Monthly Archives: October 2013

Review: ‘Ether Dome’ Play Won’t Put You To Sleep But Could Use Scalpel

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from "Ether Dome." (Courtesy T. Charles Erickson/Huntington Theatre)

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from “Ether Dome.” (Courtesy T. Charles Erickson/Huntington Theatre)

Ouch. That’s what I was saying during several of the graphic tooth-pulling and surgery scenes of “The Ether Dome,” a play about the origins of modern anesthesia now running at the Calderwood Pavilion in the South End through Nov. 23.

And that’s also what I said when I read this devastating but (in my opinion) perfectly on-point line in Carolyn Clay’s review of the show on WBUR’s arts blog, “The Artery”: “…it seems clear that the dramatist needs to administer some pain balm to herself, pick up scalpel and saw, and hack a few limbs off baby.”

Clay’s review begins:

BOSTON — You won’t require anesthesia to get through “Ether Dome,” Elizabeth Egloff’s relatively new play built on the introduction of ether — right here at Massachusetts General Hospital in 1846 — to alleviate the horrific pain of surgery. But neither will you be held to the edge of your lecture-hall seat (we the audience are medical-student observers in the dome). The three-act play is so diffuse, with at least four questionable protagonists, that there is really no one to root for — except, of course, the ether, which both transformed Hippocratic barbarism into a pretty smooth ride and started the medical ball rolling in the direction of big business.

As an utterly amateur theater-goer who was drawn to the show by the medical history, I humbly concur. It was a great pleasure to watch some of the grand old men of Massachusetts General, men whose names now grace the hospital’s buildings, brought to life in all their quirky, grumpy, brilliant glory. But I did wish for more of an editorial scalpel. Read the full “Artery” review here: The Huntington’s Ether Dome Won’t Put You To Sleep.

Pre-Med Stress Hits New Heights As MCAT Exam Changes Loom

By Alvin Tran
Guest Contributor

Becoming a doctor was never easy. There’s stress, there’s no sleep, there’s life and death. But now, that already tough career path will get even more complicated with the introduction of a new, far longer version of the Medical College Admission Test, aka, the MCAT.

Just ask pre-med Charles Denby, who panicked when he recently went online to sign up for the test and found all the sites in the U.S. were booked into January 2015. Why is that a problem? Well, that’s when the old, familiar four-hour MCAT takes a short hiatus and then morphs into a newfangled, nearly seven-hour version of the test that most students must take in order to get into medical school.

(Marquette University/Flickr)

(Marquette University/Flickr)

Denby, a 36-year-old consultant who is now pursuing a medical career, was not amused by the prospect of facing the new test. It’s “a curveball I wasn’t expecting,” he said in an interview from his home in Providence. Denby is hoping someone local will opt out of taking the test at the last minute so he can get a spot, though he briefly considered getting on a plane to avoid the new exam. “Germany and Israel are available for January right now,” he said.

Germany? Israel? Isn’t the MCAT stressful enough without getting on a plane and switching time zones?

Barbara Moran, a pre-med student in Brookline, who recently completed Kaplan’s MCAT prep class, was stunned to hear that her classmates were planning to travel to Indiana and South Dakota to take the exam. Moran, who took the exam Oct. 21, had reserved her seat in Boston months ago. “I suddenly realized I was sitting on the hottest ticket in town,” said Moran. “It was like having a seat at a Yankees-Boston World Series game.”

The soon-to-be-extinct four-hour exam now tests students’ knowledge of chemistry, physics, biology, organic chemistry and verbal reasoning; and also their nerves, as they watch the clock tick down while struggling to recall obscure equations. Now they’ll have to endure that anxiety even longer: the new test is nearly seven grueling hours long.

The Association of American Medical Colleges (AAMC), which administers the MCAT, approved changes to the test in 2012.

One of the most significant changes is the inclusion of the new section that tests students’ understanding of the socio-contextual determinants of health — essentially asking students to think beyond the specifics of the patient’s body, and consider how income and social status, education, home and work environments and other factors shape health outcomes. Continue reading

Study Raises Questions About Military Service Causing Chronic Suicidal Tendencies

A new study commissioned by the U.S. Army has found that the mental health of soldiers isn’t as different from civilians as the researchers previously thought.

Earlier this year, researchers said that soldiers, who were surveyed at different times during their Army careers, had higher rates of mental disorders before they enlisted than the rates of mental illness in the general population.

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Uber Pilots Program To Bring Flu Shots To Your Door

In this April 3, 2014 photo, a smartphone is mounted on the glass of an Uber car in Mumbai, India. Riding on its startup success and flush with fresh capital, taxi-hailing smartphone app Uber is making a big push into Asia. The company has in the last year started operating in 18 cities in Asia and the South Pacific including Seoul, Shanghai, Bangkok, Hong Kong and five Indian cities. (Rafiq Maqbool/AP)

A smartphone with the Uber app is mounted on the glass of an Uber driver. (Rafiq Maqbool/AP)

If you used Uber in Boston today, you may have noticed a new feature. The car service company was offering what it calls UberHEALTH to bring free flu shots to users’ doors.

The service was part of a one-day pilot program in Boston, New York and Washington D.C., the company announced on its blog.
Continue reading

Outbreak Deja Vu: Rumor, Conspiracies, Folklore Link Disease Narratives

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

By Jon D. Lee
Guest Contributor

Nearly five years ago, during the peak of the H1N1 — swine flu — pandemic, a joke appeared on the Internet based on the nursery rhyme “This Little Piggy.”

The joke (clearly for public health insiders) was intended to comment on the similarities between swine flu and avian flu, and it concluded this way:

And this little piggy went “cough, sneeze” and the whole world’s media went mad over the imminent destruction of the human race, and every journalist found out that they didn’t have to do too much work if they just did “Find ‘bird’, replace with ‘swine’” on all their saved articles from a year ago, er, all the way home.

The punch line makes an important point about the recycling of stories. But for all of its insight into this phenomenon, the joke doesn’t end up taking the lesson far enough.

Because it’s not just the media that recycles stories — it’s all of us.

In “An Epidemic of Rumors: How Stories Shape Our Perceptions of Disease,” I conducted an extensive study of the narratives — the rumors, legends, conspiracy theories, bits of gossip, etc. — that circulated during the H1N1, SARS and AIDS pandemics.

The results showed that all three pandemics were rife with rumors that, though created decades apart, had striking similarities. Every disease had a story claiming a government conspiracy or cover-up. Every disease had a list of surefire cures and treatments “they” don’t want you to know about. Every disease had false and inaccurate stories about where it had spread to and who was infected. Continue reading

Colleges Are Inconsistent In Handling Athlete Concussions, Harvard Study Finds

Colleges remain inconsistent in the way they handle athletes’ concussions, according to a Harvard University study that comes more than four years after the NCAA began requiring schools to educate their players about the risks of head trauma and develop plans to keep injured athletes off the field.

In a survey that included responses from 907 of the NCAA’s 1,066 members, researchers found that nearly one in five schools either don’t have the required concussion management plan or have done such a poor job in educating their coaches, medical staff and compliance officers that they are not sure one exists.

West Virginia's Terrell Chestnut is examined by medical staff during an NCAA college football game against Baylor earlier this month. He later left the game with a concussion. (Chris Jackson/AP)

West Virginia’s Terrell Chestnut is examined by medical staff during an NCAA college football game against Baylor earlier this month. He later left the game with a concussion. (Chris Jackson/AP)

“Collectively, the institutions without a concussion management plan are responsible for the well-being of thousands of college athletes each year,” according to the study co-written by Harvard researcher Christine Baugh and published this week in the American Journal of Sports Medicine. “For stakeholders to follow an institution’s concussion management plan – or to have confidence that others are following the plan – they must first know that it exists.”

The findings in the study reinforce the images fans have seen in stadiums since the problem with concussions became more widely known: Wobbly players are sent back onto the field without proper medical clearance as coaches remain ignorant to their injury – perhaps willfully. The authors recommend that the NCAA bolster its 2010 policy to require schools to make their plans public, to better educate coaches about concussion symptoms and to require that schools not only come up with plans but actually apply them.

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Surgeon General Nominee Murthy Loses Support Of Key Backers

Dr. Vivek Murthy (Charles Dharapak/AP/File)

Dr. Vivek Murthy (Charles Dharapak/AP/File)

One of the country’s leading medical journals is withdrawing support for a Brigham and Women’s Hospital physician nominated by President Obama to become the next surgeon general.

The New England Journal of Medicine (NEJM) endorsed Vivek Murthy in May, but an editorial published Wednesday withdraws that support.

Continue reading

E-Cigarette Debate: 7,000 Flavors Of Addiction, But What Health Risks?

I’m not young or edgy enough to hang out with anyone who smokes e-cigarettes, but I’ve been vaguely aware that they’re a big and growing thing, and the focus of a big and growing controversy. To wit: Do they end up a net positive, because they help people quit the classic “cancer sticks,” or a net negative, because they act as “gateway” cigarettes just when we’ve finally beaten our smoking rates down?

Answer: We don’t know yet. That’s my takeaway from a major multimedia project on electronic cigarettes on Boston University’s new research website. But it’s such an important question that it’s even a source of debate between prominent researchers on campus — though both strongly concur that more research is needed. From “Behind The Vapor:”

At Boston University, Avrum Spira, a pulmonary care physician and School of Medicine associate professor of pathology and laboratory medicine and bioinformatics who studies genomics and lung cancer, was one of the first scientists to receive funding from the FDA to investigate the health effects of e-cigarettes. “In theor y—- and how they’re marketed — e-cigarettes are a safer product because they don’t have tobacco, which has known carcinogens,” Spira says. “The question is: does safer mean safe?”

(From the Boston University video)

(From the Boston University video)

Across BU’s Medical Campus from Spira, Michael Siegel, a physician and professor of community health sciences at the School of Public Health, has emerged as perhaps the country’s most high-profile public health advocate for e-cigarettes. Siegel, who is not currently researching e-cigarettes, says he believes that the device could potentially help large numbers of smokers quit, or drastically decrease, a habit that is the leading cause of preventable deaths in the US. He points out that despite all the existing smoking cessation products on the market, only a small fraction of cigarette smokers manage to quit. Only 4 to 7 percent break the habit without some nicotine replacement or medication, according to the American Cancer Society. At the same time, Siegel says, more research is needed on the health effects of e-cigarettes as well as their effectiveness in helping people quit smoking.

Check out the full project here, including the video above, “7,000 Flavors of Addiction.” And while you’re on the new website, a couple of other particularly grabby features: The Secret’s In The Spit (the gluten-saliva link — who knew?) and The Secret Life of Neutrinos.

Reality Check: How People Catch Ebola, And How They Don’t

Dr. Elke Muhlberger (Courtesy of Kalman Zabarsky for BU Photography)

Dr. Elke Muhlberger (Courtesy of Kalman Zabarsky for BU Photography)

It’s confusing. You hear that Ebola victim Thomas Eric Duncan was so contagious that two Dallas nurses in protective gear caught the virus. But then you hear, in more recent days, that apparently nobody else did, including the inner circle who lived with him and cared for him. The CDC announced today that all of Mr. Duncan’s “community contacts” have completed their 21-day monitoring period without developing Ebola.

How to understand that? And how to address alarmists’ claims that for the nurses and so many West Africans to have caught Ebola, it must have gone “airborne”?

I turned to Dr. Elke Muhlberger, an Ebola expert long intimate with the virus — through more than 20 years of Ebola research that included two pregnancies. (I must say I find this the ultimate antidote for the fear generated by the nurses’ infections: A researcher so confident in the power of taking the right precautions that she had no fear — and rightly so, it turned out — for her babies-to-be.)

Dr. Muhlberger is an associate professor of micriobiology at Boston University and director of the Biomolecule Production Core at the National Emerging Infectious Diseases Laboratories (widely referred to as the NEIDL, pronounced “needle”) at Boston University. Our conversation, lightly edited:

Is it really true you worked on Ebola through two pregnancies?

Yes, but in the proper protective gear. That makes a huge difference, if you’re protected, if you know how to protect yourself, and that is the case in a Biosafety Level 4 lab, of course. If you compare the protective gear we’re wearing in a Biosafety Level 4 lab and the gear they’re wearing in West Africa now treating patients, it’s like comparing a stainless steel vault to a cardboard box.

But on the other hand, if you look at the nurses in Dallas, you say, ‘How did they get infected?’ It makes you worry that maybe protective gear isn’t good enough — but you’re proof of the opposite.

A Biosafety Level 4 lab is such a high-end lab, it is not possible to use protective gear like that in every hospital in the U.S.

Could you please lay out a brief primer on the biology of how Ebola is transmitted?

We know from previous outbreaks, and also from the current outbreak, that Ebola is transmitted by having very close contact to infected patients. So we know that it is transmitted by bodily fluids, which include blood, first of all — because the amount of virus in the blood is very, very high, especially at late stages of infection — but it’s also spread by vomit, by sputum, by feces, by urine and by other bodily fluids.

The reason for that is that at late stages of infection, the Ebola virus affects almost all our organs — it causes a systemic infection. One main organ targeted by Ebola virus is the liver, and that could be one of the reasons that we see these very high concentrations of viral particles in the blood. But I would like to emphasize that that occurs late in infection.

Early infection is the other way around. The primary targets — the first cells that come in contact with Ebola virus and get infected — are cells that are part of our immune system. And these cells most likely spread the virus throughout our body. But there are not so many cells infected at the very beginning of the infection, which might be the reason why Ebola virus patients do not spread virus at the very beginning of infection. And that’s why it’s safe to have contact with these patients, because the viral titers in their blood are so low that we cannot even detect them with methods like PCR, which is one of the methods we use to diagnose Ebola virus.

Is a virus only contagious when it reaches a certain level of “titer” or load? Continue reading

Ebola Tipping Point? Dispelling Myths And, Possibly, Less Hysteria Over Virus

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

Has the national hysteria over Ebola peaked? Who knows. Maybe. There seem to be fewer front page headlines screaming about it; a new national poll finds most Americans are “positive” about the response by public health authorities; and today’s news is that more than 40 Dallas residents (all who had been in contact with the Liberian man who died of Ebola) were declared virus-free.

Still, education is the antidote to hysteria, so it’s worth reiterating some of the facts. Many of them can be found in this must-read commentary in the London Review of Books by Paul Farmer, the rock star Harvard infectious disease doctor and leading advocate for global health equity in the world’s most impoverished regions. Farmer, who is also a co-founder of the Boston non-profit Partners in Health, writes that despite some of the truly scary aspects of the virus, an Ebola diagnosis is not necessarily a death sentence:

The Ebola virus is terrifying because it infects most of those who care for the afflicted and kills most of those who fall ill: at least, that’s the received wisdom. But it isn’t clear that the received wisdom is right….

…the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.

And he adds this:

I’ve been asked more than once what the formula for effective action against Ebola might be. It’s often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions. What’s the ‘model’ or the ‘minimum basic package’? What are the ‘metrics’ to evaluate ‘cost-effectiveness’? The desire for simple solutions and for proof of a high ‘return on investment’ will be encountered by anyone aiming to deliver comprehensive services (which will necessarily include both prevention and care, all too often pitted against each other) to the poor. Anyone whose metrics or proof are judged wanting is likely to receive a cool reception, even though the Ebola crisis should serve as an object lesson and rebuke to those who tolerate anaemic state funding of, or even cutbacks in, public health and healthcare delivery. Without staff, stuff, space and systems, nothing can be done.

If you want to become more educated on Ebola and find out what you can do to support the global effort, Partners In Health/Engage and Harvard are sponsoring an Ebola teach-in Wednesday night in Cambridge with a panel of practitioners and public health experts. Continue reading