Author Archives: Carey Goldberg

A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading

From Pimples To Desire, What Might Happen When You Ditch The Pill

(Becca Schmidt/Flickr via Compfight)

(Becca Schmidt/Flickr via Compfight)

By Veronica Thomas
Guest Contributor

So you’re thinking about going off the pill. Maybe you’ve been feeling depressed, getting headaches, or keep forgetting to pop the tiny tablet. Perhaps you’ve been experiencing some really strange stuff that didn’t happen before you started the pill—like inflamed, bleeding gums or cringing at another person’s touch.

Both personal anecdotes and research studies have linked these and other side effects, such as breast tenderness and nausea, to the pill. (One study suggested it might even make you pick the “wrong” partner by altering your chemical attraction to a man’s scent.)

Most randomized control trials haven’t actually found any real difference in the frequency of side effects among women taking the pill versus those taking a placebo.

“It’s an interesting phenomenon,” says Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. “Clearly some women are sensitive to the pill and experience these things, but when you try to study it scientifically on a population basis, there’s really no difference.”

Still, while four out of five American women have used the pill at some point, 30 percent have discontinued its use due to dissatisfaction—most commonly because of its side effects. The latest federal statistics on contraception use are due this fall, and experts expect trends from recent years to continue: IUD use will continue to rise, while pill use seems to have plateaued.

I tried five different formulations of the pill, but never managed to escape all the annoying symptoms.

The issues a woman experiences—or whether she has any at all—vary greatly based on the specific dosage of hormones and the unique individual swallowing them every day. Personally, along with bloating and mood swings, I got migraines with an aura, or what felt like a laser light show in my left eyeball. Twice I had to retreat to my office’s “Pump and Pray Room”—reserved for new mothers and religious employees—to lie down and recover. (What I did not know at the time was that, because of this symptom, I should not have been on an estrogen-containing pill in the first place. Women with aura migraines, along with other conditions that put them at risk for strokes, blood clots, heart disease or some cancers, should not take combination pills.)

Finally, I gave up on the pill—only to be blindsided by a whole new challenge: the unexpected side effects of going off the pill. To help others avoid similar unpleasant surprises, I spoke with three experts about what to expect when you ditch the pill for another birth control method.

Of course, just as each woman has a unique reaction to the pill, she’ll also have a unique reaction to going off. According to the feminist women’s health organization Our Bodies, Ourselves, there is “enormous variability in any individual’s response to her own hormones or any synthetic hormones she takes.” One woman’s skin may break out in pimples, while another’s clears up completely.

With this disclaimer in mind, here are eight possibly unexpected changes you might experience when you cancel your monthly refill of that crinkly foil packet:

1. Most of the side effects should disappear in a few days.

First off, while many women decide to have their period before pitching the pack, it’s safe to stop taking the pill at any point. However, you should stop immediately if experiencing any serious side effects, like headaches or high blood pressure, says Dr. Jennifer Moore Kickham, the medical director of a Massachusetts General Hospital outpatient gynecology clinic. Continue reading

Mass. Health Wonks, Start Your Engines! Contest To Guess Rise In Costs

money

This Tuesday, Sept. 2, we will know … Did Massachusetts succeed or fail in its first year of trying to keep health care costs in line with all the other things we spend money on?

In 2013, health care costs were not supposed to grow more than 3.6 percent.

So what do you think, did Massachusetts make it?

Weigh in below in the comments section, and enter our contest.

The winner will be the person who is closest (you can go over) on both of the following questions:

First, how much did health-care spending increase in 2013? Please submit to the first decimal place (for example, 0.7 percent, 1.7 percent, 4.3 percent, 6.6 percent, etc.).

Second, what was the total amount of money spent on health care in Massachusetts last year? Think double-digit billions.

Remember, the state’s calculations for both of the above will not include out-of-pocket expenses (except those related to insurance), health-care research dollars or public health spending.

The answers will come on Tuesday from the state’s Center for Health Information and Analysis.

Your prize…lunch with CHIA director Aron Boros at the hospital or health insurance cafeteria of your choice. And I might tag along too.

Hidden Price Of That Succulent Lobster: Health Woes Of Stoic Lobstermen

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

Longtime Maine lobsterman Jon Rogers (Jesse Costa/WBUR)

By Richard Knox

Mainer Jon Rogers started lobstering 47 years ago at the age of 10, when he’d go out on his grandfather’s boat.

Ask him about his health and he says, “No worse than anyone else who uses his body in his work. My hips are sore, my knees are sore, my shoulders are sore, my back is sore. I get up every day and it takes me awhile to get going. I hurt every day.”

But Rogers, who lives on a skinny, south-pointing finger of land in Casco Bay called Orr’s Island, doesn’t go to the doctor much. “I never really complained about too much unless I was really hurting,” he says.

“I’d schedule a doctor’s appointment with all the intentions of going,” Rogers says. “But if there was an opportunity to haul traps for a few days, I’d set aside the doctor’s appointment and go haul traps.” This summer he’s running 800 traps, which means his days starts around 5:30 a.m.

Rogers appears to be pretty typical of Maine’s 5,000 lobstermen, and of all 9,000 people who work in the state’s fishing industry.

“They work really hard and have a lot of chronic diseases,” says Miranda Jo Rogers, Jon’s daughter. “These people have a stoic mentality — they don’t seek health [care] until they really need it. So there are no really positive role models on how to be proactive and keep healthy.”

Lobsterman Jon Rogers with med-student daughter Meredith Jo Rogers, who is studying the health of lobster harvesters. (Courtesy)

Lobsterman Jon Rogers with med-student daughter Miranda Jo Rogers. (Courtesy)

Miranda Rogers aims to do something about that. Although she’s still a Tufts Medical School student, she’s taken on a project she expects will take her to graduation and beyond — maybe decades beyond.

“I am happily indebted to the community that raised me, and I wish to make a long-lasting difference in Maine,” she wrote recently to the state’s lobster harvesters, asking them to fill out a 24-page questionnaire on their health.

It will be the most complete look ever at the health of a difficult-to-reach population with special health care needs, low rates of health insurance and high skepticism of outsiders.

“Up and down the coast, the commercial fisherman is very talkative on his own turf, but it’s a very secretive bunch and not that trusting,” Jon Rogers says. Continue reading

Cheap, Low-Tech Devices Help Paralyzed Patients ‘Speak Their Minds’

Cathy

Cathy Hutchinson, who had a brainstem stroke, is using a head mouse to type on a prototype keyboard, and has typed that she likes it. (Courtesy SpeakYourMind Foundation.)

By Suzanne Jacobs
Guest contributor

When the man started quoting Shakespeare with his eyebrow, Dan Bacher knew he was on to something.

All it took was an off-the-shelf webcam, a green sticker and an app, and the stroke victim had regained his ability to communicate.

“Before that, what he would do is, someone would stand next to him and literally read through the alphabet, and then he would raise his eyebrow to pick a letter,” Bacher says. “He was fully dependent on someone else, and he couldn’t initiate conversation. Someone had to say, ‘Do you want to say something?’”

So Bacher, an engineer, and his colleagues put a green sticker the size of a pencil eraser on the man’s eyebrow and turned a webcam into a tracking system that could follow the green sticker and register a raised eyebrow as a mouse click. With a custom-made app, the man could then scroll through the alphabet and type on his own.

And then Shakespeare — part of a line from “Henry IV” that goes, “A good wit will make use of anything; I will turn diseases to commodity.”

“It was just like one of those wow moments, where we realized, ‘Wow, what we’re doing here really is making a difference,’” Bacher recalls. The device was just a prototype, but Bacher said he hopes to have something permanent for the patient in the coming months.

Bacher is the founder and CEO of the SpeakYourMind Foundation, a nonprofit organization based in Providence, Rhode Island, that’s developing low-cost and easy-to-use communication devices for people with neurological disorders who are “locked in,” virtually unable to move.

So far, the organization has only worked with about 12 clients and is still experimenting with prototype devices, but ultimately, Bacher says, he wants to have products that are widely available. Already, he says, people have been contacting him from around the country asking for help.

SpeakYourMind is far from the cutting edge of research on “brain-computer interfaces,” but that’s the point. Having worked in Brown University’s BrainGate Lab, one of the leading research centers for advanced brain-computer interface technology, Bacher knows all about the cutting edge, and that’s why he decided to start SpeakYourMind — to give people a simpler option, at least for now. Continue reading

Democratic AG Candidates Question Whether Partners Deal Will Cut Costs

Veronica Thomas
CommonHealth Intern

The two Democratic candidates for Massachusetts attorney general are united in their skepticism: They question whether the deal forged by current AG Martha Coakley with Partners HealthCare will succeed in containing costs.

On Tuesday, The Boston Globe hosted a debate between candidates Maura Healey and Warren Tolman, who will go head-to-head for the Democratic nomination in two weeks. While the candidates diverged on a majority of issues, ranging from sexual assault to smart gun technology, they concurred (at minute 34-36 in the YouTube video above) that the controversial Coakley-Partners deal aimed at regulating the expansion of Partners, the state’s largest hospital network, may fall short.

Boston Globe columnist Joan Vennochi asked whether the proposed Coakley-Partners deal has “enough teeth for effective enforcement.” Here are the candidates’ responses:

Maura Healey, former Assistant Attorney General: There are aspects of this deal, Joan, that I am skeptical about. I actually had left the office at the time this agreement was done. But it’s true, Joan, I was in the office. I oversaw, as Public Protection Bureau Chief, the teams that prepared the reports on transparency, and trying to point to what was driving up costs. And I oversaw teams that began this investigation that resulted in this proposed agreement. What I’ve seen, what I’ve read, gives me pause.

I mean, we all know we’ve done a great job here as a state in terms of increasing accessibility to care, increasing quality of care, but costs are key. And as AG, you need to do everything you can to put a downward pressure on costs, and so I have some skepticism about the proposed agreement.

Warren Tolman, former State Senator: So the big issue here, from my perspective, is the ability of this agreement to control costs or not.

My mom spent the last five and half years of her life in a wheelchair, in and out of a nursing home, and in and out of hospitals. And I watched as my dad — my mom and dad had raised eight kids and they grappled with these ever-increasing costs that are associated with Partners and with other healthcare entities.

So I’m very, very concerned about the impact of the ever-increasing healthcare costs and whether this agreement really does what it’s intended to do in terms of curtailing those costs. That’s the number one concern. Continue reading

Project Louise: Entering The Home Stretch, Time To Press ‘Pause’

pause button

(Maximilian Schonherr via Wikimedia Commons)

Is it just me, or do we never really outgrow that “back to school” feeling? As a new school year looms for my kids, I find myself similarly anticipating a return to seriousness, a settling down, an evaluation of past progress and a recommitment to getting things done.

Plus, we are now entering the final third of Project Louise – and that has me feeling like I’ve got a lot to do in a very short time! Yes, I work best under pressure; yes, nothing motivates me like a deadline; and yes, I tend to put things off until I really don’t have any choice but to do them. But I confess I’m feeling a bit anxious that I have not lost as much weight as I wanted to by now, and that I am going to have a really hard time hitting my end-of-year goal without some kind of drastic action.

But hold on a minute. The one thing I’ve learned this year is that making permanent change is not about drastic action. It’s about nudging, guiding, steering yourself gradually from one course to another – a gentle gliding curve, not a hard yank of the wheel. So, before anyone gets crazy here, let’s take a deep breath.

(That’s another thing I’ve learned. Breathing is good.)

So. Where are we on this path, and where do we need to go? I say “we” deliberately because I’ve already figured out one thing I want to focus more on in the home stretch: I’d really like to know what you’d like to know. What kind of advice and support do you need in order to reach your own health goals?

Over the past months, we’ve explored a bit about diet, a bit about various kinds of exercise from power yoga to cycling, and a fair amount about personal change. But what’s missing from the picture for you? What kind of experts would you like to hear from, and what would you like to learn?

Here’s one idea to get you started. Next week I’ll be talking with an internist who studies the many effects of stress on our health, and I’m hoping to get some good tips on how to manage stress more effectively. If there’s anything you’d like me to ask her, let me know. Continue reading

When Medical Care Is Futile, Other Patients Pay The Hidden Price

(U.S. Navy via Wikimedia Commons)

(U.S. Navy via Wikimedia Commons)

By Richard Knox

Every day in intensive care units across the country, patients get aggressive, expensive treatment their caregivers know is not going to save their lives or make them better.

California researchers now report this so-called “futile” care has a hidden price: It’s crowding out other patients who could otherwise survive, recover and get back to living their lives.

Their study, in Critical Care Medicine, shows that patients who could benefit from intensive care in UCLA’s teaching hospital are having to wait hours and even days in the emergency room and in nearby community hospitals because ICU beds are occupied by patients receiving futile care. Some patients die waiting.

On one day out of every six, the researchers found, UCLA’s intensive care units contain at least one patient receiving useless care while other patients are unable to get into the ICU.

More than half the time, over a three-month period the researchers examined, the hospital’s intensive care units had a least one patient receiving futile care. The study shows the ripple effects of that futile care within the UCLA hospital and in surrounding hospitals where patients were waiting to be transferred.

“It is unjust when a patient is unable to access intensive care because ICU beds are occupied by patients who cannot benefit,” the authors write.

“The ethic of ‘first come, first served,’” they say, “is not only inefficient and wasteful, but it is contrary to medicine’s responsibility to apply health care resources to best serve society.”

But the concept of “futile” care raises touchy questions. Who decides when care is futile? What if the patient’s family disagrees? What can doctors and hospitals do to avoid futility? Might efforts to avoid futile care slide toward the big R – rationing?

I talked about the study’s implications with its senior author, Dr. Neil Wenger, a UCLA professor of primary care medicine and head of the university’s ethics center. Here’s a lightly edited transcript of our conversation.

Why did you decide to study futile care? Continue reading

Pediatricians: Middle And High School Should Start No Earlier Than 8:30 AM

(eltpics/Flickr via Compfight)

(eltpics/Flickr via Compfight)

It’s one of the great joys of early parenthood: Finally being able to sleep until a reasonable hour — say, 6 a.m. Then, before you know it, you’re facing the opposite problem: Homeroom is just half an hour away, and your tween or teen remains an immovable lump beneath the covers.

As any parent who’s observed it would suspect, this is deep biology at work. Today, the American Academy of Pediatrics issues both an up-to-date explanation of research on adolescent sleep and a ringing call to the country’s schools to heed it and begin school later for “pathologically sleepy” older students. Sleep deprivation in youth is a common — “and easily fixable” — public health issue, the academy says in a policy statement.

From the press release, whose headline begins “Let Them Sleep:”

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” [statement lead author Dr. Judith] Owens said. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Many studies have documented that the average adolescent in the U.S. is chronically sleep-deprived and pathologically sleepy. A National Sleep Foundation poll found 59 percent of 6th through 8th graders and 87 percent of high school students in the U.S. were getting less than the recommended 8.5 to 9.5 hours of sleep on school nights.

This medical stance on sleep deprivation is not new; the research has been accumulating for many years. But the academy reports that about 40 percent of American high schools still start before 8 a.m., and only 15 percent launch the school-day at or after 8:30. Among middle schools, it says, more than one-fifth begin at 7:45 or earlier.

If schools are not shifting later as fast as pediatricians might like, that could be because, like virtually everything in education, it’s not as simple as it might seem.

‘Life is going on right now in hyperspeed for most of our young people.’

“Once you go deeper into the lives of kids today, things become more complex,” says Dr. Bob Weintraub, who was the headmaster of Brookline High School from 1992 to 2011 and is now a professor of educational leadership at Boston University. Based on the research, Brookline High shifted start times for most students to 8:30 during his tenure, he said, but such shifts do raise issues.

“One of the practical problems has always been for high school athletics and school activities,” he said; if school ends later, sports and other activities must start later, and outdoor sports are hindered when darkness descends. Continue reading

How To Spend All That Ice-Bucket Money? Multiple ALS Research Leads Heat Up

In this image from video posted on Facebook, courtesy of the George W. Bush Presidential Center, former President George W. Bush participates in the ice bucket challenge with the help of his wife, Laura Bush, in Kennebunkport, Maine. (AP)

In this image from video posted on Facebook, courtesy of the George W. Bush Presidential Center, former President George W. Bush participates in the ice bucket challenge with the help of his wife, Laura Bush, in Kennebunkport, Maine. (AP)

I sighed this week when I heard, “Hey, Mom, do we have a clean bucket and some ice?”

Yes, the viral ALS ice-bucket challenge that has swept the country had reached our household as well. And though my daughter averred that she would never have heard about ALS otherwise, it pushed some of my cynic buttons. (My favorite response so far had come from an acidly hilarious Facebook friend who advised celebrities: “Just write a check to support ALS research. If you still need a gimmick and social media attention, set your hair on fire instead.”)

For me, the trouble was that I had looked into ALS research a few years ago and it had struck me then as extraordinarily frustrating. It was the field that first taught me that it’s all too common for a potential treatment to look good in initial testing and then fail to pan out when tried in a bigger clinical trial. That happened with ALS over and over again. And meanwhile, patients faced inexorable neurological degeneration and far too early deaths. (One of my most admired colleagues, Dudley Clendinen, died of ALS in 2012 after eloquently chronicling his time with it.)

But then I thought: Let’s be positive. Whatever the narcissistic elements of the ice-bucket dousings, the challenge is raising millions of dollars — more than $50 million as of Friday, from more than a million new donors, according to the ALS Association. And maybe ALS research has changed?

Indeed it has, say scientists working in the field. Not that it looks like there’s a cure around the corner, but there has been major progress of late, they say, and we can expect more to come.

“In about the last seven years, the genetics of ALS has just exploded the field, and just come up with so many new ideas for how we can tackle the disease,” said Avi Rodal, an ALS researcher at Brandeis University whose work is funded by the Blazeman Foundation for ALS.

Dr. Lucie Bruijn, chief scientist of the ALS Association that is reaping the ice-bucket windfall, also describes a field that is forging ahead in multiple directions. “The understanding of the disease, the research that has gone into it, has grown exponentially,” she says. “So we’re much closer to understanding the complexity of the disease and how to approach it in a very different way from before, when many of the trials were challenging partly because we didn’t understand the disease as closely.”

The Association, she says, is focusing on six main areas, and the ice-bucket money will likely be divided among them: “We want to invest in many areas,” she says, “to be sure not to dilute it too much but to be very strategic that we don’t put all our eggs in one basket.”

Those areas, in brief and lightly edited, as she described them:

1. Genetics:
About five to 10 percent of ALS runs through families, but 90 percent is sporadic. However, we’ve found that many of the genes we identify in familial disease are potential risk factors, and certainly also seem to be involved in the sporadic form. So there’s an underlying genetics in all ALS, but sometimes it’s more dominant than others. Continue reading