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March 30, 2007
The Blue Cross Blue Shield Foundation of Massachusetts has won an award from the Council on Foundations for its Roadmap to Coverage project.
The Paul Ylvisaker Award for Public Policy Engagement, named after a former dean of the Harvard Graduate School of Education, is given to a foundation that sets the agenda for public debate, the international association of foundations said.
The Roadmap to Coverage provided research on uninsured people and options for expanding coverage in Massachusetts.
"This award recognizes not only the importance of the work of the foundation through its efforts to support a dialogue on health reform, but is also a reflection of what the entire Massachusetts health care community has achieved through passage of the Massachusetts health reform law," Nancy Turnbull, president of the foundation, said in a statement.
Posted by Elizabeth Cooney at 01:42 PM
March 30, 2007
Harvard Medical School, is again the top medical school in the United States, according to the annual rankings compiled by U.S. News & World Report. Harvard has led the rankings since 1990, when they began.
Johns Hopkins, University of Pennsylvania, Washington University in St. Louis and University of California -- San Francisco followed in the top five.
Boston University ranked 34th, Tufts University was 47th and the University of Massachusetts came in 49th out of 125 U.S. medical schools.
The standings were based on eight measures, including surveys of medical school deans and residency program directors, as well as 2006 research funding from the National Institutes of Health. Harvard received $1.17 billion from NIH that year, BU pulled in $170 million, UMass had $118 million and Tufts drew $61 million, according to U.S. News.
UMass Medical School's primary care education program ranked 11th. The University of Washington led that category.
Posted by Elizabeth Cooney at 11:29 AM
March 30, 2007
Governor Deval Patrick will announce this morning that he wants the Department of Public Health to reverse restrictions on stem cell research imposed by his predecessor, according to an administration official with direct knowledge of the governor's intentions.
Dr. Eric Keroack, the head of the federal Health and Human Services Department office responsible for providing women with access to contraceptives and counseling to prevent pregnancy resigned unexpectedly yesterday after Medicaid officials took action against him in Massachusetts.
Anesthesia can be harmful to the developing brain, Food and Drug Administration studies on animals suggest, raising concerns about potential risks in putting young children under for surgery.
In a second round of bidding earlier this year, monthly premiums for the four low-cost health insurance plans to be offered in the Boston area were cut by an average of 8 percent, according to records the Globe obtained from the Commonwealth Health Insurance Connector Authority in response to a Freedom of Information Act request.
Some analysts are scratching their heads at the move Merck & Co. is planning: The drug maker wants to sell a new painkiller that is just like Vioxx, the blockbuster drug it pulled from the market in 2004 because the treatment doubled heart risks.
All people need hope: hope for a good day today, hope for a normal life, and possibly hope for a cure, Dr. Darshak Sanghavi writes in an op-ed essay in light of cancer coming back for Elizabeth Edwards and Tony Snow. But he says that brings us to a painful and necessary question: Is there such a thing as false hope?
Posted by Elizabeth Cooney at 06:24 AM
March 29, 2007
On WBUR's CommonHealth, Nancy Turnbull of the Harvard School of Public Health tries her hand at haiku to muse about the state's new healthcare law.
Here's how she starts:
Health reform is hard.
Such a broken system.
We can’t fix it all.
So far one response is also in verse. It might be a haiku, too, but it's been a long time since White Coat Notes was in poetry class.
Kevin, M.D.'s link to a Student Doctor Network item about certified registered nurse anesthetists sparked a bit of a spat about training requirements for registered nurses. The SDN post said CRNAs make 224 percent as much as RNs and 156 percent as much as advance practice nurses.
Posted by Elizabeth Cooney at 01:03 PM
March 29, 2007
More than 5,000 child development experts are currently converging in Boston for the biennial meeting of the Society for Research in Child Development.
The conference, which runs from today through Sunday, features topics including why children become terrorists, adopting a child from China, moving poor families into higher-income neighborhoods, children and lying, and the impact of hurricanes Katrina and Rita.
Posted by Elizabeth Cooney at 11:27 AM
March 29, 2007
The World Health Organization and UNAIDS yesterday recommended that African males living in the heart of the AIDS pandemic protect themselves against HIV by undergoing circumcision -- medical advice that could lead to surgical procedures on tens of millions, from infants to elders.
Tri-City Mental Health Center, a non profit organization with facilities in suburbs north of Boston, has agreed to pay the state more than half a million dollars to settle allegations it billed the state Medicaid program and the Massachusetts Department of Mental Health for services it never rendered, officials said yesterday.
With the overwhelming advancement of innovative drugs and procedures, doctoring has moved from an individual endeavor to a team effort, and it is technology that binds the team together, Dr. Joseph B. Martin, dean of the Harvard School of Medicine and chairman of the New England Healthcare Institute, writes in an op-ed piece.
Posted by Elizabeth Cooney at 06:23 AM
March 28, 2007
Dr. William F. Owen Jr., formerly of Brigham and Women's Hospital, has been named president of the University of Medicine and Dentistry of New Jersey, the school said today.
Owen is the chancellor of the University of Tennessee Health Science Center in Memphis and vice president for health affairs at the University of Tennessee. Before that he had been chief scientist for Baxter Healthcare Corp.'s renal division while an adjunct professor at Duke University School of Medicine.
Owen graduated from Brown University and Tufts University School of Medicine. He completed his internship and residency in medicine as well as fellowships in nephrology, transplantation and immunology at Brigham and Women's.
Posted by Elizabeth Cooney at 07:40 PM
March 28, 2007
The American Cancer Society yesterday recommended for the first time that certain women get annual magnetic resonance imaging (MRI) scans for breast cancer, even though they have no signs of the disease.
The guidelines are intended for women at unusually high risk of cancer, but it left many women wondering whether they need one of these high-tech scans. Below, Globe reporter Scott Allen answers some basic questions about screening for breast cancer, the second deadliest cancer for women.
Q. What is an MRI and what makes it preferable to a mammogram?
A. Magnetic resonance imaging, or MRI, uses magnetic fields to generate cross-sectional views of soft tissue, creating images that look like detailed "slices" through the breast. The patient typically receives an intravenous injection of a dye to make potential tumors stand out more clearly, then she must hold still for 30 to 45 minutes while the MRI generates images of the breast. The procedure doesn't hurt, though the machine makes rhythmic thumping noises and some people feel claustrophobic inside the MRI tube.
Half-a-dozen major studies of women at high risk of breast cancer have shown that MRI identifies at least twice as many potential tumors as a conventional mammogram, which produces a two-dimensional X-ray or digital picture. The best quality MRI images are produced in MRIs designed specifically for breasts, where the woman lies face down on the bed, placing her breasts in a cut-out area.
Q. What are the drawbacks of an MRI scan?
A. MRI's generate far more cancer "false alarms" than mammograms because many of the suspected tumors identified by MRI turn out to be healthy tissue. Doctors are twice as likely to request a tissue sample based on an MRI image compared to a mammogram, requiring a minor surgical procedure called a biopsy. But 60 to 80 percent of the time, the biopsied tissue is not cancerous.
In addition, MRI costs up to 10 times more than a mammogram and not all insurance policies cover the high-tech scans for women who show no signs of cancer. However, the level of insurance coverage is likely to increase now that the American Cancer Society has recommended routine MRI screening for high-risk women.
Q. Who should get an annual MRI scan?
A. Women who face a very high risk of cancer -- defined as a lifetime breast cancer risk of at least 20 percent -- should get annual MRIs, according to the Cancer Society guidelines. That includes women who know they carry one of the so-called "breast cancer genes" -- mutations of BRCA1 and BRCA2 -- as well as close relatives who have not yet been tested. In addition, women with a strong family history of breast or ovarian cancer should get an MRI if they score above a 20 percent cancer risk using a statistical model called BRCAPRO.
The Cancer Society also calls for annual MRIs for women who suffer from several rare disorders as well as women who were treated with radiation to the chest -- usually for Hodgkin's Disease -- between the ages of 10 and 30. More details about the guidelines can be found on the Cancer Society's web site.
Finally, women who have been recently diagnosed with breast cancer should immediately get an MRI scan of the other breast to be sure there are no other tumors, according to a separate study in the New England Journal of Medicine this week.
Q. How can I estimate my lifetime cancer risk?
A. Unfortunately, calculating the risk of cancer is not easy -- and a woman should not automatically conclude that she faces a heightened risk of cancer even if her mother suffered from the disease. Doctors need a complete family medical history and a computer model to calculate lifetime risk, taking into consideration the number of relatives who suffered ovarian or breast cancer and the age at which they were diagnosed.
And the results can be surprising:
For example, a 35-year-old woman whose mother had breast cancer at 51 and whose maternal aunt was diagnosed with the disease at 60 faces only a 13 percent lifetime risk of breast cancer, which is not high considering that 12.7 percent of all women will develop breast cancer at some point in their lives.
By comparison, a 35-year-old woman whose paternal aunt developed both breast and ovarian cancer by age 49 and whose paternal grandmother had breast cancer at 35 faces a lifetime cancer risk of 23 percent. Based on the Cancer Society guidelines, she should get an annual MRI in addition to a mammogram.
The National Cancer Institute has developed a risk calculator . However, Cancer Society officials say women should contact their doctors to discuss the results.
Q. If I get an MRI, can I skip my mammogram?
A. No. Even though MRIs detect more tumors, radiologists regard mammograms as valuable tools that can spot some types of breast cancer better than MRIs. A British study in 2005 found that X-ray mammograms alone spotted 40 percent of the known tumors in high-risk women compared to 77 percent detected by MRI. When the two methods were combined, the researchers picked up 92 percent of the tumors.
Q. What about women whose lifetime cancer risk is less than 20 percent?
A. The Cancer Society panel concluded there isn't enough evidence to recommend MRIs for women whose cancer risk is only somewhat elevated, estimated at 15 to 20 percent lifetime risk. That would include women whose breast tissue is especially dense, making tumors harder to see on M-ray mammograms, as well as women who have experienced some forms of breast cancer, such as ductal carcinoma in situ, which is non-invasive and highly treatable. However, Cancer Society officials say that doctors may still want an MRI for some women in this group based on individual medical issues.
The Cancer Society urges all women to get annual mammograms from the time they are 40 and to perform regular self-exams because breast cancer is easiest to cure when it's detected early.
SOURCES: American Cancer Society, National Cancer Institute, New England Journal of Medicine.
Posted by Karen Weintraub at 06:29 PM
March 28, 2007
By Stephen Smith, Globe Staff
A veteran Boston Globe editor and reporter will become a communications consultant for the Boston Public Health Commission, the agency announced today.
Ann Scales, whose duties in her dozen years at The Globe ranged from covering the White House to helping create the paper's Thursday Style section, will assume her new post April 9. Scales was among 24 Globe newsroom staffers who accepted a recent buy-out.
Posted by Karen Weintraub at 05:56 PM
March 28, 2007
By Liz Kowalczyk, Globe Staff
The state's largest health insurer has awarded Beth Israel Deaconess Medical Center a $100,000 prize for its "groundbreaking approach to reducing medical errors" after the death of a newborn in 2000.
The hospital's department of obstetrics and gynecology is the first recipient of Blue Cross and Blue Shield of Massachusetts' Health Care Excellence Award, which will be presented to physicians at a health care conference in Boston on Monday.
Blue Cross president Cleve Killingsworth said in a statement that the hospital "successfully changed its culture and achieved significant results" through an initiative that borrowed team work and communication improvements from military and commercial aviation. More than 40 hospitals and other health care organizations competed for the award.
In August 2005, Dr. Benjamin Sachs, chief of obstetrics and gynecology at Beth Israel Deaconess, described numerous judgment errors and miscommunications in the baby's case in an article in the Journal of the American Medical Association. His report highlighted how medical mistakes occur, often because of an accumulation of smaller miscues, and the changes his department adopted in the aftermath.
The case, which occurred in November 2000, became a "burning platform," he wrote, resulting in "a major reorganization of the way care is provided." The hospital used "crew resource management" techniques to train the staff in teamwork and conflict resolution, and limited obstetricians' workloads. The obstetrics department also made major changes in the way it monitored patients. Rather than doctors and nurses knowing the medical situations only of patients directly under their care, the entire department now is knowledgeable about all patients.
Since then, fewer mothers and their babies have suffered complications during childbirth, and legal claims also have declined, though it's not certain that the changes caused the drop. Between 1999 and 2005, the department experienced a 35 percent reduction in "adverse events" among patients and a 50 percent decline among high-risk patients, Sachs said.
The mother in the 2000 case, referred to in the article as Mrs. W, suffered massive blood loss, required an emergency hysterectomy, and spent three weeks in the hospital. In the article, Sachs apologized to the family, taking the unusual step of admitting mistakes and apologizing for them in a public forum.
The $100,000 award will pay for obstetrics nurses to attend a national patient safety conference in May, development of an online continuing medical education course in crew resource management, and research in patient safety.
Posted by Gideon Gil at 05:49 PM
March 28, 2007
By Elizabeth Cooney, Globe Correspondent
Women who donate eggs for use in stem cell research become part of two debates: One concerns the use of embryos restricted by federal rules and rejected by some on religious grounds; and the other centers on whether women should be paid, as they are when they provide eggs for use in in vitro fertilization.
Debora Spar, a professor of business administration at Harvard Business School, contends that the debate shouldn't be about paying women for egg donation -- sometimes up to $50,000 -- but rather should focus on the health risks for the women.
Writing in tomorrow's New England Journal of Medicine, she asks whether women can give fully informed consent when there are few long-term studies of the drugs they are given to stimulate egg production and no federal guidelines governing egg donation, or collecting data about it, as there are for organ donation and other medical procedures.
"Certainly, egg donors deserve at least the same levels of information and protection," she writes. "We need to consider the health risks and ways of identifying and mitigating them."
On the question of payment, Spar said in an interview that she applies market principles to egg donation, as she did for reproductive medicine in her book "The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception."
That's more useful than making policies based on emotional, ideological or religious grounds, she said.
"Paying women money to give eggs for one purpose and not the other when the processes are absolutely identical is bad public policy," she said. "I don't have a personal agenda or any skin in the game. The practical side of me is saying this is nuts. This is not a policy that makes sense."
In the NEJM perspective piece she says the issue of payment will have to be resolved to ensure a supply of eggs for stem cell research, based on what has happened in countries that restrict payment for eggs.
"At a minimum we have to clarify the situation," she said. "We need a fresh debate on egg donation and a new set of policies."
Judy Norsigian, executive director of Our Bodies Ourselves and a women's health advocate, said in an interview that the benefits to science are too few and premature to be justified by risks known and unknown to women donating eggs.
"Hopefully, this new attention to the risks of egg extraction will result in research that should have been done long ago and that will enable women to provide true informed consent regardless of the reason they will be providing eggs," she said.
Posted by Elizabeth Cooney at 05:00 PM
March 28, 2007
People addicted to opioids such as methadone or oxycodone can be treated in their primary care doctor's office as safely and effectively as at specialized clinics, authors from Cambridge Health Alliance and Harvard Medical School report in the Annals of Family Medicine.
Dr. Ira L. Mintzer and his colleagues studied 99 patients who received the drug buprenorphine-naloxone to treat their opioid dependence at two urban primary care practices: one in a hospital clinic and the other in a neighborhood health center. After six months 54 percent of patients were sober.
Where the patients received their treatment made no significant difference in sobriety, the authors said.
"We hope that our findings will encourage other primary care physicians to consider providing this efficacious form of care," they wrote.
Posted by Elizabeth Cooney at 02:43 PM
March 28, 2007
By Liz Kowalczyk, Globe Staff
Mount Auburn Hospital in Cambridge this week began posting the percentage of its patients who get hospital acquired infections.
The hospital is in part responding to the challenge issued by Paul Levy, chief executive of Beth Israel Deaconess Medical Center, who began publicizing his hospital's infection rates on his blog, Running a Hospital, last year and requested other hospitals to do the same.
Jeanette Clough, Mount Auburn's chief executive, said "transparency can be a double-edged sword. But it's a good thing.''
The hospital is posting its performance on blood stream infections caused by the placement of intravenous tubing, and on ventilator associated pneumonia for both medical and surgical patients. In all four areas, the hospital does better than the national average, although Mount Auburn's performance has fluctuated over time.
Posted by Karen Weintraub at 11:08 AM
March 28, 2007
On WBUR's CommonHealth, Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, lists winners and losers in the first year of the state's new healthcare law.
His winners: health insurance firms, very poor citizens, hospitals that serve few of the uninsured and "politicians who are posing as innovative leaders."
His losers: uninsured immigrants, safety net hospitals and clinics, low-income patients, and "the American public who are once again being taken down a health reform blind alley."
Posted by Elizabeth Cooney at 09:32 AM
March 28, 2007
Women who face a high risk of breast cancer should undergo annual magnetic resonance imaging to detect the disease in addition to conventional mammograms, the American Cancer Society will announce today, marking the first time that leading radiologists have advocated the routine use of MRI scans as a screening test.
A report set to be released today will urge the state to do more to protect children, in part by providing medical expertise to social workers investigating cases of abuse and neglect, according to sources who have seen the report about the embattled Department of Social Services.
The Army's new acting surgeon general said yesterday that she is concerned about long-term morale because the military lacks money to hire enough nurses and mental health specialists to treat thousands of troops coming home from Iraq and Afghanistan.
Health plans offered by professional associations, a major source of health insurance for people who work for themselves, have all but disappeared, casting thousands of contractors, freelancers, and solo practitioners into the ranks of the uninsured, with little hope of obtaining new coverage.
Posted by Elizabeth Cooney at 06:24 AM
March 27, 2007
By Elizabeth Cooney, Globe Correspondent
Presidential spokesman Tony Snow's colon cancer has returned and spread to his liver, news that comes less than a week after Elizabeth Edwards, wife of presidential candidate John Edwards, revealed her breast cancer has come back in her bones.
Two Boston oncologists, speaking only in general terms, said medicine has more to offer patients with metastatic cancer -- cancer that spreads -- today than before, but that may not be enough.
"In the past 10 years we've really gotten better at this. There are more effective drugs that allow patients to live longer and better with colon cancer than 10 years ago," said Dr. Charles Fuchs, a medical oncologist who specializes in treating gastrointestinal cancer at the Dana-Farber Cancer Institute. "I would emphasize that what we have is not adequate. It's not where we want to be, but we're able to allow patients to live longer."
Snow had surgery in 2005 to remove his entire colon, followed by six months of chemotherapy. A growth that was first spotted in his lower right pelvic area last year was removed yesterday and found to be cancerous. Cancer was also in his liver.
Patients whose cancer has spread from the colon to their lymph nodes have a 35 percent to 40 percent chance of it recurring, despite the surgery and chemotherapy, Fuchs said. That recurrence typically happens within three years and the liver is the most common organ to which colon cancer migrates.
Some patients who have cancer that is confined to one portion of their liver might have chemotherapy to shrink it so it can be removed by a surgeon.
"Regrettably that tends to be only a subset of patients," he said.
For patients with metastatic, or stage IV, colon cancer, the average survival is about two years. That compares to 10 months' survival average from 10 years ago, Fuchs said.
"Clearly that is not sufficient, but we are making some measure of progress with some of the newer drugs we are now testing," he said.
For metastatic breast cancer, newer treatments make it difficult to predict survival rates, said Dr. Ann H. Partridge, a medical oncologist at Dana-Farber who focuses on breast cancer. Average survival rates are five years, but that's based on old data that don't reflect current therapies that allow improvements in both quality and quantity of life.
"Some women live a very long time -- decades -- with metastatic breast cancer and some women die within the first few months," she said. "Those two extremes are extraordinarily rare. Most women are somewhere in between."
Elizabeth Edwards said Sunday she had a "hot spot" of metastatic cancer in her hip bone as well as one rib. Breast cancer commonly spreads to more than one place in a woman's bones, Partridge said. For a woman with her type of cancer, surviving 10 years would be "possible but not probable," she said.
"But never say never," she said. "I say to women, 'I can give you an average but you are a single individual, and for you it's all or nothing. Your cancer either gets better or worse or stays the same. Our goal is to control it to stay the same or get better.' "
Posted by Elizabeth Cooney at 03:29 PM
March 27, 2007
Scientists at the University of Massachusetts Medical School are exploring a way to wipe out viruses by luring them to their destruction, like mice to mousetraps.
The mousetraps in this case are red blood cells. If a virus ends up inside a red blood cell, there are no genes it can hijack to replicate itself.
"It occurred to us that if a virus bound to a red blood cell, that was a dead end," Dr. Robert W. Finberg says in a story in today's New York Times.
Posted by Elizabeth Cooney at 09:18 AM
March 27, 2007
Caesarean sections performed without a medical reason result in longer hospital stays, higher costs and more than twice as many rehospitalizations as vaginal deliveries, according to a study by researchers at Boston University's School of Public Health published in the March issue of Obstetrics and Gynecology.
"There are trade-offs in having an elective caesarean," Eugene R. Declercq, the study’s lead author, told the New York Times. "Among them are longer recovery time and a higher chance of being rehospitalized, which shouldn’t be surprising — it’s major surgery. "
Posted by Elizabeth Cooney at 09:06 AM
March 27, 2007
At Tufts University, a multidisciplinary team led by Barry Trimmer is trying to make an ersatz caterpillar that will move around in pretty much the same way as the real thing, a story in today's New York Times reports.
The researchers at The Biomimetic Technologies for Soft-bodied Robots project see the potential to use the squishable, relatively simple creations to find land mines, repair machinery in hard-to-reach spots and even diagnose and treat diseases.
Posted by Elizabeth Cooney at 08:52 AM
March 27, 2007
Local food inspection departments are dangerously understaffed and underfunded, with the state Department of Public Health doing little to solve a problem that specialists say could have catastrophic consequences, according to a report released yesterday by state Auditor A. Joseph DeNucci.
The hot new strategy of trying to prevent heart disease by raising good cholesterol had more setbacks yesterday as new studies indicated that experimental drugs didn't work and also had safety problems.
A top drug regulator told lawmakers yesterday it could be a decade or more before science is available to safely approve generic versions of biotech drugs in the way the agency approves knockoffs of traditional drugs.
The FDA needs to find a balance between expeditious approval of drugs or devices and the kind of rigorous scrutiny that will uncover -- preferably before approval -- the dangerous side effects of many new medications, a Globe editorial says.
As a surgeon, Pauline W. Chen deals with the critically ill. But it wasn't until she started writing about it that she learned how to deal with the emotions of it.
Posted by Elizabeth Cooney at 06:20 AM
March 26, 2007
By Carey Goldberg, Globe Staff
If today’s coroner’s report is correct, Anna Nicole Smith fell victim to what some researchers consider a growing epidemic of drug poisoning deaths, says Dr. James Wines, an overdose expert at Harvard’s McLean Hospital.
The latest figures show that in 2004, poisoning, which includes drug overdoses, claimed the lives of 30,000 Americans, according to the CDC, he said. Another 800,000 suffered through non-fatal poisonings.
Opioids, which include prescription painkillers, appear to be fueling some of the recent surge in deaths caused by legal drugs, Wines said.
The coroner's report said that Smith was taking several different sedatives and sleeping medications along with other drugs.
Researchers need to gain a better understanding of the circumstances surrounding drug-related deaths in order to prevent them, Wines said.
And consumers should be sure to check with their doctors and pharmacists about whether the various drugs they’re taking could be dangerous in combination.
Posted by Karen Weintraub at 06:56 PM
March 26, 2007
By Alice Dembner and Lisa Wangsness, Globe Staff
House Speaker Salvatore DiMasi made his position clear today on the issue of blanket waivers of penalties for people who can't afford health insurance: No dice.
DiMasi, one of the architects of the state's universal health insurance law, was addressing the next big issue that will be coming before the board overseeing implementation of the law.
"I think we should have a determination on a case by case basis," he told reporters today.
As written, the law requires every adult in Massachusetts to have insurance by July 1 -- or pay a penalty in 2008 -- unless insurance is unaffordable. The law gives the Commonwealth Health Insurance Connector the authority to define what affordable means, and the board is scheduled to debate that next month.
Some advocates have asked the board to waive penalties for everyone who makes less than $49,000 a year.
Asked about that idea today, DiMasi said, "For a class of people, I don't think it should be necessary."
Posted by Karen Weintraub at 06:54 PM
March 26, 2007
Women who regularly took low doses of aspirin had a lower risk of death from all causes, but particularly heart disease and cancer, Harvard researchers report in today's Archives of Internal Medicine.
But it's still too soon to recommend aspirin for the general prevention of disease, the lead author said.
"Women should not take this study, or any study, thus far as a license to take aspirin without any supervision," Dr. Andrew T. Chan of Massachusetts General Hospital said in an interview. "Women need to discuss with their physicians whether it makes sense for them, get a sense of what their risk is for cancer or cardiovascular disease, and strategize with them how to prevent the risk of disease through other means."
Chan and his colleagues looked at 24 years of data from nearly 80,000 healthy women enrolled in the observational Nurses Health Study. Women who said they used aspirin had a 38 percent lower risk of dying from cardiovascular disease and a 12 percent lower risk of dying from cancer. Their overall risk of death was 25 percent lower than women who never took aspirin regularly.
The reduction in cardiovascular disease became apparent after five years and in cancer after 10 years.
The findings conflict with another large study of women and aspirin use called the Women's Health Study. That clinical trial, in which 40,000 women randomly received aspirin or placebo, concluded that aspirin had no effect on mortality, from cardiovascular disease or other causes.
In an editorial, Dr. John A. Baron of Dartmouth Medical School says the nurses study may not have been able to account for the differences between aspirin users and non-users, suggesting women who decide to take aspirin may have better health in the first place.
"These new findings by Chan et al cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women," he wrote.
Chan responded that he and his co-authors were able to account for health differences among the women in the nurses study because they had detailed information on risk factors. They found that women who were older and had more risk factors for cardiovascular disease were the ones who benefited the most from low to moderate aspirin use, defined as 1 to 14 325-milligram tablets per week.
Higher doses of aspirin have been linked in many studies to gastrointestinal bleeding, the authors noted.
The authors say their study confirms the importance of common mechanisms in both cancer and heart disease, such as inflammation. Aspirin is an anti-inflammatory and inflammation has been implicated in the formation of plaque that blocks arteries as well as in the transformation of normal tissue into cancer.
Proven ways to lower risk of disease are eating a healthy diet, maintaining a good body weight and exercising, Chan said.
"We know those modifications don't have risks," he said.
Posted by Elizabeth Cooney at 04:21 PM
March 26, 2007
By Stephen Smith and Liz Kowalczyk, Globe Staff
Patients with clogged arteries who have not yet had a heart attack benefit just as much from medications as angioplasty, according to a study released today.
Specialists representing different camps in cardiology have long argued about the best way to handle patients who have potentially life-threatening narrowing of arteries. Decisions about how to treat heart disease, the nation's number one killer, have significant ramifications, medically and economically.
A large team of researchers from across North America, who presented their findings today at the American College of Cardiology's annual meeting in New Orleans, studied nearly 2,300 patients suffering coronary artery disease.
"The results are very striking," said Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. "This is important for patients because it does now mean patients have choices. If your symptoms aren't so severe and aren't interfering with your lifestyle, you can afford to wait."
Half of the patients took medication and underwent angioplasty, a procedure that involves using a tiny balloon and metal scaffolds called stents to prop open arteries. The other half received only medication, including drugs to lower cholesterol, relax blood vessels, slow heart rate, and prevent blood clots.
After tracking the patients for an average of four-and-a-half years, in a trial nicknamed COURAGE, the team, including some scientists from Connecticut, found that there was no difference in outcomes between the groups.
The study should help patients and doctors make sure they're using angioplasty for the right reasons, said Dr. William Maisel, a cardiologist at Beth Israel Deaconess Medical Center.
"To place a stent to reduce the chances of a heart attack or to prevent someone from dying, those are not reasons to put in a stent," Maisel said.
The study, to be published in the New England Journal of Medicine, found that among patients experiencing angina -- chest pain that occurs when the heart muscle doesn’t get enough blood -- angioplasty provided more relief than drugs.
The report does not address how well angioplasty helps heart attack patients. Nissen said that angioplasty remains the treatment of choice for patients with a fully blocked artery, and that campaigns are underway to make sure patients having heart attacks are taken to hospitals that can swiftly perform the procedure.
"COURAGE helps us understand we may well have gone too far with angioplasty and that we may have abandoned bypass surgery too quickly," said Nissen, who was not involved in the study. Bypass surgery, in which a surgeon reroutes, or "bypasses," blood around clogged arteries, is more complicated and has a longer recovery time than angioplasty.
In Boston, because of the conservatism of local doctors, the rate of angioplasty is lower than it is nationally, according to Dr. Frederic S. Resnic, director of the cardiac catheterization laboratory at Brigham and Women's Hospital.
At the Brigham, he wrote in an e-mail, "We have always been very careful to have detailed discussions with our patients with stable coronary artery disease, to make sure that they are comfortable and understand that we are considering the procedure to relieve the
symptoms of angina, and reduce the number and amount of medications needed.
"We have also been careful to say that angioplasty has not been shown to reduce heart attacks or prolong life in these very stable patients," he wrote. "Angioplasty for stable patients is really an effective option for relieving symptoms quite completely; but should not be "sold" to patients as a life-saving procedure."
Posted by Karen Weintraub at 02:02 PM
March 26, 2007
Massachusetts continues to decline as a place to practice medicine, the Massachusetts Medical Society reports today. The deteriorating environment has led to a shortage of physicians and reduced access to care that are a cause for concern as the state implements its new healthcare law, the group warns.
The findings are based on an index the MMS compiles about the overall practice climate for physicians, including such measures as liability costs and the number of physician employment ads in the New England Journal of Medicine. It's the 13th straight year of decline.
Low reimbursements for services, administrative hurdles such as pre-authorizations for imaging tests and prescription drugs, and increasing costs of operating a practice were cited as problems local doctors face.
Posted by Elizabeth Cooney at 01:09 PM
March 26, 2007
Researchers at Beth Israel Deaconess Medical Center and Harvard Medical School are reporting preliminary success with a new way to screen for breast cancer that one day might supplement mammography, according to the American Chemical Society.
Crystals resembling those in human breast cancer.
Dr. John Frangioni and researchers in his lab have developed a way to make a contrast agent that after being injected into the bloodstream binds to a particular calcium salt called hydroxyapatite.
That salt is found in malignant micro-calcifications in the breast, but not in benign ones, according to an ACS statement. The contrast agents are designed to be used with optical tomography, an imaging method that sends near-infrared light through the body. Frangioni said it would likely be a few years before the compound is tested in human trials.
Kumar R. Bhushan, a postdoctoral fellow in Frangioni's lab, is scheduled to present the details today at the ACS meeting in Chicago.
Posted by Elizabeth Cooney at 11:20 AM
March 26, 2007
A review by the Department of Veterans Affairs in the wake of the scandal at the Walter Reed Army Medical Center has cited scores of substandard conditions in its New England hospitals and clinics, including the presence of rodents and bugs, chronic leaks, and dilapidated furniture.
In the mid-1990s, two Boston doctors treating dying patients in Peru couldn't find enough of long-forgotten but effective tuberculosis drugs. They turned to Howard Hiatt, a former dean of Harvard's School of Public Health, who called a contact inside Eli Lilly and Co. That triggered a pledge by Eli Lilly in 2003 to spend $70 million to fight multidrug-resistant tuberculosis. On Thursday, the company announced it would expand that commitment by $50 million more.
A Mediterranean-style diet high in olive oil and other "healthy" fats is just as good as the classic American Heart Association low-fat diet for the 8 million Americans who have suffered a heart attack and want to prevent a repeat, new research suggests.
African-Americans and terminally ill patients from other minority groups seek hospice services in fewer numbers than whites -- even though they could be closer to family and home, with fewer medical interventions, if they chose to die under hospice care.
Abbott Laboratories' experimental heart stents may threaten the market dominance of Boston Scientific Corp. and Johnson & Johnson, based on positive results from two studies released Saturday.
An experimental drug is the first to substantially and safely improve shortness of breath and other symptoms in people hospitalized with severe heart failure, an epidemic that is growing as baby boomers age, doctors reported yesterday.
A commitment to rebuilding the National Institutes of Health's funding -- and the inventive laboratories all over the country the NIH finances -- should be a priority for the new Congress in this year's budget and in years to come, a Globe editorial says.
Posted by Elizabeth Cooney at 06:26 AM
March 26, 2007
It takes patience, sacrifice, and lots of food to figure out whether something is really good for you, volunteers learn when they plunge into the world of diet and nutrition research at Tufts University, bellying up to the table in the name of science.
It's long been the Catch-22 of in-vitro fertilization: The chances of a successful pregnancy increase with the number of embryos implanted, but so does the likelihood of multiple pregnancies, which are riskier for both mother and offspring. Now a new study and a growing body of research suggest that, ultimately, implanting only one embryo is just as likely to lead to pregnancy.
Last week, Harvard's Initiative in Innovative Computing unveiled a modified version of 3D Slicer, a computer program developed to allow surgeons to explore an image of the body -- zooming in, rotating, and moving around as needed to see the terrain. The modified version lets researchers do the same thing with astronomical data, exploring space for interesting surprises.
Also in Health|Science: meeting mathematician David Vogan and shopping for a breast cancer surgeon.
Posted by Elizabeth Cooney at 06:23 AM
March 26, 2007
Receiving care in a Massachusetts hospital emergency room takes two-and-a-half to three hours on average. But patients typically spend four to five hours in the ERs of several large Boston teaching hospitals before being discharged. And for more than 80,000 people during one year, their visit took upward of eight hours, according to a report commissioned by the Globe.
When the new health insurance rules kick in this summer, some people will get better medical care. Others tell the Globe the coverage will come at too high a price.
Dr. Nathaniel Sims, an anesthesiologist at Massachusetts General Hospital, and his 10 patents for medical devices fit the model of user-innovator described by Eric von Hippel, a professor at the Massachusetts Institute of Technology’s Sloan School of Management in a Saturday New York Times story.
Dr. Dennis Choi, a professor of pharmacology and experimental therapeutics at Boston University, was one of four finalists to become dean of University of Florida's School of Medicine. The school chose Dr. Bruce Kone, chairman of the department of internal medicine at the University of Texas Medical School in Houston, according to Saturday's Gainesville Sun.
Posted by Elizabeth Cooney at 06:00 AM
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