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Memo To Gov.-Elect: Include Pain Sufferers As You Seek Opiate Solution

(tudedude via Compfight)

(tudedude via Compfight)

By Cindy Steinberg
Guest contrbutor

Cindy Steinberg is the policy chair for the Massachusetts Pain Initiative and the national director of policy and advocacy for the U.S. Pain Foundation.

Charlie Baker vows to tackle state opiate problem,” was the Boston Globe headline two days after Election Day.

It’s good to hear from our newly elected governor that he plans to take steps to curb the ongoing problem with illegal use of prescription medication in our state. There’s little doubt that too many lives are being harmed by drug abuse and addiction.

But in a quest to fix one problem, policymakers need to consider the potential unintended negative consequences for the patients for whom these medications are a lifeline.

Cindy Steinberg (courtesy)

Cindy Steinberg (courtesy)

Gov.-elect Baker said in that Globe interview that he plans to convene a coalition of lawmakers, health care providers and labor leaders to confront the opioid crisis in our state. Representatives of the pain community — an estimated 1.2 million Massachusetts residents live with chronic pain — must be included in these discussions as well.

For many with chronic pain, the right medications mean the difference between a life worth living or not.

But despite these legitimate needs, more and more I’m hearing from residents of our state who are unable to access treatment that their doctors say they need and that they depend on. These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia, severe back pain and many others.

These are not addicts; these are people who are trying to manage their lives with debilitating conditions such as cancer, diabetic neuropathy, sickle cell, daily migraine, fibromyalgia.

Not including members of the pain community in discussions about how these medications are prescribed, regulated and controlled marginalizes the lives of thousands of Massachusetts citizens who live with pain caused by a myriad of conditions and serious injuries.

There is not a silver bullet solution to solving the abuse of prescription drugs. We need to take a thoughtful, multifaceted approach to ensure that those who need pain medication have access to it, and that those who choose to abuse these medications are stopped. There is no group more invested in making sure that medications are responsibly controlled than members of the pain community. Continue reading

Boston Nurse Records 'Desperately Sad' Experiences Treating Ebola Patients In Liberia

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

A growing number of doctors, nurses and public health specialists across the U.S. are putting their lives on hold and heading to Ebola-ravaged regions of West Africa. Today, and in the months to come, we bring you the story of one man who is on the ground in Liberia.

John Welch, 33, is a nurse anesthetist at Boston Children’s Hospital, and works with Partners in Health (PIH) in Haiti. At least that was his life before he opened an email from the organization in late September. It was a call for volunteers and support as PIH moved into Liberia and Sierra Leone to try and stop Ebola’s spread. Welch told a supervisor he’d be happy to help if needed.

That decision, says Welch, “was about being on the right side of history. I think I would have trouble looking back, knowing that I had an opportunity, and had not stepped up.”

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he's going to Liberia. (Courtesy of John Welch)

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he’s going to Liberia. (Courtesy of John Welch)

Calming worried friends and family members was not so easy.

“How does your mother feel?” asks Lindsay Waller, an old friend and fellow anesthetist, who helps Welch prepare to discuss the decision with his family.

She’s upset and worried, Welch says, but “I am who I am because she’s my mother. [My parents] taught me these feelings of altruism and taking care of the people around you and helping out.”

The next day, on a quick trip from Boston to Columbus, Ohio, Welch makes a pitch he knows will resonate with his mother, aunt and sister: 70 percent of deaths from Ebola are women, the caregivers.

He asks his family to sit with him and watch a “Frontline” episode on Ebola. Fear and pain in the faces of patients with Ebola made the point for Welch.

“At first, I wanted to just say, ‘No, don’t go, it’s too dangerous,’ ” says Heidi Christman, Welch’s sister. But then, in the video, Christman says she saw “the brothers and sisters, friends and family that have been lost because of Ebola. And it made me realize that it’s not about me or my fears. It’s about helping these people. They deserve people like my brother.”

Her brother flew to Alabama for a CDC Ebola treatment training and in mid-October, three weeks after Welch said, “I’m in,” he was on his way to Liberia.

It wasn’t an easy journey. There are very few flights in and out of Liberia these days. Welch had several cancellations, spent an extra day in Casablanca, and his luggage was lost in transit.

When he finally lands in Liberia, Welch must take his temperature and wash his hands in chlorine, something he’ll get used to doing at least a dozen times a day. On the drive into Monrovia, a building, all lit up, stands out from a distance. Welch realizes it’s the large Doctors Without Borders Ebola Treatment Unit that he’s read about and seen in pictures. Suddenly, his assignments feels real.

After a few hours sleep, Welch leaves Monrovia and heads inland to a clinic in rural Bong County run by the International Medical Core. Welch is here to learn what it will take for PIH to set up a similar Ebola Treatment Unit in another rural county with few roads, power lines and little running water.

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4 More Mass. Medical Marijuana Dispensaries Approved

The Massachusetts Department of Public Health has given three companies provisional approval to open four medical marijuana dispensaries in the state.

Patriot Care Corp., which already has a Lowell dispensary in the works, was approved for dispensaries at 21 Milk St. in Boston and 7 Legion Ave. in Greenfield. Coastal Compassion Inc.’s proposed facility at 2 Pequod Rd. in Fairhaven and Mass Medicum Corp.’s on Revolutionary Drive in Taunton were also approved to enter the inspection and permitting phase.

The four dispensaries are proposed in counties that did not previously have any provisionally approved medical marijuana dispensaries.

Eleven other dispensaries that have already been provisionally approved are currently going through the permitting and inspection process. No dispensaries have received final registration certificates yet.

“We’re really in a fabulous spot,” in terms of the progress DPH is making, medical marijuana program director Karen van Unen said. She added that the first dispensaries are expected to open in late winter.

But the program is considerably behind timetables set under the state law approved by Massachusetts voters in November 2012. DPH has come under fire from patient advocates who say the state isn’t doing enough to ensure patient access to medical marijuana.

As WBUR’s Lynn Jolicoeur reported earlier this year, the DPH has faced widespread criticism for not thoroughly vetting applicants before provisionally approving 20 dispensaries in January:

After revelations of false or misleading claims on applications, and accusations of political favoritism, DPH launched a more thorough verification process and nine of the original 20 dispensaries were eliminated.

There are still no planned medical marijuana dispensaries for four counties — Dukes, Nantucket, Berkshire and Hampden. By law, each county is required to have at least one, but no more than five, dispensaries. There’s also a large swath of the state including Worcester and the surrounding area that has no planned dispensary.

Van Unen acknowledged she’s concerned about the slower-than-expected rollout of the medical marijuana program.

“It’s just as important to us as it is to patients to make sure that access is there, but we also felt very strongly that we need to do this diligently and do it right,” van Unen told WBUR. “We’re able to now start focusing on how we’re going to move forward to ensure that we meet the voters’ will and ensure that we have at least one dispensary in every county, as well as serving the under-served areas.”

DPH recently unveiled its physician and patient medical marijuana registration program and plans to report its first data in February, which van Unen says will allow the agency to better pinpoint areas that need dispensaries.

The state plans to open a new round of dispensary applications sometime next year.

More Medical Marijuana Coverage:

6 Mass. Hospitals Collaborate On Ebola Response Plan

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

Updated at 5 p.m.

BOSTON — Massachusetts public health leaders said Friday that while the risk of Ebola remains very low in the state, six hospitals are prepared to handle one patient each, meaning the state could treat six patients at any given time.

The announcement clears up some confusion around which hospitals are ready to care for an Ebola patient if there is a confirmed case in Massachusetts.

The six hospitals collaborating to provide care include Bay State Medical Center in Springfield and five Boston facilities: Boston Medical Center, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Tufts Medical Center and Massachusetts General Hospital.

“Hundreds of people at each hospital have spent incalculable hours in the necessary planning, training and practice efforts that are needed to respond to the challenges posed by this disease,” said Dr. Paul Biddinger, vice chair of emergency preparedness at Mass General.

Boston Children’s Hospital says it expects to join the Ebola treatment collaborative, and UMass Memorial in Worcester may as well.

The other 59 acute care hospitals in Massachusetts would screen a patient, hold anyone who is at high risk or Ebola-positive in isolation, and then transfer the patient, says Public Health Commissioner Cheryl Bartlett.

“By creating this coordinated, collaborative system, we reduce the number of people who have to have that level of intensive training to care for an Ebola patient and this is one of the reasons for our announcement today,” Bartlett said.

Massachusetts hospitals do not expect to take Ebola patients from other states. Bartlett says the Centers for Disease Control has asked each state to be ready to care for its own.

All this costly planning is making some physicians, nurses and other hospital staff nervous.

“We’re fighting fear with facts and being direct with our staff members,” said Dr. Eric Goralnick, medical director of emergency preparedness at the Brigham. “Obviously there is a lot of anxiety around this issue. We’re being aggressive around communications, and listening and listening and listening, and educating, and focused on training, exercising and preparing for this.”

There is no uniform policy for staff who treat Ebola patients in Massachusetts hospitals, but several say personnel could come and go as they would on any shift. Each doctor, nurse or lab worker would monitor their temperature twice a day.

Hospitals that take Ebola patients expect a financial hit as patients avoid “the place that is treating Ebola.” In announcing the collaborative hospital effort Friday, the Department of Public Health stressed the work it has done to prepare for Ebola, but some hospitals say they need more help with equipment, training and the possible loss of business.

More Coverage:

Against Odds, Menino Fought Successfully To Merge 2 City Hospitals

At rear left is Boston Mayor Thomas Menino, pictured standing near, Sen. Edward M. Kennedy, D-Mass., shakes hands with nurse Janet Killarney while visiting the Boston Medical Center in 2004. (Charles Krupa/AP)

At rear left is Boston Mayor Thomas Menino, pictured standing near, Sen. Edward M. Kennedy, D-Mass., shakes hands with nurse Janet Killarney while visiting the Boston Medical Center in 2004. (Charles Krupa/AP)

In 1996, it took all of Boston Mayor Thomas Menino’s political muscle to pull off what some consider a managerial miracle. Despite intense union opposition, a reluctant city council and concerns about health care costs, Menino fought successfully for the merger of two city hospitals that had been founded in the mid-19th century.

Today, Boston Medical Center stands as an enduring legacy to Menino’s efforts to serve the health needs of the city’s neediest citizens.

On Thursday a steady stream of ambulances, people in wheelchairs and children pushed in strollers entered and left the Menino Pavillion on the Boston Medical Center campus.

“Me and all my children go here. It’s a great hospital,” said Jasmine Vigo, who was leaving the Menino Center with her infant son.

“He was wheezing. I wanted to make sure it wasn’t like a viral infection or something like that. He didn’t,” she said.

Vigo said she had all four of her children in the Menino building.

The eight-story brick building, bearing the former mayor’s name, contains clinics for adults and obstetrics. Its emergency room is the busiest in the Northeast. Meanwhile, its pediatric clinic provides health care to 30,000 kids a year — and that’s just at this one building on the sprawling Boston Medical Center campus.

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Gottlieb Leaving Partners HealthCare For Partners In Health

Partners CEO Dr. Gary Gottlieb

Partners CEO Dr. Gary Gottlieb

The CEO at Partners HealthCare, the state’s largest private employer, plans to step down.

Dr. Gary Gottlieb agreed Friday to become the CEO at Partners in Health, a global health organization whose latest project is an Ebola response effort in West Africa.

Gottlieb is scheduled to make the transition on July 1, 2015. His decision comes amid acourt review of Partners’ controversial expansion plans and questions about Gottlieb’s ability to manage political dynamics outside the hospital network.

His supporters point out that Gottlieb has just begun his second five-year contract, and they say Partners board members urged Gottlieb to stay. But some current and former Partners leaders say dissatisfaction with Gottlieb’s leadership has been building for months and that the Partners in Health job offers Gottlieb a graceful way out.

He will take a dramatic pay cut, from more than $2 million a year to $200,000 a year at Partners in Health.

Gottlieb serves on the board at Partners in Health, has visited the group’s projects in Haiti and Rwanda, and calls it the most important global health initiative in the world.

“This is a singular opportunity to lead that organization at a time when it is clear that improving sustainable health care throughout the world is critical to all of us,” Gottlieb said.

Gottlieb says he began thinking seriously about moving to Partners in Health this summer, and decided to make the change earlier in the fall after hearing Partners in Health co-founder Paul Farmer describe what was happening in West Africa.

“With Ebola, maternal deaths had increased because there was no place for people to deliver babies,” said Gottlieb. “Malaria deaths had increased because there was no way to provide the appropriate care for what is a more ordinary terrible disease. The notion that building sustainable health care was essential for real social justice and real change had become even more obvious.” Continue reading

Study Raises Questions About Military Service Causing Chronic Suicidal Tendencies

A new study commissioned by the U.S. Army has found that the mental health of soldiers isn’t as different from civilians as the researchers previously thought.

Earlier this year, researchers said that soldiers, who were surveyed at different times during their Army careers, had higher rates of mental disorders before they enlisted than the rates of mental illness in the general population.

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Uber Pilots Program To Bring Flu Shots To Your Door

In this April 3, 2014 photo, a smartphone is mounted on the glass of an Uber car in Mumbai, India. Riding on its startup success and flush with fresh capital, taxi-hailing smartphone app Uber is making a big push into Asia. The company has in the last year started operating in 18 cities in Asia and the South Pacific including Seoul, Shanghai, Bangkok, Hong Kong and five Indian cities. (Rafiq Maqbool/AP)

A smartphone with the Uber app is mounted on the glass of an Uber driver. (Rafiq Maqbool/AP)

If you used Uber in Boston today, you may have noticed a new feature. The car service company was offering what it calls UberHEALTH to bring free flu shots to users’ doors.

The service was part of a one-day pilot program in Boston, New York and Washington D.C., the company announced on its blog.
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Colleges Are Inconsistent In Handling Athlete Concussions, Harvard Study Finds

Colleges remain inconsistent in the way they handle athletes’ concussions, according to a Harvard University study that comes more than four years after the NCAA began requiring schools to educate their players about the risks of head trauma and develop plans to keep injured athletes off the field.

In a survey that included responses from 907 of the NCAA’s 1,066 members, researchers found that nearly one in five schools either don’t have the required concussion management plan or have done such a poor job in educating their coaches, medical staff and compliance officers that they are not sure one exists.

West Virginia's Terrell Chestnut is examined by medical staff during an NCAA college football game against Baylor earlier this month. He later left the game with a concussion. (Chris Jackson/AP)

West Virginia’s Terrell Chestnut is examined by medical staff during an NCAA college football game against Baylor earlier this month. He later left the game with a concussion. (Chris Jackson/AP)

“Collectively, the institutions without a concussion management plan are responsible for the well-being of thousands of college athletes each year,” according to the study co-written by Harvard researcher Christine Baugh and published this week in the American Journal of Sports Medicine. “For stakeholders to follow an institution’s concussion management plan – or to have confidence that others are following the plan – they must first know that it exists.”

The findings in the study reinforce the images fans have seen in stadiums since the problem with concussions became more widely known: Wobbly players are sent back onto the field without proper medical clearance as coaches remain ignorant to their injury – perhaps willfully. The authors recommend that the NCAA bolster its 2010 policy to require schools to make their plans public, to better educate coaches about concussion symptoms and to require that schools not only come up with plans but actually apply them.

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Surgeon General Nominee Murthy Loses Support Of Key Backers

Dr. Vivek Murthy (Charles Dharapak/AP/File)

Dr. Vivek Murthy (Charles Dharapak/AP/File)

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.

The New England Journal of Medicine (NEJM) endorsed Vivek Murthy in May, but an editorial published Wednesday withdraws that support.

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