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.

When And Where Do You Stress? Ambitious Project Aims To Map Daily Life, Whole City

Passengers squeeze aboard a Red Line train at the Porter Square MBTA station. (Robin Lubbock/WBUR)

Passengers squeeze aboard a Red Line train at the Porter Square MBTA station. (Robin Lubbock/WBUR)

By Marina Renton
CommonHealth intern

Would I make it to the train station in time? Or would I miss my train home? The concern gnawed at me as I fidgeted on the uncomfortably warm and crowded subway platform. As I anxiously scanned the tracks for approaching lights, the watch on my wrist buzzed. It was telling me to check my stress levels. I pulled out my phone. High, it said; surprisingly high.

That may sound like the first draft of a science fiction novel but, in fact, it’s describing events from last month, when I tried out a watch that has sensors to measure the autonomic nervous system, which regulates our fight-or-flight response.

Neumitra, a Boston-based startup, developed the technology, and plans to launch an ambitious project this fall that would use it to chart the stress not just of individuals but of professions and institutions — even of a whole city. It may be a no-brainer that catching a train is stressful, but how does stress at Harvard compare to stress at Northeastern? North Shore to South Shore? Emergency room at Boston Medical Center to Massachusetts General Hospital?

“We’re using data from the body and data from mobile phones to understand how everyone is affected by stress,” said Rob Goldberg, co-founder of Neumitra and a neuroscientist formerly at MIT. “Our aim here is for thousands of people in Boston to be using these technologies, so we can understand the difference between a veteran, a police officer, a student, a mother, a nurse — and sometimes you belong to multiple of these categories, so what are the combined effects?”

Sync to see your stress

“I’m so stressed!” is a frequent response to the innocuous, “How are you?” The exclamation, or variations thereof, can be overheard at the office, between classes, at home…practically anywhere.

But it’s one thing to verbally express feelings of stress, and quite another to quantify those sensations. That’s where Neumitra comes in.

You can track your stress level in real time through an app that displays the data that the watch collects. The app syncs with your calendar and GPS, so you can also look back to see which events and locations cause the most stress. When your stress spikes, the watch vibrates — an alert that it might be time to take a step back and recalibrate.

We don’t understand what we’re all struggling with on a day-to-day basis.

– Rob Goldberg

The app displays stress using a color gradient: Blue means relaxed or restful, orange and red signify increasing tension. During my entire subway ride, I was either in the dark-orange or red zone. Once I was back home, I spent more time in the blue regions. Exercise brought me back into the orange (among other things, the watch measures skin conductance and temperature, so physical exertion can register as stress), but it didn’t exceed the stress I demonstrated while standing (read: trying not to fall on anyone) in a crowded subway car.

This technology is certainly fascinating, but does it really tell us anything we didn’t already know? Goldberg’s answer is an emphatic yes. “We think we [know how we feel], but we’re very detached from that,” he said.

Science at a new scale

In this age of “smart” or “connected” everything, we’re getting used to devices that monitor us, but Goldberg says Neumitra’s plans for the technology’s use on a large scale might lead to a whole new understanding of the effects of daily life on stress. Continue reading

Roxbury Center Targets Health Disparities In Boston’s Poorest Neighborhoods

Whittier Street Health Center opened its community vegetable garden on June 24. (Courtesy of Chris Aduama)

Whittier Street Health Center opened its community vegetable garden on June 24. (Courtesy of Chris Aduama)

By Marina Renton
CommonHealth Intern

When it comes to health in Boston, it’s hard to deny there’s a great divide across neighborhoods.

Need proof? A 2013 Boston Public Health Commission report found that, from 2000 to 2009, the average life expectancy for Boston residents was 77.9 years. But in the Back Bay, it was higher — 83.7 years — compared to Roxbury, where the average life expectancy was 74.

If you want to get even more local, you can analyze the same data by census tract, where life expectancy varies by as many as 33 years: 91.9 years in the Back Bay area between Massachusetts Avenue and Arlington Street, and 58.9 years in Roxbury, between Mass. Ave. and Dudley Street and Shawmut Avenue and Albany Street. That’s according to a 2012 report from the Center on Human Needs at Virginia Commonwealth University in Richmond.

The Whittier Street Health Center in Roxbury is trying to tackle the disparities in a very concrete way. With the launch of a new fitness club and community garden, the center is trying to make healthy food and exercise opportunities available and affordable to all, despite geography.

“What we’re trying to do is to remove those social determinants and barriers that are causing these [health] disparities,” said Frederica Williams, president and CEO of the health center.

‘If I Sweat, I’m Doing Something Right’

The fitness club and garden initiatives just launched June 27, but the Whittier Health and Wellness Institute is already drawing in community members.

Eight months ago, Wanda Elliott weighed 256 pounds. On a visit to her Whittier Street physician, she learned her blood pressure was high — high enough that she had to start taking medication. That was the wake-up call that motivated her to change her diet and start exercising.

“I was dragging,” she said.

Elliott began exercising at a local Y but joined the Whittier Street fitness club when it opened. In eight months, she has lost 52 pounds, leaving her 4 pounds shy of her 200 pound goal weight.

“I have two knee replacements, so I have to keep active every day,” she said. Trainers at the center helped her learn to use the exercise machines, and now it feels like a routine, she said.

“I feel addicted to working out. I feel like if I sweat, I’m doing something right,” she said. “From 256 to 204, I feel like a model. I can walk the runway; that’s how energized I feel now.”

Elliott is now off her blood pressure medication. She is working on making changes to her diet “slowly but surely,” drinking more water, eating more salad, and cutting back on red meat. Continue reading

Docs In Training Confide Their Feelings On Performing Abortions

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol July 9 in Austin. (Eric Gay/AP)

Abortion can be hard for the patient. But it can also cause turmoil for the doctor performing the procedure.

Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, found herself acting as a confidant in many discussions with residents about abortion.

“Over the years, when a resident felt confused, overwhelmed or thrilled about something to do with abortion care, they often came to me to discuss it,” she says.

Tricky questions continued to arise: Where does life actually begin? How do doctors’ personal beliefs play out in their clinical care? And, what’s really best for mothers?

(KateLMills/Flickr)

(KateLMills/Flickr)

Singer thought the general public would benefit from hearing more about the complexities of the young doctors’ experiences. So she asked four residents to write about their feelings about abortion training and services, or as one resident characterized it: “one of the most life-changing interventions we can offer.”

These personal stories are published in the July issue of the Journal of Obstetrics and Gynecology, headlined: “Four Residents’ Narratives on Abortion Training: A Residency Climate of Reflection, Support, and Mutual Respect.”

I asked Singer to offer a bit more background on the project, and here, edited, is her response, followed by some excerpts from the residents’ narratives:

Janet Singer: The abortion debate in the U.S. is so divisive, making everything seem black and white; but the real life experiences of doctors and women are much more complex. I am a nurse midwife and though personally committed to increasing access to abortion services, I believe that abortion is not a black and white issue. I speak openly about my personal beliefs with the obstetric residents I work with.

My thinking about the grey areas surrounding abortion care are the result of many conversations with colleagues and residents. One came to me overwhelmed on a day when she had done a late-term abortion and then been called to an emergency C-section for a fetus/baby just a week further along.

She needed to talk about how overwhelming it felt to try to decide where the cusp of life was, why it was OK to take one fetus/baby out of the womb so it wouldn’t live and one out so it might.  Continue reading

In Boston, Celebration And Reflection As The Americans With Disabilities Act Turns 25

Marchers walk down Tremont Street near Boston Common to mark the 25th anniversary of the Americans with Disabilities Act. (Jesse Costa/WBUR)

Marchers walk down Tremont Street near Boston Common Wednesday to mark the 25th anniversary of the Americans with Disabilities Act. (Jesse Costa/WBUR)

Curb cuts, captions on TV, beeps that replace the “walk” sign for people who can’t see: all that has become commonplace in the 25 years since the Americans with Disability Act was passed.

But ask anyone who was in a wheelchair before 1990 and you’ll hear a story of frustration.

Rolling around city blocks, looking for a way to cross the street was a daily event. People crawled up stairs if they couldn’t find someone who could lift them and their chair. Or they’d order at a restaurant that insisted its bathroom was accessible, only to find it was not.

“[The ADA is] an appropriate thing to celebrate, but it was just a start. It has succeeded legally, but socially it has a long way to go.”

– William Peace

“That happened a lot, and still happens a little bit now, but back then that happened a lot,” said Christine Griffin, director of the Disability Law Center in Boston.

Griffin remembers arriving for a conference in the nation’s capital to find the hotel was not accessible. “I turned around and got back in a cab and I flew home,” she said.

The late Sen. Ted Kennedy told a congressional hearing back in 1988 that these stories had become too common.

“I bet if you go across this country, there really isn’t a member of a family or an extended family that hasn’t been touched,” said Kennedy, a chief sponsor of the ADA.

To build support for the act, supporters tied disability rights to civil rights.

“This change had an effect on people’s thinking,” Kennedy said in an interview 10 years after the law passed. “If you think of this as a continuation of the guarantee of equal rights, you come to different conclusions than if you’re looking at special legislation to try and look at some particular group.”

Now at the 25 year mark, disability advocates are celebrating and mapping their next steps. In Boston, about 2,000 people walked or rolled to Boston Common for a parade, speeches, music, dancing and crafts.

Continue reading

Practicing Restraint In A No-Empathy Zone: At The Cancer Surgeon’s Office With My Son

Cathy Corman
Guest Contributor

I carry a genetic mutation increasing my risk of developing breast and ovarian cancer. My children have a 50 percent chance of inheriting the mutation. My 22-year-old son recently noticed a breast lump and asked me to join him when he met with a surgical oncologist to be evaluated.

The surgeon performed a skillful physical exam but provided neither effective risk assessment nor empathetic counsel. Afterward, I sent an email to friends briefly explaining what had gone wrong during the appointment. “We want to know how you managed not to hit him,” they asked. I did it by practicing restraint: slowly counting backwards from 10 and taking very deep breaths.

Here’s my countdown:

10. I did not correct the icy-blue-eyed surgeon with steel-grey hair and steady hands — 50? 60? — when he dissuaded my son from pursuing genetic testing. The surgeon had shaken my son’s hand, looked him in the eye, and palpated my son’s slender, muscular chest, identifying the small lump under my son’s left nipple. A positive finding of a mutation, the surgeon said, adjusting the top of his surgical scrubs, could expose my son to discrimination in the workplace and in obtaining health insurance. That is, I did not say, “The scenario you describe is illegal in this country.” As of March 23, 2010, with the passage of the Patient Protection and Affordable Care Act (aka “Obamacare”), if anyone were to attempt to discriminate against this young man in the workplace or in the process of applying for health insurance because of a positive finding for a genetic mutation (a pre-existing condition), this person would be subject to a massive lawsuit.

Cathy Corman (Courtesy)

Cathy Corman (Courtesy)

9. When this surgeon used the word “anxiety” for the eighth time to a) describe my son and myself and b) provide his vision of a course of action, I did not refer this man to Leslie Jamison’s collection of essays, “The Empathy Exams.”  “Empathy,” writes Jamison, “isn’t just remembering to say that must really be hard — it’s figuring out how to bring difficulty into the light so it can be seen at all. Empathy isn’t just listening, it’s asking the questions whose answers need to be listened to. Empathy requires inquiry as much as imagination. Empathy requires knowing you know nothing. Empathy means acknowledging a horizon of context that extends perpetually beyond what you can see…”

8.  I did not bring up this statistic: Though men make up only 1 percent of breast cancer diagnoses annually in the U.S., they may be up to 25 percent likelier than women to die from the disease, probably because of lack of awareness and late detection. Nor did I mention that generally male breast cancer presents with a detectable lump and is almost always linked to radiation exposure, unusually high levels of estrogen or a genetic mutation. Surely the surgeon knew these statistics? But my son did not. And I did not want to scare him.

7. I said nothing to this surgeon’s response to my son’s question, “But wouldn’t it be relevant to know if I carry the mutation?” His answer: No, you know you have a family history of breast cancer.

6. I said nothing when this surgeon dodged my son’s question: “If my grandfather didn’t have the mutation,” my son wanted to know, “wouldn’t he not have had breast cancer? And wouldn’t it be important for me to know if I carry the mutation, too, to assess my risk?” The surgeon’s reply: The only way you’ll know if you have cancer is to have the lump removed. The surgeon’s answer, while true, sidestepped the elephant in the room: whether my son carries a mutation elevating his risk of breast cancer.

5. When this surgeon ridiculed an actress whose name he could not remember for publicly disclosing her status as a mutation carrier and for undergoing prophylactic mastectomies, I offered him the actress’s name. Continue reading

Thousands Ruled Ineligible For Mass. Medicaid

Tens of thousands of people have been removed from the state’s Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker’s administration obtained by The Associated Press.

The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker’s plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents.

At $15.3 billion, MassHealth is the state’s single largest budget expense.

Based on the results of the redetermination process so far, the state was on track to achieve the savings it had hoped for in the current fiscal year without cutting benefits for eligible recipients, said Secretary of Health and Human Services Marylou Sudders. Continue reading

Bristol County Suicide Spike Not Just ‘A Bump In The Road’

Bristol County is seeing a surge in suicides.

On Monday, the Bristol County Regional Coalition for Suicide Prevention and the Bristol County District Attorney’s office released data on the extent of the issue in the county.

In the last three and a half years, 171 people in the county have died by suicide.

  • 2012: 35 confirmed suicides; 25 men and 6 women
  • 2013: 44 confirmed suicides; 29 men and 15 women
  • 2014: 58 confirmed suicides; 50 men and 8 women

The rash of suicides in Bristol County has affected mostly men in their early- to mid-50s. The number of men who have died by suicide has increased 72 percent over the past three years. These men often suffer from depression and substance abuse. And when they seek help, they are unable to find inpatient residential care.

“What we have happening in Bristol Country is not a bump in the road, and what we have happening is not a pothole. We have a sinkhole happening here in this county,” said Annemarie Matulis, director of the Bristol Country coalition.

There have been 34 confirmed suicides, 22 men and 12 women, so far this year. This means the county is on track to match the 2014 statistics or potentially surpass them, the coalition and DA’s office announced Monday.

Matulis says people close to someone who has died by suicide become themselves more prone to taking their own lives.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673).

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Doctor: You Should Not Need Prescription To Treat Urinary Tract Infection

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

Cranberry juice is often recommended to help with UTIs. (Woo Woo/Flickr Creative Commons)

My friend was looking peaked and pained the other day. Today, she was vastly better.

“UTI,” she said, and I nodded knowingly. Urinary tract infections are so common that up to half of all women get them at some point. There are many wonderful things about being a woman; cystitis is not one of them.

It was no big deal. She called her doctor and the prescription was phoned over to her pharmacy. But a recent editorial in the British medical journal BMJ argues for an even simpler solution: She should have been able to just diagnose herself and pick up the treatment over the counter.

Dr. Kyle Knox, a general practitioner, writes that letting women treat UTIs without a prescription could cut 3 million unnecessary visits to the doctor each year in the United Kingdom. From the BMJ press release:

Acute uncomplicated urinary tract infections (AUUTIs) such as cystitis are the most common bacterial infections in women. Cystitis affects around half of women at least once in their lifetime and is coded as the reason for 1% of the 300 million GP consultations held annually in the UK.

Management of cystitis is straightforward – a short course of the antibiotic nitrofurantoin and symptoms usually start to improve after a day or two.

“Therefore, in an era of ready access to information, increasing patient autonomy, and overstretched primary care services, it would seem a good idea for women to be able to access safe and effective treatment without the costs and delays associated with consulting a clinician to obtain a prescription,” suggests Knox. Continue reading

Happy 100 To You, And You — Centenarians Multiply, At Forefront Of Age Wave

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

It’s a rare milestone, to turn 100 — but not nearly as rare as it used to be.

This week in the town of Brookline, Massachusetts, the senior center hosted more than a dozen local centenarians for a “Party of the Century.” In the not-so-distant past — centenarian parties in 2002 and 2007 — party organizers had to reach out to centenarians from all of Greater Boston to gather a critical mass for a fete.

But now, the 99-and-over set has so grown that the party had to limit itself to just Brookline, says Ruthann Dobek, director of the Brookline Council on Aging. And if the numbers keep growing, she told the crowd, “we’re going to have to start it at 105 or 110 to be eligible.”

The centenarians are the leading edge of the fastest-growing sector of the population: people over 60. In this state, the population over 60 has grown 17 percent over just the last five years, and the over-60 cohort will soon outnumber people under 20 for the first time in history, says David Stevens, the executive director of the Massachusetts Association of Councils on Aging. Continue reading

Study: Bottled Water Bans May Increase Consumption Of Sugary Drinks

The University of Vermont instituted a ban on the sale of bottled water in 2013. (Courtesy University of Vermont)

The University of Vermont instituted a ban on the sale of bottled water in 2013. (Courtesy University of Vermont)

By Marina Renton
CommonHealth Intern

Bans on bottled water are sweeping the nation, driven by concerns about the environment. But, according to a new study, the bans might bring some unintended consequences, including increased consumption of sugary beverages without a reduction in plastic waste.

The study, out in this month’s issue of the American Journal of Public Health, came from the University of Vermont, which instituted its own ban on the sale of bottled water in January 2013. Researchers found that more sugar-sweetened beverages were shipped to the campus following the ban — despite efforts to reduce the presence of unhealthy drinks — while the number of bottles shipped per person actually increased.

In 2008, the average American consumed 30 gallons of bottled water a year, or over 200 single-serve bottles. While no one can fault a preference for water over less healthy beverages, the plastic bottles are not environmentally friendly — about 2 million tons of polyethylene terephthalate (PET), the plastic commonly used in beverage containers, entered the waste stream in 2013, while far less, about 899 thousand tons, were recycled.

Recently, bottled water bans have been proposed in towns and on university campuses as a way of reducing plastic waste. In 2013, Concord became the first town in the country to ban the sale of plastic water bottles under 1 liter, and others have since followed suit. Colleges and universities around the country — including Brandeis, Emerson and Harvard — also have bans in place.

Before its ban was implemented, University of Vermont made an effort to increase the presence of healthy beverages on campus by enacting a 30 percent healthy beverage requirement, meaning that at least 30 percent of the drinks for sale on campus needed to fit certain criteria, said Dr. Rachel Johnson, a UVM professor of nutrition and co-author of the new study. Continue reading