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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Possible Key To Weight Loss? Researchers Find ‘Master Switch’ To Crank Up Fat-Burning

Researchers say new science on a “metabolic master switch"  may hold the promise of someday making a dent in the obesity epidemic. (Courtesy UConn Rudd Center for Food Policy & Obesity)

Researchers say new science on a “metabolic master switch” may hold the promise of someday making a dent in the obesity epidemic. (Courtesy UConn Rudd Center for Food Policy & Obesity)

Here’s my fantasy: I’ve overindulged — let’s say, purely theoretically, on Cape Cod fried clams, french fries and beer — and would normally face the greasy regret and resign myself to extra carrots and cardio in the days to come.

But no. Instead, I simply pop a pill that cranks up my metabolism for a few hours so that I burn the extra calories instead of storing them as fat. I don’t gain an ounce.

That’s a very distant prospect. But new science on a “metabolic master switch,” just out in the New England Journal of Medicine, brings my dream one step closer to reality — and, researchers say, may hold the promise of someday making a dent in the obesity epidemic.

Until now, weight-loss treatments have focused on altering appetite and exercise, says MIT computer science professor Manolis Kellis, senior author on the paper. Now, “what we have in our hands is a third knob, if you wish, for controlling body fat,” he says. “It’s working directly on your fat cells to reprogram them to burn more energy rather than to store it as fat.”

In normal-weight mice, Kellis says, the effects of turning that knob are dramatic: “By changing the expression of one gene in these mice, they lose 50 percent of their body weight. You can feed them all the fat you want and they will not take on weight. They do not exercise more and they do not eat less, what they do is simply burn more energy when they’re awake, or even in their sleep.”

Dr. Melina Claussnitzer is lead author on the fat-burning paper just out in the New England Journal of Medicine. (Courtesy of Lovely Valentine)

Dr. Melina Claussnitzer (Courtesy of Lovely Valentine)

But mice are not men, of course. Could this work in humans?

“We experimented on human fat cells,” says Melina Claussnitzer, first author of the paper, a visiting professor at MIT and faculty member at Beth Israel Deaconess Medical Center. “And we found that we could flip them from energy-storing to energy-burning by altering the expression of a single gene — and, even more remarkably, by altering a single letter from our 3-billion-letter genome. And we could flip that switch back in either direction.”

Still, it’s a very long way from genetically editing human cells in a Petri dish to altering the metabolism of a breathing human, the researchers caution. The team has filed patents on their switch-flipping manipulations and are seeking to commercialize the approach and lead it into human clinical trials, Kellis says, but cannot speculate on a time frame.

So meanwhile, there’s no such thing as a free fried clam. But we can at least savor the story of how this cutting-edge science came to be.

Let’s begin in 2007, when researchers turned up the first genetic link to obesity, a region of the genome called FTO. To this day, it remains the strongest genome-obesity link: Some 44 percent of Europeans, it turns out, have a version that predisposes them to weigh more, on average five to seven pounds.

The natural next question was: How does it work? Does it make people eat more? Move less? Both?

Or neither, says Claussnitzer. “Despite seven years of intense efforts to hunt down a mechanism, no link has been made between the genetic differences in the region and altered functions in the brain.” Continue reading

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Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

Continue reading

Medical Professionals Voice Their Feelings In The Abortion Discussion

Abortion became legal in America 42 years ago. And since then, the voices for and against the procedure have been strong and usually certain.

But there’s one group routinely missing from the debate: medical professionals who perform abortions — or decide not to.

Now, some OB-GYN residents from Brown University’s medical school are lending their voices to the conversation about abortion. They’ve written essays featured in the journal Obstetrics and Gynecology. One of their teachers, Janet Singer, the lead author of the article, helped start a support group for Brown residents after one particularly anguished conversation.

For more, visit this earlier CommonHealth conversation with Singer.

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State-Funded Lab At Harvard Medical Aims To Reinvent Drug Discovery

Jerry Lin and Sharon Wang at the not yet one-year-old Laboratory of Systems Pharmacology at Harvard Medical School. The two are studying the effects of cancer treatment drugs on the heart. (Robin Lubbock/WBUR)

Jerry Lin and Sharon Wang at the not yet one-year-old Laboratory of Systems Pharmacology at Harvard Medical School. The two are studying the effects of cancer treatment drugs on the heart. (Robin Lubbock/WBUR)

Jerry Lin makes a few adjustments on his microscope and grins.

“Wow, it’s beating,” Lin says as a white cell floating across an inky black background begins to pulse. “That’s cool.” A few colleagues, including Lin’s lab partner, Sharon Wang, murmur approvingly.

“We want to take a real-time video to look at the pattern of how cells beat over time,” Wang says, explaining this stage of the experiment.

Once Lin and Wang understand the morphology of these heart muscle cells, they’ll test how the cells respond to various cancer treatments.

“Later on, we can look at how that frequency of beating responds to different drugs,” Wang says.

The experiment is important, says lab director Peter Sorger, because heart problems can be a side effect of a drug that stops the spread of breast cancer.

“On the one hand, it’s a marvelous magic bullet,” Sorger says. “On the other hand, it does damage on its way in. So the purpose of these studies is to understand precisely why that happens.”

Sorger and his team at the Laboratory of Systems Pharmacology are focused on cancer and on analyzing the ways cancer drugs affect the whole body. They aim to reinvent the drug development process through this systems approach, by going much deeper than would scientists supervising a typical clinical trial and by establishing a new model of collaboration. Continue reading

Everett Families, Doctors And First Responders Work To Combat Spike In Overdose Deaths

Struggling to find resource for her son as he battled his heroin addiction, Patti Scalesse decided to start the group Everett Overcoming Addiction. It brings together parents and patients who are learning to manage  substance abuse disorder. (Hadley Green for WBUR)

Struggling to find resources for her son as he battled his heroin addiction, Patti Scalesse decided to start the group Everett Overcoming Addiction. It brings together parents and patients who are learning to manage substance abuse disorder. (Hadley Green for WBUR)

Patti Scalesse says she never saw it coming. Even when she found a syringe cap in her car three years ago and called her son, Francis Kenney, to tell him not to let his friends get high in her car. When Kenney then told her they needed to talk, Scalesse never expected to hear that her boy was addicted to heroin.

“Not my kid, my kid would never use drugs, he was a Marine,” Scalesse remembers thinking. “Well guess what, he did.”

Kenney, then age 21, was discharged from the Marines with a prescription for pain medication. Within a year of his release, Scalesse says, he had switched to heroin and was asking her for help.

“I thought, OK, I’ll pack him a bag, give him a pillow, bring him to detox, five days later he’ll be home and everything will be OK. No one tells you that the next two to three years of your life is just pure chaos.”

– Patti Scalesse, speaking about her son's battle with addiction

They met in a park, down the street from a pizza joint where Scalesse learned her son routinely went into the bathroom to get high. Scalesse absorbed the shock and started figuring out how to fix the problem.

“I thought, OK, I’ll pack him a bag, give him a pillow, bring him to detox, five days later he’ll be home and everything will be OK,” she says with a dry laugh. “No one tells you that the next two to three years of your life is just pure chaos.”

Chaos, because Kenney relapsed several times, and Scalesse realized she didn’t know what to do.

“I went to the police station and city hall to see what sort of information I could get to get my son some help. Nobody had anything. They gave me a 1-800 number with a Post-it note,” Scalesse says.

So she started a group, Everett Overcoming Addiction, that brings together parents and patients who are learning to manage this chronic illness. Her son, now 24, spoke at a rally. Kenney has been off heroin for 10 months and has a job. But as Scalesse was building a website, planning events and reaching out to other families, the disease hit her family again.

“My nephew was just 17,” Scalesse says, sighing. “We did not know he was using, and we got the call that he had died.”

Continue reading

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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).

Related:

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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More Medical Marijuana Coverage:

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