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Monday, November 12, 2007

Long-term beta carotene use may help aging brains, study suggests

By Elizabeth Cooney, Globe Correspondent

Older men in good health who took beta carotene for about 18 years had better memory skills than similar men who took a placebo for the same length of time, a Harvard study shows.

The antioxidant, found in carrots, showed no benefit when taken for only three years, pointing to long duration as a critical factor in possibly slowing cognitive decline, which is a strong predictor of dementia.

The improvement was modest: Brain aging was delayed by about a year in men who took beta carotene long-term, author Francine Grodstein of Brigham and Women’s Hospital said in an interview. The study appears in today’s Archives of Internal Medicine.

She cautioned that it was too soon to recommend that men take beta carotene supplements. Beta carotene also has risks: Previous research has connected beta carotene to increased rates of lung cancer in smokers.

“Even though the changes that we saw are relatively modest, it is known that even modest changes in your memory can have a pretty big impact on the risk of dementia over the long term,” Grodstein, an associate professor of medicine at Harvard Medical School, said. It's the first study, she added, to find something that may help healthy people's memory.

The study followed about 6,000 men enrolled in the Physicians’ Health Study II over two time periods. They were given either 50 milligram pills of beta carotene or a placebo every other day. The first group participated for an average of 18 years and the second group for up to three years. They took tests of memory over the phone.

There was no improvement in the men who took beta carotene for the shorter time. The men who were on long-term beta carotene treatment did better, showing delays in cognitive aging of one to one and a half years, the study says.

In an accompanying editorial, Dr. Kristine Yaffe of the University of California, San Francisco, says it's plausible that long-term treatment may be necessary to have an effect on a disease that takes a long time to develop. But she also suggests there may be other interpretations of the results. In particular, she notes that the study doesn’t consider whether the men who took beta carotene for 18 years, staying in the study until it's completion, might be somehow different from men who did not continue to participate in the trial.

“For the clinician, there is no convincing justification to recommend the use of antioxidant dietary supplements to maintain cognitive performance in cognitively normal adults or in those with mild cognitive impairment,” she writes.

Grodstein said being conservative is appropriate.

“We don’t want to tell people to run out and start taking it immediately,” she said. “If we keep doing the research and keep working at it, it should give people hope we are going to be able to find something to help them keep their memory.”

Posted by Elizabeth Cooney at 05:01 PM

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Tuesday, November 6, 2007

Two Brigham surgeons top list of device maker payments

By Elizabeth Cooney, Globe Correspondent

Two Boston orthopedic surgeons each received $6.75 million this year from a maker of joint replacement implants, the largest among hundreds of payments revealed in a $311 million settlement of a federal criminal case that alleged five companies paid doctors to use their products.

Dr. Richard Scott and Dr. Thomas Thornhill of Brigham and Women's Hospital were paid royalties and consulting fees this year by the Johnson & Johnson subsidiary DePuy Orthopaedics, according to documents made public by the company last week. DePuy makes implants used in hip and knee replacements.

Four other companies -- Zimmer Inc., Biomet Orthopedics Inc., Smith & Nephew Inc. and Stryker Orthopaedics -- were also part of an agreement with the US Department of Justice. The five companies, which together share 95 percent of the market for hip and knee implants, were being investigated for using consulting agreements with orthopedic surgeons to influence their choice of implants. Making payments was a common practice from 2002 through 2006, according to the US Attorney's Office in New Jersey.

The disclosures come as payments to doctors by device and drug companies come under increasing scrutiny because of concerns they create a financial conflict for physicians. But the industry, and many doctors and hospitals, defend the practice, saying it fosters innovation and properly rewards physicians for helping to develop new treatments.

Without admitting fault, the device companies agreed to make public their lists of payments for this year. Michael Drewniak, a spokesman for the US Attorney's Office, said in an interview yesterday that this year's payments were similar to amounts in previous years his office examined. More than 40 surgeons were paid $1 million or more this year, the lists showed.

Scott and Thornhill said in a statement supplied by Brigham and Women's that the royalties come from their design of a knee replacement implant licensed to J&J in 1986 and a hip replacement implant licensed in 1991. They said they donate their fees from consulting to charity.

"We are both very proud of the work we have done over the years to advance the mission of orthopedic medicine," their statement said.

Scott and Thornhill do not receive royalties when they or any other surgeons use their implants at the Brigham, they said. They did not break down the amounts of royalties and fees, nor were they available to comment beyond their statement.

DePuy, which will pay a fine of $84.7 million, issued a statement last week saying, "The surgeons who received the most significant compensation from DePuy Orthopaedics contributed intellectual property and ongoing expertise to the development of products."

Zimmer listed 15 Massachusetts General Hospital surgeons who received payments totaling $8.7 million this year. The hospital said in a statement that the money represents royalties for developing materials in the 1990s that are used in implants, and that the money goes to the hospital. Mass. General does not get royalties for implants that its surgeons use at the hospital.

"Ongoing research in orthopaedic surgery has led to enhancements in strength and durability of the materials, and the MGH continues to work with industry, including Zimmer and Biomet, to license and patent innovations that will benefit patients now and in the future," the hospital statement said.

Criminal complaints were filed against four of the five implant makers, charging them with conspiring to violate the federal anti-kickback statute, the US Attorney's office said, but the complaints will be dismissed if the companies comply with terms that include federal monitoring for 18 months and five-year corporate integrity agreements. Stryker cooperated with the investigation before the other companies and has entered a non-prosecution agreement with the government.

Zimmer will pay a fine of $169.5 million, Smith & Nephew will pay $28.9 million, and Biomet will pay $26.9 million.

Posted by Elizabeth Cooney at 06:18 PM

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Thursday, October 25, 2007

Brigham to study health IT and medication safety

Brigham and Women’s Hospital has won federal funding to study how health information technology can help medications be used more safely.

The Boston hospital is one of four new Centers for Education and Research on Therapeutics named today by the Agency for Healthcare Research and Quality. It will receive $4 million over four years.

Six previously funded research centers won renewals, including Harvard Pilgrim Health Care.

Posted by Elizabeth Cooney at 02:06 PM

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Monday, October 8, 2007

Howard Hiatt honored by Institute of Medicine

The Institute of Medicine today presented the 2007 Gustav O. Lienhard Award to Dr. Howard H. Hiatt, professor of medicine at Harvard Medical School, former dean of its School of Public Health and a senior physician at the Brigham and Women's Hospital.

The $25,000 award recognizes Hiatt's contributions to improving the performance of personal health services in the United States and around the world, the institute said in a news release.

"Throughout his professional life, Howard Hiatt brought compassionate and innovative approaches to health and medical care," said Harvey V. Fineberg, president of the Institute of Medicine. "He introduced fresh analytic methods to medical and public health education, fostered interdisciplinary approaches to complex health problems, cultivated a new generation of socially responsible physicians, illuminated key challenges to making the best use of limited health resources, pioneered in research on patient safety, and championed successful programs to reduce health disparities. Many of today's leaders in health can trace the roots of their accomplishments to the inspiration, example, and guidance of Howard Hiatt."

Hiatt was formerly chief of medicine at Beth Israel Hospital in Boston, led a pioneering study of medical malpractice, called the Harvard Medical Practice Study, and helped to create the Division of Social Medicine and Health Inequalities at the Brigham in 2001.

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Tuesday, October 2, 2007

Girls' concussion risk overlooked, Times says

girls%20soccer150.bmpGirls competing in sports like soccer and basketball are more susceptible to concussions than boys are when playing the same sports, according to a story in today's New York Times.

Post-concussion syndrome — in which dizziness, lethargy and the inability to concentrate can cost teenagers weeks or months of school — is a growing concern, doctors said. Just as common among girls as boys, it is even more misunderstood among female athletes at this level, a Boston concussion expert said.

"Generally speaking, the medical profession does not do a very good job in recognizing that female athletes sustain concussions at an equal or even higher rate as males," Dr. Robert Cantu of Brigham and Women’s Hospital told the Times. "It’s flying under the radar. And as a result, looking for concussions in women is not pursued with the same diligence, and it’s setting girls up for a worse result."

Posted by Elizabeth Cooney at 07:37 AM

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Tuesday, September 25, 2007

Boston doctor fasting for debt relief for Haiti

A Boston doctor is fasting for three days as part of a national push to cancel Haiti's debt to the developed world.

Dr. Evan Lyon, a hospitalist at Brigham and Women's Hospital and a researcher in its division of social medicine and healthcare inequalities, has worked in Haiti for the past 10 years through Dr. Paul Farmer's organization, Partners in Health.

Because of his connection to Haiti, Lyon got involved with the Jubilee USA Network, a coalition of 80 religious denominations across the country that wants Congress to cancel the debt of 26 countries and make it easier for other nations to find financial relief.

"Hunger is the most important issue that we see" in Haiti, Lyon said in an interview yesterday, the second day of having only one small meal and water. "It's not uncommon for the people I take care of to come into the clinic not having eaten for one or two days. I chose to take this fast on with the understanding that for me it's a pretty modest thing to do."

Jubilee, which has organized a 40-day fast across the country that began Sept. 6, takes its inspiration from the biblical meaning of a jubilee year. Debts are canceled and slaves are freed every seven years, according to the book of Leviticus. The Jubilee Act is awaiting a hearing before the U.S. House Financial Services Committee, according to the network.

Posted by Elizabeth Cooney at 03:35 PM

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Monday, September 24, 2007

Value of annual physicals debatable, study says

Annual physicals get a checkup in today's Archives of Internal Medicine.

Adult preventive health exams and women's gynecologic exams are among the most common reasons to see a doctor, but most preventive services other than Pap smears take place outside those visits, according to researchers from the University of Pittsburgh School of Medicine and Harvard Medical School.

"There's clearly a role for the type of preventive services we studied -- cancer screening, cholesterol testing and counseling about quitting smoking, losing weight and exercise," Dr. John Z. Ayanian of Harvard said in an interview. "It's a question of what's the best approach to get those provided."

Looking closely at the exams, the authors found that checkups including gynecological exams accounted for 1 in 12 adult visits to doctors. Annual exams are more common in the Northeast than in the West, according to previous research. Physicians in Boston, for example, are more likely to say they perform the annual exams than their counterparts in San Diego. People with insurance are more likely to go for physicals than people without coverage.

Annual physical exams "fill a very important role in the US healthcare system," but it wouldn't be feasible to recommend that all adults have annual physicals because there aren't enough primary care physicians or gynecologists, said Ayanian, who practices at Brigham and Women's Hospital. People get most of their preventive services when they come for an acute problem or receive care for chronic conditions, according to the authors' analysis of data from national surveys done from 2002 to 2004.

The study may help guide policy about who should be having preventive exams and what they should include, Ayanian said. People's expectations for blood tests or EKGs during checkups may increase healthcare costs without adding value, the authors found.

"We need to be very selective about what tests we recommend on a routine basis and limit them to those that are likely to have value in affecting people's health rather than reflexively ordering tests out of some sense of tradition," he said.

Posted by Elizabeth Cooney at 06:33 PM

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Monday, September 17, 2007

WSJ: Clue to estrogen and heart health found

Texas scientists may have found an explanation for why estrogen failed to protect some older women from heart disease in the Women's Health Initiative, a finding a Boston researcher called "intriguing" in today's Wall Street Journal.

Researchers at the University of Texas Southwestern Medical Center in Dallas say a molecule created when the body processes cholesterol may block estrogen from helping blood vessels stay healthy, the story says. In women long past menopause, such as those who were in the Women's Health Initiative, these molecules may have taken over estrogen receptors and blocked the effects of the hormone they started taking, the theory goes.

Dr. JoAnn Manson of Brigham and Women's Hospital and a principal investigator for the WHI, told the Journal that the Texas work may explain why women with high cholesterol did worse on hormone therapy than those with low cholesterol.

"Their overall finding ties together very nicely with the clinical-trial results," Manson said in the story. "This could help fit pieces of the puzzle together."

Posted by Elizabeth Cooney at 11:27 AM

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Friday, September 7, 2007

Staying sharp at the AARP convention

By Elizabeth Cooney, Globe Correspondent

There were plenty of jokes about senior moments before a panel of neuroscientists began their discussion of how older people can stay sharp.

This was the AARP annual conference, after all, with oldies music piped through the Boston Convention & Exhibition Center and ads for bladder control drugs plastered in the restrooms. Gail Sheehy was competing for the crowd's attention, the doctors noted, with her session in another meeting room on "Sex and the Seasoned Woman."

But the four panelists, three from Brigham and Women's Hospital and one from the University of Massachusetts Medical School, were as serious as the crowd about how to identify, prevent and deal with cognitive decline and dementia.

They explained how memories are retrieved and noted that new brain cells and connections can continue to be made, contrary to previous beliefs.

"It's possible to learn new tricks even though we are old dogs," said Dr. Dennis J. Selkoe, co-director of the Center for Neurologic Diseases at the Brigham.

Dr. Gary L. Gottlieb, president of the Brigham and a geriatric psychiatrist, warned that depression and anxiety can lead to problems with memory that may be confused with dementia.

"The great news is depression is treatable," he said. "There are drugs people can tolerate and psychotherapies people can use."

Dr. David A. Drachman, a professor of neurology at UMass, urged audience members to protect their brains by wearing seatbelts, eating a good diet, and keeping cholesterol and blood pressure under control.

"You are never going to be as young as you are today," he said, to more than a few chuckles.

Dr. Reisa Sperling, director of therapeutic trials in Alzheimer's disease at the Brigham, had a suggestion and a plea.

Learn ballroom dancing, she said, to combine mental and physical activity with social interaction.

And volunteer for clinical trials.

"I think a cure is in someone's test tube, if we can figure out which one," she said. "It takes people to come forward to be participants in trials to test them out."

Posted by Elizabeth Cooney at 05:29 PM

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Wednesday, September 5, 2007

This week in the New England Journal of Medicine

A single variant of a gene is linked to an increased risk for both rheumatoid arthritis and systemic lupus erythematosus, providing support for the idea that common risk genes and disease pathways are involved in many autoimmune disorders, authors including researchers at the Broad Institute, Brigham and Women's Hospital and Biogen Idec report.

Giving critically ill patients recombinant human erythropoetin did not reduce the need for red-blood-cell transfusions, but it may reduce deaths in trauma patients, according to an article by researchers including doctors from the Boston University School of Medicine and University of Massachusetts Medical School.

Posted by Elizabeth Cooney at 05:26 PM

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Tuesday, September 4, 2007

NIH grants focus on genes and the environment

Seven Massachusetts researchers have won grants from a new government program to study how genes and the environment interact, the National Institutes of Health announced today.

Through the Genes, Environment and Health Initiative, researchers will study the genetics of such diseases as diabetes, cancer, heart disease and tooth decay. To learn about the environmental component, scientists will develop ways to monitor personal exposure, whether to toxins or to physical activity.

The Broad Institute of MIT and Harvard, led by Stacey Gabriel, will receive $3.8 million to become one of two genotyping centers for the initiative. The other is at Johns Hopkins University in Baltimore.

Individual investigators and their projects are:

Dr. Frank Hu, Harvard School of Public Health, genes and environment initiatives in type 2 diabetes, $622,000;

Patty Freedson, University of Massachusetts, Amherst, development of an integrated measurement system to assess physical activity, $411,000;

Stephen Intille, MIT, enabling population-scale physical activity measurement on common mobile phones, $681,000;

Bevin Engelward, MIT, comet-chip high-throughput DNA damage sensor, $429,000;

Bruce Kristal, Brigham and Women’s Hospital, mitochondrial, metabolite and protein biomarkers of effects of diet, $454,000;

Dr. Avrum Spira, Boston University, a non-invasive gene expression biomarker of airway response to tobacco smoke, $643,000.

Posted by Elizabeth Cooney at 12:57 PM

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Friday, August 31, 2007

Evidence builds for timing of estrogen therapy, researcher says

Two studies reported yesterday bolster the case for a "timing hypothesis" in women taking estrogen after menopause.

The papers published in the journal Neurology suggest that estrogen may protect the brain if the hormone is taken within 10 years of menopause. Other observational studies have shown a 20 percent to 40 percent reduction in the risk of developing dementia if estrogen is started shortly after menopause, Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital, said in an interview today.

"There is mounting evidence that a woman's age and the time since onset of menopause influence her health outcomes on estrogen, including the risk of heart disease and cognitive decline," she said. "These (Neurology) studies do suggest that premature loss of estrogen tended to have an adverse effect on memory and cognitive function and that taking estrogen after menopause may counter those risks."

One Neurology paper said that women who had their ovaries removed before menopause had a higher risk of developing dementia or other cognitive impairment if they did not take estrogen until age 50. Another paper reported that the risk of Parkinson's disease and tremors was higher in women who had their ovaries removed, but those movement disorders were both less common than mental problems.

Manson was not involved in either study.

She said that because the studies were not randomized clinical trials, they do not provide conclusive evidence. She is working on her own large-scale randomized clinical trial of low-dose estrogen in preventing memory loss and cognitive decline. Called the KEEPS study, it is currently recruiting participants, and will look at recently menopausal women.

The findings reported in Neurology, while not conclusive, may offer reassurance to women considering the hormone for treatment of hot flashes and other symptoms, she said.

"The new research suggests more favorable benefits in younger women, providing reassurance for recently menopausal women who may be considering hormone therapy for the treatment of menopausal symptoms," she said.

Posted by Elizabeth Cooney at 01:48 PM

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Transplant pioneer poses a question

joseph%20murray100.bmpTransplant pioneer Dr. Joseph E. Murray (left) is working on a second book about science and spiritual values, but he has a challenge for his former field.

In an interview in today's Vineyard Gazette, the 88-year-old Nobel laureate and author of "Surgery of the Soul" reflected on his long career, his love for Chappaquiddick and a current transplant question.

"We don't know why but when multiple tissues, say a limb with bone and muscle and tissue, are transplanted, each of the elements seem to aid in the healing rate of other elements at far greater rates than for skin transplant alone," he told the Gazette. "If I were a young doctor, that's where I'd concentrate. That work will be fruitful for 50 or 80 years," he said.

Murray performed the first successful kidney transplant in 1954 at the Peter Bent Brigham Hospital. A Globe retrospective describes the impact of that work.

Posted by Elizabeth Cooney at 08:39 AM

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Wednesday, August 29, 2007

Face transplants may be safer than thought, study says

Face transplants may be safer than previously thought, according to a new analysis of their risks, but the encouraging report will not change guidelines adopted by Brigham and Women's Hospital that limit who can have the rare procedure.

Researchers from the University of Cincinnati and the University of Louisville say in the journal Plastic and Reconstructive Surgery that an influential British report issued in 2004 overestimated the dangers by failing to take into account three important factors: newer drugs used to prevent rejection, the poorer health of kidney transplant recipients relative to face transplant patients and the different tissue composition of solid organs versus the skin.

The new analysis concludes that the risk of rejection for skin transplant patients, would be lower than predicted in 2004. Researchers based their conclusions on hand transplant patients, but said the results would be valid for both.

"I'm very encouraged that we see a lot less of rejection and even if it occurs, [doctors] were able to help them," Dr. Bohdan Pomahac, director of the Brigham program, said in an interview. "I think it's very interesting. In many ways it will correct the current estimate of morbidity associated with facial transplants."

The Brigham said last month it will perform partial face transplants only on patients already taking drugs to suppress their immune system because the drugs raise the risk of infection and cancer. That protocol will stay in place, said Pomahac, a plastic surgeon who is also the hospital's associate burn center director. He was not involved in the study by Cincinnati and Louisville researchers.

Pomahac cautioned that in the new study the number of hand transplants is small -- only 18 -- and the follow-up period may be too short for problems such as organ toxicity from taking even the newer immunosuppressant drugs to have shown up.

"I think every publication like this moves our knowledge a step forward and makes it more available ... as an option," he said.

Posted by Elizabeth Cooney at 05:40 PM

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Update on Harvard physician-scientist's move to Arizona

Dr. Robert A. Greenes says it's hard to leave Harvard and Brigham and Women's Hospital, after 40 years, but the chance to build a new biomedical informatics program in Arizona is too good to pass up.

"Harvard and the Brigham have provided a wonderful environment for my professional activity," he said in an e-mail message last night. "My decision to leave Boston after many years of working closely with so many wonderful colleagues was not easy but became irresistible as I learned more about what the opportunity could be."

Greenes, a Harvard Medical School radiology professor and program director of a Harvard-MIT training program in medical informatics, is joining Arizona State University, whose faculty teaches medical students at the new Phoenix branch of the University of Arizona College of Medicine.

He is the second prominent biomedical informatics researcher to leave Harvard for a new program, following Stephen Wong, who took about 20 lab staffers with him to Methodist Hospital Research Institute in Houston.

"Besides the attractions of the new position in terms of the commitment of the participating institutions to it, and the generous budget, and space, ... I think the big attraction for me is the chance to raise the scale of informatics activity and commitment, " Greenes said.

Greenes singled out Dr. Steven Seltzer, chief of radiology at the Brigham, for his support of biomedical informatics as the field has matured. Yesterday Seltzer called the new opportunity for Greenes an exciting one.

The University of Arizona incorporated biomedical informatics into plans for its new medical school branch in Phoenix, Greenes said. Its 24 students have just begun classes, medical school spokesman Al Brava said yesterday.

Biomedical informatics includes the role of informatics not only in genomics and molecular science, but also in imaging, clinical medicine and public health, Greenes said.

"These are heady times for informatics, and Arizona recognizes and is poised to take advantage of its potential," he said.

His wife, Carole Greenes, is also joining Arizona State University. A professor of mathematics education at Boston University, she will become dean of the School of Educational Innovation and Teacher preparation at ASU's Polytechnic campus in Mesa.

Posted by Elizabeth Cooney at 09:27 AM

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Tuesday, August 28, 2007

Another Harvard bioinformatics leader leaving

By Elizabeth Cooney, Globe Correspondent

Another biomedical informatics leader is leaving Harvard to head a new department in the Sun Belt.

robert%20greenes100.bmpDr. Robert A. Greenes (left), a Harvard Medical School radiology professor and program director of a Harvard-MIT training program in medical informatics, is joining Arizona State University, whose faculty teaches medical students at the new Phoenix branch of the University of Arizona College of Medicine.

He will chair the Phoenix-based department of biomedical informatics in ASU's School of Computing and Informatics, which was founded last year as part of the School of Engineering.

Greenes is leaving Brigham and Women's Hospital, where in 1980 he established the Decision Systems Group.

His departure follows the move in July by Stephen Wong, who took about 20 researchers with him when he left for The Methodist Hospital Research Institute in Houston to create a bioinformatics program there.

"Bob got a wonderful professional opportunity," Dr. Steven Seltzer, chief of radiology at the Brigham, said in an interview today. "They have money and they have space, so it's exciting."

The departures by Greenes and Wong are "bittersweet" transitions that Harvard monitors, he said.

"Our institution is blessed with more than its fair share of resources and part of our mission in life is to help populate the world with folks who are leaders in American medicine," Seltzer said. "Having said that, we still need to retain our highly qualified faculty and when we lose any faculty member, even if for a unique opportunity, it is a bittersweet outcome for us. We monitor as carefully as we can with any faculty attrition we have, how much is for, a 'good' reason, like moving to a nice opportunity, and how much is for a bad reason, that we are not competitive [in] either compensation or other resources."

In a statement from ASU announcing his appointment, Greenes said he was influenced by "the substantial planning efforts and resources already devoted to ASU's biomedical informatics program."

"I'm impressed by the eagerness at all levels of the university, especially its leadership, and among its partners, the University of Arizona, and other Arizona health and biomedical science institutions, to create a top-notch biomedical informatics program," Greenes said. He was traveling today and did not immediately return calls or e-mails seeking comment.

Greenes is not taking members of the Decision Systems Group with him to Arizona, Seltzer said. Dr. Lucila Ohno-Machado will succeed him as director of the group.

Posted by Elizabeth Cooney at 02:44 PM

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Thursday, August 16, 2007

New physician-scientists win Howard Hughes awards

Seven Boston physicians who spent a year or more away from medical school doing research have won grants to continue their dual roles as scientists and clinicians.

The Howard Hughes Medical Institute has given Early Career Awards of $375,000 each over five years to 20 doctors to make sure they have the time and financial support for research early in their careers, it said in a statement. Their institutions agreed to allow these tenure-track physician-scientists to devote at least 70 percent of their time to research.

The winners are alumni of either HHMI's research scholars or training fellowship programs, which bring students to the National Institutes of Health or other institutions. They are:

Dr. Sarah Fortune, Harvard University School of Public Health
Dr. Aram Hezel, Massachusetts General Hospital
Dr. Farouc Jaffer,
Massachusetts General Hospital
Dr. Eric Johannsen, Brigham and Women's Hospital
Dr. Sridhar Ramaswamy,
Massachusetts General Hospital Cancer Center
Dr. Manish Sagar, Brigham and Women's Hospital
Dr. Sean Savitz, Beth Israel Deaconess Medical Center

Posted by Elizabeth Cooney at 01:49 PM

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Wednesday, August 15, 2007

Encouraging signs on drug reviews, critic says

The voices of independent scientists are more important than ever, according to a critic of drug-company influence on government regulation, and there are signs they are being heard more than before.

Writing in tomorrow's New England Journal of Medicine, Dr. Jerry Avorn of Brigham and Women's Hospital and Harvard Medical School warns that Congress's re-authorization of user-fee funding from pharmaceutical companies to support the Food and Drug Administration means unbiased outside experts are critical to proper drug evaluation. As an example, he compares the approval of Vioxx in 1999 to this year's rejection of Arcoxia. Renewed assertiveness by FDA's external advisers made the difference in reviews of the painkillers linked to cardiac risk, he writes.

"Though the quiet voice of science may often be no match for powerful vested interests or ideology, some encouraging signs may be in the air," he writes. "The same reauthorization bill, disappointing in so many respects, may tighten somewhat the conflict-of-interest rules for outside advisers."

Posted by Elizabeth Cooney at 07:05 PM

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Six Mass. hospitals recognized for performance improvement

Six Massachusetts hospitals have made a consulting company's list of 100 US hospitals that have improved their performance.

Beth Israel Deaconess Medical Center, Brigham and Women's Hospital and Caritas St. Elizabeth's Medical Center in Boston; UMass Memorial Medical Center in Worcester; NSMC Union Hospital in Lynn and Lowell General Hospital were recognized by Thomson Healthcare for better clinical outcomes, safety, financial stability and growth from 2001 to 2005.

The unranked 2006 list appeared in last week's Modern Healthcare magazine.

Posted by Elizabeth Cooney at 08:44 AM

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Tuesday, August 14, 2007

This week in JAMA

Three studies by Boston authors appear in this week's Journal of the American Medical Association.

A study from Dana-Farber Cancer Institute found that a diet high in meat, fat, sweets and refined grains may be associated with a higher risk of colon cancer recurrence and death in people who had surgery and chemotherapy to treat stage III colon cancer.

Researchers from Brigham and Women’s Hospital report that people with diabetes have an increased risk of death in the first month and first year after they have a heart attack or unstable angina compared with people who have these acute coronary syndromes but do not have diabetes.

A new measure of a lipid protein ratio is no better at predicting coronary heart disease than traditional methods of measuring cholesterol, Boston University School of Medicine investigators from the Framingham Study say.

Posted by Elizabeth Cooney at 07:27 PM

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Monday, August 13, 2007

Antioxidants no magic bullet for heart disease, study says

Antioxidant pills do not protect high-risk women from cardiovascular disease, a Harvard study has found, adding to growing evidence that supplements can’t duplicate a healthy diet and lifestyle.

Taking vitamin C, vitamin E and beta carotene alone or together did not protect the women overall from heart attacks, coronary artery disease or stroke, Dr. JoAnne E. Manson of Harvard Medical School and colleagues report in today’s Archives of Internal Medicine.

"Antioxidants are clearly not the magic bullet for heart disease prevention," she said in an interview. "Supplements do not replace the more difficult lifestyle modifications that have been proven to lower the risk of cardiovascular disease, such as regular exercise, a heart-healthy diet, not smoking, and managing high blood pressure and high cholesterol."

The study of 8,171 women was the first large-scale randomized trial to look at the impact of vitamin C on the risk of cardiovascular events, and it was also the first to examine vitamin C, vitamin E and beta carotene individually and in combination, Manson said.

Previous randomized trials of antioxidants have been disappointing, failing to duplicate the promising results found in observational studies following people who ate high amounts of antioxidants in their food. Antioxidants have been the subject of much research because of the hope that they could limit the harm caused by compounds called free radicals.

The combination of vitamin C and vitamin E did appear to reduce the risk of stroke by 30 percent, but Manson, who is also chief of preventive medicine at Brigham and Women’s Hospital, said this result warrants further study before making a recommendation.

"It’s not ready for prime-time," she said. "People should not be going out and buying vitamin C and vitamin E for the express purpose of preventing stroke."

They shouldn’t throw away their multivitamins, either, if they take them to make up for not eating a balanced diet, she said. The trial used doses much higher than can be found in multivitamins.

"Everyone’s looking for a simple pill you cold pop that will improve health or lower the risk of heart disease," she said. "Any widespread use of these vitamins for cardiovascular disease prevention is just not warranted."

Posted by Elizabeth Cooney at 04:29 PM

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Monday, August 6, 2007

Belly dancing in the delivery room

Cathy Moore is a midwife at Brigham and Women's Hospital and a belly dancer with Goddess Dancing. Now she is bringing those two skills together, gradually introducing belly-dance techniques to some patients and birth specialists, according to a story in the Wall Street Journal that says there may be an ancient connection between childbirth and the dance form.

At the Brigham, Moore says in the story, she has to tread carefully with expectant mothers, for whom belly-dancing remains outside the medical mainstream. She also warns against certain movements: sharp hip drops and pops, and anything up on the toes.

Dr. James Greenberg, the hospital's chairman of obstetrics, told the Journal he's not sure if belly-dancing offers proven benefits.

"But there's certainly no scientific reason to think it's bad, so if it makes you feel good, and it's safe -- do it," he said.

Posted by Elizabeth Cooney at 11:01 AM

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Wednesday, July 25, 2007

Hospice care misunderstood and underused, journal authors say

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

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Friday, July 13, 2007

MGH, Brigham make US News honor roll

Massachusetts General Hospital and Brigham and Women's Hospital held on to their honor roll positions in the annual rankings by U.S. News & World Report called "America's Best Hospitals." Nine Boston hospitals are featured in the guide.

Mass. General finished fifth in the standings, down one rung from last year, and the Brigham took tenth place, up one from last year. Once again, Johns Hopkins Hospital and the Mayo Clinic finished first and second. UCLA Medical Center moved up to third from fifth and the Cleveland Clinic slipped to fourth from third.

The magazine evaluated 5,462 hospitals in 16 specialties, excluding pediatrics, and came up with 173 hospitals that met standards in one or more specialties based on reputation, care-related factors such as nursing and patient services, and mortality rate. Eighteen hospitals scored at or near the top in at least six specialties to make the honor roll.

Other hospitals were ranked in the specialty areas, but not in a cumulative score. Beth Israel Deaconess Medical Center was in the top 50 for 10 categories: diabetes (in conjunction with the Joslin Clinic); digestive disorders; respiratory care; heart and heart surgery; cancer care; kidney diseases; geriatrics; gynecology, urology; and ear, nose and throat care.

Boston-area hospitals known for their specialties also made the top 50. Dana-Farber Cancer Institute placed fifth in the list for cancer care. Joslin Clinic, with its partner Beth Israel Deaconess, was ranked 12th for endocrinology. New England Baptist Hospital was 17th for orthopedics and Spaulding Rehabilitation Hospital ranked eighth for rehabilitation. Massachusetts Eye and Ear Infirmary placed fourth in ophthalmology and in the ear, nose and throat specialty.

Boston Medical Center was ranked 41st in geriatrics.

Mass. General's winning specialty areas were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; heart and heart surgery; gynecology; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; psychiatry; and rheumatology.

The Brigham's top specialties were cancer; digestive disorders; ear, nose and throat; endocrinology; geriatrics; gynecology; heart and heart surgery; kidney disease; neurology and neurosurgery; orthopedics; respiratory disorders; urology; and rheumatology.

Posted by Elizabeth Cooney at 06:27 AM

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Wednesday, July 11, 2007

Covering people before 65 reduces health care costs later

Providing health care to uninsured adults before they qualify for Medicare coverage may not only improve their health but also reduce costs after they turn 65, a Harvard study says.

People who haven’t had insurance coverage are significantly more likely to report poor health before the age of 65, the authors report in tomorrow’s New England Journal of Medicine.

They looked at data from the national Health and Retirement Study to compare health care expenditures between insured and uninsured adults at age 59 and 60 and then again after 65. They concluded that expanding health insurance coverage for uninsured people before 65 might be offset by savings in health care costs that would come later, particularly for people who have cardiovascular disease or diabetes.

"It may be less costly than people thought," Dr. J. Michael McWilliams, a research associate at Harvard Medical School, said in an interview. "Earlier coverage improves health and reduces health care needs."

These findings are especially important as baby boomers reach 65, he said. The current generation of adults has higher rates of obesity and hypertension than their parents', pointing to more chronic disease and a greater need for preventive care, said McWilliams, who also practices general internal medicine at Brigham and Women’s Hospital.

When previously uninsured adults reach 65, they have significantly more doctor visits and hospital stays than adults who had coverage before. The uninsured patients also had more out-of-pocket expenditures after 65 that were not covered by Medicare, the authors found.

"Not only does providing coverage to these adults substantially reduce their health care needs after 65, but it also protects them financially," McWilliams said.

Posted by Elizabeth Cooney at 05:56 PM

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Monday, July 9, 2007

Electronic records alone don't improve outpatient care, study says

Electronic health records, championed as a way to improve patient health and safety, don't by themselves lead to better care in doctors' offices, a study shows.

Researchers from Harvard and Stanford found that electronic records made no difference in 14 of 17 measures of quality for outpatient health care, according to today's Archives of Internal Medicine. They examined data from the National Ambulatory Medical Care Survey gathered from visits to doctors in 2003 and 2004.

Two categories showed better performance on recommended care in the 18 percent of visits in which electronic health records were used: not prescribing tranquilizers for depression and not ordering routine urinalysis in general medical exams. But in one area -- prescribing statins for patients with high cholesterol -- physicians using electronic health records performed worse than doctors who didn't have them.

The missing piece is information to guide clinical decisions, co-author Dr. David W. Bates of Harvard Medical School said in an interview last week. Prompts to order tests, prescribe medications or avoid harmful drug interactions can make the records more than just computerized charts, the study said.

"I was surprised," he said. "I expected we would find improvement with the use of electronic health records, especially because there's a lot of evidence that with good decision support, quality measures do improve."

The survey did not ask if doctors were using electronic records with decision support tools, said Bates, who is chief of general internal medicine at Brigham and Women's Hospital. But previous research has shown quality goes up when a physician is reminded to order a lab test to monitor a patient's diabetes, for example. Decision support is most helpful with preventive care and chronic disease management, he said.

"I hope this will emphasize the importance of including good decision support in electronic health records," he said.

Posted by Elizabeth Cooney at 04:00 PM

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Thursday, June 21, 2007

Heart care beats US average at four Mass. hospitals, new Medicare rankings say

By Liz Kowalczyk, Globe Staff

A patient's chance of survival after suffering a heart attack or heart failure is better than average at four Massachusetts hospitals -- Cape Cod Hospital, Southcoast Hospital Group, Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital -- according to newly-released data from the federal government.

Medicare, the national insurance program for the elderly, today added a new element to its website Consumers now can check the survival rate for a hospital's patients within 30 days of being treated for a heart attack or heart failure.

All other Massachusetts hospitals showed survival rates -- adjusted for how sick the patients were before they were hospitalized -- equal to the average US rates. No Massachusetts hospital scored worse than the national rates. But four did better -- Beth Israel Deaconess, the Brigham and Southcoast showed mortality rates better than the national average for heart failure; the US 30-day mortality rate for these patients is 11 percent.

Cape Cod Hospital had a better than average mortality rate for heart attack patients; the US 30-day mortality rate for these patients is 16 percent.

Posted by Elizabeth Cooney at 05:32 PM

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Wednesday, June 20, 2007

Brigham resident uncovers new beach threat

By Felicia Mello, Globe Correspondent

Relentless undertows, stinging jellyfish -- the beach can be a dangerous place. Now a Harvard medical resident wants sunbathers to pay attention to yet another threat: collapsing sand holes that he says have killed dozens of young people in the past two decades, several of them in New England.

While some might see them as freak accidents, Dr. Bradley Maron has spent years studying the phenomena, after twice seeing children almost suffocate to death on a Martha's Vineyard beach. In a letter in this week's New England Journal of Medicine, he warns that a pastime as innocent as building a sandcastle could lead to a family tragedy.

Maron was a 23-year-old lab technician with dreams of a medical career when he came across a scene of "total chaos" during an afternoon walk on Edgartown's South Beach in 1998, he said in an interview. Kids at a birthday party had dug a seven-foot-deep cavity in the sand and were trying to jump over it when one fell in. The walls of the hole caved, obliterating any sign of the 8-year-old girl.

Digging frantically, a lifeguard located the child's mouth and cupped his hand over it, creating an air pocket. She survived, but the accident made an impression on the young Maron, who had witnessed a similar incident as a student lifeguard three years earlier. "I was probably at that moment of the opinion that most people are, that this must be an isolated, extremely uncommon problem," he said. "In medicine we call it a case report -- something you might see once in your whole life."

But as Maron began to investigate, urged on by his father, a cardiologist who researches sudden death in athletes, he quickly uncovered similar sand cave-ins around the country. Though the accidents are rare -- you're about as likely to die from a shark attack in the United States as from falling into a beach hole -- they fit a tragic pattern, according to Maron's research: A buildup of pressure causes the sides of a hole to crumble suddenly, burying alive a child or teenager playing inside. The victim, usually a boy, remains submerged for several minutes as bystanders panic and rescuers, afraid to use a shovel because they might hit the person, struggle to reach them by hand.

"Granulated sand runs just like when you open your sugar bowl, it just slides right in and fills up awful quick," said Dennis Arnold, director of beach patrol for South Beach, where it's illegal to dig a hole deeper than waist-height of the smallest nearby person.

Combing through media accounts and interviewing witnesses, Maron; his father, Barry; and a nurse at the Minneapolis Heart Institute, Tammy Haas, have documented 52 sand immersions in the United States, Britain, Australia and New Zealand since 1985. Six took place in New England. Thirty-one of the victims died.

One of those was Matthew Gauruder, a 17-year-old playing football at a post-prom party on a Westerly, Rhode Island, beach in 2001. Running backward to catch a pass, Gauruder fell into a hole dug by friends. As his stunned buddies tried to walk towards him, the hole caved in. He was revived briefly before later dying at a local hospital. His mother, Mavis Gauruder, said she grew up playing on New England beaches and never could have anticipated what happened to her son.

"As a parent of a teenager, the first thing you think of is has there been a car accident," said Gauruder. "This was a total shock."

Her son's death was so unusual, said Gauruder, that it's difficult to explain to others. Even Maron, a resident at Brigham and Women's Hospital, admits that the mishaps he's spent years studying pose a very small risk to most people. Still, he cringes when he sees Youtube videos of people posing in massive trenches they've excavated, or sunscreen advertisements featuring children up to their necks in sand.

He and his wife, Jill, a pediatrician, often approach families digging holes on the shore of Lake Massapoag near their Sharon home and tell them to be careful. Some shrug them off, said Maron, but others listen. "I don't want to be a vigilante about this," he said. "Kids dig in sand, that's what they do. But parents are probably unaware of the risk associated with collapse and the extent to which [it] could jeopardize their son or daughter's life."

Maron, who has two children still too young to dig, recommends that parents not allow their kids to carve out holes deeper than their knees. He continues to collect data on sand submersions and hopes to create an official national registry of the accidents.

Gauruder said she's thankful for Maron's obsession. "If one person thinks twice about digging a hole on the beach, that would be well worth it," she said. "I would not want any other family to go through what we've experienced."

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Arteries clearer in younger menopausal women taking estrogen

Younger menopausal women who took estrogen reduced their risk of developing coronary artery calcium, a predictor of heart disease, by 40 percent, a study from the Women’s Health Initiative found.

Dr. JoAnn E. Manson, chief of preventive medicine at Brigham and Women’s Hospital, and colleagues report in tomorrow’s New England Journal of Medicine an even higher risk reduction of 60 percent in the women aged 50 to 59 years old who regularly took estrogen over an average of 7.4 years, compared with those who regularly took a placebo in the randomized clinical trial of more than 1,000 women.

"The findings provide additional reassurance for recently menopausal women who are considering hormone therapy for the short-term treatment of hot flashes, night sweats and other symptoms that disrupt quality of life," Manson said in an interview. "We do caution that this should not be interpreted to mean estrogen should be taken for the express purpose of preventing cardiovascular disease. There are risks."

The risks of taking estrogen pills for more than four to five years include blood clots that can travel to the lungs, and an increased risk of stroke and breast cancer, Manson said.

Women who are more than a decade past menopause did not benefit from taking estrogen, previous studies have shown. Dr. Michael E Mendelsohn and Dr. Richard H. Karas of Tufts University School of Medicine say in an accompanying editorial that the "timing hypothesis" of estrogen therapy may explain why the larger WHI trial showed that hormone therapy did not cut the incidence of heart disease. Older women who already have hardening of the arteries don’t benefit from estrogen.

Younger women struggling to decide whether to start hormone therapy to ease menopausal symptoms should consider taking estrogen in the lowest doses for the shortest possible time, Manson said.

"The pendulum has swung from one extreme to the other," she said. "We now have a more refined understanding of the benefits and risks of hormone therapy and how age and time since menopause influence heart health outcomes."

Posted by Elizabeth Cooney at 05:20 PM

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Journal voters stray from the evidence

The results are in from the New England Journal of Medicine's first online poll of clinical decisions, and the winner was not a slam-dunk.

"What we learned from this is that evidence-based medicine is easy to talk about but hard to implement," editor-in-chief Dr. Jeffrey M. Drazen said in an interview.

Last month the journal asked readers to vote on how to handle the fictitious case of a woman who wanted to cut down on her medications for mild, persistent asthma. The vignette was created to accompany two articles on asthma treatment.

"People read those two papers and the vignette and came to very different conclusions," Drazen said.

Readers were given three choices to vote on. When the 6,085 votes from 113 countries were counted, two of the three choices were almost a tie, with only eight votes separating them. But the winner, with 37.5 percent of the votes, was not the choice consistent with what the two studies concluded, Drazen said.

"It appears that although we as physicians use new data, we do not slavishly follow them," Dr. Laura Fredenburgh of Brigham and Women's Hospital writes in tomorrow's journal.

That fits with the more than 340 comments the journal received, Drazen and Fredenburgh said. The doctors said they picked out different parts of the fictitious patient's story to guide their decisions.

Drazen said he was encouraged by the number of votes and the thoughtful nature of the comments.

"I was amazed," he said. "We'll probably do it again in the fall."

Posted by Elizabeth Cooney at 05:00 PM

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Tuesday, June 19, 2007

Boston scientists named Pew biomedical scholars

Four Boston-area scientists are among the newest class of 20 Pew Scholars in the Biomedical Sciences, the program announced today.

Funded by the Pew Charitable Trusts through a grant to the University of California at San Francisco, the awards give each scientist $240,000 over four years to support research.

Past winners have included Craig C. Mello of the University of Massachusetts Medical School, who shared the 2006 Nobel Prize in medicine or physiology for the discovery of the gene-silencing mechanism know as RNA interference.

This year's Boston-area winners are:

heldwein90.bmpEkaterina Heldwein (left), an assistant professor at Tufts University, will study how herpes viruses enter human cells. A graduate of Oregon Health and Science University, she trained at Children’s Hospital Boston and Harvard Medical School.

hung90.bmpDr. Deborah T. Hung (right), an assistant professor at Harvard Medical School and an assistant molecular biologist at Massachusetts General Hospital, will search for ways to fight the infectiousness of Pseudomonas aeruginosa, a bacterium that harms people with compromised immune systems because they have such conditions as cystic fibrosis, HIV or traumatic burns. She earned a doctorate in chemistry and a medical degree from Harvard and did additional training at Brigham and Women’s Hospital and Mass. General.

nicastro90.bmpDaniela Nicastro (left), an assistant professor at Brandeis University, will investigate the molecular interactions involved in the beating of flagella in sea urchin sperm, which are important to understanding defects that underlie such human disorders as polycystic kidney disease, chronic respiratory disease and infertility. She received a doctorate in biology from the Ludwig Maximilians University in Munich and did postdoctoral research at the Max Planck Institute for Biochemistry and the University of Colorado.

schwartz90.bmpThomas U. Schwartz (left), an assistant professor at MIT, will study the three-dimensional structure of the nuclear pore complex that regulates molecular traffic into and out of the cell nucleus, which could lead to antiviral therapies. He earned a doctorate in biochemistry from the Free University of Berlin and did postdoctoral research at Rockefeller University.

Posted by Elizabeth Cooney at 04:28 PM

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Monday, June 18, 2007

Neurontin fine funds program on drug industry influence

A Boston health educator is taking a page from the antismoking playbook.

Using money from a $430 million Pfizer Inc. settlement of illegal marketing charges, the MGH Institute of Health Professions is launching a program today to teach health care providers about drug industry influence. Just as tobacco company settlement dollars funded stop-smoking campaigns, a total of $21 million and 26 grants were earmarked nationwide to bring information about pharmaceutical marketing to prescribers and consumers.

ladd100.bmp Elissa Ladd (left), clinical assistant professor at the affiliate of Massachusetts General Hospital, won $399,400 to develop a documentary called "PERx: Prescribing Evidence-Based Therapies" and a companion website. Both are funded through fines paid by the drug giant Pfizer in 2004 when its Warner-Lambert subsidiary pleaded guilty to promoting unapproved uses for the anti-seizure drug Neurontin.

"As a practicing nurse practitioner, I was struck with the fact that pharmaceutical promotional activity was ubiquitous in our world, both as providers and consumers," Ladd said in an e-mail interview. "I felt that this promotional activity was driving the appetite in our culture for medications."

The documentary, produced by filmmaker and former pharmaceutical sales rep Kathleen Slattery-Moschkau, includes interviews with Dr. Jerry Avorn of Brigham and Women's Hospital, Dr. David Blumenthal of Mass. General, Susan M. Reverby of Wellesley College and Kenneth Kaitin of the Tufts Center for the Study of Drug Development.

While the materials were crafted as continuing medical education, the website and film are available to the public, Ladd said.

"The important outcome of this project is that prescribers of all health care professions develop an appreciation that the overuse and sometimes unnecessary prescription of expensive brand-name medications can negatively impact our overburdened health care system," she said. "Ultimately it is our patients who will suffer from the undue burden that these costs are generating."

Posted by Elizabeth Cooney at 06:46 AM

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Tuesday, June 12, 2007

Brigham and Women's wins $2m equipment grant

Brigham and Women's Hospital is one of 14 research centers to receive a total of $20.65 million in High-End Instrumentation grants to buy advanced biomedical equipment.

The National Institutes of Health made the one-time awards through its National Center for Research Resources, which announced the round of funding today.

Brigham and Women's, the only research institution in Massachusetts to be named, received the maximum award of $2 million. It will purchase a 3 Tesla magnetic resonance imaging scanner to be used for navigation during open surgeries, minimally invasive treatments, vascular procedures and thermal ablation of tumors, the NIH statement said.

Previous winners since the program's inception in 2002 have included Beth Israel Deaconess Medical Center, Brandeis University, Harvard Medical School and Massachusetts General Hospital.

Posted by Elizabeth Cooney at 09:48 AM

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Monday, June 11, 2007

On the blogs: lab waste, hospital competition

lab bucket100.bmpOn Nature Network Boston, Anna Kushnir lets us in on a dirty little secret: Labs are an environmentalist's nightmare.

"The amount of waste that my lab generates every day makes paper mills look Earth-friendly," she writes reluctantly (while noting it's not her waste bucket at left). "There is nothing I can do about it. I am not willing to risk my samples being contaminated and my experiments failing to save a pair of gloves or spare a pipette."

A Healthy Blog's John McDonough of Health Care For All and Running a Hospital's Paul Levy of Beth Israel Deaconess Medical Center are engaged in a back-and-forth on hospital competition, cost and quality. This follows previous discussions about the power of Partners HealthCare to influence payment rates.

Levy asks. "Since BIDMC has and will continue to have an excellent clinical reputation and very good relationships with community hospitals, multi-specialty groups, and other referring physicians, should we abandon our call for structural changes in the payment system? Would we be better off just living with the current arrangement, i.e., receiving rates that are just below those provided to the dominant provider network?"

McDonough lists financial data for Beth Israel Deaconess and two Partners hospitals, Massachusetts General and Brigham and Women's.

"Yes, BIDMC’s major competitors are bigger and badder," he writes. "Doesn’t seem, though, that BIDMC is doing too shabbily itself. Doesn’t seem like it’s time to take the hankies out."

That said, McDonough asks how to measure quality in hopes of moving the converstation forward.

"There are literally hundreds and hundreds of quality indicators, and each provider would like to get paid for those things it does well, and not get penalized for the things it does poorly," he says. "Who should decide which indicators matter, and which do not?"

Posted by Elizabeth Cooney at 03:52 PM

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Friday, June 8, 2007

Study suggests men at risk for heart attack should be evaluated before starting hormones for prostate cancer

Men who are at risk for a fatal heart attack should be evaluated by a cardiologist before beginning hormonal therapy to treat prostate cancer, researchers from Harvard Medical School report.

The article to appear Sunday in the Journal of Clinical Oncology follows a landmark paper by other Harvard doctors published last fall in the same journal (and reported in the Globe) that linked androgen suppression therapy to diabetes and heart disease.

Androgen suppression therapy is often prescribed for men with prostate cancer. Research has established that it improves survival rates in men with advanced stages of the disease when given with radiation therapy, but the benefits of the treatment are not as clear in men whose cancer is in earlier stages.

In the newer work, researchers led by Dr. Anthony V. D'Amico of Harvard and Brigham and Women's Hospital analyzed data from three randomized trials of 1,372 men in Australia and New Zealand, Canada and the United States. They report that nearly half of the men who were 65 and older and had heart disease risk factors suffered heart attacks sooner if they had received androgen suppression therapy for six months compared to men who had not been given the therapy.

Men who smoke or have diabetes, which put them at risk for heart attacks, should be referred for a cardiac evaluation before they start hormonal therapy to treat prostate cancer, D'Amico said in an interview.

"The study shows that a significant fraction of these men who are going to have heart attacks will have them on average 2 to 3 years sooner if the underlying heart disease is not addressed," he said.

D'Amico said his study's results "fit perfectly " with data produced by Dr. Nancy L. Keating of Brigham and Women's and Dr. Matthew R. Smith of Massachusetts General Hospital. They found that among 73,000 Medicare patients, men who received hormonal therapy significantly increased their risk of developing diabetes and also raised their risk of heart disease.

"The landmark study by Keating put on the map the issue of treatment-related diabetes and cardiovascular disease," Smith said. "Great care needs to be taken in interpreting the results of other trials because of the relatively small number of events and because the studies weren't designed to look at cardiovascular disease."

D'Amico said men can safely delay hormonal therapy to seek treatments for heart disease, which can range from taking aspirin to having stents placed to prop open clogged coronary arteries.

"Hormone therapy can cause a heart attack sooner than prostate cancer can progress," he said.

Posted by Elizabeth Cooney at 06:00 PM

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Monday, June 4, 2007

Harvard bioinformatics team leaving for Houston

A leading scientist who directed research programs at Harvard Medical School and at Brigham and Women’s Hospital is leaving Boston and taking about 20 researchers with him to develop a bioinformatics program in Houston.

stephen_wong150.bmpStephen Wong (left) is leaving his posts as director of the Center for Bioinformatics in the Harvard Center for Neurodegeneration and Repair at Harvard Medical School and executive director of the Functional and Molecular Imaging Center at Brigham and Women’s. He has been an associate professor of radiology at Harvard Medical School and part of the neuro-oncology and cancer imaging programs at Dana-Farber Cancer Institute.

On July 1 he will become chief of medical physics and vice chair of radiology at The Methodist Hospital and director of the bioinformatics program at The Methodist Hospital Research Institute. He will join the faculty at Weill Cornell Medical College, which became the hospital’s academic affiliate after it dissolved ties with Baylor University three years ago.

"This was not an easy decision to make. I think Harvard is wonderful," Wong said in an interview today. "I do think the opportunity in Houston is big. It’s a fantastic opportunity to be in on the infrastructure."

Wong said he was drawn to Methodist by Dr. King Li, with whom he had worked on molecular imaging. Li was the chief of diagnostic radiology at the National Institutes of Health Clinical Center before becoming chair of radiology at Methodist last year.

At Methodist, Wong will build a program to use information that comes from imaging and other biomedical technologies to devise diagnostic tests and treatments. He said he envisions a sort of human GPS system for interventional medicine, in which imaging guides individualized treatments.

Wong has a background in business that includes working for computer company HP and developing the online trading arm of stock broker Charles Schwab. He also worked on a digital image archive system at the University of California at San Francisco. He was recruited from industry three years ago to create the functional and molecular imaging center at the Brigham, Dr. Steven Seltzer, chair of radiology, said in an interview today.

"Steve’s a very talented Ph.D. scientist," he said. "As disappointed as we are to lose him, it’s a very exciting opportunity for Steve and for them."

Seltzer said the number of people transferring with Wong is "on the large side," calling it a testament to the resources Methodist has been able to put together. He said all but one of the Brigham people leaving with Wong are graduate students or postdoctoral fellows. Wong said the total number of people moving south with him is about 20. He will also take with him $4 million in NIH grants.

"Our backfill strategy is that talented folks are still here and some will be promoted into positions of new responsibility," Seltzer said. "We will in turn be looking at graduate students and postdoctoral fellows. We have the richness of the intellectual capital in the Boston area."

Wong said he will maintain the collaborations he has with 25 different labs in Boston.

"Science has no boundaries, so physical location doesn’t matter," he said.

Posted by Elizabeth Cooney at 06:50 PM

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Wednesday, May 23, 2007

Harvard close to hiring medical school dean

By Liz Kowalczyk, Globe Staff

Harvard University's incoming president, Drew Gilpin Faust, is close to making a key hire, dean of Harvard Medical School, and the finalists include a nationally-known cardiologist and a leading Harvard diabetes researcher, according to several Harvard doctors and officials with knowledge of the search.

Dr. Elizabeth Nabel, a cardiologist who trained at Brigham and Women's Hospital and is director of the National Heart Lung and Blood Institute, is a top finalist for the position, according to two of the sources.

Nabel and the agency's spokeswoman did not return calls asking for comment. While at the University of Michigan during the 1980s and 1990s, she rose to chief of the Division of Cardiology and became known for her research into the molecular genetics of cardiovascular diseases, according to the institute's website.

The sources said that Dr. Jeffrey Flier, chief academic officer at Beth Israel Deaconess Medical Center and a nationally-known researcher on diabetes and obesity, also is a serious contender for the job. He said through a spokeswoman that he would not comment on the search.

Harvard University spokesman John Longbrake said the university would not comment on the search until it is completed.

The next dean of Harvard Medical School will replace Dr. Joseph Martin, who steps down next month, ending a 10-year tenure during which he oversaw dramatic changes to the school's curriculum. Martin, a neurologist, plans to take a sabbatical for one year and then increase his work with the Harvard Center for Neurodegeneration & Repair, a group that is trying to develop new drugs for Parkinson's and Alzheimer's disease and other neurological disorders.

Interim Harvard University president Derek Bok convened a faculty search committee to recommend potential replacements for Martin. But he left the final decision to Faust, partly because of the medical school's importance -- it has 11,000 faculty members and $1.2 billion in National Institutes of Health research grants awarded to the medical school and its affiliated hospitals. The medical school dean also will have a key role in the development of Harvard's new Allston campus, where a major stem cell research institute and other scientific laboratories will be located.

The search committee evaluated an initial list of several hundred candidates, the sources said, but the committee is advisory; Faust conducts the final interviews, makes the ultimate decision, and negotiates the new dean's salary, resources, and fund-raising responsibilities.

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$1m cancer prize promotes sharing of ideas

Taking a page from an investors' club handbook, hedge fund managers and a Harvard scientist today introduced the Gotham Prize for Cancer Research, a $1 million annual award that will be given to a researcher who posts a promising idea on an online forum.

"As researchers who live and die by grant support, we want to hold on to our ideas," said prize co-founder Dr. Gary C. Curhan of Harvard Medical School and the School of Public Health. "But it's important to share the best ideas and also try to expedite their investigation."

To be considered, a scientist will have to send an essay of 500 to 1,000 words describing an idea for further research. If the idea is approved by a panel of cancer experts, the scientist will become a member of the online forum, where accepted ideas will be anonymously posted. Members will be asked to comment on these ideas in a spirit of collaboration the prize's founders hope will pave the way for progress in cancer research. Guests can also view the exchange.

The prize was created by New York hedge fund managers Joel Greenblatt and Robert Goldstein of the investment firm Gotham Capital and Curhan, a kidney specialist at Brigham and Women's Hospital. For the website, they took as their model the Value Investors Club, an online group where members share investment ideas.

The winner will be selected based on the quality of the idea, the feasibility of studying it, and on the comments it generates on the forum. The prize will be awarded in February. An additional $250,000 Ira Sohn Conference Foundation Prize in pediatric oncology will also be offered.

The scientific advisory board for the prizes includes Dr. Meir J. Stampfer of Harvard's medical and public health schools.

Joan S. Brugge, a cancer researcher at Harvard Medical School who is not involved in the prize, applauded the marketplace of ideas approach that the website will take.

"Since research money is really tight, any influx of support for cancer research is a good thing in general," she wrote in an e-mail. "'Experimentation' to evaluate new strategies to stimulate novel ideas and new approaches can't hurt cancer research and could indeed lead to important new breakthroughs."

Federal funding for cancer research has been flat in recent years, but still provides the foundation for basic knowledge, she said.

"These kinds of creative approaches ... should not be viewed as substitutes for continued robust/large scale support of investigator-initiated programs at NIH," Brugge wrote.

Posted by Elizabeth Cooney at 03:36 PM

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Tuesday, May 15, 2007

Even a little exercise helps, study shows

Even small amounts of physical activity can boost the fitness of postmenopausal women who are sedentary and overweight, an article in tomorrow's Journal of the American Medical Association says.

As little as 72 minutes of exercise a week showed benefits for women in a trial led by Dr. Timothy S. Church at Louisiana State University. More exercise -- up to about three hours a week -- meant higher fitness levels, as measured by the amount of oxygen they consumed while cycling or walking. But the exercise did not affect cardiovascular risk factors such as blood pressure or weight.

These findings answer a question researchers have had about what the minimum "dose" of exercise might be to deliver health benefits, I-Min Lee, an epidemiologist at Brigham and Women's Hospital, writes in a related editorial. Fitness levels are strong predictors of chronic disease and premature mortality, previous studies have shown.

Lee writes: "This might be succinctly summarized for patients and clinicians as 'Even a little is good; more may be better!'"

Posted by Elizabeth Cooney at 05:58 PM

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Monday, May 14, 2007

Bright lights, big sleep for Mars -- and Earth, too

Two bursts of bright light in the evening help the brain's clock adapt to a longer day, sleep researchers at Brigham and Women's Hospital report, something important for astronauts traveling to Mars but also for earthbound travelers, shift workers or other people whose internal clocks are out of synch.

"Utilization of bright-light exposure could work whether you're going to Mars or Los Angeles," Dr. Charles Czeisler, chief of sleep medicine at Brigham and Women's Hospital, said in an interview.

Czeisler, Dr. Richard E. Kronauer of Harvard and colleagues from the University of Lyon and the University of Colorado conducted a study for NASA's National Space Biomedical Research Institute that appears in today's Proceedings of the National Academy of Sciences.

They set out to solve the problem of what could be perpetual jet lag-like fatigue on an eventual year-and-a-half-long mission to Mars, a plan announced by President Bush in 2004. The Martian day is 39 minutes and 35 seconds longer than a day on Earth -- which doesn't seem like much at first, but adds up to more than four hours in just one week.

The researchers sequestered 12 healthy people in rooms with no time cues for 65 days. First they observed their individual internal clocks, finding a range of differences in the timing of when their bodies released melatonin. Some people were releasing the sleep-promoting hormone as much as five hours before bedtime while for others it was an hour ahead.

"This may explain why some individuals feel so tired in the evening," Czeisler said. "It's as if people are in different time zones, like England and Boston. Their internal clocks are spread out over many time zones.

Over the next 30 days, the participants were exposed to a longer day under varying amounts of light. Those who got two 45-minute sessions of bright light in the evening were able to adapt their sleep/wake cycles to a longer-than-24-hour day.

"These results suggest that people could be treated for sleep disorders" in this way, Czeisler said.

Posted by Elizabeth Cooney at 05:00 PM

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Monday, May 7, 2007

CIMIT awards $5m to medical device researchers

Proposals to build new devices to help premature infants, to inject medicine without breaking the skin and to guide surgeons operating on the brain were among projects to win $5 million in grants from the Center for Integration of Medicine and Innovative Technology, the consortium announced today.

CIMIT, composed of Boston-area teaching hospitals and engineering schools, made 37 grants that range from $40,000 to $100,000. Twenty-two have military applications, acording to CIMIT, which receives support from the US Department of Defense as well as its members.

Dr. Riccardo Barbieri of Massachusetts General Hospital won a grant to develop a computational tool based on a premature infant's heartbeat to predict episodes when they stop breathing.

Mark Horenstein of Boston University will demonstate a way to inject medications through the skin using nanoparticles, leaving no wound behind.

Dr. Nobuyuki Nakajima of Brigham and Women's Hospital will work to improve how instruments can be navigated to diagnose and treat brain injury or disease.

"Our goal ... is to bring life-changing technology to patients as quickly as possible," Dr. John Parrish, CIMIT founder and director and Vietnam War battlefield surgeon, said in a statement. "We are especially aware of the needs of soldiers wounded on the battlefield."

Posted by Elizabeth Cooney at 06:56 AM

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Friday, April 27, 2007

This week in Science

Two papers in Science, including one by Harvard researchers, were among four published yesterday in Science and Nature Genetics on genetic risk factors for developing diabetes. Alice Dembner describes them in today's Globe.

Reseachers from Massachusetts General Hospital, Dana-Farber Cancer Institute, Beth Israel Deaconess Medical Center and Brigham and Women's Hospital are part of an international team reporting on a new mechanism involved in resistance to "smart" cancer drugs Iressa and Tarceva that target lung cancer cell growth.

Scientists have identified a new gene that helps regulate the body's clock and Giulio F. Draetta of Merck
Research Laboratories
in Boston and colleagues report on a molecular component of this clock involved in the
length of the circadian period.

A team that includes researchers from the CBR Institute for Biomedical Research and Harvard Medical School in Boston reveal how the influence of micro-RNAs, small RNA molecules that regulate gene expression, extends to the immune system.

Posted by Elizabeth Cooney at 02:24 PM

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Tuesday, April 24, 2007

Angina drug helps with symptoms but doesn't reduce risk of further heart problems, study says

The anti-angina medication ranolazine safely eased chest pain in a large clinical trial led by Brigham and Women's Hospital researchers, but the drug did not make a significant difference in whether people with coronary artery disease had another heart attack or died, according to a report in tomorrow's Journal of the American Medical Association.

"It does not prolong life, but it provides important relief of symptoms," lead author Dr. David A. Morrow said in an interview.

One of the purposes of the randomized trial, which followed 6,560 patients for almost a year, was to answer questions about whether ranolazine could lead to heart problems, based on differences in heart rhythm noted in the electrocardiograms of people who took it.

The researchers found no difference in the number of heart arrhythmias reported in people who took ranolazine compared to people who took placebos.

In an editorial, Dr. L. Kristin Newby and Dr. Eric D. Peterson of Duke University Medical Center said beta-blockers and nitrates should still be the first drugs to turn to because ranolazine does not improve a patient's prognosis.

"Ranolazine may offer a back-up option for intensification of antianginal treatment if these first-line agents fail," they wrote.

Ranolazine, approved for marketing by the Food and Drug Administration in 2006, is sold as Ranexa by CV Therapeutics, which funded the trial.

Posted by Elizabeth Cooney at 04:42 PM

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Friday, April 20, 2007

This week in Science

germ 150.bmpThis week's Science includes a special section on germ cells -- the reproductive cells of an organism.

George Q. Daley of Children's Hospital Boston, Brigham and Women's Hospital and the Harvard Stem Cell Institute asks whether the cup is half empty or half full for embryonic stem cells.

David C. Page of the Whitehead Institute and MIT considers the mysteries of sexual identity from the germ cell's perspective.

Alexander F. Schier of the Broad Institute of Harvard and MIT writes about the death and birth of RNAs during the maternal-zygotic transition.

Also in Science, Rachael L. Neve of Harvard and McLean Hospital is an author of a new study in mice about neurons competing to encode a memory in the brain.

Posted by Elizabeth Cooney at 01:03 PM

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Monday, April 16, 2007

Harvard, Michigan team share cancer research honor

Scientists from Harvard Medical School and Brigham and Women's Hospital have been honored with collaborators from the University of Michigan for their discoveries about the genetics of prostate cancer.

The American Association for Cancer Research chose the team from about 30 applicants, the organization said. The researchers will share a prize of $50,000.

The Harvard members are Dr. Mark A. Rubin, Charles Lee, Dr. Sven Perner and Francesca Demichelis.

Posted by Elizabeth Cooney at 03:19 PM

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Tuesday, April 10, 2007

Women’s health, in focus

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

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

Posted by Elizabeth Cooney at 05:46 AM

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Tuesday, April 3, 2007

Atul Gawande rocks in the OR

atul-book half.bmp
Just as precious to Dr. Atul Gawande as his loupes — magnifying glasses he wears during surgery — is his iPod, which he carries with him into the operating room at Brigham and Women's Hospital and plugs into a little speaker there, a story in today's New York Times begins.

His second book, "Better: A Surgeon’s Notes on Performance" (Metropolitan Books), comes out this week. Like his first, "Complications," the story says, it consists mostly of essays he has published in The New Yorker — pieces whose common theme is both the complexity and the imperfection of modern medicine and the need for doctors to strive to do better.

Posted by Elizabeth Cooney at 09:01 AM

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Wednesday, March 28, 2007

Former Brigham doctor to head NJ medical school

Dr. William F. Owen Jr., formerly of Brigham and Women's Hospital, has been named president of the University of Medicine and Dentistry of New Jersey, the school said today.

Owen is the chancellor of the University of Tennessee Health Science Center in Memphis and vice president for health affairs at the University of Tennessee. Before that he had been chief scientist for Baxter Healthcare Corp.'s renal division while an adjunct professor at Duke University School of Medicine.

Owen graduated from Brown University and Tufts University School of Medicine. He completed his internship and residency in medicine as well as fellowships in nephrology, transplantation and immunology at Brigham and Women's.

Posted by Elizabeth Cooney at 07:40 PM

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Monday, March 26, 2007

Drugs may be just as good as surgery for clogged arteries

By Stephen Smith and Liz Kowalczyk, Globe Staff

Patients with clogged arteries who have not yet had a heart attack benefit just as much from medications as angioplasty, according to a study released today.

Specialists representing different camps in cardiology have long argued about the best way to handle patients who have potentially life-threatening narrowing of arteries. Decisions about how to treat heart disease, the nation's number one killer, have significant ramifications, medically and economically.

A large team of researchers from across North America, who presented their findings today at the American College of Cardiology's annual meeting in New Orleans, studied nearly 2,300 patients suffering coronary artery disease.

"The results are very striking," said Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. "This is important for patients because it does now mean patients have choices. If your symptoms aren't so severe and aren't interfering with your lifestyle, you can afford to wait."

Half of the patients took medication and underwent angioplasty, a procedure that involves using a tiny balloon and metal scaffolds called stents to prop open arteries. The other half received only medication, including drugs to lower cholesterol, relax blood vessels, slow heart rate, and prevent blood clots.

After tracking the patients for an average of four-and-a-half years, in a trial nicknamed COURAGE, the team, including some scientists from Connecticut, found that there was no difference in outcomes between the groups.

The study should help patients and doctors make sure they're using angioplasty for the right reasons, said Dr. William Maisel, a cardiologist at Beth Israel Deaconess Medical Center.

"To place a stent to reduce the chances of a heart attack or to prevent someone from dying, those are not reasons to put in a stent," Maisel said.

The study, to be published in the New England Journal of Medicine, found that among patients experiencing angina -- chest pain that occurs when the heart muscle doesn’t get enough blood -- angioplasty provided more relief than drugs.

The report does not address how well angioplasty helps heart attack patients. Nissen said that angioplasty remains the treatment of choice for patients with a fully blocked artery, and that campaigns are underway to make sure patients having heart attacks are taken to hospitals that can swiftly perform the procedure.

"COURAGE helps us understand we may well have gone too far with angioplasty and that we may have abandoned bypass surgery too quickly," said Nissen, who was not involved in the study. Bypass surgery, in which a surgeon reroutes, or "bypasses," blood around clogged arteries, is more complicated and has a longer recovery time than angioplasty.

In Boston, because of the conservatism of local doctors, the rate of angioplasty is lower than it is nationally, according to Dr. Frederic S. Resnic, director of the cardiac catheterization laboratory at Brigham and Women's Hospital.

At the Brigham, he wrote in an e-mail, "We have always been very careful to have detailed discussions with our patients with stable coronary artery disease, to make sure that they are comfortable and understand that we are considering the procedure to relieve the
symptoms of angina, and reduce the number and amount of medications needed.

"We have also been careful to say that angioplasty has not been shown to reduce heart attacks or prolong life in these very stable patients," he wrote. "Angioplasty for stable patients is really an effective option for relieving symptoms quite completely; but should not be "sold" to patients as a life-saving procedure."

Posted by Karen Weintraub at 02:02 PM

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Thursday, March 22, 2007

Boston oncologist picked to lead Fox Chase

Dr. Michael V. Seiden, a leading cancer clinician and researcher, is leaving Boston to become president and CEO of Fox Chase Cancer Center in Philadelphia, the center announced today.

Seiden, 48, is head of the gynecological cancer program at the Dana-Farber/Harvard Cancer Center and chief of clinical research in cancer medicine at Massachusetts General Hospital. An associate professor of medicine at Harvard, his research focuses on ovarian cancer tumor biology. He is the physician coordinator of the cancer stem cell project at the Dana-Farber/Harvard Cancer Center.

On June 1 he will succeed Dr. Robert C. Young, 67, who is retiring from Fox Chase, which treats about 6,500 new patients a year and employs about 2,500 people.

Seiden is a graduate of Oberlin College and earned his M.D. and Ph.D. at Washington University in St. Louis. He completed his internship and residency at Mass. General, was a fellow in medicine at Harvard, did a three-year clinical fellowship in medical oncology at Dana-Farber Cancer Institute and was a postdoctoral fellow in molecular pathology at Brigham and Women's Hospital.

Posted by Elizabeth Cooney at 05:55 PM

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Brigham and Women's researchers get $6M grant

Researchers from Brigham and Women's Hospital have won a five-year, $6 million grant from the National Institute of Arthritis, Musculoskeletal and Skin Disorders. The grant will allow them to study hip replacements in Medicare patients, to investigate the genetics of rheumatoid arthritis and to conduct a randomized trial of osteoporosis medication compliance, the hospital said.

Director Dr. Jeffrey N. Katz, associate professor of medicine and orthopedic surgery at Harvard, and associate director Dr. Elizabeth Karlson, associate professor of medicine at Harvard, will lead researchers from the division of rheumatology, immunology and allergy, the division of pharmacoepidemiology and the department of orthopedic surgery.


Posted by Elizabeth Cooney at 02:30 PM

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Creatine to be studied in new Parkinson's trial

By Carey Goldberg, Globe Staff

Federal researchers announced early today that they’re launching a nationwide trial to see whether creatine, a supplement long favored by body-builders, can slow the effects of Parkinson’s Disease.

The National Institute of Neurological Disorders and Stroke is aiming to enroll more than 1,700 Parkinson’s patients at sites around the country, including two in Boston: one at Brigham and Women’s Hospital and one at Beth Israel Deaconess Medical Center.

Parkinson’s is a degenerative illness that affects more than a million Americans. Initial studies suggest that creatine may slow the degeneration. Some drugs can help relieve the tremors and other symptoms of Parkinson’s, but none seems able to stop the disease from progressively worsening.

Patients in the clinical trial will be expected to participate for from five to seven years.

More info: 1-800-352-9424; info@parkinsontrial.org.

Posted by Karen Weintraub at 12:12 AM

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Thursday, March 15, 2007

Community health center dentist honored

Dr. Steve Colchamiro, dental director at Brookside Community Health Center, which is part of Brigham and Women's Hospital, has won this year's Founder's Award from the Massachusetts League of Community Health Centers.

The award honors a leader who protects and promotes healthcare access as a right for all, the community health center said in a statement. In 1971, Colchamiro established the School Dental Transportation Program, which has bused thousands of students from Boston public schools to Brookside for oral health services, often for their first visit to the dentist.

Posted by Elizabeth Cooney at 03:32 PM

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Wednesday, March 14, 2007

Soros grant to help Boston groups battle drug-resistant TB

By John Donnelly, Globe Staff

Investor and philanthropist George Soros today announced a $3 million grant to Boston-based Partners in Health and Brigham and Women's Hospital in hopes of curbing the spread of extremely drug-resistant strains of tuberculosis in the small African nation of Lesotho.

Partners in Health, which has a decade of experience in treating drug-resistant TB in Haiti, Peru, and Russia, hopes that it can develop regimens to effectively battle these emerging strains of the disease. About five Brigham and Women's doctors will be involved in the project.

These new strains -- labelled XDR-TB -- have been found in 28 countries after an outbreak was reported last year in the Kwa-Zulu Natal province of South Africa. In that first documented outbreak, 52 of 53 patients identified with XDR-TB died. Since that outbreak, South Africa's death rate for those co-infected with HIV and the drug-resistant TB has been 85 percent.

"We were always afraid that multiple drug-resistant TB could meet HIV/AIDS and this is now happening," Soros said in a conference call with reporters. "It is not getting the attention it deserves."

The resistant TB has been found mainly in patients who have HIV, a virus that weakens a person's immune system and allows other diseases to flourish.

"It's a huge problem," said Dr. Paul Farmer, co-founder of Partners in Health and one of the world's leading experts on HIV and TB treatment in poor settings. "I do think there is some paralysis" in addressing the issue, he added.

But Farmer and Dr. Jim Yong Kim, another co-founder of Partners in Health and the former HIV/AIDS director at the World Health Organization, said they believed that the Soros gift would help spark both other funding and lead to a way of treating XDR-TB.

Kim said he hopes that the research in Lesotho -- a mountainous country surrounded completely by South Africa -- will lead to treatment guidelines in a year's time for people who have both HIV and XDR-TB. He said the process of developing treatment guidelines normally takes between three and five years.

Tuberculosis can be passed by coughing or sneezing to those in close proximity. Roughly 8 million people contract the disease every year, and an estimated 2 million die annually, including many who have AIDS. Kim said that an estimated 500,000 people worldwide have multiple drug-resistant TB, and that number could jump to 1.5 million by 2015, including many cases of XDR-TB.

"We need to get ahead of this problem," Kim said, adding that if the world didn't, it could return to "the pre-antibiotic era of TB control," with no effective medication for many patients.

Partners in Health will bring experts from Haiti and Peru to Lesotho to fight the disease. Doctors in Lesotho also will be trained. The Boston groups, which have set up quarters outside a hospital in the capital of Maseru, had been sending sputum samples to the Massachusetts state laboratory for testing, but a South African lab will now take the samples.

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Tuesday, March 13, 2007

UMass Memorial hires new chief nursing officer

Nancy R. Kruger has been appointed senior vice president and chief nursing officer at UMass Memorial Medical Center in Worcester, the hospital said.

Kruger had been chief nursing officer and vice president of patient care services at Brigham and Women’s Hospital for five years. Before that she was chief nursing officer at Hershey Medical Center, the Pennsylvania State University College of Medicine’s academic medical center.

She received her bachelor’s degree in nursing from Skidmore College, completed a graduate degree in nursing from New York University and earned a doctorate in nursing science from the University of Pennsylvania.

Posted by Elizabeth Cooney at 10:37 AM

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Tuesday, March 6, 2007

Researchers urge drug companies to make safety data public

Keeping drug safety data from clinical trials confidential to protect trade secrets can delay the discovery of dangerous side effects, two Boston researchers write in the current issue of Health Affairs.

Aaron S. Kesselheim, a clinical fellow in medicine in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital, and Michelle M. Mello, associate professor of health policy and law at the Harvard School of Public Health, point to Vioxx and other cases of drugs with problems that came to light after their approval by the Food and Drug Administration.

The two urge the FDA to place a greater burden of proof on drug companies to show how they would be harmed by release of their data, they recommend more comprehensive public documents from drug companies on safety, and they ask Congress to act if the FDA doesn't.

"Disclosing safety data from clinical trials would allow protection of most commercially valuable information and better balance our interests in drug innovation and patient safety," they wrote.

Posted by Elizabeth Cooney at 09:00 AM

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Thursday, March 1, 2007

Snub of the universe? Postdocs pick elsewhere

Not a single institution on either side of the Charles cracked the Top 15 places to work in a survey of postdoctoral life scientists, the March issue of The Scientist magazine says.

Training and experience matter the most to these researchers, who have finished their Ph.D.s but don't have faculty positions, the survey reports. They ranked access to books and journals next, followed by affordable medical insurance and then equipment and supplies for research.

The closest Boston or Cambridge came was Beth Israel Deaconess Medical Center's 28th-place finish, shooting up from 97th last year.

Harvard Medical School, Brigham and Women's Hospital, Woods Hole Oceanographic Institute and Dana-Farber Cancer Institute also made the top 40. MIT dropped out of the top 40, placing 53rd.

M.D. Anderson Cancer Center in Houston topped the list, zooming up from 29th last year. The J. Gladstone Institutes in San Francisco slid to second place from first. The U.S. Environmental Protection Agency in Research Triangle Park, N.C., stayed in third.

Here's how postdocs ranked area institutions, with the 2006 ranking in parentheses:

Beth Israel Deaconess: 28 (97)
Harvard Medical School: 31 (17)
Brigham and Women's: 35 (41)
Woods Hole: 38 (11)
Dana-Farber: 39 (67)
MIT: 53 (26)
Harvard University: 71 (45)
Massachusetts General Hospital: 81 (64)

A total of 96 institutions in North America were ranked this year. Research centers with too few responses were not listed, including some in the Boston area.

For its "Best Places to Work 2007: Postdocs," the magazine polled its readers about conditions in their research facilities. The Web-based questionnaire pulled in 2,555 usable responses from people who identified themselves as non-tenured scientists working in academia or other non-commercial research organizations.

So, postdocs, White Coat Notes wonders what you think about where you work. Send us your thoughts at whitecoat@globe.com.

Posted by Elizabeth Cooney at 08:03 AM

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Wednesday, February 21, 2007

Project seeks to limit ties between doctors, drug companies

A new campaign called The Prescription Project seeks to end conflicts of interest that may arise from pharmaceutical company marketing aimed at physicians. It calls for academic medical centers to tighten their policies governing ties with industry.

"We are looking to see that payers, consumers and physicians work together to promote evidence-based medicine and to counter the bias of drug marketing," said Robert Restuccia, the project's Boston-based executive director.

The Prescription Project points to Stanford University Medical School, University of Pennsylvania Health System and Yale University School of Medicine as leaders. While their models vary, the institutions restrict gifts to doctors, drug samples and visits by industry sales representatives.

Boston hospitals surveyed by the Globe during the past week say they require drug company employees and other vendors to register with them before visiting, but other policies vary.

Tufts-New England Medical Center does not allow pharmaceutical sales representatives in clinical areas. Caritas St. Elizabeth's Medical Center says its doctors cannot give patients free samples of medications, but Partners' hospitals, Brigham and Women's and Massachusetts General, do let doctors give free samples to patients at certain approved sites, such as a practice serving a significant number of uninsured patients unable to pay on their own.

Beth Israel Deaconess Medical Center and St. Elizabeth's prohibit on-site meals paid for by drug companies and restrict gifts to under $100. Partners' hospitals have a similar cap on what doctors can accept. Gifts may include nominal-value items related to education or patient care, the Partners' rules say.

A speaker or panelist at a professional meeting may accept payment for expenses if the meeting's purpose is "promoting objective scientific and educational activities," the Beth Israel Deaconess policy states.

"We take this issue very seriously and continue to update our policies," said St. Elizabeth's spokeswomen Melanie Franco. "We will look at what the Prescription Project is saying."

The Prescription Project, funded by $6 million from the Pew Charitable Trusts, is a joint effort of Community Catalyst in Boston and the Institute on Medicine as a Profession at Columbia University. Its impetus was a January 2006 article in the Journal of the American Medical Association that said the $12 billion spent annually on drug marketing influences how doctors prescribe medications, whether they receive free lunches, free samples or free trips from companies.

Posted by Elizabeth Cooney at 01:28 PM

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Tuesday, February 20, 2007

Brigham names two leaders of technology initiative

Dr. Joseph V. Bonventre and Dr. Frederick J. Schoen have been named directors of the new Technology in Medicine Initiative at Brigham and Women's Hospital's Biomedical Research Institute, the hospital has announced.

They also will serve as liaisons between the hospital and the Center for Integration of Medicine and Innovative Technology, a consortium of area teaching hospitals, universities and research laboratories that develops medical devices.

Bonventre is a professor of medicine and health sciences and technology at Harvard Medical School, director of the renal division at Brigham and Women's and co-director of the BRI Stem Cell, Regenerative Medicine and Tissue Engineering Center.

Schoen is professor of pathology and health sciences and technology at Harvard Medical School, director of cardiac pathology and executive vice-chairman of the Brigham and Women's department of pathology.

Posted by Elizabeth Cooney at 05:48 PM

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Yearning is primary emotion after death of a loved one

Contrary to traditional notions of grief after the death of a loved one, a new study finds that yearning is felt more powerfully than depression.

Researchers from Harvard Medical School and Yale University School of Medicine found that yearning was the strongest negative emotion after loss, they report in tomorrow's Journal of the American Medical Association.

Negative emotions associated with grief peaked within six months, meaning people with more prolonged symptoms might need more help after that point. And the researchers recommend that the standard psychiatric reference, the Diagnostic and Statistical Manual of Mental Disorders, be revised to focus less on depression after the death of a loved one.

"Yearning is reacting to the loss of someone or something, and once that is gone, you miss it, you pine for it, you hunger for it, you crave it. That was the primary emotional experience after bereavement, rather than depression," Holly G. Prigerson, one of the authors, said in an interview. "This suggests that the DSM reconsider what the natural response to loss is, especially with respect to depression and yearning."

Prigerson is an associate professor of psychiatry at Harvard and director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute.

Prigerson and her colleagues were testing the theory that people respond to loss by moving through disbelief, yearning, anger, depression and acceptance, with depression being the dominant negative emotion. To do that they interviewed 233 people in the Yale Bereavement Study for up to two years following the death of a loved one from natural causes.

The participants in the study, mostly widows, did experience the five stages of grief in the sequence popularized by Elisabeth Kubler-Ross's description of terminally ill patients, but yearning was the most powerful negative emotion and, on average, participants' worst feelings peaked within six months. The level of acceptance -- the strongest emotion of all -- rose steadily over six months.

In contrast, the DSM focuses exclusively on depressive symptoms, saying they should be expected two months after a loss, Prigerson said.

Prigerson emphasized that the people in the study had lost loved ones to natural causes, reflecting 94 percent of deaths in the United States. People who had lost a child or a loved one after a traumatic death, such as a car crash or suicide, were excluded from the study.

The ones who knew for six months or more that their loved ones had a terminal illness reached acceptance sooner than those who had less time to prepare for the death, the study found.

"People never get over a loss, they just get used to it," Prigerson said. "Even years after someone dies, they get pangs of grief, they need to think about the person, and they miss them with heartache," she said. "That's normal. But intense levels beyond that become problematic."


Posted by Elizabeth Cooney at 04:14 PM

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Friday, February 16, 2007

Brigham doctor named to Boston health board

By Stephen Smith, Globe staff

Boston Mayor Thomas M. Menino today appointed a specialist in women's medical issues and healthcare disparities to the city's health board.

Dr. Paula A. Johnson, chief of the women's health division at Brigham and Women's Hospital, will replace Dr. JudyAnn Bigby on the board of the Boston Public Health Commission. Bigby, who also was a top physician at the Brigham, is the new health secretary in the administration of Governor Deval Patrick.

PaulaJohnson.jpg
Dr. Paula A. Johnson

The commission board approves major public health initiatives in the city, voting in the past, for example, to ban smoking in restaurants and bars. Boston has the nation's oldest public health agency.

Johnson is a participant in Menino's ongoing Disparities Project, which aims to bridge persistent gaps in health status that exist between racial and ethnic groups in the city. Menino has said that healthcare disparities are the city's most pressing medical issue.

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Wednesday, February 14, 2007

Post-concussion problems a concern for non-athletes too

After retired New England Patriots linebacker Ted Johnson told his story of depression and other mental impairments following a succession of on-field concussions, his neurosurgeon, Dr. Robert C. Cantu, thought he might hear from other retired professional football players.

He did. Some came to see him and others just talked to him on the phone about problems they trace to their playing days.

What surprised Cantu, who is chief of neurosurgery at Emerson Hospital in Concord and co-director of the Neurological Sports Injury Center at Brigham and Women's Hospital, was the handful of non-athletes he heard from.

"The scope of the problem goes beyond the athletic fields because people in certain lines of work sustain multiple concussions," he said.

A firefighter or a tree surgeon, for example, might sustain multiple concussions, he said. If not allowed enough time to recover, the brain is more vulnerable to a second or third concussion.

Not every head injury leads to the kind of problems Johnson had, Cantu said, but damage can still be done.

"There are many reasons for depression," he said. "Prior head injury is only one."

If someone had one or more concussions but completely recovered from them, he said, it's unlikely depression 20 years later is related to the earlier injuries. But if someone had a few concussions and ever since had been depressed, the likelihood of a connection increases, especially if the second concussion came when the effects of the first one had not gone away.

Cantu has a message for athletes or other people whose work puts them in harm's way for a concussion.

"Don't go back to a hazardous occupation while symptomatic."

Posted by Elizabeth Cooney at 11:31 AM

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Thursday, February 8, 2007

Harvard-trained doctor to lead Global Fund

Michel Kazatchkine, France's AIDS ambassador and a Harvard-educated doctor specializing in infectious diseases, was selected today as the new head of the $7 billion Global Fund to Fight AIDS, Tuberculosis and Malaria.

Kazatchkine, 60, takes over an organization that in just over five years has provided grants to 450 programs in 136 countries, accounting for two-thirds of all international funding against TB and malaria, and 20 percent of global funding to fight AIDS.

From 1977 to 1981, Kazatchkine lived in Boston while doing post-doctoral work at Brigham and Women's Hospital as a member of Harvard's Immunology Department.

-- John Donnelly

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Report: Mass. General sees barriers to Florida site

Massachusetts General Hospital has no immediate plans to open a health-care facility in northern Palm Beach County, Florida, but the institution is still considering the idea, President Peter Slavin said yesterday, according to the Palm Beach Post.

Massachusetts General officials, in Palm Beach this week for their annual fund-raising trip, say several factors stand in their way of opening a satellite facility in Jupiter, including the large number of uninsured patients, the popularity of concierge practices and concern that it could not offer the same array and quality of services away from its Boston base.

"We're still interested in the opportunity," Slavin said Tuesday before a late afternoon health symposium and cocktails with donors at the Four Seasons Palm Beach. "But we have no specific plans yet."

Any plans would include Brigham and Women's Hospital, also owned by Partners HealthCare, the Post story said.

Posted by Elizabeth Cooney at 06:49 AM

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Wednesday, January 31, 2007

Air pollution raises women's heart disease risk, says study

Stricter control of air pollution is needed to reduce the risk of heart disease in women, two Harvard researchers write in an editorial to be published in tomorrow’s New England Journal of Medicine.

Their comments accompany a study in the journal that shows long-term exposure to the fine particles in air pollution are more harmful to older women than previously known, raising their risk of heart disease and death.

Researchers from the University of Washington reviewed medical records from more than 65,000 postmenopausal women with no previous history of heart disease who participated in a long-running, federally funded study called the Women’s Health Initiative.

Other studies have shown a connection between fine particles in air pollution and death. But the pairing of the detailed medical records with data from air monitors in the 36 US cities where the women lived, revealed that women who breathed in more fine particles over a period averaging six years increased their chances of having heart attacks, strokes, blocked arteries and other illnesses. And the risk depended on the level of fine-particulate pollution in the area of the city where they lived.

"The findings of the WHI study strongly support the recommendations for tighter standards for long-term fine particulate air pollution," said Douglas W. Dockery of the Harvard School of Public Health and Peter H. Stone of Brighams and Women's Hospital and Harvard Medical School, writing in the editorial.

They noted that the US Environmental Protection Agency had recently lowered the standard for exposure to fine particles in the air over a 24-hour period but had declined to reduce the standard for longer-term exposure. Dockery and Stone called on the EPA to adopt a tighter standard, which has also been recommended by the agency's science advisers.

Posted by Elizabeth Cooney at 05:45 PM

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Tuesday, January 30, 2007

More than half Boston hospital workers got flu shots

More Boston hospital workers may be getting flu shots this season than the national average, but beyond that it’s hard to figure out how they measure up.

Public health officials have been pushing for virtually all hospital workers to get flu shots because they can easily be exposed and infect vulnerable patients. But each of six hospitals that answered a White Coat Notes query today counts health care workers involved in direct patient care in its own way. And they don’t necessarily know who might have gotten a flu shot outside their hospitals' programs.

Here are the results:

Boston Medical Center: 71 percent
Dana-Farber Cancer Institute: 63 percent
Beth Israel Deaconess Medical Center: 60 percent
Massachusetts General Hospital: 59 percent
Brigham and Women’s Hospital: about 48 percent
Tufts-New England Medical Center: more than 50 percent, according to a preliminary count

"The national average is 38 percent," said Dr. Robert Goldszer, associate chief medical officer at Brigham and Women’s. "We feel we’re doing better than average, but we know we don’t have an accurate rate."

Beth Israel has a broad definition of who comes into direct contact with patients. It’s not just the people who have day-to-day hands-on contact, but it also includes people who see patients face-to-face, such as ward secretaries, people who sit at the front desk in clinics, and workers who clean floors in patients’ rooms, said Dr. Sharon Wright, director of the infection control and hospital epidemiology program.

Beth Israel tries to track who gets a flu shot elsewhere, she said, asking employees to use an internal web site to state explicitly why they are declining to get a flu shot.

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to at least offer flu shots. The Infectious Diseases Society of America recommends that hospitals and other health care facilities mandate flu shots for employees, except for religious or medical reasons.

"JCAHO told us to immunize 100 percent of health care workers who don’t have a contraindication," Beth Israel's Wright said. "We’re trying to get to that 100 percent in three to five years. The goal this year was 60 percent and we did it."

Dr. Al DeMaria, assistant commissioner of the state Department of Public Health, said health care workers are exposed to the flu more often, they are difficult to replace if they get sick, and they put their patients at risk if they have the flu.

"Obviously we think everybody should get vaccinated against the flu, but it’s especially important for health care workers," he said.

Posted by Elizabeth Cooney at 08:32 PM

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After loss of heart docs, Brigham recruits replacements

Brigham and Women's Hospital is trying to replenish its cardiology staff, after outside recruiters raided the department last year. The Brigham, which particularly needs a strong cardiology department as it prepares to open a $350 million cardiovascular wing next year, lost six, or 10 percent, of its 50 cardiologists last year.

They were lured away by private medical companies and by Case Western Reserve University Medical School and its affiliated University Hospitals of Cleveland, which are trying to compete with the Cleveland Clinic -- world renowned for its heart care and research.

In response, Brigham executives have gone on their own head-hunting spree, hiring three cardiologists who will start their new jobs in the next few months.

The Brigham hired two doctors from Caritas St. Elizabeth's Medical Center -- Dr. Frederick Welt, director of St. Elizabeth's cardiac catheterization lab, and Dr. Pinak Shah -- and Dr. Judy Mangion from Hartford Hospital in Connecticut.

Caritas fired back, hiring away Dr. Jeffrey Popma, director of interventional cardiology at the Brigham.

Brigham executives say they don't need to replace all the doctors who left, because the new physicians will spend more of their time seeing patients, and a little less on research, and because of a slight slowdown in cardiac catheterization cases.

Case Western last year recruited Dr. Daniel Simon as its new chief of cardiology. Dr. Mukesh Jain and Dr. James Fang also signed on for high-level positions, and three Brigham cardiology fellows headed west as well.

At Case Western, the Harvard doctors have made a big splash. Overnight patients in the hospitals' cardiac services have jumped 25 percent, Simon said. The Brigham doctors also brought a significant amount of research funding with them -- about $4.5 million -- most of which they brought from the Brigham.

Simon said he left the Brigham not because of dissatisfaction with his employer, but because of the tremendous opportunity offered by Case Western's new medical school dean and the hospital system's new chief executive, who promised $20 million to hire doctors and researchers for a new cardiovascular institute.

-- Liz Kowalczyk

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Researchers to hunt heart disease clues in WHI data

Boston researchers have won two of 12 two-year contracts from the National Heart, Lung, and Blood Institute to study major diseases that affect post-menopausal women. The groups will use blood samples and data from the massive Women's Health Initiative to see what factors are important in predicting and preventing heart disease. The 12 grants will total $18.7 million.

Dr. I-Min Lee, Dr. JoAnn Manson and Dr. Howard D. Sesso of Brigham and Women's Hospital hope to tease out the biochemical mechanisms behind physical activity and lower body fat, looking for the way they reduce the risk of heart disease.

Dr. Alice Lichtenstein of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University wants to see how certain biomarkers compare with self-reports of food intake as predictors of heart disease.

Lee's team will focus on inflammatory markers, including c-reactive protein, in blood samples to look beyond known risk factors such as high blood pressure, cholesterol and insulin sensitivity.

She's interested in the protective effect of physical activity, particularly in overweight people.

"We know it's very hard for people to lose weight once they become heavy, but there are some studies that say even if you are heavy but physically active, you lower your risk," she said. "We want to understand that mechanism."

At Tufts, Lichtenstein will measure certain proteins in blood samples to see how well they predict risk for heart disease. Samples will come from 1,200 women who died of cardiovascular disease during the 15-year WHI study. Those will be compared with samples from 1,200 women who did not die.

She'll be looking for two kinds of fatty acids and two forms of vitamin K that have been associated with either an increased or decreased risk for heart disease: omega-3s vs. trans fatty acids and natural vitamin K vs. the kind formed when fat is hydrogenated.

After seeing if those biomarkers are linked to heart disease, she will compare them with food diaries to see which is the better predictor.

"We'll look at biomarkers to see if they are good predictors of outcome," she said. "If they are actually validated, then they can be used in a broad range of applications.

Posted by Elizabeth Cooney at 11:02 AM

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Friday, January 26, 2007

Exodus from news media to hospital marketing

Longtime Boston television health reporter and producer Rhonda L. Mann is Beth Israel Deaconess Medical Center's new director of marketing communications.

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Rhonda L. Mann

Mann previously managed the health news division at WCVB-Channel 5, doing on-air reporting and producing segments for medical editor Dr. Timothy Johnson.

The hospital said her appointment to fill an open position recognized her gifts as a storyteller. Another television figure turned hospital marketing professional is Peter R. Brown, vice president of public affairs and communications at Brigham and Women's Hospital, who two years ago left a 22-year career at WBZ-Channel 4.

Zineb Marchoudi, who was a writer and producer for Channel 5's 11 p.m. news, will join Mann's department at Beth Israel Deaconess as a media relations specialist. Senior editor Michael Keating is the third member of the department. He had been managing editor/features for Seacoast Media Group in Portsmouth, N.H., which publishes the Portsmouth Herald and Seacoastonline.com.

Posted by Elizabeth Cooney at 09:41 PM
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