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.

Suicide Rate Among Men Spikes In Bristol County

The number of suicides among white men between the ages of 45 and 65 spiked 72 percent from 2013 to 2014 in Bristol County, which includes 20 towns southwest of Boston and along the south coast including Taunton, New Bedford and Fall River.

The figures come from the Bristol County Regional Coalition for Suicide Prevention, which gets its data from the district attorney’s office. Among all the suicide deaths in 2014 in that county, 87 percent were men. Advocates say the male suicide rate last year was significantly higher than the state average, and the trend is similar so far in 2015.

The alarming increase in suicides in Bristol County — most of them among middle-aged men — is leading suicide prevention advocates to team up with the district attorney to get out the word that there is help. On Monday, the suicide prevention coalition and Bristol County District Attorney Thomas Quinn will release more specific data on suicide in the county. In addition, the coalition will hold a series of community forums to discuss male depression and suicide.

Continue reading

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Opinion: It’s Time To Screen Teenagers At School For Risky Substance Use

By Dr. Eugene Beresin
Guest Contributor

Hearings are being held in the Massachusetts State House on a bill that would enable public school nurses to screen teens for the risk of substance use. This practice is strongly supported by the Children’s Mental Health Campaign and the Addiction Free Future Project, and part of a mission in five states to promote screening for teenagers at risk of substance use problems.

We favor broad screening as a way to reduce death and disability due to substance use that typically starts in the teen years. We understand that this screening will be totally confidential — like all substance use screening and discussions between teens and health care providers. However, parents are free to oppose the screening of their children just as they may prevent their children from receiving vaccinations.

The downside to screening raised by some is that it will bring additional costs to the state, including extra time for training and to administer the tests. In addition, some kids may feel discomfort being asked sensitive questions. However, the overall reduced costs of treatment are great. And most kids really are open to talking about substance use in a confidential setting.

There are certainly some people who do not feel school is a place for screening of any kind. But after looking at research on substance use disorder prevention, professionals at The MGH Clay Center for Young Healthy Minds, The MGH Recovery Research Institute and the Massachusetts Children’s Mental Health Campaign feel that the benefits of early screening far outweigh the financial cost and time factors involved. The risks of excessive substance use in teenage years is very dangerous to brain development and social functioning.

A new blog post by screening advocates John F. Kelly, Ph.D., founder and director of the Recovery Research Institute and associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and Courtney Chelo, behavioral health project manager at the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) lays out the details: Continue reading

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Study: New Antibody Therapy Can Reverse Traumatic Brain Injury Damage (In Mice)

Cleveland Browns QB Jason Campbell lies near midfield after suffering a concussion in a game on Nov. 24, 2013. Traumatic brain injuries, whether they occur on a sports field or in a war zone, are on the rise. (David Richard/AP)

Cleveland Browns QB Jason Campbell lies near midfield after suffering a concussion in a game on Nov. 24, 2013. Traumatic brain injuries, whether they occur on a sports field or in a war zone, are on the rise. (David Richard/AP)

Traumatic brain injuries, whether they occur on a sports field or in a war zone, are on the rise.

What’s worse, these head traumas have been linked to long-term neurodegenerative diseases, notably Alzheimer’s and a condition known as chronic traumatic encephalopathy, or CTE.

Now, a team of researchers report they’ve discovered the “missing link” between traumatic brain injuries and these degenerative brain diseases and developed a special antibody that may help prevent the conditions — at least in mice.

In a study published online in the journal Nature, researchers at Beth Israel Deaconess Medical Center identify the “missing link” culprit as “cis P-tau, a misshapen and toxic species of tau protein that has not been previously identified,” says Kun Ping Lu, MD, PhD, the study’s co-senior author and chief of the Division of Translational Therapeutics in the Department of Medicine at BIDMC and professor of medicine at Harvard Medical School.

Lu, in an interview, explains how these toxic proteins can build up in the brain and start causing serious damage after repeated head injuries:

A single concussion, a mild traumatic brain injury (TBI), results in moderate induction of cis P-tau, which returns to the baseline within 2 weeks. However, repetitive concussions, as might occur in contact sports, result in robust induction of cis P-tau that is persistent for months in mouse brains. This is similar to what is produced following a single severe TBI caused by a blast, as seen in military blast, or an impact, as seen in a severe car accident. Strikingly, cis P-tau is produced as soon as 12 hours after TBI, setting in motion the destructive course of events that leads to Alzheimer’s and CTE.

cis P-tau protein is extremely neurotoxic, disrupting neuron structure and function, progressively spreading to other neurons throughout the brain over time, leading to neuron death. Therefore, cis P-tau has the ability to kill one neuron after another in the brain over time, eventually leading to Alzheimer’s and CTE. These results in animal models are consistent with clinical observations that either repetitive concussions or single severe TBI can lead to Alzheimer’s or CTE.

Importantly, our cis antibody is not only able to spot only the toxic cis P-tau, but also to neutralize its toxicity to neurons. As a result, treating TBI mice with cis antibody can stop brain damage after TBI and prevent its debilitating long-term consequence of Alzheimer’s and CTE. Thus, cis P-tau is an early driver of TBI and its related Alzheimer’s disease and CTE, which can be effectively blocked by antibody therapy.

The immediate implications of these findings are to emphasize TBI prevention; however, if concussion occurs, it is critically important to allow the body defense system to remove the toxic tau protein completely before another concussion occurs. The most exciting development will be to humanize our current monoclonal antibody to develop early intervention to treat TBI and to prevent Alzheimer’s disease and CTE, which can be done within next a few years. In addition, because the same toxic tau protein also destroys brain cells in Alzheimer’s, this early intervention may be used to treat this most common form of dementia in older individuals.

The BIDMC release also states that “Lu and Zhou have interests in Pinteon Therapeutics, Inc., which has licensed Pin 1 technology from BIDMC.” Continue reading

Good Palliative Care, Bad Palliative Care: A Tale Of 2 Doctors

By Marie Colantoni Pechet

As a Stage 4 colorectal cancer patient, I have had experience with palliative care doctors.

Fortunately, I haven’t had the need to meet with one in a few years.

But recently, I started experiencing pain that didn’t go away with my normal methods. I have a high pain threshold, and when I do have pain, I view it as a message from my body and I do my best to work with it. I also have a number of mind-body methods that I use to manage the pain.

I can’t recall ever taking drugs for pain. Even after my mastectomy, I didn’t need any pain medication.

Marie Pechet and family (courtesy)

Marie Pechet and family (courtesy)

But when this recent pain couldn’t be managed by my usual approaches, I resorted to taking two Tylenol, which I considered to be strong medicine (well, outside chemotherapy drugs!).

Still, the pain, even after taking Tylenol, was debilitating, so I decided to ask for something stronger. Asking for pain medication was new territory for me, and a big step.

I wrote a piece about on how wonderful I found palliative care doctors, and I made the assumption that they were all the same. So when my palliative care doctor couldn’t see me for a week, I agreed to see a different palliative care provider.

In this case, she was a nurse, though I don’t think that is the relevant difference. I walked into her office, nervous about starting on pain medication. Here are some assumptions I had about pain meds and cancer patients:

1. It isn’t a temporary situation and the dose only increases until you die.

2. You can’t drive while taking them, so your life is even more restricted than it already is.

3. They can be addictive.

4. Pain gives me a message about how my body is doing, and without feeling that, I would be out of tune with my body.

5. You are to take pain medication before you really feel the pain, to “stay ahead of it.” But what if I take it when I don’t really need it, when the pain would not actually get worse?

6. Narcotics cause constipation, which is a problem for me to begin with.

I explained all this to the nurse, and the fact that I really don’t take pills. I also explained that I tend to vomit during chemotherapy, which makes it difficult to swallow pills. I told her that I wanted to understand more about what I might be taking.

She sat quietly and let me speak, then she said, “You need to take this” and wrote out a prescription for a narcotic.

I was stunned and didn’t know where to begin.

“Is there something I can try that is between regular strength Tylenol and a narcotic?” I asked her.

“I believe this is the best for you,” was her firm reply. Continue reading

It’s Not Just The Heat: How New England’s Sharp Shifts In Weather Affect Death Rates

(Zacharmstrong/Flickr)

(Zacharmstrong/Flickr)

You know the old saw: “If you don’t like the the weather in New England, just wait a minute.”

We tend to see our rapid shifts in weather as a benign local quirk, but there’s a darker side to them as well, and it may grow as the climate shifts: Heat waves and cold snaps are linked to little spikes in death rates, and those spikes add up to long-term effects, according to a paper just out in the journal Nature.

It charted temperature and death rates among the Medicare population for all of New England, ZIP code by ZIP code, from 2000 to 2008. Among its findings: It’s not just heat or cold that kills, it’s the sudden shifts in weather.

I asked Joel D. Schwartz, professor of environmental health at the Harvard Chan School of Public Health and senior author on the paper, how he would sum up its findings. Our conversation, lightly edited:

J.S.: There are hundreds of studies that have shown that when it gets hot, more people die, and when it gets cold, more people die, on that day or in the next couple of days. But these are all studies that look at what happens in a day or two; they’re not telling you anything about the long-term effects of temperature on people’s life expectancy. Maybe all the people who die when it gets hot would have died in the next month anyway — they’re sick and something is going to cause them to die in the near future.

“If the variation in temperature went up, more people died, and that was true for winter and summer.”

– Professor Joel Schwartz

What we did is a cohort study: We took all the people in New England who are on Medicare — about 2.9 million people — and we followed them over time. And we asked the question: Does their annual mortality rate change when weather changes?

This way, we avoid having to worry about whether these are really just the short-term effects, and we can address the question: Is there really an impact on life expectancy of temperature? This is the first study to do that in a general population study; we studied all of New England.

The second new thing is that all of the studies heretofore that have looked at the effects of temperature on the risk of dying have been done in cities, because a) that’s where the weather stations are, and b) in smaller towns there aren’t enough people to really be able to see anything. But we used satellite remote sensing and we calibrated it, and were able to get the temperature for every day for every square kilometer of New England — that’s about 6/10 of a mile on a side.

We had a separate measurement of temperature for every day for every ZIP code from 2000 to 2008. And so we could calculate, then, for each person, the mean temperature in the summer for each year and the mean temperature in the winter, over multiple years. And we could ask, “Well, if mean temperature is higher one summer than the previous year in a particular zip-code, were people in that zip-code more likely to die?” And the same for winter temperature.

What we found was that indeed, if the temperature in the summer was higher, the annual mortality rate went up. If the temperature in winter was higher, the annual mortality rate went down. The summer effect was bigger than the winter effect, so if it went up by the same number of degrees in the summer and the winter, then more people would die.

The next thing we did is we asked the question, “Well, since we have this fine geographic scale of temperature, did temperature differences across ZIP codes affect mortality rates?” And what we found was that there was lower mortality rates in ZIP codes that had warmer temperatures in the winter. Continue reading

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A Warehouse Full Of Legal Weed: Medical Marijuana Takes Root In Brockton

The hallway is white, pristine, almost corporate. But the operation behind one nondescript door is something completely new and different for Massachusetts.

Five-hundred plants in white, 5-gallon buckets sway and grow strong in a breeze created by fans. Rows of LED lights turn the room purple, blue, green or red, depending on which spectrum the plants need for optimum growth. The air is moist. And there’s a hint of a certain smell in the air: the tangy, musky scent of marijuana.

Welcome to one of the state’s first legal pot farms, this one attached to a Brockton medical marijuana dispensary called In Good Health.

Marijuana plants at In Good Health in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health in Brockton. (Jesse Costa/WBUR)

Earlier this year, renting a 13,000-square-foot warehouse and planting several thousand marijuana seeds might have triggered a massive police bust, hefty fines and some serious time behind bars. But in April, this Brockton firm received its state license to grow marijuana for medical purposes.

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‘Not Just Lyme Disease Anymore': 7 New Reasons To Fear Ticks This Summer

Michael Vitelli of Marshfield Hills, Mass., a fit and active father of four who was recently laid low by the tick-borne disease anaplasmosis. (Courtesy)

Michael Vitelli of Marshfield Hills, Mass., a fit and active father of four who was recently laid low by the tickborne disease anaplasmosis. (Courtesy)

A father of four boys, Michael Vitelli of Marshfield Hills, Mass., lives a high-energy, outdoor and active life when he’s not at work. He fishes, he hikes, he golfs, he can even boast a running streak of 642 days in a row.

But last month, on what would have been day 643 of running, a tick brought him to an excruciating halt.

After feeling achey for a few days, Vitelli suddenly got too sick to get out of bed, as if with a summer flu — fever, sweats and chills, headache. Then he got even sicker. His test results looked dire: protein and bile in his urine;  liver function gone haywire; platelets, red and white blood cells down so low that his chart looked like he had leukemia, a doctor told him.

The diagnosis, after three days in the hospital: anaplasmosis, an infection borne by the same deer ticks that carry Lyme disease. It’s up dramatically in Massachusetts: About 600 confirmed and probable cases statewide last year, compared to closer to just 100 in 2010.

Never heard of it? Neither had Vitelli. Naturally, he’d heard of Lyme, which has spread across much of the country in recent decades and now infects an estimated 300,000 Americans a year at least, mainly in New England and the Midwest.

But like most people, he didn’t know that ticks can carry a whole array of nasty bugs — with obscure names like babesiosis and Borrelia miyamotoi — and that, though much less common, they, too, are on the rise, following more slowly behind the inexorable march of Lyme disease.

(Source: Massachusetts Department of Public Health)

(Source: Massachusetts Department of Public Health)

In worst-case scenarios, some of these infections can kill people, usually those who are old or have an underlying condition. Deaths are very rare; what’s not rare is for patients to get much more acutely, severely ill than is typical for Lyme disease.

“Those little ticks,” Vitelli says with the voice of bitter experience. “They can really wreak havoc with the body.”

It’s peak season for Lyme disease right now, and for these other infections as well. If the risk of Lyme hasn’t been enough to prompt you to take the recommended measures against ticks — repellent, tick checks — perhaps awareness of these rising new risks will add impetus. Public health officials also call for vigilance about persistent summer fevers with no other obvious explanation, and for greater awareness that they can be caused by bugs other than Lyme.

“If you live in an area where there’s Lyme disease, you should be aware of these other agents,” says Dr. Peter Krause, a tickborne disease expert at the Yale School of Public Health. “And that’s true throughout the United States.”

It’s also true for doctors. “If you’re thinking about Lyme disease, you should think about these other diseases, too,” says Dr. Larry Madoff, director of epidemiology and immunization at the Massachusetts Department of Public Health, who recently helped treat a case of anaplasmosis in central Massachusetts. “And even if you don’t see Lyme disease, if you have a patient who reports tick exposures or lives in an area where there’s a high prevalence of these diseases, you should think about these as well. And they are treatable,” with antibiotics.

At the risk of being accused of scaremongering, here are seven new reasons to fear, loathe and avoid ticks more than ever this summer, based on news about these more acute infections:

1. Pronounced me-ya-moe-toe-eye: 

Researchers keep finding new tickborne bugs, like Borrelia miyamotoi, which was first reported in 2013 and causes flu-like feverish illnesses so severe that a recent study found that about one-quarter of patients who tested positive for it had landed in the hospital.

About 14 percent of patients who had it also tested positive for the bacterium that causes Lyme disease. The findings suggest that Borrelia miyamotoi “may not be a rare infection in the northeastern United States,” the authors write.

2. No Relaxing In August Continue reading

Self-Diagnosing Online? Study Finds Sites Are Only Accurate About Half Of The Time

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

There’s a new warning for those of us who go online to figure out why we have a stomach ache or a nagging cough or occasional chest pain.

Symptom checkers — those tools that let you enter information and then produce a diagnosis — are accurate about half of the time, according to a study out of Harvard Medical School.

How Symptom Checkers Rate

Rate at which each tool got a diagnosis correct in the first three suggestions:

Best Performing:
Symcat – 75 percent
Isabel – 69 percent
AskMD – 68 percent

Worst Performing:
BetterMedicine – 29 percent
Earlydoc – 33 percent
Symptomate and Esagil – 34 percent

Source: Harvard Medical School study (full table page 11)

Looking at 23 websites, the Harvard study found that a third listed the correct diagnosis as the first option for patients. Half the sites had the right diagnosis among their top three results, and 58 percent listed it in their top 20 suggestions.

“Users of these tools should be aware that their performance is not perfect by any means, there’s often inaccuracies or errors,” said Dr. Ateev Mehrotra, the study’s lead author.

At the Mayo Clinic, Dr. John Wilkinson said, “We’re always trying to improve, but if most of the time the diagnosis is included in the list of possibilities, that’s all we’re attempting to do.”

Wilkinson, an editor of Mayo’s symptom checker, said patients should not expect it to deliver the correct diagnosis.

“It’s designed to be a starting point,” Wilkinson said, one that will direct patients to the best articles and help them “be better equipped to have a conversation with their doctor or a nurse triage line or whatever the next step might be.” Continue reading

CDC: Certain Antidepressants, But Not All, Taken During Pregnancy May Raise Birth Defect Risk

The debate over whether or not it’s safe to take antidepressants during pregnancy is heated, with extreme emotions — and conflicting research studies — on both sides.

But a broad new analysis led by researchers at the U.S. Centers for Disease Control and Prevention came to a fairly measured conclusion when comparing pregnant women who took SSRIs — a class of antidepressants — to women who did not take those medications during pregnancy.

The analysis suggests that certain serious birth defects occur 2 to 3.5 times more frequently among babies born to mothers taking the antidepressants Prozac or Paxil early in pregnancy. But the researchers also conclude that for pregnant women taking other SSRIs, such as Zoloft, the data “provide some reassuring evidence” that earlier studies linking the drug with specific birth defects could not be replicated.

The analysis of 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects was published in The BMJ.

“What our paper really adds, is that we can now offer women more options,” said Jennita Reefhuis, an epidemiologist with the CDC’s National Center on Birth Defects and Developmental Disabilities and the study’s lead author. Reefhuis said that since Zoloft (sertraline) was the most common SSRI taken among the women, “it was reassuring that we could not replicate the five earlier links with birth defects.”

In an interview, Reefhuis said: “The main message is that depression and other mental health conditions can be very serious and many women need to take medication to manage their symptoms. So women who are pregnant, or thinking of becoming pregnant, shouldn’t stop or start any antidepressants without speaking to a health care provider.”

The issue, she added, isn’t clear cut, but highly dependent on each individual woman and a very personal calculation of risks versus benefits. “We are trying to find the nuance here,” Reefhuis said. “It is really important that women get treated during pregnancy. Their illness doesn’t stop the moment they get pregnant. Women need options.”

It’s also important to retain perspective when evaluating risk, Reefhuis said, noting that in every pregnancy there is already a 3 percent risk of a birth defect. Continue reading

Mass. Has Paid Sick Leave, Now We Need To Change Culture Of Working While Ill

(Office for Emergency Management/Office of War Information/Domestic Operations Branch/Bureau of Special Services, via Wikimedia Commons)

(Office for Emergency Management/Office of War Information/Domestic Operations Branch/Bureau of Special Services, via Wikimedia Commons)

As of this month, we here in Massachusetts can proudly say that we enjoy the right to paid sick time. (Those of us who work for companies with 11 or more employees, anyway; workers for smaller companies can only get unpaid time.)

The law took effect July 1, and state Attorney General Maura Healey says that while it’s not the first such law in the country, “it is the most expansive.”

Yay, right? But here’s the next challenge: It’s not enough to have the law on the books; workers have to actually use it. And a new study of health care workers suggests that when it comes to calling in sick, we may often be our own worst enemies. (OK, yes, our bosses may also be our worst enemies.) It’s a sobering look: If even doctors and nurses don’t stay home when they should because of their workplace culture, what hope do the rest of us have?

The study in JAMA Pediatrics found that among more than 500 doctors and other staffers surveyed at a large children’s hospital in Philadelphia, 83 percent reported working while sick over the past year. Like, really sick: 30 percent had diarrhea, 16 percent had fever and more than half had “acute onset of significant respiratory symptoms,” which sounds to me like the kind of cough that can spread germs.

Why, oh why, would the staffers who understand best the risks of infection still come to work while possibly infectious? Solving that conundrum was the aim of the paper, titled “Reasons Why Physicians and Advanced Practice Clinicians Work While Sick.”

“Working while sick was regarded as a badge of courage, and ill physicians who stayed home were regarded as slackers.”

Among the reasons that respondents deemed important:

• 98.7 percent cited not wanting to let colleagues down

• 94.9 percent cited staffing concerns

• 92.5 percent cited not wanting to let patients down

• 64 percent cited fear of ostracism by colleagues

• 63.8 percent cited continuity of care

Other concerns that emerged from free-text responses: “extreme difficulty finding coverage (64.9 percent), a strong cultural norm to come to work unless remarkably ill (61.1 percent) and ambiguity about what constitutes ‘too sick to work’ (57 percent).” Continue reading

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