Author Archives: Benjamin Swasey

Ben is an editor — and occasional blogger — for

Economist Heidi Williams, Genius Award Winner, On Invisible Drug Industry Incentives

Last week, as she was sitting in her office at MIT, 34-year-old economist Heidi Williams got an unexpected phone call. It was from the John D. and Catherine T. MacArthur Foundation, telling her that she had just been awarded a so-called “Genius Award” — a no-strings-attached $625,000 grant that celebrates “the creative potential” of its fellows.

Williams, an assistant professor of economics at MIT, researches how invisible economic incentives affect the kind of cures that the medical industry produces. Her research has found that researchers are more likely to develop cures for late-stage cancer patients than early-stage patients, for instance, and that intellectual property law can limit innovation in genome research.

Radio Boston’s Anthony Brooks spoke with Heidi Williams about her research and her award. Their conversation, edited:

AB: Tell us how you got the news about this award, and your reaction to it.

HW: I got a phone call from an area code that I recognized as a Chicago number. And I was just completely speechless when I answered the phone and talked to them. I’m very early in my career, and I was just completely overwhelmed to hear that I had received a fellowship.

Talk to me about these invisible economic incentives that affect the cures that the medical industry produces. Can you explain how this works?

Researchers working on drug treatments often come up with a lot of ideas, but if you talk to them, many of those ideas just never reach patients. Sometimes you hear anecdotes about the reason why those products never got developed — because of mis-aligned incentives in the patent systems or because of mis-aligned incentives in the policy system more generally. I try to explain why some promising scientific leads never get developed into new drugs or medical technologies that consumers or patients actually have access to.

Why are there incentives for late-stage cancer treatment for example, but few for early-stage cancer, or even cancer prevention? What incentives control that?

When new drugs come to market in the U.S., they need to show the U.S. government evidence that the drugs are safe and effective by showing evidence that the drug improves survival. When you need to show that a drug improves survival for patients that are very sick and will die relatively quickly, you can show that in a randomized clinical trial much more quickly than if you need to show evidence that a drug improves the survival of patients that have a longer life expectancy.

Longer clinical trials take more time and cost more money, but also, biotech and pharmaceutical companies almost always file for patent protection before they start their clinical trials. And so every additional amount of time that they’re spending in clinical trials is less time that they have for their patent to actually be generating profits for them once their drug is on the market. Continue reading

More Evidence Points To Big Differences In C-Section Rates At Mass. Hospitals

There’s no question that some women need a Cesarean section for the safe delivery of their child. (I’m one of them.) But there’s widespread agreement that too many women in the U.S. have C-sections, increasing the risks for the mother and baby — as well as the costs of their care.

The employer-backed group Leapfrog is out with a national comparison of C-section rates. It says a C-section rate of 23.9 percent is a reasonable standard. Massachusetts ranks 19th among all states, with an average C-section rate of 26.2 percent.

Source: Leapfrog (Click to enlarge)

Source: Leapfrog (Click to enlarge)

“The first thing you should look at in selecting a hospital or doctor is the C-section rate, and your chances of needing a C-section when you deliver,” said Leapfrog President and CEO Leah Binder. “It’s very important to investigate that right away.”

Here are the three hospitals in Massachusetts with the lowest C-section rates, as reported to Leapfrog:

  • Harrington Memorial Hospital in Southbridge — 14.3 percent
  • Fairview Hospital in Great Barrington — 15.2 percent
  • Cambridge Health Alliance in Cambridge — 18.5 percent

And the three Massachusetts hospitals with the highest C-section rates:

  • Holy Family Hospital in Methuen — 42.7 percent
  • Steward Good Samaritan Medical Center in Brockton —  36.4 percent
  • Tufts Medical Center in Boston — 36.3 percent

You can see how all Massachusetts hospitals that report to Leapfrog compare here, as well as which hospitals decline to report their C-section rates — something that raises a red flag for Binder.

“The hospitals to worry about most are those that decline to report this data,” Binder said. “There are hospitals in Massachusetts that decline to report and you have to wonder why they did that.”

So why the big differences?

Continue reading


Can Musical Training Help Fix ‘The Cocktail Party Problem?’



By Barbara Moran

An earlier version of this post appeared on the Boston University Research News website under the headline, “The Cocktail Party Problem.”

Alan Wong first noticed the problem a few years ago. In a crowded bar or restaurant, he could barely understand his companion’s conversation. Wong, 35, blames the problem on a well-spent youth: “I went to a lot of loud concerts in my 20s, and now my hearing sucks,” says Wong, executive producer at Boston University Productions. “It’s a bummer,” he adds, “especially when I have a hard time hearing the lady friends.”

Scientists call it the “cocktail party problem,” and it’s familiar to many people, even those who pass standard hearing tests with flying colors: they can easily hear one-on-one conversation in a quiet room, but a crowded restaurant becomes an overwhelming auditory jungle. For people with even slight hearing problems, the situation can be stressful and frustrating. For those with significant hearing loss, hearing aids, or cochlear implants, cocktail parties become an unnavigable sea of babble.

“It can really affect communication,” says Gerald Kidd, a BU professor of speech, language & hearing sciences. “It causes people to avoid those kinds of places, either because they don’t want to work that hard or it’s just unpleasant to be in a situation where they’re not following things. So it’s a big problem.”

Selective Listening

Kidd and his colleague Jayaganesh Swaminathan, a BU research assistant professor of speech, language & hearing sciences, study the cocktail party problem, trying to understand exactly why this particular situation is difficult for so many people. Their research, funded by the National Institutes of Health (NIH) and the Air Force Office of Scientific Research (AFOSR), and published in Scientific Reports in June 2015, asked an intriguing question: can musicians—trained to listen selectively to instruments in an ensemble and shift their attention from one instrument to another—better understand speech in a crowded social setting?

“Music places huge demands on certain mechanisms in the brain, and at some levels, these overlap with language mechanisms,” says Aniruddh Patel, a professor of psychology at Tufts University and co-author on the paper, who studies the cognitive neuroscience of music and language. “The question is: would a high level of musical training advance speech and language as well?” In other words, can musical training help fix the cocktail party problem? Continue reading

You’re Not Lazy, You Just Quickly Minimize Exertion, Study Suggests

A new study finds we quickly change our gait for greater efficiency. (Peter Mooney/Flickr)

A new study finds we quickly change our gait for greater efficiency. (Peter Mooney/Flickr)

By Josh Eibelman
CommonHealth intern

If you’re feeling guilty and blaming yourself for being lazy, take heart: We evolved to minimize how much we move, and new research suggests we adjust our bodies quickly to expend the least possible energy.

In a new study, “Humans Can Continuously Optimize Energetic Cost During Walking,” published in the journal Current Biology, researchers found that people optimize their gaits — the manner in which they walk — in real time in order to expend less energy.

Subjects in the study were fitted with exoskeletons that forced them to walk in abnormal ways. The scientists found that participants automatically fine-tuned their manners of walking to more energetically efficient ones in response to the exoskeletons.

I spoke with Jessica Selinger, lead author of the study and a doctoral candidate at Simon Fraser University, to learn more.

How would you sum up your results?

What we found was that people quite readily will tune or change really fundamental characteristics of their gait — characteristics that have been established over millions of steps over the course of their lifetime — in order to move in a way that uses the least amount of energy.

That’s probably intuitive for a lot of us. We know that we like to do things that require the least effort and do them in the least effortful way. I might prefer to take a bus to work when I could walk or I might prefer to sit when I could stand. But what’s really interesting is that even when you make a conscious choice to exercise or spend energy, what our study shows is that your nervous system is optimizing and tuning behind-the-scenes your movements so that you’re burning the fewest calories possible.

What message do you want people to take away from these findings?

For one, it’s really remarkable that the body can do this. There are countless ways that someone could walk from point A to point B. We can choose different speeds, step rates and even muscle activity patterns, yet we have very strong preferences for particular gaits — the energetically optimal gait. It’s really amazing that our body is able to home in on what is the most energetically optimal way to move. It’s a complex problem and an impressive feat. You have to be smart to be that lazy!

And the other really interesting thing was that that people would adapt their gait even in response to very small savings in energetic cost. We’re talking about just a few percent of the body’s total energy use. It seems that the body is really sensitive to this measure. Energetic cost is not just an outcome of our movement, it is continuously shaping the way me move.

Can people do anything to counteract this laziness? Continue reading

Coming To A Clinic Near You: The $50 IUD With A Fascinating Backstory

The new Liletta intra-uterine device (Courtesy of Medicines360)

The new Liletta intra-uterine device (Courtesy of Medicines360)

Zoe Reiches got her first IUD this August — a new model with the lilting name Liletta.

Reiches, 25 and a human resources specialist in Boston, is now happily set for birth control for at least three years. “It’s convenient, I don’t have to worry about it, and I didn’t have to pay for it because of insurance,” she said. “I’m lucky in that sense.”

Millions more American women share her luck now that Obamacare has mandated birth control coverage with no co-pays for most insurers.

But the Liletta, which is just starting to roll out at clinics and hospitals here in Boston and around the country, is not only a device for the lucky — quite the opposite.

Its whole reason for being is to serve poor and uninsured women, to make IUDs — which can cost $1,000 or more — affordable to all, and available on demand at publicly funded health centers.

“This has never been done before,” said Jessica Grossman, the new CEO of Medicines360, the nonprofit pharmaceutical company behind the Liletta. “Our whole mission is to offer this low-cost product.”

Very low cost, compared to the usual thousand-plus dollars. At least until the end of the year, a special program guarantees that insured women who get a Liletta will pay no more than $75 out of pocket for it, Grossman said. A permanent patient assistance program will also provide Lilettas for free to women who qualify.

‘Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’

And, behind the scenes but even more important, public health clinics can order the Liletta for a mere $50 each.

In Massachusetts, all six Planned Parenthood clinics have begun to stock the Liletta, and it’s starting to enter “formularies” — the approved prescription lists — from major hospitals to cash-strapped community health clinics. Medicines360 reports shipping Liletta to 49 states, with more than half of the devices going to clinics that serve low-income patients.

The idea is to make the devices affordable enough that clinics can stock plenty, Grossman said, so that a woman can come in and say, “’Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’ ”

The Anonymous Donor

The Liletta is the latest chapter in the story of the great resurgence of IUDs in the United States, featuring billionaire investor Warren Buffett in a key cameo.

A New York City subway sign that is part of the new "Maybe the IUD" campaign (Courtesy of Dr. Deborah Kaplan)

A New York City subway sign that is part of the new “Maybe the IUD” campaign (Courtesy of Dr. Deborah Kaplan)

After the 1970s debacle of the Dalkon shield, which caused infections and even a few deaths, IUDs fell almost completely out of use among American women. Then, in 2001, a new, hormone-emitting device came on the market — the Mirena.

IUDs steadily gained popularity as a relatively safe, set-and-forget, long-acting but reversible option for many women. (As a no-complaints Mirena user for a decade, I’m one of them.)

More than 10 percent of American women who use birth control now choose IUDs, the most recent data show — the Mirena or the Skyla, which emit tiny amounts of hormones, or a simpler copper IUD, the Paragard.

The latest evidence of the IUD’s full rehabilitation: New York City’s Health Department this week launched its “Maybe the IUD” campaign to encourage New York women to consider an IUD.

The campaign talks about “reproductive justice,” reflecting in part a troubling trend: Unintended pregnancy is increasingly a poor woman’s problem. Look at the trend in the Guttmacher chart below: Continue reading


AG Lynch, Speaking In Massachusetts, Sees Doctors As Partners In Addiction Fight

U.S. Attorney General Loretta Lynch addresses the Opioid Misuse and Addiction Summit sponsored by the Massachusetts Medical Society in Waltham Friday. (Michael Dwyer/AP)

U.S. Attorney General Loretta Lynch addresses the Opioid Misuse and Addiction Summit sponsored by the Massachusetts Medical Society in Waltham Friday. (Michael Dwyer/AP)

U.S. Attorney General Loretta Lynch told a gathering of Massachusetts physicians and pharmacists that they are critical partners with law enforcement in the fight against prescription painkiller and heroin abuse.

Lynch, speaking Friday at the Massachusetts Medical Society headquarters in Waltham, said by harnessing “the expertise, the passion and the conviction” of health care professionals, “I have no doubt that we can preserve opportunity, strengthen families and save lives.”

Lynch credited the Massachusetts medical community “for leading a truly comprehensive campaign to reduce prescription drug abuse in” the state.

She also highlighted the Justice Department’s efforts in battling drug abuse.

Continue reading


How Childhood Stress May Lead To Disease Later In Life

(Thomas Haynie/Flickr)

(Thomas Haynie/Flickr)

What are the childhood origins of adult disease? Might there be certain developmental periods in a child’s life when he or she is particularly vulnerable to stress? And might psychological distress early in life lead to heart and other health problems later in adulthood, even after that stress is gone?

A recent study on early childhood stress published this week in the Journal of the American College of Cardiology doesn’t definitively answer these questions. But it does suggest that a high level of psychological distress in childhood may lead to a heightened risk of disease in adults, even if the stress doesn’t linger on.

The study, led by researchers at the Harvard School of Pubic Health, concludes:

Psychological distress at any point in the life course is associated with higher [cardiovascular and metabolic disease] risk. This is the first study to suggest that even if distress appears to remit by adulthood, heightened risk of cardiometabolic disease remains.

An editorial accompanying the study notes “the possibility that there are sensitive periods in childhood during which some seemingly irreversible physiological, emotional, or behavioral processes are established that affect [cardiometabolic risk]. That is, perhaps there are critical windows of risk linking childhood distress and [cardiometabolic risk] that point to windows of opportunity for intervention.”

The new study was based on an analysis of data from the 1958 British Birth Cohort Study, a longitudinal look at people born in Great Britain during a single week in March 1958. Individuals completed measures of psychological distress and a biomedical survey when they were 45 years old after repeated assessments over the course of their lives, from age 7 to 42.

I asked the new study’s lead researcher, Ashley Winning, a postdoctoral research fellow in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, some followup questions. Here, edited, are her answers:

RZ: In this study were you able to determine what, exactly, constituted “stress” for these children? Trauma, illness, abuse? If not, might you speculate on what types of stressors might be linked to later heart problems?

AW: High levels of distress in childhood may be the result of early life adversity (such as trauma, illness, abuse, neglect, poverty) and this may be one reason children in these environments are at heightened risk of poor health. However, symptoms of distress may be in response to less dire exposures too — chaotic environments, parental discord, stressful circumstances — normative responses to difficulties that may become chronic in the absence of appropriate adult capacity to help the child learn to navigate these challenges.

It’s also possible symptoms of distress are early signs of an underlying mental disorder in childhood (which may or may not have a hereditary component). We suspect that distress occurs in response to a range of difficult circumstances but what other research has suggested is that ongoing distress is less likely to occur when there is a nurturing adult or supportive environment available. Continue reading

Majority Of Young People With Depression Don’t Get Treatment, Report Finds

A new national snapshot of the state of mental health across America is, frankly, a little discouraging, especially when it comes to young people.

One startling finding from the annual report produced by the nonprofit Mental Health America: “[S]ixty-four percent of youth with depression do not receive any treatment.”

In addition, the report found:

Even among those with severe depression, 63 percent do not receive any outpatient services. Only 22 percent of youth with severe depression receive any kind of consistent outpatient treatment (7-25+ visits in a year).

I asked one of our frequent contributors, child psychiatrist Dr. Eugene Beresin, executive director of the Massachusetts General Hospital Clay Center for Young Healthy Minds and professor of psychiatry at Harvard Medical School, for his thoughts on the report.

Here, lightly edited, is his response:

First, I am not surprised. There are a number of issues not emphasized by this summary:

1. There is a huge shortage of child and adolescent psychiatrists in the U.S. Currently there are about about 7,000.

So while many parents seek help, the access to care is severely limited. Primary care pediatricians are inadequately trained in psychiatry and this has been addressed by the American Academy of Pediatrics. Their graduate training requires only two months in developmental behavioral pediatrics and few have any significant training in psychiatry. They are desperate to make referrals and often are at a loss to find qualified clinicians. Some states such as Massachusetts and New York have statewide efforts to assist them through consultation and education in psychiatry, but this only scratches the surface. Continue reading

Why To Exercise Today: It May Make Bullied Adolescents Feel Less Suicidal

How much better can exercise make you feel?

A new study suggests that the mood boost may be profound.

The nitty gritty of the study is that researchers at the University of Vermont report a 23 percent reduction in both suicidal thoughts and suicide attempts among bullied students who exercise four or more days a week. The analysis of national data from the Centers for Disease Control and Prevention showed that across the board, frequent exercise was associated with improved mood for adolescents, both bullied and not.

It’s important to note that the study shows an association only between exercise and improved mental health. Still, lead author Jeremy Sibold, an associate professor at the University of Vermont, and chairman of its Department of Rehabilitation and Movement Science, says this is an important first step. It…”shows a critical relationship between exercise and mental health in bullied adolescents,” he says. “These data do not prove that exercise will reduce sadness or suicidality, but certainly support more research in this area.”

(Nick Tonkin/Flickr)

(Nick Tonkin/Flickr)

The study, published online in the Journal of the American Academy of Child & Adolescent Psychiatry, concludes:

Physical activity is inversely related to sadness and suicidality in adolescents, highlighting the relationship between physical activity and mental health in children, and potentially implicating physical activity as a salient option in the response to bullying in schools.

An accompanying editorial, by Dr. Bradley D. Stein and Tamara Dubowitz of The Rand Corporation in Pittsburgh, says,

“…the evolving literature suggests that physical activity interventions appear to be potentially promising as preventive interventions for some children and adolescents at risk for developing mental health disorders and for augmenting more traditional interventions for children and adolescents being treated for depressive and anxiety disorders and attention deficit/hyperactivity disorder.

The “side effects” of such physical activity interventions are likely to be more positive for many children than those of many other therapeutic interventions and potentially less costly…”

I asked Sibold a few questions about the study. Here, via email, are his answers:

RZ: What’s the biggest surprise in the findings?

JS: We were not surprised really that exercise was associated with less sadness, etc., as exercise has been widely reported to have robust positive effects on a range of mental health markers.

However, our statistics were quite rigorous, and to see the positive associations extend to victims of bullying, including those who report suicidal behavior, was certainly a pleasant surprise and a first in the field we believe. It is also quite concerning that 25 percent of students overall report being bullied in the last year. This is a concern we cannot ignore in our schools. Continue reading

Mass. Doctors Join To Vent Frustrations With Electronic Health Records

(, posted with AMA permission)

(Courtesy Medical Association)

“Imagine,” said Dr. Steven J. Stack, president of the American Medical Association. “In a world where a 2-year-old can operate an iPhone, you have graduate-educated physicians brought to their knees by electronic health records.”

Has anyone ever summed up better the monumental frustrations that many doctors encounter when grappling with electronic medical records?

And those frustrations have only been growing as federal requirements for electronic medical records have kicked in and grown teeth — to the point that the AMA has now launched a campaign — called Break the Red Tape — to call for a pause on new medical-record rules.

As part of that campaign, the Massachusetts Medical Society has called a town hall meeting at its Waltham headquarters Tuesday night to let doctors vent.

Not that it’s a Boston Tea Party kind of thing.

“It’s not that every physician wants to throw their electronic medical records into Boston Harbor,” said Dr. Dennis Dimitri, president of the Massachusetts Medical Society. “In fact, physicians have been incredibly rapid in their uptake of implementation of electronic medical records. We have over 80 percent in the state now having implemented electronic medical records. But the dissatisfaction comes around the fact that the electronic medical record has not been the panacea that many might have hoped it to be.

“In fact,” Dimitri continued, “it has added significant time to the daily life of most physicians in their practices. It has not necessarily lived up to expectations in terms of its ability to provide cues to physicians to make sure that necessary treatments are not being missed. It has certainly not been able to swiftly disseminate information from one clinical setting to another. So those are some of the things we hope we’ll hear about, better understand the problems that face physicians, and then come away from this with a plan of how we ask for help in solving these problems.”

That inability to cross from one clinical setting to another that Dimitri mentioned is known by the cumbersome term “interoperability,” and even Sen. Elizabeth Warren is talking about it these days. Continue reading