On the train to New York for Thanksgiving, we sat next to a family with a very chubby girl. She was about 9, with lovely red hair and a pretty moon-shaped face. But I could see her belly bulging and her chunky arms as she played with her iPad, and I imagined some tough teenage years ahead.
While her mother slept, her dad headed to the cafe car and returned with a box of chocolate chip cookies and peanut M&M’s. “Quiet,” he said, handing the treats to the girl. “Eat them before Mom wakes up.” Then he gave her a Mountain Dew to wash it all down. It was 10 am on Thanksgiving.
Remember the concept of “benign obesity” — the idea that as long as you’re exercising and relatively fit, being a little fat probably won’t hurt you. Well, think again. A new study published in the Annals of Internal Medicine suggests there is no healthy obesity. According to the news report:
Metabolically healthy obese people have a long-term increased risk for death and cardiovascular events compared with their normal-weight counterparts, suggesting there is no such thing as benign obesity, according to a meta-analysis.
(Yale Rudd Center for Food Policy & Obesity)
When studies with follow-ups of a decade or more were considered, obese people with no metabolic abnormalities had a 24% increased risk for these events compared with metabolically healthy, normal-weight people (relative risk 1.24; 95% CI 1.02-1.55), reported Caroline K. Kramer, MD, PhD, of Mount Sinai Hospital in Toronto, and colleagues.
All metabolically unhealthy people had a similar elevated risk for the events compared with metabolically healthy, normal-weight study participants, they wrote in the Annals of Internal Medicine, specifically an RR of 3.14 for normal weight (95% CI 2.36-3.93), 2.70 for overweight (95% CI 2.08-3.30), and 2.65 for obese (95% CI 2.18-3.12).
“Our results do not support this concept of ‘benign obesity’ and demonstrate that there is no ‘healthy’ pattern of obesity,” Kramer and colleagues wrote. “Even within the same category of metabolic status (healthy or unhealthy) we show that certain cardiovascular risk factors (blood pressure, waist circumference, low high-density lipoprotein cholesterol level, insulin resistance) progressively increase from normal weight to overweight to obese.”
Two measures that the nurses’ union supports look like they’ve gathered enough signatures to move forward toward appearing on state ballots next year. One, titled The Patient Safety Act, would set a limit on how many patients a registered nurse can be assigned. That’s been a hotly debated issue for years, including in this discussion on Radio Boston this summer.
The other is titled The Hospital Transparency and Fairness Act. The Mass. Nurses Association says it “will require hospitals to be transparent about their financial holdings and other activities, to limit CEO salaries and to limit and claw back excess profits to ensure that taxpayer dollars are dedicated exclusively to safe patient care and necessary services for all communities in the Commonwealth.”
If anyone’s been loudly debating issues of limiting hospital CEO salaries and operating margins, I’ve missed it. (Possibly because executive salaries and profit margins at Boston hospitals tend to look downright socialist compared to their counterparts in some other parts of the country.) But if this measure will raise issues of whether our state’s vaunted hospitals should be more publicly accountable for what they do with their money — which, in the case of Partners HealthCare, the largest network, means $9 billion a year in operating revenues – this could be a very interesting debate.
The nurses’ association says the measures have both gathered more than 100,000 signatures. Secretary of State William Galvin tells us on his website that for the 2014 election, “the initiative petition must be signed by a minimum of 68,911 certified voters. No more than one-quarter of the certified signatures may come from any one county.”
So debaters, start your engines. Any points you’d particularly like to see brought up?
Former Secretary of State Hillary Rodham Clinton walks past the Presidential seal in the East Room of the White House in Washington, Nov. 20, 2013. (AP Photo/Jacquelyn Martin)
There’s nothing like a famous public figure to illustrate a medical lesson, as our friends over at Celebrity Diagnosis well know. But a new post on HealthNewsReview.org — a widely respected health journalism watchdog site — brings that art to new heights. You may not normally be interested in inside-baseball medical battles about how widely used blood thinners like Coumadin should be prescribed, but does this get your attention?
“…if Clinton takes a VKA [Vitamin K antagonist like Coumadin] or other oral anticoagulant continuously over the next 11 ¼ years (i.e., throughout 2 more Presidential election terms should she win in 2016 and 2020), her cumulative risk of fatal bleeding, would be about 55% (1 – 0.994^135 months). Even if she had only the all ages risk of major and fatal bleeding over the next 11 ¼ years (major bleeding: 0.29%/patient-month and fatal bleeding: 0.09%/patient-month), her risk of catastrophic bleeding before 2025 would be considerable (major bleeding: 32% (1 – 0.9971^135 months) and fatal bleeding: 12% (1 – 0.9991^135 months).
The post’s author, Dr. David K. Cundiff, argues that the current guidelines for prescribing Coumadin and other anticoagulants are skewed too heavily in favor of prescribing the drugs, despite the harms they may cause. He writes that the guidelines’ evidence base is weak, and possibly biased by financial conflicts of interest, and that we need to improve the process for setting such hugely influential guidelines.
Read the full post here for his cogent policy points, but I must confess that what stuck in my mind was his take on Hillary Clinton’s public medical record and how it could affect the next presidential campaign: Continue reading →
If you’re thinking about getting married, you might want to listen to that little voice in the back of your head.
A new study in the journal Science of more than 100 newlyweds found that a couple’s “gut” feelings about each other — feelings they couldn’t or wouldn’t verbalize — were good predictors of how happy their marriage would be four years later — better predictors than their conscious feelings. The title: “Though They May Be Unaware, Newlyweds Implicitly Know Whether Their Marriage Will Be Satisfying.”
Of course, we all have gut feelings about our partners — and they tend to be positive or we wouldn’t be partners. But this study looked at something very specific: attitudes that are at such a deep level that we may not be aware of them, but they turn up on a kind of test that experimental psychologists have been using for years, that measures reaction times down to the millisecond.
Here’s how the study worked: Say you’re a newlywed. You sit at a keyboard with your fingers on two special keys, one labeled “good” and one labeled “bad.” And you’re told that when you see a good word — say, “awesome” — you should press the good key, and when you see a bad word — say, “awful” — press the bad key.
‘Because we want so much for it to work out, we will deny those little signals.’
After a few minutes of that, you start seeing photos of your new spouse very briefly, for just 300 milliseconds, before you see the good or bad word. The idea is that the photo of your spouse is activating your automatic attitude, and if your attitude is super-positive, then you’ll be able to press the “good” key when you see the word “awesome” even faster — but you’ll respond to the bad word, “awful,” more slowly. The study found that differences of much less than a second in those reaction times were good predictors of marital satisfaction four years later.
Of course, most newlyweds are pretty crazy about each other, consciously and unconsciously. But the question is whether their love can persist once they start facing the many challenges that real-life relationships throw at them.
The lead researcher on this study, Jim McNulty, a psychology professor at Florida State University, has a theory that these deep unconscious attitudes, if they’re highly positive, can keep couples from getting as bogged down in the negative changes that inevitably come.
And he says he now he wants to work on bolstering these deep positive emotions in order to help relationships. Continue reading →
They were splashy headlines this week: The emergency contraceptive pill “Plan B” does not work well in heavier women, and appears not to work at all in women over 176 pounds.
The FDA is considering whether the pills’ labels should be changed to warn heavier women not to count on their contraceptive powers, NPR reported; the French maker of a similar pill is already planning such a warning.
But the controversial morning-after pill has a bigger problem than that. Family planning advocates have fought hard to make Plan B easier to get in order to bring down the high American rates of unintended pregnancy. But so far, on that score, it’s looking like a dud.
Plan B hasn’t made a dent in the stunning statistic that a full one-half of U.S. pregnancies are unintended. This despite its FDA approval way back in 1999 and the growing access to emergency contraception over the last couple of decades — and despite major recent victories for family planning advocates: Plan B is now available over the counter to all ages.
“While there’s a lot of data to show it can prevent pregnancy in individual women, we’ve all been disappointed that on the population level, it just hasn’t had the effect we hoped,” said Dr. Deborah Nucatola, senior director of medical services at the Planned Parenthood Federation of America. “The unintended pregnancy rate hasn’t changed at all.”
Why might that be? There are two main theories, Dr. Nucatola said: Maybe the women who most need Plan B aren’t using it when they are actually at highest risk for pregnancy. Or maybe they’re just not using methods that are effective enough, and women should shift to more effective types of emergency contraceptives.
Enter what we might call Plan C. Around the country, Planned Parenthood affiliates are launching a new campaign called EC4U to educate women and clinical staffs about two more effective methods of morning-after help: Paragard, the copper IUD, and “ella,” a relatively new pill that uses the hormone ulipristal acetate, rather than the levonorgestrel in Plan B and a similar pill, Next Choice.
Accumulating data suggest that Plan B has two main weak points. One is weight; it was highlighted in this week’s reports, but contraceptive specialists had known for many months that the pill’s effectiveness drops in overweight women and approaches nil in women with a Body Mass Index above 35. Continue reading →
In an Intensive Care Unit. (US Navy, Wikimedia Commons)
Figuring out the effects of having health insurance on people’s actual health must be a long-term game. Here in Massachusetts and elsewhere, greater access to insurance is expected to translate only gradually into better health outcomes.
But in an Obamacare season when everything that happens here holds the prospect of being multiplied by 50, here’s an interesting new data point: Initially, at least, the rise in insurance coverage in Massachusetts did not seem to translate into a rise in Intensive Care Unit use. But it also did not translate into a drop in ICU deaths. Why not? Shouldn’t better access to health care translate into fewer health crises and fewer ICU deaths? From a University of Pennsylvania press release:
While the study found no difference in mortality rates between ICU patients in Massachusetts and the four non-reform states, it determined that ICU-patient mortality rates remained the same in Massachusetts after health care reform was enacted — confounding expectations that earlier access to care might lower ICU death rates. Although previous studies demonstrated that lack of health insurance is associated with increased mortality in critical illness, it could be that lack of health insurance may coincide with other socioeconomic factors, such as unemployment or underemployment and poverty, and that acquiring health insurance does not counteract the negative impact of these factors.
Additionally, according to a recent study of Medicaid expansion, reductions in adjusted all-cause mortality were not apparent until five years after the policy change. Continue reading →
In case you missed Radio Boston yesterday, take a listen to this thoughtful conversation on do-it-yourself funeral arrangements, based on our wildly popular post on the topic (with over 3000 comments on NPR’s Facebook page; and over 70,000 CommonHealth Facebook shares so far).
Even though caring for our own dead loved ones used to be the norm (right up until the the last quarter of the 19th century) many people responded to our story on modern home funerals with a resounding: “Who knew?”
Transatlantic99 wrote, “I had no idea that this was allowed and will seriously consider staying out of funeral homes when the time comes.”
And a surprising number of commenters described their own experience with personal funerals, for instance, Boomer: “We have done two funerals from home to grave and will do it from now on…I am no longer afraid of dead bodies. The moment of death as each happened was a little traumatic. But the death care was peaceful, poignant, even humorous as we all worked together. Caring for our dead felt natural and right; fulfilling our responsibility. My family is agreed we dislike funeral businesses and having strangers with a vested financial interest involved with such a personal occasion. We dislike the exorbitant and unconscionable markups in costs at funeral businesses. The reaction I get from friends is, ‘I didn’t know that was legal!’ then, ‘How do I do it!?’”
The Radio Boston program touched on a number of topics we didn’t get into in the post, for example, what to do if a loved one dies in the hospital and you want to take the body home. (Short answer: it’s pretty much always legal, but some hospitals make it easier than others.)
Josh Slocum, executive director of the Funeral Consumers Alliance, a Burlington, Vermont nonprofit, was on the show answering questions and offering important context. “Human beings have been caring for their dead since we walked upright,” Slocum said, adding that when people actually confront death they tend to be much more emotionally resilient than they imagine. He said in the 10 years he’s been working with families in this arena he’s found that when a survivor cares for a dead loved one — that is, actually does something — it truly helps the grieving process and makes people feel a little less powerless. “Actually having something to do that was hands on,” he said, whether washing the dead body or making food for people coming to the house to pay respects, “was better therapy then they could pay for at a counselor’s office.”
My favorite comment came from a Belmont, Mass. priest, Patrick, who called in to the program.
Patrick said that several years ago, some parishioners asked for his help to try to figure out home funeral arrangements without using a funeral home. This family ended up “waking” their mother at home for two days, Patrick said, and the intimacy of the experience shifted his own thinking on death when his father died. “It changed my own take on what we would do as a family,” Patrick said. His father died at home in Stoneham after receiving hospice care. “Because I’d had this experience with parishioners, I didn’t feel that sense of rush that one normally feels at the time of death,” Patrick said. “My father died at 2 am, and we didn’t call the funeral home until that morning. We sat around his bed, we opened a bottle of champagne, we toasted him, we remembered him, we celebrated him.” This private family time, Patrick agreed, was invaluable.
So, readers, when you’re sitting around the Thanksgiving table later this week, why not raise some of these important issues with your family? How do you want to die? And how would you envision caring for loved ones after death?
A new study by Boston public health researchers paints a bleak portrait of the dating scene among young people: One in 10 high schoolers say they’ve been hit or otherwise physically hurt by someone they dated in the past year.
The study, published in the Journal of School Violence, found that “9.3 percent of U.S. high school students have been ‘hit, slapped, or physically hurt on purpose’ by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.”
“Dating violence is a big deal. It’s one of the more serious public health problems that high school students are facing,” says Emily Rothman, the study’s lead author and an associate professor at Boston University School of Public Health. ”But where it ranks in funding is not commensurate with how prevalent it is and how potentially harmful.”
Rothman says that several violence prevention programs have been shown to be effective, including one that trains middle and high school sports coaches to spend 15 minutes once a week at the end of practice talking to boys about healthy relationships with women and girls. Unfortunately, Rothman says, “too few schools have the support they need to implement these…programs.”
Here’s more from the BU news release:
Rothman and Ziming Xuan, faculty at Boston University, analyzed data from 100,901 students who participated in the national Youth Risk Behavior Surveillance System survey (YRBSS) for the years 1999-2011. They found that 9.3 percent of U.S. high school students have been “hit, slapped, or physically hurt on purpose” by a boyfriend or girlfriend in the past year – an annual prevalence rate that has not changed significantly in the past 12 years.
The experience of being hit, slapped or otherwise physically hurt was reported at nearly equivalent rates by males and females who participated in the survey. There was a statistically significant increased rate of dating-violence victimization among black (12.9 percent) and multiracial (12.2 percent) youth, as compared to whites and Asians (8 percent) or Hispanic youth (10.5 percent). The rate of dating violence victimization remained stable over the 1999-2011 period for both males and females, and for each racial subgroup, despite a number of efforts to curb dating violence in the last decade. Continue reading →
They just don’t stop coming — the far-flung body parts and systems that you can help by exercising. The latest: Your ears.
Brigham and Women’s Hospital researchers report in the American Journal of Medicine that in women, exercise is linked to a lower risk of hearing loss. (And on the flip side, obesity is linked to a higher rate.) From the Brigham press release:
Using data from 68,421 women in the Nurses’ Health Study II who were followed from 1989 to 2009, researchers analyzed information on BMI, waist circumference, physical activity, and self-reported hearing loss…Compared with women who were the least physically active, women who were the most physically active had a 17 percent lower risk of hearing loss. Walking, which was the most common form of physical activity reported among these women, was associated with lower risk; walking 2 hours per week or more was associated with a 15 percent lower risk of hearing loss, compared with walking less than one hour per week.
But wait just a minute, you may say; for me to exercise, I have to pipe loud music into my ears. Surely that negates any positive effect? I asked the study’s lead author, Dr. Sharon Curhan. She emailed:
Regarding your question about listening to music and using earbuds/headphones while working out–absolutely! What is important is that people learn how to listen to music safely. In order to avoid noise-induced hearing damage, both the “level” (volume) and “duration” of the noise exposure need to be considered. This means that the louder the music, the shorter the time of safe exposure. For example, if you want to listen to your music with earbuds for a long time (say 90 minutes/day or more), then set the volume at 60% volume or less. The longer you want to listen, the lower the volume should be. The headphone types may make a difference, too. Noise-canceling headphones or insert earphones may help reduce background noise so that the volume will not need to be turned as high. However, there are some situations when it is essential to be aware of background noise for safety reasons, such as running or biking on a busy road.
And in case you’re wondering how exercise might preserve hearing, I’d sum up the theories as “exercise makes your body healthier, including your ears.” The paper offers some possible mechanisms: Continue reading →
WELLFLEET, Mass. – When 20-month-old Adelaida Kay Van Meter died of a rare genetic disease last winter, her father, Murro, gently carried her body out of the house to his wood shop in the pines near Gull Pond. He placed her in a small cedar box and surrounded her with ice packs. For three days, the little girl’s grieving parents were able to visit her and kiss her and hug her. Then, on the third day, after the medical examiner came to sign the last bit of paperwork, Van Meter and his wife, Sophia Fox, said good-bye to their baby, screwed the lid on the box and drove to a Plymouth, Mass. crematorium, where they watched the little coffin enter the furnace.
“We took care of Adelaida when she was an infant, we took care of her when she was healthy, we advocated for her in the hospital, we took care of her when she was sick,” her father said. “Why wouldn’t we take care of her when she was dead?” Sophia Fox added: “There was no way I was going to hand her over to some stranger at a funeral parlor where she’d be put in a refrigerator with a bunch of other dead bodies. This way was so much more natural. We saw the life leave her body and we were better able to let go.”
Death remains a topic that many of us would rather avoid. And when it comes to the actual nuts and bolts of caring for the dead, most of us tend to think it’s best — and furthermore, required by law — to let professional funeral arrangers handle the arrangements.
Well, it turns out that in most states it’s perfectly legal to care for your own dead. And, with new momentum to shatter longstanding taboos and stop tip-toeing around death — from “death with dignity” measures sweeping the country to projects promoting kitchen table “conversations” about our deepest end-of-life wishes — a re-energized DIY death movement is emerging.
This “personal funeral” or “home death care” movement involves reclaiming various aspects of death: for instance, keeping the dead body at home for some time rather than having it whisked it away; rejecting embalming and other environmentally questionable measures to prettify the dead; personally transporting a loved one’s corpse to a cemetery; and even, in some cases, home burials. Families are learning to navigate these delicate tasks with help from a growing cadre of “death midwives” “doulas” or “home death guides.”
(Courtesy Murro Van Meter)
The DIY death movement is loosely knit, and motivations vary, ranging from environmental concerns to religious or financial considerations. (Traditional funerals can cost around $10,000 or more; when you do-it-yourself, the cost can be reduced into the hundreds, experts says.) Each case is fiercely personal — there’s no playbook — but they all share a very intimate sense that death should unfold as a family matter, not as a moment to relinquish loved ones to a paid stranger or parlor.
This Is Legal?
The highly personal nature of home funerals appealed to Janet Baczuk, 58, of Sandwich, Mass. So, when her 93-year-old father, Stephen, died in September, 2011, she said, “I thought, I’d like to do that for my dad.” “It’s more humane, more natural…and more environmentally sound.”
Baczuk and her sister washed their father’s dead body using essential oils, and got a permit to drive the corpse to the cemetery in their (covered) pickup truck. A World War II veteran, Stephen Baczuk was buried at Massachusetts National Cemetery in Bourne, where officials allowed his simple pine and cherry casket to be placed directly on the ground, covered by an inverted concrete vault with no lid, “like a butter dish,” Baczuk said. When her mother died back in 2006, Baczuk said, she had no inkling that home funerals were an option — but wishes she did. “I didn’t know it could be done,” she said. “I think a lot of lay people don’t know this is legal or possible.”
“When it comes to death, it doesn’t matter where you are on the scale of education or socioeconomics, many people are shocked to find that it’s legal to care for your own dead at home,” says Josh Slocum, Executive Director of the Funeral Consumers Alliance, a Burlington, Vermont, nonprofit that works on all aspects of funeral education, from helping consumers reduce costs to advocating on DIY methods. “And I think this speaks to how distant death has become for us in just over a century. In the late 1800s, even turn of the century, caring for the dead was as prosaic and ordinary as taking care of the children or milking the farm animals.”
Slocum offers this analogy: If a woman wants to run a restaurant, she needs approval from the health department and officials, of course, would be permitted to inspect her kitchen. But the health department would have no jurisdiction over the same woman’s own kitchen at home. “They cannot come in and tell her that her refrigerator is subpar, and they have no authority to tell her she is not allowed to cook dinner for her kids. They can’t compel her to order dinner from a commercial, licensed restaurant,” Slocum says. “The same holds with state funeral regulatory boards. Their job is to ensure public welfare and protect paying consumers. Bizarrely, however, many think their jurisdiction extends to telling families they must pay an unwanted third party funeral home to do something the family could do for themselves.”
What characterizes the DIY death experience is that it’s so very personal. Consider these vastly different snapshots:
• In northern California, Kimberlyrenee Gamboa’s son Kyle committed suicide by jumping off the Golden Gate Bridge in September, three weeks into his senior year in high school. A seemingly happy 18-year-old with lots of friends and into competitive lasertag, Kyle’s death was such a shock, his mother said, she doesn’t know how she’d have managed it through a typical funeral. Instead, with help from her church and and home death guide, Heidi Boucher, Kyle’s body was returned to the family home one day after his death. Boucher washed Kyle and helped arrange the body on dry ice changed every 24 hours; she gathered information to fill out Kyle’s death certificate and managed all coordination with the mortuary. For three full days, Kyle’s body lay in the family living room in an open casket, not embalmed. During that time, day and night, surrounded by pictures and candles and flowers, all of his friends and family could say good-bye and remember his short life. For Kyle’s mother, that time was critical to her healing. Continue reading →