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.

After Bombs Hit, Spaulding Moved Front And Center

In this 2013 WBUR file photo, marathon bombing survivor Mery Daniel works with occupational therapist Becky Buttiglieri outside the new Spaulding Rehabilitation Hospital. (Jesse Costa/WBUR)

In this 2013 WBUR file photo, marathon bombing survivor Mery Daniel works with occupational therapist Becky Buttiglieri outside the new Spaulding Rehabilitation Hospital. (Jesse Costa/WBUR)

When the twin explosions hit the Boston Marathon last April, Spaulding Rehabilitation Hospital was 12 days away from moving into its new building at the Charlestown Navy Yard.

Among the first patients on Spaulding’s move-in day were more than a dozen marathon survivors — some just released from acute care hospitals. They’d lost limbs, suffered burns and nerve damage, and some still had shrapnel embedded in their bodies.

“What happens in great places like Mass. General, they save people’s lives that would have otherwise been lost. We like to say once they come to rehab we give the quality of life back after that life’s been saved,” said David Storto, president of the Spaulding Rehabilitation Network and Partners Continuing Care, which includes three other hospitals, as well as 23 satellite facilities.

“People just generally, at the onset of a significant disability, they’re more concerned about the basic things in life,” Storto said. “Are they going to be able to walk again? Are they going to be able to dress themselves again? Are they going to be able to brush their teeth again without being dependent, and requiring support of other people?”

Thirty-two marathon survivors were treated on an inpatient basis at Spaulding  TWEET , including 15 of the 16 who suffered amputations and had to learn to walk on prosthetic limbs. Among them: first-grader Jane Richard, the youngest of the marathon amputees; and Mery Daniel.
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Autism: Awareness Helps, But What We Really Need Is Knowledge

The author's 15-year-old son, Sam, after an orchestra concert.

The author’s 15-year-old son, Sam, after an orchestra concert. (Courtesy)

By Ilyse Levine-Kanji
Guest contributor 

April is autism awareness month. Awareness is great. But what really frustrates me and other parents of children with autism isn’t a lack of awareness but rather how little is actually known about the disorder.

For instance, there is no explanation about why the number of autistic children is exploding. Less than a month ago, the Centers for Disease Control released updated data about the public health epidemic of autism. The CDC found that for children born in 2002, the prevalence of autism is 1 in 68, and 1 in 42 boys. This new prevalence finding is roughly 30% higher than just six years ago and roughly 120% higher than the CDC’s findings in 2002 (1 in 150).

I’m incredulous that people still argue that the increase in the prevalence of autism is only due to better diagnosis.  Do we really believe that doctors and teachers 20 years ago simply didn’t notice the devastating symptoms presented by children affected by autism?

Equally frustrating is the lack of knowledge about the capabilities and inner lives of people with autism. When my son Sam was diagnosed at 26 months in 2000, we were told that a primary hallmark of autism is social disinterest and the desire to be alone. Now that Sam is 15, we realize that couldn’t be further from the truth.

Within the first minute of meeting Sam, you know that he is different. He likes to walk up to people he doesn’t know and rapidly blurt out: “What-is-your-name-and-when-is-your-birthday?” He can say this in an unexpectedly loud voice, with his eyes averted and his back or side facing the person he’s addressing, and maybe standing too close to — or too far away from — his intended “conversation partner.” Once the person answers, Sam often simply moves away, without acknowledging the response or following up in any way, leaving the person confused about the unusual interaction.

Connection

While Sam’s social interactions are often quirky and unexpected, Sam has a deep desire to connect with others. He is always willing to go to the grocery store or run errands with me, primarily because he’s excited to see who we will run into. People joke that Sam acts like “the mayor,” greeting everyone he sees by name and with an extremely enthusiastic fist bump. (Again, we were told that people with autism have trouble recognizing others, which also hasn’t been true for Sam.)

What is accurate is that Sam has tremendous difficulty communicating. He speaks in full sentences, but it is often a struggle for him to communicate his thoughts. One way that Sam compensates for this difficulty is that he painstakingly plans out what he is going to say to someone before he sees him or her.

Sam has many rehearsed scripts in his head that he pulls out depending on the person. Continue reading

Opinion: Why Zohydro Ban Is A Tough Call

Update 4/15:

The AP reports that a federal judge blocked Massachusetts from banning the powerful new painkiller Zohydro.

U.S. District Court Judge Rya Zobel on Tuesday issued the preliminary injunction after the maker of the drug, Zogenix, said in a lawsuit that the ban ordered by Gov. Deval Patrick was unconstitutional.

Zobel said in issuing the injunction that Massachusetts appears to have overstepped its authority in banning the drug, which had been approved by the U.S. Food and Drug Administration.

Patrick ordered the ban after declaring a public health emergency in light of widespread prescription drug abuse in the state.

The judge said federal law preempted the state’s order.

By Judy Foreman
Guest contributor

U.S. District Court Judge Rya W. Zobel today disappointed anyone who expected her to quickly strike down Gov. Deval Patrick’s ban on the sale of the new pain reliever Zohydro. She declined to rule on the drugmaker’s request to quickly but temporarily lift the ban, and is continuing to consider whether to lift the ban permanently.

Judge Zobel faces a difficult decision but not because Zohydro, as many media reports have said, is more potent than anything else on the market. It’s not, and we’ll get to that in a minute.

(wikimedia commons)

(Wikimedia Commons)

First, the legalities. It should be up to federal health officials, including the U.S. Food and Drug Administration, not governors, to make decisions about the safety (or lack thereof) of drugs. For better or worse, the FDA, after a long 2013 review, and against the vote of its own advisory committee, did approve Zohydro in October of last year.

Legally, and logically, it also made little sense in the first place – except politically — for a governor to focus on one particular drug when the whole class of drugs to which it belongs — opioids, also known as narcotics – is controversial precisely because that whole class of drugs has such a complex mix of risks and benefits.

In truth, Zohydro is probably not the wonder drug that its manufacturer, Zogenix, claims, nor is it the menace that critics assert. The furor over Zohydro is simply the latest example of how difficult it is to balance the legitimate needs of people in chronic pain who need long-acting opioids and the also-legitimate need to protect vulnerable people from getting their hands on drugs they might abuse.

The unique feature of extended-release Zohydro is that it contains the opioid hydrocodone, and only hydrocodone. Continue reading

Boston Marathon Medical Director: Getting Back To What The Race Is About

 

Medical personnel work outside the medical tent after the Boston Marathon bombing on April 15, 2013. (Elise Amendola/AP)

Medical personnel work outside the medical tent after the Boston Marathon bombing on April 15, 2013. (Elise Amendola/AP)

Last April 15 at about 2:45, Dr. Aaron Baggish was enjoying the sunny spring day and, in his role as medical director of the Boston Marathon, marveling at the low volume of runners who needed his care. Then the first bomb exploded, about 15 feet away from him. It blew out his right eardrum but the crowd blocked much of the force of the blast, and within seconds he was over the barrier and starting to work on the injured.

After the bombing, Dr. Baggish, who heads the Cardiovascular Performance Program at Massachusetts General Hospital, declined requests for interviews, feeling unable to speak publicly about what happened. But as Boston gears up for its next marathon on April 21 and he prepares to help oversee the race’s medical staff once again, he agreed to share some of his thoughts.

As you reflect back on what happened at last year’s marathon, what are you thinking, what lessons do you see?

Basically, I gave up very early on trying to make sense of any of this. There’s no way to make sense of a senseless, horrible act. We’ll never be able to put it into a neat compartment and say, ‘Oh, yes, that’s why this happened.’ No sense can be made of it. So the next step is, what was the impact on me personally? How do I go about some form of healing process? And how do you reconcile the personal trauma with ‘I have a job I have to do’? And we have a job now that we have to do this year, which is as important if not more important than ever: To run the safest, most medically comprehensive race we possibly can.

Are you medical director again?

Of course. You’d better believe it. Nowhere I’d rather be.

Dr. Aaron Baggish (Courtesy MGH)

Dr. Aaron Baggish at work (MGH)

To ask you your own questions, what was the impact on you personally? How do you go about some form of healing process?

It’s been a series of phases, if you will. There was an immediate, necessary phase of blocking everything out and dealing with the professional aftermath: the meetings and debriefings and making sure the volunteers were okay. That lasted for about a month and was more of a business-as-usual sort of feel than anyone could imagine.

But once the media coverage slowed down and Boylston Street was cleared, that’s when the real, hard personal work started. That’s when the concept of PTSD became a reality.

For example?

For example, I was participating in a Triathlon on Lake Winnepesaukee in August. It’s a race I do every year, a half Iron Man, it’s a special day for me, and I was standing on the beach and watching the professional athletes get going, and they fired a cannon for the men’s start. I knew it was coming. What I didn’t realize was that they would fire a second cannon for the women. So three minutes later, they fired a second cannon and I just disintegrated. I had an unbelievable physiological response. I became nauseous, shaking, and it was then I realized that this was a real, deep scar that would be left for a long time. That was a turning point for me; it made me aware I needed to talk about things more, not publicly but with family and friends and colleagues. That was a good step, and over the fall I very actively engaged with people I trust and feel emotionally safe with, to make certain I could start processing some of this. That took some time, and there were some dark moments there. Continue reading

For Heroin Treatment, Testing A New Drug And ‘Peddling Hope’

About a year ago, Jacob Daus found himself standing before a judge in drug court, again. The 25-year-old had just finished his fourth drug-related sentence in seven years at the Barnstable County Correctional Facility. Was there anything, the judge wanted to know, that might help Daus stay away from heroin and out of jail?

“He asked me if I could come up with a plan for my release cause they didn’t know exactly what to do with me, they were just holding me,” Daus said. “I offered to start the naltrexone.”

To try to stay away from heroin and out of jail, Jacob Daus started naltrexone. (Martha Bebinger/WBUR)

To try to stay away from heroin and out of jail, Jacob Daus started naltrexone. (Martha Bebinger/WBUR)

Daus had heard about the drug from another inmate. Naltrexone seals receptors in the brain. Picture lots of little cups. The drug creates a tight lid so that the cups cannot be filled with heroin, other opiates or alcohol.

Patients can take naltrexone pills, but they have to remember, and stay motivated, to do this daily. Daus opted to take the drug as a monthly shot, which is sold under the brand name Vivitrol. Naltrexone, Vivitrol, same drug, different ways to take it. Daus had three shots.

“I would say that was the happiest time of my life,” he said.

In those three months, Daus says his cravings for heroin almost disappeared.
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Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

Newton Deploys Relaxation Experts To Help De-Stress Community

Screen shot 2014-04-07 at 1.45.34 PM

As of today, the high-achieving suburb of Newton begins a new effort to combat stress in teens: helping their parents relax.

The town is hosting four seminars for parents to help them “relax and reboot” and learn some strategies to better take care of themselves and their stressed-out teenage kids.

In case you live in Newton and are thinking of attending, sorry. They’re already full. But the town is offering several related programs, including An Open Conversation on April 30 for parents to talk about “how we define success in a high achieving community and how that impacts the stress on our teens.”

National statistics suggest that teenage stress is at an all-time high, with kids apparently adopting adult-levels of stress, according to the latest American Psychological Association report on stress in America.

In Newton, the issue is particularly poignant because three Newton high school students took their own lives during the current school year.

But even before the suicides, Newton had decided to take a somewhat novel approach. It applied for and received a “mental health and well-being” grant — $30,000 over three years — to, in effect, allow students, parents and teachers to take a massive exhale and figure out ways, large and small, to take the edge off growing up.

One solution was to contract with the Benson Henry Institute of Mind-Body Medicine, based at Massachusetts General Hospital, and offer the stress-reduction sessions.

The town was already aware of its stress-related problems: Continue reading

Eat Fat But Stay Thin: Mice Can Do It, Maybe Someday We Can Too

Generic lab mice

Generic lab mice

The journal Nature reports that some lab mice have lived out my food fantasy: Even though they ate a heavy, high-fat diet — my particular dream is unlimited Ben & Jerry’s — they did not become obese, because researchers found a novel way to tweak their metabolism.

Sigh. The caveats first: What works in mice might not in humans. It might not be safe. Clinical trials are not on the immediate horizon. This is no reason to stop eating healthy food and exercising.

But we can dream, right? And we can savor the explanations from Dr. Barbara Kahn of Beth Israel Deaconess Medical Center and Harvard Medical School, senior author on the Nature paper. She sums up: “We found an enzyme in fat that appears to be elevated in people with obesity and diabetes. And if we inhibit it in mice, we can increase the amount of energy that the animal burns, and thereby decrease the amount of calories that are stored as fat.”

It’s something like the extra energy you burn when you exercise, she said — except without the exercise.

Dr. Kahn’s team found a gene that, when suppressed, makes metabolism less efficient — which is actually a good thing if you’re trying to avoid obesity.

“Generally, in our lives, we think it’s good to be efficient — and it certainly is good to be efficient in time management,” she said. “But if your metabolism is efficient, it means you need fewer calories to generate the energy that cells need for their basic metabolism, and therefore, if you eat too many calories, you will put on weight. But if the cells are inefficient, they’ll burn up those extra calories and you won’t put on weight.”

So do these findings — centering on an enzyme known as nicotinamide N-methyltransferase or NNMT — indeed hold the promise of some sort of drug to prevent or treat obesity?

“The approach we used in the mice was mainly prevention,” Dr. Kahn said, “but the same idea should work for treatment of obesity. I have to caution, of course: one has to look into all the safety aspects if one considers such a treatment in humans. But all the cellular machinery is there, so it should work.” Continue reading

The OCD In Us All: Study Finds Almost Everyone Has Intrusive Thoughts

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Some people with OCD wash their hands compulsively. (Wikimedia Commons)

Confession: Every time I flush the toilet, I have to be out of the bathroom before the last of the water goes down the pipe. If I’m not — well, I don’t know. Something bad will happen. And when I’m choosing a spoon for breakfast — only breakfast, not later meals — sometimes I’m seized by the feeling that I’ve chosen the wrong spoon. If I use it, I doom the day. I put it back into the silverware tray and choose another.

I knew that I was far from alone — that Obsessive-Compulsive Disorder-type thoughts and behaviors are extremely widespread. But not this widespread. A study just out in the Journal of Obsessive-Compulsive and Related Disorders suggests to me that if you don’t have any of these thoughts and behaviors, you’re the weird one.

The study looked at 777 university students in 13 countries, including Canada, Israel, Iran and the United States. From the press release:

International study finds that 94 percent of people experience unwanted, intrusive thoughts

Montreal, April 8, 2014 — People who check whether their hands are clean or imagine their house might be on fire are not alone. New research from Concordia University and 15 other universities worldwide shows that 94 per cent of people experience unwanted, intrusive thoughts, images and/or impulses. Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading