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.

First Case Of Zika Virus In Boston Is Confirmed

BOSTON — A Boston resident has been diagnosed with the mosquito-borne Zika virus, the Boston Public Health Commission confirmed Thursday.

The patient, who contracted the virus while traveling abroad, is expected to make a full recovery, BPHC said in a statement.

“The vast majority of people who contract Zika do not get seriously ill, and recover quickly when they do,” Scott Zoback, spokesman for the BPHC, said in a statement.

The Zika virus, which has been found in Africa, Southeast Asia, South America and the Pacific Islands, is spread to people through the bite of an infected mosquito. The Centers for Disease Control and Prevention is advising pregnant women to avoid traveling to countries where the virus is present because there are concerns it may be linked to severe birth defects.

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Landmark Gene Discovery Cracks Open ‘Black Box’ Of Schizophrenia

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

Sydney and her mother Lori look into the bedroom mirror where Sydney experienced her first symptoms of schizophrenia. Now 20, Sydney has had no symptoms for almost two years now. (Jesse Costa/WBUR)

One November day in her senior year of high school, Sydney accidentally broke the full-length mirror leaning up against the wall of her bedroom.

She felt a gust of superstitious dread: “Oh my God, I have to put this mirror together or I’m going to have bad luck.” Then, it escalated oddly into religious terror: “The devil’s coming to get me!”

Something inside her seemed to snap, she said. She sensed demons invading through the broken glass.

Not long afterward, President Obama spoke to Sydney inside her head: “OK, this is how the world is now,” he told her. “Everyone is so in love with each other, we can hear each other in our heads.”

The menacing voices of demons started to torment her, especially at night. She became convinced that she was going out with the pop star Justin Bieber, that he was chatting with her on her phone and sending her hidden messages in his Twitter feed. She thought he set up paparazzi in her backyard on Boston’s North Shore, that he was sending planes over her house to let her know he cared.

“Is this really happening?” She would ask the voices in her head. “Is this?” Yes, they told her. Yes.

What was really happening? How does a sunny girl who’d never had psychiatric problems before, who grew up loving dance and Disney princesses, a good student who was rich in family and friends, how does that girl suddenly lose her hold on reality?

Schizophrenia affects about 1 in every 100 people, and one thing is clear: Genetics plays a role. Sydney’s uncle had schizophrenia, and scientists have identified more than 100 genes that can raise the risk for it.

Now, researchers based at the Broad Institute in Cambridge and Harvard Medical School have pinpointed the gene that is the biggest risk factor for schizophrenia discovered so far, and figured out how it does its damage: It makes the brain prune away too many of the connections between neurons.

“[I]t may be like you have an over-energetic gardener who prunes back so much that the bushes die off…”

– Bruce Cuthbert, of the National Institute of Mental Health

That finding, just published in the journal Nature, may also explain why schizophrenia tends to hit at such an odd age, in the late teens and early 20s. That pruning of connections is a normal process that ramps up during adolescence, but this genetic culprit may make it go overboard.

Pruning may sound bad, said Bruce Cuthbert, the acting director of the National Institute of Mental Health, but actually, it’s helpful: “It’s like clearing away the underbrush so your brain can function more efficiently.”

But, he said, “in people with this overactive version of the gene, it may be like you have an over-energetic gardener, who prunes back so much that the bushes die off because they don’t have enough branches.”

Cuthbert called the paper a “genetic breakthrough” and “a crucial turning point in the fight against mental illness.” Eric Lander, director of the Broad Institute, said it means we’re finally starting to understand what causes schizophrenia at the level of brain biology.

“For the first time,” Lander said, “we’re opening up the black box and looking inside and seeing, how does the disease really arise? That makes this, in my opinion, perhaps the most important paper in schizophrenia since the disease itself was ever defined,” over a century ago.

This scientific excitement does not mean, however, that the findings will lead to new treatments for schizophrenia any time soon, Lander and others said. It takes years for such basic science to translate into treatments — if it ever does.

But the new paper does suggest some promising new targets for drug development, some already being worked on for other diseases, said Harvard Medical School’s Steve McCarroll, who led the research team. Continue reading

Panel Recommends Depression Screening For Women During And After Pregnancy

(Chris Martino/Flickr)

(Chris Martino/Flickr)

On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.

The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”

Why?

“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”

The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:

The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”

She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”

Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:

In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

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U.S. Health Care Is Less Private, More ‘Socialist’ Than You Might Think

The extent of the government's role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17 in Charleston, S.C. (Mic Smith/AP)

The extent of the government’s role in health care has become a key issue in the Democratic presidential primary. Here, candidates Hillary Clinton and Bernie Sanders are seen in a debate on Jan. 17. (Mic Smith/AP)

By Richard Knox

Readers, a pop quiz:

The proportion of U.S. health care paid by tax funds is (a) less than 30 percent, (b) about half or (c) more than 60 percent.

If you picked “more than 60 percent,” you’re right — but you’re also pretty unusual.

“Many perceive that the U.S. health care financing system is predominantly private, in contrast to the universal tax-funded health care systems in nations such as Canada, France or the United Kingdom,” David Himmelstein and Steffie Woolhandler write in a new analysis of U.S. health spending in the American Journal of Public Health.

They find that 64.3 percent of U.S. health expenditures are government-financed. And they project the tax-supported proportion will rise to 67.1 percent over the coming decade as the baby boom generation ages and retires — nearly as high as Canada’s 70 percent.

“We are actually paying for a national health program, we’re just not getting it,” Woolhandler says.

tax dollars for U.S. health spending

Now, Himmelstein and Woolhandler have an agenda. For decades, they’ve been perhaps the leading researchers promoting the kind of single-payer health system that Socialist and Democratic presidential candidate Bernie Sanders has put on the debate agenda. One recent poll suggests more than half of Americans (and 30 percent of Republicans) support the idea.

But even if you disagree with the Himmelstein-Woolhandler ideology, their research is generally regarded as sound, and their method is straightforward.

They added up what federal and state governments spend on health through Medicare, Medicaid, the Veterans Health Administration, government employees’ health care premiums, tax subsidies and other programs. They argue that accounting by government agencies (the Center for Medicare and Medicaid) undercounts the real tax burden because it leaves out major pieces of the pie — such as government employees’ care ($156 billion a year) and tax subsidies for private, employer-sponsored coverage (nearly $300 billion).

And whatever you think about Medicare-for-all, it’s a good idea to see the present U.S. health care system for what it is — an increasingly government-funded financing scheme. Continue reading

SharingClinic, To Help Patients Tell Their Stories, Opens At Mass. General Hospital

Four years ago, Dr. Annie Brewster had a vision.

Brewster, a Boston internist, who was diagnosed with multiple sclerosis in 2001, had become frustrated that a crucial element of medicine — the human connection between patients and doctors — seemed to be lost in the modern era of 15-minute appointments and overly burdensome record-keeping. As a patient and a doctor, Brewster yearned for a therapeutic arena in which patients could tell their full health stories and feel they were actually heard, not rushed out the door; and where doctors, as well, could share a little more with patients.

Now, with the launch this week of the SharingClinic, an interactive “listening booth” stocked with audio stories from patients facing a range of illnesses, Brewster is a little closer to realizing her vision. Housed at the Paul S. Russell Museum of Medical History and Innovation at Massachusetts General Hospital, Brewster expects SharingClinic will continue to grow over time as more stories are collected and added to the kiosk. Eventually, she says, trained staff will begin to facilitate the storytelling in regularly scheduled “clinics” in a way that research suggests might offer an actual health boostContinue reading

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Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
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Commentary: When Sexual Violence Survivors Give Birth, Here’s What You Should Know

By Sarah Beaulieu
Guest Contributor

Sarah Beaulieu (Courtesy of the author)

Sarah Beaulieu (Courtesy of the author)

It shouldn’t have been a surprise that childbirth would leave me traumatized.

In retrospect, it seems obvious that when a survivor of sexual violence feels pain in her vagina caused by a strange being inside of her, the experience might trigger memories of an earlier trauma. But what wasn’t so obvious were the many ways that the childbirth and medical professionals didn’t prepare me for these unexpected and painful emotions related to giving birth.

With 20 years of therapy under my belt, I consider myself to be a fairly confident survivor with many tools in my resilience box. None of these tools prepared me for what happened during the birth of my son. After 12 hours of relatively peaceful labor in the hands of midwives, I dozed off, preparing for a long night. I woke up with at least two sets of hands inside of me, alarms ringing and a sense of panic in the room. My son’s heart rate had dropped dangerously low, and I needed an immediate C-section.

This experience — traumatic for even the healthiest woman — wrecked me, surfacing old post-traumatic stress disorder symptoms and pulling me into depression and anxiety. With the help of a hospital social worker, I emerged from my emotional dark place a few months later, and immersed myself in learning more about birthing as a sexual assault survivor. My experience was scary, but it couldn’t be that uncommon, I thought. After all, 1 out of 4 women share a sexual abuse history like mine, and U.S. women gave birth to nearly 4 million babies last year.

My research led me to Penny Simkin and Phyllis Klaus, two legendary birth educators who compiled much of the existing research into a single manual, “When Survivors Give Birth.”

I learned that, in fact, there were approaches to childbirth that were especially helpful to survivors of sexual violence. Not only that, but it was fairly common for pregnancy and birth to re-trigger memories and emotions related to past sexual violence. Yet despite this, the topic of sexual violence wasn’t typically covered by my midwifery practice, recommended childbirth literature or my natural childbirth class.

First and foremost, health care providers can adopt a trauma-informed approach to care for laboring mothers. Knowing that 25 percent of patients in labor and delivery will have a history of sexual violence, there is a benefit for all staff to be educated about sexual violence and its impact on birth. There are medical reasons too: Childhood trauma, including child sexual abuse, is a documented risk factor of postpartum depression and anxiety, which impacts 10 to 15 percent of new mothers — and their babies and families — each year.

Knowledge starts with screening for a history of sexual violence on standard intake forms and first visits. It also means creating a health care environment where survivors feel comfortable disclosing such histories. In my midwife’s office, there were pamphlets for every possible pregnancy complication, from gestational diabetes to heartburn to exercise during pregnancy. So, why not a pamphlet on giving birth as an abuse survivor?

Cat Fribley, an Iowa-based sexual assault advocate and doula whose practice focuses specifically on sexual violence survivors, describes trauma-informed care as “supporting the whole person with collaboration, choice and control, cultural relevance, empowerment and safety — both physical and emotional. This requires making certain adjustments to the way they work with survivors, acknowledging both the challenges that arise from sexual trauma, as well as unique coping skills — such as dissociation — that may help the survivor through the process of childbirth.”

Here’s an example: At one birth Fribley attended, “the birthing mother became visibly upset when new and unknown staff would enter the room while she was laboring. A simple sign on the door asking people to knock and announce themselves before entering helped make the birthing mom feel more in control of her environment — and the exposure of her body.” Continue reading

Options Weighed To Address State’s Health Care Price Variations

Updated 6:50 p.m.

BOSTON — Variations in prices for the same service at different hospitals in Massachusetts do not reflect different qualities of care and have not evened out over time, according to a Health Policy Commission report released Wednesday.

The report found that higher prices “are not generally associated” with better care, and that prices vary across the different types of hospitals — academic medical centers, teaching hospitals, community hospitals — as well as within each individual group.

To highlight the difference in costs just at community hospitals during a Wednesday meeting, Health Policy Commission executive director David Seltz pointed to levels of spending on maternity care. Spending for a low-risk pregnancy ranged from $16,000 at North Shore Medical Center to $9,000 at Heywood Hospital.

“While some variation in prices is warranted to support activities, unwarranted variation in prices — combined with a large share of volume at those higher-priced institutions — leads to higher spending overall and inequities in our distribution of resources,” Seltz said.

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Mass. Men Hit Particularly Hard By Opioid Crisis, New Data Show

The opioid crisis in Massachusetts is hitting men particularly hard.

Over the first nine months of 2015, 76 percent of the confirmed overdose deaths in the state were men, according to the latest quarterly opioid snapshot from the Department of Public Health.

From January through September of last year, 604 men died of opioid-related overdoses, compared with 187 women who overdosed and died over the same period, the department said.

Wednesday’s snapshot is the first time the state has released demographic data on the crisis. Continue reading

Earlier Overdose Estimates:

More Evidence That Growing Up Poor May Alter Key Brain Structures

Allan Ajifo/flickr

(Allan Ajifo/Flickr)

Poverty is bad for your brain.

That’s the basic takeaway from an emerging body of research suggesting that the distress associated with growing up poor can negatively influence brain development in many ways, and in certain cases might also lead to emotional and mental health problems, like depression.

The latest study, led by researchers at Washington University School of Medicine in St. Louis, found that poverty in early childhood may influence the development of important connections between parts of the brain that are critical for effective regulation of emotions.

The study, published in the Journal of American Psychiatry, adds “to the growing awareness of the immense public health crisis represented by the huge number of children growing up in poverty and the likely long-lasting impact this experience has on brain development and on negative mood and depression,” researchers report.

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