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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The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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Dartmouth Study Looks At When Doctors And Patients Clash Over ‘Unnecessary’ Care

A new Dartmouth study looked at whether or not doctors' actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

A new Dartmouth study looked at whether or not doctors’ actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

What happens when you want a test that your doctor thinks won’t help? Has a national campaign against high-cost, low-value care helped physicians have these tough conversations? And what drives doctors to provide care that they don’t think a patient needs?

These are the sorts of questions that researchers at the Dartmouth Institute for Health Policy and Clinical Practice sought to answer in a new study that came out Tuesday. The researchers surveyed clinicians at Atrius Health, Massachusetts’ largest outpatient care provider, with over a million patients, to determine what drives physicians to order tests they don’t think are in a patient’s best interest, and whether doctors were interested in controlling costs.

While nearly all doctors (96.8 percent) in the survey agreed that they should “limit unnecessary tests,” one in three thought that it was “unfair” to ask physicians to consider cost, and nearly one in three (30.7 percent) thought there was too much emphasis on cost. Primary care doctors were more likely to report being pressured by patients to order unnecessary tests, while surgeons were more likely to be concerned about malpractice.

Dr. Tom Sequist, one of the study’s authors, said in an interview that the researchers found a big gap between physicians’ desire to limit costly and low-value care, and their ability to do so.

“The thing that strikes me the most about this study is that over 90 percent of physicians said they were interested in reducing unnecessary cost, but only a third said they understood the role of cost in the system,” Sequist said. “It’s like saying, ‘I’m really interested in physics, but I have no idea how physics works.’ ” Continue reading

7 Things To Know About The Nation’s First Penis Transplant

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

From The New York Times to cable TV to here at CommonHealth, the country’s first penis transplant made major headlines Monday.

The patient, 64-year-old Thomas Manning, had part of his penis surgically removed four years ago after doctors found he had penile cancer. The news marked a step forward in transplant medicine, but as a resident physician and future primary care doctor, I wondered whether such an elaborate and expensive “proof-of-concept” operation would mean anything for my future patients.

The facts behind the big story:

What did the operation aim to accomplish?

The goals of this operation, according to Dr. Dicken Ko, who co-led the surgical team, were threefold: to reconstruct natural-appearing genitalia, to allow the patient to urinate normally and, hopefully, to help him regain sexual functioning.

They have achieved the first goal, and they are hopeful that Manning will be able to urinate normally in a few weeks. Finally, they did extensive reconstruction of the nerves as well, and are hopeful that he will have normal sexual function in the future.

How was this patient chosen?

For Manning, the motivation to volunteer for this experimental procedure was straightforward. “Because they cut off my penis. Very simple. Very, very simple,” he said in a phone interview. Manning volunteered for the operation and underwent extensive psychological evaluation, according to his team.

The type of injury he had was also an important factor: Because part of his penis had been surgically removed — rather than injured in an explosion — the rest of the vessels and nerves were preserved, which facilitated the operation. This was important, Dr. Ko said, because they wanted to pick a patient who was very likely to have a successful outcome to be the first to receive the transplant.

How difficult was this operation?

The main technical difficulties of the operation had to do with the vascular reconstruction involved, which is when doctors sew together the small blood vessels of the patient to the donor’s vessels.

Before the operation, they had only a vague idea if the vessels were big enough to connect. They also performed a vein graft, which is akin to a heart bypass and allows greater blood flow. That vein graft was the primary difference between the technical aspects of this operation and the first successful transplant, performed earlier this year in South Africa.

Who else could benefit from this surgery?

For now, the surgeons on this team are focusing on cancer and trauma patients, especially veterans returning with combat wounds from Iraq and Afghanistan.

The technical challenges for soldiers injured by explosions are likely to be more daunting, as the injuries are generally more extensive and their own vessels and nerves are less well-preserved. Nonetheless, the surgeons emphasized how motivated they were to work with veterans.

In a statement, Manning himself said he hoped the operation could soon be performed on “service members who put their lives on the line and suffer serious damage as a result.”

When asked about the potential for use with transgender patients, Dr. Curtis Cetrulo, a plastic surgeon and the second team leader, said it could be possible in the future. The approach, however, would have to be completely different and would require “a whole new effort” to be successful, he said. Continue reading

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Cancer Patient Receives Nation’s First Penis Transplant At MGH

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital via AP)

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital/AP)

Back in 2012, Thomas Manning of Halifax, Massachusetts, suffered a serious groin injury when a heavy cart fell on him at work. As he was being treated for it, his doctors found an aggressive cancer growing in his penis, and amputated most of it.

“He’s really an incredible person that after that surgery, totally unprovoked, said, ‘Doc, if I can have a penile transplant, I’m your patient,’ ” Manning’s doctor, MGH urologic oncologist Adam Feldman, told reporters on Monday. “And then shortly afterward was when the program started and I said, ‘You know … there just might be something here for you.’ “

It took more than three years for all the pieces to come together, but Manning, 64, has now received the country’s first penis transplant. Surgeons in South Africa and China have performed similar operations.

The operation at Mass. General took place overnight on May 8, and lasted more than 15 hours in total. The organ came from a deceased anonymous donor whose family gave special permission for the transplant.

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MIT Researchers Aim To Create An On-Demand Pharmacy

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Hundreds of thousands of bright pink, white or blue tablets and capsules in all colors of the rainbow drop into bottles on sleek conveyors every hour in a sprawling building — somewhere. Each batch of pills may take a month or more to make.

But now, in a lab near Kendall Square, a team of MIT researchers can turn out 1,000 pills in 24 hours in a device the size of your kitchen refrigerator. It’s a whole new way of making drugs.

“We’re giving them an alternative to traditional plants, and we’re reducing the time it takes to manufacture a drug,” said Allan Myerson, professor of chemical engineering at MIT.

The Defense Department is funding this project for use in various places like field hospitals serving troops, jungles to help combat a disease outbreak, and strategic spots throughout the U.S.

“These are portable units so you can put them on the back of a truck and take them anywhere,” Myerson said. “If there was an emergency, you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed.”

Sound simple? It’s not. This mini plant represents a sea of change in both size and operation. Continue reading

State’s Opioid Epidemic Is Vividly Seen On Boston’s ‘Methadone Mile’

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

The ravages of the state’s opioid epidemic are perhaps nowhere more visible than in an area of Boston known as “Methadone Mile” — a one-mile stretch of Massachusetts Avenue in the shadow of Boston Medical Center. Continue reading

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Health Care And Civic Leaders Launch Serious Illness Care Coalition

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

A group of health care and civic leaders meets at the Kennedy Library Thursday morning with a mission: ensuring that Massachusetts residents live their final weeks or months as they choose. They’re launching a new statewide effort called the Serious Illness Care coalition.

The aim of the group is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness — the kind that could lead to death within a year.

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Opinion: Pediatrician Asks, Why Can’t I Talk To You About Guns In The Home?

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

Here’s a conversation I was in on recently between a pediatric intern and the parents of a healthy, 1-day-old baby. It occurred in the Yale-New Haven Hospital well baby nursery.

“Your daughter’s physical exam is perfect,” the intern said. “She’s eating well, peeing and pooping well. I want to talk to you a little about how to help you keep her safe and healthy.”

Next came a standard discussion about the baby’s sleeping position and whether she’s got a car seat. Then, the next question:

“Do you have any guns in the home?”

Suddenly, the genial tone changed.

“I don’t think you should ask that question,” said the child’s father.

“Should I take that as a ‘yes’?” the intern pressed.

“I just don’t think you should ask.”

“Sir, we ask because we want to make sure that your baby is as safe as she can be, making sure you keep any guns locked up and away from her.”

“It’s none of your business.”

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Judge Rejects Injunction To Stop Construction On Children’s Hospital Healing Garden

Visitors relax in the Prouty Garden in this file photo. (Robin Lubbock/WBUR)

Visitors relax in the Prouty Garden in this file photo. (Robin Lubbock/WBUR)

A Suffolk Superior Court judge has denied a request for a preliminary injunction that would have stopped Boston Children’s Hospital from continuing any construction-related work on the site of its planned new clinical building. The plans call for the demolition of Prouty Garden, a healing garden that was bestowed to the hospital 60 years ago.

A group of people opposed to the development project — plaintiffs include family members of patients who’ve used Prouty Garden and physicians — had asked the judge to issue the injunction, saying the hospital has illegally started work on the site before the state Department of Public Health issues its approval.

The judge ruled the plaintiffs didn’t meet the burden of proving they’re likely to succeed in a lawsuit, but can still press forward with a suit challenging the project. Continue reading

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