas H. Lee of Partners Health Care, Dr. David F. Torchiana of Massachusetts General Hospital and Dr. James E. Lock of Children’s Hospital Boston.
As readers of the Beth Israel Deaconess CEO's blog know, Levy is a champion of transparency, urging other hospitals to join his in posting their performance measures. He responds to the doctors' contention that public reporting is too flawed (not adequately adjusted for risk, too small a sample) to be valid. (He also asks many questions -- it's a long entry.)
"So here's our Catch-22: No reporting method is statistically good enough to be made public," he writes. "But if a method is statistically good enough, we won't allow it to be made public."
Then Levy issues a challenge to health care providers:
"The medical profession simply has to get better at this issue. If they don't trust the public to understand these numbers, how about just giving them to referring primary care doctors? Certainly, they can trust their colleagues in medicine to have enough judgment to use them wisely and correctly."
And another to insurers:
"We hear a lot about insurance companies wanting to support higher quality care. When is an insurance company going to demand that the hospitals in its network provide these data to referring doctors in its network? How about this for an idea? If a hospital doesn't choose to provide the data, it can still stay in the network, but the patient's co-pay would be increased by a factor of ten if he or she chooses that hospital."
Posted by Elizabeth Cooney at 04:46 PM
July 13, 2007
By Liz Kowalczyk, Globe Staff
Harvard Medical School physicians will begin blogging under a new agreement with Gather.com, a social networking site for adults. Harvard Health Publications, which provides content from the medical school, announced this week that it is launching 35 online communities focusing on different chronic conditions, including depression, diabetes and insomnia.
Physicians will blog on each disease, offering expert advice and allowing for back and forth conversations with consumers, who also will be able to join online discussions with each other.
LifeMasters Supported SelfCare Inc., a leading provider of disease management programs, also is part of the venture.
Posted by Gideon Gil at 02:55 PM
July 13, 2007
Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.
Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.
The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.
Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.
Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.
Boston Medical Center was ranked 41st in geriatrics.
Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.
The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.
Posted by Elizabeth Cooney at 06:27 AM
July 13, 2007
For the first time, many low-income patients seeking free care at hospitals will face deductibles and copayments similar to those charged to insured patients, under proposed rules released yesterday that are designed to push more Massachusetts residents to get health insurance.
In an about-face, Blue Cross and Blue Shield of Massachusetts said it is scrapping a new policy that would have allowed owners of small businesses to contribute just one-third of the cost of their employees' health plan premiums.
Dr. James Holsinger (left), President Bush's nominee for surgeon general, yesterday insisted that he harbors no bias against homosexuals in spite of his 1991 writings viewed by some as antigay.
Scientists have found evidence that people can actively suppress disturbing memories by choosing not to think about them, a finding that could lead to improved therapies for post-traumatic stress, whose sufferers are haunted by scary memories they can't control.
Jiang Yanyong, a Chinese doctor who exposed the cover up of China's SARS outbreak in 2003, has been barred from traveling to the United States to collect a human rights award, a friend of the doctor and a human rights group said this week.
In the month after a surprising analysis revealed possible heart risks from the blockbuster diabetes drug Avandia, reports of side effects to federal regulators tripled.
Dr. John Hogness (left), the first president of the Institute of Medicine who shaped it into an unbiased critic of the US health care system, died July 2 of heart and kidney failure at the University of Washington's Wallingford retirement center. He was 85.
Dame Anne McLaren, a leading geneticist, and her former husband, artificial intelligence specialist Donald Michie, died in a car crash Sunday. Dr. McLaren was 80 and Dr. Michie was 84.
Posted by Elizabeth Cooney at 06:23 AM
July 12, 2007
The number of people dying of cancer has fallen slightly in Massachusetts while the number of newly diagnosed cases has stayed about the same. But racial and ethnic disparities remain, in both the risk of developing cancer and dying from it, a new state report says.
The change in mortality rates was small but significant, according to the state Department of Public Health’s latest study, which covers 2000 through 2004.
In 2000, the mortality rate from 24 types of cancer was 205.8 deaths per 100,000 people. In 2004 it declined to 187.9 deaths per 100,000 people. The incidence of new cases declined each year, but the decrease was not statistically significant.
"The report shows that progress is being made. When we focus on prevention, as in reducing tobacco use, or focus on screening for early identification and treatment, we can save lives," DPH Commissioner John Auerbach said in an interview today. "On the other hand, cancer remains the second leading cause of death in Massachusetts and many people are still engaged in behaviors that put them at risk."
Half of all cancers could be avoided if people didn’t smoke, adopted a healthy diet, increased their physical activity and cut their alcohol use, DPH said. About 18 percent of people in the state smoke.
Lung cancer is the most common cause of death from cancer in both men and women. The lung cancer death rate fell by 11 percent for men, but for women it stayed the same.
Breast cancer, the most common cancer in women, fell both in new cases (by 7 percent) and in deaths (by 10 percent). Prostate cancer, the most common cancer in men, also dropped in new cases (by 19 percent) and in deaths (by 24 percent).
But racial disparities persist. The incidence of both prostate and liver cancers was higher for black men than for other men. Asian men had the highest liver cancer incidence and mortality.
There were more cases of breast cancer among white women, but both black and white women died at a higher rate than Asian and Hispanic women. Black and Hispanic women had more cases of cervical cancer.
"Not all adults who should be screened for cancer are receiving screening, and certain populations bear a heavier burden of disease, particularly black and Latino people," Auerbach said. "We hope that expanding access through health care reform will be helpful in part to eliminating these disparities."
Posted by Elizabeth Cooney at 06:14 PM
July 12, 2007
By Alice Dembner, Globe Staff
State officials today voiced support for a plan that could cut the cost of monthly health insurance premiums for basic coverage that includes prescription drugs.
Staff members of the Commonwealth Health Insurance Connector, with the help of pharmacy consultants, proposed a plan that would add only $20 a month to premiums, far less than the typical $50 to $55.
The plan mandates use of generic drugs whenever possible and would cover all generics for a small copayment. However, it would require a deductible of $500 or more for most brand name drugs, in addition to sizeable copayments. Brand name drugs account for the bulk of the cost.
Members of the connector board generally endorsed the proposal, although they postponed a vote until they see how insurers would apply it in real life.
“I like the idea, but I’d rather see lower deductibles and higher copays on brands,” said Celia Wcislo, a board member and assistant division director of labor union 1199 SEIU.
Louis Malzone, executive director of the Massachusetts Coalition of Taft-Hartley Funds, a group of private health plans jointly managed by unions and management, was concerned about how the proposal would play out for older insurees, who face higher premium prices.
As the next step, staff members will get actual premium prices and a proposed schedule of copayments and deductibles from the six insurers who are offering unsubsidized health coverage through the connector.
The board would then evaluate the proposal as an alternative to rules that require all residents to have health insurance that includes drug coverage with no more than a $250 deductible.
Posted by Karen Weintraub at 02:51 PM
July 12, 2007
By Alice Dembner, Globe Staff
All four of the companies running new subsidized health insurance plans have agreed to a contract extension that will pay them 4 percent more per enrollee, state officials announced today.
The agreement, which will cost the state about $16 million more, averts a potential budget crunch that had state officials worried. Some of the companies had been asking for significantly more money.
The companies currently serve about 92,000 low-income residents in the Commonwealth Care program and are working to enroll thousands more. The contracts now run through the end of fiscal 2008.
The two companies that have enrolled the lion’s share of new insurees – Boston Medical Center HealthNet Plan and Network Health – also have yet to secure licenses from the state Division of Insurance, which are required by the federal government.
Patrick Holland, chief financial officer for the Commonwealth Health Insurance Connector Authority, said he was confident that they would be licensed by the end of 2007, about six months after the federal deadline.
The other two plans, Neighborhood Health Plan and Fallon Community Health Plan, are already licensed.
Posted by Karen Weintraub at 02:02 PM
July 12, 2007
The number of newly insured Massachusetts residents rose by about 27,000 people before the July 1 deadline to obtain coverage, the state agency implementing the healthcare law said today.
That brings the total number of newly insured people to more than 155,000, according to a Commonwealth Health Insurance Connector statement. Among them are 15,000 members who enrolled in unsubsidized insurance plans in May and June through the Connector, their employers or directly with insurers.
About 2,500 people bought private insurance through the Connector's Commonwealth Choice program since it went on sale in May, a figure that is 50 percent higher than anticipated, according to the Connector. The others purchased plans through work or from insurance companies. Another 200,000 to 270,000 uninsured people still face the requirement to buy private insurance.
Last month 12,000 people signed up for subsidized coverage through the Commonwealth Care program, bringing the total to 92,000, about 20,000 more than projected by this time.
An estimated 44,000 to 68,000 eligible for the program have yet to sign up. Of those who have enrolled, about 83 percent are getting a full subsidy.
The Connector also said that 1,100 businesses have agreed to allow part-time and contract workers to buy health insurance through pre-tax payroll deduction plans. Some of the employers adopting the plans through the Connector are Boston College, Boston Red Sox, DeMoulas Market Basket, Dunkin Donuts, Gap, Partners HealthCare and TJX.
Adults uninsured by the end of the year, and who do not qualify for an exemption, will lose their state personal income tax exemption, a penalty that will rise in subsequent years.
Posted by Elizabeth Cooney at 12:09 PM
July 12, 2007
Dr. Alice Newton (left), a Children's Hospital Boston doctor who examined a 3-year-old girl whose upper lip was bitten off, testified yesterday in New Bedford District Court that hospital staffers had to persuade the Department of Social Services not to send the child home, where her mother had allegedly failed to stop months of physical abuse by her boyfriend.
Listen to an iPod during a storm and you may get more than electrifying tunes. A Canadian jogger suffered wishbone-shaped chest and neck burns, ruptured eardrums, and a broken jaw when lightning traveled through his music player's wires. Last summer, Colorado teen Jason Bunch (left, holding his lightning-burned shoe with his mother, Kelly Risheill) was hurt when lightning struck nearby as he was listening to his iPod while mowing the lawn.
State regulators yesterday upheld a freeze on admissions for the spring term in the nursing program at Massachusetts Bay Community College, but declined to issue stiffer sanctions because of the college's pledge to make substantial changes.
A coalition of state lawmakers and activists is promoting legislation that would restore a trust fund for tobacco prevention and bolster smoking cessation programs.
General Electric Co., the world's biggest maker of medical-imaging machines, and Abbott Laboratories broke off an agreement for GE to buy some of Abbott's diagnostics units for $8.13 billion.
Posted by Elizabeth Cooney at 06:39 AM
July 11, 2007
By Stephen Smith, Globe Staff
A statewide ban on artery-clogging trans fat lost its biggest potential roadblock today when the leading association of restaurateurs told legislators it will not fight the measure.
Massachusetts would become the first state to order restaurants to remove trans fat, a staple of frying oils and baked goods that has been linked to heart disease in humans and to diabetes and obesity in animal studies.
New York City approved a similar ban last year, a move that has inspired campaigns across the nation to consider similar regulations. The ban took effect last week amid little complaint.
A prohibition here would represent one of the most sweeping public-health initiatives in the state since smoking was banned from restaurants and bars in 2004. The tobacco rule faced ferocious opposition for more than a decade, most notably from the 5,500-member Massachusetts Restaurant Association, which argued initially that it would hurt business.
But today, Restaurant Association President Peter G. Christie told lawmakers that a statewide trans-fat ban would be preferable to a patchwork of local regulations. In May, Brookline became the first town in Massachusetts to embrace a trans-fat ban, although restaurants have until November of next year to comply. Boston and Cambridge have also considered bans.
"If it's decided that we need to take these things out of our foods in restaurants for health interests, we'll be willing to work with you," Christie told the Legislature's Joint Committee on Public Health.
Christie said he has "tremendous respect" for the state Department of Public Health, and if the agency says that trans fats are "bad and we have to get rid of them from our restaurants, the question would only be how and when."
The Department of Public Health, backed by research from Harvard and elsewhere, strongly supports reducing trans fat in diets. Public Health Commissioner John Auerbach championed a trans-fat ban in Boston where he was the top health official before moving to the state office this spring.
"We know that trans fats are harmful, significantly increasing the risk of heart disease," Auerbach said in a statement today. "Innovative approaches are needed to both educate the public about the dangers and to reduce the availability of foods with trans-fat content."
The Restaurant Association's stance sends such a powerful signal about the prospects for a statewide law that Boston now will probably wait to see what happens in the Legislature before pursuing a city ban, said Barbara Ferrer, who succeeded Auerbach as executive director of the Boston Public Health Commission.
"It's very encouraging to hear that the Restaurant Association is agreeing not to oppose a statewide ban," Ferrer said. "It says to me there's a fair amount of agreement that trans fats are not healthy, don't belong in the food, and the restaurant industry is taking a progressive position."
Ultimately, the ban's fate in the Legislature will hinge on the opinions of House Speaker Salvatore F. DiMasi and Senate President Therese Murray, neither of whom would commit to a position today. The ban was proposed by State Representative Peter J. Koutoujian, a Waltham Democrat, who is House chairman of the public health committee.
In one sure sign that trans-fat bans are winning widespread acceptance, the most vocal support at today's hearing came from two restaurant owners.
John Donohue, owner of Donohue's Bar and Grill in Watertown, told the committee that he decided in November to remove trans fat from all of his dishes, including french fries and chicken fingers, switching to a healthier brew of frying oil.
"Many of the consumers were dazed and confused because they didn't know I had changed," Donohue said. "They noticed zero difference. I've had a very popular reaction from my customer base."
Artificial trans fat had become a fixture of restaurant kitchens because it costs less, extends the shelf life of some baked goods and improves the texture of others.
Restaurateurs report that cooking with other oils has been less challenging than they expected, and that while they may pay more for healthier oils, they expect prices to drop as more cafes make the switch.
State Representative Alice K. Wolf, vice chairwoman of the committee, described the push to eliminate trans fat as "a train that's left the station.
"I'm very struck by the health data about how serious the health impacts are," said Wolf, a Cambridge Democrat. "It's not so cool to fight against public health measures if you have good data behind them."
Dr. Dariush Mozaffarian, a Harvard School of Public Health cardiologist and epidemiologist, detailed the health dangers of trans fat for the lawmakers, explaining how the artificial form raises the bad kind of cholesterol and lowers the good kind, something no other kind of fat does.
Research conducted at Harvard has shown how trans fat hurts the heart and increases the chances of suffering cardiovascular disease. Scientists estimate that having as little as 40 calories of trans fat a day can boost the risk of a heart attack by 23 percent.
A typical fast-food meal of chicken nuggets and french fries, if it's prepared in artificial trans fat, can easily contain more than 100 calories of the substance, Mozaffarian said.
Primate studies have also shown consuming trans fat can elevate the risk of a condition that is a precursor to diabetes and pack dangerous fat around the belly, the Harvard researcher said.
Trans fat, he said, "has no nutritional benefit, it has great potential for harm, and it can be easily replaced."
Posted by Gideon Gil at 08:02 PM
July 11, 2007
Providing health care to uninsured adults before they qualify for Medicare coverage may not only improve their health but also reduce costs after they turn 65, a Harvard study says.
People who haven’t had insurance coverage are significantly more likely to report poor health before the age of 65, the authors report in tomorrow’s New England Journal of Medicine.
They looked at data from the national Health and Retirement Study to compare health care expenditures between insured and uninsured adults at age 59 and 60 and then again after 65. They concluded that expanding health insurance coverage for uninsured people before 65 might be offset by savings in health care costs that would come later, particularly for people who have cardiovascular disease or diabetes.
"It may be less costly than people thought," Dr. J. Michael McWilliams, a research associate at Harvard Medical School, said in an interview. "Earlier coverage improves health and reduces health care needs."
These findings are especially important as baby boomers reach 65, he said. The current generation of adults has higher rates of obesity and hypertension than their parents', pointing to more chronic disease and a greater need for preventive care, said McWilliams, who also practices general internal medicine at Brigham and Women’s Hospital.
When previously uninsured adults reach 65, they have significantly more doctor visits and hospital stays than adults who had coverage before. The uninsured patients also had more out-of-pocket expenditures after 65 that were not covered by Medicare, the authors found.
"Not only does providing coverage to these adults substantially reduce their health care needs after 65, but it also protects them financially," McWilliams said.
Posted by Elizabeth Cooney at 05:56 PM
July 11, 2007
Dr. Thomas H. Lee knows the headline he wrote is provocative: "Is Zero the Ideal Death Rate?"
But the network president of Partners Health Care and associate editor at the New England Journal of Medicine is concerned that public reporting of mortality rates for individual cardiac surgeons carries unintended, perverse consequences. He fears that surgeons might hesitate to operate on high-risk patients if they are seeking a perfect performance record, he and two colleagues write in tomorrow's issue of the journal.
"If you are being ranked, you may walk away from a patient who’s very sick, even though that patient may be at high risk for surgery but even higher risk with medicine" as treatment, he said in an interview. "When so few patients can swing things for you being ranked, we’re worried about that effect on the decision-making process."
Lee, along with co-authors Dr. David F. Torchiana, a cardiac surgeon at Massachusetts General Hospital, and Dr. James E. Lock, an interventional cardiologist at Children’s Hospital Boston, say that reporting on cardiac surgery by institution makes sense, with individual reports available only to those hospitals. Massachusetts recently joined New York, New Jersey and Pennsylvania in publicly reporting death rates for individual cardiac surgeons.
Two elements make individual reports undesirable, they said. The first problem is that risk-adjustment methods intended to account for how sick a patient is do not include variables such as socioeconomic status. The second problem is the small sample size. If the average death rate after coronary artery bypass surgery is 2 percent, one or two deaths among the 200 operations a surgeon performs can make a large difference in that surgeon’s ranking, the authors say.
Lee said a better way to report performance would be the measures the federal government chose when it rated hospitals recently: better than expected, as expected, and worse than expected.
"I worry about having a patient with diabetes who’s doing very poorly. They may have a 20 percent mortality rate with surgery but an 80 percent mortality rate without surgery," he said. "I don’t want to have to beg surgeons to operate."
Posted by Elizabeth Cooney at 05:41 PM
July 11, 2007
By Liz Kowalczyk, Globe Staff
Harvard just announced that Dr. Jeffrey S. Flier, a prominent diabetes and obesity researcher at Beth Israel Deaconess Medical Center, has been named dean of Harvard Medical School.
Harvard University President Drew Gilpin Faust said in a telephone interview that Flier has wide ranging experience across the university, developed during his nearly 30 years there. She said she was impressed that Harvard leaders and faculty in vastly different roles -- basic science researchers, academic leaders, and physicians -- all spoke highly of him.
"All brought the same sense of deep respect," she said this afternoon.
Flier succeeds Dr. Joseph Martin, who stepped down as dean last month.
Flier was selected after the head of the National Heart Lung and Blood Institute, Dr. Elizabeth Nabel, a cardiologist, withdrew as a finalist, two Harvard officials said, citing a desire to stay in Washington where her husband works. Just as Faust is the first female president of Harvard, Nabel could have been the first female dean of the medical school.
"The timing was not right for her family, but Dr. Nabel congratulates Dr. Flier and wishes him great success in his new position as dean," said NHLBI spokeswoman Susan Dambrauskas.
Flier, 59, lives in Newton; his wife, Dr. Eleftheria Maratos-Flier, also is a leading diabetes researcher at Beth Israel Deaconess.
Flier, who is known for his research into the molecular mechanisms of insulin action and insulin resistance, has served for the past five years as chief academic officer of Beth Israel Deaconess. He has been closely involved in recent discussions of the future of Harvard-wide science, as a founding member of the Harvard University Science and Engineering Committee.
"It's pretty clear we're starting from a very high base line," said Flier, who begins as dean Sept. 1. "The challenge is finding areas where this incredible institution can be strengthened," he said in an interview.
He said that his areas of focus will include implementing Harvard Medical School's new curriculum, which pushes students to better understand patients' experiences in the health care system; helping plan the university's new Allston campus and the future of science at Harvard; and increasing collaboration among researchers across the system, particularly in the area of translating basic research into treatments for patients.
Asked how he pitched himself for the job, considering the dozens of candidates, Flier recounted, "I said that I've been in this system my whole career. I've seen the system on the patient care end, the researcher end, the teaching and the academic leadership end. I know I've been successful in those areas."
Dr. James Thrall, head of radiology at Massachusetts General Hospital and a member of the search committee, said "it was very clear in the proceedings that all of the people in the Harvard community who had worked with him (Flier) held him in very high regard. Given the nature of the academic world that is refreshing. People are pretty tough and judgmental. Having the right personality is important; trust and respect become very important when (people) have legitimate disagreements."
Posted by Gideon Gil at 05:21 PM
July 11, 2007
By Alice Dembner, Globe Staff
Since state officials approved a plan in March to require all Massachusetts residents to have prescription drug coverage, those officials have been searching for ways to keep drug coverage from driving up monthly health insurance premiums.
Today, staff members of the agency overseeing the new health insurance requirement proposed a plan that would add about $20 a month to premiums - far less than the typical $50 to $55. It would cover generic drugs for a small copayment, but would impose a $1,000 deductible on most other medicines.
The proposal will go before the Commonwealth Health Insurance Connector board tomorrow morning as a possible alternative to existing rules, which require drug coverage with no more than a $250 deductible. If approved, the proposal would set the minimum drug coverage that would meet state requirements that all adults have insurance. The rules apply to private insurance plans.
While all adults must obtain insurance this year - if it is affordable - their insurance doesn't have to cover drugs until Jan. 1, 2009.
Posted by Karen Weintraub at 02:30 PM
July 11, 2007
By Liz Kowalczyk, Globe Staff
Word is that Dr. Jeffrey Flier (left), chief academic officer at Beth Israel Deaconess Medical Center and a nationally known researcher on diabetes and obesity, will be named the new dean of Harvard Medical School, as early as today.
Two Harvard officials with knowledge of the search said today that Harvard University president Drew Gilpin Faust is close to making an announcement about Flier's appointment.
Dr. Elizabeth Nabel, a cardiologist who trained at Brigham and Women's Hospital and is director of the National Heart Lung and Blood Institute in Washington, D.C., dropped out of contention, the officials said. Just as Faust is the first female president of Harvard, Nabel would have been the first female dean of the medical school.
But Nabel did not want the job for family reasons; her husband, Dr. Gary Nabel, is heading the National Institutes of Health's search for an AIDS vaccine, also in Washington.
A search committee evaluated an initial list of several hundred candidates. Faust conducts the final interviews, makes the ultimate decision, and negotiates the new dean's salary, resources, and fund-raising responsibilities.
Posted by Gideon Gil at 01:47 PM
July 11, 2007
While chief of cardiovascular research at Caritas St. Elizabeth's Medical Center, a doctor now at Northwestern tested a stem-cell extraction technique on himself before going ahead with an experiment to transplant patients' stem cells into their hearts, the Chicago Sun Times reports today.
Dr. Douglas Losordo (left, in 2002 Globe photo) moved to Northwestern University's Feinberg School of Medicine in December 2006. The pilot study began in 2003 while he was a professor of medicine at Tufts University School of Medicine and a cardiologist at St. Elizabeth's.
Losordo did not go on to have stem cells injected via catheter into his heart. Before the small trial to test safety began, he took a drug for five days that boosted production of stem cells in his bloodstream and then had them removed and purified in a process similar to dialysis, the story says.
"I wanted to see what it would be like for patients before I subjected them to the procedure," he told the Sun Times.
The study subjects all had severe angina, or chest pain, that could not be treated by surgery, stents or angioplasty. The group of patients who received stem cells injected into heart muscle that was not receiving blood flow reported fewer angina attacks over six months than the group of patients who underwent catheterization, but did not receive stem cells, the story said.
The results appear in the June 26 issue of Circulation.
Posted by Elizabeth Cooney at 11:51 AM
July 11, 2007
Overweight and obese children who are subjected to verbal taunts and physical bullying are substantially more prone during childhood to suicidal thoughts, eating disorders, and high blood pressure than their peers, according to a Yale University study released yesterday.
President Bush's first surgeon general, Dr. Richard H. Carmona (left), alleged yesterday that administration officials prevented him from providing the public with accurate scientific and medical information on such issues as stem cell research and teen pregnancy.
A new website allows consumers to compare prices offered by Vermont pharmacies for prescription drugs by clicking on their medication or medications, as well as their town or county, and pulling down a list of prices offered for various drugs by pharmacies in their area.
QLT Inc., a Canadian maker of eye-disease treatments, said a US judge upheld a jury verdict in favor of Massachusetts Eye and Ear Infirmary in a dispute over the invention of the Visudyne brand vision-loss treatment.
Posted by Elizabeth Cooney at 06:47 AM
July 10, 2007
The Great Refractor, left, which captured the first
picture of a star in 1850, and an image of the
Large Magellanic Cloud taken in 1900.
More than half a million images constituting humanity’s only record of a century’s worth of sky exist on glass plates at the Harvard College Observatory, a story in today's New York Times notes.
"Besides being 25 percent of the world’s total of astronomical photographic plates, this is the only collection that covers both hemispheres," Alison Doane (left) told the Times. She is curator of the glass database, which weighs 165 tons and contains more than a petabyte of data, the story says. There is no backup.
For the last few months, Doane and a few colleagues, along with volunteers from the Amateur Telescope Makers of Boston, have been setting the stage for a mammoth attempt to convert the entire collection into a searchable online atlas, the story says.
Posted by Elizabeth Cooney at 10:55 AM
July 10, 2007
A device first designed by two MIT graduate students in a 2002 robotics class is helping stroke patients regain motion in their arms, a story in today's New York Times says. Mechanical engineer John McBean developed the technology with Kailas Narendran, an electrical engineer and computer scientist.
A small study of their Myomo e100 device (shown in motion, left) and associated treatment, conducted with Spaulding Rehabilitation Hospital and published in April in The American Journal of Physical Medicine and Rehabilitation, found that patients who exercised with the arm brace for 18 hours over about six weeks experienced a 23 percent improvement in upper extremity function, the Times story says.
The device has been approved by the Food and Drug Administration and is expected to reach the market in the next few months.
Posted by Elizabeth Cooney at 08:15 AM
July 10, 2007
Graphic television ads starring former smoker and cancer survivor Ronaldo Martinez (above), his tinny, robotic voice warning of the consequences of cigarettes, used to run in Massachusetts until 2001 budget cuts. The Massachusetts Legislature voted last week to reinvigorate the tobacco-control program, boosting its budget to $12.75 million for next year, from $8.25 million this year.
State regulatory officials have taken the unusual step of barring Massachusetts Bay Community College from accepting new applicants in its popular nursing school.
In the latest endorsement of a science technique discovered at the University of Massachusetts, the international drug giant Roche signed a $331 million deal with Alnylam Pharmaceuticals Inc. of Cambridge for the rights to develop drugs using RNA interference.
Posted by Elizabeth Cooney at 06:56 AM
July 09, 2007
Men who are too young or too old for prostate cancer screening tests are still getting them from clinicians whose "prostatempathy" may be guiding their decisions, Harvard researchers suggest in a study of seven New England veterans' hospitals.
Health experts agree that men without symptoms who are under 40, older than 75 or expected to have less than 10 years to live do not benefit from the prostate-specific antigen test. They can suffer psychological and financial costs and possibly have procedures that may not help them, according to the article in today's Archives of Internal Medicine.
Dr. B. Price Kerfoot and his colleagues at Harvard Medical School and the Veterans Affairs Boston Healthcare System decided to look at who was ordering these tests despite the consensus that they should not be used. They found that people who rarely ordered the PSA tests, urologists and male practitioners all tended to order the tests more often for men who fell into groups considered inappropriate for the screening.
"The percentage of inappropriate PSA screening increased significantly with the age of male health care providers," the authors wrote. "It it possible that, as they age, male health care providers increasingly empathize with their older male patients over prostate cancer concerns. Their 'prostatempathy' may then lead to more aggressive screening in these older male patients."
Posted by Elizabeth Cooney at 04:15 PM
July 09, 2007
Electronic health records, championed as a way to improve patient health and safety, don't by themselves lead to better care in doctors' offices, a study shows.
Researchers from Harvard and Stanford found that electronic records made no difference in 14 of 17 measures of quality for outpatient health care, according to today's Archives of Internal Medicine. They examined data from the National Ambulatory Medical Care Survey gathered from visits to doctors in 2003 and 2004.
Two categories showed better performance on recommended care in the 18 percent of visits in which electronic health records were used: not prescribing tranquilizers for depression and not ordering routine urinalysis in general medical exams. But in one area -- prescribing statins for patients with high cholesterol -- physicians using electronic health records performed worse than doctors who didn't have them.
The missing piece is information to guide clinical decisions, co-author Dr. David W. Bates of Harvard Medical School said in an interview last week. Prompts to order tests, prescribe medications or avoid harmful drug interactions can make the records more than just computerized charts, the study said.
"I was surprised," he said. "I expected we would find improvement with the use of electronic health records, especially because there's a lot of evidence that with good decision support, quality measures do improve."
The survey did not ask if doctors were using electronic records with decision support tools, said Bates, who is chief of general internal medicine at Brigham and Women's Hospital. But previous research has shown quality goes up when a physician is reminded to order a lab test to monitor a patient's diabetes, for example. Decision support is most helpful with preventive care and chronic disease management, he said.
"I hope this will emphasize the importance of including good decision support in electronic health records," he said.
Posted by Elizabeth Cooney at 04:00 PM
July 09, 2007
On Running a Hospital, Paul Levy compares the troubles of the Caritas Christi Health Care system to the ones he faced when he took over at Beth Israel Deaconess Medical Center. It was January 2002 and Attorney General Tom Reilly was pushing to sell the hospital to a for-profit company. Levy says reorganizing the Beth Israel Deaconess board in relation to its parent Caregroup was key to its survival.
"The marvelous hospitals of the Caritas Christi system and the caring and thoughtful staff in those hospitals need to be governed by the communities they serve," Levy writes. "Local board members who are held accountable for their actions will have the business sense and the dedication to make the decisions needed to ensure that the faith-based mission of their institutions is successful."
Posted by Elizabeth Cooney at 10:20 AM
July 09, 2007
A small but growing number of mid career professionals like former Verizon operations manager Bill Kerr (with patient Rashad Paulding) are abandoning the cubicle, the construction site, and even the boardroom in favor of the bedside.
Good news, folks! Some things actually get better with age, and I'm happy to say that emotional stability is one of them, Judy Foreman writes. It says so right in the authoritative Journal of Neuroscience.
Christopher Potts, a linguist at the University of Massachusetts at Amherst, wants to learn whether there are linguistic rules that would indicate when an obscenity is meant to offend, shock or be funny and when it's intended to express anger, surprise or fear.
Dr. Paige Church (with patient Ariel Estrada) was born with spina bifida, a dangerous birth malformation that required repeated surgeries throughout her childhood. She now runs the Neonatal Intensive Care Unit follow-up program at Floating Hospital for Children where she bridges the gap between families and physicians.
Also in Health/Science, are people radioactive and does the lycopene in tomatoes help protect against prostate cancer?
Years of meticulous research came to fruition for Eugene Bell (left) more than a quarter-century ago when he mixed human cells, collagen, and other ingredients to create a skin-like tissue that could be grafted onto severely injured patients, such as those who had been badly burned. He went on to join the faculty of MIT and found two biotechnology companies and most recently had been conducting stem cell research involving adult body cells. He died June 22 after suffering a heart attack in his Boston home. Dr. Bell was 88.
Health care is staking a claim to center stage on the national political and issue agenda for the first time since the great debate about the Clinton health reform plan in the early 1990s, Drew Altman, president and CEO of the Kaiser Family Foundation, writes on the op-ed page.
Posted by Elizabeth Cooney at 07:30 AM
July 09, 2007
Dozens of groups across the state are taking a more personal approach to getting the word out about the state's new health insurance requirement, reaching people in their homes, their favorite restaurants, their health centers, and their churches and helping them sign up, Alice Dembner writes in Saturday's Globe.
Short jaunts on Mars are long on discovery, Colin Nickerson reports in Sunday's Globe.
A bill pending in the Legislature that would require psychiatric hospitals to provide patients like Gigi Alley (at right in photo, with daughter Rose) with a right long enjoyed by prison inmates: daily access to the outdoors, Felicia Mello writes in Sunday's Globe. The legislation has met with opposition from medical centers and raised questions about the proper balance between patients' autonomy and doctors' clinical judgment.
Posted by Elizabeth Cooney at 06:40 AM