Leading Pediatrician: Sick Time Is Health Issue; Will Doctors Step Up?

(Mary MacTavish/Compfight)

(Mary MacTavish/Compfight)

Call me Sherlock Holmes, but when a ballot measure has “sick” in its title, I get a sneaking suspicion that it may involve an issue of health.

As in Question 4 on the Massachusetts ballots this November, which the secretary of state titles “Earned Sick Time For Employees” and summarizes as a proposed law that “would entitle employees in Massachusetts to earn and use sick time according to certain conditions.”

It would guarantee up to 40 hours of paid sick time if you work for a large employer and up to 40 hours unpaid if you work for a small employer. (More details here.)

This referendum — and measures like it in other states and at the federal level — tend to be portrayed as labor issues, pitting employers against employees. But Dr. Mark Schuster, Chief of General Pediatrics at Boston Children’s Hospital and Professor of Pediatrics at Harvard Medical School, argues that sick days are a health issue — and no one knows that better than doctors.

In the New England Journal of Medicine, he and Dr. Paul Chung of UCLA discuss the risks inherent in an economy where about 40 percent of employees get no paid sick leave, and many cannot even take unpaid sick days without risking their jobs.

They begin with the big-picture public health problem of the 2009 H1N1 flu pandemic, when health authorities were begging sick people to stay home and some workers were responding that they simply couldn’t.

And then there are the human difficulties that play out every day:

Consider a mother who knows both how to assess her son’s asthma symptoms and when he needs to see a clinician. If his medicine doesn’t seem to be working on a weekend or at night, they go straight to the clinic, he receives treatment, and they avoid a hospital admission. But when the boy has an asthma attack on a weekday morning, his mother sends him to school, fearing that missing work will mean losing her job. Three times in 18 months, when she waits until after work to bring him to the clinic, his asthma worsens, and he ends up hospitalized. Each time, what should have been three hours in the clinic becomes three days in the hospital.

Or consider a young girl with a fever and flulike symptoms who is given Tylenol and sent to school by her father because he can’t miss work. Two days later, the girl develops the rash characteristic of fifth disease on her cheeks. Her whole class has been exposed, and because the teacher is pregnant, her fetus is at risk.

About half of American workers get no paid sick days that they can use to care for family members, they note. And they end with a call to action directed at other health care professionals: “At the intersection between health and work, the health care community needs to provide a voice for patients and their families.”

Will it, though? Continue reading

Want To Become An Organ Donor? It’s Super-Easy In Mass. Now Do You?

misscherryorchards via Compfight/Flickr

(misscherryorchards via Compfight/Flickr)

Veronica Thomas
CommonHealth Intern

Pestering someone with the same question over and over again doesn’t usually get you what you want. But with organ donation, asking repetitively might just be the key to increasing the number of much-needed organ donors.

According to a new working paper from the National Bureau of Economic Research, providing more information and opportunities for people to become organ donors could boost registrations dramatically.

This increase in donors is needed more than ever. Each day, 18 people die while waiting for a transplant organ to become available. The waiting list is over 123,000 people deep but there were only about 29,000 organ transplants last year.

The new findings are based on a survey of Massachusetts drivers, which The Washington Post’s Jason Millman describes in One Way To Boost Organ Donations: Just Keep Asking. From the article:

Researchers surveyed 368 people with a Massachusetts driver’s license or ID card, including 156 people (42.4 percent) who were already registered organ donors. Of those who weren’t registered donors, 61 people in the study decided to sign up after researchers presented them with the chance to update their status. Just two people who had been registered donors asked to remove themselves from the registry.

“Put simply, asking again for organ donation generates more donors,” wrote Judd Kessler of the University of Pennsylvania’s Wharton School and Stanford University’s Alvin Roth. They said this suggests that policymakers should look for more opportunities to keep asking this question, like on income tax forms, as the researchers said some states are considering.

Asking more than once may work for a number of reasons. Millman explains:

People may have missed the opportunity to register the first time; or, repeat requests may signal the importance of organ donation, Kessler and Roth write. The “guilt factor” may also kick in after repeat requests. And there’s also the chance that people learned something that changed their minds. On that final point, Kessler and Roth found that just informing non-donors about what organs they could donate made them more willing to register.

So, here we go. Let’s test out this strategy and see if it works. Continue reading

How Transgender People Are Changing Their Voices

Lorelei Erisis, a transgender woman, tries out the Eva app in her Ayer home. (Martha Bebinger/WBUR)

Lorelei Erisis, a transgender woman, tries out the Eva app in her Ayer home. (Martha Bebinger/WBUR)

Lorelei Erisis taps the screen of a borrowed iPhone. The key of A, with kazoo-like resonance, fills her living room in Ayer, Mass.

Erisis taps another button labeled “start,” takes a deep breath, and sings the word “he,” trying to match the tone.

A number, 75 percent, pops onto the screen.

“My pitch was too low,” Erisis says. “Oh well. Let me try again.”

Erisis, a transgender woman, is trying out Eva, a mobile phone app that may be the first of its kind. Transgender men and women who want to raise or lower the pitch of their voice can go through a series of breathing and pitch exercises designed to help with what can be the most difficult characteristic to change — their voice.

“What I often hear is, ‘I pass as a woman until I open my mouth,’ ” says Kathe Perez, a speech language pathologist who designed the Eva app. Continue reading

Son, Mom, Psychiatrists Reflect On Finding Your Own Way With ADHD

Peter and Ellen Braaten (courtesy)

Peter and Ellen Braaten (courtesy)

Peter Braaten, now 20, still retains an indelible third-grade memory of being unable — simply unable — to stay seated in a reading circle. “And I just started walking around, because that’s what made me feel okay at the time. And the teacher said, ‘No, sit down, sit down.’ And I basically just couldn’t sit there, because I felt unsettled at the time. And I just couldn’t read, I wasn’t getting into it, so I kept pacing, kept pacing…”

Ellen Braaten, PhD, Peter’s mother and the chief child neuropsychologist at Massachusetts General Hospital, is an expert on Attention Deficit Hyperactivity Disorder, but that doesn’t mean it was easy to cope with it in her son. She recalls the “humbling” experience of going to IEP — Individual Education Program — meetings with school staff as a parent rather than an expert: “Peter has seen me in IEP meetings where I’ve had to yell at them…”

They share their experiences in the podcast above with Dr. Gene Beresin, director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital, and the Center’s associate director, Dr. Steve Schlozman, who treated Peter. One central message from the podcast, Dr. Beresin says: “As with every psychological problem, we all have to find out what works for us. Because what works for one person is not necessarily what works for all. There are no magic bullets. No platitudes. No simplistic answers.” But Peter is now earning all A’s in community college, helped in part by academic coaching and regular exercise. The post below supplements the podcast above.

By Peter Braaten, Ellen Braaten and Gene Beresin
Guest contributors

Peter:

One of the most difficult things for me about being diagnosed with ADHD (especially at such an early age) was understanding this as a helpful push in the right direction. It was very hard for me to appreciate what a “diagnosis” means. Does it just mean a guide for treatment? Well, that might be fine for a doctor, but in my experience it is not good guide for others. In some ways, it significantly influences the ways others view you. Some understand what it means, while others don’t — some adults around me did not even believe it exists or just seemed to disregard it.

‘I have gotten in trouble more times than days I’ve lived on this planet.’

Context is what I find difficult with this diagnosis. It is really something that affects every aspect of your life, which is why it is so hard for other people (teachers, parents, etc.) to understand what it means for an individual to have ADHD. A diagnosis in itself does not inform others around you what tasks are easy or difficult. It does not differentiate effort levels. So for me, some activities have been pretty easy to accomplish, while others are very hard, if not impossible, without some kind of coaching. And the amount of energy that it takes me to do different projects is highly variable. But only I know this, and a teacher, parent, friend might not know what I am going through — they are not living my life.

We live in a world where results are everything. Too often I have been told to just ‘try harder.’ Well, ‘trying hard’ just doesn’t cut it anymore – it is not so simple if you have ADHD, and especially if you have problems with organization in some tasks. I have gotten in trouble more times than days I’ve lived on this planet because I complete 85% of an assignment, task, or any kind of job. And then when I just cannot do the rest, others around get angry, frustrated, or don’t understand. And worse, I get really down on myself! Continue reading

Mass. Health Insurers Report Losses; Many Premiums To Rise By 3 Percent

Health insurance rate changes for the small group market in Mass. The Q1 rates also apply to individual coverage for 2015. (Source: Mass. Office of Consumer Affairs and Business Regulation)

Health insurance rate changes for the last quarter of 2014 for the small group market in Mass. The Q1 rates also apply to individual coverage for 2015. (Source: Mass. Office of Consumer Affairs and Business Regulation)

Premiums for Massachusetts small businesses and residents who buy insurance on their own are going up.

The average increase for Jan. 1 is 3.1 percent. But this is just the base rate. Your rates could be higher or lower, depending on how much you or your fellow employees have spent on health care this year.

Insurers say premiums are going up because residents are using more care. What’s known as “utilization” in the insurance world dropped during the recession, but appears to be creeping up again. Then, say insurers, there’s the cost of some expensive new drugs, such as Sovaldi to treat Hepatitis C; taxes related to the Affordable Care Act; and the expense of dealing with the Health Connector’s failed website.

Although the average increase for Jan. 1 is just over three percent, there’s quite a range.

Shop carefully. Many of the cheaper plans will have a high deductible, so if you have a chronic disease or lots of young children, you may not want this option. You can save money by choosing a plan that limits where you seek care, but check to see if your doctor(s) are in the covered network.

Also today, the state’s three largest health plans reported that they’ve lost money so far this year.

Blue Cross Blue Shield posted a net loss of $32.2 million for the second quarter and $91.4 million loss for the first six months of the year.

“Our second quarter results reflect our continued commitment to delivering more affordable premiums to our members while we absorb costs associated with complying the ACA,” said Allen Maltz, Blue Cross CFO.

Harvard Pilgrim’s net loss through June is $10.4 million. Continue reading

Virtual Check-Ups: The Doctor Will See Your Online Responses Now

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

Veronica Thomas
CommonHealth Intern

Like many patients with chronic conditions, Lesley Watts used to come in to the doctor’s office for a check-up on her digestive disorder every 12 months. This not only meant time spent in traffic and scouring for a parking spot, but also the brain fog and stress of answering her doctor’s questions on the spot.

But a year ago, when it was time for her visit, she instead  received an email reminder to pull up an online form that asked her everything her doctor needed to know about her symptoms. From the comfort of her recliner, Watts carefully answered the questions, among them: “Overall, how have your reflux symptoms been since your last office visit?” “How much have your symptoms affected your work, social, and/or home life?”

When she was satisfied with her responses, she clicked “submit.” The next day, she received instructions from her doctor about how to manage her symptoms better. Visit complete. And patient satisfied.

“It asked me questions that I had never been asked before, and as a consequence, I learned about symptoms I had not recognized,” she remembers. “I believe I received better care because I was able to take my time and provide more accurate answers.”

“We believe that it can actually increase your engagement with the system because you’re thinking about your condition outside of the physician’s office.”
– Dr. Ronald Dixon

Virtual care and tele-medicine are hot health topics, replete with weighty promises of revolutionizing healthcare. But they often refer to realtime video-chatting or texting with a clinician—whether it’s your personal provider or a random doctor overseas.

The Massachusetts General Hospital service that Lesley Watts participated in aims to conduct virtual visits without the realtime interaction.

Instead, patients complete an online questionnaire for their specific conditions, and send it to their personal doctor—whom they already know and trust—for review and response. For the past two years, primary care clinicians at an MGH Beacon Hill practice have been using over 30 different forms to follow up with some of their adult patients.

According to Dr. Amy Fogelman, a physician at the Beacon Hill practice, the clinical questionnaires are especially useful for chronic conditions that need management over time, like obesity and hypertension. In fact, the obesity questionnaire has proven more effective at helping patients lose weight than any other method she’s tried, she says. Continue reading

Ebola Forecast: What To Expect Now And How To Contain Future Outbreaks

(European Commission DG ECHO via Compfight/Flickr)

(European Commission DG ECHO via Compfight/Flickr)

Veronica Thomas
CommonHealth Intern

A digital surveillance program used Twitter feeds and news headlines to pick up on the Ebola outbreak in West Africa a full nine days before the World Health Organization proclaimed it an epidemic. 

But that doesn’t mean the outbreak could have been prevented.

Dr. Alessandro Vespignani, a professor of computer science and physics at Northeastern University, uses network science to model and forecast the spread of disease. Like HealthMap, the online tool cited above, Vespignani’s computer simulations cannot anticipate an outbreak before it actually begins.

“They don’t have a crystal ball either,” he says. “HealthMap is really a novel way of doing disease surveillance that can provide a real edge in the early detection of outbreaks by monitoring news articles, journals, Twitter or other digital sources. But they can’t do this before the actual occurrence of the event. There was already a situation in West Africa. HealthMap was just able to pick up the anomaly before anyone else.”

As the death toll climbs over 1,000 in West Africa, I was curious to know what makes this particular outbreak so relentless and what the global community can do to contain its spread. My conversation with Dr. Vespignani, lightly edited:

First of all, what exactly are big data and network science research? And how do you use them to track disease outbreaks?

We create large-scale models for disease forecasting by creating a synthetic world in the computer that integrates all data about human mobility. Then we plug an infectious individual into the model and look at the spread of the disease. You can look at different levels of granularity—whether locally or internationally. Network science is important because most disease now spreads by human mobility. What you hear many times is, “We’re all one hop away from West Africa,” although it’s thousands of kilometers away. No one has a crystal ball, so we cannot say when there will be an Ebola disease outbreak. As soon as we have the data on the outbreak, what we can do is try understanding how it will evolve in the next few weeks or months, which is what we do with this modeling.
Continue reading

Mass. Seeks $80M More From Feds For Health Website

Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.

Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.

So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget.*

Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15. Continue reading

Why To Exercise Today: Get Better At Bearing Pain

(U.S. Navy via Wikimedia Commons)

(U.S. Navy via Wikimedia Commons)

The other day, I got going a little harder than I meant to on the stairclimber, huffing and puffing hugely at a setting a bit too high. Amid other vague thoughts (“I wonder at what point this becomes dangerous?”) was this one: “Funny, once I would have perceived being out of breath like this as unpleasant, but lately it’s neutral or even kind of fun.”

I thought of that moment when I saw the latest Phys Ed column in The New York Times: How Exercise Helps Us Tolerate Pain. Gretchen Reynolds writes:

“Regular exercise may alter how a person experiences pain, according to a new study. The longer we continue to work out, the new findings suggest, the greater our tolerance for discomfort can grow.”

It has long been known that endorphins released during exercise diminish pain in the short-term, but what about the longer-term pain effects of exercise? She describes a small study of 24 adults, and the striking — though of course preliminary — results. A control group that did not exercise saw no change in pain tolerance.

But the volunteers in the exercise group displayed substantially greater ability to withstand pain. Their pain thresholds had not changed; they began to feel pain at the same point they had before. But their tolerance had risen. They continued with the unpleasant gripping activity much longer than before. Those volunteers whose fitness had increased the most also showed the greatest increase in pain tolerance. Continue reading

Perspiration Power: Scientists Turn Sweat Into Electrical Energy

A tattoo biosensor (enlarged above) detects lactate levels during exercise; a biobattery using the technology could power electronics (Photo: Joseph Wang)

A tattoo biosensor (enlarged above) detects lactate levels during exercise; a biobattery using the technology could power electronics (Joseph Wang)

By Richard Knox

It takes energy to work up a sweat. But now researchers have cleverly figured out how to turn sweat into energy.

Scientists have devised a small skin patch they call a “temporary tattoo” that can transform lactate — one of 800 or so chemicals in sweat — into electrical energy.

Not much energy, so far. Only about 4 microwatts, less than half of what it takes to power a digital watch. But the energy alchemists are confident they can scale up their sweat “biobattery” enough to play an iPod, power a GPS device, or warn a marathoner when it’s time to top up her electrolytes.

The researchers think their work could also have military and biomedical applications, if they can tweak the technology to squeeze more electricity out of sweat.

“Sweat has been largely neglected, not thought of as a worthwhile physiological fluid.”
– Researcher Josh Windmiller

“Right now we’re working on the biofuel cell so it can get higher power,” Wenzhao Jia, of the University of California San Diego, tells CommonHealth. She’s describing the skin-patch biobattery tomorrow at a meeting of the American Chemical Society in San Francisco.

One problem in experiments so far: People who are less fit produce more energy from their sweat than those who are moderately fit. The fittest subjects produce the least amount of power. The researchers are trying to figure out how to compensate for this.

“We want to integrate another electronic element such as a super-capacitor that can store the power,” Jia says. “Ultimately, we can connect a number of cells together to make the current higher.”

Jia says the sweat-powered battery grew out of an earlier effort to monitor levels of lactate, a metabolic byproduct when sugar (glucose) is broken down to produce energy — a process called glycolysis. (It’s the buildup of lactate, or lactic acid, that makes your muscles sore after strenuous exercise.) Continue reading