Monthly Archives: October 2013

Calling 911 From Your Cellphone? Don’t Assume They’ll Know Exactly Where You Are

Trainer Kevin Lewis (Carey Goldberg/WBUR)

Training specialist Kevin Lewis of the Massachusetts 911 department at a call center training screen. (Carey Goldberg/WBUR)

One afternoon this fall, as Dr. Ian Sklaver was coaching his 13-year-old daughter’s soccer team, one of the players suddenly collapsed and stopped breathing. Her skin took on a blue pallor, and her pulse was thready, barely there.

Sklaver, who practices at Garden City Pediatrics in Beverly, Massachusetts, immediately started CPR and called 911. We need an ambulance, he told the dispatcher urgently, giving the name of the school he was at and the street it was on.

The dispatcher asked him a question or two, he recalls, “and then asked me the bewildering question of ‘What town are you in?’ And I told them, and then they reconnected me to another person to re-tell the same story again — which seemed to be taking a lot of time away from doing CPR.”

Fortunately, the player was fine — but Sklaver was left mystified.

He has Google Maps, Find-My-iPhone and other free apps, he said, “that can find me to the exact street address. And I call 911, the most important call one could potentially make,” and he’s asked what town he’s in.

Our goal is to bring the 911 system into the 21st century.

– David Furth, FCC

So — if apps like Google Maps and Uber seem to know just where your phone is, why doesn’t the 911 system?

The answer is sadly simple. The 911 system “is based on technology that was developed almost 40 years ago,” said Brian Fontes, CEO of the National Emergency Number Association, a nonprofit that focuses on 911 issues.

“And it was designed for a wired-only world where you have your wired phone tethered to a fixed address,” he explained. “Much has changed, obviously, over the years, and today roughly 75 or 80 percent of 911 calls come in from wireless devices.”

Back when cellphones were new, the 911 system could only map which tower had relayed a given call. In recent years, with GPS, the system has gotten much better at locating cellphone calls. But it is still behind commercial apps. Continue reading

New Wellesley President, Dr. Paula Johnson: Advocate For Women’s Health, Access To Care And Beyond

Dr. Paula Johnson is a woman of breadth: she can give a speech calling for a new movement in health care comparable to the civil rights movement — with greater access to quality health care for all — and she can also deliver compassion in the clinic with her patients. (I know, she treated my mother years ago.)

Dr. Paula Johnson (Courtesy Wellesley College)

Dr. Paula Johnson (Courtesy Wellesley College)

Johnson runs the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, where she’s also the chief of women’s health. She’s also a professor at Harvard Medical School, and on Thursday she was named the new president of Wellesley College.

Johnson was a key driver behind a massive effort to end gender bias in medical research, starting with an exhaustive report on the problem (and a TED Talk that’s been viewed more than 1 million times). When the National Institutes of Health announced it would distribute more than $10 million in grants to help combat a persistent pattern of gender bias in science and medical research, Johnson called it “a significant step” but said much more needs to be done.

She was out front as a cheerleader of the benefits for women from President Obama’s Affordable Care Act; and she was passionate about the importance of the HPV vaccine for both women and men, in particular, when it comes to head and neck cancers.

I asked Johnson, who is also a cardiologist, for a list of her top 10 medical accomplishments, and here, lightly edited, is what her people sent over: Continue reading

Related:

Price Of User-Friendly Form Of Overdose Reversal Drug Spikes

Evzio’s “Trainer.” (Jesse Costa/WBUR)

Evzio’s “Trainer.” (Jesse Costa/WBUR)

In the midst of the opioid epidemic, there’s a spike in the price of injectable naloxone, the drug used to reverse an overdose.

Evzio, made by Richmond-based Kaleo, is a user-friendly, pocket-sized device. The wholesale price for a kit was $690 when it hit the market in July 2014. In November 2015, the wholesale price rose to $900. At the beginning of February, it increased 400 percent to $4,500.

Health plans in Massachusetts cover Evzio. It’s “a very important component of dealing with the heroin and opioid epidemic,” said Massachusetts Association of Health Plans CEO Lora Pellegrini. “So it’s really shocking to see these price increases and I’m not sure that they’re justified.”

Kaleo CEO Spencer Williamson says the price hike is justified by the behavior of insurance companies. He has a story that explains what he means.

Continue reading

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Dental Schools To Introduce Training On Opioid Abuse

Gov. Baker and health administration officials joined heads of local dental medicine schools Thursday to announce an agreement on new educational standards that introduce training for opioid abuse prevention and management into their core curriculums. (Antonio Caban/SHNS)

Gov. Baker and health administration officials joined heads of local dental medicine schools Thursday to announce an agreement on new educational standards that introduce training for opioid abuse prevention and management into their core curriculums. (Antonio Caban/SHNS)

As he waits on the Legislature to compromise over opioid abuse prevention strategies, Gov. Charlie Baker on Thursday detailed an agreement reached with the deans of the state’s three dental medicine schools to introduce training for opioid abuse prevention and management into their core curriculums.

The governor, who has reached similar agreements with the heads of the state’s medical schools over improved training of future physicians to deal with pain management and substance abuse, continues to take steps on his own to chip away at the substance abuse crisis and the proliferation of addictive opioids.

Baker betrayed little frustration with the pace of action in the Legislature, despite calling it “critically important” for the House and Senate negotiators to deliver a bill to his desk.

“I know that they are trading proposals. I know that it’s an active conversation that’s going on, and my hope is that it will be able to land in a place that works for both the House and the Senate sooner rather than later. I would be more concerned about this if there wasn’t any back and forth going on with respect to the issue, but there is,” Baker said.

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Dementia Cases May Be Declining, Researchers Report, And Improved Heart Health Could Be Key

Decima Assise, who has Alzheimer's disease, and Harry Lomping walk the halls, Friday, Nov. 6, 2015, at The Easton Home in Easton, Pa. (Matt Rourke/AP)

Decima Assise, who has Alzheimer’s disease, and Harry Lomping walk the halls, Friday, Nov. 6, 2015, at The Easton Home in Easton, Pa. (Matt Rourke/AP)

Don’t misread this new report: the number of people expected to develop all types of dementia is still expected to skyrocket in the coming years, with estimates of more than 13 million older adults in the U.S. afflicted with Alzheimer’s disease by 2050.

But the report offers what researchers call “cautious hope.”

The analysis, based on data from the Framingham Heart Study (FHS), and published in The New England Journal of Medicine, suggests that the rate of new cases of dementia may be declining. Over a period from the late 1970s until the early 2000s, researchers report about a 20 percent reduction in dementia cases per decade. One potential reason: What’s good for your heart is also good for your brain.  And the report finds that among the Framingham study participants, at least, overall heart health has generally improved over the decades. (Though obesity and diabetes prevalences have not.)

Claudia Satizabal, the study’s lead author and an instructor of neurology at the Boston University School of Medicine, said in an interview that “with this study, what we’re showing is that we could potentially prevent some cases or delay the onset of [dementia] with improved cardiovascular health.” But, she warned, while the study points to improved heart health as a potential factor in the improved dementia outlook, “we need more research to identify which other factors have contributed to this decline so that we can extend this beneficial trend.”

Researchers began tracking cognitive decline and dementia in the FHS participants beginning in 1975 and into the present; for the current study they rely on data from about 5,000 participants. This analysis involved dividing the years into four time periods — the late ’70s, late ’80s, ‘1990s and 2000s. The researchers estimated the incidence of dementia at any given age in each of those periods for five years.

“We found that there has been a progressive decline in the incidence of all dementias,” Satizabal said. “If we compare to the late ’70s, we observe a decline of 22 percent in the late ’80s, then a 38 percent decline in the 1990s and a 44 percent decline in the 2000s.”

Notably, she said, the decline was more pronounced with a type of dementia caused by strokes. And also notably, the decline was only seen among participants with a high school diploma or above. Higher education, Satizabal said, can often be related to a better quality of life, and better vascular health overall.

Continue reading

Why To Exercise Today: The Size Of Your Brain As You Age

(Wikimedia Commons/NIH)

(Wikimedia Commons/NIH)

Voice of panic: “Noooooo, don’t let my brain shrink!”

Voice of reason: “No one is shrinking your brain.”

Voice of panic: “But a study just out in the journal Neurology finds that people who are less fit in middle age tend to have smaller brains when they’re measured 20 years later.”

Voice of reason: “Right, but it’s just a link, not proof of causation. Anyway, that smaller size is compared to fitter people. So don’t panic, just get back on that treadmill…”

Would write more but too busy jogging. From the press release:

“We found a direct correlation in our study between poor fitness and brain volume decades later, which indicates accelerated brain aging,” said study author Nicole Spartano, PhD, with Boston University School of Medicine in Boston.

For the study, 1,583 people enrolled in the Framingham Heart Study, with an average age of 40 and without dementia or heart disease, took a treadmill test. They took another one two decades later, along with MRI brain scans. The researchers also analyzed the results when they excluded participants who developed heart disease or started taking beta blockers to control blood pressure or heart problems; this group had 1,094 people. Continue reading

For Menopause-Related Sleep Problems, Study Suggests Trying Acupuncture

If you’ve reached menopause and just can’t sleep like you used to, you might want to learn about a special spot on your body. No, not that one. It’s the Sanyinjiao acupoint, or Spleen 6 — a small area just above the ankle on the inside of the leg. New research suggests that for women with menopause-related sleep problems, acupuncture, particularly on that point, may offer relief.

(Fairy heart/Flickr)

(Fairy heart/Flickr)

Among the myriad discomforts that afflict menopausal women, sleep problems may not get as much attention as hot flashes. But all manner of sleep disturbances — from waking up at the crack of dawn unable to fall back asleep to full blown insomnia — are pervasive among this demographic.

Researchers report that the prevalence of menopause-related sleep disturbances ranges from 8.4 to 56.6 percent. Estrogen deficiency contributes to the problem; nocturnal hot flashes are also sometimes a factor.

In the new review, a meta-analysis of more than 30 clinical trials involving 2,433 participants published in the journal Obstetrics and Gynecology, researchers in China found a “substantial association” between acupuncture and improved sleep in peri-menopausal and post-menopausal women. Specifically, the researchers say they demonstrated “that the association of reduction in menopause-related sleep disturbance and acupuncture was correlated with changes in serum estradiol levels particularly when the Sanyinjiao acupoint was stimulated.” (Estradiol is the estrogen mostly produced from the ovaries, and can also be used to treat peri-menopausal symptoms.)

The researchers theorize that the elevated serum estradiol levels may be the key to why acupuncture could help alleviate the sleep disturbances.

There are caveats: the researchers report an association only between acupuncture and a decrease in sleep disturbances; also, sleep quality assessments were mostly based on patients perceptions; in addition, the researchers report that their analysis only looked at articles in English and Chinese, which might limit the generalizability of the review.

Continue reading

Mystery Solved: Why That ‘Opioid-Induced Constipation’ Super Bowl Ad?


I imagined 100 million people all scratching their heads at the same time and saying, “Huh?”

The source of their bafflement: Why, among all the usual Super Bowl ads for cars and beers, is there a minute-long tale (watch it above) of a man who envies others — even a dog — their digestive regularity?

The voice-over describes his plight: “If you need an opioid to manage your chronic pain, you may be so constipated it feels like everyone can go…except you. Tried many things? Still struggling to find relief? You may have opioid induced constipation — OIC.”

The condition sounds straightforward enough, and the social media poop jokes were predictable enough. The mystery was: How does something that looks like a public service announcement about opioid constipation show up on the most expensive advertising real-estate around?

A skeptical friend sent over these queries: “Are there really enough people on opioids that they can justify paying for a Super Bowl commercial? Isn’t anyone on legitimate opioids in a doctor’s care and getting info about anti-constipation meds?”

First of all, yes, there are enough people on opioids. The U.S. Pain Foundation estimates on its OIC page that nearly 8 million people who are on opioids suffer from related constipation. And that estimate may well be low, said the foundation’s founder, Paul Gileno, because people don’t tend to seek care for constipation, they often just try to treat it with over-the-counter and natural remedies. The U.S. Pain Foundation is one of a half-dozen groups listed at the end of the ad as co-sponsors, and some of its funding comes from pharmaceutical companies.

Secondly, Gileno said, no, many doctors are not on top of opioid-related constipation. “We’d all love to assume it’s being take care of, but it’s really not,” he said — to the point that some patients even skip their opioid doses despite the added pain, just to try to cope with the constipation.

About three-quarters of pain management happens in primary care doctors’ offices, he said, and those typically brief visits are often so focused on alleviating pain that they do not delve into side effects. Patients may also fail to connect their pain medication with their constipation.

“Early on in my pain journey, I didn’t realize that was a side effect, and quite honestly, my primary care doctor didn’t know either, he didn’t bring it up to me,” Gileno said. “It was only when I was able to see a good pain management doctor that he knew that was a side effect.”

The point of the Super Bowl ad was to get a conversation going about this embarrassing but important aspect of pain treatment, Gileno said.

But Super Bowl conversation-starters do not come cheap. USA Today reports that a 30-second ad costs up to $5 million. On this list of sponsors, who has that kind of money? Yes, it’s the two pharmaceutical companies at the bottom: Continue reading

A $1 Pill That Could Save Thousands Of Lives: Research Suggests Cheap Way To Avoid U.N.-Caused Cholera

(United Nations Photo/Flickr)

(United Nations Photo/Flickr)

By Richard Knox

Here’s a way to get a big bang for a buck:

If a few hundred United Nations peacekeeping troops had taken a $1 antibiotic pill five years ago before they were deployed to Haiti, it may well have prevented a cholera outbreak that has so far sickened 753,000 Haitians and killed more than 9,000.

That’s the takeaway of a new study by Yale University researchers in the journal PLoS.

The authors believe their evidence should prompt the U.N. to adopt a simple and incredibly cost-effective strategy: Make sure all the 150,000 peacekeepers it sends out into the world each year from cholera-afflicted countries get preventive doses of antibiotics before deployment.

It’s not the first time the U.N. has gotten that advice. It was first suggested by a panel of outside experts the agency appointed back in 2011 to investigate the Haitian epidemic. But so far the U.N. has rejected the panel’s recommendation on preventive antibiotics.

It’s not clear whether that will change. The U.N.’s chief medical officer, Dr. Jillian Farmer, said in an interview Friday that she welcomes the new study. But she noted it does not address “the biggest barrier to implementing the antibiotic recommendation” — a concern that what she calls “mass administration” of antibiotics would give rise to antibiotic-resistant strains of cholera.

“It may be we will be able to do this [administer pre-deployment antibiotics to U.N. peacekeepers],” Farmer said. “I don’t have a closed mind.”

The Yale researchers and others argue that the concern about generating resistant cholera strains is overblown because the antibiotics would be targeted — not administered massively. They further argue that the U.N. should sponsor research to answer that question, given the urgency of the question.

“When we have a case as extreme as Haiti showing the status quo doesn’t work, we should be working to build evidence for a solution that does, not using a lack of proven solutions as an excuse not to act,” said Adam Houston, who works with the Boston-based Institute for Justice and Democracy in Haiti.

The new study is the latest chapter in a tragic story that’s been unfolding since mid-October of 2010, when, researchers say, a single U.N. peacekeeper from Nepal most likely introduced cholera to Haiti, touching off the most explosive cholera epidemic in modern times. Before the outbreak. Haiti had been cholera-free for at least a century; thus, its citizens had no immunity to the disease.

“Based on DNA evidence, this outbreak was probably started by one or very few infected, asymptomatic individuals — I would guess one,” said Daniele Lantagne, a Tufts University environmental engineer who was one of four independent experts appointed by the U.N. in 2011 to investigate the outbreak.

Since none of the 454 Nepalese peacekeeping troops deployed to Haiti in late 2010 showed any symptoms of cholera, all of them would have had to take a prophylactic dose of antibiotic to prevent any one of them from starting the outbreak. That would have cost around $500 — a tiny price to pay to avoid a devastating epidemic that — absent the investment of billions of dollars in clean water and sanitation — will continue into Haiti’s indefinite future.

The new analysis finds that prophylactic antibiotics would have reduced the chances of the Haitian epidemic by 91 percent. When antibiotics are combined with cholera vaccination, the risk of an outbreak goes down by 98 percent.

The U.N. began requiring cholera vaccination of all its field personnel late last year. But the new study says vaccination by itself isn’t very effective; it reduces the risk of an outbreak by only 60 percent at best.

That’s because vaccination can prevent someone from falling ill from cholera, but it doesn’t prevent infection — so a vaccinated person can still carry the cholera bacterium and pass it on to others.

“Vaccination alone is not enough,” said Virginia Pitzer, who led the Yale research team. “Vaccination plus antibiotic prophylaxis would be best.”

“Antibiotics are far and away the most effective and the least expensive,” added epidemiologist Joseph Lewnard, the study’s first author. “It hits the problem from two angles. It not only prevents those exposed to cholera from experiencing an infection, but if they do get infected it shortens the duration of shedding the bacteria. So once they arrive [at their deployment destination] they would no longer have bacteria in their stools.” Continue reading

Calls For Better Pain Relief Measures For Newborns, Premature Infants

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

In this file photo, an infant is seen in the neonatal intensive care unit of the Swedish Medical Center in Seattle. (Paul Joseph Brown/AP)

What could be more heartbreaking than witnessing some of the smallest, sickest babies undergoing painful medical procedures?

Yet that’s precisely the population subject to some of the most intrusive prodding and pricking, the “greatest number of painful stimuli” in the neonatal intensive care unit, or NICU.

Now the American Association of Pediatricians is calling for better, more comprehensive pain relief measures for newborns, including those born prematurely — both with medications and through alternative, non-drug measures — and for more research on effective treatments.

The AAP’s updated policy statement, published in the journal Pediatrics, asserts that “although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures.”

The AAP calls for new measures, specifically:

Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

If you’ve ever been in a NICU, you may have seen these types of procedures take place: suctioning of various secretions from the nose and throat; blood draws from veins, arteries, feet or heels; IVs being placed; adhesive tape — used to keep all those tubes and IVs in place — removed.

A landmark 2008 study from France found that the vast majority of newborns in the NICU didn’t get pain relief; researchers found only about 21 percent of infants were given either pain medication or non-drug pain relief before undergoing a painful procedure.

Why is this important? Continue reading