In observance of the Fourth of July, White Coat Notes is taking a long weekend.

We'll be back Tuesday, July 7.

The robot glides past the beeping heart monitor, past a row of patients supine on their electric beds, past the beehive of the nurses’ station. The sleek, metallic body, dusky blue, stops outside Room 9 and slowly rolls through the doorway. The face of Timothy Liesching, a pulmonary critical care doctor, gazes at his patient from a computer screen on top of the robot. The machine that Liesching, director of telemedicine at the Lahey Clinic, is guiding down the corridors of Beverly Hospital is the only one like this in New England, say officials at the clinic.

A federal investigation has found that heart attack survivors enrolled in a study of chelation, a controversial alternative medicine treatment, were not told enough about potential dangers from the drug being tested, including death.

Britain faces a projected 100,000 new swine flu cases a day by the end of August and must revamp its flu strategy to cope, the nation’s health minister said yesterday.

President Obama, pledging to overhaul healthcare this year despite divisions in Congress and the public, took on his skeptics directly yesterday, seeking to assure patients that their costs would not increase and that they would not be victims of a “government takeover.’’

The odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than a decade, a large Medicare study concludes.

The Food and Drug Administration will require two smoking-cessation drugs, Chantix and Zyban, to carry the agency’s strongest safety warning over side effects including depression and suicidal thoughts.

The University of Rhode Island has named Ron Jordan, a former president of the nation’s largest pharmacy association, as the next dean of its College of Pharmacy (third item).

“ 'Recession obesity' is the term du jour for the unhealthy side effects of people who lose their jobs and health insurance, then drop their gym memberships, delay medical care, and eat cheaper but less healthy meals," Wendy Everett, president of the New England Healthcare Institute, and Paul S. Grogan, president and CEO of The Boston Foundation, write on the opinion page. "Massachusetts residents are particularly vulnerable to these unhealthy trends. But it doesn’t have to be this way; we can do something about it, and we should start now."

By Kay Lazar
Globe Staff

The deaths of two more Boston residents have been linked to swine flu, Boston health authorities reported tonight, bringing to four the number of Massachusetts adults killed by the novel virus.

The victims, both men, were 52 and 30 years old.

The 52-year-old had underlying medical conditions that might have made him more susceptible to complications from the germ, known scientifically as H1N1, but the younger victim did not, said Boston Public Health Commission spokeswoman Susan Harrington. She declined to elaborate, citing patient confidentiality laws.

Test results confirmed today that the 52-year-old, who died last Friday in his home, was infected with the virus.

The 30-year-old was hospitalized two weeks ago and died Monday; preliminary tests strongly suggest he harbored H1N1. Tests designed to confirm his infection are pending in Atlanta at the US Centers for Disease Control and Prevention.

Since the arrival of the virus in Massachusetts in April, Boston appears to have borne a disproportionate share of the illness, said Barbara Ferrer, executive director of the Boston Public Health Commission. In addition to all four of the state's swine flu-related deaths, the city has recorded 475 of the 1,287 cases of swine flu confirmed in the state.

"Boston has about 11 percent of the state population but roughly 30 percent of the H1N1 confirmed cases," Ferrer said.

That ferocity has perplexed disease specialists.

"We are going to need to work closely with the state and CDC to understand the pattern of H1N1," Ferrer said. "As with any urban city, people live in much closer proximity with each other and given this is transmitted through respiratory droplets, that proximity is worth noting. The density in Boston is much greater than the density in a Webster or Wayland."

Earlier this week, health authorities reported that the virus had killed an 84-year-old Boston resident. The state's first swine flu victim was a 30-year-old mother from Boston who died June 14. Like the 30-year-old man who died on Monday, the woman suffered from none of the underlying medical conditions -- such as heart disease, asthma, diabetes, or cancer -- that can turn a relatively mild viral infection into a life-threatening illness, city disease trackers said.

Despite the four deaths, surveillance data show that for the first time since the virus hit the state, there is decreasing illness linked to influenza in Boston and across Massachusetts. Still, the level of flu activity is much higher now than normal for summertime.

Nationwide, the germ has proved most troublesome to younger adults and children, unlike the seasonal flu, which disproportionately harms the aged. More than two-thirds of the confirmed illnesses in Massachusetts have been in people under 25.

Some disease specialists theorize that older people may have added protection because they were exposed to H1N1 viruses circulating widely from 1918 to 1957, before those strains vanished for two decades. Other H1N1 strains have been circulating in recent years, however.

In this swine flu outbreak -- there have been more than 21,000 confirmed cases nationwide -- the vast majority of illnesses have been mild. But officials are concerned that the strain might re-emerge in the fall, possibly in a more virulent form.

Citing that possibility, Senator Richard T. Moore, an Uxbridge Democrat who chairs the legislature's Health Care Financing Committee, yesterday sent a letter to state public health Commissioner John Auerbach asking how various Massachusetts health and educational agencies are coordinating strategies to help protect the state's one million school-aged children.

State public health spokeswoman Jennifer Manley said preparing for the fall is a "high priority" for the department. She said Auerbach was unavailable to comment because he was flying back last night from the CDC in Atlanta, where he discussed this issue and other swine-flu related concerns with federal officials and health directors from around the country.

"It will be a busy summer of planning as we work with our partners in health care, in government, and with the public to prepare for the upcoming flu season," she said.

By Patricia Wen
Globe Staff

The child psychiatrist of 4-year-old Rebecca Riley, who died of an overdose of psychiatric drugs, will not be criminally prosecuted in the girl's death, clearing one of several legal hurdles that the doctor faces in connection to the child's death.

Plymouth County District Attorney Timothy J. Cruz today announced that a grand jury has declined to indict Dr. Kayoko Kifuji of Tufts Medical Center. Kifuji had treated the Hull girl for bipolar disorder and attention deficit hyperactivity disorder since she was 2. When the girl died on Dec. 13, 2006, she was taking three psychotropic medications.

While Rebecca's death cast a harsh spotlight on Kifuji and renewed calls for tighter restrictions on psychiatric drugs for children, Kifuji's lawyers have asserted that she was a compassionate clinician who ordered safe dosages of all medications. Kifuji has said it was the girl's parents who killed their child by dispensing the fatal levels of drugs. Michael and Carolyn Riley face murder charges for what prosecutors say was a pattern of over-medicating their daughter in an effort to sedate her.

Soon after Rebecca died, the Board of Registration in Medicine began an investigation, and Kifuji voluntarily suspended her practice.

"The next step for her will be the reinstatement of her license to practice medicine," said her lawyer, Bruce Singal of Boston, today.

Kifuji also faces a medical malpractice suit filed by the administrator of the girl's estate. In that case, Kifuji is accused, among other things, of poor oversight of the girl's medications and ignoring reports from Rebecca's school that she often seemed overly drugged and too tired.

By Elizabeth Cooney
Globe Correspondent

The nation's obesity crisis has hit Massachusetts hard -- just not as hard as the rest of the country, according to a study that takes the measure of the nation's waistline.

About 21 percent of adults in the state are obese, a figure that, while alarming, is among the lowest in the country (only Colorado is lower). But the state's children do not share that distinction: At 30 percent – a rate that combines overweight and obesity – they are among the middle of the pack nationally as the state prepares to begin screening children to determine if they weigh too much.

The troubling numbers come from an annual analysis released today by the Trust for America's Health and the Robert Wood Johnson Foundation, a philanthropy focused on health. The report, based on federal data gathered differently for adults and children, also sounds an alarm about aging and overweight Baby Boomers.

"Although we are ranked relatively well for our adults, it's an issue we are very concerned about," said John Auerbach, commissioner of the state Department of Public Health. "We have about 60 percent of adults who are overweight and that's not a statistic we are proud of, even if we look better than most of the country. That's not a good statistic, and obviously we are concerned about the percentage of children who are overweight."

By Carolyn Y. Johnson
Globe Staff

Harvard scientists announced today they had discovered a master human heart cell that gives rise to three major types of heart tissue, providing new tools for drug development and an important advance toward the ultimate goal of repairing damaged hearts.

Using human embryonic stem cells, the researchers have unraveled part of the process by which the human heart is built during development -- insights they hope could be used to understand congenital heart disease and create new therapies for cardiovascular disease, the top cause of death in the United States.

"Since these [cells] are entirely human, you can use this system now to study the role of specific genes in human heart disease, and as ways to screen drugs for cardiotoxicity and for therapeutic effect," said Dr. Kenneth R. Chien, director of the Cardiovascular Research Center at Massachusetts General Hospital and principal faculty member at the Harvard Stem Cell Institute. He is senior author of the paper, published in Nature today.

Edward Givler is a retired race car hobbyist who once held a lap record on New England’s largest speedway, but when he ambled slowly into the waiting room of a Boston hospital recently, his ambitions as a motorist were far more humble. He wanted to find out if he should continue to drive.

Researchers, led by cardiologists at Massachusetts General Hospital, reported yesterday that testing patients for a protein associated with inflammation may help predict the risk of heart attacks and strokes in certain cases but that it is probably not useful as a widespread, routine screening tool.

Dunkin’ Donuts has temporarily halted the sale of hot chocolate and Dunkaccino brand beverages after learning that some equipment used at a supplier’s facility was contaminated with salmonella (third item).

Lexington drug maker Amag Pharmaceuticals Inc. said yesterday it has won approval for an iron replacement therapy with the potential to be its first blockbuster drug.

Wal-Mart has embraced President Obama’s call for requiring all large employers to offer health insurance to their workers, adding momentum to the president’s push for far-reaching changes to the nation’s healthcare system.

Dr. Orrie M. Friedman, who founded Collaborative Research Inc., which helped pioneer the field of biotechnology, then used his riches for philanthropy, died in his Brookline home Sunday of complications from Parkinson’s disease. He was 94.

"As the Commonwealth of Massachusetts and its 6 million residents struggle to pay their medical bills, they have a new tool on their side, starting today. A law cracking down on the marketing that pharmaceutical firms do with doctors goes into effect," A Globe editorial says. "No one expects miracles from the new rules, but they should ensure that doctors’ prescribing decisions will focus more on patient needs and less on the gifts and fancy meals many doctors have long received from drug companies."

Beth Israel Deaconess Medical Center expects to break even at the end of the current fiscal year while it looks for leaner measures to weather the next one, according to its CEO.

In an item posted on his blog Running a Hospital early this morning, Paul Levy thanks the hospital staff for coming together to close a $20 million budget shortfall earlier this year. The effort, which reduced to 70 layoffs what could have been 600 and protected lower-paid workers, struck a chord beyond the hospital and Boston.

But Levy says the work is not done yet and what lies ahead for the fiscal year that begins Oct. 1 may be more difficult.

"There is nothing on the national or state political and economic scene to suggest that the coming years will offer good news for us and for other hospitals," he writes. "Unless we act decisively, it is reasonable to expect a slow and steady deterioration in our capital position, our ability to compete, and ultimately our ability to carry out our mission in a manner that meets the standard of excellence we demand for ourselves."

The face of the insurance industry in Washington is a slight, soft-spoken former AFL-CIO employee benefits director with a penchant for data-driven logic. She has the confidence and intellectual agility of a skilled debater, but prefers to dwell on areas of agreement. On healthcare, Karen Ignagni often sounds like the lifelong Democrat that she is.

A doctor accused of botching dozens of prostate cancer surgeries at a Veterans Administration hospital admitted yesterday that he sometimes missed his target when implanting radioactive seeds, leaving patients with incorrect dosages.

The makers of Tylenol, Excedrin, and other medications yesterday tried to dissuade regulators from placing new restrictions on their popular painkillers, including possibly removing some of them from store shelves.

"The H1N1 pandemic reveals the fallacy of relying on public health emergency laws to contain an epidemic," Wendy Parmet, professor of law at Northeastern University School of Law and author of "Populations, Public Health and the Law," writes on the opinion page. "The best way to prepare for a public health disaster is to focus our attention and our laws on ameliorating our everyday health problems."

By Tara Ballenger, Globe Correspondent

The state health department and the Boston Public Health Commission today confirmed Boston's second swine flu-related death. An 84-year-old man died on June 18 after being hospitalized for six days for flu symptoms. His test results came back today, indicating he was positive for H1N1 influenza, the scientific term for swine flu.

According to a statement released by the Boston Public Health Commission, the man had several health conditions that placed him at high risk for the flu. However, neither his exact conditions nor the hospital where he was treated could be released by the commission because of patient confidentiality.

According the CDC website, people who suffer from asthma, diabetes, chronic lung disease or heart disease, as well as pregnant women can develop severe respiratory illness from exposure to H1N1.

"While we have seen recent evidence of flu-like illness decreasing in Massachusetts, this tragic case underscores that we are still seeing person-to-person spread of the virus," said Massachusetts Department of Public Health commissioner John Auerbach.

A Boston woman in her 30s died from the virus earlier this month.

Officials said there have been 474 confirmed cases of the swine flu in Boston and 1,287 statewide as of June 26.

Boston cancer researchers looked outside typical funding sources when they wanted to try a novel laboratory experiment, an example cited in a New York Times story about federal grants favoring science that "plays it safe."

Dr. Ewa T. Sicinska of the Dana-Farber Cancer Institute didn't even apply for a National Institutes of Health grant when she wanted to grow human cancers in mice, according to Dr. George D. Demetri, who leads the research group supporting her. Implanting human cancer cells in mice has been tried before, in hopes of understanding the disease better, but with little success.

Sicinska embarked on the work with support from the Ludwig Fund, which allows six cancer centers, including Dana-Farber, to use its money as they see fit. With a quarter of a million dollars of Ludwig money, she has implanted tumors in mice without immune systems, the story says. Four types of sarcomas — cancers of fat, muscle or bone — are growing in them and look genetically identical to the tumors removed from patients.

Demetri told the Times he did not apply for an NIH grant “because we have lots of experience in what’s fundable.”

In the Sunday Globe:

Governor Deval Patrick plans to announce a spending proposal tomorrow that retains medical coverage for some 30,000 legal immigrants who are at risk of losing it, and will also agree to ensure dental coverage for another 700,000 of the state’s poorest residents, administration officials said yesterday.

"The fuzzy math behind the Massachusetts universal healthcare law is starting to add up - just as Washington studies the law as a possible model for the nation," columnist Joan Vennochi writes. "Because of a recession-related drop in state revenues and a surge in enrollment by the recently unemployed, the truth is emerging at an inconvenient time. Massachusetts doesn’t have enough money to pay for the coverage envisioned by the law."

Jonathan O. Cole, the former chief of psychopharmacology at McLean Hospital and the first director of the psychopharmacology research branch at the National Institute of Mental Health in Bethesda, Md., died May 26 of complications of renal disease at Beth Israel Deaconess Medical Center in Boston.

In Saturday's Globe:

"With malaria sapping so much life and potential, Uganda has been driven to spray the interior of homes with DDT," columnist Derrick Z. Jackson writes from Mbarara.

Dr. Carl S. Hoar Jr., a general and vascular surgeon at the former New England Deaconess Hospital for nearly 40 years, died June 9 at Beth Israel Deaconess Medical Center in Boston of complications from a medical procedure. He was 88.

Dr. Jean Dausset, a French immunologist who shared the Nobel Prize in Medicine in 1980 for discoveries about the human immune system that vastly improved the odds of success in organ transplants, died in Mallorca, Spain, June 6. He was 92.

In g:

More than five years after the US Food and Drug Administration banished an herbal weight-loss compound called ephedra that was blamed for 155 deaths, the love affair with supplements blazes hotter than ever.

Beth Piknick, president of the Massachusetts Nurses Association, and a longtime registered nurse at Cape Cod Hospital in Hyannis, weighs in on TV nurses in “HawthoRNe.’’

About 1 out of 14 abnormal test results were never reported to patients, according to a survey of primary care medical records.

A protein found in the urine of children with appendicitis might lead to a better way to accurately diagnose the disease (second item).

Do you have to rub contact lenses to clean them if your cleanser is 'no rub'?

In Science & Innovation:

A protein found on brain cells, known to contribute to nicotine addiction, may also be the key to developing drugs for a wide range of diseases and medical conditions, including obesity, schizophrenia, and Alzheimer’s disease.

Why don’t plants get nitrogen from the air?

Also in today's Globe:

The state’s network of community health departments is stretched so thin that some are unable to provide important services, public health officials said.

A surprising number of teenagers - nearly 15 percent - think they’re going to die young, leading many to drug use, suicide attempts, and other unsafe behavior, new research suggests.

By Michael Paulson, Globe Staff

Caritas Christi Health Care, the financially challenged Catholic hospital system founded by the Archdiocese of Boston, is abruptly ending its joint venture with a Missouri-based health insurer at the insistence of Cardinal Sean P. O'Malley, who has decided that the relationship represented too much of an entanglement between Catholic hospitals and abortion providers.

The dramatic development, just days before the joint venture was scheduled to start providing care to low-income residents as part of the state's efforts to establish near universal health coverage here, is a vindication of sorts for a variety of very conservative Catholic critics of the cardinal, who have been arguing angrily and loudly that it would be "evil" for Caritas to partner with a health provider that covers abortion services.

The development is also a setback for Caritas, because it represents the undoing of one of the most significant steps its new chief executive, Dr. Ralph de la Torre, had announced as part of his efforts to turn around the hospital system's finances. It was not immediately clear last night what the financial impact of the change is on Caritas, but the decision is a stark and public reminder from O'Malley to de la Torre and the general public that moral concerns will trump monetary concerns at the Catholic hospitals.

By Stephen Smith, Globe Staff

Two Boston social service agencies specializing in housing -- one focused on substance abuse, the other on AIDS -- announced this week that they are merging.

Victory Programs, a 34-year-old agency that provides services to substance abusers, and AIDS Housing Corporation, which has provided assistance to people infected with HIV since 1991, are combining under the Victory Programs umbrella. The organizations have a long history of working together.

Across the nation, AIDS service organizations have seen their mission change -- sometimes merging, sometimes going out of business -- as a disease once regarded as an almost certain death sentence became more of a chronic medical condition.

Jonathan Scott, the executive director of Victory Programs, will preside over the combined agency. Joe Carleo, formerly executive director of AIDS Housing Corporation, will become director of community affairs for Victory Programs.

A Boston hospital executive who led New England Deaconess Hospital for more than two decades has died. He was 95.

Robert D. "Don" Lowry, chief executive officer of the Deaconess from 1954 until his retirement in 1976, died Monday at his home in Chelsea, according to Beth Israel Deaconess Medical Center CEO Paul Levy.

In a message to hospital staff quoted on his blog last night, Levy said that during Lowry's tenure, the Deaconess grew from 298 beds to a 482-bed specialty referral hospital known for treating diabetes, heart disease, and cancer. Lowry was later named "trustee for life" at Beth Israel Deaconess, the institution formed by a 1996 merger with Beth Israel Hospital.

"Don had the reputation of being a great builder – but being a builder of buildings was not what made him a great leader," friend and former colleague Joanne Casella, chief administrative officer in the Beth Israel Deaconess department of medicine, said in the message. "It was that he was a builder of trust."

In a landmark agreement, Massachusetts General Hospital and Brigham and Women’s Hospital are pledging to spend millions of dollars to resolve complaints that ill-suited equipment and sometimes-indifferent medical workers make disabled patients feel unwelcome.

Genzyme Corp. yesterday said supplies of two drugs that treat rare genetic disorders could be rationed for longer than originally thought. The extension is a result of an expanded cleanup effort at the biotechnology company’s Boston manufacturing plant and lower inventory for one of the drugs than initially calculated.

Swine flu has infected as many as 1 million Americans, US health officials said yesterday, adding that 6 percent or more of some urban populations are infected.

Alcohol abuse has devastated Russia, with drinking causing more than half of deaths among Russians aged 15 to 54 in the turbulent era following the Soviet collapse, a team of public health researchers say.

"CVS Caremark’s research shows that one-quarter of original prescriptions for chronic conditions never get filled, and more than half of patients taking a maintenance medication will stop taking it within their first year, likely leading to significant increases in surgeries, unnecessary hospital admissions, and other costly treatments," Thomas M. Ryan, chairman, CEO, and president of CVS Caremark, writes on the opinion page. "By increasing prescription adherence, savings would be substantial, estimated at $177 billion annually."

A Newburyport psychiatrist tells a tale of academic exclusion in a post about power and dissent.

Dr. Daniel Carlat, who writes The Carlat Psychiatry Blog, mentions colleague Dr. Doug Bremner's post about being dis-invited from co-authorship on a journal article after ruffling some feathers with a critical blog item. It's easy to get lost in the links referring to yet other links, but staying on Carlat's blog will bring you to his own experience of shunning.

Two Boston physicians are feeding the public's appetite for celebrity news while meeting their need for trusted health information in a venture that explains the medical meaning behind the headlines.

CelebrityDiagnosis.com, the brainchild of husband-and-wife team Dr. Mark Boguski and Dr. Michele Berman, offers background information on health conditions in the news, from Hillary Clinton's broken elbow to singer Susan Boyle's exhaustion.