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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Thousands Ruled Ineligible For Mass. Medicaid

Tens of thousands of people have been removed from the state’s Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker’s administration obtained by The Associated Press.

The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker’s plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents.

At $15.3 billion, MassHealth is the state’s single largest budget expense.

Based on the results of the redetermination process so far, the state was on track to achieve the savings it had hoped for in the current fiscal year without cutting benefits for eligible recipients, said Secretary of Health and Human Services Marylou Sudders. Continue reading

Bristol County Suicide Spike Not Just ‘A Bump In The Road’

Bristol County is seeing a surge in suicides.

On Monday, the Bristol County Regional Coalition for Suicide Prevention and the Bristol County District Attorney’s office released data on the extent of the issue in the county.

In the last three and a half years, 171 people in the county have died by suicide.

  • 2012: 35 confirmed suicides; 25 men and 6 women
  • 2013: 44 confirmed suicides; 29 men and 15 women
  • 2014: 58 confirmed suicides; 50 men and 8 women

The rash of suicides in Bristol County has affected mostly men in their early- to mid-50s. The number of men who have died by suicide has increased 72 percent over the past three years. These men often suffer from depression and substance abuse. And when they seek help, they are unable to find inpatient residential care.

“What we have happening in Bristol Country is not a bump in the road, and what we have happening is not a pothole. We have a sinkhole happening here in this county,” said Annemarie Matulis, director of the Bristol Country coalition.

There have been 34 confirmed suicides, 22 men and 12 women, so far this year. This means the county is on track to match the 2014 statistics or potentially surpass them, the coalition and DA’s office announced Monday.

Matulis says people close to someone who has died by suicide become themselves more prone to taking their own lives.

Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673).

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Suicide Rate Among Men Spikes In Bristol County

The number of suicides among white men between the ages of 45 and 65 spiked 72 percent from 2013 to 2014 in Bristol County, which includes 20 towns southwest of Boston and along the south coast including Taunton, New Bedford and Fall River.

The figures come from the Bristol County Regional Coalition for Suicide Prevention, which gets its data from the district attorney’s office. Among all the suicide deaths in 2014 in that county, 87 percent were men. Advocates say the male suicide rate last year was significantly higher than the state average, and the trend is similar so far in 2015.

The alarming increase in suicides in Bristol County — most of them among middle-aged men — is leading suicide prevention advocates to team up with the district attorney to get out the word that there is help. On Monday, the suicide prevention coalition and Bristol County District Attorney Thomas Quinn will release more specific data on suicide in the county. In addition, the coalition will hold a series of community forums to discuss male depression and suicide.

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A Warehouse Full Of Legal Weed: Medical Marijuana Takes Root In Brockton

The hallway is white, pristine, almost corporate. But the operation behind one nondescript door is something completely new and different for Massachusetts.

Five-hundred plants in white, 5-gallon buckets sway and grow strong in a breeze created by fans. Rows of LED lights turn the room purple, blue, green or red, depending on which spectrum the plants need for optimum growth. The air is moist. And there’s a hint of a certain smell in the air: the tangy, musky scent of marijuana.

Welcome to one of the state’s first legal pot farms, this one attached to a Brockton medical marijuana dispensary called In Good Health.

Marijuana plants at In Good Health in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health in Brockton. (Jesse Costa/WBUR)

Earlier this year, renting a 13,000-square-foot warehouse and planting several thousand marijuana seeds might have triggered a massive police bust, hefty fines and some serious time behind bars. But in April, this Brockton firm received its state license to grow marijuana for medical purposes.

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Self-Diagnosing Online? Study Finds Sites Are Only Accurate About Half Of The Time

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

There’s a new warning for those of us who go online to figure out why we have a stomach ache or a nagging cough or occasional chest pain.

Symptom checkers — those tools that let you enter information and then produce a diagnosis — are accurate about half of the time, according to a study out of Harvard Medical School.

How Symptom Checkers Rate

Rate at which each tool got a diagnosis correct in the first three suggestions:

Best Performing:
Symcat – 75 percent
Isabel – 69 percent
AskMD – 68 percent

Worst Performing:
BetterMedicine – 29 percent
Earlydoc – 33 percent
Symptomate and Esagil – 34 percent

Source: Harvard Medical School study (full table page 11)

Looking at 23 websites, the Harvard study found that a third listed the correct diagnosis as the first option for patients. Half the sites had the right diagnosis among their top three results, and 58 percent listed it in their top 20 suggestions.

“Users of these tools should be aware that their performance is not perfect by any means, there’s often inaccuracies or errors,” said Dr. Ateev Mehrotra, the study’s lead author.

At the Mayo Clinic, Dr. John Wilkinson said, “We’re always trying to improve, but if most of the time the diagnosis is included in the list of possibilities, that’s all we’re attempting to do.”

Wilkinson, an editor of Mayo’s symptom checker, said patients should not expect it to deliver the correct diagnosis.

“It’s designed to be a starting point,” Wilkinson said, one that will direct patients to the best articles and help them “be better equipped to have a conversation with their doctor or a nurse triage line or whatever the next step might be.” Continue reading

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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