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.

Mourning The AIDS Researchers Killed In Ukraine Plane Crash

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

With an estimated 100 HIV/AIDS researchers believed to have been on the Malaysian Airlines flight that went down in Ukraine, the official mourning has begun and will surely grow as names and details emerge. This just in from James Friedman, executive director of the American Academy of HIV Medicine:

It is with heavy heart we learn many of those that perished in the crash of Malaysia Airlines Flight 17 were leading HIV/AIDS researchers traveling to the International AIDS Conference scheduled to begin on Sunday in Australia. While all names have not yet been released, the passing of Dr. Joep Lange, a leading HIV/AIDS researcher, has been confirmed.

It is due to their continued dedication to HIV/AIDS patients worldwide that they were making this journey. Not only did this tragedy take the lives of these researchers, but also robbed the world of their future discoveries and contributions to the HIV/AIDS patients they served.

The HIV/AIDS community mourns the loss of these talented and compassionate researchers and HIV care providers. Our condolences to the families of all those affected by the Malaysia Airlines Flight 17 tragedy.

The New York Times profiles Dr. Lange here, and the Australian Broadcasting Corporation reports that Canadian HIV researcher Trevor Stratton said the crash was a huge loss to the AIDS research world.

“What if the cure for AIDS was on that plane? Really? We don’t know,” he said.

“There were some really prominent researchers that have been doing this for a very long time and we’re getting close to vaccines and people are talking about cures and the end of AIDS.

Please Discuss: ‘Gene Drives,’ Sci-Fi Scary Or Cool Leap Forward?

Scientists say new "gene drive" technology could help fight malaria by affecting the mosquitoes that carry it. (Wikimedia Commons)

Scientists say new “gene drive” technology could help fight malaria by affecting the mosquitoes that carry it. (Wikimedia Commons)

Perhaps you’ve followed that teeny tiny controversy around genetically modified foods, the “GMO” debate. Or you watched the fierce back-and-forth over whether it was a good idea to modify a strain of avian flu in the lab to make it spread more easily, in order to study it.

If this is your kind of spectator sport, it’s time to learn about gene drives, a powerful new genetic technology that basically flips Charles Darwin on his head, allowing a sort of artificial selection to help chosen genes come to dominate in a population.

A paper just out in the journal eLife outlines a way to use gene drives to spread just about any altered gene through wild populations that use sex to reproduce. And a related paper just out in the journal Science calls for greater oversight and a public discourse about the potential risks and benefits of gene drive technology — now, while it’s still in early stages and confined to labs.

I can already imagine the “pro” side of the debate: “This could eradicate malaria. Reduce the use of pesticides. Bolster agriculture for a crowded planet.” And the “con” side: “But what if it goes wrong out in the wild? Have you read no science fiction?”

I spoke with two of the paper’s co-authors: Kevin Esvelt, a technology development fellow at the Wyss Institute for Biologically Inspired Engineering and Harvard Medical School, who is also the lead author of the eLife paper; and Kenneth Oye, Professor in Engineering Systems and Political Science at MIT and director of policy and practices of the National Science Foundation’s Synthetic Biology Engineering Research Center. Our conversation, edited:

CG: So what exactly is a gene drive and why are we talking about it now?

Kevin Esvelt: A gene drive is a potential new technology that may let us alter the traits of wild populations but only over many generations. We think that gene drives have the potential to fix a lot of the problems that we’re currently facing, and that natural ecosystems are facing, because it allows us to alter wild populations in a way that we could never do before.

We would really like to start a public conversation about how we can develop it and use it responsibly, because we all depend on healthy ecosystems and share a responsibility to pass them on to future generations.

So how do they work? The reason we haven’t been able to alter wild populations to date is natural selection. When you say natural selection, you think, ‘How many organisms survive and reproduce?’ And that’s pretty much how it works. The more likely you are to survive and reproduce, then the more copies of your genes there are going to be. So genes that help an organism reproduce more often are going to be favored.

The problem is, when we want to alter a species, the way we want to alter it usually doesn’t help it survive and reproduce in nature. But that’s not the only way that a gene can reproduce. We have two copies of each gene, and when organisms have children, each of the offspring has a 50% chance of getting either copy. But you can imagine that a gene could gain an advantage if it could stack the deck — if it could ensure that it, rather than the alternate version, was inherited 70%, 80%, 90%, or 99% of the time.

How gene drives affect which genes are passed down (Courtesy Kevin Esvelt)

How gene drives affect which genes are passed down (Courtesy Kevin Esvelt)

There are a lot of genes in nature that do exactly this; they’ve figured out an incredible variety of ways of doing that. Almost every species in nature has what we would call an ‘inheritance-biasing gene drive’ somewhere in its genome, or at the very least the broken remnants of one. They’re actually all over the place in nature.

The idea that we could harness these to spread our alterations through populations has actually been around for a long time. Continue reading

New Concerns About Coakley-Partners Deal

There are new concerns about an agreement Attorney General Martha Coakley negotiated to try and control the prices and market power of Partners HealthCare. The implication, from a commission created to help reduce health spending, is that the deal does not go far enough.

“Without lasting change to the market structures,” the Health Policy Commission (HPC) writes in comments to be filed in court, “price caps may not be effective in keeping costs down.”

Price caps?

The commission dug in on a portion of the deal Coakley reached with Partners — the part that says network prices could not rise faster than inflation for six and a half years.

“Prices themselves, they are important,” said commission chairman Stuart Altman, “but they’re not the end of the game.”

To explain why, picture a colleague, neighbor, maybe your grandmother — someone who’s had hip replacement surgery. Now picture two hospitals.

“In one place,” said Altman, “a hip costs $10,000 to replace. In another, it’s $15,000.”

Under Coakley’s deal, prices at each of these Partners hospitals would rise slowly. But there’s nothing to keep Partners from sending more patients to the $15,000 facility. If more patients have hips replaced at the higher-cost hospital, then total health care costs would go up, even if prices don’t.

“Total medical expenditures, when we finally figure it out, is going to up by a lot, but yet the price increases were fine,” Altman said.

Coakley would have someone monitoring Partners, who could, in theory, intervene if a significant number of patients shift from lower- to higher-cost hospitals. But that monitor would only have access to spending for patients covered by a global budget, which Partners says is about 25 percent of its business.
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Judge Delays Review Of Partners HealthCare Deal

Update 6:35 p.m.: A judge has granted Attorney General Martha Coakley’s request for an extension. The comment period will now close Sept. 15, and Coakley will have until Sept. 25 to file comments from her office after seeing the full Health Policy Commission report. A new hearing has been set for Sept. 29.

Our original post continues:

BOSTON — Massachusetts Attorney General Martha Coakley is asking a judge to postpone reviewing a settlement between her office and Partners HealthCare that would allow the hospital network to acquire three new hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Coakley’s motion asks a judge to wait until September to hold a hearing on the deal, which aims to limit the market clout of the state’s largest hospital network in exchange for allowing it to acquire South Shore Hospital and Hallmark Health.

A spokesman for the attorney general says Coakley has seen findings from a preliminary review of the deal from the state’s Health Policy Commission, and she believes the court should consider the full report.

The statement reads in full:

Our office always retained the option to seek to renegotiate portions of this agreement as it relates to Hallmark following a Final Report by the Health Policy Commission.  After reviewing the preliminary findings by the HPC, we believe it is in the interest of the public and the parties involved to wait for the final report before any final consent judgment is considered by the court.

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Survey: Transgender Discrimination In Mass. Public Spots, Health Effects Seen

(Codep08/Compfight)

(Codep08/Compfight)

By Qainat Khan
WBUR

On a break from her job near South Station, Vivian Taylor was on her way in to use the station’s ladies’ room when a man suddenly blocked her way, she recalls.

“Where do you think you’re going?” he asked her, threateningly.

“I didn’t want to have a confrontation while I was at work, but it was a very unsettling experience,” said Taylor, a transgender woman who served in Iraq in 2009 and 2010. “For about the next half hour, that fella just stood there — as if he was on guard — standing there glaring at me in front of the door to the bathroom.”

A survey out today suggests Taylor’s experience is not uncommon. The results, based on 452 responses, show that almost two-thirds of transgender and gender non-conforming Massachusetts residents experienced discrimination last year in public places, including transportation, retail and health care settings.

The survey, conducted by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition, found that respondents who reported discrimination had an 84 percent increased risk of adverse physical symptoms associated with stress — such as headaches, upset stomachs and pounding hearts — and a 99 percent increased risk of emotional symptoms compared to respondents who reported no such discrimination in the past year.

“It’s a hard thing to have to go through the world just having to be that conscious of your own safety,” Taylor, who was a respondent on the survey, said. “That’s a very stressful experience, to just always know that it’s possible that somebody is going to come after you for no other reason than what you look like, or how you dress, or what your voice sounds like.”

The survey also found that 20 percent of respondents postponed or did not seek health care because of prior discrimination in a medical setting. Five percent of respondents said a health care provider refused to provide them with care because of their gender identity. Continue reading

How Playing Music Affects The Developing Brain

A cellist at the Conservatory Lab Charter School in Boston plays during a recital rehearsal. Research has found music instruction has beneficial effects on young brains. (Jesse Costa/WBUR)

A bassist at the Conservatory Lab Charter School in Boston plays during a recital rehearsal. Research has found music instruction has beneficial effects on young brains. (Jesse Costa/WBUR)

Remember “Mozart Makes You Smarter”?

A 1993 study of college students showed them performing better on spatial reasoning tests after listening to a Mozart sonata. That led to claims that listening to Mozart temporarily increases IQs — and to a raft of products purporting to provide all sorts of benefits to the brain.

In 1998, Zell Miller, then the governor of Georgia, even proposed providing every newborn in his state with a CD of classical music.

But subsequent research has cast doubt on the claims.

Ani Patel, an associate professor of psychology at Tufts University and the author of “Music, Language, and the Brain,” says that while listening to music can be relaxing and contemplative, the idea that simply plugging in your iPod is going to make you more intelligent doesn’t quite hold up to scientific scrutiny.

“On the other hand,” Patel says, “there’s now a growing body of work that suggests that actually learning to play a musical instrument does have impacts on other abilities.” These include speech perception, the ability to understand emotions in the voice and the ability to handle multiple tasks simultaneously.

Patel says this is a relatively new field of scientific study.

“The whole field of music neuroscience really began to take off around 2000,” he says. “These studies where we take people, often children, and give them training in music and then measure how their cognition changes and how their brain changes both in terms of its processing [and] its structure, are very few and still just emerging.”

Patel says that music neuroscience, which draws on cognitive science, music education and neuroscience, can help answer basic questions about the workings of the human brain.
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On The Road With Project Louise, Marveling ‘Who Is This Person?’

macdonalds

(Photo: Robin Lubbock/WBUR)

In my previous job, I spent a fair amount of time on the road each summer, traveling to theaters in the Berkshires and on Cape Cod. (Hey, somebody had to do it.) And I gained weight – because, I told myself, it was impossible not to gain weight when I was traveling so much, eating road food and going to restaurants and so on.

Well, that was just plain wrong.

I realized that this weekend, when a family event put me on the highway for an eight-hour road trip. (Sixteen, actually, if we’re talking round trip.) And I am here to tell you that, even on the New Jersey Turnpike, you do not have to eat junk.

True, 99 percent of what they sell on the New Jersey Turnpike is junk. But I managed to find some dark-chocolate-covered soy nuts for a snack, along with plenty of water, and that was a lovely supplement to the fruit and whole-grain crackers I had packed for myself. Add in the veggie-packed chicken sandwich I toted along, and you can see that I was doing just fine without the aid of Ronald McD. or Popeye.

What’s a little surprising to me is that I did not exactly do this consciously. I did not say to myself, “Hmm, I am trying to lose weight, and I am doing Project Louise, and I will be letting myself and my readers down if I succumb to the lure of the French fry, so I’d better pack other food.” No, I just ate what I really wanted to eat. I chose my food for its taste, and it tasted a lot better than those fries.

At the hotel, too, I made a choice that would have surprised me a year ago. Continue reading

Why To Exercise Today: ‘Survival Of The Moderately Fit’

crowded marathon runners

(geograph.org.uk)

I know, it’s downright un-Bostonian of me to suggest that regularly running marathons is anything less than glorious. But a persuasive New Yorker article looks at the mounting evidence that extreme exercise really can be too much of a good thing — specifically, it may cause heart damage.

So if feeling anything less than super-fit has ever blocked you from working out, banish the sheepishness. From the New Yorker article, Extreme Exercise And The Heart:

[Cardiologist James] O’Keefe suggests that extreme exercise is “not conducive to great long-term cardiovascular health,” and cautions against the assumption that, if moderate exercise is good, more must be better. “Darwin was wrong about one thing,” O’Keefe says. “It’s not survival of the fittest but survival of the moderately fit.”

For those of us who believe that the “everything in moderation” rule applies to, well, everything, this argument makes sense. Exercise remains one of the best things you can do to improve your cardiovascular health, but you certainly do not need to run marathons to achieve the benefits. Moderate amounts of exercise throughout life are perfectly adequate. Athletes who exercise in extremes generally do so for reasons other than their health—competitiveness, professional requirement, compulsion. But recognizing that exercising more than a certain amount reaps no greater cardiovascular benefits is quite different than suggesting that this level of exercise causes cardiovascular harm.

Lose The Spoon: Study Finds Milliliters Best For Measuring Kids' Meds

Spoon with liquid medication (Wikimedia Commons)

Spoon with liquid medication (Wikimedia Commons)

Veronica Thomas
CommonHealth Intern

You wake up to your 8-year-old son crying in the middle of the night. He’s had a sore throat for a few days, which the pediatrician is treating with liquid Tylenol. As you grab the bottle and kitchen spoon from the medicine cabinet, you wrack your brain trying to remember the doctor’s instructions. Was it two teaspoons or two tablespoons? But wait, the pharmacist had said to measure it in milliliters.

Confusion about medication measurement like this is surprisingly common among parents, often resulting in serious dosing errors that contribute to more than 10,000 calls to poison centers each year and 70,000 ER visits.

Parents who used teaspoons or tablespoons were twice as likely to make a mistake.

A new study in the journal Pediatrics found that around 39 percent of parents incorrectly measured the dose they intended and about 41 percent made an error in measuring what their doctor had prescribed. The researchers found that parents who used teaspoon or tablespoon units for medications were twice as likely to make a mistake in measuring the dose compared to parents who only measured medications in milliliters.

This increased error may partly be due to the fact that parents measuring in teaspoons or tablespoons are more likely to use a kitchen spoon to measure the medication, rather than a standardized instrument like an oral syringe or cup. However, even parents using standardized instruments were more likely to make a dosing mistake if they used teaspoon or tablespoon units. The link between tablespoon or teaspoon use and measurement error was even stronger among parents with low health literacy or limited English proficiency.

To minimize this confusion and reduce medication errors among parents, the study investigators suggest adopting a milliliter-only unit of measurement. But while a standardized unit of measure seems like the logical fix, it probably won’t be a quick one, according to Dr. Shonna Yin, the lead investigator of the study.

She sees growing support for a move towards a standard milliliter system from groups like the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Poison Control Centers, but says concerns remain that this transition would cause greater confusion, since parents are familiar with teaspoon and tablespoon terms.

I asked Dr. Yin, from the New York University School of Medicine and Bellevue Hospital Center, to provide additional insight on the study’s implications, including what parents can do to reduce dosing errors. Our conversation, edited:
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Buffer Zone Ruling Aftermath: Street Scene At Clinic, New Bill Filed

Outside the Planned Parenthood clinic in Boston. (Photo: B.D. Colen)

Outside the Planned Parenthood clinic in Boston on Saturday. (Photo: B.D. Colen)

The 35-foot “buffer zone” outside the Planned Parenthood clinic on Commonwealth Avenue in Boston is gone, struck down by the Supreme Court’s buffer-zone ruling last month. But a bill filed today in the Massachusetts Legislature would restore some added protections to staff and patients at the state’s reproductive health centers.

Among them, Planned Parenthood writes, is police power to issue a “dispersal order” when a group has impeded access to a facility; a prohibition on using “threat or force to intentionally injure or intimidate” someone trying to enter or leave the facility; and a “clear passage” section that bans impeding anyone trying to come or go.

An opinion piece in the Boston Globe today argues that no anti-abortion protester has ever been arrested for committing violence, and that the buffer zone “restricts and punishes not violence but expression.”

The author might want to take a look here on socialdocumentary.net at the evocative photos shot at the clinic on Saturday by B.D. Colen, a former Pulitzer Prize-winning medical reporter who teaches documentary photography at MIT. True, no physical violence. But you can imagine what it’s like to be a desperate young woman who has to navigate through dozens of protesters and “counselors” to get into the clinic.

The photo set’s “Photographer’s Statement” includes a heart-wrenching letter from a former student of Colen’s, who speaks to the emotional effects of laws and rulings that can make an agonizing time even harder. An excerpt:

“No one gives us – young and old women – enough credit about how terrifying that whole process is – with or without protestors. When they changed the laws to force a woman to look at the sonograms before they’d do the procedure, I cried. I remember being asked if I wanted to see the sonograms – I remember saying no and meaning it. I’m glad that at the time my voice was heard and my opinion was respected. What a cruel unnecessary law. What a lack of understanding that law demonstrated…

“I wish I was in Boston right now. I’d sit out there on that street after work or on my weekends.

“People think that women who have unwanted pregnancies are stupid or careless. That’s so far from the truth that I want to laugh instead of cry. I wasn’t stupid or careless – and even if I was, that shouldn’t matter. Women’s bodies are built to get pregnant. No birth control is 100% effective. I always knew my body was a fighter and stubborn as hell. Now I have concrete proof.
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