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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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« June 17, 2007 - June 23, 2007 | Main | July 01, 2007 - July 07, 2007 »

June 30, 2007

Halamka gets Googled

halamka 150.bmpDr. John D. Halamka is nothing if not connected.

The chief information officer at Beth Israel Deaconess Medical Center has a radio frequency identification chip implanted in his body that points to his personal health information. He belongs to a statewide group working on ways to connect medical records throughout different health care systems. He has championed technology as critical to patient safety at Beth Israel.

Now he's part of a new Google Health Advisory Council. The search-engine giant's announcement says the 24 experts it has convened -- including well-known diet book author Dr. Dean Ornish, former NIH head Dr. Bernardine Healy and former FDA commissioner Dr. David Kessler -- will "broadly help us better understand the problems consumers and providers face every day and offer feedback on product ideas and development."

The council move its causing a bit of a stir for two reasons, at least as reflected on the Wall Street Journal's Health Blog and Kevin, MD. One fear is that patient privacy will be compromised if it goes online in some fashion. The second wave of criticism came from nurses, medical librarians and even medical bloggers disappointed not to be represented on the panel.

Halamka is traveling in Japan, his out-of-office e-mail reply said earlier today. Known for being almost as tightly attached to his Blackberry as his RFID chip is to him, he won't surprise anyone if he comments later.

Update: Here's Halamka's response from a Buddhist temple on Mt. Koya, where he was not immediately able to access the critical comments:

"Google's mission in the healthcare area is to empower consumers to make better health decisions. They can accomplish this by helping patients search better and helping them manage their personal health information," he wrote. "If patients provide aspects of their medical history during the search process (with appropriate privacy protections, of course) then the relevance of the refined search results is likely to be much higher."


Posted by Elizabeth Cooney at 08:06 AM
June 29, 2007

School health center to serve students and residents

The state's first school-based health center to also serve neighborhood residents will open its doors in August.

The Helen A. Bowditch Health Center in the Elm Park Community School in Worcester will be operated by Family Health Center of Worcester. Children will be seen during school hours; After school hours, the center will be open to the neighborhood.

Elm Park Community School enrolls students from one of the poorest, most densely populated neighborhoods in Worcester whose residents have a high risk for asthma, diabetes and cardiovascular disease. A Family Health survey of families found that more than one-third relied on emergency rooms for medical care or had no regular health care provider. More than half said their entire family would seek health care at the school.

Posted by Elizabeth Cooney at 11:10 AM
June 29, 2007

Today's Globe: Caritas deal off, transplanted DNA, fish from China

The Archdiocese of Boston's tentative deal to hand over its troubled Caritas Christi Health Care system to Ascension Health of St. Louis collapsed yesterday after five months of research by Ascension showed the hospital chain was in worse financial shape than it expected, according to officials at competing hospitals and others familiar with the talks.

Biologists have converted one species of bacterium into another by replacing all of its DNA, a critical step toward their ultimate goal of designing entire organisms from scratch, according to a study published yesterday.

Federal authorities, under fire for responding slowly to tainted Chinese imports, yesterday said they will halt shipments of five fish species sent from China because they are laced with dangerous chemicals.

Posted by Elizabeth Cooney at 06:39 AM
June 28, 2007

When hospice care is 'too late'

By Elizabeth Cooney, Globe Correspondent

About 12 percent of Massachusetts family members said their loved ones entered hospice care too late, resulting in less satisfaction with their care, according to a national survey.

The survey also found that the number of days people spent in hospice care affected satisfaction levels less than whether they got that care too late.

Brown University researchers report in the Journal of Pain and Symptom Management that 11.4 percent of respondents thought their relatives received hospice care too late. In Massachusetts, the figure was 12.6 percent. Vermont had the lowest rate, at 7.8 percent, and South Carolina had the highest, 15 percent.

There was a strong association between people who said their loved ones were referred to hospice too late and also reported dissatisfaction with the quality of care. The researchers expected this to be true for the shortest stays, but even referrals to hospice two days before death were called "the right time" by three-quarters of the relatives.

"We firmly believed, in our hearts and souls, that people of short length of stay were going to have greater unmet needs, more concerns and more dissatisfaction," lead author Dr. Joan M. Teno said in an interview. "Much to my surprise, the opposite is true."

Among people whose relatives had only two days of hospice care, only 24 percent said that was too late. Teno said she would have expected a much higher rate.

"I think this relates to how well hospice programs rally the troops to make everything happen," she said. "The entire hospice team mobilizes very quickly. They go in there and they do a very intensive intervention for the last 24 or 48 hours."

Hospice experts say that dying people and their families benefit the most when they receive hospice care for at least three months, but the average stay lasts less than two months. Thirty percent of hospice patients die in seven days or fewer, according to the National Hospice and Palliative Care Organization, which worked with the Brown researchers to survey more than 100,000 families from 631 hospices.

Posted by Elizabeth Cooney at 04:04 PM
June 28, 2007

Joslin name goes NASCAR

joslin NASCAR 150.bmpJoslin Diabetes Center’s partnership with Walgreens is bringing it into pharmacies nationwide. Now the 10-month-old alliance is hitting the road.

Joslin’s name is going NASCAR, along with Walgreens and its co-sponsor in car racing, the drug company Eli Lilly. Logos from all three will grace a Ford Fusion driven for Carl A. Haas Motorsports by rookie driver Kyle Krisiloff. He’ll be racing Saturday in Loudon, N.H., as part of the NASCAR Busch Series.

The effort to drive awareness of diabetes is the first of its kind for NASCAR, according to Joslin. The clinic and research center is not paying for the sponsorship, spokeswoman Jenny Catherine Eriksen said.

Posted by Elizabeth Cooney at 01:05 PM
June 28, 2007

Notables

Cambridge Health Alliance will accept an award today from the National Association of Public Hospitals and Health Systems for its role in medical school curriculum change.

CHA developed a program for third-year Harvard Medical School students to follow patients for a year at one hospital instead of traditional rotations in different settings. The hospital was chosen for the 2007 Chair Award from 64 submissions, NAPH said in a statement.

Dr. Samantha L. Rosman, a third-year resident in pediatrics in Boston, has been re-elected to the American Medical Association's board of trustees. She is a 2004 graduate of Columbia University College of Physicians and Surgeons. After completing her residency, she will begin a fellowship in pediatric emergency medicine at Boston Medical Center.

Shedlack100.bmpDr. Karen Shedlack (left), medical adviser for the mental retardation division of Vinfen, has won a 2007 Distinguished Fellowship from the American Psychiatric Association.

Before joining Vinfen, a private, nonprofit human services organization based in Cambridge, Shedlack was medical director for the adult developmental disabilities program at McLean Hospital and worked in the department of psychology and brain science at the Massachusetts Institute of Technology.

Virgin Life Care has named three Boston academics to its science advisory board.

A subsidiary of the Virgin group headed by Sir Richard Branson, the Boston company develops activity-based health rewards programs.

The board members are Dr. I-Min Lee of Harvard Medical School and the Harvard School of Public Health, Kyle McInnis of UMass-Boston and Jessica Whitely of UMass-Boston and Brown Medical School.


Children's Hospital Boston has honored five doctors with Community Physician Awards for the care they give in pediatric practices and community health centers.

They are Dr. Anthony Compagnone of Hyde Park Pediatrics, Dr. Debra Ann Gfeller of Holliston Pediatrics, Dr. David Holder of the Martha Eliot Health Center, Dr. Richard Marshall of Harvard Vanguard Associates at Copley and Dr. Robert Michaels of Longwood Pediatrics.

Posted by Elizabeth Cooney at 11:05 AM
June 28, 2007

Today's Globe: elephants, autism center, antidepressants, video gaming

A Stanford University scientist has discovered that elephants actually have two distinct ways of communicating: by ordinary soundwaves rippling through the air, and by vibrations transmitted through the ground to exquisitely sensitive elephant toes.

The New England Center for Children signed a deal last week with officials in Abu Dhabi, the capital of the United Arab Emirates, to start a program for children with autism, the center announced yesterday.

Newborns face little risk of birth defects from antidepressants taken by many women early in pregnancy, according to two of the biggest studies. The research focuses on the class of drugs chosen most often for depression and anxiety, including the brands Prozac, Paxil and Zoloft.

The American Medical Association yesterday backed off calling excessive video-game playing a formal psychiatric addiction, saying instead that more research is needed.

Posted by Elizabeth Cooney at 06:25 AM
June 27, 2007

Keeping promises to research subjects

By Elizabeth Cooney, Globe Correspondent

Academic researchers keep their distance from pharmaceutical companies providing drugs for clinical trials, but sometimes that arms-length remove can lead to problems, Harvard authors say.

In an article in tomorrow's New England Journal of Medicine the Harvard scientists explore a case in which research subjects sued the drug company Amgen when a Parkinson's therapy being tested by the University of Kentucky Medical Center was no longer available to them. The study was stopped early because of concerns that the drug was neither safe nor effective, but some subjects said it helped them and wanted to keep taking it.

Participants had signed informed-consent agreements that said they could continue getting the drug after the trial ended, but the court ruled last year in Abney v. Amgen that the form each subject signed was a contract between the subject and the researchers, not Amgen. That meant Amgen had no obligation to provide the drug.

"I think this is one of those issues that kind of lurk below the water line but probably is quite prevalent," Michelle M. Mello of the Harvard School of Public Health said in an interview. "Consent forms promising access to study drugs are fairly routine. We want subjects to feel that whatever promises that are made to them are going to be carried out unless there’s a very good reason not to."

Mello and co-author Dr. Steven Joffe of Harvard Medical School suggest that research centers could solve the problem by ensuring that promises made to trial subjects are legally binding on the sponsor or met by the research center and that any limits to promises are clearly spelled out.

"Much of the problem highlighted by Abney can be avoided through more careful drafting of contracts," the authors write. "Notwithstanding the advantage of an arms-length relationship between academic investigators and industry sponsors, such an arrangement has undesirable legal consequences."

Posted by Elizabeth Cooney at 05:00 PM
June 27, 2007

Harvard researcher wins diabetes award

ADA winner 150.bmpDr. Gökhan Hotamisligil has won the American Diabetes Association's outstanding scientific achievement award for his discoveries about the link between obesity, insulin resistance, and inflammation, the group said.

He is chair of the department of genetics and complex diseases at the Harvard School of Public Health.

Posted by Elizabeth Cooney at 04:15 PM
June 27, 2007

Today's Globe: health law poll, chronic illnesses, children's mental health, law and disorder, Pfizer case

The state's health insurance initiative gets strong support from Massachusetts residents, even though most believe it will result in higher taxes, according to a poll of 1,003 people being released today.

The number of American children with chronic illnesses has quadrupled since the time when some of their parents were children, portending more disability and higher health costs for a new generation of adults, a study said.

Joseph Biederman 100.bmpFour-year-old Rebecca Riley allegedly died of an overdose given to her by her parents, a tragedy that has little to do with any specific disorder, Dr. Jerrold F. Rosenbaum, chief of psychiatry at Massachusetts General Hospital, and Dr. Michael S. Jellinek, chief of child psychiatry at MGH, write on the op-ed page. It is appalling that Dr. Joseph Biederman's (left) distinguished lifelong work caring for children has been dragged into this fray, they say.

When it was founded nearly 30 years ago, Boston-based Lawyers Concerned for Lawyers functioned as a support group for attorneys with drinking problems. Today, attorneys and other legal professionals contact LCL mainly for help battling depression.

Pfizer Inc., the world's largest pharmaceutical maker, said a Nigerian court ruled against adding more claims to allegations that the company improperly tested a meningitis drug on children in 1996.

Posted by Elizabeth Cooney at 06:30 AM
June 26, 2007

Insurance initiative could face budget crunch

By Alice Dembner, Globe Staff

Some of the companies running new subsidized health insurance plans are asking for more money than the state is willing to pay, a Massachusetts official said today, and could precipitate a budget crunch for the state's health insurance initiative.

Under state contracts, four companies now serve about 80,000 low-income residents in the Commonwealth Care program and are working to enroll at least 60,000 more. The state wants to extend their contracts by six months, until June 30, 2008, but the companies are bargaining for a larger fee, according to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector, which oversees the program.

State negotiators have offered a 4 percent increase, and agreed to pick up more of the cost if expenses rise significantly, Kingsdale told members of the connector board. That would add about $16 million to the state's cost, money that is already built into the fiscal 2008 budget now being finalized by the Legislature. However, that could leave little room for other possible increases in expenses, if enrollment is higher than expected, for example.

From the companies' point of view, "it’s not enough,” Kingsdale said, “and from a budgeting perspective, it’s probably too much.”


The companies are used to working in a climate where doctors and hospitals demand increases of 5 to 10 percent every year, Kingsdale said. But the state needs to keep cost increases to single digits, he said.

"The sustainability of health reform hangs on that," he told the board at a morning meeting.

Kingsdale said he thinks one or two of the companies would agree to the 4 percent increase. If the others don't, the connector would seek new bids from the companies. In that case, enrollment could be suspended until a new contract is signed, Kingsdale said.

Board members suggested that Kingsdale hold the line in negotiations. "Otherwise you’re trapped in a spiral upwards," said Dolores Mitchell, a board member and executive director of the Group Insurance Commission, which manages state employees' coverage.

Officials for the four companies -- Network Health, Boston Medical Center HealthNet Plan, Fallon Community Health Plan and Neighborhood Health Plan -- either declined comment or did not respond to a request for comment.

Posted by Karen Weintraub at 06:15 PM
June 26, 2007

MGH doctor lobbies for childhood cancer research

By Elizabeth Cooney, Globe Correspondent

howard weinstein 85.bmpDr. Howard Weinstein (left) has been caring for children with cancer and researching ways to treat them for 30 years, but he's never seen so many clinical trials stalled for want of funding.

That's why the chief of the center for pediatric hematology and oncology at Massachusetts General Hospital was on Capitol Hill this afternoon. About 300 people from across the country -- cancer doctors, parents of children who died of cancer and families with children who survived -- were all lobbying for passage of a bill called the Childhood Cancer Act of 2007.

"Twenty trials that are ready to be launched will not be activated in the next weeks to months because of the budget," he said in an interview. "It's such a frustrating time because there's an explosion of new drugs that we're really anxious to test in children, but we don't have the funding."

The National Cancer Institute provides about $28 million a year for studies of childhood cancer, but the field could use double that amount, Weinstein said. Four years of flat funding for the National Institutes of Health have meant real declines in the money available for research, after medical inflation is taken into account.

The bill asks for $150 million over five years to pay for studies organized by the Children's Oncology Group, a group of cancer centers around the country formed seven years ago to coordinate research. The bill would also support families and establish a national childhood cancer registry.

"Twelve thousand children a year are diagnosed with cancer," he said. "I think our job is to make sure every child in this country with cancer has the opportunity to be cured."


Posted by Elizabeth Cooney at 06:10 PM
June 26, 2007

Notables

kitty dukakis 85.bmpKitty Dukakis (left), wife of former Governor Michael Dukakis and author of books about her battles with addiction and depression, was honored by the National Alliance on Mental Illness at its conference in San Diego last week. Author of last year's "Shock: The Healing Power of Electroconvulsive Therapy" with former Globe medical reporter Larry Tye and the 1990 book "Now You Know" about addiction to alcohol and diet pills, she was recognized for sharing her struggles and reducing the stigma associated with mental illness.

donald berwick.jpgDr. Donald M. Berwick (left), a Harvard Medical School professor who heads the Institute for Healthcare Improvement in Cambridge, is among 15 finalists for an award honoring innovators over 60 for their work on social problems.

Five Purpose Prize winners will each receive $100,000 from the San Francisco think tank Civic Ventures in September. Berwick, 60, was nominated for his work to help hospitals improve care through the "100,000 Lives" patient safety campaign. Each finalist is awarded at least $10,000.

Posted by Elizabeth Cooney at 04:20 PM
June 26, 2007

On the blogs: Medicare For All, who collects deductibles?

On Let's Talk Health Care, Harvard Pilgrim CEO Charlie Baker considers the proposal that expanding Medicare to cover all Americans would fix the country's health care coverage crisis because it has lower administrative costs and pays better than private insurance plans. But Medicare For All is not as simple as it seems, he writes.

"Private plans pay MORE than Medicare pays, not less!" he says, "If people want Medicare For All, they need to be prepared to either dramatically raise Medicare rates and payment — and therefore, Medicare costs — by a lot of money — 20 to 25 percent by this estimate — or kick the bejeebers out of the physician and hospital communities and make them eat the difference."

On WBUR's CommonHealth, Michael V. Sack, president and CEO of Hallmark Health, which operates Lawrence Memorial Hospital and Melrose-Wakefield Hospital, says insurers, not hospitals, should be charged with explaining and collecting the co-payments and deductibles that many newly insured residents will have to pay as of the July 1 deadline for near-universal coverage.

"Hospitals throughout Massachusetts spend a great deal of human and financial resources in trying to obtain payment for the services they provide," he writes. "Unfortunately, even after significant investment of time and personnel, the co-payments and deductibles can be the hardest money to collect."

Posted by Elizabeth Cooney at 01:38 PM
June 26, 2007

Today's Globe: imaging firms fight Medicare cuts

Makers of medical imaging equipment are lobbying to overturn Medicare cutbacks after weathering some of the worst sales numbers in recent memory. Congress made the cuts following criticism that some health care providers were performing more tests than necessary simply to boost revenue. But equipment makers such as General Electric Co. and providers of diagnostic tests such as Alliance Imaging Inc. are waging a campaign to convince federal lawmakers that the six-month-old policy is having a negative effect on public health.

Posted by Elizabeth Cooney at 06:27 AM
June 25, 2007

MIT researcher offers hope for syndrome that causes retardation, autism

By Carey Goldberg, Globe Staff

Blocking a key brain chemical can reverse many of the symptoms of Fragile X Syndrome -- an inherited form of mental retardation often accompanied by autism -- in mice engineered to have the disease, an on-line scientific journal reported this afternoon.

The findings raise the prospect that drugs with similar effects may someday help restore brain function in human children with the syndrome, and possibly with some forms of autism as well, said Susumu Tonegawa of MIT's Picower Institute for Learning and Memory, senior author of the paper in today's Proceedings of the National Academy of Sciences. About 100,000 Americans have Fragile X.

Mental retardation has long been thought to be permanent. But recent research increasingly suggests that even with diseases that strike after birth, the brain may be more fixable than previously believed. Earlier this year, scientists from Scotland reported that dramatic recoveries could be achieved in mice with Rett Syndrome, another genetic disease related to autism.

Tonegawa's paper says "that some of the abnormalities with mental retardation syndromes and autism aren't necessarily cemented in stone," said Eric Klann, a professor in New York University's Center for Neural Sciences, who was familiar with the paper but not involved with the research. "I think it gives some degree of hope."

The research focused on blocking an enzyme called PAK. Tonegawa's research used genetic manipulation rather than drugs, but he said that he believes drug and biotech companies are already working on developing compounds that block the same enzyme. His lab may seek access to such compounds that are aimed for other diseases, or ask a chemist to synthesize them, he said.

There are currently several drugs in development as possible treatments for people with Fragile X Syndrome, said Katie Clapp, co-founder of FRAXA Research Foundation, a locally based nonprofit that helped fund the research. Her 18-year-old son, Andy, has the syndrome. None of the compounds has reached the point that she would want Andy to try them, she said, nor are they publicly available.

"But talk to me in a couple of months," she said. "There are more drug targets coming out of research that we're funding, and some of it does suggest drugs that are already available. So sometimes I feel like I'm living a dream --- a really good one."

Posted by Karen Weintraub at 05:22 PM
June 25, 2007

Getting medical devices to talk to each other

By Elizabeth Cooney, Globe Correspondent

There is no shortage of examples to illustrate the frustrating technological gaps that can put patients’ lives at risk, Dr. Julian M. Goldman told a conference on health care technology and safety yesterday.

Take the ventilator used during heart surgery, for instance, the Massachusetts General Hospital anesthesiologist and biomedical engineer said. The patient needs the ventilator both before and after using the heart/lung machine that pumps blood during heart surgery. But doctors can forget to turn the turn the ventilator back on – and the alarm that signals when the machine isn’t working is often silenced because it tends to go off unnecessarily. It would make sense if there were an alarm that sounded only when both machines were off, but that's not possible, Goldman said, because the two machines, made by different companies, can’t talk to each other.

"There's no shortage of clinical scenarios," Goldman, of Massachusetts General Hospital, said in an interview, after a morning filled with stories of fragmented health information. "The challenge is to turn war stories into actionable solutions."

Interoperability – the way for medical devices to work together – is the subject of the three-day conference that started in Cambridge today and is sponsored by the Center for Integration of Medicine and Innovative Technology among others. The conversation includes electronic health records in all settings and remote monitoring of health conditions.

Dr. Robert M. Kolodner, National Coordinator for Health Information Technology, challenged audience members from health care, business and government to forget their professional roles for a moment.

“Make it personal. Think about the quality and value of the health care services you and your family demand."

Posted by Elizabeth Cooney at 03:08 PM
June 25, 2007

Primary care doctors improve on quality measures

By Liz Kowalczyk, Globe Staff

The quality of medical care provided by Massachusetts physicians exceeds the national average in many areas, but some doctors here fall short in key ways, particularly in treating patients who are depressed and screening patients for colorectal cancer.

New data from the Massachusetts Health Quality Partners, a coalition that includes doctors, hospitals, and health plans, show that on 12 of 17 measures, Massachusetts doctors score in the top 10 percent of doctors in health plans nationwide.

The MHQP is posting on its website today new performance ratings for primary care doctors in 150 Massachusetts physician groups -- though not for individual doctors. The group makes individual results available privately to doctors.

MHQP has added three new measures this year: how well doctors screen patients for colorectal cancer; whether they use the right antibiotics to treat children with upper respiratory infections; and whether they test diabetic patients for kidney disease.

Barbra Rabson, executive director of the group, said doctors have used the information over the past several years to steadily improve the care they provide to patients, especially children with asthma and diabetic patients. Most physician groups, for example, test at least 90 percent of their diabetic patients for high cholesterol.

But there still is significant variation among physicians in some areas, particularly on the newer measures. For example, 71 percent of patients statewide receive colorectal cancer screening, but among medical groups the percentage varies from 40 percent to 93 percen

June 25, 2007

Today's Globe: doses and devices for children, staph germ, Lyme controversy, ovarian cancer, Rubik's Cube

Doctors have long struggled with how best to treat small children with drugs and medical devices that are mostly designed, tested, and approved for use by adults. A Cambridge-based nonprofit that is officially being launched today hopes to change that. The Institute for Pediatric Innovation says it will work with three major children's hospitals in California, Kansas, and Ohio to redesign drugs and devices to better fit children.

A dangerous, drug-resistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study.

deer tick100.bmpMore than two decades since the threat of Lyme disease was recognized, doctors and patients are still warring over how to identify and treat the insect-borne illness.

Ovarian cancer has long been known as the "silent killer," growing imperceptibly inside victims until the disease has spread too far to be stopped. Now, Seattle researchers have come up with what may be the first early-warning system for a disease that is expected to kill 15,280 women this year, most of whom never knew they had cancer until it was too late.

Remember Rubik's Cube, that devious little puzzle from the 1980s? Cubing -- as it is known -- has had a revival, thanks to the growing popularity of "speedcubing" competitions to see who can take a randomly scrambled cube and solve it the fastest.

nafi toksoz150.bmpWhen MIT geophysics professor Nafi Toksoz (left) embarked on his career, no one had yet articulated the theory of plate tectonics. Now 73 and a legend in his field, Toksoz still teaches, ponders the earth's evolution, and tries to better answer the great question that keeps seismologists up at night: How do you predict an earthquake?

Also in Health/Science, the color of light in fiber optic cables and prescribing exercise.

Posted by Elizabeth Cooney at 06:03 AM
June 25, 2007

In case you missed it: breast-feeding battle

currier150.bmpShe already has a doctorate from Harvard. Now, after five years of medical training, all that stands between Sophie Currier (left) of Brookline and an elite, double-barreled MD-PhD is a daylong exam and her commitment to breast-feeding her infant daughter, Carey Goldberg reports in Saturday's Globe.

With North Shore Medical Center and Northeast Health System each building new outpatient care centers in Danvers, the town is becoming "the medical center point of the North Shore," Town Manager Wayne Marquis said in a story in Sunday's Globe.

Posted by Elizabeth Cooney at 06:00 AM
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