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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Why To Exercise Today: Minimizing ‘Menopause Misery’

(pennstatelive/Flickr)

(pennstatelive/Flickr)

A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

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Panel Recommends Depression Screening For Women During And After Pregnancy

(Chris Martino/Flickr)

(Chris Martino/Flickr)

On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.

The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”

Why?

“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”

The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:

The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”

She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”

Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:

In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

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Options Weighed To Address State’s Health Care Price Variations

Updated 6:50 p.m.

BOSTON — Variations in prices for the same service at different hospitals in Massachusetts do not reflect different qualities of care and have not evened out over time, according to a Health Policy Commission report released Wednesday.

The report found that higher prices “are not generally associated” with better care, and that prices vary across the different types of hospitals — academic medical centers, teaching hospitals, community hospitals — as well as within each individual group.

To highlight the difference in costs just at community hospitals during a Wednesday meeting, Health Policy Commission executive director David Seltz pointed to levels of spending on maternity care. Spending for a low-risk pregnancy ranged from $16,000 at North Shore Medical Center to $9,000 at Heywood Hospital.

“While some variation in prices is warranted to support activities, unwarranted variation in prices — combined with a large share of volume at those higher-priced institutions — leads to higher spending overall and inequities in our distribution of resources,” Seltz said.

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More Evidence That Growing Up Poor May Alter Key Brain Structures

Allan Ajifo/flickr

(Allan Ajifo/Flickr)

Poverty is bad for your brain.

That’s the basic takeaway from an emerging body of research suggesting that the distress associated with growing up poor can negatively influence brain development in many ways, and in certain cases might also lead to emotional and mental health problems, like depression.

The latest study, led by researchers at Washington University School of Medicine in St. Louis, found that poverty in early childhood may influence the development of important connections between parts of the brain that are critical for effective regulation of emotions.

The study, published in the Journal of American Psychiatry, adds “to the growing awareness of the immense public health crisis represented by the huge number of children growing up in poverty and the likely long-lasting impact this experience has on brain development and on negative mood and depression,” researchers report.

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‘Heroes Of CRISPR’: Vivid Yarn And Lessons Learned From A Scientific Leap Ahead

(Courtesy of NIH)

(Courtesy of NIH)

It’s being billed as biotech’s Battle Royale, an East Coast-West Coast conflict over stakes that may amount to hundreds of millions of dollars, playing out in the arcane arena of U.S. patent law.

For the story on the legal fight that kicked into full gear this week, you can read the Washington Post’s Carolyn Johnson: Control of CRISPR, Biotech’s Most Promising Breakthrough, Is In Dispute.

Everybody loves a good fight, but the import of CRISPR for humankind is not the conflict or the money. It’s that this new gene-editing technology is indisputably transforming biological research around the world, speeding up discoveries in areas from cancer to crop science.

“Medical breakthroughs often emerge from completely unpredictable origins.”

– Eric Lander

So what are the roots of this bio-revolution? And what can we learn from how it was discovered? Eric Lander explores the CRISPR backstory in a vivid scientific yarn just out in the journal Cell, available free online for the next two weeks.

Lander co-led the Human Genome Project and is now the director of the Cambridge-based genomics giant The Broad Institute, which is involved in the CRISPR patent dispute. He’s also a leading science storyteller, from popular MIT lectures on introductory biology to surely one of the most riveting episodes of The Moth ever made.

The Broad’s rivals in the patent dispute may have different versions of specific chapters (Update, 1/26: Understatement! The article unleashed a major backlash online) but Lander also draws general lessons from the CRISPR back-story:

The most important is that medical breakthroughs often emerge from completely unpredictable origins. The early heroes of CRISPR were not on a quest to edit the human genome — or even to study human disease. Their motivations were a mix of personal curiosity (to understand bizarre repeat sequences in salt-tolerant microbes), military exigency (to defend against biological warfare), and industrial application (to improve yogurt production).

The history also illustrates the growing role in biology of “hypothesis-free” discovery based on big data. The discovery of the CRISPR loci, their biological function, and the tracrRNA all emerged not from wet-bench experiments but from open-ended bioinformatic exploration of large-scale, often public, genomic datasets. “Hypothesis-driven” science of course remains essential, but the 21st century will see an increasing partnership between these two approaches. Continue reading

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Opinion: What A Cancer Cure ‘Moon Shot’ Might Look Like

During his final State of the Union address, President Obama announced a new national effort to cure cancer. He said Vice President Joe Biden, who lost his 46-year-old son to cancer last year, would lead the effort. (Evan Vucci/AP)

During his final State of the Union address, President Obama announced a new national effort to cure cancer. He said Vice President Joe Biden, who lost his 46-year-old son to cancer last year, would lead the initiative. (Evan Vucci/AP)

In his final State of the Union address Tuesday night, President Obama called for a historic new effort to find a cure for cancer, a “moon shot.”  

“For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” Obama said in naming Vice President Joe Biden to lead the effort. 

So what might such a massive endeavor look like? Here, Barrett Rollins, M.D., Ph.D., chief scientific officer at the Dana-Farber Cancer Institute, offers his vision:

President Obama’s call for a new national effort against cancer — a “moon shot” — comes at a most opportune time. Cancer research has advanced significantly and now genomic analysis of tumors can reveal the specific DNA changes that drive cancer growth.

Our patients at Dana-Farber/Brigham and Women’s Cancer Center and Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, through the Profile research project, are benefiting from this — using the powerful technique of next-generation sequencing, scanning more than 300 cancer-related genes in every patient’s tumor to look for abnormalities. In a growing number of cases, the DNA changes can be targeted by precision therapies such as designer drugs that block overactive growth pathways. Often it will take combinations of targeted drugs to halt cancer progression, and many studies of these combinations are underway.

At the same time, there’s enormous promise in the field of immunotherapy. We’ve learned how to boost the body’s natural defenses against cancer and how to remove the molecular “brakes” that cancer cells exploit to hide from immune soldier cells and hinder their attack on tumors. Drugs that help the immune system fight cancer are coming quickly to the market, and there is promising research on related strategies such as cancer vaccines and genetic manipulation of immune cells to recognize cancer cells in the body. Continue reading

Opinion: When The Doctor Must Choose Between Her Patients And Her Notes

By Dr. Mary C. Zeng
Guest Contributor

It’s been a long day in the psychiatry clinic.

Seeing patients is never dull, and each interaction is meaningful in its own way. From the moment they walk into my office to the moment they leave, I try my best to be fully present with the patients sitting in front of me. That means listening to every word, watching every nuance of body language, hearing every concern — both spoken and unspoken. It means bearing their grief as they tell me about the father they’re losing to cancer, their pain as they suffer through profound bouts of depression and their agony as they recall their nightmares of childhood trauma.

It also means putting aside my personal agenda to focus wholly on them, which includes resisting my urge to take notes during the patient interview so that I can save time later, with fewer notes to complete after the patient leaves.

It is a common complaint that doctors look at their computer screens and type on their keyboards more than they listen to their patients. But consider this reality: From the doctor’s perspective, every moment she spends focusing on you, the patient, rather than on the “note” she needs to write up about your appointment, is a debt that must be repaid later in the day. If the doctor can’t complete your note during the 15 minutes you spend with her, then she must add another 15 minutes to the end of her workday in order to finish that note. Multiply that 15 minutes by the 10-15 patients she sees in a day and all of a sudden she has missed the family dinner and the kids are already asleep by the time she comes home.

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Analysis: Controversy Over CDC’s Proposed Opioid Prescribing Guidelines

OxyContin pills are arranged at a pharmacy in Montpelier, Vt. in this 2013 file photo. Opioid drugs include OxyContin. (Toby Talbot/AP)

OxyContin pills are arranged at a pharmacy in Montpelier, Vt. in this 2013 file photo. Opioid drugs include OxyContin. (Toby Talbot/AP)

Updated at 3 p.m.

By Judy Foreman

The U.S. Centers for Disease Control and Prevention recently came out with controversial proposed guidelines for opioid prescribing through a process that critics say may harm pain patients and is based on relatively low-grade evidence.

One of those critics is Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, a patient advocacy group which receives funding from opioid manufacturers. Steinberg said in an interview and in emails that she’s worried the guidelines may negatively impact patients suffering with severe pain. “I am concerned that if these guidelines go forward as they are now written, they will lead to further restrictions on access to opioids for people with unremitting pain who truly need them and take them responsibly,” she said.

Dr. Jane Ballantyne, president of the non-profit Physicians for Responsible Opioid Prescribing (PROP), which is part of a larger group involved in the guidelines process, said in a telephone interview that the worry about limited access to opioids for chronic pain patients is a “very legitimate fear.” But, she added: “We don’t want to reduce access for people already dependent on opioids. The guidelines are designed to not have so many people dependent on opioids in the future…”

Ballantyne said that the new guidelines are similar to previous guidelines with two key exceptions: lower dose limitations and the recommendation that, for acute pain not related to major surgery or trauma, opioids should be prescribed for only three days.

The month-long period for public comment on the proposed guidelines will be over Jan. 13.

A major concern of some critics is the lack of solid evidence backing up the guidelines, which give recommendations on prescribing practices; they include when to start opioids, how to establish treatment goals, how to discuss risks and benefits, recommended limitations on drug doses, duration of treatment and other issues. Continue reading

Opinion: American-Muslim Doctor Reflects On Bigotry At Some Top Hospitals, And Beyond

By Altaf Saadi, M.D.
Guest Contributor

Recently, the wife of a prominent Boston businessman — one of my many wealthy, white patients at Massachusetts General Hospital — greeted me this way: “So what foreign medical school did you go to anyway?”

For background, I’m a petite, Middle Eastern young woman with a headscarf, and I’m guessing I do not resemble her vision of what a doctor “should” look like. That image is probably taller, whiter, male and not Muslim.

My answer (in perfect, unaccented English) to her question about where I was trained? “Harvard Medical School.” After that, her lips remained pursed shut for the rest of our encounter.

As the daughter of Iraqi and Iranian immigrants, such interactions unfortunately have been common for me and my family members since we moved to America weeks before 9/11. When former President Bush declared war on Iraq the following year, for example, my sister and I heard classmates scream, “Go back to your country!” from their pickup truck on our walk home from high school.

I thought that attending college and medical school at Yale and Harvard, respectively, would be my golden ticket to America’s meritocratic dream, that my prestigious diplomas would shield me from future experiences with racism and bigotry. As a neurology medical resident in “liberal” Boston, (and working at a hospital ranked No. 1 by U.S. News & World Report) I also thought that I would be judged based on my medical acumen, not by the color of my skin or the scarf I wear on my head. But I was wrong.

Dr. Altaf Saadi (Courtesy of the author)

Dr. Altaf Saadi (Courtesy of the author)

Another time in the hospital, a male patient told me that his religion is superior to mine. While I was listening to his lungs to help in the management of his shortness of breath, he added, “Why do you wear that thing on your head anyway?” Despite his abrasive behavior, I politely informed him of his treatment plan and told him that I am praying for his speedy recovery.

Another day,  an 80-year old patient with dementia began hitting me on the head when I checked in on her for my daily visit. Pointing to my headscarf, she said, “I don’t want someone with that taking care of me.” Despite her mental condition, the racism still stung as I continued to strive to provide her the best care possible.

My experiences are not isolated. A recent study in the American Journal of Bioethics found that 24 percent of Muslim physicians have experienced religious discrimination in the workplace.

This election year has made it harder to be a Muslim in America. Republican front-runner Donald Trump has advocated for registering Muslims inside the United States and banning those of us who reside abroad. Unfortunately, the majority of Republican Party members agree with him and the number of hate crimes against Muslims have tripled in recent weeks. Yet, I also recognize that Muslims are just America’s newest “outsiders.” Throughout our history, Catholics, Irish, Italians, women, African-Americans, Jews, Latinos and gays have all been targets of nativist fear-mongering. Many of these groups still face significant prejudice today, and hospitals are not immune from such discrimination, whether implicit or explicit.

When I was a third-year medical student, it appeared to me that the pediatric residents and attending physicians would spend extra time caring for the white infants and children during morning rounds. The two African-American babies and one Arab infant admitted to the inpatient pediatrics service at the time were never “oohed and aahed” at and received noticeably less attention. “Have you noticed that only the white children are called ‘cute’?” I asked my friend after our third day on the pediatrics rotation. My friend, an African-American medical student, had his own grievance. He had overheard a doctor refer to an African-American father as an “angry black man.” “I don’t understand,” my friend said. “His daughter is dying, he is upset, and has questions. He’s not asking any more questions than the other parents.”

Our observations were also not isolated incidents. Multiple peer-reviewed studies have shown that physicians unconsciously prefer and spend more time with white patients than African-American ones.

I also recall the occasional episode of overt racism in the hospital. One surgeon — prominent and stern in his crisp white coat — said the following about a Hispanic patient who was coming to have her melanoma examined for excision: “I can’t believe these people! They have been here for a decade, can’t bother to learn English, and we’re stuck waiting for an interpreter.”

But the episodes of implicit racism have been more commonplace. Continue reading

Mass. Wants To Be Home To Nation’s Leading Cluster Of Digital Health Companies

Massachusetts government leaders and the state’s health care and technology sectors have announced a new partnership. The goal is to make the Bay State home to the nation’s leading cluster of digital health companies. WBUR’s Curt Nickisch reports the announcement shows political and industry will, but little money, at least not yet.

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