Monday, November 5, 2007

Screening shows 1 in 7 teens might have substance abuse problem

About 1 in 7 teenagers in Massachusetts and Vermont might have a substance abuse problem, according to screening questionnaires filled out during routine doctors’ visits, a study has found. The adolescents' answers were more likely to indicate a problem during an appointment when they were sick or injured than when they were having a checkup.

“Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only,” wrote Dr. John R. Knight of Children’s Hospital Boston, lead author of the study in this month’s Archives of Pediatrics & Adolescent Medicine.

Researchers from Children’s, Tufts-New England Medical Center, Cambridge Health Alliance, the University of Vermont and Fallon Clinic in Worcester asked more than 2,000 12- to 18-year-old patients to answer six questions: five about using alcohol or other drugs and one about engaging in risky behaviors, such as riding in a car with someone who was impaired. Two 'yes' answers meant the teen screened positive for substance abuse.

Overall, 14.8 percent of patients said yes to at least two of the six questions. The most positive responses to the questions came in school-based health centers, at just under 30 percent of patients, followed by rural family practices, at about 25 percent. At sick visits, 23.2 percent of the screenings were positive, compared with 11.4 percent of well visits.

Positive screenings do not establish a diagnosis, the authors write, but they do require follow-up. Noting that sick visits are generally allotted less time than well visits, they suggest healthcare providers be trained in how to help patients who test positive by either offering brief advice or referring them for counseling or treatment.

Posted by Elizabeth Cooney at 05:41 PM

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Wednesday, October 24, 2007

Boston group to share genetic data on autism

A Boston group is sharing genetic information from families affected by autism with other researchers to promote understanding of the developmental disorder.

The Autism Consortium, whose members include hospitals, medical schools and universities in the Boston area, will transfer profiles of 500,000 genetic variations found across the genomes of 700 families with two or more children who have autism. The data will be held by the Autism Genetic Resource Exchange, a program of the advocacy organization Autism Speaks. Scientists can apply to the exchange, which gathered DNA from the families. The samples have been scanned for sequences where there are deletions or extra copies of DNA segments. The consortium is sharing the genetic variations it found.

"We returned all of the raw data to AGRE so they can distribute it to any other investigtors who want to begin exploring what may be the genetic underpinnings of autism," Mark Daly, a consortium member from Massachusetts General Hospital and the Broad Institute of MIT and Harvard, said in an interview. "Understanding the genetics underlying a complex disease is not an easy problem to solve. So there's no excuse for hoarding your data when much more can be learned by sharing."

Only a small percentage of autism arises from a recognizable genetic cause, such as Fragile X syndrome, Daly said. Recent research suggests that some families with autism might have higher rates of genomic abnormalities, but very few of these abnormalities have been conclusively identified.

"There's very strong heritability to autism but very little of the heritability has been explained by specific mutations of specific genes," he said. "What we hope is that this data is a starting point. We need to perform collaborative research in the spirit of the Human Genome Project to deliver on the trust the public has placed in us."

Members of the Autism Consortium are Beth Israel Deaconess Medical Center, Boston Medical Center, Boston University, Boston University School of Medicine, the Broad Institute of MIT and Harvard, Cambridge Health Alliance, Children’s Hospital Boston, Harvard University, Harvard Medical School, Massachusetts General Hospital, Massachusetts Institute of Technology, McLean Hospital and Tufts-New England Medical Center.

Posted by Elizabeth Cooney at 11:37 AM

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Thursday, October 11, 2007

Four Boston doctors named Howard Hughes investigators

From left, Daley, Engle, Haber and Karumanchi

Four Boston physician-scientists have been selected by the Howard Hughes Medical Institute in an initiative to promote patient-oriented research.

Dr. George Daley and Dr. Elizabeth Engle, both of Children’s Hospital Boston, Dr. Daniel Haber of Massachusetts General Hospital, and Dr. S. Ananth Karumanchi of Beth Israel Deaconess Medical Center are among 15 new HHMI Investigators. Boston has the most winners in this new group.

Daley is a world leader in hematopoetic and embryonic stem cell research; Engle has identified genetic factors behind disorders that limit patients’ control over their eye movements; Haber studies how individuals’ genetic mutations affect their response to cancer drugs; and Karumanchi has identified the soluble proteins produced by the placenta that can trigger pre-eclampsia in a pregnant mother.

HHMI received 242 applications from eligible candidates. The 15 selected physician-scientists from 13 institutions will receive a total

of about $150 million in their first five-year terms.

Posted by Elizabeth Cooney at 07:00 AM

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Tuesday, October 2, 2007

Residents stand up for SCHIP

By Elizabeth Cooney, Globe Correspondent

Pediatric residents in Massachusetts and around the country gathered at noon today to push for expansion of a children's insurance plan that President Bush has threatened to veto.

At Boston Medical Center, about 50 residents, pediatricians, nurses and social workers paused in the hospital's main lobby as part of "Stand Up for SCHIP," the insurance program that covers children who don't qualify for Medicaid. There would have been one more, but that resident stayed behind in the intensive care unit with a child in respiratory distress, chief resident Marie Clark told the group. The child's father couldn't afford the asthma medication prescribed during an office visit on Friday, Dr. Suzanne Steinbach added, as an example of how lack of insurance hurts children.

"All of us here have had the same story," Dr. Barry Zuckerman, chief of pediatrics, said. "All of us are asking the president to do the right thing for children."

The State Children's Health Insurance Program is a federal program that covers 6.6 million children. It was set to expire after 10 years but Congress and the Bush administration are at odds over its funding and expansion. It is temporarily funded through mid-November.

Congress passed a bill that would expand the program by $35 billion over five years, to be paid for with new tobacco taxes.The number of uninsured children who could participate nationwide would grow to 10 million. Bush, who wants to increase funding by $5 billion over five years, has promised to veto the bill.

"Congressional leaders have put forward an irresponsible plan that would dramatically expand this program beyond its original intent," the president said in his radio address Saturday. "And they know I will veto it."

In Massachusetts, families earning three times the federal poverty level can obtain insurance through SCHIP for their children. The plan covers 90,500 children in the state.

Last week residents at Stanford's Lucile Packard Children's Hosptial in California planned a demonstration for today that spread to more than 30 hospitals around the country.

At Children's Hospital Boston, about 40 residents stood outside on Longwood Avenue to hear chief resident Carl Eriksson and second-year resident Michelle Niescierenko .

"We need to come together in solidarity with pediatric residents around the country to make a stand for children's health," Eriksson said.

At UMass Medical School in Worcester, about 40 medical students, interns, residents, staffers and administrators stood outside to voice their support for an expanded SCHIP program.

"It's not socialized medicine," UMass professor Dr. David Keller said in a statement. "It is good for our children."

Posted by Elizabeth Cooney at 04:58 PM

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Residents to take a stand on SCHIP

At noon today, pediatric residents across the country will join a 15-minute Stand up for SCHIP to urge President Bush not to veto an expansion of coverage for uninsured children who don't qualify for Medicaid.

The action started at Stanford's Lucile Packard Children's Hosptial in California but soon spread to dozens of hospitals, including Boston Medical Center, Children's Hospital Boston and UMass Memorial Medical Center in Massachusetts. The House and Senate have voted to reauthorize and expand the State Children's Health Insurance Plan, but the president has said he would veto it.

"It means children who could be covered won't be and the possibility that some children already covered may lose their insurance," Dr. Barry Zuckerman of Boston Medical Center said in an interview yesterday. "We see the consequences when patients don't get care when they don't have insurance."

Posted by Elizabeth Cooney at 10:51 AM

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Monday, September 17, 2007

Children's group building online medical records for major employer group

A group from Children's Hospital Boston has been hired by a corporate consortium to develop online medical records for their employees.

Dossia, a group of eight major employers including Wal-Mart and Intel, chose the Children's Hospital Informatics Program to adapt its own program called Indivo to provide secure health records for 5 million employees and their dependents and retirees.

The Children's program, which also has ties to Harvard and MIT, has been working for 10 years to create Web-based records for patients that include a lifetime of health information across different doctors and care sites. The Dossia goal is to allow its workers to have access to their medical records, to communicate with their doctors, and to pull together information from different sources, the group said.

Dossia does not disclose details of its contracts, Colette Cote, a spokeswoman for member Pitney-Bowes and Dossia, said when asked about the financial terms of the agreement with Children's. The other companies in Dossia are AT&T, Sanofi-aventis, Applied Materials, BP America Inc. and Cardinal Health.

Indivo will be introduced at Children's this fall and Dossia plans to roll out its version to some members by the end of the year, its statement said.

Posted by Elizabeth Cooney at 05:06 PM

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Thursday, September 6, 2007

BU, Children's win grant to develop minimally invasive heart surgery

Attached to a steerable needle, miniaturized instruments
such as this tissue-nibbling device (shown next to a
sharpened pencil) could be used in minimally invasive
heart surgery.

Researchers at Boston University and Children's Hospital Boston have won a five-year, $5 million grant to make complex heart repairs possible without open-heart surgery.

Working with California medical instrument maker Mircofabrica Inc., Pierre Dupont of BU's School of Engineering and cardiac surgeon Dr. Pedro del Nido of Children's will develop robotic instruments that can reach the heart through small incisions in the chest and heart walls.

"The goal is to develop techniques where we are not only making just small incisions but actually working to repair defects inside the heart while the heart is still beating," del Nido said in an interview.

Patients would avoid potential complications associated with being on a bypass machine during open-heart surgery, while surgeons would still be able to achieve the precision possible with traditional surgical instruments. The project is primarily aimed at adults with heart disease, although there may be pediatric applications, del Nido said.

The National Institutes of Health Bioengineering Research Partnership award is the second grant for this project, del Nido said. The first grant, now in its fourth year, funded the creation of an imaging system in three-dimensional ultrasound to allow surgeons to see inside the heart. The new grant focuses on creating the tools to perform repairs.

Using real-time imaging, a surgeon will be able to use a joystick controller to guide instruments through the chambers of the heart. Tools could be deployed from the tip of an instrument to remove blockages, fix valves and close leaks in the heart.

Current minimally invasive techniques use catheters to bring devices into the heart, deploying tiny umbrellas to patch holes in the heart or using balloons to clear blockages.

"We view this as the next level of intervention that is in a way a hybrid of catheter-based intervention and open-heart surgery, using the tools of open-heart surgery in the reconstruction but the navigation through a blood vessel or through chambers of the heart while the heart is beating," del Nido said.

Posted by Elizabeth Cooney at 05:23 PM

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Monday, August 27, 2007

Harvard leader named dean of Duke medical school

A Harvard Medical School physician-scientist has been named dean of the Duke University School of Medicine, the North Carolina school announced today.

Dr. Nancy C. Andrews (left), dean for basic sciences and graduate studies at Harvard Medical School, is the first woman to fill the position, Duke said. She will succeed Dr. R. Sanders Williams, who was promoted to senior vice chancellor for academic affairs at Duke.

Andrews, 48, is a pediatric hematologist/oncologist at Children's Hospital Boston and the Dana-Farber Cancer Institute. She previously directed the Harvard/MIT MD/PhD program. A member of the Institute of Medicine of the National Academy of Sciences, she was a Howard Hughes Investigator from 1993 to 2006.

Andrews earned bachelor's and master's degrees in molecular biophysics and biochemistry from Yale University, a Ph.D. in biology from MIT, and an MD from Harvard Medical School. She completed her residency at Children's and a fellowship in pediatric hematology/oncology at Children's and Dana-Farber.

Posted by Elizabeth Cooney at 02:51 PM

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Mass. adults second-leanest, but youth overweight rates rank in the middle

By Elizabeth Cooney, Globe Correspondent

Massachusetts adults are the second-leanest in the country, according to a report released today, but the state's younger residents rank in the middle on the overweight scale.

The adult obesity rate was 19.8 percent, placing the state higher than only Colorado. For children age 10 to 17, the rate of being overweight was 13.6 percent, or 27th highest on the national list in the fourth annual "F as in Fat: How Obesity Policies Are Failing in America, 2007" from the Trust for America's Health. Almost a third of American adults are obese, it said.

The report, funded by the Robert Wood Johnson Foundation, is based on data that the Centers for Disease Control and Prevention gathered from 2004 through 2006. Children are considered overweight if they are at or above the 95th percentile of body mass index for their age. Adults fall into the obese category if their BMI is 30 or above.

Adult obesity climbed in 31 states last year, including a gain of 1.2 percentage points in Massachusetts, which was also among 22 states that saw increases for two years in a row. In no state did obesity decline.

There's nothing surprising about the trends going upward, obesity specialist Dr. David Ludwig of Children's Hospital Boston said in an interview.

The difference between adults and youths may reflect the makeup of the population, with obesity being more prevalent among certain economic, social and ethnic groups, he said, but the rising trend among all segments is more important.

"The obesity epidemic continues to escalate," he said. "Even if we were to see a leveling off, especially with children, the full impact of the epidemic will not be felt for some time to come."

Type 2 diabetes, high blood pressure, high cholesterol and other serious complications are showing up in children now, which will translate into shorter life expectancy in the United States for the first time since the Civil War, he said, citing a paper he wrote two years ago. Ludwig was not involved in the report released today.

Mississippi's 30.6 percent adult obesity rate was the highest and Colorado's 17.6 percent was the lowest. For youths, the highest rate of 22.8 percent was found in Washington, D.C., and the lowest was 8.5 percent in Utah. For both children and adults, the highest rates of overweight were found in the South.

But Massachusetts isn't far behind, Ludwig said.

"Rather than focus on which state is winning the race, so to speak, the state-to-state variations are from my perspective less important than the overall more remarkable finding of this increase in obesity among adults and children everywhere," he said.

The report tracked policies in schools to encourage better nutrition and more physical activity. Massachusetts is not among the 17 states whose school lunches, breakfasts and snacks must meet higher standards than required by federal guidelines. The state is also not one of the 22 that have rules for other food sold in schools, from vending machines to bakes sales. But Massachusetts does send home fitness assessments about students, among 16 states to do so.

Posted by Elizabeth Cooney at 11:00 AM

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Friday, August 24, 2007

Beth Israel Deaconess to train medical microbiology fellows

Beth Israel Deaconess Medical Center will launch two new fellowship programs in medical microbiology, the hospital said.

Both are designed to teach doctors to understand bacterial agents, parasites and viruses and to run academic, hospital or public health laboratories. The fellows will train at Children's Hospital Boston and the Massachusetts Department of Public Health as well as Beth Israel Deaconess.

Posted by Elizabeth Cooney at 10:13 AM

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Children's Hospital ranks second on US News list

Children's Hospital Boston came in second in a US News & World Report ranking of pediatric hospitals, the magazine said today.

Children's Hospital of Philadelphia took first place and Johns Hopkins Hospital in Baltimore finished third on a list of 30 pediatric hospitals. This is the first time the magazine has created a separate ranking for pediatric hospitals or children's hospitals within a medical center.

The rankings are based on reputation, death rates and care-related measures such as volume, nursing care, advanced technology and outside recognition.

Posted by Elizabeth Cooney at 12:01 AM

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Wednesday, August 22, 2007

Notables

A Brown University neuroscientist has won Germany's top honor for basic neurological research for creating a device that translates thought into action.

John P. Donoghue, who developed a brain implant called BrainGate that allows paralyzed people to use their thoughts to move a computer cursor, control a wheelchair or operate a robotic arm, will receive one of two K.J. Zulch prizes next week. The other goes to University of Melbourne professor emeritus Graeme Clark, who invented the cochlear implant.

Dr. Robert Ian McCaslin of Children's Hospital Boston has been named director of Mo HealthNet, the Medicaid agency for the state of Missouri, Governor Matt Blunt said. He has been an attending physician in the pediatric emergency department at Children's and an instructor at Harvard Medical School.

Each year MIT's Technology Review names 35 innovators under 35 for its TR35. This year eight technologists and scientists from New England make the list.

David Berry, 29, Flagship Ventures, Cambridge: renewable petroleum from microbes
Adam Cohen, 28, of Harvard University: making molecules motionless
Ali Khademhosseini, 31, Harvard-MIT Division of Health Sciences and Technology: improving engineered tissues
Ivan Kristic, 21, One Laptop per Child (on leave from Harvard): making antivirus software obsolete
Christopher Loose, 27, SteriCoat, Cambridge: beating up bacteria
Anna Lysyanskaya, 31, Brown University: Securing online privacy
Kristala Jones Prather, 34, MIT: reverse-engineering biology
Mehmet Yanik, 29, MIT: stopping light on microchips

Posted by Elizabeth Cooney at 07:03 AM

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Tuesday, August 7, 2007

Underinsured children fall into vaccine gap

By Elizabeth Cooney, Globe Correspondent

Children whose private health insurance does not pay for new recommended vaccines may not be eligible to receive them in public programs, leaving them more vulnerable than if they had no insurance, according to a Harvard study.

These gaps are occurring as the number and cost of new vaccines have escalated. New vaccines recommended for children have doubled in the past five years and the cost to fully vaccinate a child -- about $1,170 -- is 7.5 times higher in 2007 than it was in 1995, Dr. Grace M. Lee of Harvard Medical School and colleagues write in tomorrow’s Journal of the American Medical Association. They surveyed state immunization program managers in 48 states from January to June 2006.

"We assumed kids with health insurance would have coverage for vaccinations, but we found a group of children whose insurance didn’t cover the cost of vaccine. That to me was surprising," Lee said in an interview.

Those children were referred to public health clinics, but they were still unable to receive vaccine because funding to pay for it was not available, the researchers found. The work was funded by the US Centers for Disease Control and Prevention.

"To us that was alarming because we had always seen the public sector as a safety net for vulnerable children," said Lee, also of Children’s Hospital Boston and Harvard Pilgrim Health Care. "Now we find that with the newer, more expensive vaccines, a lot of states are unable to provide these vaccines to kids who can’t afford them."

Massachusetts covers all children for all vaccines recommended by the Advisory Committee on Immunization Practices, except the new vaccine against human papillomavirus. ACIP sets policy for the federal Vaccines for Children program, which pays for all vaccinations for children who are uninsured, eligible for Medicaid, of American Indian or Alaskan Native origin, or seen at a federally qualified community health center.

In July, Massachusetts began providing rotavirus and meningococcal conjugate vaccines for all children, Dr. Susan M. Lett of the state Department of Public Health and a co-author of the JAMA article said in an interview. The vaccines to protect against severe diarrhea in infants and meningitis in teenagers, respectively, were included in the state budget recommended by Governor Deval Patrick. The governor's budget had also proposed coverage for a vaccine for adolescent girls against HPV, the virus that causes cervical cancer, but the legislature requested a study on it instead.

The JAMA study did not attempt to find out how many families might pay out of pocket for vaccines. The HPV vaccine costs about $120 for each of three doses, the meningitis vaccine costs about $80, and the rotavirus vaccine costs about $60.

"I imagine that if a family can’t afford health insurance that covers vaccines, they probably wouldn’t be able to afford to pay for that," Lee said.

Based on a 2000 estimate by other researchers that 14 percent of children in the United States are underinsured, the JAMA authors estimate that 2.3 million children are unable to receive meningococcal conjugate vaccine from their private health care providers and 1.2 million children can’t get it from public health clinics.

In an accompanying editorial, Dr. Matthew M. Davis of the University of Michigan suggests a tiered approach to financing newly recommended vaccines for underinsured children where funding is not available.

"Vaccines that benefit more of the population per individual immunized would receive higher priority," he writes.

Lee and her co-authors suggest working with insurance plans to include coverage.

"Until those enhancements can be made to health insurance plans, I think we need to support our public sector safety net," she said. "We need to come up with funding for these kids who are falling through the cracks to bridge the gap until we can have all health insurance plans covering vaccines."

Posted by Elizabeth Cooney at 07:07 PM

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Thursday, August 2, 2007

Korean cloning fraud covered an accidental stem cell first, Harvard paper says

Harvard scientists have answered a question that lingered after Korean scientists retracted their fraudulent claim
that they had cloned the first human embryonic stem cells: Where did the stem cell line they created come from?

Kitai Kim, Dr. George Q. Daley (left) and their colleagues at Children's Hospital Boston and the Harvard Stem Cell Institute report today in Cell Stem Cell that the embryonic stem cells created by the Korean lab resulted not from somatic cell nuclear transfer, a technique in which a person's DNA is injected into a donor egg cell that has had its own DNA removed, but from parthenogenesis, the process of making an embryo from the donor egg alone.

Cells derived from parthenogenesis carry a distinct genetic fingerprint because they have a duplicate set of chromosomes from the egg. Most of the genetic sequences are identical, but some show differences from the donor egg. Investigators looking into the Korean claims last year said parthenogenesis could not explain these different patterns, the paper said.

Kim and Daley's group analyzed the cells further and found that the DNA differences were clustered at certain points, just as they are in experiments on parthenogenesis in mice.

The Koreans appear to have created the first human embryonic stem cells from a woman's egg alone, the paper says.

Daley's lab is studying parthenogenetic cells as another possible source of embryonic stem cells to treat disease.

A Children's Hospital interview with Daley is here.

Posted by Elizabeth Cooney at 12:40 PM

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Thursday, July 26, 2007

State revokes license of resident who fell asleep in OR

By Liz Kowalczyk, Globe Staff

The Board of Registration in Medicine, which licenses Massachusetts doctors, yesterday retroactively revoked the medical license of Dr. Thomas Ho, finding that he fell asleep during a surgical procedure in December 2005 and inhaled anesthetic gas while on lunch break at work the following month.

Both incidents occurred during a rotation at Children's Hospital Boston. Ho had taken a prescription drug that caused him to doze off, the board said, and when he fell asleep he was the only anesthesiologist in the operating room.

Ho, who was an anesthesiology resident based at Brigham and Women's Hospital, took a voluntary leave in January 2006. He can apply for a new license if he demonstrates at least 15 months of continuous sobriety, and compliance with a chemical dependency monitoring contract.

A Children's Hospital spokeswoman, Michelle Davis, said today: "No patient was harmed, and as soon as the situation was discovered he was discharged from Children's."

In another case, the board indefinitely suspended the license of Dr. Joseph Fahey, a pediatrician in Worcester who admitted during a board investigation in 2005 that he had used cocaine and marijuana. The board immediately stayed the suspension because Fahey agreed to a probation agreement that includes monitoring him for drug use until 2010. Fahey has not been practicing medicine, but can do so under the terms of the agreement.

The board also indefinitely suspended the license of Dr. Camilla Parham, a family practitioner who had worked in Cambridge, for behaving inappropriately with a patient at a party. The board immediately stayed the suspension because Parham agreed to enter a probation agreement, which includes a requirement that she take continuing medical education courses in physician/patient boundaries. Parham has not been practicing medicine, but can do so as long as she adheres to the terms of the agreement.

Posted by Gideon Gil at 11:39 AM

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Friday, July 13, 2007

On the blogs: Levy ponders surgeons' report card Catch-22

Public reporting campaign meets surgical caution on Running a Hospital today.

In this week's New England Journal of Medicine three Harvard doctors argue that making mortality rates public for individual cardiac surgeons could end up harming patients if the rankings push surgeons to avoid operating on high-risk patients.

Today Paul Levy responds in detail to the White Coat Notes post about the opinion piece in the journal, written by Dr. Thomas H. Lee of Partners Health Care, Dr. David F. Torchiana of Massachusetts General Hospital and Dr. James E. Lock of Children’s Hospital Boston.

As readers of the Beth Israel Deaconess CEO's blog know, Levy is a champion of transparency, urging other hospitals to join his in posting their performance measures. He responds to the doctors' contention that public reporting is too flawed (not adequately adjusted for risk, too small a sample) to be valid. (He also asks many questions -- it's a long entry.)

"So here's our Catch-22: No reporting method is statistically good enough to be made public," he writes. "But if a method is statistically good enough, we won't allow it to be made public."

Then Levy issues a challenge to health care providers:

"The medical profession simply has to get better at this issue. If they don't trust the public to understand these numbers, how about just giving them to referring primary care doctors? Certainly, they can trust their colleagues in medicine to have enough judgment to use them wisely and correctly."

And another to insurers:

"We hear a lot about insurance companies wanting to support higher quality care. When is an insurance company going to demand that the hospitals in its network provide these data to referring doctors in its network? How about this for an idea? If a hospital doesn't choose to provide the data, it can still stay in the network, but the patient's co-pay would be increased by a factor of ten if he or she chooses that hospital."

Posted by Elizabeth Cooney at 04:46 PM

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Wednesday, July 11, 2007

Surgeon rankings have unintended consequences, doctors say

Dr. Thomas H. Lee knows the headline he wrote is provocative: "Is Zero the Ideal Death Rate?"

But the network president of Partners Health Care and associate editor at the New England Journal of Medicine is concerned that public reporting of mortality rates for individual cardiac surgeons carries unintended, perverse consequences. He fears that surgeons might hesitate to operate on high-risk patients if they are seeking a perfect performance record, he and two colleagues write in tomorrow's issue of the journal.

"If you are being ranked, you may walk away from a patient who’s very sick, even though that patient may be at high risk for surgery but even higher risk with medicine" as treatment, he said in an interview. "When so few patients can swing things for you being ranked, we’re worried about that effect on the decision-making process."

Lee, along with co-authors Dr. David F. Torchiana, a cardiac surgeon at Massachusetts General Hospital, and Dr. James E. Lock, an interventional cardiologist at Children’s Hospital Boston, say that reporting on cardiac surgery by institution makes sense, with individual reports available only to those hospitals. Massachusetts recently joined New York, New Jersey and Pennsylvania in publicly reporting death rates for individual cardiac surgeons.

Two elements make individual reports undesirable, they said. The first problem is that risk-adjustment methods intended to account for how sick a patient is do not include variables such as socioeconomic status. The second problem is the small sample size. If the average death rate after coronary artery bypass surgery is 2 percent, one or two deaths among the 200 operations a surgeon performs can make a large difference in that surgeon’s ranking, the authors say.

Lee said a better way to report performance would be the measures the federal government chose when it rated hospitals recently: better than expected, as expected, and worse than expected.

"I worry about having a patient with diabetes who’s doing very poorly. They may have a 20 percent mortality rate with surgery but an 80 percent mortality rate without surgery," he said. "I don’t want to have to beg surgeons to operate."

Posted by Elizabeth Cooney at 05:41 PM

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Wednesday, July 4, 2007

Doctor advises how to resolve family-hospital disputes over ending life support

They’re called "medical futility" cases, when family members and hospitals disagree on whether to continue life support for very sick patients. Although rare, they raise questions about respect for others’ viewpoints, a Children’s Hospital Boston doctor says.

Writing in tomorrow’s New England Journal of Medicine, Dr. Robert D. Truog warns against laws that allow a hospital ethics committee to be "surrogate judge and jury."

He considers the recent case of 19-month-old Emilio Gonzales, whose mother went to court to prevent Austin Children’s Hospital from turning off his respirator. Emilio had a rare, fatal genetic disorder called Leigh’s disease that meant he was in intensive care for five months with declining neurological function. Under the Texas Advance Directives Act, the hospital’s ethics committee decided to withdraw life support despite the objections of his mother, Caterina Gonzales.

"I’m concerned that legislation like that in Texas makes it just too easy for people in the medical profession to override the desires of those who have unpopular views," Truog said in an interview. "We’ve got a beautiful system of laws designed to protect people from the tyranny of the majority. The Texas law just bypasses it."

Massachusetts has no law governing cases like these, Truog said. Director of medical ethics at Harvard Medical School, he wrote a policy for Children’s about medically futile care. Under that policy, if a hospital ethics committee were to conclude that medical treatment should be stopped and the family disagreed, it would assist the family in finding and sometimes paying for a lawyer to take the hospital to court so a judge would decide.

In Emilio’s case, his mother found legal help through right-to-life groups, Truog said, but the process should have included safeguards to make that recourse standard. Those safeguards also have the benefit of allowing time for more discussion between the family and the hospital, he said, rather than ending the argument with a unilateral decision. Emilio died before the judge ruled, an outcome that is common in cases like these, Truog said.

The beliefs of people providing care in cases like these should not be ignored, he said. Clinicians should be supported in the difficult job of giving care that they don’t agree is the right thing to do. But their concerns do not automatically win the day, he wrote.

"The claim that continued life support for Emilio was morally objectionable was nothing more than an assertion that the values of the clinicians were correct while those of Ms. Gonzales were wrong," Truog wrote. "I believe that in cases like that of Emilio Gonzales, we should seek to enhance our capacity to tolerate the choices of others, even when we believe they are wrong."

Posted by Elizabeth Cooney at 05:00 PM

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Thursday, June 28, 2007

Notables

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

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

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

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

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

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

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

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

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

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

Posted by Elizabeth Cooney at 11:05 AM

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Friday, June 22, 2007

Harvard researcher wins MERIT Award from NIH

Xihong Lin (left), professor of biostatistics at the Harvard School of Public Health, has won a MERIT Award from the National Institutes of Health.

Lin will develop statistical methods for analyzing cancer research data, including long-term and family data as well as genomic and proteomic information in epidemiological studies and population sciences, NIH said in a statement.

Fewer than 5 percent of NIH-funded investigators are selected to receive the awards.

Current MERIT recipients in Massachusetts and their instituions are:

Beth Israel Deaconess Medical Center: Benjamin G. Neel
CBR Institute for Biomedical Research: Timothy R. Springer
Children's Hospital Boston: Michael Klagsbrun and Bruce R. Zetter
Dana-Farber Cancer Institute: Stanley Korsmeyer and David M. Livingston
Harvard: John Blenis, Stephen C. Harrison, Peter M. Howley and Andrew G. Myers
Massachusetts General Hospital: Daniel Haber
MIT: Michael R. Lieber, Stephen J. Lippard and Alexander Rich
Tufts: John M. Coffin
Whitehead Institute for Biomedical Research: Rudolph Jaenisch

Posted by Elizabeth Cooney at 11:05 AM

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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:

Ekaterina 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.

Dr. 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.

Daniela 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.

Thomas 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

Daley named president of stem cell group

Dr. George Q. Daley, associate director of the stem cell program at Children's Hospital Boston, has been named president of the International Institute for Stem Cell Research, the hospital said today.

An associate professor at Harvard Medical School, he is also affiliated with Dana-Farber Cancer Institute and Brigham and Women's Hospital.

The nonprofit stem cell organization, which is meeting in Australia this week, was formed in 2002 to foster the exchange of information on stem cell research. In February the group established ethical guidelines for stem cell research.

"I hope to make these guidelines more relevant to practitioners and stem cell oversight committees worldwide," Daley said in a statement. "As countries debate what sorts of regulations to put in place, we want to take a leadership role, acknowledging the social context of the work while removing unnecessary barriers to scientific progress."

Posted by Elizabeth Cooney at 04:46 PM

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Friday, May 25, 2007

Notables

Louis Kunkel, director of the program in genomics at Children's Hospital Boston, has won a one-year $100,000 distinguished investigator award from the Mental Health Research Association to study gene expression in autistic children.

Dr. Mary Jane England, president of Regis College, has been honored as this year's outstanding psychiatrist for lifetime achievement by the Massachusetts Psychiatric Society.

Dr. Suzanne A. Bird, medical director of Cambridge Health Alliance's psychiatric emergency service, has received the annual Irma Bland Award for Excellence in Teaching Residents from the American Psychiatric Association.

Maureen Walsh, a nurse and health teacher at St. Francis Xavier School in South Weymouth, was one of 13 people to receive national recognition from the Food Allergy & Anaphylaxis Network for service to children with food allergies.

US Representative Patrick Kennedy of Rhode Island will be honored with fellow Congressman Jim Ramstad of Minnesota for their Campaign to Insure Mental Health and Addiction Equity at Mental Health America's annual meeting June 6 through 9 in Washington.

Posted by Elizabeth Cooney at 11:34 AM

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Tuesday, May 22, 2007

Children's hires Jamaica Plain health center head

Children’s Hospital Boston has named James Cote (left) executive director of the Martha Eliot Health Center, a community health center in Jamaica Plain that is licensed and operated by Children’s.

Cote, who had been the health center's interim leader for the past year, has also worked at Children’s and Boston Medical Center. He holds an MBA with a specialty in health care administration and marketing from UMass-Boston and a bachelor's degree in biology from Saint Joseph’s College in North Windam, Maine.

Posted by Elizabeth Cooney at 10:03 AM

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Monday, May 14, 2007

Today's Globe: house calls, fading vitamins, medical e-files jobs, mammogram decline, Dr. Dorothy Villee, withholding vaccinations,

Dr. Myron Siu, 32, an internist who works at Tufts-New England Medical Center, started house calls last August; he's believed to be the only Cantonese-speaking doctor in Boston with a weekly commitment to see patients in their homes.

Judy Foreman's love affair with vitamins and supplements is over: With a few exceptions -- stay tuned -- she's tossing them out, she writes in Health Sense.

Also in Health/Science, meet psychologist Ed Tronick (left), who probes the emotional life of infants, and find out why people blink their eyes and why we need sunshine.

In Business, Massachusetts is among the leaders nationally in the use of electronic