Blogger, CommonHealth
Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau.
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.
Commissioner Stacey Monahan comparing the price per pound for her weekly supplies, something she says she never does during her normal shopping routine. (Photo: Jared Bennett/WBUR)
Could you live on $4.50 worth of food per day?
This past week I learned: I can’t.
Starting today, the state’s secretary of Health and Human Services, John Polanowicz, and the commissioner of the Department of Transitional Assistance (DTA), Stacey Monahan, are taking on the “SNAP challenge” — to eat on a budget of $31.50 a week, the average weekly Supplemental Nutrition Assistance Program benefit in Massachusetts. They’re doing it to make several points: to better understand what it’s like to live on public assistance, to become a better advocate and, of course, to get attention.
According to the DTA, more than 800,000 people in Massachusetts receive federal SNAP benefits. Recipients qualify based on income and household size.
SNAP benefits — totaling about $81 billion a year nationally — have been in political hot water. Multiple budget plans debated in Congress propose spending cuts to the program. They include a plan to cut $20 billion from SNAP specifically and a plan by the House Agriculture Committee to reduce the farm and food bill, which SNAP falls under, by $3.5 billion a year.
At the Massachusetts level, the experiment comes just after a recent state auditor’s report controversially raised questions about abuse and wastefulness in the program.
As Polanowicz, Monahan and U.S. Rep. James McGovern start their challenge, I will be ending my own week-long experiment in thrifty eating. I began the SNAP challenge last Wednesday, and ended up spending $33.40 for the week, even with some help along the way. Continue reading →
Readers, we’ll be discussing this on Radio Boston today at 3 p.m.; any particular comments or questions to be mentioned on air? Please write them in the Comments below.
Human genes may not be patented, the Supreme Court ruled on Thursday.
“A naturally occurring DNA segment is a product of nature and not patent eligible merely because it has been isolated,” Justice Clarence Thomas wrote for a unanimous court. But manipulating a gene to create something not found in nature is an invention eligible for patent protection.
The case concerned patents held by Myriad Genetics, a Utah company, on genes that correlate with increased risk of hereditary breast and ovarian cancer.
The central question for the justices in the case, Association for Molecular Pathology v. Myriad Genetics, No. 12-398, was whether isolated genes are “products of nature” that may not be patented or “human-made inventions” eligible for patent protection.
And its take on the implications:
The court’s ruling will shape the course of scientific research and medical testing, and it may alter the willingness of businesses to invest in the expensive work of isolating and understanding genetic material.
From The Wall Street Journal:
The court was handing down one of its most significant rulings in the age of molecular medicine, deciding who may own the fundamental building blocks of life.
The case involved Myriad Genetics Inc., MYGN +10.29%which holds patents related to two genes, known as BRCA1 and BRCA2, that can indicate whether a woman has a heightened risk of developing breast cancer or ovarian cancer.
Justice Clarence Thomas, writing for the court, said the genes Myriad isolated are products of nature, which aren’t eligible for patents.
“Myriad did not create anything,” Justice Thomas wrote in an 18-page opinion. “To be sure, it found an important and useful gene, but separating that gene from its surrounding genetic material is not an act of invention.”
Even if a discovery is brilliant or groundbreaking, that doesn’t necessarily mean it’s patentable, the court said.
However, the ruling wasn’t a complete loss for Myriad. The court said that DNA molecules synthesized in a laboratory were eligible for patent protection. Myriad’s shares soared after the court’s ruling.
GUANTANAMO BAY, Cuba (Dec. 31, 2009) A Soldier stands guard in a tower at Camp Delta at Joint Task Force Guantanamo Bay. (U.S. Army photo by Spc. Cody Black/Wikimedia Commons)
President Obama has promised to shut down the base at Guantanamo Bay, but for now, it continues to fester. And here’s yet one more way it’s morally troubling: A commentary just out in the prestigious New England Journal of Medicine argues that it is medically unethical for the doctors there to participate in force-feeding the dozens of hunger-strikers who have been fasting for weeks in protest.
Written by three Boston University professors – George J. Annas, J.D., M.P.H.; Sondra S. Crosby, M.D.; and Leonard H. Glantz, J.D. — it begins:
American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.
The full piece is here, and The Guardian newspaper quotes the lead author, ethicist George Annas, here:
In an interview, Dr Annas said the force-feeding went against international standards of medical ethics. He said that a hunger strike was a legitimate form of protest – not an attempt to commit suicide – and that the portrayal of doctors at Guantánamo as ethically intervening to preserve life was wrong. “That is at the core of this. These people are not trying to commit suicide. They are risking death to make a political point,” he said.
That is backed up by the World Medical Association, which has declared that force-feeding hunger strikers is “never ethically acceptable”.
PET scan of a normal brain (NIA/Wikimedia Commons)
A diagnosis of depression is usually followed by months of uncertainty and experimentation. Should I try talk therapy first? Are medications the answer? If so which ones, and how long will I have to wait to know if they’re working?
But a new government-funded study suggests there may soon be a way to decide by looking at brain scans.
If the part of the brain called the insula is overactive, the patient should be prescribed medication, the study indicates; if the insula is underactive, than cognitive behavioral therapy, a type of talk therapy, may be better.
This power to predict, if confirmed by other research, will help avoid months of trial and error treatment, and – though brain scans are costly – might save money in the end, by getting the patient effective care much faster, said Diego Pizzagalli, director of the Neuroimaging Center and the Center for Depression, Anxiety and Stress Research at McLean Hospital. He was not involved in the study.
Published in today’s issue of JAMA Psychiatry, the study also reinforces the idea that depression is not one condition, as it’s currently defined in the “bible” of psychiatry – the newly published edition of the Diagnostic and Statistical Manual.
Instead, Pizzagalli said, it’s a wide-ranging set of symptoms that experts have decided should be called depression. Psychiatrists are currently debating whether such symptoms – or the underlying biology – should be used to define psychiatric conditions.
“What we are learning through our work is that basically the diagnosis of depression does not map one to one to biology,” said Pizzagalli, also an associate professor of psychiatry at Harvard Medical School. “Using neuroimaging we can differentiate between subgroups of patients in important ways.” Continue reading →
News about another Massachusetts hospital merger or affiliation is starting to look like wallpaper. You may notice it, but it rarely captures your attention. But this article, buried in the New York Times, is worth reading. It makes the case that mergers increase the cost of health care for all of us.
Massachusetts could be the lead character in this story, “Health Care’s Overlooked Cost Factor,” although the Federal Trade Commission hasn’t made the findings of any investigations into abuses of market power here public. The state’s Health Policy Commission (HPC) said last month that the pending merger of South Shore Hospital and Partners Healthcare, “is likely to have a significant impact on the Commonwealth’s ability to meet its health care cost growth goals, and on the competitive market.”
The HPC has several more proposed mergers or affiliations in line for review. The commission can’t block the expansion of hospital networks in Massachusetts. In fact, it may want to encourage some of them. But here’s the dilemma: Small hospitals and physician groups have to join larger networks to compete in the world of global budgets, but if most of the state’s hospitals end up in just a few big groups, it will be hard for insurers to demand lower prices. Unless the state decides to step up regulation…
When a pediatric cardiologist tells me we need a law requiring hospitals to screen newborns’ oxygen levels to detect potentially dangerous heart defects, I listen.
Cardiologist and author Darshak Sanghavi writes on WBUR’s Cognoscenti today that the Massachusetts legislature held a hearing last week on making “pulse oximetry tests” for newborns mandatory in the state — as several other states have already done. He writes:
The results have been dramatic. Hours after the law was passed in New Jersey, for example, it saved a newborn’s life.
But Massachusetts, a leader in health care innovation, and home to some of the nation’s best health care centers, hasn’t followed suit. Instead, the state Department of Public Health decided earlier this year the screening shouldn’t be mandatory. They reasoned that doctors and hospitals would do the right thing on their own.
But that’s an incorrect assumption. According to a state-sponsored 2012 survey of Massachusetts birthing facilities, only one-quarter were performing the screening, even though the federal recommendation had been out for almost a year.
Recent studies raise concerns about vitamin supplements
I used to pop a multivitamin every day. You’re just supposed to, right? Then I started paying closer attention to the research, and I dropped them from my morning routine.
My neck gets tired from watching the good-for-you-bad-for-you vitamin pendulum; here’s the kind of thing I mean, from October:
Last we heard — last fall, actually — a study of more than 38,000 older women in Iowa brought disturbing news to the millions who take daily vitamins. It found, as NPR reported: “Use of many common supplements — iron, in particular — appeared to increase the risk of dying, and only calcium supplements appeared to reduce mortality risk. The increased risk amounted to a few percentage points in most instances.”
Now comes a somewhat countervailing study: The Journal of the American Medical Association reports that in 15,000 older men, multivitamins do confer apparent benefit, reducing the total risk of cancer by 8 percent.
So what’s the bottom line? Dr. Paul Offit, best known for his vaccine research, took an outspoken stance in The New York Times this weekend, and it has been on the most-emailed list since. Headlined “Don’t take your vitamins,” it says in part:
Nutrition experts argue that people need only the recommended daily allowance — the amount of vitamins found in a routine diet. Vitamin manufacturers argue that a regular diet doesn’t contain enough vitamins, and that more is better. Most people assume that, at the very least, excess vitamins can’t do any harm. It turns out, however, that scientists have known for years that large quantities of supplemental vitamins can be quite harmful indeed.
Offit offers a lucid explanation of how large doses of antioxidants could become too much of a good thing. Uh oh. I contacted Dr. Pieter Cohen, a general internist at Cambridge Health Alliance who researches dietary supplements, for a reality check. Our conversation, edited:
So why is this Paul Offit piece so emailed? What is it telling us that we want others to know?
He’s recommending not to take multivitamins, and we so often hear: Since we can’t eat every day out of our personal gardens, we should make up for it by taking a multivitamin with a nice bucolic image on the label.
But, I think [Paul Offit] overstates the case and is alarmist: He’s saying multivitamins are dangerous and avoid them –
Or is he talking about megavitamins?
Since the editors have titled it “Don’t take your vitamins,” and we generally take multivitamins which are not megavitamins, this would imply to me, ‘Don’t take multivitamins because they are dangerous.’
That’s false. There’s a ton of data: Over 175,000 people have been carefully studied while taking multivitamins, and what the huge database is telling me is that taking your multivitamin won’t kill you. That’s why the headline is misleading, because in fact we know that for the great majority of people, taking multivitamins is not going to kill them. Continue reading →
Padi, the Masschusetts General Hospital mummy (Photo: Sascha Garrey)
Over the weekend, Padihershef, the most famous mummy in Boston, was treated to a facelift.
Since 1823, when the city of Boston donated him to the hospital as a medical oddity, Padihershef — nicknamed Padi — has kept a silent vigil in his ornate but fading coffin in the Ether Dome, the amphitheater of Massachusetts General Hospital.
He has been privy to pedagogical surgeries performed in front of generations of medical students. But this weekend, it was Padi’s turn to take the stage.
Mimi Leveque, a seasoned mummy conservator and restorer of ancient artifacts, performed what she called a “mummy spa-treatment,” in which she removed salt deposits from Padi’s face using swabs dipped in saliva, while a team of medical experts examined MRI scans of the hospital’s ancient resident.
The effort aimed in part to answer the question that has haunted the Ether Dome for nearly two centuries: Who is the man behind the mummy?
A few things are known about the mysterious Padi. About 2,500 years ago, 40-year-old Padihershef was unmarried and working as a stone-cutter in the Necropolis in Thebes.
Bone X-rays from 1931 and 1976 revealed stunted bone growth in Padi’s skeleton, suggesting he suffered from a grim illness in his childhood.
Part of the weekend’s hubbub was to compare these older bone scans to recent MRI’s to get a better understanding of how Padi died. Leveque speculates that his bones may have been subject to a slow crushing from a large object, one theory of the cause of Padi’s death.
Whatever it was that annihilated the stone-cutting bachelor centuries ago, the afterlife has been kind to Padihershef’s looks and reputation. Lying between the top and bottom cases of his coffin — which was also receiving some modernizing restorative re-vamps — his celebrity mummy’s skin was deeply bronzed, encasing high cheekbones and a grin of teeth so white that even the slickest game-show host would be impressed.
“The Egyptians didn’t have sugar the way we do,” Leveque said. “Teeth preserve well.”
Casey was diagnosed with canine compulsive disorder. He’s now on Prozac. (Courtesy)
When Casey, a 6-year-old German Shepherd, gets anxious, she chases her tail.
But it’s not the kind of endearing, once-around-and-it’s-done kind of tail-chasing we’ve all seen. Left unchecked, Casey circles around and around, pursuing her tail until she can bite it. Then, even when the blood starts flowing, the dog is driven to continue the chase.
“It’s upsetting,” says Paula Bagge, a Hopkinton, Mass. business owner who has been living with Casey since puppyhood. “And it’s damaging. She hurls herself around the house, and it’s like a big bloody paintbrush spraying the walls.” Once, Bagge tied the dog’s leash to a coffee table in an attempt to control the chasing. But Casey, who weighs about 85 pounds, just started dragging the coffee table around with her. Now, she’s on Prozac.
Dogs, it turns out, can have obsessive-compulsive disorder, just like people. And in a new study, Dr. Nicholas Dodman, a professor of clinical sciences at the Cummings School of Veterinary Medicine at Tufts University, found that structural brain abnormalities in dogs, in this case Doberman pinschers, with canine compulsive disorder (CCD) are similar to those of humans with OCD.
In an earlier study, Dodman, a leading researcher on repetitive behavior in animals, found a specific gene associated with canine OCD.
Studying anxiety disorders in dogs, Dodman says, may ultimately help scientists come up with better therapies and medications to treat OCD and related conditions in people. Current drugs for OCD, such as SSRI’s (or for dogs, a beef-flavored form of Prozac) are notoriously ineffective for many sufferers. Indeed, Dodman says, only around 43 to 60 percent of people suffering from OCD show a postive response from an SSRI; the average reduction of symptoms in people taking these drugs is only about 23 to 43 percent. “Certainly not a panacea,” he says.
So, to further this research, Dodman spends time thinking about bears who pace obsessively, for instance, or parrots unable to stop preening and picking their feathers and beagles who overeat to the point of exploding,
Dodman calls the latest dog-brain imaging study, conducted in collaboration with researchers at McLean Hospital, in Belmont, Mass., “another piece of the puzzle, another brick in the wall.”
He says while more research must be done, it’s becoming increasingly evident that dogs with OCD are a great model for exploring human psychopathology: they show similar behaviors, respond to drugs in comparable ways and now, at least in this small study, seem to have the same brain abnormalities as people with the condition. “When you know what your dealing with it’s much easier to create targeted approaches,” to treatment, Dodman says. “If you don’t know what you’re dealing with it’s just kind of like going with your sense of smell.”
OCD afflicts about 2 percent of the population and often goes untreated or undiagnosed. People suffering from the disorder, marked by intrusive thoughts and repetitive behaviors such as hand washing, locking and unlocking doors, counting, or repeating the same steps, feel these impulses as uncontrollable. And the compulsive rituals, often triggered by stress or trauma, can be incredibly time-consuming, interfering with daily life.
Famously, Lena Dunham, the star and creator of the HBO series “Girls” came out with her own OCD on air, with repetitive tics, obsessive counting and painfully compulsive use of Q-tips. Continue reading →
A new cost analysis of the long-term impacts of breastfeeding found that lower-than-recommended breastfeeding rates among U.S. mothers “may cause as many as 5,000 cases of breast cancer, nearly 54,000 cases of hypertension, and almost 14,000 heart attacks each year.” The study, led by a researcher at Harvard Medical School and published today in the journal Obstetrics & Gynecology also found that the economic toll associated with such “sub-optimal” breastfeeding practices reaches into the billions annually.
The study’s lead author, Melissa Bartick, M.D., an assistant professor of internal medicine at Harvard Medical School and an internist at Cambridge Health Alliance says via email that the bottom line of the analysis is this: “Women need to be supported to be able to breastfeed each child for at least a year — their health, and our economy depend on it.” She adds: “The CDC has found that 60% of women do not even reach their personal breastfeeding goals. Now we know this has a real cost, with thousands of women suffering needless disease and premature death.”
(Bartick also happens to be founder of the “Ban The Bags” campaign, a pro-breastfeeding advocacy group working to stop the common hospital practice of handing over free infant formula samples, or gift bags, to new moms after they give birth.)
Here’s more detail on the breastfeeding study from the Cambridge Health Alliance news release:
The analysis used sophisticated models to compare the effect of current breastfeeding rates in a simulated group of nearly two million U.S. women who turned 15 in 2002. The authors modeled this cohort of women across their lifetimes and estimated cumulative costs. They then compared these results to what would be expected if 90% of the women followed medical recommendations to breastfeed each child for one year. Currently, only about 25% of US children are still breastfeeding at one year of age. Continue reading →
