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.

Posted by Gideon Gil at 01:09 PM

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Tuesday, October 2, 2007

Girls' concussion risk overlooked, Times says

Girls 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

Transplant 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.

Dr. 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.