Medicine/Science

The latest cool stuff out of some of the nation's best labs; news on medical research and what it may mean for patients.

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What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

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Having A Baby? Big Differences In Hospital Quality Across Massachusetts

If you’re one of the roughly 70,000 women who will give birth in Massachusetts this year, you may be planning to deliver at a hospital close to home or where your OB practices. But what you might not realize is that when it comes to childbirth, there are big differences in hospital quality across the state.

For example:

  • Your chance of having a Cesarean section is almost three times higher at some hospitals
  • While some hospitals allow you to schedule an early delivery even when it’s not medically necessary, other hospitals have stopped this practice because a baby’s brain, lungs and liver need the full 39 weeks to develop
  • Your chance of having an episiotomy — a surgical cut to enlarge the vaginal opening — ranges from 0 to 31 percent
  • Trying for a natural delivery after having had a C-section is encouraged at some hospitals but not offered at others
  • Three times as many women breastfeed their babies at some hospitals as compared to others

“The door you walk in will have a big impact” on what happens during and after childbirth, says Carol Sakala, director of programs at the nonprofit maternity quality group Childbirth Connection.

The hospital where women choose to deliver “absolutely matters,” says Dr. Neel Shah, an assistant professor of obstetrics at Harvard Medical School. Take C-section rates, Shah says. “In many ways, which hospital you go to is a bigger predictor of whether or not you’re going to get a C-section than your own risk or your own preferences.”

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Transgender Patients Create Their Own Networks Of ‘Safe’ Providers

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT organizations. (Jesse Costa/WBUR)

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT groups. (Jesse Costa/WBUR)

A nurse looked at the couple: a man of medium height with a large belly and a tall, thin woman. The nurse handed the woman a small paper cup and asked for a urine sample.

“Well, that’s not really going to work because my husband is the one who’s pregnant,” the woman said. Then Karl Surkan, a transgender man who teaches gender studies at MIT, took the cup.

“Well, then I guess I need a urine sample from you,” Surkan remembered the nurse saying to him.

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Other nurses and doctors might make the same mistake. Transgender men are pretty unusual in OB offices and maternity wards. The nurse in this case wasn’t hostile, Surkan said, just “not knowledgeable about the existence of masculine-looking people who are pregnant.”

Still, Surkan would give the nurse a low score on an online provider rating system he co-founded late last year — TransRecord.com. Transgender and genderfluid patients log in, name a provider, and respond to eight questions that identify a doctor, nurse or counselor as transgender friendly — or not.

“This is a population that is heavily medicalized,” Surkan said. From the pre-transition period, through a gender change, to potentially decades of hormone therapy, these patients will be frequent users of health care. Continue reading

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Mass. AG Shifts Health Care Costs Conversation To Behavioral Health

If you have ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy.

Now, that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. It takes stock of behavioral health benefits and the low health insurance pay rate for these services in Massachusetts. Healey is shifting the focus of her office’s health care cost report after several, under former Attorney General Martha Coakley, that highlighted the wide gaps between payments made to high- and low-cost hospitals.

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Healey says she’s changing gears because “it’s really important to look at the whole health of the patient.”

“We need to get to a place where we treat people who’ve got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones,” Healey says.

Seventy-nine percent of Massachusetts residents enrolled in MassHealth or ConnectorCare have coverage that separates general medical care from mental health and substance abuse. For members of commercial health plans. that number is much lower but still significant: 31 percent.  Healey’s report does not say that the separation is necessarily bad, but that the state needs a better system of sharing patient information between medical and behavioral health providers, and more coordination of care.

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State Launches Opioid Addiction Awareness Campaign Aimed At Parents

A screenshot from a new state public service announcement about addiction. (YouTube)

A screenshot from a new public service announcement, created by the state, about opioid addiction. (YouTube)

Calling education an “essential part of the cure for this epidemic,” Gov. Charlie Baker on Wednesday announced the launch of an opioid addiction awareness campaign aimed at parents.

The “Stop Addiction In Its Tracks” campaign is a recommendation of Gov. Baker’s opioid abuse task force, which was charged with developing a statewide strategy for combating addiction. The group is set to announce its full slate of recommendations next week.

The campaign includes TV and digital ads that will run through the end of July, pointing people to a new state website — mass.gov/StopAddiction. The website offers information on warning signs of opioid addiction; a list of commonly misused prescription medications; a guide for how guardians can talk to kids of different ages about the dangers of opioid misuse; information on Narcan, a medication that can reverse the effects of an overdose; as well as how to get help.

“With this messaging, we are impressing on parents that the road to heroin could start with what is left in our own homes and medicine cabinets,” Health and Human Services Secretary Marylou Sudders said in a statement. Continue reading

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I Bought Narcan, And Here’s What I Learned

Evzio's "Trainer" (Jesse Costa/WBUR)

Evzio’s “Trainer” (Jesse Costa/WBUR)

I walked into a CVS across the street from WBUR this week to get some naloxone, which you might know by the brand name, Narcan. It temporarily reverses the effects of an opioid overdose and restores breathing.

For me, the purchase is not urgent. But I saw a woman in a cafe restroom recently who was in rough shape, I have a cousin who’s managing his addiction to heroin, I’m reporting on this issue, and I have three teenagers. I decided I wanted to be ready to help.

I asked the pharmacist for Evzio. It’s a newish option, an injectable form of naloxone, kind of like an EpiPen. Mark Herzog, a VP at Kaleo, the company that makes Evzio, handed me the “trainer” (pictured above) at a conference. It comes in a kit along with two injection canisters. Continue reading

Mass. Adopts Final ICU Nurse Staffing Rules

The 2014 nurse staffing law will apply to burn units and intensive care for newborns along with intensive care units for adults, under final regulations adopted by the Health Policy Commission on Wednesday.

Passed by the Legislature in part to avoid a ballot referendum, the law required each ICU nurse be assigned only up to two patients, and only one patient if that is what is required.

An acuity tool would be used to determine the nursing needs of patients, under the regulations approved on a voice vote Wednesday.

The final regulations designate March 31, 2016, as the acuity tool deadline for academic hospital ICUs, and push back the deadline at community hospitals and in neonatal ICUs to Jan. 31, 2017.

“All of us are committed to really high quality patient care, and I would really prefer to not see this have to be rigidly written in law and regulation, but that’s where we are,” Health and Human Services Secretary Marylou Sudders, who is on the commission, said after the vote.

The regulations drew a mixed response from nurses and a warning from a health care workers against cutting hospital jobs. Continue reading

Too Restrictive? Marijuana Labs Raise Concerns About Mass. Lead Regulations

The state’s first medical marijuana dispensary is expected to open in Salem later this month. But it may not have any actual dried marijuana for sale.

The main problem: lead.

“To date, every sample of cannabis that we have tested for heavy metals, particularly lead, would fail the existing regulations  TWEET ,” said Chris Hudalla, the chief scientific officer at ProVerde Laboratories, one of two marijuana testing facilities in Massachusetts.

Hudalla says there is no question that elevated lead levels would be dangerous for patients. But he claims the state standard is too restrictive and unrealistic. It is based on the assumption that patients will ingest 1 ounce a day — much more than most patients would reasonably use.

The amount of lead allowed in Massachusetts (212 parts per billion) is nearly 14 times lower than Connecticut and almost 50 times lower than what’s permitted by Colorado. Continue reading

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Your Doctor, Always Available, For A Monthly Fee

For 10 years, Jeff Gold showed up to a job he wanted to love: being a family doctor.

“I was busy as a bee,” says Gold, 39, with up to 2,500 patients, seeing 20 or so a day.

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Rushing from one patient to the next, calling insurers who wouldn’t approve prescriptions, filling out paperwork that didn’t seem relevant to his patients, Gold kept asking himself, is this what I signed up for?

“I thought I was gonna help everybody and spend time with everybody and it’s impossible to do,” Gold says.

So Gold quit, wrote a business plan to be a doctor who does not take insurance, hired one staff member (a nurse), and borrowed almost $400,000 to outfit a two-exam-room office next to a candy shop and café in Marblehead.

Gold may be the first physician in Massachusetts practicing under a model called direct primary care. For a flat monthly fee, Gold offers patients one-hour same-day appointments, no wait. The doctor is available 24/7 in person, at the office, at the patient’s home, via text, email or Skype. Continue reading