Author Archives: Carey Goldberg

Judge Wrestles With Partners Deal

Suffolk Superior Court Judge Janet Sanders is wrestling with a decision that will shape the health care industry in Massachusetts for at least a decade.

On the face of it, Sanders is reviewing a customary settlement in an anti-trust case. Partners HealthCare and Attorney General Martha Coakley reached an agreement to avoid a lengthy court fight. The agreement would allow Partners to acquire at least three hospitals and hire more physicians in exchange for limits on price increases and unchecked expansion through the next decade.

“[Sanders] has two choices: either enter it or not enter it,” says Partners attorney Bruce Sokler of Mintz Levin. “It’s not like she can rewrite the decree or decide what the right answer is for health care. There are other forums for that in the commonwealth.”

But this case, Commonwealth of Massachusetts v. Partners HealthCare et al, is not proceeding like any routine anti-trust matter.

For one thing:

“This is the first time I’ve ever had this kind of opposition to a consent decree,” Sanders said during a hearing Monday.

Continue reading

Word To Pediatricians: IUDs And Implants Top Choices For Teen Birth Control

From a Planned Parenthood video on the IUD (YouTube)

From a Planned Parenthood video on the IUD (YouTube)

By Veronica Thomas
Guest contributor

When a teen girl tells her pediatrician she’s thinking about having sex, the response is often a brief talk about abstinence, a handful of condoms, and a referral to the family planning clinic across town.

But a new recommendation makes pediatricians likelier to discuss the whole gamut of birth control methods—with IUDs and hormonal implants topping the list.

Released today by the American Academy of Pediatrics, the recommendation says doctors should discuss a broad range of birth control options with sexually active teens, but should start with the methods that protect against pregnancy best: long-acting reversible contraceptives, which include the hormonal implant, copper IUD and two hormonal IUDs.

Teen pregnancy rates have dropped dramatically over the past two decades to a record low, but the U.S. still has one of the highest rates among developed countries: more than 750,000 pregnancies each year. Though most sexually active teens use some form of birth control, they rarely pick the most effective methods and often use them incorrectly—whether it’s missing a few doses of the pill or accidentally tearing a condom.

“It’s sort of a set-and-forget method.”
– Heather Boonstra, Guttmacher Institute

Because IUDs and implants don’t rely on any action from the user, they’re a particularly good fit for teens, says Heather Boonstra, Director of Public Policy at the Guttmacher Institute.

“It’s sort of a set-and-forget method,” she says. Once inserted by a trained professional, an implant or IUD can last from three to ten years, and will be over 99 percent effective. The implant is a matchstick-sized rod inserted in the upper arm; the IUD is a small, T-shaped device placed into the uterus.

Their use has been rising for years in the general population. From 2002 to 2009, implant and IUD use nearly doubled among women overall. But while use of these long-acting methods has also been increasing among teens, less than five percent of all teen contraceptive users currently choose them.

That’s because most teens have never even heard of the implant or IUD, says Boonstra. Continue reading

Just A Status Conference On Partners Deal, But Health Care History

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley, a key player in the Partners deal and also a candidate for governor. (Steven Senne/AP/File)

Health care history unfolds in Suffolk Superior Court today. It may just be a status conference, but it could still be a heck of a show because…

1) The hearing is about a deal that many experts say will shape health care in Massachusetts for a decade or longer. It would limit, but not stop, the expansion of Partners HealthCare, already the largest hospital/physician network in the state.

2) There are some dramatic characters.

• Attorney General Martha Coakley, who’s running for governor, and taking a lot of heat for allegedly letting Partners off too easily. Coakley has repeatedly said she won many more concessions from Partners by negotiating than she would have by suing to try and stop Partners’ expansion. Her court filing is here.

• Some of the city’s top attorneys, representing Partners, the two hospitals it wants to acquire and dozens of supporters and opponents of the deal.

• Judge Janet Sanders, who has not, as far as I can tell, ever worked in health care, signaled that she may need expert help reviewing the voluminous materials filed about this agreement. And while Partners, South Shore Hospital and Hallmark Health are anxious to move ahead with their mergers, Sanders said on Friday that “the issues raised are too important to be dealt with hastily.”

Alerts about protests outside the courthouse went out last week.

But there’s another reason that health care industry watchers toss around words like “historic” or “milestone” in conversations about today’s hearing and the proceedings before Judge Sanders. This level of scrutiny — of one hospital system merging with another — is just very, very unusual in Massachusetts or elsewhere. It’s all triggered by the 2012 law that focuses on controlling health care costs. We are watching the sausage get made. It isn’t pretty or easy to decipher, but it is more open than anything I think we’ve seen before.

School Lockdown Calculus: The Line Between Preparedness And Trauma

(Cory Doctorow/flickr)

(Cory Doctorow/flickr)

By Dr. Steven Schlozman
Guest Contributor

“If there’s a lockdown and they tell me to go under the table, and there’s a window open next to my desk, I’m going out that window. There’s no way I’m sticking around.”

That’s what a 14-year-old boy recently told me after he was reminded again that with the start of the school year comes as well the now increasingly familiar “lockdown” drill protocols.

Not very long ago, you’d probably have to ask kids what “lockdown drill” meant. Now, however, most kids recognize the term as routine. There’s recess, lunch-time, fire drills and lockdowns. Since the beginning of this school year alone, there have been more than 10 actual school lockdowns across our nation. One, as recently as this week, in New York. Importantly, none of these incidents featured the horrible images that come to mind when we picture nightmares like Sandy Hook or Columbine. A child might think she’s seen a gun in the school, or neighbors nearby might brandish shotguns in the midst of suburban altercations.

In all cases, schools aren’t taking any chances. The lockdown is quickly enacted and, school officials are quick to note, no one gets hurt.

But at what cost? Is there a psychological risk to what has now become routine practice? It’s time that we examine the lockdown and all its potential repercussions.

As a child psychiatrist, I worry a lot about these drills. Schools regularly ask for advice from mental health professionals on these matters, and parents often reach out and ask, understandably, what we ought to do in the setting of the still enormously rare and, at the same time, increasing and enormously traumatic spate of school shootings. The implementation of the mandatory lock down drill at our nation’s schools represents an awful lot of energy and resources and a potentially significant threat to the psychological well-being of our students in preparation for something that still thankfully hardly every happens.

Here are the facts:

•School shootings are horrific.

•School shootings are extremely rare.

•School shootings are increasing (at least according to this FBI analysis).

•Given how rare these events are, one can accurately say that school shootings are in fact increasing at a steady clip.

In other words, if we go hypothetically from one event to four events per year, that’s a fourfold increase even though the overall number of schools without incidents still massively dwarfs the schools that have had to endure a shooter.

•Every parent and every teacher worries about these events.

•Kids, it turns out, seems to worry less about these shootings than do adults.

•Some kids, however, are significantly frightened by these drills. Continue reading

Coakley Submits Amended Partners Agreement Capping Hallmark Prices

Massachusetts Attorney General Martha Coakley has submitted an amended agreement Thursday with Partners HealthCare over its proposed acquisition of Hallmark Health System.

The original agreement sanctioned Partners HealthCare to acquire South Shore Hospital and Hallmark Health System. Coakley says the amended agreement, which would cap prices at Hallmark for six and a half years, ensures the merger won’t increase health care costs in the state.

Under the re-negotiated agreement, Partners has also agreed to maintain the current level of psychiatric behavioral health services at Hallmark and North Shore facilities for five years.

Suffolk Superior Court Judge Janet Saunders is scheduled to consider the amended agreement at a hearing Monday. If approved, the settlement would resolve the attorney general’s anti-trust investigation into Partners and allow the merger and acquisition to go forward.

The agreement went back to the negotiating table after Massachusetts’ Health Policy Commission said the deal would raise the cost of medical spending in the region by an estimated $15.5 million to $23 million per year for three major commercial payers. Partners owns North Shore Medical Center and Hallmark Health System has two hospitals and about 400 physicians.

With reporting by State House News Service and the WBUR Newsroom

Study: Aerobics Plus Resistance Training May Be Best Against Teen Obesity

obese kid

A new study published online in JAMA Pediatrics finds that a combination of aerobic workouts plus resistance training offers the best hope for teenagers battling obesity.

From the abstract:

Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

Here’s more from The New York Times coverage of the study, which found that “diet without exercise accomplishes little:”

Canadian researchers put 304 obese teenagers on a diet with a daily energy deficit of 250 calories (measured from their resting energy expenditure). Then they assigned them randomly to one of four groups for 22 weeks: aerobic training on exercise machines like treadmills, resistance exercise using weight machines and free weights, combined aerobic and resistance training, and a diet-only group with no exercise… Continue reading

‘The EbolaCoaster’: Boston Prepares Intensively For What-Ifs

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

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

By Richard Knox

Ebola in Boston? It’s not as far-fetched as you might think.

If the disease does pop up here, it will be a big deal — but probably not as nightmarish as you might imagine.

First of all, virtually no public health or infectious disease specialists think an imported case of Ebola could touch off an outbreak.

That’s because the virus is not spread through the air (except perhaps by certain medical procedures which generate sprays of virus-containing droplets). People can catch it only if they’re exposed to bodily fluids of obviously sick Ebola victims.

No airport screening program could detect such silent infections.

Moreover, U.S. medical personnel have the training and equipment to prevent its spread, and public health experts know how to identify and isolate contagious patients and track down close contacts who might have been exposed.

Still, against the increasingly dire backdrop of West Africa’s epidemic, Boston’s 20 hospitals, two dozen community health centers, public health officials and others have been preparing since August for the possibility that Ebola could appear here.

“My husband calls it the Ebolacoaster,” says Dr. Sharon Wright, director of infection control at the Beth Israel Deaconess Medical Center, speaking of the intense back-to-back “what-if” planning sessions.

The risk of an imported case of Ebola, Wright says in an interview, “is probably more than I would have thought a few weeks ago.”

A Silent Infection

Boston’s not alone. Health centers across the country are sorting out Ebola preparedness plans at a feverish pace. “Ebola doesn’t pose a health risk to the U.S. public, but we’re taking precautions at home,” Dr.Thomas Frieden, director of the Centers for Disease Control and Prevention, told reporters on a conference call Tuesday.

One complication specific to the Ebola virus is that it can take up to three weeks after someone is infected before symptoms appear. Continue reading

NIH Grants $10M To Help Erase Research Gender Gap, But Is It Enough?

The National Institutes of Health this morning announced it will distribute more than $10 million in grants to help combat a persistent pattern of gender bias in science and medical research. The New York Times reports:

The researchers will use the additional funds to include more human participants — generally women — in clinical trials and to ensure that their laboratory animals, even cell lines, are representative of both genders. The money also will be used to analyze gender differences in the resulting data, officials said.

Dr. Paula Johnson (courtesy)

Dr. Paula Johnson (courtesy)

But a key advocate on the topic, Dr. Paula Johnson, Chief of the Division of Women’s Health at Brigham & Women’s Hospital, and Executive Director for the Connors Center for Women’s Health and Gender Biology, says this grant represents just a tiny step forward. In this opinion piece, Johnson details some of the critical work still needed order to level the medical research playing field:

Today, the National Institutes of Health (NIH) took a significant step towards improving the health of women by announcing $10.1 million in grants to fund sex-specific medical research. The new funding will allow researchers to better understand the impact sex differences have on disease and thereby more accurately detect and treat illnesses from depression and drug addiction to lung cancer and Alzheimer’s disease.

This latest development is welcome news in a recent series of advancements being made to address the sex and gender inequities that persist in biomedical research.

But despite this progress, the evidence of gender disparities in biomedical research, and the impact they have on the health of both women and men, are so remarkable, it is surprising that the problem has not yet been adequately addressed.

Despite the passage of the historic 1993 NIH Revitalization Act that mandated the inclusion of women and minorities in NIH-funded clinical trials, women are still underrepresented; male mice (and other animals) are still predominant in disease studies; the sex of stem cells are not routinely considered in this promising area of research, and research results are still not consistently analyzed and reported by sex. Even more disturbing is that, in light of these facts, women are disproportionately impacted by a number of diseases including Alzheimer’s disease, some forms of lung cancer found in non-smoking women, depression and aspects of cardiovascular disease.

When we lack sex-specific research, we don’t know why. Continue reading

Mass. Reports First Case Of Cold Virus, E68

Massachusetts has its first confirmed case of a cold virus that has sent hundreds of children to hospitals across the the country.

The case of an 8-year-old girl who was treated at Boston Children’s Hospital and released means Enterovirus 68 is here and spreading, says state epidemiologist Al DeMaria. It is not typically as dangerous as the flu, he says, except in children with asthma.

“Compared to influenza virus, this virus does not cause a lot of serious complications,” DeMaria said. “In fact, the vast majority of children who have asthma attacks get better.”

DeMaria urges children with asthma to take their management medications. He asks everyone to wash their hands often.

- Here’s the full press release from the state Health Department:

The Massachusetts Department of Public Health (DPH) today announced a confirmed case of Enterovirus D68. The patient is a school aged child with a history of asthma who became ill in early September and has since been treated and released from an area hospital. Due to privacy considerations, DPH will not be releasing additional patient information.

“With enterovirus D68 now widespread across the country, this news comes as no surprise,” said DPH Commissioner Cheryl Bartlett, RN. “We have been working closely with pediatric providers and area hospitals to ensure the proper testing was done to identify the virus. For most children, this virus is relatively mild – but for children with asthma or other respiratory illnesses, it can be serious. Parents should contact their pediatrician if their child is experiencing respiratory issues.”DPH State Epidemiologist Dr. Alfred DeMaria underscored the importance of simple, common-sense steps such as hand-washing to reduce the spread of illness. “As with any other respiratory virus, hand washing is the key to reduce spread, use soap and warm water for 20 seconds” said Dr. DeMaria.

Other tips for parents and patients include:
Avoid touching eyes, nose and mouth with unwashed hands
Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the home is sick

Continue reading

Why To Exercise Today: To Beat Back The Toxic Stress Of Life

frodrig/flickr

frodrig/flickr

Apparently all manner of stress — whether it’s bad morning traffic, or the death of someone you love — can harm your health in deep and profound ways. That’s according to a soon-to-be published study by researchers at Oregon State University. But the key, as NPR reports, is how you manage your stress:

Chronic stress is hazardous to health and can lead to early death from heart disease, cancer and of other health problems. But it turns out it doesn’t matter whether the stress comes from major events in life or from minor problems. Both can be deadly.

And it may be that it’s not the stress from major life events like divorce, illness and job loss trickled down to everyday life that gets you; it’s how you react to the smaller, everyday stress.

The most stressed-out people have the highest risk of premature death, according to one study that followed 1,293 men for years.

OK, so wouldn’t it be great to take little pill for combatting all of this health-undermining stress; something that allowed you to just laugh at all the bad drivers in Boston rather than screaming obscenities and giving everyone the finger?

Well, apparently, there’s something even better!

NPR quotes Dr. Robert Waldinger, a psychiatrist at Massachusetts General Hospital and Harvard University, who offers what appears to be the closest thing to a secret, stress-busting heavy weapon: exercise. Continue reading