Drug ads take a lot of heat. Ubiquitous TV commercials aimed at consumers are blamed both for spurring patient demand and boosting health care costs. But only one of those may be true, according to a new Harvard study.

Researchers led by Michael Law, formerly a research fellow at Harvard Medical School and now a health policy researcher at the University of British Columbia, tested the effects of direct-to-consumer advertising on clopidogrel, sold by Bristol-Myers Squibb and Sanofi-Aventis as Plavix. Prescribed to prevent blood clots in people who have had heart attacks, it was initially sold without being marketed directly to patients. The researchers analyzed sales three years before and four years after consumer ads began so they could isolate the effect of the ads from promotions to physicians or free samples distributed when the drug was new.

Looking at pharmacy data from Medicaid programs in 27 states, including Massachusetts, they found that sales have steadily risen since the drug was introduced, moving up in a pattern that did not change from 1999 through 2005. But the cost to the Medicaid programs did rise by $207 million after ads began in 2002, the authors report in tomorrow's Archives of Internal Medicine. The drug's maker raised the price 12 percent, or 40 cents per pill, when it launched the $350 million ad campaign.

"The Bristol-Myers Squibb/Sanofi partnership supports direct-to-consumer advertising as a way to encourage consumers to play a more active role in their health care,” Laura Hortas, a Bristol-Myers spokeswoman, told Bloomberg News today.

The study's conclusions are consistent with what Law and colleagues at the University of Alberta reported last year about three heavily advertised drugs.

"We found similar lackluster results for drugs advertised directly to patients," Law said in an interview. "It makes us continue to wonder why so much is being spent on these activities."

In G Health:

Stop breast self-exams? No mammograms until 50? Even the experts are confused about the new guidelines.

Dr. Amy N. Ship, whose sons were born with serious illnesses, gained firsthand knowledge about the importance of compassionate care.

Why does eating quickly seem to lead to weight gain?

Text messaging is an effective tool for reminding patients to use sunscreen.

Levels of "bad" cholesterol are on the decline, but 1 out of every 5 adults still have high LDL levels and many of those don’t know they have a problem (second item).

In Science & Innovation:

More than two centuries ago, the Italian scientist Luigi Galvani found that electricity could make a dead frog’s leg kick, as if it were alive. Today, using the same basic principle but new tools, scientists are employing light to trigger brain cells - looking not for a kick, but for the origins of emotions, behaviors, and diseases in the brain.

Despite its high-profile success with the AbioCor self-contained artificial heart, Abiomed Inc. has been refocusing on a less flashy though potentially more durable product: cardiac-assist devices, known as recovery pumps, which are used in hospital settings to help critically ill patients’ hearts recover, rather than having to be replaced.

What’s the deal with lights that are supposed to be better for the environment?

Buoyed by their weekend victory on a vote beginning the health care debate, several Senate Democrats expressed optimism yesterday they could find a way to keep a government-run insurance plan in the sweeping bill.

President Obama’s vision for making health care in America more effective and efficient collided last week with the realities of the nation’s medical system and fears that broad administrative changes would lead to rationing of care.

With the help of a couple of like-minded graduate students, Harvard Medical School's Nina Dudnik enlisted dozens of science students to scour the labs and rescue unneeded microscopes, petri dishes, beakers, centrifuges, ovens, and vast numbers of test tubes. With them, the nonprofit organization she built, called Seeding Labs, has, over the last six years, equipped 22 science laboratories at universities in 13 Latin American and African countries.

By Stephanie S. Daly, Globe Correspondent

State public health officials today announced the deaths of two people from swine flu, including a child under the age of four, underscoring the vulnerability that young people appear to have to the unusual virus.

The child is just the second in Massachusetts to die from H1N1, and the first child to die from the virus during this fall's flu season. The first child died in the spring.

"Death due to H1N1 is rare, but it does happen,'' said Dr. Lauren Smith, medical director of the state Department of Public Health. "I understand that the death of the child is a tragic thing.''

By Carolyn Y. Johnson, Globe Staff

Advanced Cell Technology Inc., the Worcester stem cell company that has struggled financially, announced today it has filed its first investigational new drug application with the US Food and Drug Administration.

The federal agency will have 30 days to review and respond to the company’s plan to inject retinal cells derived from human embryonic stem cells into 12 patients suffering from a rare form of retinal degenerative disease, called Stargardt’s Macular Dystrophy.

The only clinical trial utilizing human embryonic stem cells to gain FDA approval has been a Geron Corp. study. That trial was put on clinical hold in August, and last month Geron came to an agreement with federal regulators on how to proceed in order to reinitiate the trial.

By Stephen Smith

Somewhere in Massachusetts this week, the state's millionth dose of swine flu vaccine should arrive.

Public health authorities announced today that with an allotment of shots and spray Tuesday, the state had received or ordered 1,020,000 doses of vaccine to slow the march of the H1N1 virus. And Dr. Lauren Smith, medical director of the Department of Public Health, cautiously forecast that by the end of this month, 1.5 millions doses will be in the state or headed here.

Still, that's about 300,000 doses fewer than state authorities originally expected to have on hand by the start of December. Production of swine flu vaccine has not met the projections of pharmaceutical companies or the expectations of federal health authorities, who have been criticized in some quarters -- including on Capitol Hill -- for overly rosy predictions about how much vaccine would be available and when.

Vaccination efforts in Massachusetts are being targeted at 1.6 million patients at greatest risk of complications from the virus and the people who take care of them. That includes pregnant women, children under 18, adults who take care of children younger than 6 months, and health care workers with direct patient contact.

As more vaccine becomes available -- the state expects 3.5 million doses by late January -- the priority list will be expanded, state officials said.

By Stephen Smith, Globe Staff

She began guarding the public's health when Jimmy Carter was president and Michael S. Dukakis was in his first term as governor. Nancy Ridley has ridden herd over laboratory safety, food and drug safety, radiation control, patient safety, and, in the wake of the Sept. 11, 2001, attacks, emergency preparations.

Ridley, who's retiring, was hailed this morning for her 32 years of service at the Massachusetts Department of Public Health. She was showered with flowers, a plaque commemorating a new safety award that bears her name -- and a Paul Revere bowl. The last was a gift with a message: Paul Revere, after he'd done his midnight ride thing, became America's first public health czar when, in 1799, he became Boston's first health officer.

Albert Sherman, a veteran member of the state Public Health Council, offered an effusive tribute to Ridley, noting that former House Speaker Thomas Finneran back in the day referred to Ridley as one of the two most powerful women in state government.

Sherman recalled, too, how when it was revealed that the steely Ridley was en route to a nursing home for an inspection, the powerful, wealthy owners of facilities would turn weak-kneed "and drop a dime to their lawyers."

Ridley smiled, wistfully. The audience applauded, heartily.

A program that helps 34,000 laid-off Massachusetts workers pay for health insurance would not be on the verge of insolvency if the state had collected the correct tax from employers who fund the program, according to a report released today.

The Medical Security Trust Fund, the pool of money that pays for health insurance for the unemployed, will run out of money in December without emergency measures, according to state officials.

But if the fees on employers had kept pace with inflation -- something required by the 1988 law that created the program -- the Medical Security Trust Fund would not be going broke, according to the report from the Massachusetts Budget and Policy Center, an independent think tank.

Dr. Kenneth Baughman, a Brigham and Women's Hospital cardiologist from Newton, died at age 63 after being struck by a car while jogging Monday morning in Florida, where he had traveled to attend a medical conference. (Courtesy: Brigham and Women's Hospital)

By Matt Rocheleau, Globe Correspondent

A Brigham and Women's Hospital cardiologist was struck by a car while jogging and died yesterday morning in Orlando, where he was attending a medical conference, according to police.

Dr. Kenneth L. Baughman, 63, director of advanced heart disease at the Brigham, was in Orlando for the American Heart Association’s Scientific Sessions 2009. He was pronounced dead at the scene after being hit by a 2007 Saturn sedan while crossing the four-way intersection of Sand Lake Road, or State Road 482, and Universal Boulevard in Orlando at around 6 a.m. Monday, said Orlando Police Sgt. Bud Jones.

An investigation into the accident is ongoing, said Jones, but he does not believe charges will be filed against the 50-year-old driver, Gary Krotke, of Haines City, Fla.

By Stephen Smith, Globe Staff

An influential scientific panel today jolted widely accepted beliefs about breast cancer screening, recommending that women in their 40s forgo routine mammograms and that older women undergo the test every other year instead of annually.

The US Preventive Services Task Force, established by the federal government to set standards on disease prevention and primary care, concluded that mammography saves relatively few lives in women 40 to 49, and that this benefit is eclipsed by the risks, including tests that erroneously detect tumors when none exist.

The task force used a similar analysis to determine that women from 50 to 74 -- when breast cancer becomes increasingly common -- should be screened, but that little was gained by performing mammograms on a yearly schedule. The panel also found that breast self-examinations are not useful, at any age.

The guidelines, published in the Annals of Internal Medicine, will likely sow considerable consternation among women and their doctors. Recommendations on who should be screened -- and when -- have vacillated for decades, although in recent years, most groups have championed breast cancer screening starting at 40. In fact, the Preventive Services Task Force seven years ago endorsed exactly such a policy. The American Cancer Society and the National Cancer Institute, the government's cancer research agency, continue to advise routine mammograms for this age group.

By Liz Kowalczyk, Globe Staff

The surgery training program at Massachusetts General Hospital has been put on probation by a national accrediting organization.

The unusual action carries no penalties, but candidates may have second thoughts about applying to a program on probation.

The Accreditation Council for Graduate Medical Education warned the hospital in April that a significant number of junior surgeons were working too many hours and were on the job seven days straight, in violation of patient safety rules. The organization believes heavy workloads contribute to fatigue-related mistakes, and had given the hospital until Aug. 15 to fix the problem.

Even though the hospital made "enormous changes" and is now in "100 percent compliance" with the rules, said Dr. Andrew Warshaw, chief of surgery, the accrediting group told Mass. General last month that it had put the program on probation.

More than a million low-income Massachusetts residents covered by Medicaid will be required to pay more for doctor visits and receive prior approval for some medications under a plan announced today by the Patrick administration to begin to close a $307 million shortfall in the state's MassHealth program.

Some of the biggest changes will come in dental care for adults, who will no longer receive dentures or other oral care except for cleanings, X-rays and emergency services. That change, alone, is expected to save about $15 million this fiscal year, said interim Medicaid director Terence Dougherty.

The state will also stop paying for personal care attendants for patients requiring these in-home aides less than 15 hours a week.

Things go better with Coke, the old slogan used to say, but a Harvard nutrition researcher known for battling the obesity epidemic isn't buying it.

The American Academy of Family Physicians, which represents more than 94,000 family doctors across the country, has accepted a one-year, six-figure grant from the Coca-Cola Company to "develop consumer education content on beverages and sweeteners for FamilyDoctor.org," the group's web site for patients.

Dr. Walter Willett of the Harvard School of Public Health has made an offer to the group: Use our free web site.

"While consumers need such educational materials, I think developing them with funding from Coca-Cola has the potential to call into question the objectivity of the information being disseminated," Willett wrote in a letter dated Monday. "There is plenty of well-vetted material already available on this topic ... to which your website could easily link -- free of charge."

An academy official said its consumer alliance, whose first member Coca-Cola was announced last month, was formed for a different reason. The academy is looking for other sources of revenue beyond member dues and unrestricted grants from pharmaceutical companies that support continuing medical education and exhibits at annual meetings, according to Dr. Douglas Henley, academy executive vice president and CEO. He would not give an exact figure for the deal.

"There's a very solid firewall between the unrestricted grant we get from the funder vs. the development and production of the content they present," he said about pharmaceutical company support. "We intend to do exactly the same thing on the consumer side with the Consumer Alliance. Coca-Cola and any other company we do an alliance with know and understand that before we sign a contract, the content is ours and totally independent."

Henley said he is familiar with the Harvard web site, which urges consumers to avoid high-calorie, sweetened drinks, which research has linked to weight gain and type 2 diabetes.

"It's a very good web site with great content about beverage choices and beverage information on all types, not only sugary beverages but fruit juice and sports drinks and coffee and tea," he said. "We appreciate Dr. Willett's offer and we really are looking for other credible sources of information ... to develop content on our web site."

Two powerful health care interest groups yesterday urged lawmakers constructing a sweeping health care overhaul to focus on cost containment and affordability.

"So, with the Stupak-Pitts amendment hanging from it like an albatross, a bill was passed that would cover millions of uninsured Americans but also strip millions of American women of reproductive health converge," columnist Ellen Goodman writes on the opinion page. "To the uncompromising went the victory."

Massachusetts medical device companies continue to battle a proposed federal tax on device makers as lawmakers work to reconcile differences in the House and Senate versions of national health care overhaul legislation.

If you’re looking to launch a business, here are two words any budding entrepreneur should know: hand sanitizer.

Atrius Health, a Newton alliance of five community medical groups across Eastern Massachusetts, yesterday said it is expanding its ties with Beth Israel Deaconess Medical Center in Boston in an effort to control costs while maintaining quality.

Cigarette smoking rose slightly for the first time in almost 15 years, dashing health officials’ hopes that the US rate had moved permanently below 20 percent.

Gene Cohen, an impish geriatric psychiatrist who championed the idea that people past retirement age have untapped stores of creativity and intellectually rigorous skills in their later years, died Saturday of prostate cancer at his home in suburban Kensington, Md. He was 65.

By Stephen Smith, Globe Staff

Swine flu has killed at least 540 children nationally since emerging in the United States last April, according to federal estimates released today that provide compelling evidence that the novel virus is causing serious illness among more young people than typical seasonal strains.

The report from the US Centers for Disease Control and Prevention, based on a sophisticated but not-fully-vetted statistical model, estimated that 8 million children fell ill with the H1N1 virus from April through Oct. 17, resulting in 36,000 hospital stays. Children under the age of 18 accounted for more than one-third of all swine flu cases, the report said.

It is not so much that the swine flu is more lethal than the seasonal strain, specialists said. Instead, the virus found a whole swath of millions of children and young adults who had never been exposed to ancestors of this H1N1 strain and who therefore had no natural immunity. And vaccine only started to become available during the past month.

The CDC report did not break out state estimates, but in the past month, coughing, feverish children have flooded Massachusetts emergency rooms. Since early October, two-thirds of those hospitalized with confirmed cases of swine flu have been 18 or younger, according to data provided today by the state Department of Public Health.

Among all age groups in Massachusetts, visits to doctors offices for flu-like symptoms have reached levels almost twice the peaks of recent flu seasons.

A cardiologist at Lahey Clinic said he was fired for resisting pressure from two top physicians at the hospital to use stents made by device giant Medtronic Inc., even though the company’s stents might not have been best for some patients.

A half-dozen New England health insurers weighed in among the top 10 commercial health plans nationally in a ranking set to be released today by U.S. News and World Report magazine and the National Committee for Quality Assurance, a nonprofit organization in Washington, D.C.

Several hospitals north of Boston are modifying their visitation rules in response to the spread of H1N1 and seasonal flu in Massachusetts.

As federal regulators take their first tentative steps toward policing the wild west of medical information online, pharmaceutical companies are pressing their case to market drugs via Google, Twitter, and other websites.

Analysis of a dozen published studies testing possible new uses for the Pfizer Inc. epilepsy drug Neurontin found that reporting of the results was often fudged, indicating the medicine worked better than internal company documents showed.

A prominent figure in diabetes research is leaving the National Institutes of Health to lead patient care and research at the University of Massachusetts Medical School and its hospital partner.

Dr. David Harlan, who heads the diabetes branch at the National Institute of Diabetes, Digestive, and Kidney Diseases in Bethesda, Md., will become division chief of diabetes at the medical school and director of the diabetes center at UMass Memorial Medical Center, both in Worcester. He will also be associate director of the school's diabetes and endocrinology research center. The appointments are effective next month. He succeeds Dr. Aldo Rossini, who retired last year.

At UMass, Harlan, 53, hopes to refashion the way care is delivered to people who have diabetes.

"It's an easy diagnosis to make, but the management of [diabetes] is very difficult." he said in an interview. "Many patients, I think, feel more or less on their own, and that the system doesn't work very well for them. So one motivation to come to UMass is the opportunity to look top to bottom at how diabetes care delivery is done and to try to come up with better ways to help patients with this disease. NIH is a fabulous place, but it doesn't have a real hospital -- all patients seen here have to be enrolled in some kind of research protocol."

Massachusetts officials are closely monitoring an abortion funding ban in the sweeping health care legislation before Congress to make sure that it does not restrict women’s access to abortion coverage in the state.

The top executive of French drug maker Sanofi-Aventis SA reached out to Boston-area researchers and biotechnology start-ups yesterday, offering “partnerships for innovation" that could range from investing in drugs to outright acquisitions.

The American Medical Association yesterday voted to oppose the military’s “don’t ask, don’t tell" policy, and declared that gay marriage bans contribute to health disparities.

CVS Caremark Corp., the operator of more than 7,000 US drugstores, has agreed to settle a lawsuit with New York’s attorney general for $875,000 over the sale of expired eggs, milk, baby formula, and over-the-counter drugs.

By Stephen Smith, Globe Staff

A 65-year-old Boston man with existing health problems died Oct. 31 from swine flu, the 14th person to succumb to the virus in Massachusetts, city health officials said this afternoon.

The man, whose identity was not disclosed because of patient confidentiality laws, was hospitalized Oct. 14 and was described by the Boston Public Health Commission as having "multiple health conditions." People with chronic conditions such as asthma are more likely to suffer serious complications from the H1N1 flu virus.

He is the fifth Boston resident to die from the H1N1 virus. Laboratory test results confirmed that his death was caused by the germ.

While the young have disproportionately been struck by the disease, there is increasing evidence that the virus may prove most lethal in the elderly, whose ability to fight illness is compromised by both age and infirmity. Two of the 14 Massachusetts swine flu victims have now been 65 or older.

Patients and doctors may think doctors' visits are shrinking, as dwindling numbers of primary care physicians are pressured to do more. But not only are appointments lasting a little longer, Boston researchers say, their quality is also higher than a decade ago.

A team from the Veterans Affairs Boston Healthcare System analyzed national data gathered from 1997 through 2005. They tracked how long people spent with their doctors and whether recommended screening or counseling took place. They compared certain medical conditions to see if there were differences in time and quality of care. Prescriptions were reviewed to see if they complied with national guidelines.

At the beginning of the study period, overall visits averaged 18 minutes. Almost 10 years later, the average time increased to 20.8 minutes. Some visits grew more than others: general medical exams lasted 3.4 minutes longer, diabetes visits were 4.2 minutes longer, hypertension visits were 3.7 minutes longer, and visits for joint diseases were 5.9 minutes longer.

Counseling or screening -- two factors considered signs of high quality -- lengthened the visits by 2.6 to 4.2 minutes, the study found. Providing appropriate medications did not take more time. Together, all three were more likely to occur later in the study period than earlier.

"We found no evidence for the commonly held belief that physicians are spending less time with their patients or that quality of care has diminished," the authors write in the Archives of Internal Medicine, also noting that the number of primary care visits rose 10 percent during the study period. "In fact, patients spent more time with their primary care physicians during office visits in 2005 than they did almost a decade earlier, and overall they received better care."