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.

‘Ether Dome': The Story Of Numbing And Inflicting Pain

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from "Ether Dome." (Courtesy T. Charles Erickson/Huntington Theatre)

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from “Ether Dome.” (Courtesy T. Charles Erickson/Huntington Theatre)

On Oct. 16, 1846, a flustered young man named William Morton raced up marble steps to the dome of Massachusetts General Hospital.

“He was late, and you don’t want to keep surgeons waiting,” said Dr. John Herman, a psychiatrist at Mass General who is steeped in the history of that day.

A group of physicians awaited Morton in the operating room, located high above other floors because “before ether, people screamed,” Herman said.

Morton, a dentist, had promised to put an end to those screams, to the pain patients endured during surgery.

That day, with a patient waiting, Morton pulled out a glass bottle of ether that he had colored red, according to Herman, to disguise the common gas. Morton told the patient to inhale. Moments later, a surgeon sliced into the neck of a relaxed man.

“As he came out of the anesthesia, the surgeon, John Collins Warren, said ‘Mr. Abbott, did you feel pain?’ and Abbott said, ‘Did you begin the procedure?’ ” Herman recounted. “The world changed. Within days, news of what happened here traveled by steamship and by locomotive … to the capitals of the world.” Continue reading

Harvard Poll On Ebola Risk Finds Public Dazed And Very Confused

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

Americans are seriously confused about how Ebola spreads. And it’s no wonder.

A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.

Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.

And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.

Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.

In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.

(Courtesy of Harvard School of Public Health)

(Courtesy of Harvard School of Public Health)

The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.

More than a third worry they or someone in their immediate family will get Ebola. Continue reading

For Hospitals And Clinics: Insurance To Protect Against Losses From Ebola

A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.

“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.

Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.

Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.

“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.

The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.

More Coverage:

Project Louise: What To Do About Cholesterol?

(Wikimedia Commons)

(Wikimedia Commons)

One of my original goals for this project was: “Lower my cholesterol and triglycerides.” I’ve been doing some serious thinking about that lately, along with a bit of research, and I’d like to share the results with you.

The serious thinking started last spring, when I ran across the current controversy about the risks of statins in postmenopausal women.

A growing number of physicians and researchers are arguing that, for some women like me, the risks of taking statins to lower cholesterol may outweigh the potential benefits. And the risks are scary: muscle pain (and, more rarely, permanent muscle damage), kidney and liver issues and – yikes! – increased risk of diabetes. Aside from being my own biggest fear, diabetes also, ironically, increases the risk of heart disease, the very thing statins are meant to prevent.

All this gave me pause, because my doctor had prescribed a statin a while ago, and my argument to the nurse practitioner (whom I actually see more often than the doctor) that I didn’t really want to take it had been met with a firm insistence that I should. Based on my numbers, she said – total cholesterol around 350, with an HDL (“good” cholesterol) of around 60 – there was no question.

So I took it for about a month, but I felt tired and achy – maybe just because of life in general, but the achiness felt worse than usual. So when I saw the new studies, I thought, “You know what? I’m just going to stop.”

And I did, and I felt better. But I’ve been avoiding going back to the nurse practitioner to tell her. All of which strikes me as the behavior of a naughty child, rather than a mature adult.

So, as a mature adult, this week I sought another opinion. My editor, Carey Goldberg, suggested I talk with Dr. Vikas Saini, a cardiovascular specialist and the president of the Lown Institute. He’s known for promoting the cause of “right care,” or “avoiding avoidable care” – that is, for arguing that modern medical practice too often overtreats patients, with frequently expensive and sometimes disastrous results. This seems self-evident to me, though it has been enough to create huge controversy in some circles.

In any case, I called Dr. Saini and talked with him about statins, in both general and personal terms. After noting that statins have become a fairly polarizing issue in the medical community, he asked a few questions about my personal and family history.

Dr. Vikas Saini

Dr. Vikas Saini

I gave him my numbers, which he agreed create a slightly increased risk – on paper, anyway. But when I told him that both my grandmothers had high cholesterol but lived into their 90s (and neither died of heart disease), and that neither of my parents, who also had high cholesterol, died of heart disease, either, he said that this history “makes me very, very suspicious of any attempt to paint your high cholesterol as a risk factor. It doesn’t add up.”

Well, hurrah. So I’m not being stupid to stop taking the statin?

“I don’t think that’s stupid at all,” Saini said. “I personally wouldn’t do much of anything except check your numbers.”

And, of course, keep increasing my commitment to exercise – “at least get it up to three times a week” – and eat your basic Mediterranean diet with plenty of olive oil, and work on stress reduction. All these factors, he noted, clearly help prevent heart disease. Continue reading

Selling Mass. On A New Idea: Shop For Care

(Screenshot from Get The Deal On Care)

(Screenshot from Get The Deal On Care)

Could Massachusetts be the only government in the world trying to persuade citizens to shop for health care? I’m scanning Google, trying to come up with another country, province, city…maybe some remote island that has decided: It’s time to learn how to get the best deal you can on care.

Nope, I can’t come up with any other place.

But here it is: Get The Deal on Care. In addition to the website, you may see ads on the T, Twitter or Facebook that will encourage patients to become more savvy consumers of health care.

“We’re at the beginning of a movement here,” said Barbara Anthony, undersecretary for consumer affairs and business regulation, referring to a provision in a Massachusetts law that took effect Oct. 1. It requires all insurers to make real-time prices available to members online and over the phone, and provide members their cost for the service, taking into account co-pays and deductibles.

“We hear about the dawn of patient-centered care,” she said. “We want to put patients in the driver seat. Well, you can’t put consumers or patients in the driver seat if they don’t have information.”
Continue reading

Study Of 80,000 Birthing Moms Suggests Epidurals Safer Than Thought

(archibald jude via Compfight)

(archibald jude via Compfight)

I subscribe to the dentistry school of birthing babies. That is, I wouldn’t want to get a tooth filled without Novocaine, and I wouldn’t want to have a baby without an epidural.

I know that opinions — strong ones — vary on this, but for those of my ilk who’d like yet another data point to support the pain-relief side, here it is: A national study, one of the biggest yet, of complications from epidurals has just been presented at the annual conference of the American Society of Anesthesiologists now under way in New Orleans. And it suggests that epidurals are even safer than previously thought, with rates of the most-feared complications well under 1 percent.

Dr. Samir Jani, a senior resident in anesthesiology at Beth Israel Deaconess Medical Center, presented the findings, gleaned from a giant national database of anesthesiology cases, the National Anesthesia Clinical Outcomes Registry.

He found that among more than 80,000 cases of anesthesia during labor and delivery, 2,223 involved complications, for an overall rate of 2.78 percent. But most of those concerned medication errors — over-dosing, under-dosing, or use of expired drugs.

The rate of the complications that many women fear most — nerve damage or an excruciating “spinal headache” — were even lower than previously estimated, Dr. Jani said: .2 percent — that’s 2/10 of one percent — for the headache; .002 percent for spinal nerve damage and .14 percent for damage to other nerves.

“So it’s well under 1 percent for the kinds of complications that I think a lot of women worry about,” he said, not the 1-2 percent that he’s been quoting his patients based on textbook teachings.

An awkward question: But don’t anesthesiologists tend to be pretty pro-anesthesia? Mightn’t that bias the results?

“Actually,” Dr. Jani said, “Whenever I talk to all my patients, I tell them, ‘I’m not here to sell you an epidural. it’s your ultimate decision.’ And I think that that’s the mentality that almost all of us have. We aren’t ever going to force on a patient what they don’t want. But in that informed consent process, it’s important we quote not only possible complications but the rates to the best of our knowledge. At the end of the day, it’s good to be able to tell your patient that this is a safe and efficient method to be able to control labor pain.”

And what about the common belief that getting an epidural can hinder the pushing process in labor? Continue reading

8 Things You Need To Know About Ebola

Cpl. Zachary Wicker shows the use of a germ-protective gear in Fort Bliss, Texas, Tuesday, Oct. 14, 2014. About 500 Fort Bliss soldiers are preparing for deployment to West Africa where they will provide support in a military effort to contain the Ebola outbreak. /Juan Carlos Llorca/AP)

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.

Here’s what you need to know about Ebola:

Continue reading

Report Shows Stark Care Disparities, More Amputations Among Black Diabetics

Dartmouth Atlas Project

Dartmouth Atlas Project

Consider this alarming statistic: The rate of diabetes-related amputations is nearly three times higher among blacks compared to other Medicare beneficiaries.

This, according to a new report from the Dartmouth Atlas Project, located at the Dartmouth Institute of Health Care Policy and Clinical Practice. This is the influential consortium that issues eye-popping reports detailing often painfully unfair regional and ethnic variations in medical care. Here are some of the findings from the report, “Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease” released today:

•Amputation rates vary fivefold across U.S. regions among all Medicare patients with diabetes and peripheral artery disease.

•Amputation rates in the rural Southeast, particularly among black patients, are significantly higher than other regions of the country. (Think Mississippi.)

•The amputation rate for black patients is seven times higher in some regions than others

•There is an eightfold difference across regions among blacks in the likelihood that they undergo invasive surgery to increase circulation in the lower legs. In a news conference announcing the report, Marshall Chin, MD, a leading expert on racial and ethnic disparities in health care and a professor at the University of Chicago called these types of diabetes-related amputations “entirely preventable.” “In some ways,” Chin said, “these disparities are hidden unless we look for them.” And here’s more from the Dartmouth news release:

There are significant racial and regional disparities in the care of patients with diabetes. According to a new report from the Dartmouth Atlas Project, blacks are less likely to get routine preventive care than other patients and three times more likely to lose a leg to amputation, a devastating complication of diabetes and circulatory problems…

Amputation rates vary fivefold across U.S. regions among all Medicare patients with diabetes and peripheral artery disease (PAD), the report found. Amputation rates in the rural Southeast, particularly among black patients, are significantly higher than other regions of the country. Furthermore, the amputation rate for black patients is seven times higher in some regions than others and there is an eightfold difference across regions among blacks in the likelihood that they undergo invasive surgery to increase circulation in the lower legs. Continue reading

Mass. Officials Try To Quell Ebola Fear

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

At this moment, in Massachusetts, the fear of Ebola may be more troubling than preparing for the possible cases.

Gov. Deval Patrick and Boston Mayor Marty Walsh pulled their top health, police, fire and transportation leaders into a briefing Tuesday morning and then addressed the public from Logan Airport. Their message: We’re ready, don’t worry.

Sometime Sunday afternoon, as word spread that a Braintree patient was being screened for Ebola, the fear factor in Boston spiked. Could this virus that’s killed 4,447 people as of early Tuesday in West Africa be in our midst? I heard from moms who were disinfecting playground equipment, from colleagues whose parents called with worry, and Walsh says his phone was ringing off the hook.

“I know this weekend was very fearful for a lot of people,” Walsh said, “but in the case of an Ebola case, we were prepared for it.”

Ebola has been ruled out in all of the scares this weekend — that Braintree patient and the five sick travelers who landed at Logan Airport from Dubai. Patrick says there have been several dozen cases in Massachusetts where doctors or nurses suspected Ebola and took precautions.

“I want to make clear that there have been no confirmed cases of Ebola in Massachusetts,” he said. “Each of the individuals that I referred to have been examined and Ebola has been ruled out.”
Continue reading

What The Boston Marathon Response Can Teach Us About Ebola: 5 Lessons

By Leonard Marcus, Ph.D, Barry Dorn, M.D., Richard Serino and Eric J. McNulty, M.A.

The massive and growing Ebola outbreak in West Africa is tragic both in the suffering and deaths among the affected population and in the difficulty of mounting a sufficient response. The number of cases is rising exponentially. We have had the first death in the U.S., the first case of someone contracting the disease in this country and the first case of transmission in Europe. Over the weekend, a man who had recently traveled to Liberia was taken to Beth Israel Deaconess Medical Center to be evaluated for possible Ebola.

Fear and anxiety are rising.

This has the potential to be the defining public health crisis of the 21st century. Boston has stepped up by sending doctors and other health care professionals with extensive experience and expertise. There is, however, something more that Boston has to share: the leadership lessons from the Boston Marathon bombing response.

(Ebola in Guinea/European Commission HG ECHO/flickr)

(Ebola in Guinea/European Commission HG ECHO/flickr)

After the Marathon, we saw federal, state and local agencies, as well as organizations in the private and non-profit sectors, came together as an integrated enterprise that can serve as a model for the Ebola response. While the two events are quite different, the principles for leadership effectiveness are actually similar.

There are five key interrelated lessons from Boston that can be useful as the world confronts Ebola:

Build A United Effort

An effective Ebola response requires linking and leveraging many organizations into a collaborative, cooperative enterprise, much like we saw in Boston after the bombing. Continue reading