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 Teens Talk Of Suicide: What You Need To Know

By Gene Beresin, MD and Steve Schlozman, MD
Guest Contributors

Here’s the kind of call we get all too frequently:

“Doctor, my son said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”

Needless to say, situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so awful?

For clinicians like us who work with kids, these moments are at once common and anxiety-provoking. We know that teenagers suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and providers alike must share the burden of the inexact science of determining where the greatest risks lie.

Suicide has been in the news lately with a flurry of new research and reports and, of course, the high profile death earlier this summer of Robin Williams.

But suicidal behavior among teenagers and kids in their early 20s is different and unique.

So let’s look at a couple of fictional — yet highly representative — scenarios.

depressed

Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started behaving like a different person. He became more irritable, more isolated and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.

Myths: Common But Distorted 

There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time — and this is important — kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.

We have to ask. It’s really that simple. But, we ask with some very basic facts in mind. Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Center for Disease Control Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.

The Underlying Mood Disorder

In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Each year in the United States, about 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicide.

The greatest risk factors for a teenager to die by suicide include the presence of some mood disorder (most commonly depression), coupled with the use of drugs, or other substances, and previous attempts.

Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at highest risk.

Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision. Continue reading

Tackling Autism In Babies? Small Study An ‘Absolute Miracle,’ Says Mom

Megan says the experimental trial she participated in with her daughter Isabel was "an absolute miracle," transforming the child from a troubled baby who looked headed for autism to a typical, happy preschooler.

Megan says the experimental trial she participated in with her daughter Isabel was “an absolute miracle,” transforming the child from a troubled baby who looked headed for autism to a typical, happy preschooler.

Research out this week suggests that it’s never too early to begin therapy to treat some of the defining symptoms of autism. Karen Weintraub reports on the promising new findings in USA Today under the headline, “Study: Autism Signs In Babies Can Be Erased.”

Karen expands on her report here:

In a small pilot study — the first to look at starting therapy in babies this young — researchers at the University of California Davis’ MIND Institute, began treating 7 babies who showed symptoms likely to turn into autism later. By their third birthdays, five of the children no longer exhibited any symptoms of autism, and a sixth was diagnosed with mild autism.

Because the study was so small, and autism cannot reliably be diagnosed in infancy, the researchers stopped short of calling the treatment a breakthrough. But they said they will be following up with a larger study, which they hoped would confirm the results.

One mother involved in the trial described the treatment as “an absolute miracle” for her daughter, Isabel. The mother, Megan, asked not to be fully identified, but talked openly about the trial and its benefits for her family.

At nine months old, Isabel wouldn’t turn her head when someone walked into a room calling her name. She never babbled, Megan said. She was physically delayed in fine and gross motor skills, and didn’t seem to know how to play with toys. All those are signs commonly seen in children who go on to be diagnosed with autism.

Megan heard about the trial through her pediatrician and the family – including Isabel’s dad and her older brother – moved from the Seattle area to Sacramento, so they could participate in the study.

In 12 weekly sessions, lead researcher Sally Rogers coached Megan and her husband John as they played with baby Isabel. Where most children will smile or giggle when happy, Isabel’s facial expressions didn’t change much; where others might cry if scared by a loud sound, Isabel rarely reacted to anything in her environment. But Rogers showed them that Isabel might glance over quickly when she was interested or look at her hands when something was too loud or overwhelming – cues that Megan and John could take to do more or less of whatever they were doing.

Once they learned to “speak” Isabel’s language, Megan said she and John were able to react to her and engage with their baby for the first time. Eventually, through this interaction, Isabel learned that she could communicate – and have fun doing it. That primed her to learn even more, Megan said.

Megan said she and her husband would never have figured out what to do without the coaching. Continue reading

How Mass. Plans To Re-Enroll 450,000 Residents In Health Insurance

All of the estimated 450,000 Massachusetts residents who get health insurance through the Health Connector or MassHealth — some of whom have been in a confusing phase of temporary coverage this year — will soon begin the process of applying for coverage for 2015.

If the state’s new health insurance website is up and running — which the Patrick administration promises it will be — then residents will be able to beginning applying online Nov. 15. If the website still isn’t working, or using a computer isn’t convenient, then you’ll have to fill out a paper application.

Either way, you might want to keep a copy of this timeline handy through January. There are several different deadlines that may be tricky to remember. Here’s an explanation:

(Click to enlarge)

(Click to enlarge)

The key on the bottom left of the chart describes each diamond. Pay close attention to the red diamonds — these are the working end dates for your coverage. I say “working” because these dates assume insurers and the federal government grant the state’s request for extensions.

The state is seeking the extensions so it can spread out the re-enrollment period to avoid overloading members or the system. All the plans through the Connector and MassHealth are currently set to end on Dec. 31, but your coverage may be good for a few more weeks if the extensions are approved. Make sure to look for the coverage end date on any letters you receive.

If you have a commercial health plan through the Connector, find the gray QHP (qualified health plan) box on the top left of timeline and follow the timeline across. Look for your open enrollment package in the mail in early November. Your coverage ends on Dec. 31.

If you had a Commonwealth Care plan last year that has been continued this year, then look for the gold box. The state hopes to extend your coverage through January, so you’ll have two-plus months to review your coverage options.

If you have temporary coverage through MassHealth, then you will be reminded to re-enroll in waves based on when you signed up. You’ll fall into the purple, blue or green boxes above. According to this timeline, your coverage is expected to end sometime between Jan. 15, 2015 and Feb. 15, 2015. But again, the state does not yet have approval for that extension.

The Patrick administration is also waiting to hear if the federal government will give Massachusetts another $80 million to build the new health insurance website, or the $18 million requested to fund outreach, ads and other enrollment efforts.

Related Coverage:

Surprise In Mass. Primary: 21 Percent For Single-Payer Candidate Berwick

Note to politicians: Backing “Medicare for all” is looking less and less like electoral poison. If, deep in your heart, you believe American health care would be better off with a Canadian-style, single-payer system, you might now consider coming out of the closet. (In Democratic primaries in blue states, at least.)

That’s my suggested takeaway from the striking Massachusetts Democratic primary showing of Dr. Donald Berwick, who rocketed from near-zero name recognition among general voters to 21 percent at the polls. Catch him saying forcefully in the video above: “Let’s take the step in health care that the rest of the country hasn’t had the guts to take: single payer. Medicare for all.”

Now, Vermont not only has a mainstream politician who backed a single-payer system — Gov. Peter Shumlin — it’s actually translating the idea into practice as we speak. But let’s put it this way: This seems to be the first time that a candidate in a mainstream political party in a state that is not a verdant utopian duchy has run on a single-payer platform. And though he did not defeat the longtime familiar faces, he did surprisingly well.

“The term I’ve used, and it’s a bold term, but it’s confiscation.”
– Dr. Donald Berwick

Of course, we knew that Massachusetts voters tend to like the idea of single payer. As recently as 2010, 14 fairly middle-of-the-road districts voted in favor of a non-binding ballot measure calling for “creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts.”

Analysts projected that the results meant a statewide majority in support of a single-payer system. The single-payer idea had polled well in non-binding ballot measures before, as well. But now we’ve seen that sentiment translated into support for a candidate.

Other politicians, including President Obama, have backed the general idea of a single-payer system, but they always add a “but,” said Dr. Steffi Woolhandler, who helped found Physicians for a National Health Program.

“And the ‘but’ usually has to do with the political situation,” she said. “But it’s actually important to say what’s the right thing to do and to really work toward the right solution, and that’s what Don [Berwick] has been willing to do, to say, ‘We need single payer and skip the ‘but,’ let’s just say we need single payer and that we need to start working toward it.’”

Will Berwick’s strong showing change the playing field for other candidates? Dr. Woolhandler says yes: “Politicians understand votes. Unfortunately, they also understand money. But they do understand votes, and I think other politicians will see that voters are behind the idea of single payer.”

I asked Dr. Berwick about the reaction to his single-payer position in his many campaign-season travels, and he said the biggest surprise was how positive the response had been from voters who would likely not call themselves progressives. They either already agreed with the idea, he said, or responded instantly after one sentence of explanation with, “That sounds right to me. Let me tell you my story.”

“I remember a carpenter in Hingham,” he said. “I don’t think he would have said he was a progressive — he was a somewhat older carpenter struggling to make ends meet, sitting on a sofa at a gathering, a meet-and-greet, and I started talking about this, and I guess — embarrassingly, to me — I was expecting some pushback. But he immediately said, ‘I’ve got to tell you a story.’ And he told me about his struggle to get health insurance.

“He very carefully went through the policy options, he had picked one that had a maximum deductible that was pretty stiff, and he was ready to swallow it. And he did, he signed up for that plan. And then, the problem was that he had three major illnesses the following year. And he discovered — to his dismay — that the deductible did not apply to the year, it applied to each separate episode. So this guy, who’s working with his hands and trying to just get through and have his family’s ends meet, suddenly found himself tens of thousands of dollars in debt, because of the complexity [of health insurance.] And he said, ‘Enough of this!’ He immediately understood and was fully on board, and that kind of experience has been pretty constant for me.”

Overall, Dr. Berwick said, “The response has been extremely positive beyond anything I would have anticipated. Continue reading

Study: Bullying By Siblings May Double Risk Of Depression, Self-Harm

(Wikimedia Commons)

(Wikimedia Commons)

By Nicole Tay
CommonHealth intern

When I was growing up, I used to complain about the loneliness of being an only child. “I want an older brother like Mandy!” I would plead to my parents. I just wanted an older, cooler playmate; I never considered the potential downside.

Now, at 22, I’ve heard my share of horror stories; the sibling bullies who called my friends “butt face” or “stupid” or “brat;” the burnt Barbie dolls; the bag of caterpillars dumped on my poor friend’s head.

Is sibling bullying just a harmless rite of passage — or can it actually entail developmental repercussions?

A new study published today by the American Academy of Pediatrics targets that very question. After surveying more than 6,900 young people in the UK, researchers found that victims of frequent sibling bullying were twice as predisposed to depression, anxiety, and self-harm in young adulthood as non-bullied controls. This British-based study comes on the heels of similar findings in an American study last year. From the paper:

Of the 786 children who reported that they had been bullied by a sibling several times a week (55.3% female), depression was reported by 12.3% at age 18 years, self-harm occurred in 14.1%, and anxiety was reported by 16.0%.

And from the abstract: Continue reading

Mass. Study: Limited Health Insurance Networks Save Money, Cause No Harm

Jonathan Gruber of MIT (Courtesy MIT)

Jonathan Gruber of MIT (Courtesy MIT)

Most patients, myself included, do not like to be told, “You can’t see that doctor or go to that hospital.” But the message is becoming more common as we, patients, or our employers choose what are known as “limited” or “narrow” network plans (note the not-so-subtle name change).

These plans are often cheaper than other options because they cut out expensive hospitals and because insurers negotiate better prices with hospitals and doctors who are promised our business.

But there’s a backlash that’s both real and hyped. Some of the hype is refuted by a study out today.

It looks at a broad movement toward limited network plans in Massachusetts in 2011, when state employees got a three-month “premium holiday” if they switched from more traditional coverage to the lower-cost option.

State employees who chose to switch reduced their health care spending by 36 percent.

“Clearly, this was a big cost-saver for the state,” says study co-author Jon Gruber.

The savings, says Gruber, occurred because patients with limited network coverage relied more on primary care and less on specialists. There is no sign that patients received lower quality care or that their health deteriorated.

Gruber, who had a hand in creating both the Massachusetts coverage law and the Affordable Care Act, claims the political implications of this Massachusetts limited network experiment are profound.

“There’s a lot of discussion about ObamaCare leading to more ‘limited’ choices,” says Gruber, and “isn’t that a shame.” But Gruber says people in these plans “don’t appear to be suffering.” Continue reading

Primary Cheat Sheet On Mass. Governor Candidates’ Health Care Positions

Judging by your presence at this url, you are, perhaps, not entirely indifferent to health care? And you may, in fact, live in the lovely Bay State, according to the results of an unscientific reader survey we did once. So, in case you plan to vote in the 2014 state gubernatorial primaries, we’ve compiled a health care cheat sheet. We requested brief position statements from the five candidates facing a primary contest. In alphabetical order, and with a link to the full campaign site on each name:

Charlie Baker:
Massachusetts had a health care system that worked, with nearly every citizen having access to the high quality care they preferred, but the disastrous Health Connector website launch and the burdensome federal health overhaul disrupted that for far too many Massachusetts families. As Governor, I will fight for a waiver from the federal health law to protect Massachusetts’ exemplary health care system. I have also proposed a plan to improve the quality of health care, increase transparency and reduce costs for families. My proposals will allow patients to act as informed consumers, prioritize primary care – giving patients with multiple illnesses better treatment – and protect Massachusetts’ health system from federal burdens.

Don Berwick:
Massachusetts needs a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. Don is a pediatrician and an executive who has spent 30 years working to make health care work better, at a lower cost. He is the only candidate for governor supporting single payer health care – Medicare for all. Health care is now 42% of our state budget, up 59% in the last decade alone. Every other major line item in our budget is down. Single payer health care would be simpler, more affordable, more focused on the patient, and it would be a huge jobs creator.

Martha Coakley:
As Governor, Martha will have three goals for our healthcare system: expanding access, maintaining quality, and driving down cost. She has already taken the lead on controlling costs, publishing a series of groundbreaking reports that shed light on the cost-drivers in our system, and going forward she will focus on investing in proven prevention, promoting the role of community health centers, and increasing transparency. She is especially committed to improving care for those struggling with mental and behavioral illness and substance abuse; she has called for higher reimbursements for community-based services, more coverage from private insurance, and incentives for greater coordination of care. She believes we must end the stigma associated with mental and behavioral health.

Mark Fisher:
Did not respond but his campaign’s Web page on health care is here.

Steve Grossman:
We need to revolutionize the delivery of health care services to reduce or eliminate health disparities, primarily by significantly increasing our commitment to and investment in community hospitals and health centers. We must also use every appropriate tool to rein in excessive price increases at our largest medical institutions that could severely undermine achieving the goals of Chapter 224. That’s why I oppose the Partners HealthCare deal Martha Coakley has negotiated, which according to the Health Policy Commission, would raise costs by tens of millions of dollars and harm Massachusetts families and businesses. As governor, I plan to lead a serious conversation with the people of Massachusetts concerning single payer as a vehicle for reforming our health payment system, a conversation that the Boston Globe described in its editorial endorsement of me as “precisely what’s in order.”

Note: We don’t include the independents because we focused on the candidates running in the primary.

We’re No. 1, Not In A Good Way: Highest Hospital Administrative Costs

(Connor Tarter/Flickr via Compfight)

(Connor Tarter/Flickr via Compfight)

By Alvin Tran
Guest Contributor

When it comes to hospital administrative costs, a new Health Affairs study finds, our country is No. 1 and we’re way ahead of the curve — unfortunately.

In the study, researchers analyzed hospital accounting data to compare administrative costs across eight countries: Canada, England, France, Germany, the Netherlands, Scotland, the United States and Wales. They found that administrative costs accounted for more than 25 percent of total U.S. hospital expenditures — far ahead of the pack.

“We were surprised by just how big the differences have grown. The U.S. is in another league than every other country,” said Dr. David Himmelstein, the study’s lead author and a professor at the City University of New York’s School of Public Health.

Himmelstein and his colleagues also found that countries operating under a single-payer health system, such as Canada and Scotland, had the lowest administrative spending, and calculated that the U.S. could save $150 billion a year if it had a system like theirs.

“You’re pulverizing all this money on something that does not make people better.”
– Economist Uwe Reinhardt

Based on Medicare Costs Report data from 2011, hospital administrative spending in the U.S. amounted to $667 per capita — more than double what the Netherlands and England spend.

In the Netherlands, administrative costs consumed just 19.8 percent of hospital budgets — compared to 25.3 percent in the U.S. —  and in England, just 15.5 percent.

In a phone interview, Himmelstein said American hospital administrative costs have doubled over the last decade. “We anticipate that they’ll continue to go up because we’re continuing to pursue health policies that stimulate administration,” he added.

Uwe Reinhardt, a health economist and professor at Princeton University, sees high hospital administrative costs as a moral question. “You’re pulverizing all this money on something that does not make people better — doesn’t improve their health,” he said.

Reinhardt, who said he had once believed the new federal health law would lower administrative costs, now thinks Obamacare has become too challenging and complex, especially with the addition of navigators and health exchange administrators.

“I think the administration of the American health system has outpaced our ability to cope with it. Even the best IT people cannot cope with it anymore,” he said, adding that “Obamacare, if anything, adds to the administrative overhead.” Continue reading

So Much For The Killer Bra: Study Finds No Link With Breast Cancer

(canonsnapper via Compfight)

(canonsnapper via Compfight)

If you’re a bra-wearing woman, maybe you know this feeling: You exhale with relief as you unhook your band at the end of a long day. Looking over your shoulder into the mirror, you see the slight indentation the elastic has left on your torso, and think: “Constriction like this just can’t be good.”

That intuition resonates with popular theorizing that bras can lead to breast cancer by blocking the healthy drainage of waste products from the breast area. Hence the higher breast cancer rates in developed countries.

But give me good hard data over feelings and pop theories every time. A big new study, funded by the National Cancer Institute, finds no link at all between bras and breast cancer.

The study, published in the journal “Cancer Epidemiology, Biomarkers & Prevention,” found that whether women wear bras just a few hours a day or more than 16, whether they wear underwires or wireless, whether they have big cups or small cups, brassieres are guiltless: They just do not seem to be linked to the two most common forms of breast cancer.

The research involved hundreds of postmenopausal women: 454 with invasive ductal carcinoma, 590 with invasive lobular carcinoma, and 469 without breast cancer, who served as controls. Each woman answered questions about everything from her pregnancy history to the age at which she started wearing a bra, whether it had an underwire, cup size, band size and how many hours a day she wore it.

Bottom line: It looks like your bra won’t kill you unless someone strangles you with it. Which contradicts a 1995 book that added gallons of fuel to the theory that bras are harmful: “Dressed To Kill: The Link Between Breast Cancer and Bras.”

The new paper’s senior author, Dr. Christopher Li, head of the Translational Research Program at the Fred Hutchinson Cancer Research Center, says “Dressed To Kill” provided some of the impetus for the study. Our conversation, lightly edited:

Why did you think this study was worth doing?

The whole theory about bra-wearing and breast cancer came to my attention years ago, when there was this book published called “Dressed to Kill.” The whole premise of the book was that bra-wearing is the primary culprit for breast cancer in the world. Being a breast cancer researcher, I had never heard of this theory, and people, friends of mine who had seen it, were saying, ‘What’s going on with this?’ Continue reading

Project Louise: The Dog Ate My Homework

(Girl.In.the.D via Flickr)

(Girl.In.the.D via Flickr)

Hmm, was that me last week, waxing rhapsodic about that great “back to school” feeling? So, here we are, near the end of my kids’ first week back at school, and I have to say: What was I smoking?

Yeah, it’s lovely to get out the pencil cases and pick out the first-day outfit and meet the teachers and see old friends and try to spot new ones. But it’s also a flat-out crazy week of adjusting to new routines, getting back in the groove, filling out more paperwork than anyone should have to deal with in this electronic age and, oh yeah, getting to work more or less on time.

Unsurprisingly, I find all this a bit stressful. (Can I get an amen?) And that’s why it seemed like such a great idea last week to promise that I would interview an expert on stress, and then let you all know all the great things I learned.

Only here’s the thing: I was too stressed out to get it done. Sure, I could tell you that her book didn’t arrive in the mail as quickly as it was supposed to (which it didn’t), and that therefore I didn’t get back in touch with her publisher to set up the interview before the long weekend (which I didn’t), and that then I came up with a backup plan (which I did) to interview someone else (which I didn’t), but essentially that all boils down to the adult equivalent of “the dog ate my homework.”

So, look, I’m sorry, and I promise – I swear – I more than swear, I’ve told my editor! – to have real information on dealing with stress next week. But meanwhile, let’s just talk about stress for a quick minute. I’ve told you some of mine, but here’s a more complete list:

  • Taking care of a teenager and a 6-year-old
  • Working full-time-plus at a job that requires evenings out fairly often, and even the odd weekend
  • Trying to hold the family finances together in spite of some real (and private) challenges
  • Resolving some seemingly intractable problems in a key relationship (also private, so I wouldn’t even mention it but it’s a huge stressor)
(Wikimedia Commons)

(Wikimedia Commons)

  • Learning to navigate this strange new electronic world we all live in – and, for example, figuring out those lines between public and private, to say nothing of taming an email inbox that daily threatens to crash from its own weight; this sounds trivial compared to everything else, but it’s surprising how much angst it causes
  • Wondering how I’m ever going to fix up the “charming,” “needs TLC” old wreck I live in, enough to either be happy in it or put it on the market
  • Fretting about my health, not just the tired old song-and-dance you’ve been hearing about my weight and cholesterol and so forth, but also that funny-looking mole on my back
  • And did I mention the three dogs and the gecko?

Continue reading