Author Archives: Rachel Zimmerman

Blogger, CommonHealth Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years in Seattle, New York and in Boston as a health and medicine reporter. Rachel has also written for The New York Times, the (now-defunct) Seattle Post-Intelligencer and the alternative newspaper Willamette Week, in Portland, Ore., among other publications. Rachel co-wrote a book about birth, published by Bantam/Random House, and spent 2008 as a Knight Science Journalism Fellow at MIT. Rachel lives in Cambridge with her husband and two daughters.

Vermont Gov. Won’t Pursue Single Payer Health Care This Year

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin of Vermont announced on Wednesday that his state would not pursue single payer health care in this coming legislative session.

Shumlin blamed a sluggish economy for his decision. The taxes required for single payer would prove too burdensome for Vermont, a state that has downgraded its revenues twice this year.

The taxes required to implement single payer would include an 11.5 percent increase in payroll taxes and up to a 9.5 percent increase in income taxes for every Vermonter.

Shumlin added: “Making fundamental changes in our health care system — nearly 20 percent of our economy — is a huge undertaking, and one that must be done with care.”

You can read Shumlin’s prepared remarks here.

Related:

The Art Of Surgery: Painting The Operating Room On Canvas

Coronary Bypass Operation at Brigham and Women's, Boston 2010 oil 40 x 70. A painting by Joel Babb. (Courtesy of Joel Babb)

Coronary Bypass Operation at Brigham and Women’s, Boston 2010 oil 40 x 70. A painting by Joel Babb. (Courtesy of Joel Babb)

When I walked into Joel Babb’s studio a few years ago, I was immediately drawn to a large painting in the middle of the room.  Propped on an easel and framed by the gaze of the sun, the painting transported me to an operating room.  Honestly, not a place I wanted to go.  But when I looked closely, I realized it was an open heart surgery — the life-saving procedure I had done when I was 10-months old. I looked closer and noticed the instruments, the placement of the patient’s head, the colors.

“I had that surgery,” I said to Joel.

“So did I.” he smiled.

That painting has stayed with me and it’s not the first medical painting Babb has finished.  I asked him to share some reflections on the art of medical painting — especially when the featured subject is so close to home. Here’s what he wrote:

In 1995-6, I painted a recreation of the first successful organ transplant which was done by Dr. Joe Murray at Brigham and Women’s Hospital in 1954.  I love to paint landscapes but when I was asked me to do a painting of a famous surgical procedure I was immediately interested.

As part of the process of doing that painting Dr. Joe Murray, who received the Nobel Prize for the transplant surgery, took me around the operating rooms of the Brigham so I could observe and photograph operations while understanding the organization of the operating room. For this specific painting, I was working with the advice and cooperation of three doctors to recreate an event which happened 40 years before.

The operating room no longer existed, and there were only two black and white photographs taken from an observation gallery above on that day. So the doctors had to remember the configuration of the room, the people present, and I had to draw that room from a different perspective, and pose models in surgical gowns under both artificial and natural light. This required a whole series of drawings over several months to come to a final composition. This painting was conceived as complementing the Countway’s painting of the first use of anesthesia (ether) in surgery by Hinckley.

First Successful Organ Transplantation in Man 1996 oil 70 x 88. A painting by Joel Babb (Courtesy of Joel Babb)

First Successful Organ Transplantation in Man 1996 oil 70 x 88. A painting by Joel Babb (Courtesy of Joel Babb)

The painting of the first use of anesthesia by Hinckley hangs in the Countway Library of Medicine at Harvard Medical School.  The doctors told me that anesthesia was the greatest surgical innovation of the 19th century, and they regarded transplantation as the greatest innovation of the 20th century. 

I envisioned my painting as a pendant to the Hinckley — the figures are the same size as those in the Hinckley, but my painting is somewhat smaller because the rooms depicted are smaller. I tried to make the style contemporary, but subdued and historical.  To me there is a feeling of transition as Dr. Moore carries the kidney from the donor operation to the recipient just as one moves from awareness through unconsciousness to awareness when you undergo surgery experience anesthesia.  To Dr. Moore the transplant operation suggests the dawning of a new day of surgery.

After completing the transplant painting, I asked Dr. Moore if he could arrange for me to observe and photograph further surgeries with the intention of doing a contemporary surgical painting without the constraints of doing a commission. He agreed.

I remember photographing a mastectomy, a breast reduction, a complicated breast reconstruction, removal of a formerly transplanted kidney, and a lung cancer operation. But what I really wanted was to observe a heart operation — I had open heart surgery myself as a boy of 13 in 1960. The idea of a saving surgical intervention has been part of my development ever since.

I was able to observe Dr. John Collins and his team do a bypass operation. During the procedure the anesthesiologist let me stand in her place near the head of the patient, on a little foot stool which enabled me to see over the “ether screen,” giving me an incredible view of what the surgeons were doing. Continue reading

New Spending Bill Adds Abortion Coverage For Peace Corps Rape Victims

File this under: “About #$@%&*! Time.

Tucked away in the recently passed $1.1 trillion federal spending bill is a provision that, according to women’s health and abortion rights advocates, is long overdue, ending a 35-year-old ban. The new measure offers abortion coverage to Peace Corps volunteers victimized by rape, incest or facing a life-threatening pregnancy; similar coverage is already provided to federal employees.

Bryan Dwyer, director of Peace Corps and Training in Kigali, Rwanda, and a Peace Corps volunteer in El Salvador from 2000-2002, expressed his strong approval for the new measure:

As both an RPCV [Returned Peace Corps Volunteer] and staff member, I am very pleased that PC [Peace Corps] Volunteers will now be afforded this protection, even as I earnestly hope that no one ever needs to avail herself of it.

Another former Peace Corps employee I talked to was a bit more blunt:

In a long overdue concession to reality, conservative members of Congress no longer forced their abusive “no choice no matter what” policy on women in the Peace Corps. For far too many years, they had prevailed in insisting that women who choose to serve our country who had been raped and impregnated should be repaid with no health care coverage to end those pregnancies. I am glad this truly appalling policy is finally at an end.

Edson Chilundo/flickr

Edson Chilundo/flickr

Here are more details and background in a Glamour magazine report:

Over the weekend, the Senate passed a $1.1 trillion spending bill that includes a provision to provide abortion coverage for Peace Corps volunteers in cases of rape, incest, or life endangerment.

It’s an important win for reproductive rights advocates in a year plagued by restrictions on abortion and other women’s health measures. President Obama is expected to sign the bill into law, granting Peace Corps volunteers and trainees the same type of abortion coverage offered to federal employees….

Currently, just over 60 percent of Peace Corps volunteers are female, and many of them work in areas with little to no access to safe, reliable health care. Continue reading

Where Does Fat Go When You Lose Weight? Mostly Into Thin Air

(Phoney Nickle/Flickr)

(Phoney Nickle/Flickr)

By Richard Knox

A couple of years ago, Ruben Meerman took off 40 pounds. And that got him wondering: What exactly happened to all that fat?

Conventional wisdom was that he “burned” it off. Or sweated it off. Or excreted it. None of that satisfied Meerman, who has a physics degree and makes his living explaining science to schoolkids and for the Australian Broadcasting Corporation.

So Meerman tackled the problem and eventually came up with a surprising answer: Most of the lost fat disappears into thin air.

More specifically, 84 percent of those fat molecules get exhaled as colorless, odorless carbon dioxide. The other 16 percent departs the body as H-2-O — plain old water.

Meerman says the discovery “got me really excited because I’d stumbled onto a gap in the knowledge. It struck me as remarkable that no one had thought this was interesting enough to pursue.”

The British Medical Journal thought so too. It has published a paper, co-authored by biochemist Andrew Brown of the University of South Wales, in its annual Christmas issue, which features off-beat (but peer-reviewed) research.

Weight Loss Realism

Meerman hopes the work will dispel misconceptions held by health professionals as well as the general public. And, he hopes it will provide a helpful dose of realism to counter the impossible expectations millions have about weight loss.

If people understand where the fat goes (and how), they’ll get “why there’s a limit to how quickly you can lose weight,” Meerman said in a Skype interview from Sydney. “And if you understand the limit, you won’t be so quickly depressed if you don’t lose 20 pounds in the first two weeks.”

First, the misconceptions. Meerman and Brown surveyed 150 professionals — split equally among family doctors, dietitians and personal trainers — about where they think the fat goes during weight loss.

By far the most common answer was that the fat was transformed into energy or heat — that is, “burned off.” About two-thirds of doctors thought so. A slightly higher proportion of dietitians did too, and about 55 percent of personal trainers.

But that would violate the Law of Conservation of Mass. It’s a basic precept of chemistry, formulated in 1789 by the French scientist Antoine Lavoisier, which holds that mass is neither created nor destroyed in chemical reactions. The total mass at the end must equal the mass at the starting point — even if matter is quite transformed in the process, from solid to liquid or gas.

The Energy Of A Bomb

Meerman points out that if fat were transformed into pure energy during weight loss, the results would be cataclysmic. Continue reading

A Prescription For Better Teaching, Stronger Doctors

The author's stethoscope from medical school stethoscope. (Courtesy)

The author’s stethoscope from medical school. (Courtesy)

By James Morris
Guest Contributor

Medicine, in many ways, is changing. Patient-centered care is all the rage and the old, iconic image of the all-knowing doctor is fading away.

In one concrete example of this shift, a new Medical College Admission Test (MCAT) is just around the corner. Starting in spring 2015 for the class that will enter medical school in the fall of 2016, the new MCAT promises a “better test for tomorrow’s doctors.”

Among other changes, it will have a new section focusing on the social determinants of health — essentially asking students to consider how income and social status, education, home and work environments and other factors shape health outcomes.

Premedical education takes place at the undergraduate level. I went to medical school, but now spend most of my time working with undergraduates in the classroom.  I often think about what I learned in medical school and how it translates — or doesn’t translate — to teaching, and why it matters.

Of course, there are the obvious connections. One of the classes I teach is comparative vertebrate anatomy, and I use what I learned about anatomy in medical school directly in this class.

But there are other lessons that don’t apply. Doctors often use three-letter abbreviations in their notes. HPI is the history of the present illness, the patient’s narrative of what brought them to the doctor’s office or hospital, as heard and interpreted by the physician.

CAD is coronary artery disease. TIA is a transient ischemic attack, a “mini-stroke.”

There is a saying I remember from medical school: Physicians are especially fond of TLA’s … three letter abbreviations.

I don’t use many acronyms in my teaching. But sometimes, it’s helpful: For problem sets, I sometimes use “PS.” However, when I do this, I am inundated with emails and questions asking what they mean.

In medical school, mnemonics are also widely used to help aspiring physicians learn and remember all kinds of information. The 12 cranial nerves can be recalled using the mnemonic “On Old Olympus’ Towering Top, A Finn And German Viewed Some Hops,” where the first letter of each word of the saying is the first letter of each of the cranial nerves: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, auditory, glossopharyngeal, vagus, spinal accessory, and hypoglossal.

Or, for Harry Potter aficionados, there is “Only Owls Observe Them Traveling And Finding Voldemort Guarding Very Ambiguous Horcruxes.”

These are handy, but I learned so many mnemonics in medical school that I often had trouble remembering which mnemonic was used for what kind of information. Is that the mnemonic for the cranial nerves, or the bones in the wrist, or the femoral triangle, or the major branches of the aorta? Continue reading

Gov. Patrick Announces $1M Grant To Help Develop Faster Ebola Test

Dr. Rick Sacra, a Massachusetts doctor who contracted the Ebola virus in Liberia, and Gov. Deval Patrick converse Tuesday at the State House. (Stephan Savoia/AP)

Dr. Rick Sacra, a Massachusetts doctor who contracted the Ebola virus in Liberia, and Gov. Deval Patrick converse Tuesday at the State House. (Stephan Savoia/AP)

The Massachusetts Life Sciences Center, a quasi-public agency, will issue a $1 million grant to help develop a faster, more accurate test for diagnosing Ebola, Gov. Deval Patrick announced Tuesday.

Also Tuesday, a Massachusetts doctor who had Ebola announced he’s returning to Liberia, where he contracted the virus, to resume his work.

The grant will support a partnership of local life sciences companies, nonprofits and academic institutions that will try to speed up the launch of an Ebola detection tool already in development by Diagnostics For All, a nonprofit organization.

Officials on hand for the State House announcement promised the new tool — which will accept a “single finger-stick of blood” and provide a clear “yes” or “no” response in 45 minutes — will be cheaper, easier to use and lead to earlier diagnosis than current tests.

They said current tests are time- and labor-intensive and not always sensitive enough to detect Ebola at its earliest onset, which they said is critical to containing and effectively treating the disease. Continue reading

Why To Exercise (Outdoors) Today: Tranquility For Aging Ladies

(frodrig/Flickr)

(frodrig/Flickr)

It’s cold, it’s dark, it’s uninviting out there. So, all the more reason to drag yourself outside and do something.

In yet another study on how exercise can combat the bad physical and mental effects of aging, new research suggests that women who can get out the door, fight the elements and exercise might find some nifty benefits. Those benefits include alleviating depression and increasing adherence to an exercise program.

The small study, published in the journal Menopause, asserts it’s the outside air that really helps (as opposed to the stuffy gym or the treadmill in your basement, though I’ve found that when you’re desperate, those work too):

“Between baseline and week 12, depression symptoms decreased and physical activity level increased only for the outdoor group…” write the authors, led by Isabelle Dionne of the University Institute of Geriatrics of Sherbrooke in Quebec.

From the Reuters report:

Outdoor workouts left women in a better mood and kept them exercising longer than counterparts who exercised indoors, according to a small study from Canada.

Results of the three-month trial involving women in their 50s and 60s suggest that outdoor exercise programs should be promoted to help older women keep active, the researchers conclude…Only about 13 percent of Canadian women older than 59 years and less than 9 percent of older American adults get at least 150 minutes of physical activity each week… Continue reading

Brigham And Women’s Vivek Murthy Confirmed To U.S. Surgeon General Post

A Brigham and Women’s physician will become the next U.S. surgeon general.

Democrats squeaked out a 51-43 vote Monday to confirm Dr. Vivek Murthy, 37, in the waning days of their control over the U.S. Senate.

Dr. Vivek Murthy is an internist at Boston’s Brigham and Women’s Hospital. His nomination for U.S. surgeon general has stalled, largely due to his advocacy of gun control. (Charles Dharapak/AP/File)

Dr. Vivek Murthy (Charles Dharapak/AP/File)

Murthy’s nomination stalled earlier this year when the National Rifle Association raised objection to Murthy’s characterization of guns as a health issue. Murthy said he would focus on childhood obesity, not guns, if approved as the nation’s top doctor. Many public health leaders and physicians fumed about the NRA’s influence, but the White House did not press for a vote and many of Murthy’s supporters assumed the nomination was dead.

Then on Saturday, Senate Majority Leader Harry Reid, using a procedural move, put Murthy’s nomination back in play. And on Monday he was approved by a single vote majority a year after being nominated and 17 months after the position was vacated.

Continue reading

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The Psychological Aftermath Of The Sydney Siege

A hostage runs to armed tactical response police officers for safety after she escaped from a cafe under siege at Martin Place in Sydney, Australia, on Monday. (Rob Griffith/AP)

A hostage runs to armed tactical response police officers for safety after she escaped from a cafe under siege at Martin Place in Sydney, Australia, on Monday. (Rob Griffith/AP)

By Jessica Alpert

The images of five hostages escaping from the Lindt Chocolate Cafe in Sydney are striking. A woman runs into the arms of law enforcement, her trauma and fear palpable.

This story is still developing, but one thing is for sure: “It really doesn’t take much to instill fear,” says Max Abrahms, a professor of political science at Northeastern University and an expert on terrorism. “This one guy managed to shut down an entire city, divert many planes away from Sydney, and transfix the world in real time following this story.”

As of press time, police were reporting that the hostage taker and two people were killed. For those who survived, what lies ahead psychologically?

Dr. David Gitlin, Brigham and Women’s Hospital vice chair of clinical programs and chief of medical psychiatric services, says recent research suggests reliving or “debriefing” survivors is counterproductive and “actually may precipitate the development of PTSD.”

Instead, health professionals are encouraged to use a resilience model in the immediate aftermath of an event like this one, “helping people think about the things they need to do to feel safe and secure…to deal with things on their timetable,” says Gitlin. Of course, this may come into conflict with the needs of law enforcement, who are looking for further control of an event or preparing evidence for prosecution. As this siege has ended and it’s believed that the assailant acted alone, Gitlin hopes that those now released will not be interrogated at this time.

Gitlin, who led the Brigham’s psychiatric team after the Boston Marathon Bombings, explains that “people need to be surrounded by their loved ones, put into a safe environment, and only process this when they are ready to do so.”

Acute Stress Reaction and PTSD

There are two types of trauma, says Gitlin. Continue reading

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Foggy Days, Sleepless Nights: When Alzheimer’s Care Goes Nocturnal

(Ronel Reyes/Flickr via Compfight)

(Ronel Reyes/Flickr via Compfight)

By Jessica Alpert

Marion Tripp was what you might call a quintessential “Yankee.” From impeccable pie crusts to crackshot deer hunting, she regularly impressed people with her wide range of skills. When her daughter and son-in-law started an organic farm in rural Maine, she’d bundle up in a snowmobile suit and sell their rutabagas at the local farmer’s market. I never knew Marion but her grandson — my husband — loves to remember her this way.

Not the way she was at the end.

Alzheimer’s ravaged Marion’s brain and left her confused, “mean,” paranoid, and violent. The last three years of her life, she had round-the-clock care since she rarely slept more than a few hours at a time. Her nocturnal habits were not unique. Indeed, in the world of Alzheimer’s, this tendency toward nighttime wakefulness is known as “sundowning.”

“Several things go awry with Alzheimer’s that affect the person’s brain chemistry and changes their circadian rhythm,” says Dr. Paul Raia, vice president of clinical services for the Massachusetts/New Hampshire chapter of the Alzheimer’s Association. He says there are various reasons for this nocturnal shift including lack of melatonin, diminished access to natural light and less rapid eye movement or REM sleep.

But it’s not just about being unable to sleep for long stretches of time. Like Marion Tripp, many Alzheimer’s patients are often agitated, angry, even violent. “During that period [of REM sleep], you are ridding the toxins from your brain and you’re stabilizing memory and you’re dreaming and essentially you are paralyzed with your body in a relaxing mode,” says Raia. “[The patients] may take a series of small naps throughout the day and when they wake up, they may not be fully awake. They can’t navigate well or negotiate well in their environment.” Continue reading