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Investing in stroke care

FOR ALMOST a decade now, medicine has had a technological fix for the country's third-biggest killer: strokes. Unfortunately, fewer than 3 percent of stroke patients are benefiting from that fix, a drug called tissue plasminogen activator, which breaks up the clots in brain blood vessels that cause most strokes. Treating more stroke victims with TPA in the three-hour window when it is effective would help far more patients survive strokes and escape the debilitating injuries that make strokes the greatest cause of disability among adults. A bill backed by Senator Edward M. Kennedy that would direct federal assistance to states for improving stroke care should get top priority in Congress.

Successful treatment of stroke is infrequent, because victims wait too long before going to a hospital, and emergency room personnel often lack the training to diagnose the type of stroke the patient is suffering. One out of five strokes is caused by a burst blood vessel, not a clot, and administering TPA in such cases actually worsens the condition.

The state of Massachusetts is working to improve its stroke safety net by designating 33 of the state's acute-care hospitals as Primary Stroke Services. From Berkshire County to Boston, stroke victims will have relatively close access to a hospital with full-time availability of diagnostic and therapeutic services for stroke victims. Emergency medical technicians will be trained to take victims to Primary Stroke Service hospitals.

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Kennedy's bill, cosposnored by Republican Senator Thad Cochran of Mississippi, addresses the major weak points of stroke treatment, including the failure of patients and family members to recognize symptoms. The bill calls on the Department of Health and Human Services to develop an information campaign to make the public more aware of these symptoms: vision problems, dizziness, confusion, difficulty in speaking or understanding, facial droop, partial paralysis, and headaches.

The department would also be authorized to help develop computer technologies so that smaller, rural hospitals can be linked with more advanced stroke-care centers. The Martha's Vineyard hospital has such a connection with Massachusetts General Hospital.

Kennedy introduced his bill in 2001 with Republican Senator William Frist of Tennessee, now the majority leader. As sensible as the measure is, it has languished in Congress because it would commit the federal government to spend money -- estimated at between $50 million and $100 milllion -- which many in Congress are reluctant to do while they are running up large deficits. In fact, this bill would be one of the most effective public-health investments the government could make. 

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