Teen's death draws questions

Excerpts from the Globe's blog on the Boston-area medical community.

The death of a Florida teenager after breast surgery - even though it was triggered by a rare reaction to anesthesia - is raising questions about operations to improve young patients' appearance. Stephanie Kuleba, 18, was having surgery to correct inverted nipples and breast asymmetry, which would typically involve placing an implant in the smaller breast to match the bigger one.

Deciding where medical necessity ends and quality of life begins can be difficult to determine. But the risks of every surgery, elective or not, are certain, said Dr. Richard Ehrlichman, a Wellesley plastic surgeon, who was not involved in the case. "It should never be taken lightly," he said.

Dr. Brian Labow, director of the Adolescent Breast Clinic at Children's Hospital Boston, bristled at using the word "cosmetic" to describe the girl's surgery.

"When we're talking about breast deficiency after mastectomies, no one talks about that as 'cosmetic,' " said Labow, also not involved in the case. "It's a bit of a double standard when you have an underdeveloped breast. I don't understand the difference."

ELIZABETH COONEY

Because women generally earn less than men and use more healthcare, they face a greater burden from copayments and deductibles that are part of the state's health insurance initiative, according to a report from the Center for Women's Health and Human Rights at Suffolk University. While acknowledging that the initiative has provided coverage for many women, the report recommends that the state monitor the impact of reform on women.

"The need for a gender analysis at each stage of planning, implementation and evaluation is already apparent if Massachusetts healthcare reform is to live up to its promise of improving women's health," said Susan Sered, a Suffolk sociology professor who wrote the report with the help of her students.

ALICE DEMBNER

Victor Ambros of the University of Massachusetts Medical School and Gary Ruvkun of Harvard Medical School, along with David Baulcombe of the University of Cambridge in England, will share one of nine Franklin Institute Awards.

The institute, which prides itself on anticipating Nobel Prize recognition in science, singled out these three researchers for their discovery in 1993 that small strands of RNA called microRNAs could turn off genes that produce proteins.

ELIZABETH COONEY

Harvard historian of medicine Allan M. Brandt was awarded the prestigious Bancroft Prize for his book "The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America."

The prizes, which include an award of $10,000 to each author, are given each year to books in American history, biography, and diplomacy.