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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Boston Globe Health and Science staff:
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 Short White Coat blogger Ishani Ganguli
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« April 01, 2007 - April 07, 2007 | Main | April 15, 2007 - April 21, 2007 »

April 13, 2007

This week in PLoS and JCI

gene screen.jpgHarvard researchers including Dr. Todd R. Golub report in PLoS Medicine, the online Public Library of Science journal, that, using a molecular biology technique called microarray expression profiling (an example of a detail is at left), they were able to identify compounds that could target genes involved in Ewing sarcoma, the second most common childhood cancer of bone and soft tissue.

In the Journal of Clinical Investigation, Dr. Alan D'Andrea and colleagues at Dana-Farber Cancer Institute show a new therapeutic target for the treatment of Fanconi anemia, which carries the risk of cancer and bone-marrow failure.

Also in the Journal of Clinical Investigation, Dr. Rong Tian and colleagues from Brigham and Women's Hospital report that in mice, mutations in a protein that triggers cells to generate more energy are associated with heart failure.

Posted by Elizabeth Cooney at 11:02 AM
April 13, 2007

On the blogs: healthcare law link, falls on the way home

A Healthy Blog points the way to a new website launched with the Massachusetts Hospital Association and the Massachusetts League of Community Health Centers to provide information and outreach materials about the state's new healthcare law.

On Running a Hospital, Beth Israel CEO Paul Levy reveals an interesting pattern that a hospital staffer noticed about patients who fall at the end of their stays, when they sitting on the edge of their hospital beds, dressed to go home.

"We think that our staff members were receiving a subliminal message: They would see a healthy, dressed person in the room and might not have paid the same degree of attention to the patient as they would have an hour earlier when he or she might have been sitting on the edge of the bed in a hospital gown," he wrote. "Slight dizziness or instability of this person would then lead to the fall."

Posted by Elizabeth Cooney at 10:09 AM
April 13, 2007

Today's Globe: "stuck kids," drug-resistant gonorrhea, disabled veterans, monkey gene map, obesity-risk gene, Arcoxia

The state's mental health system for children is clogged with some of its worst backups in years, leading to long emergency room waits and a record number of "stuck kids" who are deemed well enough to leave hospital units but have nowhere to go.

Antibiotic-resistant gonorrhea is spreading rapidly across the United States, federal health officials reported yesterday, raising alarm about doctors' ability to treat the common sexually transmitted infection.

The Army might be shortchanging injured soldiers by rating the severity of their disabilities with a system that is both unwieldy and inconsistent, the head of a special commission said yesterday.

Scientists have unraveled the DNA of another of our primate relatives, this time a monkey named the rhesus macaque -- and the work has far more immediate impact than just to study evolution.

British researchers have produced the first clear evidence for a gene common in the population that dictates why some people gain excess weight while others do not.

Merck & Co.'s experimental arthritis drug Arcoxia shouldn't be allowed on the US market, a Food and Drug Administration advisory panel said, citing some of the same risks that led to the withdrawal of the similar treatment Vioxx.

Posted by Elizabeth Cooney at 06:17 AM
April 12, 2007

UMass Amherst brings back public health bachelor's

By James Vaznis, Globe Staff

The University of Massachusetts at Amherst will bring back its undergraduate degree in public health sciences this fall.

The degree should help meet a growing demand for public health workers to respond to pandemics, bio-terrorism, and other public health crisis. The university dropped the degree in 1989 to focus on its graduate programs in public health.

The state Board of Higher Education is expected to approve the program at its meeting next week. UMass already has started to admit students.

Brandeis University is the only other Massachusetts college that offers an undergraduate major in public health, according to the state board.


Posted by Karen Weintraub at 03:24 PM
April 12, 2007

Harvard team identifies protein from a dinosaur

By Colin Nickerson, Globe Staff

Scientists at Harvard Medical School have for the first time isolated and identified protein from a dinosaur -- a Tyrannosaurus rex that perished in Montana 68 million years ago and was partly preserved under tons of sandstone. Some of the protein identified in the Cretaceous era predator match that of modern-day chickens, the research revealed.

The findings, being published tomorrow in the journal Science, upset the long-held assumption that protein and other basic materials of life could not possibly survive in detectable amounts for more than a few hundred thousand years. They also raise the possibility that scientists might eventually recover DNA from prehistoric beasts, allowing for even more sophisticated analyses of ancient organisms and the processes of evolution.

"People are going to be looking differently at prehistoric bones because now we see they may carry tissue and information that nobody believed could still exist," said Mary H. Schweitzer, a paleontologist at North Carolina State University and a coauthor of both articles.

In all, scientists at Harvard were able to isolate seven tiny strips of collagen protein from soft tissue found in the thigh bone of a Tyrannosaurus rex recovered earlier in the decade from beneath 60 feet of sandstone ledge in Montana's Hell Creek formation.

"At the very least, this breakthrough shows we can look at [protein] sequences that are many, many millions of years old," said John M. Asara, director of the mass spectrometry core facility at Beth Israel Deaconess Medical Center and one of the authors. "That's a first."

Paleontologists not involved in the the T.rex protein research said it represented an astonishing piece of scientific sleuthwork.

"This research might be creating a whole new field of molecular paleontology," said Lawrence M. Witmer, a paleontologist at Ohio University. "This research has opened a door we didn't even suspect was there."

But some scientists doubted whether the experiment will have much practical effect on the study of prehistoric life. Many seemed to believe that the surviving soft tissue found in the Montana T. rex was a fluke -- and that there will never be enough material for the sort of fullbore scientific scrutiny that would allow large conclusions to be drawn about the animals.

"If there were regular opportunities for this kind of matching and comparison, [these] techniques might add important evidence to genuine conundrums -- outstanding questions about the origin and relationships of various vertebrate groups," said Farish A. Jenkins Jr., a Harvard professor of zoology and internationally-recognized expert in vertebrate paleontology. "But the reality remains that finding soft tissues preserved with actual soft tissue structure intact is outside the realm of common expectation, so the applicability of their techniques is very limited."

Similar skepticism was expressed by Mark A. Norell, a paleontologist with the American Museum of Natural History: "This is a very cool experiment. But I don't think curators are going to start grinding up their fossil bones to obtain the really minuscule bits of protein that might be available. There probably just isn't going to be enough of this material" to conduct major research.

"Science requires replication," he said. "You need thousands of comparisons. Not dozens."

Still, buzz surrounded the the mind-boggling findings that protein dating back tens of millions of years can be identified at all. Until now, the oldest positively-identified proteins were recovered from the bones of a wooly mammoth reckoned to be a couple hundred thousand years old, according to Schweitzer. DNA has been taken from the 38,000 year-old bones of a Neanderthal, believed to be a prehistoric relative of modern humans.

Several of the T. rex protein snippets captured at Harvard matched sequences in modern chickens, which the authors of the Science articles say lends more credence to the increasingly accepted view among paleontologists that birds are descended from dinosaurs. "We've added molecular evidence to evidence based on the architecture of bones," said Asara.

The research marked an unusual collaboration between field paleontologists -- famous for rough expeditions to remote places in search of rare fossils -- and medical researchers more familiar with finicky lab equipment and computer readouts than sharp pickaxes, smelly sleeping bags, and battered sifting trays.

Lewis Cantley, professor of systems biology at Harvard Medical School and one of the authors, said the techniques used in sequencing the dinosaur protein from minuscule amounts of material could be useful for researchers who need to find the tiny molecular changes that lead to cancer. "We're creating a cross-discipline of biomedical researchers and paleontologists."

The T. rex femur at the center of the research was found in 2003 by John Horner, a paleontologist with Montana's Museum of the Rockies and reknowned fossil hunter. Schweitzer, analyzing the bone, found evidence that the big bone still contained actual bone and vascular tissue. In most preserved dinosaur remains, minerals have replaced all organic matter, the process known as fossilization.

Scientists were quick to discount any suggestion that the sequencing of protein from a T. rex might represent a toddling first step toward cloning dinousaurs, as in Michael Crichton's novel Jurassic Park and the movies that followed. Cloning would require DNA, which deteriorates more rapidly than protein. Collagen, the sort isolated from the t. rex, is a notably durable protein.

"The idea of cloning prehistoric animals from genetic materials remains science fiction," said Ohio University's Witmer. "But keep in mind, until very, very recently, just the idea of obtaining any genetic material at all from animals so old was dismissed as pure science fiction."

April 12, 2007

On the blogs: race at MIT, infection rates, what not to wear

sherley150.bmpOn Nature Network Boston, Corie Lok asks why there may be more attention paid to gender equity than racial equity at MIT, in light of the February hunger strike by African-American scientist James L. Sherley. Sherley (at right in photo) alleges racism in denial of tenure. Last week MIT named a faculty committee to study the issue of race in faculty hiring and promotion.

"It’s a shame that Sherley had to go to such extremes to get the university to seriously study the issue of race," she writes. "While there was an existing committee on faculty diversity at MIT, it wasn’t able to come together to do a comprehensive study on minority faculty the way women faculty did successfully in the 1990s."

On Running a Hospital, Paul Levy posts the latest central line infection rates for Beth Israel Deaconess Medical Center, measured in cases per thousand ICU patient days.

"The average over the last several months remains better than for the previous year, but the rate for February comes from two actual cases, worse than January and with 100 fewer patient days," he writes. "We treat them as sentinel events and try to learn what went wrong and why."

Kevin, M.D., links to an American College of Physicians story about how physicians dress.

"A patient suing over a post-surgical error said that she knew her surgeon wasn't focused on her because he came to her room in jeans, a T-shirt and athletic shoes," the story said.

Posted by Elizabeth Cooney at 10:49 AM
April 12, 2007

Board approves exemptions to health insurance law

By Alice Dembner, Globe Staff

A state board voted unanimously this morning to allow about 20 percent of the state’s uninsured adults to avoid buying insurance. A law requiring coverage for everyone who is not specifically exempted takes effect July 1.

The Commonwealth Health Insurance Connector board decided that even the lowest-cost insurance would not be affordable for about 68,000 individuals with low and moderate incomes.

The board also extended free coverage to individuals earning up to about $15,000 a year and families of 4 earning up to $31,000, and reduced the cost of insurance by $5 a month for those earning between $15,000 and $20,000 who are eligible for Commonwealth Care.

Board members yesterday said the moves were a compromise, designed to provide affordable coverage for 99 percent of the state’s population, but also provide an exception for those who would be truly burdened by the monthly premiums. People who are exempt will continue to be able to get emergency care through the state’s free care pool.

A person would be automatically exempted for example, if he or she earned about $33,000 and can’t find coverage for less than $150 a month. A family earning would be exempt, for example, if it earned up to $70,000 and could not find insurance premiums for $320 or less.

Posted by Karen Weintraub at 10:23 AM
April 12, 2007

HHMI opens competition for 50 scientists and $600m

At at time when federal funding for scientific research is harder to come by, the Howard Hughes Medical Institute is opening up a competition today to select 50 new investigators who will share $600 million for biomedical research.

For the first time scientists can apply directly to become HHMI investigators rather than needing their institutions to nominate them.

The researchers must belong to eligible institutions. In Massachusetts, 10 qualify: Boston Biomedical Research Institute, Boston College, Boston University, Brandeis University, Harvard Medical School and associated hospitals, Harvard University, the Marine Biological Laboratory, MIT, Tufts University School of Medicine, and the University of Massachusetts Medical School.

The competition comes at a time when funding from the National Institutes of Health, which is based on individual grant proposals, is declining, when inflation is taken into account. Established researchers worry about sustaining their work while younger investigators are taking longer to win approval for their first grant applications.

HHMI, which has spent $8.3 billion over 20 years on biomedical research and science education, won’t be filling that gap, senior scientific officer Dr. Josephine Briggs said in an interview yesterday.

"Our resources are very sizable, but they do not in any way compensate for the problem of the shrinking NIH budget," she said. "The support that Hughes is able to offer is something that the scientific community will of course welcome with delight, but at the same time all of us hope we can see a reversal in the decline in federal funding."

HHMI holds competitions every three or four years. This time, it's looking for people in the earlier stages of their careers, Briggs said.

HHMI investigators receive initial five-year appointments that come with support for their own salaries as well as flexible budgets they can use to pay for personnel and some equipment. Appointments can be renewed.

To be eligible to apply, a candidate must hold a Ph.D., M.D. or equivalent degree; have a tenured or tenure-track position as assistant professor or higher at one of about 200 eligible host institutions; and be the principal investigator on one or more active, national, peer-reviewed research grants at least three years long, such as an NIH R01 award.

The deadline for applications is June 13; expert panels will convene to review them in January, and decisions will be made in March.

"The charge is that they be addressing fundamental and important biological questions. It can be for any discipline, and in this new competition we hope to see chemists, mathematicians, engineers and anybody who’s doing something truly special in addressing biological questions," Briggs said.

"We expect a very hefty Boston response."

Posted by Elizabeth Cooney at 08:10 AM
April 12, 2007

Today's Globe: Thompson cancer, stem cell vote, mentally retarded case, Winchester Hospital, Walter Reed neglect

thompson150.bmpPotential presidential candidate Fred Thompson, known to millions of "Law & Order" viewers as a gruff district attorney, disclosed yesterday that he was diagnosed with non-Hodgkin's lymphoma, a form of cancer, nearly three years ago.

A stubborn Senate voted yesterday to ease restrictions on federally funded embryonic stem cell research, ignoring President Bush's threat of a second veto on legislation designed to lead to new medical treatments.

A federal magistrate judge has found that the state has failed to provide adequate treatment and services for some 800 mentally retarded people in nursing homes, repeatedly violating a settlement agreement it made seven years ago to settle a class-action lawsuit.

Responding to residents' concerns, Winchester Hospital has scaled back a plan to build a new healthcare complex on Washington Street.

Money woes and Pentagon neglect are to blame for shoddy outpatient conditions and bureaucratic delays at Walter Reed Army Medical Center, an independent review has concluded.

Posted by Elizabeth Cooney at 05:58 AM
April 11, 2007

Public health expansion slashed in House proposal

By Stephen Smith, Globe Staff

The House Ways and Means Committee today dealt a serious setback to Governor Deval Patrick's proposal to significantly expand public health services, eliminating or scaling back several of the governor's key initiatives.

The House budget contains no money for cervical cancer vaccines for girls, while Patrick had proposed spending $12.5 million to inoculate about 42,000 11- and 12-year-olds.

"I'm disappointed," said John Auerbach, the state's new public health commissioner. "I believe that making the vaccine available would have been a valuable public health initiative, given the data that show that this vaccine can be very helpful in terms of preventing cancers."

The governor's call to substantially reinvigorate the state's decimated Tobacco Control Program was also dealt a blow: The House budget contains only $8.2 million for anti-smoking campaigns, compared with Patrick's request for $16.2 million.

The House plan was released on the same day that a national leader in tobacco-control efforts visited Beacon Hill to press his case for restoring the state's once-vaunted campaign to reduce the leading cause of preventable deaths. Matthew Myers, president of the Campaign for Tobacco-Free Kids, presented Patrick and state health officials with a report showing that sales of cigarettes increased in Massachusetts last year, even as they declined nationally.

"We're deeply disappointed that the House has done so little in the face of such strong evidence about an increase in sales," Myers said.

Overall, the House spending plan for public health programs falls $31.6 million short of Patrick's proposal, according to an analysis by the Massachusetts Public Health Association. The interest group review shows that the budget of the Department of Public Health would remain essentially flat under the House proposal.

Posted by Karen Weintraub at 06:08 PM
April 11, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

The air around the medical school quad was rife with the promise of autumn and movie stars last week.

Brightly colored leaves were plastic—taped to the branches of budding trees lining the quad and strewn on the surrounding grass last Tuesday for the filming of a scene in Columbia Pictures' "21." But besides Jim Sturgess, the star, the other actors in the movie (including Kevin Spacey, Laurence Fishburne, and Kate Bosworth) were nowhere to be stalked.

"21" is directed by Legally Blonde’s Robert Luketic and based on the best-selling book "Bringing Down the House: The Inside Story of Six MIT Students Who Took Vegas for Millions." It turns out one of the six gets into Harvard Med at the end of the movie, so the film crew arrived here before dawn to recreate an autumn scene.

Fake medical students were planted all around the quad lawn, standing beside their bicycles or chatting in clusters. Larger crowds of these movie extras followed around a beckoning crew member, back and forth ad infinitum, as the real students looked on.

The most striking feature of our movie selves was the nearly uniform attire: long woolen coats and sharply pressed khakis, offset by overstuffed backpacks. The professors were mainly of the elderly, bearded or mustachioed variety, not quite as diverse as we usually see on campus.

Not a bad impression overall, though many of us not-so-secretly wished we could have played ourselves. I’m excited to see the finished product and to find out just how close they come to capturing something of the medical school setting.

Not that it matters necessarily in Hollywood.

Posted by Ishani Ganguli at 05:27 PM
April 11, 2007

How two doctors think

070410_bc_howdrsthink.gifSlate's Book Club features a conversation between Dr. Jerome Groopman, professor of medicine at Harvard Medical School and author of "How Doctors Think," and Dr. Darshak Sanghavi, an assistant professor of pediatrics at the University of Massachusetts Medical School who met Groopman when he was a fellow at Children's Hospital Boston.

"Algorithms and treatment guidelines are based on prototypes," Groopman writes. "They are not substitutes for individual thinking. And they break down when cases are atypical or complex."

Sanghavi, an occasional contributor to the Globe, summarizes their different points of view:

"This ultimately returns to our disagreement about standardizing medical care," he writes. "You feel it often constricts good medical practice; I think we don't have enough of it."

Posted by Elizabeth Cooney at 02:07 PM
April 11, 2007

On the blogs: Defensive medicine, a matter of degrees

On Kevin, M.D., Dr. Kevin Pho, a Nashua primary care physician, wrestles with defensive medicine and how to keep it from driving health care costs higher and potentially harming patients.

"Defensive medicine is expensive, has no basis in evidence-based study, and exposes the patient to a host of complications," he writes. "Contrary to popular opinion, more medicine does not equal better medicine."

On Running a Hospital, Beth Israel Deaconess CEO Paul Levy tells a college student that law degrees are best for people planning to become lawyers, not hoping to get better educated, and master's degrees in public health are not appreciated as much as they should be.

"I don't believe it ought to be the case, but the degree is sometimes not valued in hospital settings," he writes. "I think it is because hospitals are dominated by doctors, who often view an MPH as a poor substitute for a medical degree and think people who get one were not smart enough to get into medical school."

Posted by Elizabeth Cooney at 10:00 AM
April 11, 2007

About 20 percent of uninsured would be exempted from state law

By Alice Dembner, Globe Staff

About 20 percent of uninsured adults would be exempted from meeting the state's new requirement that everyone have health insurance, under a proposal that will be voted on tomorrow by a state board.

The proposal, from the staff of the board overseeing implementation of the new universal health insurance law, estimates that even the lowest-cost insurance would not be affordable for about 68,000 individuals with low and moderate incomes.

In addition, the staff proposal would expand subsidies for the lowest-income families who qualify for a state-sponsored insurance program called Commonwealth Care.

This would extend free coverage to individuals earning up to about $15,000 a year and families of 4 earning up to $31,000. It would also reduce the cost of insurance by $5 a month for those earning between $15,000 and $20,000 who are eligible for Commonwealth Care.

The increased subsidies would cost the state about $13 million more than the $470 million estimated for the fiscal year that starts July 1.

"The proposal represents a reasonable way to determine generally whether insurance is affordable for most people," wrote Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector in a memo outlining the proposal to board members.

"If we do not find a way to oblige most individuals to participate, healthcare reform will fail to achieve its promise," he wrote. "However, we are walking a tightrope."

The proposal adopts some of the recommendations of a coalition of advocacy, labor and medical groups that had argued that applying the insurance mandate to people who couldn't afford it would undermine public support for the initiative.

But the statff proposal requires Massachusetts residents to pay a higher percentage of their income toward health insurance than that coalition suggested was affordable.

Under the law, all adults must have insurance by July 1 or pay a penalty. The penalty, initially about $200, will be imposed on those who do not have insurance by Dec. 31.

Individuals making about $33,000 a year would be required to comply with the law if they can find an insurance policy that meets state standards and that costs $150 a month or less, about 5.5 percent of their income, according to the staff proposal. The coalition had proposed that the limit be set a 4.5 percent of income and include not only premiums, but some out of pocket expenses.

The proposal also allows individuals to apply for hardship waivers of the law.

Posted by Karen Weintraub at 09:08 AM
April 11, 2007

Today's Globe: cigarette sales, stem cells for diabetes, BI residents heading west, healthcare law one year later

Cigarette sales in Massachusetts increased 3.2 percent last year even as usage continued to decline nationally, according to a report being released today that provides new evidence the state is losing ground in its battle against tobacco.

Researchers have demonstrated for the first time that the progression of Type-1 diabetes can be halted -- and possibly reversed -- by a stem cell transplant that preserves the body's diminishing ability to make insulin, according to a study published today in the Journal of the American Medical Association.

Some surgical residents at Beth Israel Deaconess Medical Center in Boston will be heading west to receive training at Saint Vincent Hospital in Worcester, under a new affiliation agreement, the hospitals said yesterday.

Last April 12, Massachusetts enacted an ambitious, complex law to expand affordable health insurance to most of the state's half-million uninsured. One year later, how is it going? John E. McDonough, executive director of Health Care For All, gives his answer in an opinion piece.

Posted by Elizabeth Cooney at 06:26 AM
April 10, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. Ishani's posts will appear here, as part of White Coat Notes.

Call it a testament to the media’s role in education, or total cluelessness on my part: I discovered today, when reading Liz Kowalczyk’s piece in the Globe on the white coat hierarchy and in a subsequent conversation with a fourth-year friend, that my classmates and I may be wearing the hip-length version of the white coat through our residency training and even as attending (senior) physicians. So much for the distinguishing mark of a medical student.

I will argue, however, that the true mark of a medical student can still be considered the wearing of said coat outside the hospital. Residents and even higher-up med students usually know better. While first-years are still enamored by the short-white look, my guess is that one wants to shed the garment as soon as possible after wearing it for twenty-four hours straight.

I got a welcoming e-mail today from Paul Levy, president and CEO of Beth Israel Deaconess Medical Center and, dare I say, a fellow blogger. After the initial shock that someone besides my mother -- and a health care honcho at that -- read my first entry, I was pleased to see today’s great equalizer, the blogosphere, at work.

I’d read about the "blogging community" before, but as a newly inducted member, I’m looking forward to more such interactions as well as conversations with readers. Please feel free to e-mail me at shortwhitecoat@gmail.com with ideas, concerns, or general musings on medical education.

Posted by Ishani Ganguli at 06:52 PM
April 10, 2007

Two new state health officials appointed

By Stephen Smith, Globe Staff

The former chief of the state's HIV/AIDS Bureau and a top United Way official were appointed assistant secretaries of health today by Dr. JudyAnn Bigby, Massachusetts's health secretary.

Jean McGuire, who was an assistant commissioner in the Department of Public Health from 1997 to 2003, is the new assistant secretary for disability policies and programs. McGuire presided over the AIDS division at the public health agency before leaving for a position at Northeastern University. Early in her career, McGuire's work focused on special education and rehabilitation of adults with significant disabilities.

Marilyn Anderson Chase will be assistant secretary for children, youth, and families. Chase spent 10 years as senior vice president for community impact at the United Way of Massachusetts Bay.

Posted by Karen Weintraub at 05:08 PM
April 10, 2007

Beth Israel rolls out in-house ambulance service

BIDMC_ambulance_4_07_low-rez--half.bmp

Beth Israel Deaconess Medical Center rolled out its own ambulance service today with two vehicles to transport patients between its east and west campuses and from its hospital in Needham to the downtown medical center. A $250,000 gift from Robert and Carol Mayer of Chestnut Hill will pay for launching the service.

Beth Israel sends patients on 6,000 trips a year, just between its two campuses along Brookline Avenue, in "often complicated and costly transfers," the hospital said.

Most of the transfers -- 93 percent -- are to move patients to beds and the rest are for procedures and tests, hospital spokesman Jerry Berger said. The cost comes to more than $1 million a year.

Ambulance staff will be trained by Beth Israel and Cataldo Ambulance, and a dispatcher will work in the hospital’s emergency department, Dr. Mark Zeidel, chair of medicine, said in a hospital statement.

Posted by Elizabeth Cooney at 04:42 PM
April 10, 2007

On the blogs: variations in end-of-life care, manipulating data

On Running a Hospital, Beth Israel Deaconess CEO Paul Levy considers whether the variation in how care is delivered, particularly near the end of life, reflects "overuse, underuse, misuse, and waste in the health care system." He cites a Dartmouth study that said the amount of resources spent didn't change the outcomes, then wonders what should be done. He's gotten 16 answers so far.

On Nature Network Boston, Corie Lok writes about scientific fraud, from ignoring data that don’t fit to falsifying images.

Posted by Elizabeth Cooney at 11:50 AM
April 10, 2007

Canadian medical grads lured to US

When Montrealer Dr. Glenn Saxe first got to Boston to begin his residency in psychiatry at Harvard Medical School, he thought he'd return home when his training was over, a story in today's Toronto Star says. But like so many of his Canadian counterparts – 12,040 Canadian-educated physicians live in the US – Saxe decided to stay once his training was complete.

"As I spent time in Boston and Harvard, there were more and more opportunities. More interesting and important research to get involved in," said Saxe, who is a specialist in post-traumatic stress disorder in children. "I met an American woman, married her and decided this was a place where I could really contribute."

One in nine Canadian-educated doctors who graduated last year is taking care of American patients, according to a new study in the Canadian Medical Association Journal.

Posted by Elizabeth Cooney at 08:56 AM
April 10, 2007

Short White Coat

Short White Coat is our new blog, written by first-year Harvard medical student Ishani Ganguli. A short white coat is the hip-length garment worn by medical students to signify their place in the medical hierarchy. Ishani's posts will appear here, as part of White Coat Notes. E-mail Ishani at shortwhitecoat@gmail.com.

ishani 2.JPG

Under the mandate of Harvard Medical School's recently unveiled New Integrated Curriculum, my professors draw connections with fresh gusto, whether it is between disciplines or from benches to bedsides.

For one such integrated experience during my physiology course, I accompanied classmates to the intensive care unit at Beth Israel Deaconess Medical Center one day last month. Eight of us gathered in a meeting room outside the unit so that our professor could tell us about the patient we would observe and discuss, in an attempt to heighten our textbook appreciation of the lungs and kidneys.

As he finished describing a 45-year-old woman's unrelenting multi-organ failure and led us into her room, I mentally prepared myself for the sight. It wasn't my first time in the ICU -- I had been exposed as a candy-striper in high school -— but it was the first time I could bring any real medical knowledge to bear in such a setting, and it was a daunting prospect.

The patient's face was pea green from liver failure; a labeled rectangle of scotch tape was affixed to her left cheek as if it were an inanimate object. I stared dumbly at her lying there, machines taking over for virtually every function of her organs. She seemed a bridge between the cadaver that first appalled, then hardly fazed me in anatomy class last fall, and the patient whose medical story I had solicited in a practice interview the week before.

Pausing little for reflection himself, my professor began to quiz the group on her heart function and prompted me and my classmates to do quick mental calculations of her breathing volumes. In these moments of first-year naivete, it was a glimpse into my third and fourth years in the clinics, and the ritual of being "pimped" by medical superiors -— that is, questioned on medical knowledge in front of patients and hospital staff. Wondering whether she could hear me in her comatose state, I swallowed my sense of futility and started to do the math.

I was connecting my textbook learning with the patient case in front of me, certainly. But I was also helpless to do anything with that connection to actually help her, and my presence in that room -— my integrated learning experience —- seemed an impediment to any hope she had to survive. Despite my rational understanding that I was being trained to treat future patients like her, I felt uneasy to be using her for pedagogic ends, and dreaded the thought of her loved ones walking into the room.

April 10, 2007

Today's Globe: white coats, defibrillator batteries

coats.jpg
(Wiqan Ang for the Boston Globe)

White coats are everywhere in Boston's academic medical centers, a universal sign that the wearer is a medical professional. But look closer, and you will notice that not all white coats are alike.

Boston Scientific Corp. has notified doctors that some of its implantable heart defibrillators contain batteries that could deplete early, shortening the life span of the devices.

Posted by Elizabeth Cooney at 05:55 AM
April 10, 2007

Women’s health, in focus

paulajohnson96.bmpDr. Paula Johnson (left), executive director of the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital, describes her career path and the center's goals in a Saturday New York Times feature called "The Boss."

"People think of women’s health as mammograms and Pap smears besides general health care, but it’s much more," said Johnson, who is a cardiologist. "It’s understanding the science of sex differences and how that science influences the way we deliver care, both in the office and by means of highly technical procedures."

Posted by Elizabeth Cooney at 05:46 AM
April 09, 2007

Coalition calls on state to make health insurance more affordable

By Alice Dembner, Globe Staff

The state isn't yet doing enough to help people of low- and moderate incomes afford health insurance, a coalition of advocacy and medical groups told Governor Deval Patrick today.

The Affordable Care Today coalition, which helped secure passage of the state's health insurance law, called for the state to increase subsidies for those with the lowest incomes and to allow people with moderate incomes to opt out of the health insurance requirement if they would have to spend more than 4 to 8 percent of their income paying for it. Download file

The governor’s spokesman Kyle Sullivan, said that Patrick would review the proposal, along with others, as he seeks to strike a "delicate balance."

"He believes we must be ambitious in expanding coverage without imposing financial hardship on those who truly cannot afford health insurance," Sullivan said.

The board that is charged with implementing the law, the Commonwealth Health Insurance Connector, is due to set preliminary rules Thursday on who should be exempted from the law because health insurance would be unaffordable for them.

Rev. Hurmon Hamilton, pastor of Roxbury Presbyterian Church and president of the Greater Boston Interfaith Organization, said the coalition's proposal would protect the most financially vulnerable while ensuring that about 75 percent of those without insurance would be covered.
"We want to bring people as much healthcare as possible, not squeeze folks as much as possible," Rev. Hamilton said.

A proposal from another advocacy group, Community Catalyst, released last week, suggested that individuals earning less than $30,000 a year be exempted from any penalty if they don't get insurance. That group also suggested that people earning between $30,000 and $60,000 be exempted if they had to spend more than 4 to 8.5 percent of their income on health insurance.

However, Jonathan Gruber, an economist at the Massachusetts Institute of Technology and a member of the Connector board, presented a report last week that suggested nearly everyone could afford insurance and no broad waivers were needed.

Many observers suggest that finding a workable compromise on this question will make or break public acceptance of the new law.

The coalition proposal suggests that the state provide fully subsidized insurance to people earning up to $15,000 a year, an increase from the current $10,000. In addition, it suggests lowering premiums for those earning $15,000 to $30,000 to 1 to 3 percent of income. Individuals earning between $30,000 and $60,000 would be exempted from buying insurance at market prices only if the premium and deductible cost more than 4 to 8 percent of their income based on a sliding scale, the proposal suggests.

The proposal would add $12 million to $16 million to the cost of state-funded premiums, according to the coalition. It would also likely exempt more people than some policy-makers consider feasible to make the law work.

Posted by Karen Weintraub at 06:05 PM
April 09, 2007

Charlie Baker adds 'blogger' to his Harvard Pilgrim titles

Charlie Baker, president and CEO of Harvard Pilgrim Health Care, has joined the blogging world with Let's Talk Health Care.

"Health insurance is a complicated topic," he wrote in his first post Friday. "I’m in the business, and I struggle at times to understand the benefits, the coverages, the rules and the jargon."

Cost is the dominant theme and the red HPHC shield is a prominent link to the company's products. A poll asks users if they've ever inquired about how much a treatment or test costs and an info center points to information about the new Massachusetts healthcare law, quality measures and how to save money on coverage.

Posted by Elizabeth Cooney at 02:49 PM
April 09, 2007

MGH group to study genes and heart attacks

Researchers at Massachusetts General Hospital have won a three-year, $4.2 million grant from the National Heart, Lung and Blood Institute to study genes that may put people at risk for heart attacks, the hospital said.

Dr. David Altshuler, also a founding member of the Broad Institute of Harvard and MIT, and Dr. Sek Katherisan will look at gene variations in 1,500 people who had heart attacks at an early age and 1,500 who did not. They will use data from a study started in 1998 at eight sites, including Mass. General, that make up the Myocardial Infarction Genetics Consortium.

In men under 50 and women under 60, genes may play a greater role in heart attacks, they said. Heart attacks cluster in certain families, regardless of traditional risk factors, but this inherited risk is not explained by gene variants already known to contribute to disease.

Posted by Elizabeth Cooney at 01:52 PM
April 09, 2007

Today's Globe: anti-anemia drug roadblocks, AIDS orphans, bed sores, new hepatitis drug

A licensing deal between Beth Israel Deaconess Medical Center and a Florida biotechnology company to produce a "super" form of an anti-anemia drug is in danger of foundering just two years after it was signed.

As the creator of the first global center dedicated exclusively to health and human rights, at the Harvard School of Public Health, Countess Albina du Boisrouvray probably has as much hands-on experience in both as anyone. She's adopted the world's AIDS orphans as her cause.

Until recently, most experts believed that bed sores were an unambiguous indicator of bad care.

Also in Health/Science, the power of trash, Scrabble as a science and drug combinations.

In Business & Innovation, for Vertex Pharmaceuticals Inc., the future hinges on a potential billion-dollar drug for hepatitis C and a liver-research conference about to kick off 3,700 miles away in Spain where it will unveil new data from human trials of the pill.

Posted by Elizabeth Cooney at 06:25 AM
April 09, 2007

In case you missed it: lessons from heart disease

In many ways, scientists’ hard-won and increasingly detailed understanding of what causes heart disease and what to do for it often goes unknown or ignored. A Sunday New York Times story follows a Brigham and Women's Hospital patient who did many things right, but also made some crucial miscalculations that were so common that nearly every patient makes them, cardiologists say.

Posted by Elizabeth Cooney at 06:18 AM
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