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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
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Monday, November 5, 2007

Screening shows 1 in 7 teens might have substance abuse problem

About 1 in 7 teenagers in Massachusetts and Vermont might have a substance abuse problem, according to screening questionnaires filled out during routine doctors’ visits, a study has found. The adolescents' answers were more likely to indicate a problem during an appointment when they were sick or injured than when they were having a checkup.

“Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only,” wrote Dr. John R. Knight of Children’s Hospital Boston, lead author of the study in this month’s Archives of Pediatrics & Adolescent Medicine.

Researchers from Children’s, Tufts-New England Medical Center, Cambridge Health Alliance, the University of Vermont and Fallon Clinic in Worcester asked more than 2,000 12- to 18-year-old patients to answer six questions: five about using alcohol or other drugs and one about engaging in risky behaviors, such as riding in a car with someone who was impaired. Two 'yes' answers meant the teen screened positive for substance abuse.

Overall, 14.8 percent of patients said yes to at least two of the six questions. The most positive responses to the questions came in school-based health centers, at just under 30 percent of patients, followed by rural family practices, at about 25 percent. At sick visits, 23.2 percent of the screenings were positive, compared with 11.4 percent of well visits.

Positive screenings do not establish a diagnosis, the authors write, but they do require follow-up. Noting that sick visits are generally allotted less time than well visits, they suggest healthcare providers be trained in how to help patients who test positive by either offering brief advice or referring them for counseling or treatment.

Posted by Elizabeth Cooney at 05:41 PM

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Wednesday, October 24, 2007

Boston group to share genetic data on autism

A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.

The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.

"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."

Only a small percentage of autism arises from a recognizable genetic cause, such as Fragile X syndrome, Daly said. Recent research suggests that some families with autism might have higher rates of genomic abnormalities, but very few of these abnormalities have been conclusively identified.

"There's very strong heritability to autism but very little of the heritability has been explained by specific mutations of specific genes," he said. "What we hope is that this data is a starting point. We need to perform collaborative research in the spirit of the Human Genome Project to deliver on the trust the public has placed in us."

Members of the Autism Consortium are Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Boston University School of Medicine, the Broad Institute of MIT and Harvard, Cambridge Health Alliance, Children’s Hospital Boston, Harvard University, Harvard Medical School, Massachusetts General Hospital, Massachusetts Institute of Technology, McLean Hospital and Tufts-New England Medical Center.

Posted by Elizabeth Cooney at 11:37 AM

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Thursday, October 11, 2007

Four Boston doctors named Howard Hughes investigators

From left, Daley, Engle, Haber and Karumanchi

Four Boston physician-scientists have been selected by the Howard Hughes Medical Institute in an initiative to promote patient-oriented research.

Dr. George Daley and Dr. Elizabeth Engle, both of Children’s Hospital Boston, Dr. Daniel Haber of Massachusetts General Hospital, and Dr. S. Ananth Karumanchi of Beth Israel Deaconess Medical Center are among 15 new HHMI Investigators. Boston has the most winners in this new group.

Daley is a world leader in hematopoetic and embryonic stem cell research; Engle has identified genetic factors behind disorders that limit patients’ control over their eye movements; Haber studies how individuals’ genetic mutations affect their response to cancer drugs; and Karumanchi has identified the soluble proteins produced by the placenta that can trigger pre-eclampsia in a pregnant mother.

HHMI received 242 applications from eligible candidates. The 15 selected physician-scientists from 13 institutions will receive a total

of about $150 million in their first five-year terms.

Posted by Elizabeth Cooney at 07:00 AM

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Tuesday, October 2, 2007

Residents stand up for SCHIP

By Elizabeth Cooney, Globe Correspondent

Pediatric residents in Massachusetts and around the country gathered at noon today to push for expansion of a children's insurance plan that President Bush has threatened to veto.

At Boston Medical Center, about 50 residents, pediatricians, nurses and social workers paused in the hospital's main lobby as part of "Stand Up for SCHIP," the insurance program that covers children who don't qualify for Medicaid. There would have been one more, but that resident stayed behind in the intensive care unit with a child in respiratory distress, chief resident Marie Clark told the group. The child's father couldn't afford the asthma medication prescribed during an office visit on Friday, Dr. Suzanne Steinbach added, as an example of how lack of insurance hurts children.

"All of us here have had the same story," Dr. Barry Zuckerman, chief of pediatrics, said. "All of us are asking the president to do the right thing for children."

The State Children's Health Insurance Program is a federal program that covers 6.6 million children. It was set to expire after 10 years but Congress and the Bush administration are at odds over its funding and expansion. It is temporarily funded through mid-November.

Congress passed a bill that would expand the program by $35 billion over five years, to be paid for with new tobacco taxes.The number of uninsured children who could participate nationwide would grow to 10 million. Bush, who wants to increase funding by $5 billion over five years, has promised to veto the bill.

"Congressional leaders have put forward an irresponsible plan that would dramatically expand this program beyond its original intent," the president said in his radio address Saturday. "And they know I will veto it."

In Massachusetts, families earning three times the federal poverty level can obtain insurance through SCHIP for their children. The plan covers 90,500 children in the state.

Last week residents at Stanford's Lucile Packard Children's Hosptial in California planned a demonstration for today that spread to more than 30 hospitals around the country.

At Children's Hospital Boston, about 40 residents stood outside on Longwood Avenue to hear chief resident Carl Eriksson and second-year resident Michelle Niescierenko .

"We need to come together in solidarity with pediatric residents around the country to make a stand for children's health," Eriksson said.

At UMass Medical School in Worcester, about 40 medical students, interns, residents, staffers and administrators stood outside to voice their support for an expanded SCHIP program.

"It's not socialized medicine," UMass professor Dr. David Keller said in a statement. "It is good for our children."

Posted by Elizabeth Cooney at 04:58 PM

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Residents to take a stand on SCHIP

At noon today, pediatric residents across the country will join a 15-minute Stand up for SCHIP to urge President Bush not to veto an expansion of coverage for uninsured children who don't qualify for Medicaid.

The action started at Stanford's Lucile Packard Children's Hosptial in California but soon spread to dozens of hospitals, including Boston Medical Center, Children's Hospital Boston and UMass Memorial Medical Center in Massachusetts. The House and Senate have voted to reauthorize and expand the State Children's Health Insurance Plan, but the president has said he would veto it.

"It means children who could be covered won't be and the possibility that some children already covered may lose their insurance," Dr. Barry Zuckerman of Boston Medical Center said in an interview yesterday. "We see the consequences when patients don't get care when they don't have insurance."

Posted by Elizabeth Cooney at 10:51 AM

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Monday, September 17, 2007

Children's group building online medical records for major employer group

A group from Children's Hospital Boston has been hired by a corporate consortium to develop online medical records for their employees.

Dossia, a group of eight major employers including Wal-Mart and Intel, chose the Children's Hospital Informatics Program to adapt its own program called Indivo to provide secure health records for 5 million employees and their dependents and retirees.

The Children's program, which also has ties to Harvard and MIT, has been working for 10 years to create Web-based records for patients that include a lifetime of health information across different doctors and care sites. The Dossia goal is to allow its workers to have access to their medical records, to communicate with their doctors, and to pull together information from different sources, the group said.

Dossia does not disclose details of its contracts, Colette Cote, a spokeswoman for member Pitney-Bowes and Dossia, said when asked about the financial terms of the agreement with Children's. The other companies in Dossia are AT&T, Sanofi-aventis, Applied Materials, BP America Inc. and Cardinal Health.

Indivo will be introduced at Children's this fall and Dossia plans to roll out its version to some members by the end of the year, its statement said.

Posted by Elizabeth Cooney at 05:06 PM

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Thursday, September 6, 2007

BU, Children's win grant to develop minimally invasive heart surgery

Attached to a steerable needle, miniaturized instruments
such as this tissue-nibbling device (shown next to a
sharpened pencil) could be used in minimally invasive
heart surgery.

Researchers at Boston University and Children's Hospital Boston have won a five-year, $5 million grant to make complex heart repairs possible without open-heart surgery.

Working with California medical instrument maker Mircofabrica Inc., Pierre Dupont of BU's School of Engineering and cardiac surgeon Dr. Pedro del Nido of Children's will develop robotic instruments that can reach the heart through small incisions in the chest and heart walls.

"The goal is to develop techniques where we are not only making just small incisions but actually working to repair defects inside the heart while the heart is still beating," del Nido said in an interview.

Patients would avoid potential complications associated with being on a bypass machine during open-heart surgery, while surgeons would still be able to achieve the precision possible with traditional surgical instruments. The project is primarily aimed at adults with heart disease, although there may be pediatric applications, del Nido said.

The National Institutes of Health Bioengineering Research Partnership award is the second grant for this project, del Nido said. The first grant, now in its fourth year, funded the creation of an imaging system in three-dimensional ultrasound to allow surgeons to see inside the heart. The new grant focuses on creating the tools to perform repairs.

Using real-time imaging, a surgeon will be able to use a joystick controller to guide instruments through the chambers of the heart. Tools could be deployed from the tip of an instrument to remove blockages, fix valves and close leaks in the heart.

Current minimally invasive techniques use catheters to bring devices into the heart, deploying tiny umbrellas to patch holes in the heart or using balloons to clear blockages.

"We view this as the next level of intervention that is in a way a hybrid of catheter-based intervention and open-heart surgery, using the tools of open-heart surgery in the reconstruction but the navigation through a blood vessel or through chambers of the heart while the heart is beating," del Nido said.

Posted by Elizabeth Cooney at 05:23 PM

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Monday, August 27, 2007

Harvard leader named dean of Duke medical school

andrews100.bmpA Harvard Medical School physician-scientist has been named dean of the Duke University School of Medicine, the North Carolina school announced today.

Dr. Nancy C. Andrews (left), dean for basic sciences and graduate studies at Harvard Medical School, is the first woman to fill the position, Duke said. She will succeed Dr. R. Sanders Williams, who was promoted to senior vice chancellor for academic affairs at Duke.

Andrews, 48, is a pediatric hematologist/oncologist at Children's Hospital Boston and the Dana-Farber Cancer Institute. She previously directed the Harvard/MIT MD/PhD program. A member of the Institute of Medicine of the National Academy of Sciences, she was a Howard Hughes Investigator from 1993 to 2006.

Andrews earned bachelor's and master's degrees in molecular biophysics and biochemistry from Yale University, a Ph.D. in biology from MIT, and an MD from Harvard Medical School. She completed her residency at Children's and a fellowship in pediatric hematology/oncology at Children's and Dana-Farber.

Posted by Elizabeth Cooney at 02:51 PM

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Mass. adults second-leanest, but youth overweight rates rank in the middle

By Elizabeth Cooney, Globe Correspondent

Massachusetts adults are the second-leanest in the country, according to a report released today, but the state's younger residents rank in the middle on the overweight scale.

The adult obesity rate was 19.8 percent, placing the state higher than only Colorado. For children age 10 to 17, the rate of being overweight was 13.6 percent, or 27th highest on the national list in the fourth annual "F as in Fat: How Obesity Policies Are Failing in America, 2007" from the Trust for America's Health. Almost a third of American adults are obese, it said.

The report, funded by the Robert Wood Johnson Foundation, is based on data that the Centers for Disease Control and Prevention gathered from 2004 through 2006. Children are considered overweight if they are at or above the 95th percentile of body mass index for their age. Adults fall into the obese category if their BMI is 30 or above.

Adult obesity climbed in 31 states last year, including a gain of 1.2 percentage points in Massachusetts, which was also among 22 states that saw increases for two years in a row. In no state did obesity decline.

There's nothing surprising about the trends going upward, obesity specialist Dr. David Ludwig of Children's Hospital Boston said in an interview.

The difference between adults and youths may reflect the makeup of the population, with obesity being more prevalent among certain economic, social and ethnic groups, he said, but the rising trend among all segments is more important.

"The obesity epidemic continues to escalate," he said. "Even if we were to see a leveling off, especially with children, the full impact of the epidemic will not be felt for some time to come."

Type 2 diabetes, high blood pressure, high cholesterol and other serious complications are showing up in children now, which will translate into shorter life expectancy in the United States for the first time since the Civil War, he said, citing a paper he wrote two years ago. Ludwig was not involved in the report released today.

Mississippi's 30.6 percent adult obesity rate was the highest and Colorado's 17.6 percent was the lowest. For youths, the highest rate of 22.8 percent was found in Washington, D.C., and the lowest was 8.5 percent in Utah. For both children and adults, the highest rates of overweight were found in the South.

But Massachusetts isn't far behind, Ludwig said.

"Rather than focus on which state is winning the race, so to speak, the state-to-state variations are from my perspective less important than the overall more remarkable finding of this increase in obesity among adults and children everywhere," he said.

The report tracked policies in schools to encourage better nutrition and more physical activity. Massachusetts is not among the 17 states whose school lunches, breakfasts and snacks must meet higher standards than required by federal guidelines. The state is also not one of the 22 that have rules for other food sold in schools, from vending machines to bakes sales. But Massachusetts does send home fitness assessments about students, among 16 states to do so.

Posted by Elizabeth Cooney at 11:00 AM

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Friday, August 24, 2007

Beth Israel Deaconess to train medical microbiology fellows

Beth Israel Deaconess Medical Center will launch two new fellowship programs in medical microbiology, the hospital said.

Both are designed to teach doctors to understand bacterial agents, parasites and viruses and to run academic, hospital or public health laboratories. The fellows will train at Children's Hospital Boston and the Massachusetts Department of Public Health as well as Beth Israel Deaconess.

Posted by Elizabeth Cooney at 10:13 AM

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Children's Hospital ranks second on US News list

Children's Hospital Boston came in second in a US News & World Report ranking of pediatric hospitals, the magazine said today.

Children's Hospital of Philadelphia took first place and Johns Hopkins Hospital in Baltimore finished third on a list of 30 pediatric hospitals. This is the first time the magazine has created a separate ranking for pediatric hospitals or children's hospitals within a medical center.

The rankings are based on reputation, death rates and care-related measures such as volume, nursing care, advanced technology and outside recognition.

Posted by Elizabeth Cooney at 12:01 AM

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Wednesday, August 22, 2007


A Brown University neuroscientist has won Germany's top honor for basic neurological research for creating a device that translates thought into action.

John P. Donoghue, who developed a brain implant called BrainGate that allows paralyzed people to use their thoughts to move a computer cursor, control a wheelchair or operate a robotic arm, will receive one of two K.J. Zulch prizes next week. The other goes to University of Melbourne professor emeritus Graeme Clark, who invented the cochlear implant.

Dr. Robert Ian McCaslin of Children's Hospital Boston has been named director of Mo HealthNet, the Medicaid agency for the state of Missouri, Governor Matt Blunt said. He has been an attending physician in the pediatric emergency department at Children's and an instructor at Harvard Medical School.

Each year MIT's Technology Review names 35 innovators under 35 for its TR35. This year eight technologists and scientists from New England make the list.

David Berry, 29, Flagship Ventures, Cambridge: renewable petroleum from microbes
Adam Cohen, 28, of Harvard University: making molecules motionless
Ali Khademhosseini, 31, Harvard-MIT Division of Health Sciences and Technology: improving engineered tissues
Ivan Kristic, 21, One Laptop per Child (on leave from Harvard): making antivirus software obsolete
Christopher Loose, 27, SteriCoat, Cambridge: beating up bacteria
Anna Lysyanskaya, 31, Brown University: Securing online privacy
Kristala Jones Prather, 34, MIT: reverse-engineering biology
Mehmet Yanik, 29, MIT: stopping light on microchips

Posted by Elizabeth Cooney at 07:03 AM

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Tuesday, August 7, 2007

Underinsured children fall into vaccine gap

By Elizabeth Cooney, Globe Correspondent

Children whose private health insurance does not pay for new recommended vaccines may not be eligible to receive them in public programs, leaving them more vulnerable than if they had no insurance, according to a Harvard study.

These gaps are occurring as the number and cost of new vaccines have escalated. New vaccines recommended for children have doubled in the past five years and the cost to fully vaccinate a child -- about $1,170 -- is 7.5 times higher in 2007 than it was in 1995, Dr. Grace M. Lee of Harvard Medical School and colleagues write in tomorrow’s Journal of the American Medical Association. They surveyed state immunization program managers in 48 states from January to June 2006.

"We assumed kids with health insurance would have coverage for vaccinations, but we found a group of children whose insurance didn’t cover the cost of vaccine. That to me was surprising," Lee said in an interview.

Those children were referred to public health clinics, but they were still unable to receive vaccine because funding to pay for it was not available, the researchers found. The work was funded by the US Centers for Disease Control and Prevention.

"To us that was alarming because we had always seen the public sector as a safety net for vulnerable children," said Lee, also of Children’s Hospital Boston and Harvard Pilgrim Health Care. "Now we find that with the newer, more expensive vaccines, a lot of states are unable to provide these vaccines to kids who can’t afford them."

Massachusetts covers all children for all vaccines recommended by the Advisory Committee on Immunization Practices, except the new vaccine against human papillomavirus. ACIP sets policy for the federal Vaccines for Children program, which pays for all vaccinations for children who are uninsured, eligible for Medicaid, of American Indian or Alaskan Native origin, or seen at a federally qualified community health center.

In July, Massachusetts began providing rotavirus and meningococcal conjugate vaccines for all children, Dr. Susan M. Lett of the state Department of Public Health and a co-author of the JAMA article said in an interview. The vaccines to protect against severe diarrhea in infants and meningitis in teenagers, respectively, were included in the state budget recommended by Governor Deval Patrick. The governor's budget had also proposed coverage for a vaccine for adolescent girls against HPV, the virus that causes cervical cancer, but the legislature requested a study on it instead.

The JAMA study did not attempt to find out how many families might pay out of pocket for vaccines. The HPV vaccine costs about $120 for each of three doses, the meningitis vaccine costs about $80, and the rotavirus vaccine costs about $60.

"I imagine that if a family can’t afford health insurance that covers vaccines, they probably wouldn’t be able to afford to pay for that," Lee said.

Based on a 2000 estimate by other researchers that 14 percent of children in the United States are underinsured, the JAMA authors estimate that 2.3 million children are unable to receive meningococcal conjugate vaccine from their private health care providers and 1.2 million children can’t get it from public health clinics.

In an accompanying editorial, Dr. Matthew M. Davis of the University of Michigan suggests a tiered approach to financing newly recommended vaccines for underinsured children where funding is not available.

"Vaccines that benefit more of the population per individual immunized would receive higher priority," he writes.

Lee and her co-authors suggest working with insurance plans to include coverage.

"Until those enhancements can be made to health insurance plans, I think we need to support our public sector safety net," she said. "We need to come up with funding for these kids who are falling through the cracks to bridge the gap until we can have all health insurance plans covering vaccines."

Posted by Elizabeth Cooney at 07:07 PM

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Thursday, August 2, 2007

Korean cloning fraud covered an accidental stem cell first, Harvard paper says

Harvard scientists have answered a question that lingered after Korean scientists retracted their fraudulent claim
that they had cloned the first human embryonic stem cells: Where did the stem cell line they created come from?

george q. daley100.bmpKitai Kim, Dr. George Q. Daley (left) and their colleagues at Children's Hospital Boston and the Harvard Stem Cell Institute report today in Cell Stem Cell that the embryonic stem cells created by the Korean lab resulted not from somatic cell nuclear transfer, a technique in which a person's DNA is injected into a donor egg cell that has had its own DNA removed, but from parthenogenesis, the process of making an embryo from the donor egg alone.

Cells derived from parthenogenesis carry a distinct genetic fingerprint because they have a duplicate set of chromosomes from the egg. Most of the genetic sequences are identical, but some show differences from the donor egg. Investigators looking into the Korean claims last year said parthenogenesis could not explain these different patterns, the paper said.

Kim and Daley's group analyzed the cells further and found that the DNA differences were clustered at certain points, just as they are in experiments on parthenogenesis in mice.

The Koreans appear to have created the first human embryonic stem cells from a woman's egg alone, the paper says.

Daley's lab is studying parthenogenetic cells as another possible source of embryonic stem cells to treat disease.

A Children's Hospital interview with Daley is here.

Posted by Elizabeth Cooney at 12:40 PM

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Thursday, July 26, 2007

State revokes license of resident who fell asleep in OR

By Liz Kowalczyk, Globe Staff

The Board of Registration in Medicine, which licenses Massachusetts doctors, yesterday retroactively revoked the medical license of Dr. Thomas Ho, finding that he fell asleep during a surgical procedure in December 2005 and inhaled anesthetic gas while on lunch break at work the following month.

Both incidents occurred during a rotation at Children's Hospital Boston. Ho had taken a prescription drug that caused him to doze off, the board said, and when he fell asleep he was the only anesthesiologist in the operating room.

Ho, who was an anesthesiology resident based at Brigham and Women's Hospital, took a voluntary leave in January 2006. He can apply for a new license if he demonstrates at least 15 months of continuous sobriety, and compliance with a chemical dependency monitoring contract.

A Children's Hospital spokeswoman, Michelle Davis, said today: "No patient was harmed, and as soon as the situation was discovered he was discharged from Children's."

In another case, the board indefinitely suspended the license of Dr. Joseph Fahey, a pediatrician in Worcester who admitted during a board investigation in 2005 that he had used cocaine and marijuana. The board immediately stayed the suspension because Fahey agreed to a probation agreement that includes monitoring him for drug use until 2010. Fahey has not been practicing medicine, but can do so under the terms of the agreement.

The board also indefinitely suspended the license of Dr. Camilla Parham, a family practitioner who had worked in Cambridge, for behaving inappropriately with a patient at a party. The board immediately stayed the suspension because Parham agreed to enter a probation agreement, which includes a requirement that she take continuing medical education courses in physician/patient boundaries. Parham has not been practicing medicine, but can do so as long as she adheres to the terms of the agreement.

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Friday, July 13, 2007

On the blogs: Levy ponders surgeons' report card Catch-22

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

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Wednesday, July 11, 2007

Surgeon rankings have unintended consequences, doctors say

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

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Wednesday, July 4, 2007

Doctor advises how to resolve family-hospital disputes over ending life support

They’re called "medical futility" cases, when family members and hospitals disagree on whether to continue life support for very sick patients. Although rare, they raise questions about respect for others’ viewpoints, a Children’s Hospital Boston doctor says.

Writing in tomorrow’s New England Journal of Medicine, Dr. Robert D. Truog warns against laws that allow a hospital ethics committee to be "surrogate judge and jury."

He considers the recent case of 19-month-old Emilio Gonzales, whose mother went to court to prevent Austin Children’s Hospital from turning off his respirator. Emilio had a rare, fatal genetic disorder called Leigh’s disease that meant he was in intensive care for five months with declining neurological function. Under the Texas Advance Directives Act, the hospital’s ethics committee decided to withdraw life support despite the objections of his mother, Caterina Gonzales.

"I’m concerned that legislation like that in Texas makes it just too easy for people in the medical profession to override the desires of those who have unpopular views," Truog said in an interview. "We’ve got a beautiful system of laws designed to protect people from the tyranny of the majority. The Texas law just bypasses it."

Massachusetts has no law governing cases like these, Truog said. Director of medical ethics at Harvard Medical School, he wrote a policy for Children’s about medically futile care. Under that policy, if a hospital ethics committee were to conclude that medical treatment should be stopped and the family disagreed, it would assist the family in finding and sometimes paying for a lawyer to take the hospital to court so a judge would decide.

In Emilio’s case, his mother found legal help through right-to-life groups, Truog said, but the process should have included safeguards to make that recourse standard. Those safeguards also have the benefit of allowing time for more discussion between the family and the hospital, he said, rather than ending the argument with a unilateral decision. Emilio died before the judge ruled, an outcome that is common in cases like these, Truog said.

The beliefs of people providing care in cases like these should not be ignored, he said. Clinicians should be supported in the difficult job of giving care that they don’t agree is the right thing to do. But their concerns do not automatically win the day, he wrote.

"The claim that continued life support for Emilio was morally objectionable was nothing more than an assertion that the values of the clinicians were correct while those of Ms. Gonzales were wrong," Truog wrote. "I believe that in cases like that of Emilio Gonzales, we should seek to enhance our capacity to tolerate the choices of others, even when we believe they are wrong."

Posted by Elizabeth Cooney at 05:00 PM

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Thursday, June 28, 2007


Cambridge Health Alliance will accept an award today from the National Association of Public Hospitals and Health Systems for its role in medical school curriculum change.

CHA developed a program for third-year Harvard Medical School students to follow patients for a year at one hospital instead of traditional rotations in different settings. The hospital was chosen for the 2007 Chair Award from 64 submissions, NAPH said in a statement.

Dr. Samantha L. Rosman, a third-year resident in pediatrics in Boston, has been re-elected to the American Medical Association's board of trustees. She is a 2004 graduate of Columbia University College of Physicians and Surgeons. After completing her residency, she will begin a fellowship in pediatric emergency medicine at Boston Medical Center.

Shedlack100.bmpDr. Karen Shedlack (left), medical adviser for the mental retardation division of Vinfen, has won a 2007 Distinguished Fellowship from the American Psychiatric Association.

Before joining Vinfen, a private, nonprofit human services organization based in Cambridge, Shedlack was medical director for the adult developmental disabilities program at McLean Hospital and worked in the department of psychology and brain science at the Massachusetts Institute of Technology.

Virgin Life Care has named three Boston academics to its science advisory board.

A subsidiary of the Virgin group headed by Sir Richard Branson, the Boston company develops activity-based health rewards programs.

The board members are Dr. I-Min Lee of Harvard Medical School and the Harvard School of Public Health, Kyle McInnis of UMass-Boston and Jessica Whitely of UMass-Boston and Brown Medical School.

Children's Hospital Boston has honored five doctors with Community Physician Awards for the care they give in pediatric practices and community health centers.

They are Dr. Anthony Compagnone of Hyde Park Pediatrics, Dr. Debra Ann Gfeller of Holliston Pediatrics, Dr. David Holder of the Martha Eliot Health Center, Dr. Richard Marshall of Harvard Vanguard Associates at Copley and Dr. Robert Michaels of Longwood Pediatrics.

Posted by Elizabeth Cooney at 11:05 AM

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Friday, June 22, 2007

Harvard researcher wins MERIT Award from NIH

Lin100.bmpXihong Lin (left), professor of biostatistics at the Harvard School of Public Health, has won a MERIT Award from the National Institutes of Health.

Lin will develop statistical methods for analyzing cancer research data, including long-term and family data as well as genomic and proteomic information in epidemiological studies and population sciences, NIH said in a statement.

Fewer than 5 percent of NIH-funded investigators are selected to receive the awards.

Current MERIT recipients in Massachusetts and their instituions are:

Beth Israel Deaconess Medical Center: Benjamin G. Neel
CBR Institute for Biomedical Research: Timothy R. Springer
Children's Hospital Boston: Michael Klagsbrun and Bruce R. Zetter
Dana-Farber Cancer Institute: Stanley Korsmeyer and David M. Livingston
Harvard: John Blenis, Stephen C. Harrison, Peter M. Howley and Andrew G. Myers
Massachusetts General Hospital: Daniel Haber
MIT: Michael R. Lieber, Stephen J. Lippard and Alexander Rich
Tufts: John M. Coffin
Whitehead Institute for Biomedical Research: Rudolph Jaenisch

Posted by Elizabeth Cooney at 11:05 AM

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Tuesday, June 19, 2007

Boston scientists named Pew biomedical scholars

Four Boston-area scientists are among the newest class of 20 Pew Scholars in the Biomedical Sciences, the program announced today.

Funded by the Pew Charitable Trusts through a grant to the University of California at San Francisco, the awards give each scientist $240,000 over four years to support research.

Past winners have included Craig C. Mello of the University of Massachusetts Medical School, who shared the 2006 Nobel Prize in medicine or physiology for the discovery of the gene-silencing mechanism know as RNA interference.

This year's Boston-area winners are:

heldwein90.bmpEkaterina Heldwein (left), an assistant professor at Tufts University, will study how herpes viruses enter human cells. A graduate of Oregon Health and Science University, she trained at Children’s Hospital Boston and Harvard Medical School.

hung90.bmpDr. Deborah T. Hung (right), an assistant professor at Harvard Medical School and an assistant molecular biologist at Massachusetts General Hospital, will search for ways to fight the infectiousness of Pseudomonas aeruginosa, a bacterium that harms people with compromised immune systems because they have such conditions as cystic fibrosis, HIV or traumatic burns. She earned a doctorate in chemistry and a medical degree from Harvard and did additional training at Brigham and Women’s Hospital and Mass. General.

nicastro90.bmpDaniela Nicastro (left), an assistant professor at Brandeis University, will investigate the molecular interactions involved in the beating of flagella in sea urchin sperm, which are important to understanding defects that underlie such human disorders as polycystic kidney disease, chronic respiratory disease and infertility. She received a doctorate in biology from the Ludwig Maximilians University in Munich and did postdoctoral research at the Max Planck Institute for Biochemistry and the University of Colorado.

schwartz90.bmpThomas U. Schwartz (left), an assistant professor at MIT, will study the three-dimensional structure of the nuclear pore complex that regulates molecular traffic into and out of the cell nucleus, which could lead to antiviral therapies. He earned a doctorate in biochemistry from the Free University of Berlin and did postdoctoral research at Rockefeller University.

Posted by Elizabeth Cooney at 04:28 PM

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Monday, June 18, 2007

Daley named president of stem cell group

george daley.jpgDr. George Q. Daley, associate director of the stem cell program at Children's Hospital Boston, has been named president of the International Institute for Stem Cell Research, the hospital said today.

An associate professor at Harvard Medical School, he is also affiliated with Dana-Farber Cancer Institute and Brigham and Women's Hospital.

The nonprofit stem cell organization, which is meeting in Australia this week, was formed in 2002 to foster the exchange of information on stem cell research. In February the group established ethical guidelines for stem cell research.

"I hope to make these guidelines more relevant to practitioners and stem cell oversight committees worldwide," Daley said in a statement. "As countries debate what sorts of regulations to put in place, we want to take a leadership role, acknowledging the social context of the work while removing unnecessary barriers to scientific progress."

Posted by Elizabeth Cooney at 04:46 PM

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Friday, May 25, 2007


Louis Kunkel, director of the program in genomics at Children's Hospital Boston, has won a one-year $100,000 distinguished investigator award from the Mental Health Research Association to study gene expression in autistic children.

Dr. Mary Jane England, president of Regis College, has been honored as this year's outstanding psychiatrist for lifetime achievement by the Massachusetts Psychiatric Society.

Dr. Suzanne A. Bird, medical director of Cambridge Health Alliance's psychiatric emergency service, has received the annual Irma Bland Award for Excellence in Teaching Residents from the American Psychiatric Association.

Maureen Walsh, a nurse and health teacher at St. Francis Xavier School in South Weymouth, was one of 13 people to receive national recognition from the Food Allergy & Anaphylaxis Network for service to children with food allergies.

US Representative Patrick Kennedy of Rhode Island will be honored with fellow Congressman Jim Ramstad of Minnesota for their Campaign to Insure Mental Health and Addiction Equity at Mental Health America's annual meeting June 6 through 9 in Washington.

Posted by Elizabeth Cooney at 11:34 AM

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Tuesday, May 22, 2007

Children's hires Jamaica Plain health center head

cote100.bmpChildren’s Hospital Boston has named James Cote (left) executive director of the Martha Eliot Health Center, a community health center in Jamaica Plain that is licensed and operated by Children’s.

Cote, who had been the health center's interim leader for the past year, has also worked at Children’s and Boston Medical Center. He holds an MBA with a specialty in health care administration and marketing from UMass-Boston and a bachelor's degree in biology from Saint Joseph’s College in North Windam, Maine.

Posted by Elizabeth Cooney at 10:03 AM

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Monday, May 14, 2007

Today's Globe: house calls, fading vitamins, medical e-files jobs, mammogram decline, Dr. Dorothy Villee, withholding vaccinations,

Dr. Myron Siu, 32, an internist who works at Tufts-New England Medical Center, started house calls last August; he's believed to be the only Cantonese-speaking doctor in Boston with a weekly commitment to see patients in their homes.

Judy Foreman's
love affair with vitamins and supplements is over: With a few exceptions -- stay tuned -- she's tossing them out, she writes in Health Sense.

tronick100.bmpAlso in Health/Science, meet psychologist Ed Tronick (left), who probes the emotional life of infants, and find out why people blink their eyes and why we need sunshine.

In Business, Massachusetts is among the leaders nationally in the use of electronic patient records and computerized drug prescribing. But its workforce is not keeping pace: The state lacks enough people who know how computers work and who understand how doctors diagnose and treat diseases.

US women are getting mammograms to screen for breast cancer at declining rates, according to a study describing a trend that some health officials fear may reverse progress against the deadly disease.

Dr. Dorothy (Balzer) Villee, an associate in endocrinology at Children's Hospital in Boston for nearly 30 years who volunteered with patients in their final days at Hospice & Palliative Care of Cape Cod, died of a stroke April 23 in Brigham and Women's Hospital in Boston. She was 79.

If a majority of children are vaccinated, but some are not, the burden of disease can move into these high-risk populations where infection can have severe consequences, Dr. Maria Raven of New York University and Bellevue Hospital Center writes on the op-ed page.

Posted by Elizabeth Cooney at 05:41 AM

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Monday, May 7, 2007

CIMIT awards $5m to medical device researchers

Proposals to build new devices to help premature infants, to inject medicine without breaking the skin and to guide surgeons operating on the brain were among projects to win $5 million in grants from the Center for Integration of Medicine and Innovative Technology, the consortium announced today.

CIMIT, composed of Boston-area teaching hospitals and engineering schools, made 37 grants that range from $40,000 to $100,000. Twenty-two have military applications, acording to CIMIT, which receives support from the US Department of Defense as well as its members.

Dr. Riccardo Barbieri of Massachusetts General Hospital won a grant to develop a computational tool based on a premature infant's heartbeat to predict episodes when they stop breathing.

Mark Horenstein of Boston University will demonstate a way to inject medications through the skin using nanoparticles, leaving no wound behind.

Dr. Nobuyuki Nakajima of Brigham and Women's Hospital will work to improve how instruments can be navigated to diagnose and treat brain injury or disease.

"Our goal ... is to bring life-changing technology to patients as quickly as possible," Dr. John Parrish, CIMIT founder and director and Vietnam War battlefield surgeon, said in a statement. "We are especially aware of the needs of soldiers wounded on the battlefield."

Posted by Elizabeth Cooney at 06:56 AM

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Friday, May 4, 2007

Children's author takes kid-sized approach to weight loss

ludwigbook.jpgThere's no shortage of weight loss books, but few are designed for children, Dr. David M. Ludwig thought. So he set out to condense lessons learned from the Optimal Weight for Life program at Children's Hospital Boston and put them between the covers of a new book.

"What works for adults won't necessarily work for kids, especially when there's conflict about food at home," he said in an interview. "We start with the right eating program, bring in the right amount of physical activity, and then we need the right parenting program."

"Ending the Food Fight" (Houghton Mifflin, $26), with recipes by dietitian Suzanne Rostler, spells out a nine-week program that favors a low-glycemic diet emphasizing high-quality food. Even young children can understand the difference between "fake" foods that are heavily processed and real foods without excess sugar and fat, Ludwig says.

Children's minds and bodies aren't designed for treadmill-like exercise, he said, but they will be active if they are encouraged to play outside or try dance or yoga.

As for parents, they need to shift from coercion to cooperation with their kids, modeling good food and activity choices in a fast-food, sedentary world.

"All too often parents try to take control of the situation, excessively restricting some foods or pushing kids to have other foods," he said. "Criticism, nagging, even punishment seem like they work in the short term, but they really don't over the long term."

Posted by Elizabeth Cooney at 01:26 PM

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Tuesday, May 1, 2007

Children's rolls out computerized drug ordering

Doctors at Children's Hospital Boston began this weekend prescribing medications by computer, and nurses are entering into the system when they give the drugs to patients, replacing paper records.

Lab results and pharmacy information were computerized in an earlier effort, along with other documentation from doctors and nurses.

nigrin100.bmp"The whole project is centered around creating an integrated electronic clinical information system, but this is probably the biggest in terms of how our clinicians act in the hospital," Dr. Daniel Nigrin (left), the hospital's chief information officer, said yesterday.

Nigrin, who conceded he hasn't gotten a lot of sleep since Saturday, said the transition has been smooth after months of training on CHAMPS, which stands for Children's Hospital Applications Maximizing Patient Safety. Thirty hours into the process, there were a peak of 1,300 staffers connected and working through the system.

On patient units, nurses can enter information at the nursing station or on bedside computers on wheels (known by the acronym COWs). Information on patients will be available to providers wherever they are, instead of just on the unit where the patient is.

Trained "superusers," dressed in blue shirts, will be available on units for the next couple of weeks to lend support, he said.

Nigrin said such a program is hardly unique to Children's, but the young patients they care for have more complex needs than adults when it comes to safety checks for administering drugs, an important part of order-entry systems.

"Medication dosing in children can be a very exact science," he said. "We deal with teeny 1-pound babies as well as hulking 18-year-old football players, so for that range of patient population we need to be very precise."

Posted by Elizabeth Cooney at 04:46 PM

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Friday, April 20, 2007

This week in Science

germ 150.bmpThis week's Science includes a special section on germ cells -- the reproductive cells of an organism.

George Q. Daley of Children's Hospital Boston, Brigham and Women's Hospital and the Harvard Stem Cell Institute asks whether the cup is half empty or half full for embryonic stem cells.

David C. Page of the Whitehead Institute and MIT considers the mysteries of sexual identity from the germ cell's perspective.

Alexander F. Schier of the Broad Institute of Harvard and MIT writes about the death and birth of RNAs during the maternal-zygotic transition.

Also in Science, Rachael L. Neve of Harvard and McLean Hospital is an author of a new study in mice about neurons competing to encode a memory in the brain.

Posted by Elizabeth Cooney at 01:03 PM

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Thursday, April 19, 2007

Children's doctors to care for babies at Caritas hospitals

By Liz Kowalczyk, Globe Staff

Children's Hospital Boston and Caritas Christi Health Care today announced an affiliation agreement in which Children's Hospital doctors will provide care at three Caritas nurseries for sick babies.

Children's physicians will staff the neonatal intensive care unit at Caritas St. Elizabeth’s Medical Center in Boston and the special care nurseries at Caritas Good Samaritan Medical Center in Brockton and Caritas Holy Family Hospital and Medical Center in Methuen.

The agreement provides a guarantee to Caritas that it won't encounter a shortage of specialists to staff its nurseries and the opportunity to associate itself with the prestigious Harvard teaching hospital.

Children's, which will care for the sickest children at its own neonatal intensive care unit, extends its reach to a new group of potential patients.

Posted by Karen Weintraub at 12:43 PM

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Wednesday, April 11, 2007

How two doctors think

070410_bc_howdrsthink.gifSlate's Book Club features a conversation between Dr. Jerome Groopman, professor of medicine at Harvard Medical School and author of "How Doctors Think," and Dr. Darshak Sanghavi, an assistant professor of pediatrics at the University of Massachusetts Medical School who met Groopman when he was a fellow at Children's Hospital Boston.

"Algorithms and treatment guidelines are based on prototypes," Groopman writes. "They are not substitutes for individual thinking. And they break down when cases are atypical or complex."

Sanghavi, an occasional contributor to the Globe, summarizes their different points of view:

"This ultimately returns to our disagreement about standardizing medical care," he writes. "You feel it often constricts good medical practice; I think we don't have enough of it."

Posted by Elizabeth Cooney at 02:07 PM

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Monday, April 2, 2007

Urine tests for drug use unreliable, Children's study says

Random urine tests for drug use have a high error rate even when performed in adolescent substance abuse programs, researchers from Children's Hospital Boston report in the April issue of Pediatrics.

Dr. Sharon Levy and her colleagues at the hospital's Center for Adolescent Substance Abuse Research took 710 random urine tests from 110 patients who were 13 to 21 years old and enrolled in a drug program. Comparing the results with those obtained from confirmed laboratory tests, they found that 12 percent of the random tests had results that could be misinterpreted.

Some of the samples were too diluted to interpret reliably. Of the samples confirmed to show Oxycontin use, two-thirds had tested negative at first.

Drug-testing programs demand rigorous procedures and well-trained people to obtain accurate results, the authors conclude.

"'Quick and dirty' drug-testing programs that use procedures of convenience are likely to result in unintended consequences, such as misidentifying some students as using illicit drugs when they are not and enabling others to continue illicit drug use by allowing them to evade detection easily," the Children's authors wrote.

In last month's issue the American Academy of Pediatrics said drug testing of adolescents at home or in school was unreliable and lacked scientific proof of effectiveness.

Posted by Elizabeth Cooney at 06:28 AM

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Friday, March 23, 2007

Top scientists gather for metastasis meeting

Cancer researchers from Boston and around the world have gathered in Houston for a symposium today and tomorrow to talk about metastasis -- how cancer spreads -- and to honor Dr. Isaiah J. Fidler, the scientist who confirmed a 100-year-old theory of how cancer kills.

Speakers at the symposium include Dr. M. Judah Folkman of Children's Hospital Boston and Harvard Medical School, Robert Weinberg of the Whitehead Institute for Biomedical Research at the Massachusetts Institute of Technology, Dr. Harold Dvorak of Beth Israel Deaconess Medical Center and Harvard, and Richard Hynes of Howard Hughes Medical Institute and MIT.

Fidler, whose recent research focuses on prostate and pancreatic cancer, is stepping down as chair of cancer biology at The University of Texas M. D. Anderson Cancer Center in September.

Posted by Elizabeth Cooney at 06:03 PM

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Tuesday, March 6, 2007

Children's to help Somali refugee families

Children's Hospital Boston has won a grant from the Robert Wood Johnson Foundation to bring mental-health services to Somali refugee families, the hospital announced today.

The $300,000 award will fund mental health programs at the Lilla G. Frederick Pilot Middle School in Dorchester over the next three years. The project is expected to serve 700 people, including children and their families, the hospital statement said.

The Boston University Graduate School of Social Work is offering two full scholarships to their Master’s of Social Work program to Somali individuals who will provide services as part of their training during the three-year grant period.

Other organizations involved are the Boston Public Schools, Refugee and Immigrant Assistance Center, Somali Development Center, The Alliance for Inclusion and Prevention, The Boston Healing Landscape Project and the Boston Center for Refugee Health and Human Rights.

Posted by Elizabeth Cooney at 06:07 PM

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Monday, March 5, 2007

Renewal of federal funding for kids' insurance urged

Politicians and children's health advocates pushed for renewal of federal funding for children's health insurance in an event at Children's Hospital today, citing a poll that says 90 percent of Massachusetts voters favor providing health coverage to all uninsured children.

U.S. Sen. Edward M. Kennedy, U.S. Sen. John F. Kerry and Boston Mayor Thomas M. Menino joined Diluvina Vasquez Allard of the Massachusetts Communities Action Network and Dr. James Mandell, president and CEO of Children's, in calling for passage of the law authorizing the State Children's Health Insurance Program.

SCHIP pays for part of the state's MassHealth program.

The poll was conducted by New England Alliance for Children's Health, which found similar levels of support for SCHIP in the other five New England states, the group said in a statement.

Posted by Elizabeth Cooney at 02:30 PM

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Home and school drug testing flawed, pediatricians say

Drug testing of adolescents at home or in school is unreliable and lacks scientific proof of effectiveness, the American Academy of Pediatrics says in its journal Pediatrics today. Simple conversations with a school counselor are more effective and cost far less, according to the study.

In 1996 the AAP published a policy statement opposing testing adolescents for drugs without their consent. Since then two US Supreme Court decisions have upheld random testing, first for student athletes and then for any student participating in extracurricular activities. At the same time, drug-testing companies have begun marketing kits to parents for use at home. The current policy addendum was written in response to these two trends.

"Testing can be a very powerful tool when it is used properly in a clinical population," Dr. John R. Knight, associate professor of pediatrics at Harvard Medical School and director of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston, said in an interview. He is the lead author of the article. "It's just a really bad screening test."

There is little proof that drug testing in schools works, he said, citing two studies whose results conflict. Testing is complicated, it produces errors, its results can be hard to interpret and the Internet is awash in ways to defeat it.

"It's almost like an arms race," Knight said. "We think up new tests and kids who are using drugs think up new ways to beat the new tests."

The tests also miss ecstasy, inhalants such as glue and paint thinners and prescription drugs such as oxycodone, as well as alcohol, he said.

Where drug tests do work is in programs where young people are committed to recovering from drug abuse and agree to monitoring, he said. For the larger population of students, talking to a doctor or school nurse works better, published data has shown, he said.

"I am in favor of screening teens for drug and alcohol abuse and I know how it can be done cheaper and more effectively," he said. "Have a health care provider ask the young person, with a confidential questionnaire or a simple oral test, and most of the time they give you an honest answer."

Schools can do the same kind of screening, instead of taking samples for lab tests, Knight said he told the president's Office of National Drug Control policy in November. Using charges for tests by Quest Laboratories, he calculated that a school with 1,000 students that tested half of them once each year, yielding 30 percent positive results, would spend $142,000 on tests and $58,000 to administer the program.

Screening all the students with confidential questionnaires and follow-up counseling would cost about $50,000 per year for one school-based counselor, he estimated. The government could better spend its money on treatment or prevention programs, he said.

"We should be taking the money they're dangling in front of the schools willing to do the testing and we should be putting it into treatment for young people," he said.

Posted by Elizabeth Cooney at 11:00 AM

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Wednesday, February 21, 2007

Children's creates database on media violence research

Violence gets our attention, in movies, video games, television, music, print, or on the Internet, especially if our children are watching.

The Center on Media and Child Health at Children's Hospital Boston has created a database of research findings and chose violence as the first topic they would make available free to parents, clinicians and researchers who want to know what peer-reviewed studies can tell them.

They can ask a question, read a summary in lay language or search 700 research articles to find answers.

"Our goal was to gather all of the studies in a single location and present them in a standardized form to create the first interdisciplinary library of research on media effects," Brandy King, librarian for CMCH, said in a statement from Children's. "We chose violence as our first research topic because it is the most thoroughly investigated area of media effects."

Posted by Elizabeth Cooney at 11:38 AM

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Tuesday, February 20, 2007

Should doctor-patient conversations be taped?

Interesting suggestion from Blog, MD, the blog of Dr. Samuel C. Blackman, a Boston pediatric oncologist. He discusses a recent study in the British Medical Journal, which looked at whether mothers of infants in the ICU were able to recall information better when given audiotapes of their conversations with doctors.

"A couple of years ago, when I was a relatively new 1st year fellow, a family brought a tape recorder into the room and set it down right in front of me," he writes. "I can’t remember whether or not they asked me if I would mind being taped (I think they did), but I remember being weirded out by it and telling them that I’d prefer not to have my every word recorded."

But he's had a change of heart. "One would think that a tool as simple as a tape recorder would be more widely used for complex discussions such as informed consent for chemotherapy," he writes. "I believe that offering parents the opportunity to tape one’s important discussions with them telegraphs a message of confidence and trust, and would go a long way to establish rapport at a very important moment in a family’s life."

He's eager for comments from parents of children with cancer and from cancer patients themselves.

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Wednesday, February 14, 2007

Sex makes young people feel good. So?

Young people feel better after sex.

Not earth-shattering news, you say?

Children's Hospital Boston researcher Dr. Lydia A. Shrier, lead author of a study that reached that conclusion, understands why you'd react that way, but hear her out. She says that until we know what adolescents really think about sex, anyone trying to help them have safer sex -- or no sex -- might be wasting their time.

"If we don't understand exactly how they feel around the time of sex, we're going to miss the boat with our risk reduction or abstinence messages," said Shrier, whose study appears in the Journal of Adolescent Health. "We all know that feelings are very much connected to how we behave."

To assess young people's emotions, Shrier's team gave hand-held computers to 67 adolescents and young adults, 15 to 21 years old, and randomly beeped them at least every three waking hours for a week. A message would then pop up on the participants' PDAs asking them how they were feeling and whether they had had sex since the previous page. To be in the study, the young people had to say they were sexually active.

That's different from asking people what they think about sex or to remember later what they felt like at the time, Shrier emphasized. This nearly real-time report of how they felt makes the study different from previous work, including her own, she said.

"We examined real events in these kids' lives as they were happening. We didn't ask them to recall things or to select out a particular thing," she said. "We asked them to monitor themselves with computers and respond to signals, so we were getting what was actually going on."

The study also stands apart from surveys that asked adolescents their feelings about their first sexual experiences, which tended to be more negative than what the researchers found this time.

Policy makers need to pay attention, Shrier said.

"Without taking a political stance, I'd just say we all want people to ultimately be sexually healthy adults, whatever our beliefs are," she said. "And whether we want kids to reduce sexual risk or be abstinent, we have to understand the feelings of the young people having sex."

Posted by Elizabeth Cooney at 05:12 PM

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Children's study: Steroids no help for Kawasaki disease

Children with Kawasaki disease are at risk for developing
coronary-artery aneurysms. Standard therapy includes giving these children intravenous immune globulin and aspirin. A study in the New England Journal of Medicine, led by Dr. Jane W. Newburger of Children's Hospital Boston and Harvard Medical School, shows that adding a single pulsed dose of intravenous methylprednisolone did not produce better outcomes than the standard therapy.

Posted by Elizabeth Cooney at 05:00 PM

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Tuesday, February 13, 2007

Three-quarters of impaired doctors recover, study says

Three-quarters of Massachusetts physicians being monitored for substance abuse or mental and behavioral health problems successfully completed their programs while continuing to practice, a study by the Massachusetts Medical Society's Physician Health Services program found.

The success rate was nearly identical for both types of disorders, showing that techniques developed for helping physicians with substance abuse can be applied to other problems, the authors reported in the Journal of Psychiatric Practice. But they also found that women fared worse than men.

"We thought men and women would do equally well," said Dr. John R. Knight of Harvard Medical School and Children's Hospital Boston. "We don't know the exact reasons the women did so poorly. It's really going to require a new look at our program, and I think we've got to consider offering new services for women physicians."

Overall results showed that 75 percent of doctors with substance abuse disorders and 74 percent with mental and behavior problems met all the requirements of the medical society's monitoring program. But women relapsed significantly sooner than men and only 62 percent of women physicians were successful, compared with 78 percent of male physicians.

Five members of the Physician Health Services program, including Knight, looked at 10 years of records for 58 physicians with mental and behavioral problems, such as depression or bipolar illness, and 120 with substance abuse disorders who agreed to monitoring by the program. They were followed for at least three years.

Monitoring included oversight by other physicians they worked with, meetings with supervisors, and drug tests for those with substance abuse problems. Physicians who also had dealings with the state licensing board had a higher success rate than others, especially when substance abuse was involved.

Nancy Achin Audesse, executive director of the state Board of Registration in Medicine, was encouraged by the report.

"I think it is very good news that we have a system in place to identify physicians who are in trouble, to handle them, and to help them back to recovery," she said. "When we have these experienced and capable doctors and they end up with health problems, we don't want to lose them from practice. We want to get them back into healthy practice."

Posted by Elizabeth Cooney at 06:45 PM

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Friday, February 2, 2007

Predicting which drugs will make it

To develop more successful drugs, you have to look at both the winners and the losers. But that means drug companies need to share their gold mine of information on unsuccessful medicines, two researchers from Children's Hospital Boston's Informatics Program say.

Based on information about failed drugs, Dr. Asher D. Schachter and Marco F. Ramoni say they can predict which drugs in early development will be safe and effective.

They make that case in the February Nature Reviews Drug Discovery, saying their model could help save $283 million per approved drug.

"Suppressing negative data harms everyone," Schachter said. "Companies could reduce drug development costs and pass on some of those savings to the consumer."

Schachter and Ramoni just founded Phorecaster, a consulting business that has no customers or profits yet.

Schachter, a pediatric nephrologist, said to create their forecasting model they looked at data about early-stage drugs described in publications from the Tufts Center for the Study of Drug Development and other public sources.

They were able to predict success in phase 3 trials and new-drug-application approval with 78 percent accuracy, they said.

Posted by Elizabeth Cooney at 02:31 PM

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Beth Israel Deaconess COO leaving

Dr. Michael F. Epstein, executive vice president and chief operating officer of Beth Israel Deaconess Medical Center, is leaving the hospital after five years.

Before coming to Beth Israel to work with CEO Paul Levy on a recovery plan for the then financially troubled hospital, he was a neonatologist and later COO and chief medical officer at Children's Hospital Boston.

The goals of the recovery plan have been achieved with Beth Israel's return to financial stability, he said in a memo to employees. His resignation will be effective May 1.

"There is no other position or job offer that would have lured me away from BIDMC," he wrote. "But the celebration of my 60th birthday a little over a year ago reminded me that there are important connections to family members and friends to nurture, places to visit, books to read, gardens to plant, and marathons to run, and since that birthday, the clock seems to be running a bit more rapidly. So, while the work continues to be exciting and engaging, I have decided it is now time to move on."

Epstein is "a terrific person," Levy said. "I was incredibly lucky to have him with us."
with us.

Posted by Elizabeth Cooney at 09:05 AM

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Thursday, February 1, 2007

Stem cell guidelines drafted by Children's doctor

Scientists have released the most comprehensive set of rules yet to govern the ethically charged field of embryonic stem cell research.

The guidelines, put together by the International Society for Stem Cell Research (ISSCR) under the direction of Children’s Hospital Boston scientist Dr. George Q. Daley, calls for special oversight of embryonic stem cell research.

george q. daleyg_w.jpg
Dr. George Q. Daley, Children's Hospital Boston

The guidelines are very similar to a report issued in 2005 by the U.S. National Academy of Sciences, but are designed to apply to scientists around the world, not just American scientists.

The rules include bans on: growing human embryos in a dish for more than 14 days; breeding animals which might have human eggs or sperm; and, using cloning technology in an attempt to create a live human child. All are widely viewed as anathema by stem cell researchers today.

Embryonic stem cell research has been controversial because scientist break apart human embryos – which some consider to be human lives – in order to obtain the stem cells. This is typically done using frozen embryos that would otherwise be discarded by fertility clinics. It has also been controversial because some scientists, including Daley, plan to use cloning.

Critics charge that this means scientists are creating human embryos with plans to destroy them. Defenders counter that the technique will allow them to study diseases in entirely new ways.

The ISSCR panel was divided on another hot-button ethical issue: Whether researchers should be allowed to pay woman to donate eggs for research. Fertility clinics pay, but scientists have shied away from the practice.

The guidelines have no legal force, but the authors called on the editors of top scientific journals to make following the rules a prerequisite for publication. A summary of the guidelines appears in the current issue of the journal Science.

-Gareth Cook

Posted by Karen Weintraub at 12:21 PM
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