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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Doctors In Massachusetts Now Required To Offer End-Of-Life Counseling

With a new state law taking available, this information will be offered for end-of-life care. (Robin Lubbock/WBUR)

Under new state regulations, patients with a terminal condition will be offered end-of-life information like this sample brochure, as well as counseling about their options. (Robin Lubbock/WBUR)

About nine months ago, John Polanowicz was in a hospital room at Brigham and Women’s watching his 44-year-old brother-in-law Bobby struggle to breathe. Bobby had advanced lung cancer. Now, with a tube down his throat, he was trying to respond to questions about his end-of-life wishes using a marker on a white board.

“We were all trying to decide,” Polanowicz recalled, “would we keep him trached and vented, and hope against hope that there would be some change in the disease process?”

Bobby was losing the battle with cancer. He had wanted to fight to the end, but no one had talked to Bobby about how to deal with the end.

“It would have been much easier for the family to have had some of these conversations before 4 in the afternoon on the day that he passed,” Polanowicz said.

On Friday, Polanowicz, Massachusetts’ secretary for health and human services, posts regulations designed to help patients like his brother-in-law avoid describing their final medical wishes with an erasable marker. Doctors, hospitals, nursing homes and other health providers in Massachusetts are now required to offer end-of-life counseling to terminally ill patients. The requirement, part of a 2012 law, takes effect Friday with the posting of rules about how it will work.

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Where Does Fat Go When You Lose Weight? Mostly Into Thin Air

(Phoney Nickle/Flickr)

(Phoney Nickle/Flickr)

By Richard Knox

A couple of years ago, Ruben Meerman took off 40 pounds. And that got him wondering: What exactly happened to all that fat?

Conventional wisdom was that he “burned” it off. Or sweated it off. Or excreted it. None of that satisfied Meerman, who has a physics degree and makes his living explaining science to schoolkids and for the Australian Broadcasting Corporation.

So Meerman tackled the problem and eventually came up with a surprising answer: Most of the lost fat disappears into thin air.

More specifically, 84 percent of those fat molecules get exhaled as colorless, odorless carbon dioxide. The other 16 percent departs the body as H-2-O — plain old water.

Meerman says the discovery “got me really excited because I’d stumbled onto a gap in the knowledge. It struck me as remarkable that no one had thought this was interesting enough to pursue.”

The British Medical Journal thought so too. It has published a paper, co-authored by biochemist Andrew Brown of the University of South Wales, in its annual Christmas issue, which features off-beat (but peer-reviewed) research.

Weight Loss Realism

Meerman hopes the work will dispel misconceptions held by health professionals as well as the general public. And, he hopes it will provide a helpful dose of realism to counter the impossible expectations millions have about weight loss.

If people understand where the fat goes (and how), they’ll get “why there’s a limit to how quickly you can lose weight,” Meerman said in a Skype interview from Sydney. “And if you understand the limit, you won’t be so quickly depressed if you don’t lose 20 pounds in the first two weeks.”

First, the misconceptions. Meerman and Brown surveyed 150 professionals — split equally among family doctors, dietitians and personal trainers — about where they think the fat goes during weight loss.

By far the most common answer was that the fat was transformed into energy or heat — that is, “burned off.” About two-thirds of doctors thought so. A slightly higher proportion of dietitians did too, and about 55 percent of personal trainers.

But that would violate the Law of Conservation of Mass. It’s a basic precept of chemistry, formulated in 1789 by the French scientist Antoine Lavoisier, which holds that mass is neither created nor destroyed in chemical reactions. The total mass at the end must equal the mass at the starting point — even if matter is quite transformed in the process, from solid to liquid or gas.

The Energy Of A Bomb

Meerman points out that if fat were transformed into pure energy during weight loss, the results would be cataclysmic. Continue reading

Gov. Patrick Announces $1M Grant To Help Develop Faster Ebola Test

Dr. Rick Sacra, a Massachusetts doctor who contracted the Ebola virus in Liberia, and Gov. Deval Patrick converse Tuesday at the State House. (Stephan Savoia/AP)

Dr. Rick Sacra, a Massachusetts doctor who contracted the Ebola virus in Liberia, and Gov. Deval Patrick converse Tuesday at the State House. (Stephan Savoia/AP)

The Massachusetts Life Sciences Center, a quasi-public agency, will issue a $1 million grant to help develop a faster, more accurate test for diagnosing Ebola, Gov. Deval Patrick announced Tuesday.

Also Tuesday, a Massachusetts doctor who had Ebola announced he’s returning to Liberia, where he contracted the virus, to resume his work.

The grant will support a partnership of local life sciences companies, nonprofits and academic institutions that will try to speed up the launch of an Ebola detection tool already in development by Diagnostics For All, a nonprofit organization.

Officials on hand for the State House announcement promised the new tool — which will accept a “single finger-stick of blood” and provide a clear “yes” or “no” response in 45 minutes — will be cheaper, easier to use and lead to earlier diagnosis than current tests.

They said current tests are time- and labor-intensive and not always sensitive enough to detect Ebola at its earliest onset, which they said is critical to containing and effectively treating the disease. Continue reading

Brigham And Women’s Vivek Murthy Confirmed To U.S. Surgeon General Post

A Brigham and Women’s physician will become the next U.S. surgeon general.

Democrats squeaked out a 51-43 vote Monday to confirm Dr. Vivek Murthy, 37, in the waning days of their control over the U.S. Senate.

Dr. Vivek Murthy is an internist at Boston’s Brigham and Women’s Hospital. His nomination for U.S. surgeon general has stalled, largely due to his advocacy of gun control. (Charles Dharapak/AP/File)

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

Murthy’s nomination stalled earlier this year when the National Rifle Association raised objection to Murthy’s characterization of guns as a health issue. Murthy said he would focus on childhood obesity, not guns, if approved as the nation’s top doctor. Many public health leaders and physicians fumed about the NRA’s influence, but the White House did not press for a vote and many of Murthy’s supporters assumed the nomination was dead.

Then on Saturday, Senate Majority Leader Harry Reid, using a procedural move, put Murthy’s nomination back in play. And on Monday he was approved by a single vote majority a year after being nominated and 17 months after the position was vacated.

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Tufts Medical Center And Boston Medical Center In Merger Talks

The wave of Massachusetts hospital consolidations is building.

Tufts Medical Center and Boston Medical Center (BMC) issued statements Wednesday night confirming that the two not-for-profit institutions are discussing a merger.

“Tufts MC is our neighbor, we know them, we respect them, and we share a common geography and a commitment to providing high quality care to all patients,” said Jennifer Watson, chief of staff at BMC. “Like the rest of the health care community we have considered strategic partnerships, and with Tufts MC we have recognized that the combination of our individual strengths could create a partnership uniquely positioned to improve health care in Massachusetts.”

“Our organizations share a commitment to high quality, lower cost health care and to serving every patient with the greatest respect and compassion,” Tufts Medical Center Vice President Brooke Hynes said in a statement. “We also share a mutual commitment to our academic missions of clinical excellence, teaching and research.”

It’s not clear how close the hospitals are to an agreement. They have separate medical schools that would not be part of the deal. The buildings are just over a mile apart (Tufts in Chinatown, BMC in the South End). Their missions have traditionally been somewhat different, with BMC as a major trauma and safety net hospital and Tufts striving to model the low cost, high quality alternative to other, more expensive Boston hospitals.

But it sounds like the talks are going well. Continue reading

MGH Patient Monitored For Possible Ebola ‘Cleared Medically,’ Discharged

A patient who was being monitored for possible Ebola and then tested positive for malaria was “cleared medically” and discharged from Massachusetts General Hospital Friday morning, hospital officials announced in a statement.

The patient’s release and current condition are not a threat to anyone else, MGH officials said. The patient, who has not been identified, had been under the hospital’s care since Tuesday.

“As we noted previously this patient had been definitively diagnosed with malaria and is responding well to anti-malaria treatment,” hospital officials said in the statement. “The patient has had no fever or other symptoms for the past 24 hours.”

In a press conference Wednesday, Dr. David Hooper, the head of Mass General’s infection control unit, said the patient had traveled to Liberia in recent weeks, but worked in an administrative role.

Hooper said he did not have the patient’s permission to disclose where he worked while in Liberia, but said the patient “did not have direct contact with Ebola patients” and was tested “out of an abundance of caution.”

MGH officials also noted in the statement that screening the patient for Ebola afforded them the “opportunity to see firsthand the benefits of the extensive preparations that have been under way through the hospital for the past several months.”

Officials praised their response and said preparations included carefully following Centers for Disease Control and Prevention protocols for treating possible Ebola cases.

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After High-Profile Death, Medical Errors Still Harm Hundreds Of Thousands

Betsy Lehman, a former Boston Globe health columnist, died as a result of a massive chemotherapy overdose. (Courtesy of the Lehman family)

Betsy Lehman, a former Boston Globe health columnist, died as a result of a massive chemotherapy overdose. (Courtesy of the Distel-Lehman family)

By Richard Knox

Two decades after a Boston Globe reporter died from a preventable medical error in one of the nation’s top hospitals, hundreds of thousands of patients in Massachusetts are still suffering as a result of medical mistakes.

A new survey finds that one in every four Massachusetts adults reports a mistake in their own medical care or that of someone close to them over the past five years — a rate that translates to more than a million people. Half of them say they or someone close to them suffered serious harm as a result.

The numbers come from a study commissioned by the Betsy Lehman Center for Patient Safety and Medical Error Reduction. It’s a state agency named for the Globe health columnist who died as a result of a massive chemotherapy overdose 20 years ago Wednesday.

The Lehman Center launched a renewed effort to reduce medical errors at an event Tuesday at the John F. Kennedy Presidential Library. The center, a state agency, was founded in 2004 but closed its doors in 2009 for lack of funding.

But now the center is up and running again, with $900,000 in annual state funding derived from a tax on medical institutions and health insurers.

The arresting new numbers on the impact of medical mishaps come from a Harvard School of Public Health poll, one of several studies commissioned by the Lehman Center and released Tuesday.

“If you translate our poll findings into absolute lives and numbers, approximately 1.2 million people in the commonwealth either experienced a medical error or had someone close to them experience a medical error over the last five years,” says Robert Blendon, who conducted the survey.

Prevention Efforts Fall Short

Blendon says the results suggest about 600,000 people suffer “serious health consequences” as a result of medical errors. Half the respondents told the Harvard researches the errors involved misdiagnosis, while many also report they got the wrong operation, drug, dosage, test or treatment. Other frequent errors involve infections that occurred as the result of patient care, and wrong or unclear instructions about followup care.

It’s strong evidence, experts in patient safety say, that the national movement to prevent medical errors has fallen far short of its goals.

At the same time, federal health officials on Tuesday released new data that suggest the national rate of medical errors has begun to decline. The report, by the Department of Health and Human Services, says the declining rate means that 50,000 fewer Americans died because of medical errors between 2010 and 2013 than otherwise would have.

‘It Could Happen To Anyone’

Lehman’s fatal overdose, detailed in the Globe by this reporter, helped launch a national movement to prevent medical mistakes. It’s cited in the very first sentence of a landmark 1999 report on medical errors by the National Institute of Medicine.

“When Betsy died it came as a great shock to everyone that something like that could happen,” says Barbara Fain, executive director of the Lehman Center. “One of the lessons is that if this could happen to Betsy, it could happen to anyone.” Continue reading

World AIDS Day: A Look At The Gains And Challenges In The Fight Against HIV

A woman adjusts a red ribbon, symbol of the fight against AIDS, during a demonstration on World AIDS Day in Spain on Dec. 1, 2014. (Alvaro Barrientos/AP)

A woman adjusts a red ribbon, symbol of the fight against AIDS, during a demonstration on World AIDS Day in Spain on Dec. 1, 2014. (Alvaro Barrientos/AP)

From ribbons to lights on buildings, you may have seen a lot of red Monday — it’s the symbolic color for World AIDS Day (Dec. 1), which raises awareness about HIV.

The day began in 1988, some years after the AIDS epidemic was first identified in the early ’80s. As the world marks the day with events and vigils, here is a look at the current state of HIV:

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Medical Marijuana 101: What Does A Dispensary Worker Need To Know?

As the marijuana industry takes shape in Massachusetts, it will need a trained workforce. What skills will that person behind the dispensary counter have? How about employees who will process marijuana? Who’s training these workers? Here’s a glimpse as the Northeastern Institute of Cannabis (NIC) in Natick opens its doors.

The Northeastern Institute of Cannabis in Natick (Martha Bebinger/WBUR)

The Northeastern Institute of Cannabis in Natick (Martha Bebinger/WBUR)

On a sunny fall afternoon, men and women sat at tables in a stark white classroom. For that day, the class was called “patient services.”

“Get a complete list of symptoms, right at the beginning,” instructor Bill Downing said. “Ask your patients, ‘How long have you suffered from this condition?’ It gives you a feeling for what their situation is.”

Downing, who is also a marijuana caregiver, clicks through charts that match the reasons patients use marijuana — relief from pain, depression, nausea and glaucoma, with compounds in the plant that are most likely to help.

CannLabs' breakdown of health benefits specific cannabinoids have for certain diseases. (Courtesy of CannLabs)

Click to enlarge: CannLabs’ breakdown of health benefits specific cannabinoids have for certain diseases. (Courtesy of CannLabs)

He runs through the marijuana-infused products his students would be selling at a dispensary: tinctures, lip balm, bubble bath, salves and lotions.

“Topical applications are great for localized pain,” he said. “And they don’t get you high.”

This is one of 12 classes students must complete and pass tests on to receive a certificate from NIC. It’s a for-profit training center with two classrooms in an office park. The course costs $1,500 and covers growing marijuana, legal, business, science and regulatory issues.

“This industry’s coming, and we need to be ready to train the workers,” said NIC events coordinator Chris Foye. “That’s what we’re going to do.”

NIC opened this fall. So far, 14 students have graduated and 70 more are enrolled. There’s one other classroom program in Massachusetts. The New England Grass Roots Institute says its classes are for person enrichment, not professional training. Foye says NIC is filling a demand from dispensary owners who will be required to pay $500 to register each employee yearly with the state. Continue reading

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Quadruple Amputee Gains New Arms, From Donor Who ‘Gave Best Hugs’

Will Lautzenheiser looked down at his rosy, fleshy new arm at a Brigham and Women’s Hospital news conference this week and exclaimed, “It’s the most beautiful arm!”

For three years, Lautzenheiser — a quadruple amputee in the wake of a virulent bacterial infection in 2011 — had lived without arms. Now, he and his Brigham and Women’s Hospital transplant team have just revealed, he has two new ones, the gifts of an anonymous donor. A medical team of 35, including 13 surgeons, operated on him for nine hours last month to attach them.

Lautzenheiser, 40, spoke with us last year in the video above about his “sit-down” comedy career: “Did You Hear The One About The Comedian With No Arms And Legs?” That armless footage is now outdated.

It will take months for the new arms and hands to gain sensation and function, but Lautzenheiser, a former film professor at Boston University, says he’s already putting them to good use, hugging his partner, Angel Gonzalez. “To be able to hold my love in my arms again is really the best,” he said.

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women's Hospital press conference. (Photo courtesy BWH)

Arm transplant recipient Will Lautzenheiser uses his new arms to hug his partner, Angel Gonzalez, at a Brigham and Women’s Hospital press conference. (Photo courtesy BWH)

The late donor put those arms to similar use, as described in a message from his family that New England Organ Bank President Richard Luskin read aloud to Lautzenheiser: “Our son gave the best hugs. We pray that you make a wonderful recovery and that your loved ones will be able to enjoy your warm embrace.”

Thus far, Lautzenheiser says, his new arms have little sensation, mainly just a bit of feeling in the skin right below where they’re joined to his own body. As for moving them, “If I really focus, I can occasionally move my thumb just a little bit, a few millimeters. It bends. I can pronate and supinate my wrist on my right arm. I have a little bit of wrist motion, a little bit of forearm motion.” Continue reading