Author Archives: Karen Weintraub

‘Only A Game’ Questions NFL Medical Advisor On Football Safety

(Kevin Domingue/Flickr Creative Commons)

(Kevin Domingue/Flickr Creative Commons)

I’ve said it before and I’ll say it again: A child of mine will play tackle football over my dead body. A young brain is too precious a thing to risk. And though the data are not all in, we know plenty about the potential brain damage of repeated head hits, including recent findings that linked youth football to cognitive impairment. Oh, and let’s not forget the 2013 study that found that a single season of contact-sports head blows could affect learning and memory.

So I was surprised to learn from an excellent commentary this morning by WBUR’s Bill Littlefield of Only a Game fame that a prominent Boston medical leader was touting football’s safety. From the Boston Globe here:

Dr. Elizabeth G. Nabel, the president of Brigham and Women’s Hospital and the National Football League’s new adviser, said Tuesday that football is safer than it has ever been, but she called on the NFL to commit more money to medical research and better educate the public about sports injuries.

Nabel, 63, in her first public comments as the NFL’s chief health and medical adviser, said that if her children were still young, she would allow them to play football. She noted that her son, now 29, played football in the eighth grade.

“I think football is getting safer all the time,” Nabel told reporters at the NFL’s offices in New York.

Really, Dr. Nabel? You’ll understand if I want to seek a second opinion — maybe from a former NFL player who can’t remember his own kids’ names.

Bill Littlefield’s commentary – As Concussion Crisis Mounts, NFL Turns To … Cardiology Specialist? — points out that Dr. Nabel’s impressive CV does not seem to include any expertise in brain trauma. He writes:

Experience as a hospital administrator would not seem to be the key qualification for a person charged with advising the heads of an industry where the most significant problem is a 30 percent rate of brain damage among the workforce.

He concludes: Continue reading

Cancer Haves And Have-Nots: Care And Treatment In 2 Different Worlds

By Michael J. Misialek, M.D.
Guest Contributor

Imagine feeling a lump on your body, visiting a doctor, and then waiting seven months (if you’re lucky) to find out whether it is cancer.

This has been the reality for the vast majority of patients in two of the world’s most impoverished nations, Rwanda and Haiti — both emerging from different but unthinkably grim histories of structural violence.

But since 2012, more patients are getting the care that everyone deserves, no matter what country they live in. A medical partnership between several Boston-based hospitals has radically reduced turnaround time for cancer diagnosis, and shrunk the number of people who fall through the cracks.

It is difficult to quantify the exact numbers here, since record keeping in the past has been poor. One data point: In Rwanda, where these interventions are in place, far fewer patients are lost to follow-up after they’ve been treated compared to patients in other poor countries, according to Dr. Larry Shulman, senior vice president for medical affairs at Dana-Farber Cancer Institute, and leader of the medical partnership.

As a pathologist at of one of these partner institutions — Newton-Wellesley Hospital — I can’t help but think about the patient behind the slides under the microscope. Here’s one: Tushime, an 11-year-old Rwandan girl, who had a large tumor protruding from her jaw.

The tissue sample from Tushime’s tumor arrived in Boston in a suitcase carried by an employee of Partners in Health, the global nonprofit. Like all other specimens, hers was processed into a slide by the pathology department of Brigham and Women’s Hospital and read by Harvard faculty.

Tushime’s tumor turned out to be a rhabdomyosarcoma, a common childhood sarcoma. After 48 weeks of chemotherapy and surgery in Rwanda, she is now healthy and free of disease. Doctors there used standard chemotherapy for a cost of about $300 (which was covered by Partners in Health, Dana Farber and the Rwandan government). They relied on age-old, tried and true chemotherapy drugs; in comparison, the newer chemotherapy agents in the U.S. often cost several thousands of dollars.

Even though access to care has improved dramatically in the developing world there is so much work to be done. There are patients who still present with tumors at an advanced stage, many being neglected for months or even years because of barriers to care. There’s often a lack of access to facilities for both diagnosis and treatment, and funding for cancer care is limited. As a result, ordinary diagnoses become extraordinary.

This is an image of a less aggressive (low grade) breast cancer, something that is fairly common among patients in the U.S. You can see the well formed tubules and glands of cancer, but fewer tumor cells growing in a more organized fashion -- only about 30 percent of the image is tumor. (Courtesy of Michael J. Misialek)

This is an image of a less aggressive (low grade) breast cancer, something that is fairly common among patients in the U.S. You can see the well formed tubules and glands of cancer, but fewer tumor cells growing in a more organized fashion — only about 30 percent of the image is tumor. (Courtesy of Michael J. Misialek)

This is an image of an aggressive (high grade) breast cancer not uncommonly diagnosed among patients in countries where access to medical care is limited, such as Haiti. You can see a solid mass of cancer -- the photo is 100 percent tumor. (Courtesy of Michael J. Misialek)

This is an image of an aggressive (high grade) breast cancer not uncommonly diagnosed among patients in countries where access to medical care is limited, such as Haiti. You can see a solid mass of cancer — the photo is 100 percent tumor. (Courtesy of Michael J. Misialek)

Under my microscope, I’ve seen some of the most aggressive appearing tumors from patients in these countries. What are typically rare cancers here in the U.S., such as sarcomas or unusual variants of breast cancers, are all too common in developing nations. Continue reading

The Upside Of Admission To The Psych Unit: A Doctor’s Inside View

By Helen M. Farrell, M.D.
Guest Contributor

I met J in the Emergency Department. Dark red blood was oozing out of self-inflicted deep lacerations to her forearms. The surgical team was consulted and the cuts were debrided, cleaned, stitched and neatly bandaged. J was patched up. But she was not healed. Her wounds ran deeper than a surgeon’s instruments could access.

Together, we had a thoughtful conversation that included a review of her suicidal thoughts, intermittent hallucinations and innermost feelings. These vacillated unpredictably between anger and worthlessness. I informed J that she was going to be admitted to the psychiatric unit for her safety and treatment.

“Locked up?!” These are typical words expressed by patients who learn that they are going to be admitted involuntarily to the psychiatric unit. When J heard this news, her own tear-stained face scrunched up in an expression of horror. After several minutes of pleading, she finally resigned herself to the plan.

A nurse came into the room and took J’s phone. She took her sweater, her belt and the laces from her shoes. J stripped down into a standard hospital gown. It is common for patients to make one last plea and many have told me that they fear the psychiatric unit is analogous to prison.

J is representative of the many patients whom I treat on a day-to-day basis. She is a composite of those actual people who suffer from serious mental illnesses ranging from psychotic and mood disorders to personality disorders that require hospital level care.

Not Your Mother’s Psych Ward
The days of psychiatrists wantonly locking up patients like J against their will are long gone. They have been replaced by a legal process called civil commitment that firmly puts patients’ rights first. Yes, J was being admitted against her will, but she would retain her power to make treatment decisions, summons legal counsel, and even have a hearing with a judge. These safeguards apply to patients like J who are mentally ill and at risk of harm to themselves or others as a direct result of mental illness.

We know about the extreme cases of mental illness — those who involuntarily get locked on a psychiatric unit. An estimated one-quarter of the United States population will suffer from mental illness. But what about those people whom we never hear about? Far too many people, victims of stigma, neglect treatment and suffer in the isolating silence of darkness. They are compelled to withdraw because of fear and shame.

Beyond Shock Therapy

Driving much of that stigma is the fantasy of what happens behind that infamous locked door. Images from “One Flew Over the Cuckoo’s Nest” fill people’s imaginations, as do fantasies of the “shock therapy” room, which many incorrectly think is a place of punishment and not treatment. Continue reading

More resources:

Study: Even After Depression Lifts, Sufferers Face Higher Stroke Risk

(mac keer/Flickr)

(mac keer/Flickr)

In case you missed this piece on NPR today, it’s worth a listen: Harvard researchers have found that long after the dark symptoms of depression have lifted, those of us who suffered from the disorder have an increased risk of stroke later in life.

Patti Neighmond reports on the new study, published in the Journal of the American Heart Association:

Medical researchers have known for several years that there is some sort of link between long-term depression and an increased risk of stroke. But now scientists are finding that even after such depression eases, the risk of stroke can remain high.

“We thought that once people’s depressive symptoms got better their stroke risk would go back down to the same as somebody who’d never been depressed,” says epidemiologist Maria Glymour, who led the study when she was at Harvard’s T.H. Chan School of Public Health. But that’s not what her team found.

Even two years after their chronic depression lifted, Glymour says, a person’s risk for stroke was 66 percent higher than it was for someone who had not experienced depression.

The study authors conclude that to mitigate this risk of stroke, depression should be identified and treated early:

This study, in conjunction with other work confirming that depressive symptoms are causally related to stroke risk, suggests that clinicians should seek to identify and treat depressive symptoms as early as possible relative to their onset, before adverse consequences begin to accumulate.

Continue reading

‘On Point’ Caller’s Baby Born At 22 Weeks; ‘It Doesn’t Always Turn Out OK’

In this May 2 photo provided by Tundi and Nate Brady, their 5-year-old son, Dexter, plays at home in Iowa City, Iowa. Born 16 weeks premature, he spent five months in a neonatal intensive care unit after birth and is now a healthy 5 1/2-year-old whose only major medical issue is needing oxygen when he sleeps. "We were so lucky," his Tundi says. (Tundi Brady via AP)

In this May 2 photo provided by Tundi and Nate Brady, their 5-year-old son, Dexter, plays at home in Iowa City, Iowa. Born 16 weeks premature, he spent five months in a neonatal intensive care unit after birth and is now a healthy 5 1/2-year-old whose only major medical issue is needing oxygen when he sleeps. “We were so lucky,” his Tundi says. (Tundi Brady via AP)

This just in from our friends at On Point:

Our hour discussion Wednesday on a landmark new study regarding mortality rates for extremely premature infants included a lot of powerful calls from listeners who faced some of the complicated choices new parents must sometimes unexpectedly make.

One of those callers, Jennifer from Charleston, South Carolina, was kind enough to share her family’s story, and underline the confusing mix of medical and emotional choices families are forced to make.

“In 2012, I suddenly had to give birth, I had an emergency C-section, because my daughter was having heart-trouble in the womb, and she was born at 22-and-a-half weeks gestation

They really laid out all the options out on the table. I really think the most important thing is that the doctors and nurses really sit down and weigh out all the options with the mother, and the father, or whomever…

She lived for seven days. On the seventh day, she did have a lot of complications for being born that early. Her viability wasn’t the best when she was born. She wasn’t even a pound, she was 14-and-a-half ounces. She had problems with her lungs, she was bleeding in the brain, and on the seventh day, they gave us the option to remove life support. That really was the better option.

I have no regrets for my choice. A lot of people, including family members, tell us we made the wrong choice, constantly, but given the opportunity, given all the options we were given at that time, I’m glad that we did it. I think everyone needs to make their own decision.

The most important thing is that I know it’s a tough decision to go into what the best treatment options are, but it’s a case by case basis. I was very thankful for the doctors and nurses we interacted with. They were very open and honest about treatment. They were real.

You see those things on social media, ‘This baby was born this early and turned out OK.’ It doesn’t always turn out OK. I’m thankful they were so real with us.

We did what was right for us, at that point, and we saw that the quality of life was going to be too hard.”

Continue reading

Boston Medical Center And Tufts Medical Center End Merger Talks

(Kalman Zabarsky/BU)

(Kalman Zabarsky/BU)

Boston Medical Center and Tufts Medical Center announced Wednesday that they are ending merger talks.

The two nonprofit hospitals, which had been in talks since last year, said in a statement that both sides “determined that at this time it is best for our medical centers to remain separate.”

Here’s the full statement from BMC President Kate Walsh and Tufts President Michael Wagner:

Over the last several months, Tufts Medical Center and Boston Medical Center have carefully considered how we might combine our two organizations. We have had thoughtful conversations and considered different options for tackling the complex task of integrating two vital, but different, academic medical centers. After much consideration, we have determined that at this time it is best for our medical centers to remain separate. We conclude these discussions with great respect for each organization’s mission and remain open to future opportunities for collaboration as neighboring institutions.

Continue reading

50 Years Of American Health Choices: Smoking Gains Offset By Getting Fatter

(Lucia Sofo via Wikimedia Commons)

(Lucia Sofo via Wikimedia Commons)

Feeling optimistic? Then you may see the moral of this story as, “Yay, public health efforts! They can wield amazing power and save many lives.”

In more of a glass-half-empty mood? Then your takeaway may be, “If it’s not one thing, it’s another.” Or perhaps, that public health must play an eternal game of Whack-a-Mole.

The story itself: The National Bureau of Economic Research just sent over word of a new working paper that looks at American health behaviors and their effects over 50 years, from 1960 to 2010. It examined six behaviors: obesity, smoking, heavy drinking, unsafe driving, firearms, and poison or overdoses. What most struck me: Though we’re generally living longer, our health gains from shunning cigarettes and safer driving are all but erased by the rise in obesity and drug overdoses. Sigh. From the summary:

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

(Source: NBER working paper 20631, “The Contribution of Behavior Change and Public Health to Improved U.S. Population Health”)

…The authors find that the gains associated with declines in smoking, motor vehicle fatalities, and heavy drinking are essentially offset by the losses arising from rising obesity and misuse of firearms and poisonous substances. Valued in dollar terms, there is a near zero net gain in health from public health and behavioral changes over the past fifty years. However, the analysis includes a mix of some risk factors that have been aggressively addressed through public health and behavioral changes over a long period (smoking, unsafe driving), and others that are in the earlier stages of being addressed and have proven challenging (obesity, prescription drug addiction).

The authors conclude “our study demonstrates the enormous benefits of public health and behavioral change in improving population health, underscoring the importance of continued advances in these areas of research and practice.”

I asked Harvard health economist David Cutler, who co-authored the report, what he’d want the public’s takeaway to be (and included a plea to help me beat down my own cynicism.) His e-mailed response:

There are some who see this as ‘glass mostly empty’ – i.e., if it’s not one thing, it’s another. But remember how hard these changes are. Quitting smoking is very difficult, and yet millions of people have done it. Reducing caloric intake is very difficult, though weights finally seem to be stabilizing. The difficulty of these interventions makes the successes particularly notable.

Readers, your own thoughts? Read the full paper here and the summary here.

A Life Filled With Promise Is Overpowered By A Complex Web Of Pain And Trauma

Jamie Neal's family -- her father Bob, mother Debbie and brother Abe -- at their church in Duxbury (Jesse Costa/WBUR)

Jamie Neal’s family — her father Bob, mother Debbie and brother Abe — at their church in Duxbury (Jesse Costa/WBUR)

When Jamie Neal was home on medical leave from Williams College in early 2010, her parents were going to great lengths to try to protect her.

“I knew she was suicidal,” says Jamie’s mother, Debbie Neal. “My husband and I decided we would do everything to keep her alive.”

Several months earlier, in August 2009, the Duxbury resident had made a suicide attempt that left her in a coma for several days.

“The last few months before she died, I had her sleep in my bed next to me,” Debbie Neal explains. “And every single day, I asked her on a [scale of] 1 to 10 how she felt and was she suicidal. And she would tell me that she was a 5 and that she wasn’t suicidal.”

In March of 2010, the 21-year-old killed herself in the family’s home. Suicide had become her desperate attempt to escape a complex web of pain and trauma: not only mental illness, but sexual assault and drug addiction — a dark journey in a life filled with so much promise.

CAPTION

Jamie Neal was a member of three varsity sports teams beginning her freshman year at Duxbury High School. She was recruited to play basketball at Williams College. (Courtesy the Neal family)

Like many other survivors of suicide, the Neals recall a loved one who was outwardly happy — even, in Jamie’s case, “outrageously fun.” She had a ready smile.

“Jamie was always, always smiling,” Debbie Neal says. “It kind of defined who she was. She loved other people who were struggling. And she was very kind, and she had a beautiful heart.”

There were some signs early on that Jamie might have mental health issues. A nursery school teacher noticed the normally cheerful, outgoing girl would sometimes withdraw into a sad state. And the straight-A student was a perfectionist in everything she did.

“That perfectionism drove her and motivated her,” says Jamie’s brother, Abe Neal. “On the other hand, I don’t want to say it necessarily did her in. But it was very difficult for her. You would find her at four in the morning editing some minor paper for an English class. And she was also very hard on herself as things started going downhill with herself.” Continue reading

Colleges Work To Prevent Suicide And Fight Stigma Around Mental Health On Campus

A training session for Worcester Polytechnic Institute’s Student Support Network. The group's more than 400 members are trained to intervene and help students dealing with mental health issues. (Jesse Costa/WBUR)

A training session for Worcester Polytechnic Institute’s Student Support Network. The group’s more than 400 members are trained to intervene and help students dealing with mental health issues. (Jesse Costa/WBUR)

As another academic year winds down, many colleges are reviewing how they raise awareness of mental health issues on campus, and what additional steps they can take to try to prevent suicide among students.

More than 1,000 college students die by suicide every year. Suicide is listed as the nation’s second-leading cause of death for people of college age, though people not enrolled in school take their own lives at a higher rate than those attending college. And research has found about 7 percent of undergraduate and graduate students seriously consider suicide.

Suicide prevention efforts vary greatly among schools. So does the rate of students seeking help from campus mental health services. According to the Association for University and College Counseling Center Directors, college mental health centers see on average about 10 percent of the student body, though mental health providers say the need is much greater. Smaller schools serve a greater percentage of their student body through campus mental health services than large colleges and universities do.

There’s also no consistency in how suicide is tracked in higher education. WBUR reached out to 10 Massachusetts colleges and universities to request information on their suicide rates and suicide prevention programs. Only two, Worcester Polytechnic Institute and Worcester State University, provided data. WPI has experienced one suicide since 2006 (in May 2011) and four in the last 18 years. Since implementing prevention programs several years ago, the school’s suicide rate has dropped below the national average. Worcester State University reports it has had one suicide in the last 10 years.

In the latest installment of our series, “Suicide: A Crisis in the Shadows,” several people involved in and affected by the issue of college suicide prevention joined WBUR to share their thoughts. Below find highlights from that conversation, and listen to it in full above. Continue reading

Related:

The Checkup: How Patients Can Try To Take The Power Back

It doesn’t help, of course, to be half-naked or in a bottom-baring johnny. But even when fully clothed, we patients — and we’re pretty much all patients at some point — often feel powerless or uncharacteristically passive in our encounters with the health care system.

In the latest episode of our WBUR/Slate podcast, The Checkup, we explore three strategies to help you take charge of your medical experience:

• How to be a better medical shopper in terms of both cost and quality: Tips and insights from Dr. Don Goldmann of the Institute for Healthcare Improvement.

• Telling your own medical story can help you heal, say Dr. Annie Brewster and Prof. Jonathan Adler of Health Story Collaborative.

• Also, medical informatics whiz Dr. Isaac Kohane talks about pushing the “blue button” to gain real control of your own medical data.

In case you missed other recent episodes: “High Anxiety” looked at hormones, parenting and fear of flying; “Sexual Reality Checks” examined penis size, female desire and aging;  and “Grossology” included a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal. )

But lists get tedious — why not just subscribe?

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.