One of the country’s leading medical journals is withdrawing support for a Brigham and Women’s Hospital physician nominated by President Obama to become the next surgeon general.
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On Oct. 16, 1846, a flustered young man named William Morton raced up marble steps to the dome of Massachusetts General Hospital.
“He was late, and you don’t want to keep surgeons waiting,” said Dr. John Herman, a psychiatrist at Mass General who is steeped in the history of that day.
A group of physicians awaited Morton in the operating room, located high above other floors because “before ether, people screamed,” Herman said.
Morton, a dentist, had promised to put an end to those screams, to the pain patients endured during surgery.
That day, with a patient waiting, Morton pulled out a glass bottle of ether that he had colored red, according to Herman, to disguise the common gas. Morton told the patient to inhale. Moments later, a surgeon sliced into the neck of a relaxed man.
“As he came out of the anesthesia, the surgeon, John Collins Warren, said ‘Mr. Abbott, did you feel pain?’ and Abbott said, ‘Did you begin the procedure?’ ” Herman recounted. “The world changed. Within days, news of what happened here traveled by steamship and by locomotive … to the capitals of the world.” Continue reading
By Richard Knox
Americans are seriously confused about how Ebola spreads. And it’s no wonder.
A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.
Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.
And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.
Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.
In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.
The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.
More than a third worry they or someone in their immediate family will get Ebola. Continue reading
Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.
Here’s what you need to know about Ebola:
A man who travels frequently to Liberia caused a stir Sunday afternoon when he arrived at a Braintree clinic with Ebola-like symptoms. But doctors and public health officials say that the man is not considered at high risk for the often deadly virus. His case did, however, give us the first public look at how nurses, EMTs, hospital staff and others have prepared to respond when there is an Ebola alert.
WBUR’s Martha Bebinger spoke with WBUR’s Bob Oakes on Monday with more on the story.
Bob Oakes: How did this man, who has not been identified, become the focus of police escorts, press conferences and numerous statements on Sunday?
Martha Bebinger: The man called his primary care practice, Harvard Vanguard, in Braintree Sunday morning, complaining of a headache, muscle aches and some other problems. He was given an appointment in the afternoon. The man went to the Harvard Vanguard pharmacy to pick up a prescription for something else, then left.
But after that first call, Harvard Vanguard reviewed his medical record and noticed that the man traveled frequently to Liberia. The office staff then called the patient and “intercepted” him as he was coming in. They asked him to wait in his car while they called for an ambulance. The Harvard Vanguard office was closed for a period of time, while they disinfected surfaces in the pharmacy they believe he touched, and then reopened.
The man waited, cooperatively, we’re told, in his car, sort of a self-quarantine, until an ambulance arrived. What kind of precautions were in place there?
Brewster ambulance completed their Ebola response training about a week ago. Brewster’s director of training, Jeff Jacobson, says the company was on the scene in 15 minutes with two ambulances, one that had been sealed inside with plastic and three EMTs wearing hazardous materials suits.
“Once the patient is removed from the ambulance and into the hospital, two more folks get into the level B suits and remove all the plastic, put in sealed containers, then the vehicle is disinfected, following the Centers for Disease Control recommendations,” Jacobson said.
In all, Jacobson estimates there were 40 responders, including police, firefighters, local public health and Harvard Vanguard personnel.
Forty personnel arrived? And were all of those responders trained in Ebola safety practices?
I heard both yes and no. Only people who may come in contact with the patient or his body fluids need to wear gloves and protective gear. But I also heard there was a call Sunday, after this incident, on which some participants felt the response was too much while others thought that a maximum effort is warranted as responders test and adjust their reaction to Ebola.
The ambulance took the patient to Beth Israel Deaconess Medical Center, where I imagine there were a few nervous staff members. Earlier Sunday, the CDC confirmed that a nurse who treated a man who died from Ebola in Dallas has come down with the virus. Continue reading
Pick your viral anxiety: Do you want to focus your media-fueled jitters on Ebola or on enterovirus D68?
Personally, even with today’s news of the first U.S. death from Ebola, I pick the enterovirus every time. For one thing, it’s actually around; it’s not a single case in Texas. But I’d prefer no anxiety at all, and the best antidote tends to be knowledge. So here are some data points:
The Massachusetts Department of Public Health fact sheet on enterovirus D68 is here and the CDC’s here. At a news conference last week, Dr. Alfred DeMaria, the department’s medical director for the Bureau of Infectious Disease, told reporters that enterovirus D68 had probably been “the predominant cause of respiratory illness over the last four weeks.”
Mostly, that meant colds, he said, and he thinks he even had the bug himself. But reports of lung ailments have “decreased significantly over the past couple of weeks,” he said, so “enterovirus 68 seems to be going away.”
Let’s hope. But what the heck? Here & Now reports that the enterovirus has been connected to five deaths nationwide, most recently of a 4-year-old in New Jersey. Of course, we know that viruses can sometimes lead to deaths by unleashing bacterial infections; flu has been known to kill dozens of American children in a bad year. But still, what to make of all the coverage of this unfamiliar virus?
I asked Dr. Ben Kruskal, chief of infectious diseases at Harvard Vanguard Medical Associates. My takeaway: Yes, this is quite a bit like flu, only it’s drawing attention because it’s a virus that’s acting atypically, surprisingly. Our conversation, edited:
There are so many viruses around; why are we even hearing about this one and what should we make of the coverage?
We’re hearing about it because it is not just a strain of a virus we don’t see very often but because it’s causing unusual manifestations, and manifestations that have enough impact for us to pay attention to. It’s actually in 30 or 40 states now, and we don’t really know how widespread it is because it’s clinically not terribly distinctive. It’s a respiratory virus that looks like a lot of other respiratory viruses, including the flu and the cold viruses and a whole bunch of others. And the reason we’re paying attention is not just the fact that it’s an unusual strain — then it would be a sort of laboratory curiosity — but because it’s actually on a more severe end of the spectrum for some people.
So it’s been confirmed that it’s here in Massachusetts, and it sounds like we have had more kids being hospitalized for respiratory trouble than usual in recent weeks, right? For example, Tufts Medical Center tells us that they’ve had 54 hospital admissions of kids with repiratory problems this year, compared to 27 admissions by this date last year, and they’re tending to stay in longer and need more treatment.
I understand from Dan Slater, who’s the director of pediatrics here at Harvard Vanguard, that we went months without having to admit any kids with asthma to the hospital, and in the last few weeks we’ve had quite a few admissions.
So what’s your public health message then at this point? What do you say to parents?
It’s reasonable to think of this outbreak in most respects as being like a sort of a nastier flu season. The timing is different from the flu season but in terms of how it manifests itself, it’s pretty similar to a severe flu. Remember that the flu and this virus — like any infectious agent — have a spectrum of severity. So even though this one is on average more severe, there are still lots of people who will get just a regular old cold. And there are some people who will get kind of a nasty cold. And there are some people who will get more severe things, including asthma-like illness in people who don’t have pre-existing asthma or an exacerbation of underlying asthma in people who do.
So are there telltale symptoms to watch for? Continue reading
Massachusetts has launched a new era of shopping. It began last week. Did you notice?
Right this minute, if you have private health insurance, you can go to your health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.
It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information — nothing. Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.
Then two years ago Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public. Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices.
“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”
There are caveats.
How much coffee do you drink every day? One cup in the morning? Or do you gulp it all day?
Scientists have long known that your DNA influences how much java you consume. Now a huge study has identified some genes that may play a role.
Their apparent effect is quite small. But variations in such genes may modify coffee’s effect on a person’s health, and so genetic research may help scientists explore that, said Marilyn Cornelis of the Harvard School of Public Health. She led the research.
Health care history unfolds in Suffolk Superior Court today. It may just be a status conference, but it could still be a heck of a show because…
1) The hearing is about a deal that many experts say will shape health care in Massachusetts for a decade or longer. It would limit, but not stop, the expansion of Partners HealthCare, already the largest hospital/physician network in the state.
2) There are some dramatic characters.
• Attorney General Martha Coakley, who’s running for governor, and taking a lot of heat for allegedly letting Partners off too easily. Coakley has repeatedly said she won many more concessions from Partners by negotiating than she would have by suing to try and stop Partners’ expansion. Her court filing is here.
• Some of the city’s top attorneys, representing Partners, the two hospitals it wants to acquire and dozens of supporters and opponents of the deal.
• Judge Janet Sanders, who has not, as far as I can tell, ever worked in health care, signaled that she may need expert help reviewing the voluminous materials filed about this agreement. And while Partners, South Shore Hospital and Hallmark Health are anxious to move ahead with their mergers, Sanders said on Friday that “the issues raised are too important to be dealt with hastily.”
Alerts about protests outside the courthouse went out last week.
But there’s another reason that health care industry watchers toss around words like “historic” or “milestone” in conversations about today’s hearing and the proceedings before Judge Sanders. This level of scrutiny — of one hospital system merging with another — is just very, very unusual in Massachusetts or elsewhere. It’s all triggered by the 2012 law that focuses on controlling health care costs. We are watching the sausage get made. It isn’t pretty or easy to decipher, but it is more open than anything I think we’ve seen before.