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How Transgender People Are Changing Their Voices

Lorelei Erisis, a transgender woman, tries out the Eva app in her Ayer home. (Martha Bebinger/WBUR)

Lorelei Erisis, a transgender woman, tries out the Eva app in her Ayer home. (Martha Bebinger/WBUR)

Lorelei Erisis taps the screen of a borrowed iPhone. The key of A, with kazoo-like resonance, fills her living room in Ayer, Mass.

Erisis taps another button labeled “start,” takes a deep breath, and sings the word “he,” trying to match the tone.

A number, 75 percent, pops onto the screen.

“My pitch was too low,” Erisis says. “Oh well. Let me try again.”

Erisis, a transgender woman, is trying out Eva, a mobile phone app that may be the first of its kind. Transgender men and women who want to raise or lower the pitch of their voice can go through a series of breathing and pitch exercises designed to help with what can be the most difficult characteristic to change — their voice.

“What I often hear is, ‘I pass as a woman until I open my mouth,’ ” says Kathe Perez, a speech language pathologist who designed the Eva app. Continue reading

Mass. Seeks $80M More From Feds For Health Website

Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.

Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.

So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget.*

Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15. Continue reading

Mass. Pledges New State-Run Insurance Website Will Work

The decision is in: Massachusetts will go with a new state-run health insurance website.

The Patrick administration revealed Friday that it is no longer building out the option of sending residents shopping for coverage to the federal health insurance site, HealthCare.gov.

“We are poised to offer consumers a streamlined, single point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment,” Gov. Deval Patrick wrote in a letter to federal officials, dated Thursday.

About 450,000 residents are expected to use the state’s new site, built with the Virginia-based company hCentive, when it is set to go live Nov. 15. The residents include:

– at least 251,000 residents who’ve tried to enroll for free or subsidized coverage since last October and are in a temporary plan through MassHealth (this coverage expires Dec. 31);

– another 98,000 people who were in Commonwealth Care when the website failed and have remained in those plans (this coverage also expires Dec. 31);

– and residents who purchase private insurance through the Health Connector.

Many of these people are wary of state promises. They waited months after applying for coverage online, not sure if they had health insurance. Continue reading

Beyond Good And Evil: New Science Casts Light On Morality In The Brain

Harvard brain scientist Joshua Buckholtz has never forgotten a convict he met back when he was an undergrad conducting psychological tests in prisons. The man had beaten another man nearly to death for stepping on his foot in a dance club.

“I wanted to ask him,” he recalls, “‘In what world was the reward of beating this person so severely, for this — to me — minor infraction, worth having terrible food and barbed wire around you?’ ”

But over the years, Buckholtz became convinced that this bad deed was a result of faulty brain processing, perhaps in a circuit called the frontostriatal dopamine system. In an impulsive person’s brain, he says, attention just gets so narrowly focused on an immediate reward that, in effect, the future disappears.

He explains: “If you had asked this person, ‘What will happen if you beat someone nearly to death?’, they will tell you, ‘Oh, I’ll be put away.’ It’s not that these people who commit crimes are dumb, but what happens is, in the moment, that information about costs and consequences can’t get in to their decision-making.”

For two decades, researchers have scanned and analyzed the brains of psychopaths and murderers, but they haven’t pinpointed any single source of evil in the brain. What they’ve found instead, as Buckholtz puts it, “is that our folk concepts of good and evil are much more complicated, and multi-faceted, and riven with uncertainty than we ever thought possible before.”

In other words, so much for the old idea that we have an angel on one shoulder and a devil on the other, and that morality is simply a battle between the two. Using new technology, brain researchers are beginning to tease apart the biology that underlies our decisions to behave badly or do good deeds. They’re even experimenting with ways to alter our judgments of what is right and wrong, and our deep gut feelings of moral conviction.

One thing is certain: We may think in simple terms of “good” and “evil,” but that’s not how it looks in the brain at all.

In past years, as neuroscientists and psychologists began to delve into morality, “Many of us were after a moral center of the brain, or a particular system or circuit that was responsible for all of morality,” says assistant professor Liane Young, who runs The Morality Lab at Boston College. But “it turns out that morality can’t be located in any one area, or even set of areas — that it’s all over, that it colors all aspects of our life, and that’s why it takes up so much space in the brain.”

So there’s no “root of all evil.” Rather, says Buckholtz, “When we do brain studies of moral decision-making, what we are led into is an understanding that there are many different paths to antisocial behavior.”

If we wanted to build antisocial offenders, he says, brain science knows some of the recipe: They’d be hyper-responsive to rewards like drugs, sex and status — and the more immediate, the better. “Another thing we would build in is an inability to maintain representations of consequences and costs,” he says. “We would certainly short-circuit their empathic response to other people. We would absolutely limit their ability to regulate their emotions, particularly negative emotions like anger and fear.”

At his Harvard lab, Buckholtz is currently studying the key ability that long-ago convict lacked — to weigh future consequence against immediate gratification. In one ongoing experiment (see the video above), he’s testing whether he can use electrical stimulation to alter people’s choices. Continue reading

Medical Marijuana 101: Doctors, Regulators Brace For ‘Big Marijuana’

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children’s Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

“Is there anything to prevent innovative products with marijuana that will do the exact same thing?” asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

“At the heart of it,” Levy said, “the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it.” Continue reading

Governor Reviewing Mass. Bill That Would Expand Autism Supports

Gov. Deval Patrick, in an April 29 file photo (Josh Reynolds/AP)

Gov. Deval Patrick, in an April 29 file photo (Josh Reynolds/AP)

Many parents of children on the autism spectrum are celebrating passage of a bill that is among dozens already on Gov. Deval Patrick’s desk.

The bill would create a tax-free savings account for autism and disability care; would require Medicaid coverage for autism behavioral treatment; and would give thousands of residents with autism access to state disability services. Currently only those whose IQ is under 70 qualify.

Barbara L’Italien, with the advocacy group ARC of Massachusetts, has seen autism rates skyrocket since her son was diagnosed in 1990.

“It is a public health crisis,” she says. “It is something we need to wrap our arms around and be proactive about, and I think this legislation really attempts to do that.”

The costs of expanding Medicaid and disability services is not clear.

A spokeswoman says Patrick is reviewing the bill.

Mass. Substance Abuse Bill Responds To Tide Of Sadness And Fear

Massachusetts State House (Wikimedia Commons)

Massachusetts State House (Wikimedia Commons)

In response to stories that seem to be on the rise in communities across the state — stories of parents trying to revive children after a heroin overdose, of young people seeking treatment their insurance plan won’t cover, and of babies born addicted to opiates — state lawmakers on the last day of their formal session approved a bill they say will help save the lives of those addicted to heroin, prescription painkillers and alcohol.

The measure, among several major bills passed just after midnight Friday, requires insurers to pay for any care a doctor decides is medically necessary. Insurers say this and other requirements included in the bill are a mistake.

In outlining the House and Senate compromise on the substance abuse bill Thursday afternoon, Sen. John Keenan of Quincy talked about his father.

“He was a good, decent, hard-working man, he was a great husband, a great father, but he was an alcoholic.” Keenan remembered an afternoon when his family told his father he had to get help. His dad resisted, but finally agreed. Someone got on the phone and found him a bed in a treatment program that was paid for by the Keenan’s insurance plan.

“That very day changed lives. My father had 26 years of sobriety before he passed away last year,” Keenan said. “He had 26 years with my mother, 26 years as a great father, 26 years with his seven children and their spouses, and 26 years as a great papa to his 20 grandchildren. So this can work.”

“This” being a requirement that insurers pay for up to 14 days of overnight detox and rehabilitation treatment as well as counseling, medication and any other services a clinician says are “medically necessary.”

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As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best.

Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better.

The House bill requires insurers to pay for at least 10 inpatient days of addiction treatment if that’s determined to be medically necessary; the Senate bill requires up to 21 days of inpatient coverage.

“We just believe patients should have a choice.”
– Leominster Sen. Jennifer Flanagan

But the American Society of Addiction Medicine estimates that 95 percent of opioid-dependent patients do not need inpatient care, and might be better off with medication maintenance and several months of outpatient therapy. Lawmakers maintain that they do not want to mandate any form of treatment.

“If we have this epidemic that continues to grow, we’re essentially in uncharted territory, and current treatment options aren’t working,” said Leominster Sen. Jennifer Flanagan, one of the bill’s co-sponsors. “If people want inpatient treatment or medication maintenance, they should be able to decide that with their doctors.”

At the same time, a new report contains some surprising findings about medication maintenance addiction treatment. It says that methadone, long used to treat heroin addiction, may be the most effective and cheapest treatment.

The report, from The New England Comparative Effectiveness Public Advisory Council, found that when comparing methadone with suboxone (Buprenorphine) or naltrexone (Vivitrol), more patients stayed in treatment longer if they were taking methadone. Continue reading

Brain Scientists Learn To Alter And Even Erase Memories

This optogenetic device uses light to activate specific brain cells. (Courtesy McGovern Institute for Brain Research at MIT)

This optogenetic device uses light to activate specific brain cells. (Courtesy McGovern Institute for Brain Research at MIT)

For 32 years, Leslie Ridlon worked in the military. For most of her career she was in army intelligence. Her job was to watch live video of fatal attacks to make sure the missions were successful.

“I had to memorize the details, and I have not got it out of my head, it stays there, the things I saw,” she says. “The beheading — I saw someone who got their head cut off — I can still see that.”

Leslie Ridlon retired from the military eight years ago, but she finds she cannot work because she suffers from severe PTSD. (Courtesy)

Leslie Ridlon retired from the military last year, but she finds she cannot work because she suffers from severe PTSD. (Courtesy)

Ridlon is now 49 and retired from the military last year, but she finds she cannot work because she suffers from severe post traumatic stress disorder. She has tried conventional therapy for PTSD, in which a patient is exposed repeatedly to a traumatic memory in a safe environment. The goal is to modify the disturbing memory. But she says that type of therapy doesn’t work for her.

“They tried to get me to remember things,” she says. “I had a soldier who died, got blown up by a mortar — he was torn into pieces. So they wanted me to bring that back. I needed to stop that. It was destroying me.”

She has concluded that some memories will never leave her. “Everything I could get rid of as far as memory I think I’ve already done it,” she says. “I think the deep ones that you suffer from, I don’t think anyone can take them away. I don’t believe anyone can. I think the ones I have now, they’re going to just stay there. I’m just going to have to manage them.”

But what if these traumatic memories could be altered or even erased permanently? Researchers say they are beginning to be able to do that — not just in animals, but in people as well.

Not long ago, scientists thought of memory as something inflexible, akin to a videotape of an event that could be recalled by hitting rewind and then play. But in recent decades, new technology has helped change the way we understand how memory works — and what we can do with it. Scientists can now manipulate memory in ways they hope will eventually lead to treatments for disorders ranging from depression to post-traumatic stress to Alzheimer’s disease.

“We now understand there are points in time when we can change memory, where we can create windows of opportunity that allows us to alter memories, and even erase specific memories,” says Marijn Kroes, a neuroscientist at New York University.
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Inspired By Family Illness, Philanthropist Gives $650 Million For Psychiatric Research

The Broad Institute of Harvard and MIT  summer student Lydia Emerson and aesearch associate Aldo Amaya. (Courtesy/Kelly Davidson Photography)

Researchers at the Broad Institute plan to use Ted Stanley’s money to catalog all the genetic variations that contribute to severe psychiatric disorders. (Courtesy/Kelly Davidson Photography)

In the largest-ever donation to psychiatric research, Connecticut businessman Ted Stanley is giving $650 million to the Eli and Edythe Broad Institute of MIT and Harvard. The goal — to find and treat the genetic underpinnings of mental illnesses — was inspired by a family experience.

Ted Stanley made his fortune in the collectibles business. He founded The Danbury Mint, a company (later MBI, Inc.) whose first product was a series of medals commemorating the biggest scientific achievement of its time: the moon landing in 1969. While his business grew, his son Jonathan Stanley grew up as a normal Connecticut kid. Until, at age 19, Jonathan came down with bipolar disorder with psychosis, which got worse over the next three years.

“We’ll call it the epiphany from my dad’s standpoint at least,” Jonathan Stanley remembered of the turning point in his illness. “I went three days straight running through the streets of New York, no food, no water, no money, running from secret agents. And not surprisingly, after I stripped naked in a deli, ended up in a psychiatric facility.”

Jonathan was a college junior at the time.

“My dad came to visit, and he got to see his beloved son in a straitjacket,” Jonathan Stanley said.

The Stanleys were lucky. Jonathan responded well to the lithium, then a newly-approved drug. He went on to graduate from college and law school, too. Yet along the way, his father had met other fathers whose sons did not respond to treatment. He met other families who had to keep living with uncontrolled mental illness.

Ted Stanley said that gave him a focus for his philanthropy.

There was something out there that our son could take, and it made the problem go away,” he said. “And I’d like to see that happen for a lot of other people. And that’s why I’m doing what I’m doing.”

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