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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Mass. Becomes First State To Require Price Tags For Health Care

CLICK TO ENLARGE: Massachusetts residents can now shop for their health care online, seeing prices for procedures and visits. (screenshot)

CLICK TO ENLARGE: Massachusetts residents can now shop for their health care online, seeing prices for procedures and visits. (screenshot)

Massachusetts has launched a new era of shopping. It began last week. Did you notice?

Right this minute, if you have private health insurance, you can go to your health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.

It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information — nothing. Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.

Then two years ago Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public. Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices.

“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

There are caveats.
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DNA Linked To How Much Coffee You Drink

A woman holds a coffee drink outside a Starbucks in Chicago on May 31. (Gene J. Puskar/AP)

A woman holds a coffee drink outside a Starbucks in Chicago on May 31. (Gene J. Puskar/AP)

How much coffee do you drink every day? One cup in the morning? Or do you gulp it all day?

Scientists have long known that your DNA influences how much java you consume. Now a huge study has identified some genes that may play a role.

Their apparent effect is quite small. But variations in such genes may modify coffee’s effect on a person’s health, and so genetic research may help scientists explore that, said Marilyn Cornelis of the Harvard School of Public Health. She led the research.
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Just A Status Conference On Partners Deal, But Health Care History

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley, a key player in the Partners deal and also a candidate for governor. (Steven Senne/AP/File)

Health care history unfolds in Suffolk Superior Court today. It may just be a status conference, but it could still be a heck of a show because…

1) The hearing is about a deal that many experts say will shape health care in Massachusetts for a decade or longer. It would limit, but not stop, the expansion of Partners HealthCare, already the largest hospital/physician network in the state.

2) There are some dramatic characters.

• Attorney General Martha Coakley, who’s running for governor, and taking a lot of heat for allegedly letting Partners off too easily. Coakley has repeatedly said she won many more concessions from Partners by negotiating than she would have by suing to try and stop Partners’ expansion. Her court filing is here.

• Some of the city’s top attorneys, representing Partners, the two hospitals it wants to acquire and dozens of supporters and opponents of the deal.

• Judge Janet Sanders, who has not, as far as I can tell, ever worked in health care, signaled that she may need expert help reviewing the voluminous materials filed about this agreement. And while Partners, South Shore Hospital and Hallmark Health are anxious to move ahead with their mergers, Sanders said on Friday that “the issues raised are too important to be dealt with hastily.”

Alerts about protests outside the courthouse went out last week.

But there’s another reason that health care industry watchers toss around words like “historic” or “milestone” in conversations about today’s hearing and the proceedings before Judge Sanders. This level of scrutiny — of one hospital system merging with another — is just very, very unusual in Massachusetts or elsewhere. It’s all triggered by the 2012 law that focuses on controlling health care costs. We are watching the sausage get made. It isn’t pretty or easy to decipher, but it is more open than anything I think we’ve seen before.

Mass. Doctor Working In Liberia Diagnosed With Ebola

A family physician from Massachusetts has become the third American aid worker infected with Ebola.

Dr. Rick Sacra, of Holden, was volunteering at a hospital in Liberia run by a Christian missionary group when he became infected with the virus.

An undated photo of Dr. Rick Sacra (simusa.org)

An undated photo of Dr. Rick Sacra (simusa.org)

The 51-year-old was scheduled to return to Liberia last week, but moved his trip up to the beginning of August.

“When he said he was going back early I wasn’t surprised,” said Frances Anthes, who runs the Family Health Center of Worcester where Sacra is a family physician. “We all knew it was a difficult situation. He asked for prayers and I know I promised them.”

Sacra, his wife and his three sons have spent years in the country as medical missionaries, and Sacra had been in close touch with colleagues in Liberia all summer about the unfolding health care catastrophe there.

“Dr. Sacra is probably the closest thing that a living human-being can be to being a saint,” said Dr. Gregory Culley, Sacra’s supervisor at the Worcester health center.

Culley says he received an email from Sacra last week. “It was bad news and good news. He said the epidemic is zero controlled, it’s chaos and anarchy in Monrovia, and the entire medical system has broken down.”

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Beyond Good And Evil: New Science Casts Light On Morality In The Brain

Harvard brain scientist Joshua Buckholtz has never forgotten a convict he met back when he was an undergrad conducting psychological tests in prisons. The man had beaten another man nearly to death for stepping on his foot in a dance club.

“I wanted to ask him,” he recalls, “‘In what world was the reward of beating this person so severely, for this — to me — minor infraction, worth having terrible food and barbed wire around you?’ ”

But over the years, Buckholtz became convinced that this bad deed was a result of faulty brain processing, perhaps in a circuit called the frontostriatal dopamine system. In an impulsive person’s brain, he says, attention just gets so narrowly focused on an immediate reward that, in effect, the future disappears.

He explains: “If you had asked this person, ‘What will happen if you beat someone nearly to death?’, they will tell you, ‘Oh, I’ll be put away.’ It’s not that these people who commit crimes are dumb, but what happens is, in the moment, that information about costs and consequences can’t get in to their decision-making.”

For two decades, researchers have scanned and analyzed the brains of psychopaths and murderers, but they haven’t pinpointed any single source of evil in the brain. What they’ve found instead, as Buckholtz puts it, “is that our folk concepts of good and evil are much more complicated, and multi-faceted, and riven with uncertainty than we ever thought possible before.”

In other words, so much for the old idea that we have an angel on one shoulder and a devil on the other, and that morality is simply a battle between the two. Using new technology, brain researchers are beginning to tease apart the biology that underlies our decisions to behave badly or do good deeds. They’re even experimenting with ways to alter our judgments of what is right and wrong, and our deep gut feelings of moral conviction.

One thing is certain: We may think in simple terms of “good” and “evil,” but that’s not how it looks in the brain at all.

In past years, as neuroscientists and psychologists began to delve into morality, “Many of us were after a moral center of the brain, or a particular system or circuit that was responsible for all of morality,” says assistant professor Liane Young, who runs The Morality Lab at Boston College. But “it turns out that morality can’t be located in any one area, or even set of areas — that it’s all over, that it colors all aspects of our life, and that’s why it takes up so much space in the brain.”

So there’s no “root of all evil.” Rather, says Buckholtz, “When we do brain studies of moral decision-making, what we are led into is an understanding that there are many different paths to antisocial behavior.”

If we wanted to build antisocial offenders, he says, brain science knows some of the recipe: They’d be hyper-responsive to rewards like drugs, sex and status — and the more immediate, the better. “Another thing we would build in is an inability to maintain representations of consequences and costs,” he says. “We would certainly short-circuit their empathic response to other people. We would absolutely limit their ability to regulate their emotions, particularly negative emotions like anger and fear.”

At his Harvard lab, Buckholtz is currently studying the key ability that long-ago convict lacked — to weigh future consequence against immediate gratification. In one ongoing experiment (see the video above), he’s testing whether he can use electrical stimulation to alter people’s choices. Continue reading

Medical Marijuana 101: Doctors, Regulators Brace For ‘Big Marijuana’

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children’s Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

“Is there anything to prevent innovative products with marijuana that will do the exact same thing?” asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

“At the heart of it,” Levy said, “the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it.” Continue reading

Mass. Substance Abuse Bill Responds To Tide Of Sadness And Fear

Massachusetts State House (Wikimedia Commons)

Massachusetts State House (Wikimedia Commons)

In response to stories that seem to be on the rise in communities across the state — stories of parents trying to revive children after a heroin overdose, of young people seeking treatment their insurance plan won’t cover, and of babies born addicted to opiates — state lawmakers on the last day of their formal session approved a bill they say will help save the lives of those addicted to heroin, prescription painkillers and alcohol.

The measure, among several major bills passed just after midnight Friday, requires insurers to pay for any care a doctor decides is medically necessary. Insurers say this and other requirements included in the bill are a mistake.

In outlining the House and Senate compromise on the substance abuse bill Thursday afternoon, Sen. John Keenan of Quincy talked about his father.

“He was a good, decent, hard-working man, he was a great husband, a great father, but he was an alcoholic.” Keenan remembered an afternoon when his family told his father he had to get help. His dad resisted, but finally agreed. Someone got on the phone and found him a bed in a treatment program that was paid for by the Keenan’s insurance plan.

“That very day changed lives. My father had 26 years of sobriety before he passed away last year,” Keenan said. “He had 26 years with my mother, 26 years as a great father, 26 years with his seven children and their spouses, and 26 years as a great papa to his 20 grandchildren. So this can work.”

“This” being a requirement that insurers pay for up to 14 days of overnight detox and rehabilitation treatment as well as counseling, medication and any other services a clinician says are “medically necessary.”

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As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

Hydrocodone pills, also known as Vicodin. (Toby Talbot/AP)

As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best.

Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better.

The House bill requires insurers to pay for at least 10 inpatient days of addiction treatment if that’s determined to be medically necessary; the Senate bill requires up to 21 days of inpatient coverage.

“We just believe patients should have a choice.”
– Leominster Sen. Jennifer Flanagan

But the American Society of Addiction Medicine estimates that 95 percent of opioid-dependent patients do not need inpatient care, and might be better off with medication maintenance and several months of outpatient therapy. Lawmakers maintain that they do not want to mandate any form of treatment.

“If we have this epidemic that continues to grow, we’re essentially in uncharted territory, and current treatment options aren’t working,” said Leominster Sen. Jennifer Flanagan, one of the bill’s co-sponsors. “If people want inpatient treatment or medication maintenance, they should be able to decide that with their doctors.”

At the same time, a new report contains some surprising findings about medication maintenance addiction treatment. It says that methadone, long used to treat heroin addiction, may be the most effective and cheapest treatment.

The report, from The New England Comparative Effectiveness Public Advisory Council, found that when comparing methadone with suboxone (Buprenorphine) or naltrexone (Vivitrol), more patients stayed in treatment longer if they were taking methadone. Continue reading

When Hand, Foot And Mouth Disease Sweeps Through: What To Know

(Bob Reck via Compfight)

Veronica Thomas
CommonHealth Intern

Summer is not only the season for watermelon and zucchini. It’s also the time for Hand, Foot and Mouth Disease. Typically found in younger kids, it’s a contagious viral illness marked by a fever and rash — either skin or mouth blisters.

Hand, Foot and Mouth swept through several WBUR employees’ families recently, so we checked in with an expert: Dr. Clement Bottino, a pediatrician at Boston Children’s Hospital in the Division of General Pediatrics who sees a lot of the illness in the Primary Care Center. “Nothing unusual,” he says, “just the summertime viruses.”

“Viruses are kind of like vegetables,” he explains. “There are winter and summer varieties. The winter ones cause illnesses like the common cold, while those in the summer cause fever-plus-rash-type illnesses, like Hand, Foot and Mouth.”

Hand, Foot and Mouth typically affects children under the age of 5, but older children and even adults can catch it as well. Symptoms can vary. Some children may only have a fever and mouth blisters, while others have the characteristic rash without other symptoms. The rash may present with classic red bumps on a child’s hands and feet, or a more diffuse rash that includes the diaper area.

Some people, particularly adults, may show no symptoms at all, but they can still spread the illness to others. Hand, Foot and Mouth is transmitted through direct contact with saliva, mucus or feces. Daycare is notorious as a hotbed of activities for spreading infection: hugging, sharing cups, coughing and sneezing, and touching infected objects. While patients are most contagious during their first week of illness, they can spread the virus for weeks after the symptoms fade.

According to Dr. Bottino, the most important thing for parents to know is that the virus is mild and “self-limited,” meaning it usually goes away on its own, causing no scars or lasting problems. Most patients feel better in seven to 10 days without any treatment at all. I asked Dr. Bottino what else parents should know about Hand, Foot and Mouth Disease. Our conversation, edited: Continue reading

Brain Scientists Learn To Alter And Even Erase Memories

This optogenetic device uses light to activate specific brain cells. (Courtesy McGovern Institute for Brain Research at MIT)

This optogenetic device uses light to activate specific brain cells. (Courtesy McGovern Institute for Brain Research at MIT)

For 32 years, Leslie Ridlon worked in the military. For most of her career she was in army intelligence. Her job was to watch live video of fatal attacks to make sure the missions were successful.

“I had to memorize the details, and I have not got it out of my head, it stays there, the things I saw,” she says. “The beheading — I saw someone who got their head cut off — I can still see that.”

Leslie Ridlon retired from the military eight years ago, but she finds she cannot work because she suffers from severe PTSD. (Courtesy)

Leslie Ridlon retired from the military last year, but she finds she cannot work because she suffers from severe PTSD. (Courtesy)

Ridlon is now 49 and retired from the military last year, but she finds she cannot work because she suffers from severe post traumatic stress disorder. She has tried conventional therapy for PTSD, in which a patient is exposed repeatedly to a traumatic memory in a safe environment. The goal is to modify the disturbing memory. But she says that type of therapy doesn’t work for her.

“They tried to get me to remember things,” she says. “I had a soldier who died, got blown up by a mortar — he was torn into pieces. So they wanted me to bring that back. I needed to stop that. It was destroying me.”

She has concluded that some memories will never leave her. “Everything I could get rid of as far as memory I think I’ve already done it,” she says. “I think the deep ones that you suffer from, I don’t think anyone can take them away. I don’t believe anyone can. I think the ones I have now, they’re going to just stay there. I’m just going to have to manage them.”

But what if these traumatic memories could be altered or even erased permanently? Researchers say they are beginning to be able to do that — not just in animals, but in people as well.

Not long ago, scientists thought of memory as something inflexible, akin to a videotape of an event that could be recalled by hitting rewind and then play. But in recent decades, new technology has helped change the way we understand how memory works — and what we can do with it. Scientists can now manipulate memory in ways they hope will eventually lead to treatments for disorders ranging from depression to post-traumatic stress to Alzheimer’s disease.

“We now understand there are points in time when we can change memory, where we can create windows of opportunity that allows us to alter memories, and even erase specific memories,” says Marijn Kroes, a neuroscientist at New York University.
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