The age requirement for tobacco sales would rise from 18 to 21 in the city of Boston, under a proposal out Wednesday from Mayor Marty Walsh.
Author Archives: Karen Weintraub
The stomach cramp and nausea began one hot Friday evening in August, midway through a vacation on Martha’s Vineyard. The next morning, nearly doubled over in pain, a patient who we’ll call “Nancy” walked gingerly into the emergency room at Martha’s Vineyard Hospital.
Nancy is a 55-year-old former nurse who would prefer not to use her real name because she works with the hospitals in this story.
Even Nancy, who spends hours every day focused on health care costs, would gasp when she saw the bill for this visit.
In the ER, a doctor poked at Nancy’s tender belly and took blood for tests and a urine sample. The doctor ordered a CT scan of Nancy’s abdomen and pelvis, using contrast. It showed bulges, inflammation and thickening in Nancy’s colon. The diagnosis: uncomplicated diverticulitis. Nancy filled a prescription for an antibiotic, took some Advil, and felt better after a few days on a clear liquid diet.
Five weeks later, the diverticulitis monster invaded Nancy’s intestines again. This time she went to an urgent care center closer to home, run by Beth Israel Deaconess Medical Center (BIDMC). A doctor there ordered the same single CT scan of the abdomen and pelvis, again with contrast.
Nancy says the care she received at both places was great. But a month later, when she received the bills and her insurance company’s explanation of benefits for both visits on the same day, she was stunned.
The explanation of benefits show Blue Cross had paid Martha’s Vineyard Hospital almost seven times what it paid BIDMC’s urgent care center for the same CT scan — $3,888.76 vs. $574.97. Continue reading
Seventy clinicians from Boston Children’s Hospital have sent hospital administrators a petition imploring them to “reverse course” on plans to demolish Prouty Garden, a healing garden that was gifted to the hospital 60 years ago.
The petition calls Prouty Garden a “precious asset,” an “enduring therapeutic resource” and a testament to the hospital’s commitment to compassionate care.
The doctors, nurses and nurse practitioners who signed the petition say they’ve been left out of the hospital’s decision to construct an 11-story clinical building on the site of the garden and build other smaller, green spaces throughout the property.
Dermatology program director Dr. Stephen Gellis helped organize the petition.
“You cannot replace [Prouty Garden] with indoor gardens or with the [outdoor] garden they’re planning,” Gellis told WBUR. “It’s just depressing. I think so many people have gotten joy from the garden and solace.”
Advice columnist Steve Almond has a typically provocative piece on WBUR’s Cognoscenti today: “Why I’m Not Talking To My Kids About The Paris Attacks.” He and his wife decided, he writes, that “we have absolutely no interest in exposing our kids to the sort of panic-stricken coverage whose central aim is the profitable stoking of anxiety.”
But for parents whose children have been exposed to the news from Paris, here are some extensive and sage tips, broken down by age group, from child psychiatrist Gene Beresin, director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, re-posted with permission from The Clay Center’s website.
By Dr. Gene Beresin
Our hearts go out to the families of those who lost their lives or were injured in the recent terrorist acts in Paris.
At times like these, amid our shock, grief and fear, we need to be particularly attuned to the impact such events have on our children. Kids of all ages have questions and various emotional reactions — compounded all the more by the footage and commentary they may be seeing and experiencing. It is abundantly clear from sound research that children and teens can develop significant stress responses to what they are exposed to in the media.
While we want to shield our kids from the horrific images and stories of the terrorist attacks, it is increasingly hard to create an impervious shield. Full protection is impossible, and we should instead be prepared to help them in the wake of yet another mass killing.
While the world may feel to us increasingly unsafe, it’s our obligations as parents and caregivers to provide comfort, reassurance and guidance to our kids.
Here are some tips for all of us as we navigate this tragic time.
For Parents And Caregivers
Let’s face it: We’re all scared. These terrorist acts leave us feeling afraid, angry and insecure. However, we as adults need to find our own way of coping; after all, the more secure we feel, the better we are able to help our kids.
• We need, in times like these, to engage with others. Adults as well as kids require a sense of community to help us feel connected and protected. So, don’t worry alone; talk about what you are feeling with your partner, spouse and friends. It’s our relationships that hold us safely in this world.
• Make time for self-care through relaxing activities such as reading, listening to music or exercising.
• Pace yourself in terms of the amount of information you choose to consume. Sometimes, it’s best to just disconnect completely.
• If you have specific questions about your kids, call your pediatrician, primary care provider or mental health professional for advice.
Universal Impact On Children Of All Ages
Children need answers to three fundamental questions:
• Am I safe?
• Are you, the people who take care of me, safe?
• How will these events affect my daily life?
Parents should expect to answer these questions over and over again. For those with toddlers and preschool children who may not yet be able to express their concerns in words, it’s still important to reassure them that everyone is safe, and that life will continue in a normal fashion. Continue reading
It’s unlikely that your therapist will be replaced by a computer program anytime soon.
That’s the takeaway of recent study out of Britain looking at the effectiveness of computer-assisted therapy for depression.
The bottom line: The computer programs offered little or no benefit compared to more typical primary care for adults with depression. That’s largely because the patients were generally “unwilling to engage” with the programs, and adherence faltered, researchers conclude, adding that the study “highlighted the difficulty in repeatedly logging on to computer systems when [patients] are clinically depressed.”
In an accompanying editorial, Christopher Dowrick, a professor of primary care medicine at the University of Liverpool, stated what may seem obvious: Many depressed patients, he wrote, don’t want to interact with computers; rather, “they prefer to interact with human beings.” He noted that the poor result “suggests that guided self help is not the panacea that busy [primary care doctors] and cost conscious clinical commissioning groups would wish for.”
As part of the study, published in the BMJ, 691 patients suffering from depression were randomly assigned to receive the usual primary care, including access to mental health care, or the usual care plus one of two computer-assisted options that offer cognitive behavior therapy (CBT), a form of therapy that encourages patients to reframe negative thoughts. Patients were assessed at four, 12 and 24 months; those using the computer programs (one called “Beating the Blues” and the other “MoodGYM“) were also contacted weekly by phone and offered encouragement and technical support.
The context of all this is that demand for mental health services generally exceeds supply around the globe, and health systems are seeking ways to bridge the gap. According to the new paper, demand for cognitive behavioral therapy, for instance, “cannot be met by existing therapist resources.” So, the thinking goes, maybe a computer can ease some of the caseload. And in some cases, it works. Indeed, Britain’s National Institute of Health and Care Excellence (NICE) guidelines recommend computerized CBT as an “initial lower intensity treatment for depression….” based on studies that showed it can be effective.
However, results of this latest study may nudge clinicians and policymakers to rethink the computer’s role in therapy.
Here are the results, summed up in BMJ news release:
Results showed that cCBT offered little or no benefit over usual GP care. By four months, 44% of patients in the usual care group, 50% of patients in the Beating the Blues group, and 49% in the MoodGYM group remained depressed…. Continue reading
As the state’s opioid epidemic shows no signs of slowing down, a Beacon Hill panel listened Monday to hours of testimony on Gov. Charlie Baker’s bill seeking to stem the scourge.
The head of the Massachusetts Medical Society (MMS) is calling for lawmakers to change two key provisions in a bill that Gov. Charlie Baker says is needed to fight the state’s growing opioid addiction epidemic.
The Joint Committee on Mental Health and Substance Abuse held a hearing on the legislation Monday, during which MMS President Dr. Dennis Dimitri urged changes to two controversial proposals: limiting first-time opioid prescriptions to a three-day supply, and letting hospitals hold addiction patients against their will for up to three days while trying to place them in treatment.
Recent Coverage Of The Opioid Addiction Crisis In Mass.
Testifying before the committee, Baker defended the proposals, saying they are necessary to stem the problem.
“For some patients in the throes of this addiction, the choices may be between a jail cell, a coffin or treatment through this proposed process,” Baker said. “I choose the latter over the other two.”
According to a press release, MMS President Dimitri testified that the involuntary commitment proposal “cannot work without access to treatment resources and post-hospitalization care.”
Dimitri also said that involuntary commitment “could further exacerbate” the problem of emergency department overcrowding “without actually benefiting patients.”
Dear readers: CommonHealth is pleased to host a special M.D.-PhD guest writer, David Scales, for the next four weeks. His first assignment: What strikes you most about the latest state numbers on cancer?
Those numbers are just out from the Massachusetts Cancer Registry — the state Department of Public Health plans to post them here within the next couple of days. The good news is that overall, the death rate from cancer in Massachusetts has been dropping. But not all the news is good. Please read on.
By David Scales
As a resident in general internal medicine, I’m not a cancer expert. But my biggest takeaway from these latest state cancer numbers is positive: that we’re becoming better at detecting cancers and getting better at treating them.
We have a long way to go to extend these advances broadly to groups that are less likely to get screened for cancers, including African-Americans, Hispanics and people with low access to health care, but it’s encouraging to see that the trends are generally going in the right direction.
So what should you take away from the new numbers? My top five points:
• Good news and bad news
Bad news first: Cancer diagnosis rates — the number of people diagnosed with cancer for every 100,000 people — are higher in Massachusetts than nationwide.
OK, now the good news: Mortality rates from cancer are generally lower here than national rates. That may sound confusing, but it means people living in Massachusetts are more likely to be diagnosed with cancer but less likely to die from it than people in the rest of the country.
The reasons for this aren’t clear, but Massachusetts has some of the best hospitals in the world. It’s possible we are better both at detecting cancers and at treating them.
• More reason to get that colonoscopy
The report has great news for the prevention of colorectal cancer, the third most common cancer in both men and women in Massachusetts.
Men have seen a huge drop in colorectal cancer diagnoses, from a rate of 68.4 to 39.1 per 100,000 people, meaning that fewer and fewer men are being diagnosed with the disease.
There’s been a large drop in women as well, from 48.2 to 32.0 per 100,000. It’s not yet clear what caused this drop, but the Massachusetts Department of Public Health speculates that it may be due to colonoscopies. During a colonoscopy, the doctor takes out growths in the colon called polyps, some of which may be pre-cancerous. If polyps are removed before they cause cancer, then that would explain why fewer people are getting diagnosed with the disease. Overall, this is good news — it suggests that colorectal cancer screening is working.
• Don’t smoke, don’t smoke, don’t smoke
There are few certainties in life and even fewer in medicine. But one thing is clear: Don’t smoke.
The leading cause of cancer-related deaths in Massachusetts is lung cancer. And while the number of people dying from lung cancer has decreased, that decrease is almost certainly due to reduced rates of smoking. Men smoke more than women, though, so they continue to be more likely to get lung cancer and are more likely to die from it than women.
• Blacks and whites and prostate cancer Continue reading
A call goes out to 911. Sirens scream through the streets.
Boston EMS responded to 135,040 calls last year. More than 2,000 of them (2,038 to be exact) were patients with narcotic related illness (NRI), based on the observations of an EMT.
The vast majority involved heroin. Pleas for help with an overdose were a small segment of EMS calls. But the upward trend is “just striking,” said Boston EMS Superintendent in Chief Brendan Kearney.
About five years ago, Jamie Banks noticed that the whine of gas-powered leaf blowers around her home in Lincoln, Massachusetts, had grown from an occasional burst of nearby noise to a frequent, high-decibel din that could last for hours, several days a week.
She would wake up to the engine roar, she says, step outside and observe landscape workers wielding four or five blowers, raising a 30-foot-high miasma of dust that commuters would skirt as they walked to the nearby train station in the town center.
“At my home it had become a 360-degrees surround-sound situation,” she said. “It was ubiquitous.” And it was all year round, Banks added, the machines used not just for leaves but to clear parking lots and driveways, gutters and planting beds. Even to blast snow off roofs.
A health care researcher with a Ph.D, Banks began looking into the health effects of the fine dust, exhaust pollution and noise caused by leaf blowers, and found causes for concern — including a clear recommendation against using gas-powered leaf blowers and lawn equipment from the American Lung Association.
In 2012, Banks teamed up with Robin Wilkerson, a Lincoln garden designer who worried not just about the noise and dust and carbon footprint of leaf blowers, but also about their impact on the land.
“People were scouring their land of valuable organic matter,” Willkerson said, and then often replacing it with dyed mulch from Louisiana. “It just seemed like lunacy.”
Something needed to be done, they both decided.
At this point in the story, which has played out in many towns and cities around the country, a big fight ensues. Residents who hate the blowers try to get the machines banned. Landscapers, landlords and homeowners who use the blowers fight back. The neighbor-vs.-neighbor battles often grow heated, as they have recently in the big Boston suburbs of Newton and Brookline.
And often, the attempts to regulate lose. Some California towns banned leaf blowers back when they were new in the 1990s, but blower use has been growing enormously, and relatively few towns have blocked them or successfully enforced limits.
In New England, where leaf-peeping season is now routinely followed by leaf-blowing season, no town has passed an outright ban, though a few have imposed restrictions.
First-world problems, you might say. And you might be correct. Lincoln, a gorgeous New England hamlet of old stone walls along winding, wooded lanes, is one of the richest towns in the U.S., with median annual household incomes topping $100,000. The leaf blower issue naturally tends to arise in affluent suburbs where people can afford landscapers and increasingly seek a manicured look.
But it can surface just about anywhere there are trees and blowers, and it doesn’t seem trivial if it’s happening where you live or (try to) work.
No less a literary personage than James Fallows of The Atlantic, who has become very vocally active against leaf blowers, argues that the issue speaks to big concepts about collective versus private life. A trenchant New Yorker article on the mother of all leaf blower regulation fights in California found that it became “a referendum on what it means to be a neighbor.”
As Banks and Wilkerson learned more about the battles over bans around the country, they decided to pursue a more positive path in Lincoln.
They started in 2012 by forming a citizen group, Quiet Lincoln, to spread word about the issue. The next year, in 2013, they asked their fellow citizens at Lincoln’s Town Meeting to approve a study panel. And thus, the Lincoln Leaf Blower Study Committee was formed.
No landscaping companies joined, but the panel did include members from the Department of Public Works, which uses blowers, and the Rural Land Foundation — which owns a small collection of stores and offices in the town known as the “mall,” and employs landscapers to maintain it — along with residents.
The committee surveyed the town to get a sense of people’s feeling about leaf blowers, and found that 46 percent of respondents were bothered by the noise and 37 percent by the dust and air pollution.
“We recognized the importance of education if we were to get town support around this issue,” Banks said. “This is a problem that affects some individuals and not others, so it’s very hard to get broad-based support.” Continue reading