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.

Must-Watch Video: Paralyzed Woman Uses Brain Signals To Serve Self Coffee

[Youtube.com]

The first reason to watch this 4-minute video of a paralyzed woman using her brain signals to move a robot arm is that you will never take for granted again your ability to lift your morning cup of coffee to your mouth.

The second reason is that it’s the latest cool development to come out of the BrainGate project, which showed that it’s possible to “read out” brain signals in paralyzed people and convert them into actions, previously by moving a computer cursor and now a robotic arm. The journal Nature has just published the robotic-arm results, and posted the video above. Read the full press release from Brown University here. From Brown:

Researchers in the BrainGate collaboration of the Providence Veterans Affairs Medical Center, Brown University and Massachusetts General Hospital describe experiments in which two participants with tetraplegia used the investigational* BrainGate BCI [Brain-Computer Interface] to precisely control robotic arms to reach and grasp for objects in three-dimensional space. They controlled the robots by thinking about moving their own arms and hands. This is the first demonstration of 3D control of robot arms by neural activity of people.

On a particularly poignant day in the research, one of the participants used a robot arm to pick up a bottle of coffee, bring it to her lips and tip it to take a drink through a straw. It was the first time she had served herself anything to drink for nearly 15 years. Her smile after she had taken a sip was especially inspiring because her success indicated that the BrainGate team’s research has moved substantially closer toward the goal of restoring independence for people who have lost functional control of their limbs.

Suggestion: The smile comes at about 3:30 in the video. Don’t miss it.

FILED UNDER: Medicine/Science, Science, neuroscience

May 16, 2012 | 11:51 AM | By Carey Goldberg

The Nation’s Least Active High Schoolers: How To Get Mass. Kids Moving More

(geograph.org.uk)

Massachusetts tends to do well compared to other states on measures of obesity and activity — but not that well. Particularly our high school students: They score worst in the nation on getting the recommended daily hour of physical activity.

Children’s exercise levels are the topic of discussion today at a Massachusetts Health Policy Forum hosted by Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care Foundation and The Boston Foundation. It’s titled “Overweight and Obesity in Massachusetts: A Focus on Physical Activity,” and aims to address the need to coordinate state, local and school efforts to increase kids’ activity levels. From the briefing paper released today by the Mass. Health Policy Forum:

Overall, Massachusetts ranks 33^rd for the percentage of children who are obese and ranks dead last with the lowest percentage of high school students who meet the recommendation for 60 minutes of moderate to vigorous exercise daily.

Among Massachusetts high school students:

67% of students were not regularly physically active and fare worse than the national average.

Only 17% of students were physically active daily.

82% did not attend physical education classes daily and fare worse than the national average.

Over 23% of children reported not being physically active for 60 minutes on any day.

30% of students reported watching television for 3 or more hours per day on school days.

What is to be done? Clearly that’s a topic worth many hours of discussion, but the brief also includes this useful chart of what other states have been doing: Continue reading →

FILED UNDER: Medicine/Science, fitness, pediatrics

May 16, 2012 | 10:59 AM | By Carey Goldberg

Provost Reif, Steward Through Financial Crisis, Elected MIT President

New MIT President L. Rafael Reif (Courtesy of MIT)

As WBUR reports here, MIT has just named its 17th president: L. Rafael Reif, an electrical engineer who has been the university’s provost for the last seven years and helped shepherd it through the recession.

The full MIT press release is here, but a couple of highlights: He helped balance the university’s budget through the financial crisis of recent years, and he grew up poor in Venezuela and earned electrical engineering degrees from Stanford despite speaking little English when he arrived. From MIT:

As the Institute’s chief academic officer since 2005, Reif led the design and implementation of the strategy that allowed MIT to weather the global financial crisis; drove the growth of MIT’s global strategy; promoted a major faculty-led effort to address challenges around race and diversity; helped foster the emergence of an innovation cluster adjacent to MIT in Kendall Square; led the development of MITx, the Institute’s new initiative in online learning; and led MIT’s role in the formation of edX, the recently announced partnership between MIT and Harvard University that builds on MITx and that aims to enrich residential education while bringing online learning to great numbers of people around the world.

On money:

The family was poor, supported by his father’s work as a photographer, and spoke Spanish and Yiddish at home.

Reif played a critical role in balancing MIT’s budget before, during and after the global financial crisis. Early in his tenure as provost, he led a “rebalancing” process that eliminated a $50 million structural deficit — putting the Institute in a much better position to weather the global downturn that began in 2008. Then, after the crisis struck, Reif led the team that designed and implemented the strategy for managing budget cuts. Among other steps, a 200-member Institute-wide Planning Task Force ultimately achieved significant long-term cost reductions by acting upon 77 percent of all ideas submitted by members of the MIT community.

And some fascinating personal notes:

Leo Rafael Reif (pronounced “rife”) is the youngest of four sons of Eastern European emigrés who fled Europe in the late 1930s, living first in Ecuador and then Colombia before settling in Venezuela. The family was poor, supported by his father’s work as a photographer, and spoke Spanish and Yiddish at home. Continue reading →

FILED UNDER: Medicine/Science, Money, Science, MIT

May 16, 2012 | 9:13 AM | By Carey Goldberg

The Ancient Rome Angle On Mass. Health Reform, Circa 2012

The emperor Diocletian (fmschmitt.com)

Boston Globe columnist Jeff Jacoby is often too caveman-ish for my taste, but he certainly gets erudition points today for comparing Gov. Deval Patrick to the third-century Roman emperor Diocletian.

In a column headlined “On health care, state doesn’t know best,” he describes Diocletian’s “famous” (I guess to everyone but me) “Edict on Prices.” It “established price ceilings for a wide range of goods and services,” and it totally backfired, leading to hoarding, black-marketeering, speculation and a general economic worsening. Now to the proposals afoot to contain rising health costs in Massachusetts:

These bills aren’t written in Latin and they don’t impose the death penalty, but their core principle is not much different from Diocletian’s: The state knows best. What fraction of the local economy should health care consume? How fast should medical spending rise? On what business model should provider networks be organized? How should hospital and doctors fees be calculated? Where should consumers get information on quality and cost of care? When are a provider’s high rates justified? What penalty should it bear when they aren’t? In the world these plans envision, decision after decision comes not through the voluntary interplay of doctors, patients, hospitals, and insurers, but from government agents who impose them from above.

And his conclusion: “Price controls invariably make economic problems worse. It was true in Diocletian’s Rome. It’s no less true in Deval Patrick’s Massachusetts.”

There are already some thoughtful comments, both agreeing and disagreeing, below the column on the Globe’s site here. Including: Continue reading →

FILED UNDER: Medicine/Science, Politics, health reform 2012, mahealthcosts

May 15, 2012 | 9:37 AM | By Rachel Zimmerman

Blame It On Binky: Sippy Cups, Pacifiers And A Trip To The Emergency Room

At a recent baby shower, a pregnant colleague received a pacifier with an attached fuzzy lamb — easier to find and keep in the infants’ mouth. We all oohed and ahhed. But perhaps this darling little sucking device should have come with a black box warning: a new study found that every four hours a child is treated in the emergency department for injuries related to her pacifier, sippy cup or baby bottle.

In what’s being called the first study of its kind, researchers estimate that on average 2,270 injuries per year in the U.S. are related to mishaps involving these ostensibly soothing devices. Most of the accidents examined here involved falls with the product in the child’s mouth.

A new source of parental anxiety: pacifiers, bottles and sippy cups (Nationwide Children's Hospital)

The study, published in the journal Pediatrics, and conducted by researchers at the Center for Biobehavioral Health and the Center for Injury Research and Policy at Nationwide Children’s Hospital also found (according to the news release):

…that from 1991 to 2010, an estimated 45,398 children younger than three years of age were treated in U.S. emergency departments for injuries related to the use of these products. This equates to an average of 2,270 injuries per year, or one child treated in a hospital emergency department every four hours for these injuries.

The study [released online May 14 and published in the June print issue of Pediatrics] found that baby bottles accounted for 66 percent of injuries, followed by pacifiers at 20 percent and sippy cups at 14 percent. Body regions most commonly injured were the mouth (71 percent) and the head, face or neck (20 percent). Continue reading →

FILED UNDER: Medicine/Science, accidents, children's health, pacifiers, sippy cups

May 15, 2012 | 9:07 AM | By Rachel Zimmerman

Patrick To Business: Cut Health Care Costs Aggressively, Let Government Play A Role

Gov. Deval Patrick. (Photo: Massachusetts Energy and Environmental Affairs/flickr)

For the first time since lawmakers in the Massachusetts House and Senate unveiled separate plans to cut health care costs, Gov. Deval Patrick is weighing in.

At a Greater Boston Chamber of Commerce breakfast this morning, Patrick told business leaders that the state should set aggressive spending targets, let government play a role in keeping insurance premiums down, and not necessarily create an entirely new agency to oversee the new reforms. In making his case for government oversight as a way to counter a not-always-reliable marketplace, Patrick put himself at odds with several elements of both the House and Senate plans.

“Industry can do better than the GSP [Gross State Product],” he said, according to a copy of his prepared remarks given to WBUR. “I certainly could not imagine accepting GSP plus anything…”

Here is Patrick’s entire speech, as prepared for delivery, from his office:

Thank you very much, Paul, and good morning, ladies and gentlemen.

As I think about the last couple of times we have been together at a Chamber breakfast, I realize I often come here to talk about health care. It makes some sense to do so in this company. Health care reform is one of the most important public-private initiatives in recent Massachusetts history. Many of you helped create and now help sustain it, and all of you deal with the challenge of rising insurance premiums. So you will understand if I return to the subject again this morning, especially given the developments of the past two weeks – and the past two years, for that matter.

We have a lot to be proud of when it comes to health care reform. We started with the belief that health is a public good and that everyone deserves access to affordable, quality care. That, for us, is a basic value, an expression of the kind of Commonwealth we want to live in, meaningful enough to motivate a broad coalition of legislators, policy makers, business and labor leaders and patient advocates in 2006 to reform the way we access health care.

And that reform is working. Here are the facts:

Almost everyone has access. 98.2 percent of our total population is insured. 99.8 percent of children. While the national trend between 2006 to 2010 was going in the other direction, we increased the number of insured in Massachusetts by more than 400,000 people.
Continue reading →

FILED UNDER: Insurance, Medicine/Science, Money, Gov. Deval Patrick, health cost bill

May 14, 2012 | 5:04 PM | By Carey Goldberg

Oh, Joy! The Prospect Of Laxative-Free Colonoscopies

(ex_magician/flickr)

Even now, weeks after my first colonoscopy, certain tastes and smells still trigger odd sensory flashbacks to the gallon of salty-swampy laxative liquid I had to glug to clean out my intestines before the procedure.

The taste didn’t seem so bad at first. I scoffed at all the whiners who have made the nastiness of colonoscopy prep so legendary. But near the end of the gallon, I found myself gagging and forced to suck on lollipops to help the swallowing along. Not that I’d ever skip the test. Colon cancer is too common and deadly, killing 50,000 Americans a year, and the effectiveness data on colonoscopies look good. Still, I couldn’t help wondering aloud: Does it really, truly have to be like this?

So even though the prospect of a laxative-free colonoscopy is years away, I can make no pretense of journalistic objectivity. I’m overjoyed to share this news: A new study out of Massachusetts General Hospital, following about 600 patients, suggests that a colonoscopy without the noxious preliminaries is feasible.

The point isn’t just to make life easier for people getting colonoscopies. It’s to help persuade them to get the test in the first place.

I did my due diligence: I asked the study’s leader, Dr. Michael Zalis, director of CT Colonography in the hospital’s imaging department, whether any potential financial conflicts needed to be disclosed — a start-up to develop laxative-free colonoscopies, that kind of thing? But no, no such disclosures, he said. The study was funded by the American Cancer Society, General Electric and the National Institutes of Health. Good enough — please sign me up for ten years from now.

A bit of background: Medical innovators had already invented the “virtual colonoscopy,” in which a patient’s innards are inspected using an abdominal CT scan rather than by inserting a long fiber-optic tube with a camera and a light on the end. But the patient still has to go through the colon-cleansing prep. The new study, just out in the May 15 Annals of Internal Medicine, takes the “virtual” one step farther: it uses software and a special contrast agent to make the colon cleanse virtual as well.

The point isn’t just to make life easier for people getting colonoscopies; It’s to help persuade them to get the test in the first place. Only about half of adults follow the recommendations for getting tested — which include universal testing for people over 50 — and surveys find that the nastiness of the prep is part of the problem.

Let me cut to the chase: If all goes well, I asked Dr. Zalis, how soon might the virtual cleansing be available? Conservatively speaking, he said, at least one more study is needed to confirm his team’s results, and that will probably take at least three years. Continue reading →

FILED UNDER: Medicine/Science, Money, Science, cancer screening, colonoscopy

May 14, 2012 | 12:21 PM | By Carey Goldberg

Berwick On Mass. Health Reform: More Pain, More Gain

Dr. Donald Berwick, former Medicare chief

I don’t know about you, but when my dentist says that I’m about to experience some “temporary discomfort,” I know what that really means is, “Hang in there, this is going to hurt like heck.”

In the Boston Globe, Dr. Donald Berwick, the widely admired former chief of Medicare and one of the nation’s leading health policy mavens, has just weighed in on the competing proposals for cost-cutting reform in Massachusetts. He argues in favor of aiming for more ambitious cost-cutting targets: The House’s tougher goal rather than the Senate’s less ambitious one, or even the still-tougher target put forth by business and religious groups.

I must say that what struck me most in his essay were the repeated references to pain for a good cause. Massachusetts needs “large-scale changes in delivery that will be temporarily uncomfortable for most providers.” Government must step in because “The changes are just too hard for most to face.” And “Undoubtedly, this transition will be wrenching.” I’m left wondering: Is there a political equivalent to Novocaine?

The whole piece is an important read but here’s an excerpt: Continue reading →

FILED UNDER: Medicine/Science, donald berwick, health reform 2012, mahealthcosts

May 14, 2012 | 10:57 AM | By Carey Goldberg

Health Reform 2012: Hello, How Much Will My Care Cost?

phone

“Hello, is this the state medical care price line? My doctor says I need to get a mammogram, and suggested I go to XYZ imaging center. I have ABC insurance. Could you please tell me how much that will cost me? $200? Okay, thanks very much.”

Not exactly how things work now, is it? But as the Massachusetts legislature works toward the next, cost-cutting phase of health reform, both the House and the Senate proposals envision a toll-free number and online information for patients who want a sense in advance of how much their care is about to cost.

Costs of Care founder Dr. Neel Shah

I asked Dr. Neel Shah, founder and executive director of the Boston nonprofit Costs of Care, what he thought of the legislative proposals. He was just coming off a night shift for his day job, as a senior resident and soon-to-be chief resident in Obstetrics and Gynecology at Brigham and Women’s Hospital, but he kindly shared some thoughts, reacting in part to chunks of the draft bills that talk about price disclosure (see the bottom of this post.) Our conversation, edited:

Judging by the draft bills released in the last few days by the House and Senate, you’re about to get your wish: Medical costs in Massachusetts are likely to become much more transparent to patients. Is that true?

A; Well, I’m cautiously optimistic. I think it’s important to keep our eye on the overall goal of the legislation, which is to improve the value of the care we’re delivering and help us get more bang for the buck.

There are a lot of different parts of the bills. None of them is a silver bullet solution but they’re all important steps. The cost transparency part of the bill gets us part of the way there.

What do you mean?

First, a disclaimer: I’m not pessimistic about this. But to speak more broadly for a minute: Every year, in our essay contest we get dozens of anecdotes from all over the country that illustrate how difficult it is for patients to find out what their care will cost. It’s really hard on patients, and for physicians it’s not any easier. Continue reading →

FILED UNDER: Medicine/Science, health reform 2012, mahealthcosts

May 11, 2012 | 1:31 PM | By Carey Goldberg

When You Lose Your Sport, What Happens To Your Self?

I saw this flyer recently on my gym’s bulletin board. The loneliness and loss of identity it describes are surely shared by a great many people who have to leave sports, famous or not, but what comes to mind is the suicide of Junior Seau, the 43-year-old former NFL player who shot himself in the chest last week.

Much of the coverage has focused on the possibility that Seau, like many other football players, suffered concussions that wrought permanent damage to his brain. But what struck me most were the descriptions of him as a player — upbeat, intense, loving the game — and then his life after retiring: He drove his car off a cliff in 2010. His girlfriend told police he assaulted her.

Junior Seau smiles during 2007 football training camp in Foxborough, Mass. (AP)

“I’m sorry to say, Superman is dead,” said San Diego Chargers chaplain Shawn Mitchell after Seau’s suicide, according to The Associated Press. “All of us can appear to be super, but all of us need to reach out and find support when we’re hurting.”

Finding support is the idea behind the therapy group that Dr. Matthew Krouner, the Brookline post-doctoral fellow in clinical psychology who posted that notice above, is aiming to put together.

It would not be only for elite athletes, he said. “This group could be for anybody who has at one time identified themselves as an athlete. It could be high school, it could be they like to run marathons, it could be they play pick-up basketball once a week. But once you’re not able to do that anymore, even if it’s not a professional identity, there’s a real sense of loss and a grieving that can take place. For elite athletes, the transition out of sport is conceptualized as a loss or grief experience.”

‘For elite athletes, the transition out of sport is conceptualized as a loss or grief experience.’

Dr. Krouner never had a stellar sports career himself, he says, but always played, and had long been fascinated by stories of pro athletes whose lives deteriorated after they retired from sports at young ages, when many people are just starting their careers. They had to face the monumental challenge of losing an “all-encompassing identity — it’s how you relate to other people, it’s how you use your body, it’s your mental stimulation.”

Athletes have become more open in recent years about mental health issues, reducing the stigma. So “it seems like a good time for more supports to be out there,” Dr. Krouner said. “There tends to be a sort of expected toughness factor among athletes and that may make them less likely to seek out mental health resources, but hopefully by putting more and more out there, it can appeal to the need that is present.”

That need is very real, said Justine Siegal, director of sports partnerships at Northeastern University’s Sport in Society program and a doctoral candidate in sports psychology there.

Plan the exit well in advance

It is estimated that about 20 percent of athletes need “considerable psychological adjustment” after they leave the sport, she said. Continue reading →