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| July 29, 2007 - August 04, 2007 »
July 27, 2007
On Hemodynamics, Dr. Joe Wright, who is an NPR commentator, Harvard Medical School graduate and new medical intern, compares HIV to type 2 diabetes, chronic conditions that both carry stigma. Here's his point of departure:
"In mid-February 2007, I heard a cardiologist talking about the cardiovascular effects of HIV, who then put his talk in context by casually saying, 'Even so, I’d choose to have HIV over having diabetes.' The doctors-in-training listening nodded in agreement. They probably didn’t remember that people used to talk about comparing HIV to diabetes like it was an impossible dream," he writes. "Even back in 1996 and 1997, people were starting to say that living with HIV could finally be like living with diabetes, a difficult but manageable chronic disease. This didn't mean that it would be easy."
On nurse at small, Betsy Baumgartner talks about how she loves and hates her job when it means really being there for her patients in their time of need.
"How can you look someone in the eye ... someone who has the right to know, wants to know, is ready to hear it, trusts you completely, and asks, 'What do you know that I don't?'" she asks. "How do you answer this question when what you know is one of the worst possible scenarios for any human being?"
Posted by Elizabeth Cooney at 04:22 PM
July 27, 2007
Hispanic News Press has launched a bilingual health magazine for the Boston area called Health and Family/Salud y Familia.
About 20,000 copies of the quarterly have been distributed to hospital waiting rooms, doctors’ offices and community organizations in areas where there are large numbers of Spanish speakers, marketing director Raul Medina said in an interview. Stories are written in Spanish and summaries appear in English.
Hispanic News Press publishes El Planeta in Boston, Lawrence, Worcester, Springfield and Providence. Some copies of the health magazine have been distributed in those cities, too.
The 16-page health magazine’s first cover story features Red Sox third baseman Mike Lowell talking about his battle with testicular cancer. Lowell was born in Puerto Rico, and his father is from Cuba.
Posted by Elizabeth Cooney at 02:31 PM
July 27, 2007
By Stephen Smith, Globe Staff
For the first time this summer, a bird carrying West Nile virus has been found in Massachusetts. The infected blue jay was detected in Marlborough and tested positive yesterday.
No human cases of the mosquito-borne disease have been reported this year in the state. Last year, three people contracted the illness in Massachusetts; all survived.
So far this year, most human cases of the disease have been reported west of the Mississippi River, with California reporting 27 cases, the most in the nation.
In the most severe cases, the infection can cause a high fever, headache, neck stiffness, stupor, coma, tremors, convulsions, muscle weakness, and paralysis. The US Centers for Disease Control and Prevention estimates that one of every 150 people infected with West Nile develops severe symptoms.
To avoid contact with infected mosquitoes, the Massachusetts Department of Public Health recommends limiting outdoor activities from dusk to dawn, peak biting times for mosquitoes. Otherwise, wear as much clothing as comfortable and apply insect repellent such as DEET, permethrin, picaridin, or oil of lemon eucalyptus.
DEET should not be used on infants under the age of 2 months and should be used in concentrations of 30 percent or less on older children. Oil of lemon eucalyptus should not be used on children under 3 years old.
Posted by Karen Weintraub at 11:11 AM
July 27, 2007
Boston's largest Harvard-affiliated hospitals are setting up a $35 million venture capital fund, an aggressive effort to push their inventions out of the laboratory and into the market.
Beth Israel Deaconess Medical Center yesterday said it will spend $1 billion over the next 15 years to build a suburban clinic, replace buildings at its cramped Longwood campus, upgrade facilities, and add hospital beds.
Last winter, researchers from Cambridge biotechnology company Alnylam Pharmaceuticals Inc. successfully made 26 people sick, part of its plan to develop a new drug to fight a lung infection called respiratory syncytial virus, or RSV.
Former New England Patriots offensive coordinator Charlie Weis (left) said yesterday he will not appeal a Suffolk Superior Court jury's verdict that cleared two surgeons from Massachusetts General Hospital this week of misconduct in his medical-malpractice lawsuit. Weis, now head coach at Notre Dame, alleged that Charles Ferguson, director of Mass. General's surgical-residency program, and Richard Hodin, a gastrointestinal surgeon and professor at Harvard Medical School, botched his gastric bypass surgery in June 2002.
The family of an Iraq war veteran from Belchertown who took his own life after allegedly being turned away for treatment at the Northampton VA medical center filed a federal lawsuit yesterday accusing the government and Veterans Affairs Secretary Jim Nicholson of negligence in 23-year-old Lance Corporal Jeffrey Lucey's death.
The Food and Drug Administration will ask outside specialists next week whether the diabetes drug Avandia should be pulled from the market over concerns of heart attack risk.
Daniel E. Koshland Jr., the molecular biologist who revised scientists' ideas on how enzymes work, remodeled the biology department at the University of California, Berkeley into one of the nation's best and, as editor, refashioned Science into one of the leading scientific journals in the world, died Monday at Kaiser Permanente Medical Center in Walnut Creek, Calif., after a stroke. He was 87.
Posted by Elizabeth Cooney at 06:56 AM
July 26, 2007
By Stephen Smith, Globe Staff
Massachusetts health authorities today advised consumers to discard any recalled products made by Castleberry's Food Co., even if the canned products look and smell safe.
Four people in Indiana and Texas fell ill with botulism after eating Castleberry's Hot Dog Chili Sauce; no botulism cases have been reported in Massachusetts.
The company is recalling a long list of products, sold under a variety of brand names, including chili with and without beans, beef stew, corned beef hash, and barbecue beef. Some dog food made by the company is also being recalled. For a full list of the recalled products, go to http://www.castleberrys.com/news_productrecall.asp.
Products found on Massachusetts store shelves are being removed and destroyed, the state Department of Public Health said.
Posted by Karen Weintraub at 06:46 PM
July 26, 2007
Wondering where your members of Congress stand on healthcare and medical research?
The not-for-profit advocacy group Research!America queried US senators and representatives last month on federal funding for research and public health, the healthcare system, stem cells and other issues.
The seven members of the all-Democratic Massachusetts delegation who responded showed almost unanimous agreement on the issues.
They support increasing budgets for the National Institutes of Health and the Centers for Disease Control and Prevention, they agree that the healthcare system needs to be completely revamped, and they want to lift restrictions on stem cell research.
Only Representative Richard Neal disagreed that the US is losing its competitive edge in science, technology and innovation, while he was on board with his colleagues urging increased investment in education and research.
Representatives Barney Frank, Edward Markey, Michael Capuano and Stephen Lynch have not responded, the site says today.
The 15-question survey follows a poll of registered voters conducted last year by Research!America and funded by the Albert and Mary Lasker Foundation. Voters surveyed said the health care system needs to change and research needs more funding from the government.
Posted by Elizabeth Cooney at 12:15 PM
July 26, 2007
On Nature Network Boston, M. William Lensch, a scientist at Children's Hospital Boston and the Harvard Stem Cell Institute, writes a mournful entry about the gap created when researchers must depend on small foundation grants now that government funding of science -- which helps pay for a sponsoring institution's overhead -- is shrinking. It's a new version of the "valley of death" between academic research and commercialization of a discovery.
"With private grants ... you might be paying for all your own reagents but you are not paying your share for the bench space you have, the light shining down on it, or the salary of who sweeps the floor around it relative to someone with the same amount of grant support from the NIH," he writes. "Dig? Here’s where the Valley of Death comes in."
On WBUR's CommonHealth, John E. McDonough of Health Care For All outlines the predicament facing Massachusetts as it expands access to coverage while costs rise. He questions the objectives of the state Quality and Cost Council, created by the healthcare law.
"The set of goals embraces a popular hypothesis in health policy -- that if we just get quality right, given the documented amount of clinical waste in our system, that’s the magic pill to cure our cost disease. Wouldn’t it be luverly?" he writes. "What if this hypothesis is wrong? What if we do everything quality-wise and costs still rise at destructive, unsustainable rates? Are we willing to consider "R" word - regulation?"
Posted by Elizabeth Cooney at 12:11 PM
July 26, 2007
By Liz Kowalczyk, Globe Staff
The Board of Registration in Medicine, which licenses Massachusetts doctors, yesterday retroactively revoked the medical license of Dr. Thomas Ho, finding that he fell asleep during a surgical procedure in December 2005 and inhaled anesthetic gas while on lunch break at work the following month.
Both incidents occurred during a rotation at Children's Hospital Boston. Ho had taken a prescription drug that caused him to doze off, the board said, and when he fell asleep he was the only anesthesiologist in the operating room.
Ho, who was an anesthesiology resident based at Brigham and Women's Hospital, took a voluntary leave in January 2006. He can apply for a new license if he demonstrates at least 15 months of continuous sobriety, and compliance with a chemical dependency monitoring contract.
A Children's Hospital spokeswoman, Michelle Davis, said today: "No patient was harmed, and as soon as the situation was discovered he was discharged from Children's."
In another case, the board indefinitely suspended the license of Dr. Joseph Fahey, a pediatrician in Worcester who admitted during a board investigation in 2005 that he had used cocaine and marijuana. The board immediately stayed the suspension because Fahey agreed to a probation agreement that includes monitoring him for drug use until 2010. Fahey has not been practicing medicine, but can do so under the terms of the agreement.
The board also indefinitely suspended the license of Dr. Camilla Parham, a family practitioner who had worked in Cambridge, for behaving inappropriately with a patient at a party. The board immediately stayed the suspension because Parham agreed to enter a probation agreement, which includes a requirement that she take continuing medical education courses in physician/patient boundaries. Parham has not been practicing medicine, but can do so as long as she adheres to the terms of the agreement.
Posted by Gideon Gil at 11:39 AM
July 26, 2007
A report out today flags some of the big issues that could hamstring Massachusetts’ health insurance initiative – affordability, affordability, affordability.
The issue brief from the nonpartisan Center for Studying Health System Change is based on interviews with 25 observers – employers, state officials, insurers and advocates – done in January and updated in June.
The cost of insurance could keep both small employers and individuals from buying, the report asserts, leaving the results far short of universal coverage.
"Places like sandwich shops and auto repair companies are not embracing the reform," the report says, quoting an unnamed insurance broker.
In addition, rising costs could make the initiative unaffordable for the state, particularly if the economy sours, the report points out. And it questions whether the agency set up to implement the effort – the Commonwealth Health Insurance Connector – will add significant administrative costs to the total.
"At what point do the costs to the state getting one additional individual insured outweigh the benefits?" the report asks.
Posted by Karen Weintraub at 06:13 AM
July 26, 2007
Dr. Beverly Shafer (left) of Beverly is one of roughly 69 surgeons nationwide, and the only one in Massachusetts, who turn excess skin from living donors into usable grafts for others through the Musculoskeletal Transplant Foundation, a New Jersey-based nonprofit organization that describes itself as the nation's largest tissue bank.
Pembroke Hospital employees yelled and swore at patients, engaged in inappropriate horseplay, and failed to report a patient's stolen credit card on which $650 had been charged, all in possible violation of state regulations or hospital policy, according to an investigation by the state Department of Mental Health.
Matt Nagle (left), paralyzed from the shoulders down six years ago when he went to help friends in a brawl and was stabbed in the neck, volunteered for experimental treatments. Sensors and electrodes implanted in his body allowed him to operate a robotic hand, play computer games, and, at last, breathe on his own. He died Monday in Brockton. He was 27 years old.
Working for long periods in the harsh and unforgiving conditions near the North Pole and South Pole often causes people to suffer a stew of psychological symptoms dubbed "polar madness," scientists said yesterday.
A presidential commission examining the care given to wounded US service members yesterday recommended "fundamental changes" aimed at simplifying the military's convoluted healthcare bureaucracy and overhauling the veterans disability system for the first time in more than half a century.
Walt Disney Co., responding to congressional calls for Hollywood to discourage tobacco use, will eliminate cigarette smoking from some films. Family movies from Disney, the first studio to make the pledge, won't show cigarette smoking, and executives will discourage scenes in Touchstone and Miramax productions, the Burbank, Calif.-based company said yesterday.
Posted by Elizabeth Cooney at 06:11 AM
July 25, 2007
Hospice care for dying patients has entered mainstream medicine, but it is still misunderstood and underused, according to two opinion pieces in tomorrow’s New England Journal of Medicine. Attitudes and economic constraints are the reasons why, the authors say.
The median length of time a patient receives hospice care is 26 days; one-third of patients enter hospice in the week before they die. That means they have less time to have their unnecessary pain relieved or their families’ care-giving burden eased, both reviews said.
Physicians who equate death with professional failure or think hospice is appropriate only for people near death send patients to hospice too late, Dr. Gail Gazelle of Brigham and Women’s Hospital writes, citing previous research. And patients often think that hospice is only for people dying of cancer, although 40 percent of hospice admissions are for people with conditions such as advanced cardiac disease and dementia.
Patients and doctors alike may not realize that Medicare pays for home hospice care in 80 percent of cases, and private insurers also provide coverage.
But the limits of what hospice payments cover create another barrier, forcing patients to choose between medical treatments and palliative care, Dr. Alexi A. Wright of Dana-Farber Cancer Institute and Dr. Ingrid T. Katz of Beth Israel Deaconess Medical Center say in the other perspective appearing in the journal.
Citing the case of a Massachusetts woman dying of colon cancer, they say hospice care meant she had to give up the chemotherapy and intravenous feeding that kept her comfortable. Only large hospices –- with at least 400 patients -– are economically able to add patients’ current medical treatment to hospice care, but this option is not available in Massachusetts, the doctors write.
Only 2.5 percent of the country’s hospices have an average patient census of 400 or more that can sustain the costs of medical treatments using Medicare’s payment formula, they write.
While health experts worry that open access might bankrupt Medicare, "patients will simply have to hope for access to a hospice that is large enough to help them," Wright and Katz conclude.
Posted by Elizabeth Cooney at 05:00 PM
July 25, 2007
By Alice Dembner, Globe Staff
A study released today suggests that obesity spreads through social connections, particularly via close friendships.
This doesn’t replace the effects of genetics, failing to exercise or supersizing food. But researchers writing in the New England Journal of Medicine say it provides a possible explanation for the rapid increase in obesity over the last few decades. Nationally surveys show that nearly one-third of US adults are now obese.
The condition appears to spread though what researchers are calling “social contagion,” a tendency of people who become obese to influence the behavior of others and to convey -- perhaps subliminally -- the message that being overweight is okay.
"Obesity is not just an individual problem, but a collective problem," said Dr. Nicholas Christakis, a professor of medical sociology at Harvard Medical School and co-author of the report. To slow the epidemic, he said, "treating people in groups may be more effective than treating them individually."
Studying more than 12,000 people linked to a long-running study of heart disease based in Framingham, the researchers found that an individual's chances of becoming obese increased by 57 percent if someone they consider a friend grew obese.
If the friendship was close and mutual and one person became obese, the other's risk soared by 171 percent. The study found similar, but smaller influences between siblings and spouses, but neighbors who aren't friends had no effect.
Surprisingly, obesity seemed to spread even if friends were geographically distant.
"We were stunned to find that friends who are hundreds of miles away have just as much impact on a person's weight as those who are geographically close," said James Fowler, the paper's other author, who is an associate professor of political science at the University of California San Diego. This led researchers to suggest that the effect wasn't only due to sharing behaviors -- such as eating together -- but to sharing ideas about what constitutes an appropriate weight.
Because the study looked at relationships over time, the researchers were able to exclude cases in which obese people chose overweight friends, and therefore were able to make a stronger case for a causal effect.
Researchers have developed an illustration showing how relationships impact obesity.
Posted by Karen Weintraub at 01:36 PM
July 25, 2007
By Carey Goldberg, Globe Staff
Dr. Benjamin Sachs (left), chair of the obstetrics department at Beth Israel Deaconess Medical Center for the last 18 years, is leaving to become senior vice president of Tulane University and dean of its medical school.
He writes in an e-mail:
"Two years ago, the Gulf region was devastated by hurricanes Katrina and Rita and yet people today are still struggling. What attracted me to this position was the opportunity to help rebuild the healthcare system of New Orleans and the Gulf coast. Both a redesigned medical system that provides high quality care for all and a marked growth in world class biomedical research are vital for the region's economic recovery. Tulane is absolutely committed to these goals and to continuing to play a major role in the region's recovery."
A native of London, Sachs came to Boston 29 years ago to complete his residency at Brigham and Women's Hospital. He married and raised two sons here. He helped develop new clinical and research programs, and became a national leader on ways to use team-training to improve patient safety.
"I am deeply saddened by the thought of leaving all my friends and colleagues," he writes. "At the same time, I am energized by the idea that I have been asked to help lead a great university, and strive to make a difference in the lives of so many Americans that live on the Gulf coast."
Paul F. Levy, president and CEO of Beth Israel Deaconess, told staff in a memo this morning about Sachs's departure.
"Those of you who know Ben knows that he would not leave us for a "standard" academic appointment at another institution," he wrote. "Here, he is taking on a mission of great humanitarian import."
Sachs will begin his new job in November, Levy wrote. He said that Dr. DeWayne Pursley would step in as interim chair of the obstetrics department, while retaining his current post as chief of neonatology. The hospital will conudct a nationwide search for a replacement for Sachs, he said.
Here is Sachs's e-mail, followed by Levy's memo:
I am writing to let you know that I have accepted a new position as Senior Vice President of Tulane University and Dean of the Medical School. Tulane’s medical school was founded in 1834 and has a rich history of many major accomplishments.
Two years ago, the Gulf region was devastated by hurricanes Katrina and Rita and yet people today are still struggling. What attracted me to this position was the opportunity to help rebuild the healthcare system of New Orleans and the Gulf coast. Both a redesigned medical system that provides high quality care for all and a marked growth in world class biomedical research are vital for the region’s economic recovery. Tulane is absolutely committed to these goals and to continuing to play a major role in the region’s recovery.
Tulane University is the largest employer in the city. Under the extraordinary leadership of President Scott Cowen, Tulane is playing a vital role in the rebuilding process. In just 2 years, Scott has led Tulane through a dramatic recovery and has undertaken a major redesign of the entire university. I believe that as a result of all the changes that Tulane is better prepared to meet the challenges of the 21st century than most major research universities in the USA.
To give you a flavor of Tulane: at the graduation ceremony this spring the commencement speaker, Brian Williams, asked all the students who had volunteered to help the region to recover from the storm to stand and be recognized. I understand that almost all the students stood up. One of the parents said to me that one could not pay for this kind of education. The university had instilled into the very souls of the students the concept of public service. In fact, Tulane is the only major research university in the country that has public service as an integrated component of the undergraduate experience. In this environment, the faculty can educate the next generation of physicians not only in the science of medicine but also by example, to truly demonstrate humanitarian values
As you know, I was born and raised in London, England and came to Boston 29 years ago to complete my residency at the Brigham and Women’s Hospital. Meeting Vickie and the rich intellectual life at Harvard were powerful influences in my decision to stay in Boston. For the past 24 years, my professional home has been at the Beth Israel Deaconess Medical Center and for the past 18 years I have been the department chair. We are very fortunate that our hospital is now run by a talented and visionary leader, Paul Levy.
It has been a great privilege to live in Boston. I have had the opportunity to work for Harvard and one of the greatest academic medical centers. These institutions have given me the opportunity to hold many leadership positions, help develop new clinical and research programs in women’s health and spearhead nationally, team-training as a new way to improve patient safety. They also gave our department the support needed to develop women’s health centers in Philippines, Armenia and Ukraine. Lastly, I have been privileged to have had the opportunity to contribute to the life of our city and the Jewish community.
We are blessed by having raised two wonderful sons in Beantown. Alex has just graduated from Emory with a major in economics and a minor in Arabic and is now pursuing graduate studies in biology. Jonathan is continuing his studies at Boston University having just graduated from Boston University Academy.
I am deeply saddened by the thought of leaving all my friends and colleagues. At the same time, I am energized by the idea that I have been asked to help lead a great university, and strive to make a difference in the lives of so many Americans that live on the Gulf coast.
We will be keeping a home in Boston so please stay in touch and please visit.
From: Levy,Paul (CEO,Beth Israel Deaconess)
Sent: Wednesday, July 25, 2007 10:34 AM
To: BIDMC Community
Subject: Dr. Sachs on the move
Another transition here at BIDMC. First, Herb Kressel, our chief of radiology, stepped down to become editor of the most respected radiology journal in the country. Then, Jeff Flier accepted an offer to become Dean of our local medical school. Now, Ben Sachs, our distinguished chief of obstetrics and gynecology, has announced that he has accepted an offer to become Senior Vice President of Tulane University and Dean of the Medical School.
Those of you who know Ben knows that he would not leave us for a "standard" academic appointment at another institution. Here, he is taking on a mission of great humanitarian import. As he says in a letter to his friends today:
"Two years ago, the Gulf region was devastated by hurricanes Katrina and Rita and yet people today are still struggling. What attracted me to this position was the opportunity to help rebuild the healthcare system of New Orleans and the Gulf coast. Both a redesigned medical system that provides high quality care for all and a marked growth in world class biomedical research are vital for the region's economic recovery. Tulane is absolutely committed to these goals and playing a major role in the region's recovery. I am energized by the thought that I can help make a difference using the skills and experience I have gained over the last 3 decades."
This assignment is so consistent with Ben's philosophy of life and his prior good deeds throughout the world (e.g., in Ukraine, where he was driving force for improvements in the medical system), that we cannot be surprised. Of course, here at BIDMC, Ben has also been known for running a superb department, with an outstanding record in clinical care, education, and research. He has been an innovator in everything from team training to encouraging young researchers in fields like preeclampsia.
All of us at BIDMC take some pride when one of our senior medical leaders - in this moment Dr. Sachs, and also recently Drs. Flier and Kressel - move on to be of service to a broader audience. We wish Ben well and look forward to receiving his favorite recipes for jambalaya!
Ben takes over his new post in November. Doctor DeWayne Pursley will step in as interim chair, in addition to retaining his post as chief of neonatology, while we conduct a nationwide search for a new chief.
Paul F. Levy
President and CEO
Posted by Gideon Gil at 11:13 AM
July 25, 2007
The American Medical Association, which received $286 million in revenue last year to protect the profession, has served physicians poorly, a Harvard Business School professor writes in today's Washington Post.
Regina E. Herzlinger (left), who is also a senior fellow of the Manhattan Institute, says doctors' professionalism and incomes have taken a terrible beating recently. Some physicians are switching occupations and showing up in her classes seeking MBAs, saying they can no longer practice medicine, she writes.
"You might expect that the AMA would fight the insurers, hospitals, government bureaucrats and ivory tower academics who have diminished physicians' incomes, besmirched their ethical reputations and compromised their professionalism -- but you would be wrong," she writes. "No, instead, at its annual meeting last month, the AMA declared war on retail medical clinics, located in places such as CVS and Wal-Mart."
"We and doctors deserve better advocates."
Posted by Elizabeth Cooney at 10:57 AM
July 25, 2007
Technology consultant Esther Dyson writes about being one of 10 members of Harvard geneticist George Church's Personal Genome project in today's Wall Street Journal.
The project's goal is to recruit 100,000 volunteers whose information will be public for anyone to use, whether for research, their own healthcare or commerce, she says.
She worries about the thousands that will follow the first group willing to post not only their genomes, but also their medical records and answers to extensive questionnaires on the Internet for all to see.
"The 10 of us are fairly well informed, and we know whom to turn to for help if we get an anomalous result," she writes. "But what if the 99,999th person has something alarming in his medical records? This is a research project: We will be careful not to give clinical advice or diagnoses, which could subject us to additional regulation."
Despite that concern, she has faith in the project's goals.
"No one said it would be easy, but the knowledge from our project, and with luck from many others, will ultimately lead to better information that will be there for anyone to use," she concludes.
Posted by Elizabeth Cooney at 08:18 AM
July 25, 2007
A grand jury yesterday refused to indict Dr. Anna M. Pou (left), who was accused of killing four elderly patients in the chaotic aftermath of Hurricane Katrina, ending a case that inflamed public opinion in New Orleans, turned the doctor into a quasi-folk hero, and demoralized an already-shaken medical community.
An ad campaign by drugmaker GlaxoSmithKline to educate blacks about genital herpes, a sexually transmitted disease that is far more common among African-Americans than other racial or ethnic groups, has divided public health authorities and raised complicated questions about race, sex, disease, and commerce.
A US health specialist urged governments worldwide yesterday to endorse circumcision to slow the spread of HIV, saying men without the procedure have a greater risk of contracting the virus from infected female partners.
Wyeth, the world's largest maker of hormone treatments, has unexpectedly failed to win federal approval for its experimental menopause pill, Pristiq.
Albert Ellis, whose streamlined, confrontational approach to psychotherapy made him one of the most influential and provocative figures in modern psychology, died early yesterday at his home in an apartment above the institute he founded in Manhattan. He was 93.
Even though patients receive 95 percent of their healthcare outside of a hospital, it's just too expensive to be a primary-care doctor in America today, Debra A. Geihsler, president and CEO of Harvard Vanguard Medical Associates & Atrius Health, writes in an opinion piece.
Posted by Elizabeth Cooney at 06:41 AM
July 24, 2007
By Elizabeth Cooney, Globe Correspondent
Just when the new healthcare law in Massachusetts is expected to send more people to doctors’ offices, the state’s shortage of primary care physicians continues to be critical, according to a physician workforce study released today.
For the second year in a row, family practice and internal medicine doctors are harder to find, both for patients seeking appointments and for hospitals and group practices trying to recruit them, according to the sixth annual survey conducted by the Massachusetts Medical Society.
"Supply and demand are both going in the wrong direction," Dr. B. Dale Magee, the society’s president, said in an interview. "With the new healthcare reform law, we anticipate that the demand for physician services is going to increase, not only across the board, but especially for primary care physicians."
As of July 1, residents of Massachusetts were required to have health insurance. New coverage will mean new patient visits, health experts believe.
"We would anticipate in the earlier stages of the law that a disproportionate number of people with more advanced diseases will require care than later on," Magee said. "If you aren't seeing the doctor, you don't know you have high blood pressure or you may not know you have kidney disease. A lot comes to light with good preventive medicine."
Psychiatry also appeared on the list of critical shortages for the second year. Vascular surgery jumped to critical this year, up from its first ranking on the severe list last year.
Anesthesiology, cardiology, gastroenterology and neurosurgery are continuing a six-year trend of severe or critical shortages. Urology was added to the severe shortage list this year.
The study polled physicians, hospital presidents, residency and fellowship program directors, physician offices, and patients.
Internal medicine appointments are harder to get this year, the office survey found. A little over half (51 percent) are accepting new patients, down from 64 percent last year. The average time a new patient waits to see an internist with openings is 52 days, compared with 33 days last year.
Last year, 53 percent of patients reported they could see their primary care physician within a week of calling, but that fell to 42 percent this year.
Among hospitals, 68 percent of teaching hospitals and 83 percent of community hospitals are having trouble filling their physician vacancies. For 72 percent of community hospitals and 38 percent of teaching hospitals, that meant changing the provision of services.
Seventy percent of medical directors at group practices said the average amount of time to recruit a doctor had gone up over the last three years.
The medical society is trying to get state and federal government programs to consider some form of loan forgiveness for doctors who leave medical school deep in debt as a way to encourage them to choose the less lucrative primary care specialty, Magee said.
The society is also working with the American College of Physicians to bring more nurse practitioners and physician assistants into primary care offices to ease the crunch. Medical schools are being encouraged to highlight the need for primary care physicians. Fewer than 30 percent of medical school graduates in Massachusetts choose primary care, while 50 percent or more would be ideal, Magee said.
A separate Physician Practice Environment Index published by the medical society last year has shown a 13-year decline. Rising costs of doing business, including liability payments, and declining income account for much of the deterioration, the society said.
Today’s survey said that 86 percent of doctors believe that over the next five years their salaries will either decline or remain the same. About a quarter (24 percent) said they are planning or considering a move out of Massachusetts.
If given the chance, just over half (51 percent) said they would choose medicine again as their profession.
Posted by Elizabeth Cooney at 06:48 PM
July 24, 2007
Almost two years after Hurricane Katrina, nearly a third of the people who live along the coastline from North Carolina to Texas say they would not evacuate if ordered to do so, according to a Harvard survey, up from almost a quarter of people who told researchers last year they would stay in their homes.
Fewer people who live in the New Orleans metropolitan area –- 14 percent –- said they wouldn’t leave. But 61 percent of the respondents in the New Orleans area said they didn’t know where the nearest shelter was, and 54 percent were sure they would be rescued if they stayed home.
"Public officials need to be concerned that the further we get from the severe hurricanes of 2005, the less willing people are to evacuate," Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health, said in comments released with the survey today. "Officials need to remind people that many homes are vulnerable to major storms. They also need to ensure safe evacuation routes are available and the public is aware of them."
The latest survey, conducted last month, asked 5,406 people who lived in counties within 20 miles of the Atlantic Ocean or the Gulf of Mexico how prepared they were for a hurricane. Almost half of them had lived in places that had already been hit by damaging hurricanes.
Three-quarters of residents who said they wouldn’t leave thought their homes would be safe during a hurricane. More than half were afraid that evacuation routes would be too crowded; about a third worried that leaving would be dangerous; and a third also were concerned about theft or damage to their homes. About a quarter didn’t want to leave their pets.
If they did have to leave their homes, about two-thirds said they were most concerned that shelters would be dirty, lack clean water and be too crowded. Almost two-thirds of respondents thought they would be exposed to sick people and have no medical care.
Posted by Elizabeth Cooney at 05:27 PM
July 24, 2007
By Alice Dembner, Globe Staff
Pads designed to protect human hips do not help the most vulnerable patients avoid hip fractures, according to a study led by a Boston researcher that is being published tomorrow in the Journal of the American Medical Association.
The study tested specially designed hip protectors in more than 1,000 residents of nursing homes in greater Boston, St. Louis and Baltimore. It was halted after 20 months when it became clear that the pads were offering no protection.
Hip fracture in the elderly can trigger a cascade of medical problems that result in the death of nearly 30 percent of patients a year after the break. Most of the fractures result from falls, and falls are particularly common among nursing home residents.
Led by Dr. Douglas Kiel, director of medical research at Hebrew SeniorLife, the study was unique in its design -- with patients wearing protectors on one hip and not the other, using special undergarments. The research was an attempt to provide a definitive answer after a number of other studies that offered conflicting results.
But in an accompanying editorial, two doctors from Finland say more research is still needed, because there are so many different hip protectors available and because wearing the pads on one hip and not the other might have physically unbalanced the residents.
Kiel and two other authors drew fire today from the Associated Press for not disclosing to the journal their financial ties to companies that make bone-protecting drugs. Kiel and JAMA’s editor, Dr. Catherine DeAngelis, called the drug ties irrelevant to the study.
Kiel told the AP that the drugs take at least a year to work and therefore are not ideal for nursing home residents. The study also did not attempt to compare the effects of drugs to hip protectors.
"We have no financial disclosures with hip protectors," Kiel told the AP. "We were asked repeatedly by the editors whether we were following JAMA's full disclosures and we said yes."
Posted by Karen Weintraub at 04:00 PM
July 24, 2007
A jury today found in favor of two Massachusetts General Hospital surgeons who had been sued for malpractice by University of Notre Dame football coach Charlie Weis, who bled internally after gastric bypass surgery five years ago.
The Suffolk Superior Court jury found that surgeons Charles Ferguson and Richard Hodin were not negligent in their care of Weis, former offensive coordinator of the New England Patriots who nearly died after the 2002 obesity surgery and testified that he still has difficulty walking.
Internal bleeding is a known complication of gastric bypass surgery, and the doctors argued that they waited to perform a second operation to stop the bleeding because they thought it would stop on its own and were concerned about risks of further surgery.
The first trial of the malpractice suit ended dramatically in a mistrial in February, after the surgeons rushed to the aid of a juror who had collapsed in the courtroom.
Posted by Gideon Gil at 03:26 PM
July 24, 2007
Boston-based Reach Out and Read, which promotes reading among low-income children, was awarded a literacy prize from the United Nations Educational, Scientific and Cultural Organization (UNESCO) -- one of only five awarded worldwide.
The group, which hands out free books to children when they visit the doctor, was founded in 1989 by Dr. Barry Zuckerman and Dr. Robert Needleman at what was then Boston City Hospital (now Boston Medical Center). The goal is to encourage parents to read to their children and prepare low-income children for school.
Posted by Elizabeth Cooney at 11:25 AM
July 24, 2007
Joslin Diabetes Center is expected to disclose today that it has found a new partner to build a $300 million biotechnology laboratory on land it owns in the Longwood Medical Area.
People who drank more than one diet soda each day developed the same risks for heart disease as those who downed sugary regular soda, a large but inconclusive study found.
The US Senate is expected to vote this summer on a bill that could help enhance access to mental health treatment for more than 113 million Americans by requiring that private health insurance provide equal coverage for mental health treatment, Dr. Russ Newman, executive director for professional practice for the American Psychological Association, writes on the op-ed page. In New England almost 6 million people could benefit.
Posted by Elizabeth Cooney at 06:36 AM
July 23, 2007
By Felicia Mello, Globe Correspondent
After losing a foot and part of a leg to a landmine during the invasion of Iraq, Garth Stewart is determined to keep active. The 24-year-old retired Army specialist makes time for jujitsu and boxing in between history classes at Columbia University in New York. Still, sometimes the artificial limb he uses can't keep up with his busy schedule.
"Your hip ends up doing so much work because it has to draw the foot forward," he said. "At the end of the day you have soreness in your back."
Hoping to help Stewart and others who have lost limbs walk more normally, a team of researchers from MIT, Brown University and the Providence Veterans Affairs Medical Center today unveiled the first motor-powered prosthetic foot. The computer-controlled appendage can relax or stiffen in response to changing terrain, propelling the wearer forward more quickly and reducing fatigue.
"The ankle kind of has a mind of its own," Stewart said in a telephone interview, after demonstrating the device in front of an audience of reporters and fellow amputees at the medical center. "At first I felt like it was fighting me, but once I got accustomed to the rhythm, it felt like having my leg back."
The US Department of Veterans Affairs, which spent $7.2 million to develop the prosthesis, has poured resources into creating better aids for the large number of wartime amputees returning from Iraq and Afghanistan. Six percent of soldiers wounded in the Iraq conflict have required amputation of a limb, compared with 3 percent in previous wars, according to a 2004 US Senate report.
"One of the things that's different about this war is that soldiers are surviving injuries that formerly would have been fatal, due to advances in field medicine and also the fact that soldiers are protected with Kevlar body armor," said Robert Swift, associate chief of staff for research at the medical center. "However, what's not protected is their limbs."
Seventy percent of leg amputees suffer from back problems caused in part by traditional prostheses, said Hugh Herr, a Massachusetts Institute of Technology professor and a double amputee who helped develop the device and tested it on himself.
Herr said in an interview that he and his colleagues "stole ideas from nature" to create the prosthesis, which is heavier than a conventional artificial foot but requires less energy to walk. It uses a motor instead of muscle and springs to replace the stringy tendons that connect muscle to bone.
The researchers plan to begin clinical trials on the prosthesis in March.
Herr said he and his team are also working on developing artificial limbs that would be controlled directly by the brain rather than by a computer, by taking advantage of the 'phantom limb' phenomenon in which an amputee's brain tries to move an appendage that is no longer there.
Posted by Gideon Gil at 07:23 PM
July 23, 2007
Surprise: On Running a Hospital, Paul Levy, president of Beth Israel Deaconess Medical Center, says the Joint Commission, which accredits hospitals, showed up this morning for an unannounced visit. Until last year, these periodic reviews of safety and quality were scheduled in advance, but now hospitals get no warning. The accrediting body, which used to be called the Joint Commission on Accreditation of Healthcare Organizations, will spend a week at the hospital.
"And, yes, we will publish our results once they go through the process of review at the Joint Commission headquarters," Levy writes.
Sugarcoating: On Healthy Children, Boston Medical Center pediatrician Dr. Steven Parker explores how doctors use euphemisms. Their intentions may be good, but they can end up creating confusion, he says.
"I know why this happens so often. Nice guys and compassionate to a fault, we pediatric providers hate to give bad news and avoid it when we can," he writes. "We think we are doing the family a favor: doesn't 'developmentally delayed' sound so much more hopeful, so much nicer, than 'mentally retarded?' "
HIPAA help: On WBUR's CommonHealth, Lori Abrams Berry of the Lynn Community Health Center worries that undocumented immigrants are being told that community health centers must report them to immigration officials if they seek health care.
"We need to find as many ways as we can to put the word out that community health centers are NOT obligated to report undocumented patients to immigration authorities," she writes. "On the contrary, HIPAA regulations actually prohibit us from giving information about our patients to anyone without their permission. (Who knew how handy this would turn out to be?)"
Posted by Elizabeth Cooney at 04:32 PM
July 23, 2007
The Friday Evening Lecture Series at the Marine Biological Laboratory in Woods Hole continues with a presentation by Robert S. Langer of MIT about biomaterials and how they will change our lives. At 8 p.m. in the Lillie Auditorium, 7 MBL Street. Call 508-289-7423, or go to www.mbl.edu/fel.
Posted by Karen Weintraub at 11:40 AM
July 23, 2007
Maritza Ciliberto (left, with her mother) is reaching out to Latinos and teaching health professionals how to address cultural barriers to dementia care, part of a stepped up effort nationally by the Alzheimer's Association and others.
Adding folic acid to most breads, pastas, rice, and other grain-based foods has been a spectacular success in preventing neural tube birth defects, but it may have also led to an unintended consequence: an estimated 15,000 more cases of colon and rectal cancer each year than there otherwise might have been, a study suggests.
The BioSuit, a prototype spacesuit recently completed by scientists at the Massachusetts Institute of Technology, will be the first new look for astronauts in more than four decades, replacing the lumpy, awkward 300-pound outfit with something worthy of a super hero.
Orrie Friedman (left), a pioneer of biotechnology, dreams of developing a viable treatment for Alzheimer's disease, which contributed to his brother's death three years ago, and endowing a biomedicine institute at Brandeis University in his name.
Also in Health/Science, why turmeric stains and whether group therapy helps breast cancer patients.
Growing numbers of Mainers are contracting a staph infection that is resistant to commonly used antibiotics.
From bringing healthcare to housing projects and raising awareness in the medical community and among patients during early years of AIDS to obstetrics and gynecology work in recent years, Carol London (left) wore many uniforms during a career of helping others in their time of need. Mrs. London, 55, died of cancer July 12 at her Newton home.
Posted by Elizabeth Cooney at 07:20 AM