Author Archives: Martha Bebinger

Martha Bebinger covers health care and other general assignments for WBUR. She was a Nieman Fellow at Harvard University, class of 2010.

Slashing The Pink Ribbon From Beyond The Grave

We’ve written about “Pink Fatigue,” “depinkification,” “pinkwashing,” “Taking on the Pink Juggernaut.” It’s getting to the point that every pink-tinged October also brings a backlash arguing that National Breast Cancer Awareness Month has perhaps jumped the shark.

But never have I read as powerful and furious an indictment of the current breast cancer scene as a piece by longtime Los Angeles Times reporter Laurie Becklund, As I Lay Dying. She died of metastatic breast cancer on Feb. 8, a postscript notes, but I suspect her writing will live virally on for a long time. An excerpt:

Promise me, I told my friends and family, that you’ll never say that I died after “fighting a courageous battle with breast cancer.” This tired, trite line dishonors the dead and the dying by suggesting that we, the victims, are responsible for our deaths or that the fight we were in was ever fair.

Promise me you’ll never wear a pink ribbon in my name or drop a dollar into a bucket that goes to breast cancer “awareness” for “early detection for a cure,” the mantra of fund-raising juggernaut Susan G. Komen, which has propagated a distorted message about breast cancer and how to “cure” it.

I’m proof that early detection doesn’t cure cancer. I had more than 20 mammograms, and none of them caught my disease. In fact, we now have significant studies showing that routine mammogram screening, which may result in misdiagnoses, unnecessary treatment and radiation overexposure, can harm more people than it helps.

Laurie Becklund tells her own story of unexpected cancer recurrence; she describes grappling with her new identity as someone who was surely dying, and her encounters with other women in the same situation; and she expresses her outrage at how the medical establishment and the breast cancer world have failed such patients. Part of her conclusion:

The most powerful organization in the breast cancer universe, Susan G. Komen , has raised $2.5 billion over the last 20 years, much more than many corporations will ever earn. Yet Komen channels only a fraction of those funds into research or systems to help those who are already seriously sick. Most of that money continues to go to a breast cancer “awareness” campaign that is now painfully out of date. Continue reading

Painkillers? Prozac? Brazilian Blowout? Hotline Counsels Pregnant Women On Risks

(Tatiana VdB/Flickr/Creative Commons)

(Tatiana VdB/Flickr/Creative Commons)

Joy Shapiro of Framingham, Mass., was the sort of hyper-cautious expectant mother who doesn’t just cut out alcohol and caffeine. She worried about the ingredients in everything she consumed or put on her body, from fitness drinks to sunscreen.

But thanks to a referral from her obstetrician, she had a secret weapon against her anxiety: Patricia Cole, the program coordinator for MotherToBaby Massachusetts — also known as the Pregnancy Exposure Infoline — whom she “bombarded” with queries.

“At one point, I emailed her like 20 ingredients that were in my face cream to say, ‘Are any of these going to be a detriment to my pregnancy?’” Shapiro says. “You’re essentially living for two, and you want to make sure you’re not doing anything that could harm your child.”

Cole helped Shapiro navigate not just food and cosmetics but medications — prescription steroids, acid reflux, nasal sprays. The sorts of decisions that have become commonplace, nearly universal, in a country where 9 out of 10 pregnant women take at least one medication during pregnancy, and 7 out of 10 take a prescription drug.

“Less than 10 percent of approved medications have enough data to show what, if any, concerns there are for fetal effects.”

– Dr. Cheryl Broussard, CDC

Many of the old concerns about risky exposures during pregnancy — leaded paint, thalidomide — have faded, but in this nation of prescription-fillers, meds have become a major worry.

Last year, the CDC launched its Treating for Two Website, part of a national initiative aimed at making medication use during pregnancy safer. It seeks better research on the effects of meds during pregnancy, and better guidance for expectant mothers and their doctors. The agency warned just last month about the potential risks of opioid painkillers — such as codeine or oxycodone — for pregnant women.

“Really, the problem is that we just don’t know a lot of information,” says Dr. Cheryl Broussard, a CDC expert on medication use during pregnancy. “We know that up to 9 out of 10 pregnant women take at least one medication during pregnancy, but less than 10 percent of approved medications have enough data to show what, if any, concerns there are for fetal effects.”

Clinical trials on drugs seeking approval generally do not include pregnant women, or drop women if they become pregnant. Continue reading

Debating Vitamin D: Leading Docs Still Wrangling On Best Dose For Patients

(Suzanne Schroeter/Flickr)

(Suzanne Schroeter/Flickr)

The message on vitamin D is pretty clear if you talk to Dr. JoAnn E. Manson, M.D., chief of the preventive medicine division at Brigham and Women’s Hospital in Boston, who is leading the largest clinical trial in the world investigating the potential health benefits of vitamin D. It boils down to this: Curb Your Enthusiasm. At least for the time being. Even in the midst of a hellish winter when you may be tempted to take an extra dose of the so-called “Sunshine Vitamin” for a boost.

In a commentary piece published this week in the Journal of the American Medical Association, Dr. Manson urges caution. She says that even though the public has become smitten with vitamin D, its growing popularity has led to mega-dosing that’s not backed by the current evidence. “More isn’t always better, more is sometimes worse,” Manson said in an interview. “We don’t yet have the answers, so we shouldn’t make assumptions.” But, she adds, in a couple of years, gold-standard evidence on whether higher doses of vitamin D are good for you should be out.

But get on the phone with Dr. Michael F. Holick, Ph.D., M.D., a leading vitamin D proponent, endocrinologist at Boston Medical Center and professor at Boston University School of Medicine, and you’ll get a totally different, but equally clear message. Vitamin D deficiency and insufficiency are far more widespread than certain professional medical groups suggest, Holick says, and dosing at higher levels shows “no evidence of toxicity.”

How did we get here and what’s a patient to do?

Here’s a little background:

In debates over nutrition, vitamin D is one of those supplements that’s drawn both passionate supporters and equally aggressive skeptics over the years. And, like coffee, chocolate and red wine, it’s often the subject of studies that can make your head spin: it’s good for you…until it’s not.

The current vitamin D guidelines from the Institute of Medicine recommend 600 IU’s per day for adults up to 70 years old and 800 IU’s per day for those over 70. “This,” writes Manson in her JAMA piece “is equivalent to 3 to 4 daily servings of fortified foods such as milk, yogurt, soy beverages, orange juice, or cereal, plus fatty fish twice per week. These amounts are adequate for at least 97.5% of U.S. and Canadian residents, she says, and it’s good even in the bleakest, darkest season, “even if you’re in Antartica in winter.” Continue reading

Nutrition Panel: Cut Down On Sugar To Combat Obesity, Chronic Disease

(Mel B via Compfight)

(Mel B via Compfight)

A U.S. advisory panel on nutrition has issued a sweeping report on the American diet that many of us won’t find earth shattering. One key conclusion: we should eat less sugar.

The 2015 Dietary Guidelines Advisory Committee offered its recommendations to the U.S. Department of Health and Human Services and the Department of Agriculture today as part of a process to develop new national dietary guidelines, which are updated every five years. Public comments are currently being accepted.

As far as sugar goes, the report states that: “Higher consumption of sugar-sweetened foods and beverages as well as refined grains was identified as detrimental in almost all conclusion statements with moderate to strong evidence.”

The report’s authors said they were guided by “two fundamental realities”:

“First, about half of all American adults — 117 million individuals — have one or more preventable, chronic diseases, and about two-thirds of U.S. adults — nearly 155 million individuals — are overweight or obese. These conditions have been highly prevalent for more than two decades. Poor dietary patterns, overconsumption of calories, and physical inactivity directly contribute to these disorders. Second, individual nutrition and physical activity behaviors and other health-related lifestyle behaviors are strongly influenced by personal, social, organizational, and environmental contexts and systems. Positive changes in individual diet and physical activity behaviors, and in the environmental contexts and systems that affect them, could substantially improve health outcomes.

Here’s more about the dietary recommendations:

The overall body of evidence examined by the 2015 DGAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low-or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meat;i and low in sugar-sweetened foods and drinks and refined grains. Vegetables and fruit are the only characteristics of the diet that were consistently identified in every conclusion statement across the health outcomes. Whole grains were identified slightly less consistently compared to vegetables and fruits, but were identified in every conclusion with moderate to strong evidence. For studies with limited evidence, grains were not as consistently defined and/or they were not identified as a key characteristic. Low- or non-fat dairy, seafood, legumes, nuts, and alcohol were identified as beneficial characteristics of the diet for some, but not all, outcomes. For conclusions with moderate to strong evidence, higher intake of red and processed meats was identified as detrimental compared to lower intake….

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On ‘Radio Open Source,’ An Intimate Look At Decades Of Depression

I’ve never met the Cambridge-based writer George Scialabba, but now I can’t stop thinking about him.

About his personal psychiatric records, from his decades of treatment for depression, so courageously shared in a recent piece he wrote in The Baffler: “The Endlessly Examined Life,” subtitled “A Most Chronic Depression.” And about his extraordinary recent interview with his friend, Christopher Lydon, on “Radio Open Source.” You can hear it in the podcast above.

Writer George Scialabba (Courtesy Radio Open Source)

Writer George Scialabba (Courtesy Radio Open Source)

The conversation is interspersed with dramatic readings of excerpts from George’s medical records, and it includes a bit of kind encouragement from one who knows:

One of the things that hurts most about depression is that you don’t really believe that it’s ever going to go away, get better. It just doesn’t seem like something with a plausible cause. So you can’t imagine what the remedy is. So people should tell you: “Look, eventually, everybody gets a little better. Some people are still mildly depressed, but virtually no one is acutely depressed for decades and decades — their whole life. It’ll get a little better, and probably a lot better. So hang on.”

So many of us know depression personally — one in 10 Americans, by an estimate that must set the bar very high — that I expect this powerful, double-platform exploration of George Scialabba’s experience will elicit very varying personal responses. “Radio Open Source’s” post about the interview includes just one comment, at last look, but it’s a gorgeous one, including this:

Well, you would think that this subject is not where you want to go in this particular winter of 2015. But it’s not about depression. Or not about only that. What it’s really about is what happened in spite of it or because of it; what happens climbing out of it, or trying to. I have had to learn and will probably have to learn again that we are not only our particular illness. It’s the illness, the suffering, the pain, which you can never convey (but need to try) even to the most sympathetic, that pain itself that is the door through which you walk to somewhere else. But also I think one needs to have something to grab onto — maybe the rope of creative expression and reaching out. Something.

One brief personal reaction: I like George’s theory that depression may be the result of faulty emotional “shock absorbers.” But I was most struck by the possibility that, after he ended his intense involvement in the religious order Opus Dei, he never fully recovered because he needed that involvement, perhaps that faith, to face life. He had a great big Human Condition problem more than a personal psychological problem. Just a thought. But it’s what I find most echoing in my mind. That, and the fact that his psychiatrists seemed to mean very well, and some surely did help him, but they came nowhere near a solution to the enduring mystery of his long emotional suffering.

Read excerpts of George’s medical records in the Baffler piece here, listen to the podcast above, and please share what echoes most for you.

Further listening: “Radio Open Source: The Untethered, Untenured Mind

Partners HealthCare Drops Bid To Acquire South Shore Hospital

Partners HealthCare is withdrawing its bid to acquire South Shore Hospital, state Attorney General Maura Healey’s office announced Tuesday.

The move comes less than a month after a judge rejected a deal Partners had struck with former Attorney General Martha Coakley’s office that would have allowed Partners to acquire South Shore and two other local hospitals in exchange for some limits on price and staff increases.

In a statement Healey’s office said the state would continue to evaluate Partners’ bid to acquire Hallmark Health Corp.’s Lawrence Memorial and Melrose-Wakefield hospitals “if and when Partners and Hallmark complete pending federal regulatory obligations.”

“We appreciate the thoughtful process that Partners engaged in while making this important decision, and believe it is the right choice for Partners and the Commonwealth,” Healey, who opposed the deal Partners had reached with Coakley, said in the statement. “We are thankful for the valuable input that was provided by the health care community throughout this process to help reach this result.”

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Study: For Sleep Problems In Older Age, Try Mindful Meditation

(Fairy Heart/flickr)

(Fairy Heart/flickr)

Insomnia is insidious, infuriating and often debilitating.

For anyone who has suffered with eyes-wide-open at 4 a.m. it’s not terribly surprising that more and more Americans (particularly older people and women) are being prescribed serious drugs to help them sleep.

But these medications, known as benzodiazepines, have been linked to numerous health problems, ranging from an increased risk of dementia, to car crashes and falls. And once you’re on them, it’s hard to stop, as I can attest from personal experience. While debate continues over the safety and effectiveness of these medications, a small study suggests that an alternative approach may offer some relief.

Research published online by JAMA Internal Medicine found that a practice of mindful meditation — basically just focusing on breathing and remaining in the present moment while observing your thoughts easily drift by — may help certain people with sleep problems. “Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance…” the report concludes.

The study, by researchers at the University of Southern California in Los Angeles, reflects a growing body of evidence showing that the practice of “mindful meditation” can be used as a low-cost, non-drug intervention that can, in certain cases, reduce stress and help with other physical and mental health woes.

Here’s more from the JAMA release:

Sleep disturbances are a medical and public health concern for our nation’s aging population. An estimated 50 percent of individuals 55 years and older have some sort of sleep problem. Moderate sleep disturbances in older adults are associated with higher levels of fatigue, disturbed mood, such as depressive symptoms, and a reduced quality of life… Continue reading

10 Bits Of Blizzard Therapy From Laura Ingalls Wilder’s ‘The Long Winter’

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder wrote about. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder described. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

I pulled Laura Ingalls Wilder’s “The Long Winter” from my son’s bookshelf with the very explicit intention of helping myself feel better about this epic weather.

It worked.

Of course, any reading of the vivid “Little House on the Prairie” accounts of laborious pioneer life will always work to induce a great surge of gratitude for our modern comforts. Friends of mine call it “The Brutal Series.” (Wilder is back on the bestseller list, I see, with a never-before-published autobiography written in 1930.)

But “The Long Winter” offers, I would argue, the best of all antidotes to feelings that this is a horrible, awful, nasty winter. The trick is to compare our current winter woes not to our usual milder weather but to a dire prairie winter: the kind of winter when young Laura would wake, shivering, to a frigid house buffeted by blizzard, spend the dreary day twisting hay for heat and grinding wheat for the coarse brown bread that was her family’s last remaining food, crawl back into a cold bed and shiver until the shivering itself made her warm enough to fall asleep.

“There were no more lessons. There was nothing in the world but cold and dark and work and coarse brown bread and winds blowing.”

Suddenly, the Boston winter of 2015 feels more like a season of relative ease and mild inconvenience.

There’s nothing like reading the whole book, but here are 10 boons of modernity that “Long Winter” passages cast into gratitude-inducing relief:

1. Weather forecasts

“Heap big snow come.” That’s the closest thing Laura’s family gets to a forecast, from “a very old Indian.” The more detailed forecast: “Heap big snow, big wind.”

Much as we may sometimes curse the messengers who bring us dire forecasts, life without them meant that Laura’s Pa took his life into his hands every time he ventured the couple of miles back to their claim land to load the hay he carted to their house in the tiny town of De Smet. A blizzard could hit at any time, and he’d be unable to make his way home.

Author Laura Ingalls Wilder (Wikimedia Commons)

Author Laura Ingalls Wilder (Wikimedia Commons)

2. Powerful plows

A major element of “The Long Winter’s” plot is the snow blockade (see photo above) that stops all train traffic to the town for months, cutting it off from supplies. The “cut” around the tracks repeatedly fills with 20 feet of snow and ice, beyond the snowplow engine’s power to remove.

Even driving a horse and cart over such deep snow becomes a dangerous ordeal when the horse steps on a snow surface with air pockets beneath and falls, panicked, into a deep snow pit. It then falls to the driver to dig the horse out.

3. Stronger houses

Early in the winter, Laura wakes to find that “ice crackled on the quilt where leaking rain had fallen.”

…Her teeth chattered while she pulled on her clothes. Ma was dressing too, behind the curtain, but they were both too cold to say anything. They met at the stove where the fire was blazing furiously without warming the air at all. The window was a white blur of madly swirling snow. Snow had blown under the door and across the floor and every nail in the walls was white with frost.

4. Heat Continue reading

Health Connector Extends Sign-Up Deadline By A Week

The Massachusetts Health Connector is extending the deadline to complete an application and pick a health plan until Feb. 23.

The deadline had been Feb. 15, but officials pushed it back a week because heavy snowstorms have made it hard for some people to sign up for insurance.

Officials say the extreme weather also led to a number of days this month when the call center was short-staffed, leading to long wait times.

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