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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.
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Thursday, October 25, 2007

Lahey expansion under way

The Lahey Clinic Medical Center, North Shore, broke ground yesterday for a $50 million expansion in Peabody.

A new three-story wing will add 63,500 square feet to the current 162,000 square-foot space off Route 128. Its cancer center, orthopedic surgery and emergency departments will be enlarged and sleep disorders, spine and pain units will be added. About 25 doctors and 125 nurses, technical and clerical workers will be hired. The project is expected to be completed in spring of 2009.

Posted by Elizabeth Cooney at 10:52 AM

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Thursday, September 27, 2007

Lahey analysis: Diabetes drugs increase risk of heart failure but not death

By Elizabeth Cooney, Globe Correspondent

Certain diabetes drugs should be used with caution in people who have heart disease or a history of heart failure, researchers from the Lahey Clinic report after analyzing previous studies, a finding they hope will clarify the debate on treatment.

Dr. Richard W. Nesto and his colleagues reviewed the results of seven randomized clinical trials that enrolled a total of 20,000 patients to study Actos and Avandia, two drugs from the class called thiazolidinediones, or TZDs, that lower blood sugar. Their article in tomorrow’s Lancet concludes that while TZDs do increase by 72 percent the relative risk of heart failure in people who have type 2 diabetes or are close to it, the drugs do not raise the risk of cardiovascular death. The risk of heart failure was already known.

"I view this as helpful information because if doctors want to use this drug even despite the recent debate about it, they can more appropriately select patients for the drugs in whom the risk of heart failure would be very, very low," Nesto, who is Lahey’s chair of cardiovascular medicine, said in an interview.

The Lahey report follows another review article by Dr. Steven E. Nissen of the Cleveland Clinic published in June in the New England Journal of Medicine. That analysis found a significant increase in the risk of heart attack for people taking Avandia and a borderline-significant risk of cardiovascular death. The US Food and Drug Administration added a warning to the label for Avandia in August.

Nesto said the data his group examined were more robust than the results Nissen analyzed. A panel of experts judged whether heart attacks occurred in the studies Nesto chose, and all the studies had been previously published.

"We did not find an increase in cardiovascular death despite the increased risk of heart failure and despite the findings of the other meta-analysis that there was a trend toward an increase in the risk of death," Nesto said. "I'm hopeful that this information will help clinicians if they want to use TZDs to more carefully select appropriate patients."

The drugs are still effective at lowering blood sugar, he said. Older drugs that reduce blood sugar have not raised the same degree of concern about cardiovascular side effects, but "these other drugs have not come under the degree of scrutiny that TZDs have," he said.

In a comment that appears in the Lancet, Dr. John G.F. Cleland and Stephen L. Atkin of the University of Hull in England criticize the use of blood sugar levels as a surrogate marker for how well drugs work, rather than patient outcomes such as quality of life and survival.

"All the meta-analyses consistently fail to spot the elephant in the room," they write. "Treatments should be effective rather than merely innocuous."

In a second comment, Dr. Victor Montori of the Mayo Clinic says using surrogate markers represent a false economy in drug testing.

“Patients and society may end up paying dearly for drugs that cause more harm than good,” he writes.

An editorial urges drug makers to do post-marketing studies on the long-term effects of drugs.

“Regulatory agencies must hold manufacturers’ feet to the fire to ensure that these are performed,” it says. “Unless limitations on the understanding, analysis, and communication of drug safety issues are addressed, the TZDs will simply become the latest in a series of preventable drug disasters.”

Nesto said he had not read the comments or the editorial.

“The fact remains that the target of treatment in diabetes patients is still the control of blood sugar,” he said.

Posted by Elizabeth Cooney at 07:11 PM

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Thursday, August 9, 2007

Beth Israel Deaconess takes over cardiothoracic surgery at St. Vincent

Beth Israel Deaconess Medical Center has taken over the cardiothoracic surgery program at St. Vincent Hospital previously run by Tufts-New England Medical Center and is starting a transplant referral program at the Worcester hospital, the hospitals said.

BIDMC physicians already staff the 348-bed medical center's emergency and radiation oncology departments. The change in cardiothoracic surgery took place July 1, when Dr. Robert M. Bojar, a surgeon based at St. Vincent, switched from Tufts-NEMC to BIDMC. Bojar and Dr. David C. Liu, another BIDMC surgeon, now operate in Worcester.

Tufts-NEMC spokeswoman Brooke Tyson Hynes said yesterday the cardiothoracic surgery change came about because of BIDMC's new surgical residency program at St. Vincent. On July 1, seven surgical residents began the first BIDMC rotations at the Worcester hospital, a year after University of Massachusetts Medical School and its clinical partner, UMass Memorial Medical Center, ended their surgical residency programs at St. Vincent.

Under the new arrangement for transplant patients, St. Vincent specialists will refer patients to BIDMC for kidney, liver or pancreas transplants, Dr. Douglas W. Hanto, chief of transplantation at BIDMC, said yesterday. Most St. Vincent patients had previously been referred to UMass Memorial, which provides kidney, liver and pancreas transplants through a joint program with the Lahey Clinic.

Posted by Elizabeth Cooney at 08:16 AM

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Thursday, April 19, 2007

Two doctors disciplined by medical board

By Liz Kowalczyk, Globe Staff

The Board of Registration in Medicine has disciplined two physicians, Dr. Matthew Cushing Jr. and Dr. Douglas M. Katz.

The board revoked Cushing's license, following a similar action by the California Medical Board in 2004 over his treatment of a patient who later died of an overdose. No Massachusetts office was listed for Cushing, whose specialty is internal medicine.

The board reprimanded Katz, a 1987 graduate of the School of Medicine, State University of New York, for "engaging in communication" with a patient whose tattoo he removed "designed to foster a personal relationship beyond the boundaries of a doctor/patient relationship."

Katz, who is board certified in internal medicine, practices in Peabody and is affiliated with Lahey Clinic and Union Hospital.

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Monday, April 16, 2007

Three Mass. hospitals make integrated network top 100

Three Massachusetts hospitals have been named among the country's top 100 integrated health networks -- hospital systems that operate as a unified group.

Baystate Health System in Springfield was ranked 31st, Cambridge Health Alliance came in 49th and Lahey Clinic in Burlington finished 85th in the ratings released by Verispan. There were 587 hospital networks considered.

The healthcare information company said it surveyed health systems about patient access, clinical quality, physicians and the use of technology.

Posted by Elizabeth Cooney at 03:58 PM

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Wednesday, February 7, 2007

Birkett to lead state chapter of surgeons group

Dr. Desmond H. Birkett of Lahey Clinic has been named president-elect for 2007 of the Massachusetts chapter of the American College of Surgeons.

Birkett is the chair of general surgery at Lahey and a clinical professor of surgery at Tufts University School of Medicine.

Posted by Elizabeth Cooney at 06:05 PM

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Wednesday, January 31, 2007

Levy pans joint liver transplant program

Paul Levy has harsh words for the new joint program for liver transplantation between Lahey Clinic and UMass Memorial Medical Center. Both transplant centers will continue to function independently, with surgeons operating in Burlington and Worcester, undermining the promise of collaboration, he writes in his blog today.

"I cannot imagine how asking Lahey doctors to commute to Worcester for a relatively small liver transplantation program will be a good use of their time or will optimize patient care and control costs overall," Levy says. He is president and CEO of Beth Israel Deaconess Medical Center, which has its own liver transplant program.

Levy welcomed word that Dartmouth-Hitchcock Medical Center on the New Hampshire-Vermont border may be canceling plans for its own liver transplantation program because there would be too few patients.

Dartmouth-Hitchcock denied that suggestion.

"DHMC will not be expanding its solid organ transplant program to include liver transplants at this time, but no final decisions have been made," hospital spokesman Jason E. Aldous said.

Posted by Elizabeth Cooney at 06:48 AM

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Monday, January 29, 2007

Lahey and Children's detail North Shore expansion

Children's Hospital Boston will double its space in Lahey Clinic's North Shore center when it's done in 2009, the clinic said today.

Children's opened its outpatient satellite in Peabody in 1994. The new 15,000-square-foot pediatric space is part of Lahey's $50 million addition, which includes a larger emergency department and more room for cancer, cardiology, neuroscience and orthopedic services.

Posted by Elizabeth Cooney at 02:13 PM

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Friday, January 26, 2007

Statins over-prescribed, Harvard doctor says

Dr. John Abramson argued in his 2004 book "Overdosed America" that pharmaceutical companies are distorting medical knowledge. Now he writes in a medical journal that too many people -- healthy women of any age and men over 65 -- are taking statins without proof they need them.

A clinical instructor at Harvard Medical School and former chair of family practice at Lahey Clinic, he questions National Cholesterol Education Program guidelines recommending the blockbuster drugs for people who may have high cholesterol but don't have clogged arteries.

Commenting with Dr. Jim Wright of the University of British Columbia in the Jan. 20 Lancet, he says there's no proof that statins prevent heart attacks or strokes in healthy people, yet high cholesterol numbers are enough to prompt a prescription. We called him, and here's some of what he said:

Q. Where did the NCEP recommendations come from?

A: The full report is 284 pages. Near the back, talking about women, it says "the rationale for therapy is based on extrapolation of benefit from men of similar risk." We know you cannot extrapolate from men to women. ... And there are no gold-standard clinical trials that show benefit for older men without a history of heart disease.

Q. What about people who do have heart disease?

A. There is good evidence that statins are beneficial for secondary prevention but there's even better evidence that living a healthy lifestyle is even more effective than taking a statin, though they are not mutually exclusive. Don't think that by taking your statin you are doing everything you can do to reduce your risk of heart disease.

Everyone is focused on cholesterol, not on real epidemiological facts of what the risks are.

Q. Why?

A. The guidelines that create the clinical imperative for physicians are done by experts who have financial ties to drug companies that make the drugs being considered in the process. Fifty-nine percent of the experts who formulate the guidelines have financial ties.

In a meta-analysis of statins in the October Lancet, 13 out of 14 studies were commercially sponsored. The one that was not commercially sponsored showed distinctly less benefit from statins.

Q. What about you? The Lancet says you are an expert consultant to plaintiff's attorneys on litigation involving the drug industry, including Pfizer for its marketing of atorvastatin.

A. That's right.

Posted by Elizabeth Cooney at 10:06 PM

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Two new deans bring Lahey, Tufts closer

Lahey Clinic's ties to Tufts University School of Medicine just got stronger through the appointments of two new deans.

Dr. David J. Schoetz, a colon and rectal surgeon, is the first Tufts academic dean at Lahey in Burlington. Dr. David A. Neumeyer is the new dean of admissions at Tufts, chairing the admissions committee he has been on for five years. At Lahey he is co-director of the Sleep Disorders Center.

The relationship between Tufts and Lahey began only about six years ago, said Schoetz, who looks for Lahey's 200 doctors with Tufts faculty appointments to become more closely integrated with the medical school and increase Lahey's research projects.

Tufts has similar posts at its other major academic affiliates, including New England Medical Center, Caritas St. Elizabeth's Medical Center and Baystate Medical Center.

"These appointments more formally reflect a long-standing and important relationship with Lahey Clinic," Dr. Jeffrey Glassroth, vice dean for academic and clinical affairs at Tufts School of Medicine, wrote in an email.

Posted by Elizabeth Cooney at 09:58 PM
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