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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
Contributors
Boston Globe Health and Science staff:
Scott Allen
Alice Dembner
Carey Goldberg
Liz Kowalczyk
Stephen Smith
Colin Nickerson
Beth Daley
Karen Weintraub, Deputy Health and Science Editor, and Gideon Gil, Health and Science Editor.
 Short White Coat blogger Ishani Ganguli
 Short White Coat blogger Jennifer Srygley
Week of: November 4
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« October 21, 2007 - October 27, 2007 | Main | November 4, 2007 - November 10, 2007 »

November 2, 2007

Attorney General announces review of Caritas

By Chris Reidy, Globe Staff

Massachusetts Attorney General Martha Coakley announced today that she will work with a consultant to conduct a review of the Caritas Christi Health Care System.

Caritas Christi is owned by the Archdiocese of Boston, which has been exploring a possible sale of the six-hospital system, the second largest in New England.

In the past year, the archdiocese attempted to transfer ownership of the Caritas Christi system and its $275 million in debt to two successful Catholic healthcare chains, but was unable to reach a deal with either system, the Globe has reported.

"With the recent termination of affiliation discussions with other systems, we believe it is now an appropriate time to conduct a more focused review of Caritas on a stand-alone basis," Coakley said in a statement today.

Coakley's office said it will partner with Health Strategies and Solutions, a healthcare consulting firm that has provided consulting services to the attorney general's office for the last three years, in conducting the review.

The attorney general's office is responsible for overseeing the public's interest in the viability of the commonwealth's nonprofit charitable hospitals.

Coakley's press release included a statement from John Chessare, president and chief executive of Caritas Christi.

"We work with the attorney general's office on a regular basis, and we look forward to continuing to work with them while providing exceptional healthcare," he said.

November 2, 2007

Compassionate caregiver connects with patients and families

barbara%20moscowitz%2085.bmpBarbara Moscowitz (left) thinks older adults are overlooked by people who can't see past their walkers and hearing aids, their illnesses and infirmities, to the human beings inside.

"I want to live in a universe that will see me not as a long list of chronic diseases but as an individual first who might have to cope with illness," Moscowitz, 54, said in an interview.

For her work at Massachusetts General Hospital with people with Alzheimer's and their families, she received the Kenneth B. Schwartz Center's Compassionate Caregiver of the Year Award last night at a dinner attended by 1,700 people. The honor is named for the Boston lawyer who, while being treated for the lung cancer he would die of, wrote movingly in the Boston Globe magazine about how his caregivers' human touch "made the unbearable bearable."

Coordinator of geriatric social work at Mass. General, Moscowitz focuses on the needs of families confronting their loved ones' diagnosis with Alzheimer's disease.

"So many families of Alzheimer's patients need so much support and guidance. It's like learning a new language," she said. "It just disturbs me greatly that a lot of people are given a diagnosis and then a web site or telephone number and told to go off and figure it out."

Moscowitz gave unwavering assistance to Kasey Kaufman when her mother was slipping away into the fog of dementia, the former CBS4 reporter said in a letter nominating Moscowitz for the Schwartz award.

"I like to say that Barbara saved our lives but that would be telling only part of the story," she wrote. "Barbara helped us to understand my mom's illness."

Kaufman's mother called Moscowitz "that tiny gal with the big heart," Kaufman's letter said.

Patricia Bresky, a psychologist in California, said in her first phone conversation with Moscowitz, she grasped not only her father's medical condition but also the family dynamics.

"For the first time since the onset of my father's symptoms two years before, I felt the ground beneath me," Bresky said in a letter to the Schwartz Center.

Moscowitz said she values the Schwartz Center's work to keep human connections alive in healthcare that can be hurried.

"They are the penicillin for what ails medicine now," she said.

Posted by Elizabeth Cooney at 09:18 AM
November 2, 2007

Today's Globe: overdose antidote, Carney's future, child health bill

State health authorities will start supplying addicts next month with a kit containing two doses of a medication that can reverse a potentially lethal overdose within minutes, hoping to reverse a tide of heroin deaths sweeping Massachusetts.

carney%20lobby%20150.bmpBoston officials led by City Council president Maureen Feeney are asking the Archdiocese of Boston to cut Caritas Carney Hospital loose from the Caritas Christi Health System so it can look for a buyer on its own.

A defiant Democratic-controlled Congress voted yesterday to provide health insurance to an additional 4 million lower-income children, ignoring President Bush's threat of a second straight veto on the issue.

Posted by Elizabeth Cooney at 06:45 AM
November 1, 2007

Short White Coat: Decisions, decisions

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

ishani 2.JPG

On Tuesday night, I witnessed a near-riot -- during yet another class meeting to explain how we’ll be affected by the med school’s new curriculum.

In the next two weeks, we’ll have to rank our choices for the hospital where we’ll spend almost all of our waking and sleeping hours in our third year of medical school. Though recent pilot programs have tested out the so-called longitudinal approach to our clinical training (read: spend the year in one hospital instead of several), it will be required for the first time for the class of 2010. This translates into what would seem an important choice.

But any merits of the new plan aside, the administration managed to ruffle some feathers in communicating this information to us.

Students clamoring for information about what to expect while faculty seemingly don't want to ruin the surprise -- it’s been a bit of a theme ever since the curriculum was unveiled last fall. This time, we were left wondering how to make the decision, and whether it even mattered in the first place.

For Tuesday’s meeting, we packed into our familiar lecture hall, plied with Sicilian pizza and bottled water. The event began unpromisingly, with a PowerPoint slide explaining how the changing practice of medicine -- and not the “otherwise excellent” HMS system -- should be blamed for any grievances we might have with our third year. We heard the usual curriculum buzzwords like integrative and multidisciplinary, and were presented with impossibly quantitative demonstrations of how they planned to “make our lives palatable” in the coming year.

The crowd was soon frothing at the mouth for something tangible on which to hang our decisions. We wanted to see the heads of each hospital's third-year clerkship affirm or deny the stereotypes so often heard in passing from third-year veterans -- for example, that Massachusetts General Hospital is for pre-surgery gunners who relish overnight stays, while the Beth Israel Deaconess program caters to the overly self-reflective.

But such distinctions were obfuscated by administrators who urged us to focus on the similarities between the programs and dismissed factors such as parking and geography as inconsequential. Data were thrown at us to prove that all students were happy wherever they went. Demands for pro/con lists and bullet-pointed hospital highlights were deftly sidestepped. And then they told us we had to make a decision.

(A hapless fourth-year envoy, not picking up on the palpable hostility in the air, took this moment to remind us how magical our wards experience would be, no matter where we were. Surprisingly, nothing was thrown at him.)

Near the end of the two hours, one particularly grounded hospital medical education head conceded that this issue had been anticipated in planning meetings. But the frustrations remain. Until all of our administrators sort out their mixed messages, perhaps we should just shake off this self-imposed burden of informed decision-making and embrace the bliss of random choice.

Excuse me while I find a hat to pick out of. But wait, did you just say Mass. General has parking? It’s going to be a long two weeks.

Posted by Ishani Ganguli at 04:18 PM
November 1, 2007

On the blogs: advice for Big Papi, primary-care pressures

Everyone has a piece of advice for the World Champion Boston Red Sox, even healthcare advocates. Although it seems unlikely that he asked, Health Care For All's Consumer Health Quality Council member Linda Klein has suggestions for slugger David Ortiz when he has knee surgery.

"I understand you will be undergoing knee surgery soon," she wrote. "Enclosed please find a list of steps patients can take to protect themselves from infection."

Saying independent primary care practice has become impossible, Kevin, M.D. links to a Concord (N.H.) Monitor story about five primary care doctors who left a Dartmouth-Hitchcock group practice to strike out on their own to avoid what they called micromanagement from the hospital. After eight years, they returned to hospital ownership, the story says. It's the second group Concord Hospital has bought this year, according to the paper.

"The bottom line is it's about money," Dr. Frank Betchart told the Monitor. "The expenses and costs of doing business were going up and the revenue was flat, and there wasn't anything we could do to counter that except seeing more patients, which didn't make sense."

Posted by Elizabeth Cooney at 01:46 PM
November 1, 2007

Driving and dementia: when to take the keys

By Elizabeth Cooney, Globe Correspondent

A diagnosis of Alzheimer's disease does not automatically mean an end to driving, experts on aging said at an MIT conference today, but because there is no test to determine when people with dementia should no longer get behind the wheel, families need help deciding when to take away the keys.

"All people with Alzheimer's will eventually be unable to drive," said Robert Stern, co-director of Boston University's Alzheimer's Disease Clinical and Research Program. "That does not mean they can't drive early on in the disease. Everyone has a different course. It steals cognitive skills at a different pace."

Caregivers say their loved ones with Alzheimer's are driving an average of 10 months longer than they think is safe, gerontologist Jodi Olshevski of The Hartford said. The insurance company collaborated with MIT's AgeLab and BU to find ways to help caregivers spot -- and then deal with -- the warning signs of trouble.

Family members helped test workshops and written materials that explained how to assess driving skills and how to start the discussion about ending driving. Today the group released a new version of "At the Crossroads," first published in 2000. The booklet for families and materials for support group leaders are available free through The Hartford.

Posted by Elizabeth Cooney at 11:08 AM
November 1, 2007

Grand Rounds gets personal

Paul Levy says his blog Running a Hospital gets the most responses not when he talks policy or science, but when he shares personal stories he comes across as CEO of Beth Israel Deaconess Medical Center. That's why, when his turn came to host this week's edition of medical blogging's Grands Rounds, he solicited entries about personal experiences that changed the writer's behavior or beliefs.

Sometimes the writer is a patient, sometimes a caregiver and sometimes both. A Philadelphia nurse anesthetist writes about her harrowing experience as a patient with what is benignly titled "awareness under anesthesia."

"My horrific experience under anesthesia has empowered me to become a strong listener, a better CRNA, a more genuine patient advocate, and a more caring person," Terry Freemark writes on her blog, Counting Sheep. "I try to tune in to my patients’ preoperative anxieties, and I pay particular care and diligence to ensuring that their anesthetic experience is optimized to their comfort, well-being, and safety. To do anything less for my patients would be diminishing to the standards of my profession, to what I’ve lived through, and to who I am."

She'll be hosting next week's Grand Rounds. The subject is pain.

Posted by Elizabeth Cooney at 11:03 AM
November 1, 2007

Today's Globe: brain abnormalities in seniors; meat, fat and cancer; pink dominoes; Leslie Orgel

One in 60 older people may be walking around with benign brain tumors and not know it. Even more may have bulging blood vessels in the head that could burst, according to a surprising Dutch study that finds brain abnormalities are not very uncommon.

Excess body fat and red meat are linked to an increased risk of common cancers and should be avoided, the World Cancer Research Fund and the American Institute for Cancer Research said.

We march, we pin ribbons, we buy anything from anyone who will give a percentage to breast cancer research. While we are selling bracelets, the government is leading the charge to destroy the mammography field, Monique Doyle Spencer, author of "The Courage Muscle: A Chicken's Guide to Living with Breast Cancer," writes on the op-ed page

Leslie Orgel, the Salk Institute theoretical chemist who was the father of the RNA world theory of the origin of life and who joined with Nobel laureate Francis Crick to postulate that life might have been seeded on Earth by a higher intelligence, died at the San Diego Hospice & Palliative Care on Saturday from pancreatic cancer. He was 80.

Posted by Elizabeth Cooney at 06:25 AM
October 31, 2007

Today's Globe: doctors seek protection for apologies, vitamin D and cancer

Consumers, insurers, and regulators are pushing for openness about medical errors, but Massachusetts doctors believe they need a change in state law so what they say cannot be used against them in a court of law.

A large new study found no sign that vitamin D lowers the overall risk of dying from cancer, injecting a note of caution to the latest vitamin craze. The exception: People with more vitamin D in their blood did have a significantly lower risk of death from colorectal cancer, supporting earlier findings.

Posted by Elizabeth Cooney at 06:40 AM
October 30, 2007

One in eight veterans under 65 is uninsured, study finds

By Elizabeth Cooney, Globe Correspondent

Most Americans might think that veterans automatically have healthcare from the government, but one in eight working-age veterans is uninsured, a study from Cambridge Health Alliance reports.

Healthcare at Veterans Health Administration hospitals and clinics is limited to veterans who have service-related conditions or who have incomes of less than about $30,000 a year, depending on where they live. That leaves many middle-income veterans under 65 without coverage of any kind, mirroring the situation of other uninsured groups, Dr. Steffie Woolhandler, author of the study in the American Journal of Public Health, said in an interview.

“I and I think a majority of Americans had assumed that all veterans were automatically eligible for healthcare, and this in fact was true in the late 1990s,” she said. Now “the majority of middle-income veterans are excluded.”

A 1996 law opened VA care to all veterans, with a $50 co-pay for those were not classified as poor. But in 2002, regional directors were told not to market enrollment to new veterans because demand was exceeding resources, according to a department memo quoted in the journal article. Then in 2003, enrollment was halted for most veterans without qualifying medical conditions or incomes.

Using government data, Woolhandler and her co-authors found 1.8 million veterans who were uninsured and not receiving VA care in 2004, the most recent year available. That represented an increase of 290,000 since 2000. They also identified 3.8 million family members of those veterans who also had no health insurance. Together they account for 12.2 percent of the 47 million uninsured people in the United States.

“This really epitomizes the uninsured in the United States. They are working-age families earning too little to be able to afford to buy health insurance but too much to qualify for Medicaid,” she said.

The typical uninsured veteran is a 45-year-old man who has worked in the past year and is earning from $30,000 to $40,000 a year, Woolhandler said.

“Our soldiers serve so we don’t have to. They’re serving and protecting us,” she said. “They’re holding up their part of the bargain and when they come home, we’re really saying we as a society don’t have any obligation to serve and protect them by providing healthcare.”

Posted by Elizabeth Cooney at 05:13 PM
October 30, 2007

Specialist referrals for imaging vary with who does the test, Mass. General study says

Doctors who send their patients for imaging tests to someone in their own specialty order diagnostic imaging more frequently than doctors who refer their patients to radiologists, Boston researchers report.

The reason for the difference may be financial, radiologist Dr. G. Scott Gazelle of Massachusetts General Hospital said in an interview about his article in the November issue of Radiology.

But that's impossible to know from the study's results, Dr. Nicholas DiNubile, a spokesman for the American Academy of Orthopedic Surgeons, responded in an interview, saying numbers of MRIs, CT scans, and X-rays alone can't determine whether they are ordered too often or not enough.

Looking at a national database of outpatient visits for such conditions as heart problems, broken bones, joint pain or suspected stroke, Gazelle and his team from the Institute for Technology Assessment at Mass. General found that physicians ordered imaging tests up to twice as often if they referred patients to doctors in their own specialty such as cardiology, orthopedics or neurology, compared with doctors who sent their patients to radiologists.

Previous research has indicated that doctors may order more scans when referring patients to a facility they own, but the authors of the new study decided to look at same-specialty referrals overall, rather than only referrals doctors made to imaging facilities they own. Gazelle said the authors made that choice in light of laws intended to curb self-referral that restrict some Medicare payments to doctors who refer patients to themselves.

"People are much more clever about it now," said Gazelle, who is on the board of chancellors of the American College of Radiology. "Same-specialty referral is in my view a proxy for self-referral."

All imaging has grown rapidly over recent years, but imaging done by non-radiologists has grown faster than imaging by radiologists, the study notes.

"I don't have a problem if a cardiologist or an orthopedist interprets imaging studies if they are qualified and do a good job," Gazelle said. "I do have a problem with the financial motivation to overuse it."

DiNubile, a knee specialist in Havertown, Penn., whose 25-surgeon group has its own imaging center staffed by a radiologist, said there is a turf war between specialists and radiologists who want to get back their business. He faults the study for not saying who owned the imaging facility where patients are being sent.

"The real question is whether that increases referrals when the physician owns his own shop," he said.

A better way to evaluate utilization rates would be to examine the imaging tests themselves to see if they were ordered appropriately, DiNubile said. Too many normal readings would suggest that too many tests are being ordered, for example.

"You always want to be sure to do the right thing," DiNubile said. "Is the right thing more utilization or less?"

Gazelle said the study was not intended to measure the quality of the imaging tests.

"The issue is we are using societal resources to pay for healthcare," he said. "We all ought to be ordering studies for the same reason."

Posted by Elizabeth Cooney at 01:39 PM
October 30, 2007

Scientists rate Mass. General best place to work

Massachusetts General Hospital is the best place to work in academia, according to a survey of scientists by The Scientist. Beth Israel Deaconess Medical Center ranked 10th and Dana-Farber Cancer Institute came in 34th in the magazine's list of top 40 US academic institutions.

The poll asked respondents to rate their working environment. Mass. General scored high in job satisfaction, peers, management and policies, and infrastructure and environment, the magazine reports in its November issue, which will go online tomorrow.

The Top 15 institutions in the U.S.:

1. Massachusetts General Hospital, Boston, MA
2. National Cancer Institute-Frederick, Frederick, MD
3. Clemson University, Clemson, SC
4. Purdue University, West Lafayette, IN
5. Trudeau Institute, Saranac Lake, NY
6. St. Jude Children's Research Hospital, Memphis, TN
7. The J. David Gladstone Institutes, San Francisco, CA
8. University of Nebraska - Lincoln, NE
9. University of Texas Southwestern Medical Center, Dallas, TX
10. Beth Israel Deaconess Medical Center, Boston, MA
11. University of Texas M.D. Anderson Cancer Center, Houston, TX
12. Duke University, Durham, NC
13. Wadsworth Center, Albany, NY
14. Georgia Institute of Technology, Atlanta, GA
15. Mayo Clinic, Rochester, MN

Posted by Elizabeth Cooney at 10:36 AM
October 30, 2007

Today's Globe: child healthcare bill, going the distance, Mt. Auburn gift, out in the cold

President Bush and other critics of a $35 billion spending increase for children's health insurance say they'll support expanding coverage to families of four making as much as $62,000 a year, but they want to limit states' ability to go beyond that level.


nova%20marathon%20150.bmpTonight "Nova" shows that anyone can run 26.2 miles. It tells the story through 13 self-described sloths, a group handpicked to test if somebody can go from the couch to the finish line of the Boston Marathon in only nine months. Tufts University former longtime swim coach Donald Megerle and nutrition professor Miriam Nelson got the team ready for Hopkinton.

frank%20stanton%2085.bmpMount Auburn Hospital of Cambridge said it received its largest donation ever, from a charity founded by Frank Stanton (left), the legendary CBS executive who died in December at 98. The $6.5 million gift from the Ruth and Frank Stanton Fund was made public Saturday. The hospital will name its new building, currently under construction, for Frank Stanton.

The recommendation barring the sale of all over-the-counter cold medications for children under 6 dramatizes the tension between policy makers and academics who advocated for the ban and rank-and-file pediatricians and parents who have to deal with ill children, Dr. Darshak Sanghavi, a pediatric cardiologist at the UMass Medical School, writes on the op-ed page.

Posted by Elizabeth Cooney at 06:55 AM
October 29, 2007

Today's Globe: power of music, old drug and new hope, pediatrician's cough conundrum, overdue kudos

Just why evolution would have endowed our brains with the neural machinery to make music is a mystery. What is clear is that the brain is abundantly wired to process music.

blake%20althaus%20100.bmpBlake Althaus (left) wasn't expected to live much past his second birthday. A genetic disorder was weakening muscles throughout his body, as well as his aorta, the main artery from his heart - leaving him lethargic and nearly immobile. Then a Baltimore researcher following a medical hunch, discovered that a years-old blood pressure medication seemed to reverse the symptoms of his disease, known as Marfan syndrome.

In my 30 years as a pediatrician, the only side effects I've seen from the cough medications - including the ones pulled by drug companies - were occasional sleepless nights (rather than drowsiness) caused by antihistamines, writes Dr. Victoria Rogers McEvoy, is chief of pediatrics and medical director of the Mass. General West Medical Group and assistant professor of pediatrics at Harvard Medical School.

william%20hinton%2085.bmpDr. William Hinton (left) developed the test for syphilis in 1927. But the son of slaves, he kept a low profile because of the racism of his time. Forty-eight years after Hinton's death, the Boston History & Innovation Collaborative will honor Hinton's contributions to healthcare on Nov. 13.

Also in Health|Science, why can't we capture lightning and convert it into usable electricity and is it possible to literally die of a broken heart?

Posted by Elizabeth Cooney at 06:46 AM
October 29, 2007

In case you missed it: trail of misery, wired for excitement, drive-through flu shots, reaching the uninsured, Caritas review, Arthur Kornberg, Gian F. Poggio

robert%20whitney%20300.bmp
Robert Whitney said he was a victim of hernia repair
surgery performed by Dr. Jose Veizaga-Mendez.
(Aram Boghosian for The Boston Globe)

Massachusetts regulators have alleged that Dr. Jose Veizaga-Mendez provided dangerously substandard care to at least eight patients from 2000 to 2003, including two who died as a result. But, by the time Massachusetts officials lodged formal charges against Veizaga-Mendez in January, the Bolivia-trained surgeon had already moved on to a new job at a veterans' hospital in rural Illinois - where he is in deep trouble again. The case illustrates an oversight system that sometimes protects doctors' rights at the expense of patients, Scott Allen reports in Sunday's Globe.

Red Sox fans experience many highs and lows while watching the team. MIT researchers and one diehard supporter put those emotions to the test during Game 1 of the World Series.

flu%20shot%2085.bmpIn a new twist on drive-through convenience, patients at Caritas Norwood Hospital next week can get a flu shot while idling in their cars, much like they would pick up a coffee or a burger at a fast-food window. State officials say it may be the first such offering in the state.

More than 12,000 people sought charity care at New Bedford area hospitals in the last 18 months, and free or subsidized health insurancewould seem to be an easy sell. But less than one-third of those 12,000 low-income people have signed up, despite aggressive efforts to promote the state's insurance programs. The problem highlights the challenge Massachusetts faces as it tries to reach its landmark goal of near-universal coverage, Alice Dembner writes in Saturday's Globe.

Attorney General Martha Coakley is examining the finances of Caritas Christi Health Care and its troubled hospital in lower Dorchester, Caritas Carney Hospital.

roger%20and%20arthur%20kornberg%20150.bmpDr. Arthur Kornberg (with son Roger, at left), whose test-tube synthesis of DNA earned him the Nobel Prize in 1959, died of respiratory failure Friday at Stanford Hospital, the hospital said. He was 89. One of Dr. Kornberg's sons, Dr. Roger Kornberg, won the 2006 Nobel Prize in Chemistry for his work studying the enzymes that create RNA.

Dr. Gian F. Poggio, a retired Johns Hopkins Hospital professor who worked in vision and brain research, died of Parkinson's disease complications Oct. 19 in Genoa, Italy. The former Roland Park, Md., resident was 80.


Posted by Elizabeth Cooney at 06:44 AM
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