Face transplant criteria broaden in Boston
Excerpts from the Globe's blog on the Boston-area medical community.
A Boston hospital poised to offer face transplants has enlarged the pool of patients it would consider for the life-changing surgery, the doctor leading the program said last week, after the first face transplant in the nation was reported.
Dr. Bohdan Pomahac, a plastic surgeon at Brigham and Women's Hospital, welcomed the recent announcement by the Cleveland Clinic that its surgeons had replaced 80 percent of a woman's face with the face of a deceased female donor, making it the fourth face transplant in the world.
"I think it's very exciting," Pomahac said in an interview. "I hope it's going to open the door for many more patients and allow us to help them."
Three years ago the world's first face transplant gave a new face to a French woman who had been mauled by her dog. Since then a Chinese man who had been attacked by a bear and a French man with a disfiguring genetic condition have had face transplants. Like other transplant recipients, they have to take drugs to prevent rejection of donor tissue. But because face transplants aren't life-saving surgeries, debate has arisen on whether it is ethically acceptable to put these patients on such powerful drugs for the rest of their lives.
The Brigham said last year it would offer face transplants only to people who were already taking the anti-rejection drugs. But in May the hospital expanded its protocol to anyone whose deformity involves 25 percent of the face, or all of a major facial part such as the entire lip or entire nose.
Potential face transplant patients are being interviewed, Pomahac said. The New England Organ Bank, the region's organ-procurement organization, approved the Brigham's program earlier this year.
The state's tally, conducted by the Urban Institute, found that only 167,000 people - or 2.6 percent of the state's residents - did not have insurance when they conducted a poll this summer. Last year the US Census Bureau gauged the insurance rate at 95 percent in Massachusetts, making it the state with the highest coverage in the country.
"These survey results are a clear endorsement of our approach to covering the uninsured but also point to the critical need to tackle the unsustainable growth in health care costs in order to protect the progress we have made," Sarah Iselin, commissioner of the state Division of Health Care Finance and Policy, said in a statement.
Writing in Clinical Infectious Diseases, scientists from the College of Veterinary Medicine in Columbus, Ohio, say that the average number of disease outbreaks per year associated with raw milk has more than doubled to 5.2 per year from 1993 through 2006 compared with the previous 19 years.
Contamination with disease-causing bacteria can occur at any point along the route from cow to human, including collection, processing, distribution, and storage, the authors say.
Pasteurization is the most effective way to destroy microbes such as salmonella, E. coli, and listeria.
Last year's outbreak of listeriosis, in which three people died, was unusual in that it was traced to contamination after pasteurization at a Central Massachusetts dairy.
Pasteurization does not change the nutritional value of milk, says prior research the authors cite.
But raw milk adherents dispute that, saying the process destroys good bacteria with the bad.
ELIZABETH COONEY 