The latest cool stuff out of some of the nation's best labs; news on medical research and what it may mean for patients.


CDC Report Tracks The IUD Renaissance

You might call it the “Comeback Contraception.” In any case, it seems, IUD use is on the upswing.

This week’s CDC National Health Statistic Report highlights the surge: The number of women using long-acting reversible contraception (LARC) has almost doubled in recent years, and most of the increase is due to the growing popularity of IUDs.

From the report:

Among women currently using contraception, use of LARC increased from 6.0% for 2006–2010 to 11.6% for 2011–2013. Use of IUDs makes up the bulk of this category, with 10.3% of current contraceptors using an IUD during 2011–2013.

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

Intrauterine devices remain less popular than other forms of contraception, according to the report. The pill ranks as the most widely used method (it’s taken by 25.9 percent of women who use contraception, or 9.7 million women), followed by female sterilization (25.1 percent, or 9.4 million women) and the male condom (used by just over 15 percent, or 5.8 million women).

Still, LARC devices, including IUDs and contraceptive implants, were used by 11.6 percent or 4.4 million women, according to the report: “While the most commonly used methods — female sterilization, the pill, and the male condom — appear to remain consistent over time, an increase has been noted in the use of LARC methods, primarily the IUD.”

A confluence of events have contributed to the IUD’s renaissance, experts say, including an improved product, a drop in price and more promotion by doctors, including the American Academy of Pediatrics, and backing by the family of Warren Buffett.



Darker Days: Talk Therapy May Be More Durable Than Light Treatment For Seasonal Affective Disorder

For me, it’s already started: As the darkness descends around 5 p.m., my mood starts to sink too. And it’s not even Thanksgiving.

Victims of SAD, or seasonal affective disorder, a form of depression marked by a dip in mood during the darker winter months, take note: Light therapy may help, but talk therapy may be more “durable” in the long-term.

Researchers at the University of Vermont report that light therapy (essentially, simulating sunrise by sitting in front of a device upon waking that emits high intensity artificial light, around 10,000 lux, for at least 30 minutes) was comparably effective as cognitive behavioral therapy for addressing acute episodes of SAD.

(Lloyd Morgan/Flickr)

(Lloyd Morgan/Flickr)

However, the researchers found that after two subsequent winters nearly half the subjects in the light therapy group reported a recurrence of depression, compared with just over one-fourth of those in the cognitive behavioral therapy (CBT) group.

Lead researcher Kelly Rohan, Ph.D. a professor in the Department of Psychological Sciences at the University of Vermont in Burlington, said in an interview that after two winters: “The CBT [patients] maintained their gains better, and we found a more enduring effect of the CBT treatment two years out. Fewer had recurrences of depression and, as a whole, their depressive symptoms were fewer and less intense than people with light therapy.”

Over 14 million Americans suffer from SAD, the researchers report, based on extrapolating a national number from a smaller U.S. sample; prevalence ranges from 1.5 percent of the population in southern states like Florida to over 9 percent in the northern regions of the country.

“There’s no argument that light therapy is a very effective treatment that can substantially improve winter depressive symptomsunder acute conditions, Rohan said in the interview. “But there’s an assumption that people stick to it, and interventions that require effort from people face compliance issues over time.”

The study’s bottom line, she said, is:

“I think the data show that consumers have choices — light therapy is very effective — the question is, ‘Am I willing to stick with it long term and then continue on through the whole winter and pick it up next fall through the winter?’…if so, more power to you. However, if you are willing to consider an alternative, that is CBT, it might be more durable  — you can carry it into the future like a toolbox, you’ve got coping techniques you can use over time.” 

(Full disclosure: Dr. Rohan receives book royalties from Oxford University Press for the treatment manual for the cognitive-behavioral therapy for SAD intervention.)

So how does CBT for SAD differ from therapy for general depression? Rohan says the approach is similar — with a bit of custom tailoring. For instance, the therapist might say something like: “‘We know the dark days are a big contributor to the onset of your symptoms and we can’t control that — we can’t control the sunrise and sunset. But we can control your reaction, and what you think and what you do in response to these light and temperature changes.’ ”

In general, CBT for this condition hinges on reframing the patient’s thinking about the approaching winter — away from a negative attitude about the shorter, darker, freezing, snowbound days, and toward a more positive approach, for instance: What kind of fun, frolicking things can I get out and do in the cold?

“Instead of hibernating and becoming more socially withdrawn,” Rohan said, “we try to get people more engaged in fun winter activities.”

And if you think escaping to the Caribbean will solve your problem, think again: “We don’t endorse jumping on a plane — that’s avoidance, that’s pretending it’s summer when it’s actually winter,” she said. “And dialing the heat up in your home or going to a tanning bed, we don’t advocate for that either — that’s denial, that’s never an adaptive coping strategy. We want people to take winter by the horns.”

Personally, sunshine-filled vacation therapy in winter has worked for me, but Rohan pushed me to rethink this strategy. “When you come back from a trip like that, re-entry can be really jarring,” she said. “Patients feel great when they’re there, when they come back to reality it can really bite.”

Here are some more specifics on the study, published online in the American Journal of Psychiatry, from the UVM news release:

In the study, 177 research subjects were treated with six weeks of either light therapy – timed, daily exposure to bright artificial light of specific wavelengths using a light box – or a special form of CBT that taught them to challenge negative thoughts about dark winter months and resist behaviors, like social isolation, that effect mood. Continue reading

Chest Pain Is Top Item On Nation’s $80 Billion ER Care Bill, Study Finds

(Courtesy Dr. J. Slutzman, presented to the American College of Emergency Physicians)

(Courtesy Dr. J. Slutzman, presented to the American College of Emergency Physicians)

If you’re feeling chest pain that you think might be a heart attack, there’s only one thing to do, medical experts say: Seek emergency care. Do not pass go, do not collect $200. Or rather, do not think about the roughly $1,000 your care will cost the hospital. Your life may be at stake.

But at a calmer moment less fraught with risk, you might want to contemplate the bigger picture of chest pain and emergency care, as sketched out by Dr. Jonathan Slutzman of UMass Medical School and colleagues at a recent national conference on emergency medicine. To wit: Your costs are part of a national Emergency Department care bill that totals nearly $80 billion, including nearly $5 billion for chest pain alone.

Every year, Americans log a total of about 130 million visits to emergency rooms, Dr. Slutzman said. Among those visits, according to his team’s analysis of millions of records, patients who come in for chest pain are the single biggest line item on the bill.

“Chest pain is one of the two most common reasons somebody comes into the Emergency Department,” he said. “It’s somewhere on the order of 5 percent of all visits,” which may not seem like very much until you realize it’s 5 percent of 130 million, and each chest-pain visit costs about $1,000.

The grand total: $4.7 billion. It’s so high because chest pain is both a high-volume diagnosis and the treatment is high-intensity, Slutzman said, usually including blood tests, X-rays, sometimes CT scans and sometimes stress tests. They add up.

So now that we see that prodigious price tag, what is to be done?

Emergency medical specialists are working on that problem, he said, in part by figuring out what the “best practices” are for evaluating chest pain. “This is on people’s radar screens,” he said, “to try and ‘rightsize’ our care,” meaning that “we can safely treat many patients while doing less.”

To which I naturally responded: “Yikes. I don’t really want the system to be trying to save money when I might be having a heart attack.”

Slutzman calmed me down. His No. 1 takeaway from the findings, he said, is that more patients should probably be evaluated as to whether they’re having a heart attack without having to stay overnight in a hospital. Chest pain patients tend to be almost reflexively kept in the hospital for at least one night of testing, he said, “and a big subset of those people don’t really need it. One big key is more rapid access to outpatient providers. If someone can see their doctor in one to two days and maybe get some additional testing then, they can be safely discharged.”

That calmed me down a bit. I do believe in staying out of the hospital whenever possible.

He calmed me still further with a story:

Historically, back in the late ’80s and early ’90s, if you walked into an Emergency Department with chest pain, you got admitted to a cardiac Intensive Care Unit, pretty much no matter what, because there was so much concern that they could be missing heart attack. There was a lot of fear of that.

And then, over time, we learned more and more. We could read our electrocardiograms — our EKGs — a little better, we could learn a little bit more about what the squiggles meant, and which ones were dangerous and which ones weren’t.

And then we got more blood tests that were a little bit more sensitive and a little bit more specific, and a little bit better at figuring out who was having a heart attack and who wasn’t. Continue reading

Opinion: Doctors Aren’t The Only Problem When It Comes To Opioid Abuse

By Anne-Marie Williams

I applaud the work of Gov. Charlie Baker and his Opioid Working Group in making bold moves to address the worsening epidemic, but I was alarmed by how physicians were portrayed during a recent panel on the crisis, in which Baker participated.

During the panel, physicians were portrayed both as over-prescribers of pain medications and defensive opponents to the governor’s efforts to address the opioid crisis.

Baker has talked in the past about doctors and hospitals as partners in this fight while saying he’s surprised by the cavalier attitude he hears from many physicians about their pain prescribing practices.

(Alex E. Proimos/flickr)

(Alex E. Proimos/flickr)

However, at this forum physicians were repeatedly cited for frivolous dispensing of pain medication, with no attention paid to the difficulties of balancing adequate pain control with the risk of addiction, and physicians groups were raised as some of the predominant opponents to the governor’s legislation.

As a medical student, I beg to disagree.

Doctors are critical allies in halting the opioid epidemic. I would caution the governor to avoid dismissing physicians’ objections to his proposals as defensive attempts to resist oversight. I work with many doctors and medical students who feel hampered by systemic barriers to better addressing substance use disorders in our practice. Instead of calling them out, I urge the governor to call physicians groups in to the fight.

The opioid epidemic is rooted in more than overzealous prescribers. Profiteering by pharmaceutical companies, systematic failures of the FDA, widespread barriers to medical and mental health care and the poverty that so many in our population face all have important roles in the story.

And providers have a unique perspective on ways that new policies such as 72-hour limits on opioid prescriptions or involuntary commitment for people with addiction might actually challenge their ability to provide effective care to patients with addiction. Here’s the president of the Massachusetts Medical Society, Dr. Dennis Dimitri, detailing that perspective. Continue reading

Fatal Fat Shaming? How Weight Discrimination May Lead To Premature Death

Jeff Newell, left, in November 2014, and then on Oct. 18 of this year, after finishing his first road race (Courtesy)

Jeff Newell, left, in November 2014, and then on Oct. 18 of this year, after finishing his first road race (Courtesy)

As soon as the chair broke under the weight of his 533 pounds, Jeff Newell knew he wouldn’t get the job.

With a background in customer service and a culinary arts degree, Newell, of Taunton, Massachusetts, had been searching fruitlessly for work for several years. Finally, a great job near his home opened up that seemed a perfect fit with his credentials. But then came the chair-breaking incident. Humiliating, yes, but even more infuriating because the interviewer, offering neither help nor an apology, simply shook her head and made a face.

“I knew what she was thinking: ‘This person is overweight and he’s going to be lazy and why should I hire him?’ ” Newell said. The situation was mortifying emotionally, but also took a physical toll. Newell broke out in a sweat, his heart racing.

The sort of weight-based discrimination that he says he experienced is not just unpleasant and stressful; it may actually lead to premature death, a recent study finds.

While earlier research has shown that weight discrimination is associated with poor health outcomes for a variety of reasons, the new study, led by researchers at Florida State University, concludes that in addition, “weight discrimination may shorten life expectancy.”

The new analysis found an association only, and no causal link between discrimination and life expectancy. Still, researchers in the field say the paper, published in the journal Psychological Science, adds to a growing body of literature pointing to the deep, long-term impact of weight bias and discrimination.

“I think this is one of the most important papers to come out in the research of weight stigma,” said A. Janet Tomiyama, Ph.D., assistant professor in the Psychology Department at the University of California, Los Angeles, where she studies weight stigma and directs UCLA’s Dieting, Stress, and Health Laboratory. “The finding itself is astonishing, but even more significant is that they were able to replicate the finding across two very high quality cohort studies. The crucial implication here is that the stigma alone of being heavy can be harmful to health — and we know that weight stigma is rampant in this country.”

The findings emerged after researchers analyzed data from two separate national studies: the Health and Retirement Study (HRS), with more than 13,000 participants, and the Midlife in the United States Study (MIDUS), with more than 5,000 participants. The two studies (conducted about 10 years apart) both included reports on perceived discrimination, including weight discrimination.

The new analysis found that weight discrimination was associated with an increase in mortality risk of nearly 60 percent among both HRS and MIDUS participants and also that the increased risk “was not accounted for by common physical and psychological risk factors.” In other words, the health effects of the discrimination were teased out from the health effects of the weight itself.

In an interview, Angelina Sutin, the study’s lead researcher and an assistant professor in the Department of Behavioral Sciences and Social Medicine at Florida State University College of Medicine in Tallahassee, said the big surprise was that even after statistically controlling for other factors such as body-mass index, level of disease, depression and smoking, among others, the experience of weight discrimination was linked with people dying earlier than expected.

“What was really surprising was that the association was there not just in one sample but in two, and the associations were almost identical,” Sutin said.

Weight discrimination and bias are widespread, according to an overview on the stigma of obesity, and that translates into inequities in employment, health care and education

And that stigma appears to contribute to a “vicious cycle,” according to Tomiyama, of UCLA, who writes about “a positive feedback loop wherein weight stigma begets weight gain.”

Indeed, in an earlier study, Tomiyama found that children labeled as “too fat” had an increased risk of having an obese body mass index nearly a decade later.

So why might stigma be causing such problems, and possibly contributing to premature death?

That question wasn’t addressed in the recent study, but Sutin offered some informed speculation.

“Part of it might be stress that people are carrying around with them,” she said. But sometimes it’s where the discrimination comes from that’s meaningful. For instance, she said: “Families are often the source of weight discrimination,” and that can be particularly painful, since “families are supposed to be a support.”

Also, several studies find that weight bias is rampant among medical students and other health care providers. Even eating disorder specialists are not immune to negative stereotypes about obese patients, according to a 2014 study. This attitude among health care professionals can lead to delays in care and treatment, and also misdiagnoses, experts say.

Much of the research on weight stigma and discrimination is led by Rebecca Puhl, Ph.D., deputy director of the Rudd Center for Food Policy & Obesity and a professor in the Department of Human Development & Family Studies at the University of Connecticut. She said there are several possible mechanisms at work that could contribute to premature mortality for people subject to weight discrimination.

“Other studies have found that when people are exposed to weight stigma or discrimination, that they actually experience elevated physiological stress responses (e.g., cortisol reactivity, blood pressure) which could contribute to poor health outcomes,” Puhl wrote in an email. “In addition, studies show that exposure to weight stigma can also lead to increased calorie intake, food consumption, and binge eating, which could play roles as well. The idea here is that weight stigma can induce emotional distress, which in turn becomes a trigger for turning to some of these maladaptive eating patterns as temporary coping strategies to alleviate those negative feelings.”

Sarah Bramblette, who has a master’s degree in health law, says even though she suffers from a medical condition called Lipedema that contributed to her current weight of over 400 pounds, she has been subjected to weight discrimination throughout her life. While she says some of the nasty comments hurt her feelings, it’s the bias from health professionals that has the greatest impact.

Here’s how Bramblette opened her recent TedxNSU talk at Nova Southeastern University in Fort Lauderdale:

When I first appeared on stage, what was your perception of me? Lazy, disgusting, perhaps depressed, unmotivated, unhealthy? Based on my appearance it’s usually assumed… that my weight and my condition in life are self-induced. That’s not true, but often I don’t get a second chance to make a first impression….Weight bias that I’ve experienced in health care has hurt me physically. When doctors and nurses have the perception that I’m lazy and unmotivated and noncompliant, that influences the care they provide and it has a negative impact on my health.

Continue reading

Often Bedridden For 25 Years, Advocate Welcomes NIH Move On Fatigue Syndrome

Writer Rivka Solomon, who has Myalgic Encephalitis -- also known as chronic fatigue syndrome -- protests federal inaction in Washington, D.C. (Courtesy)

Writer Rivka Solomon, who has myalgic encephalomyelitis — also known as chronic fatigue syndrome — protests federal inaction in Washington, D.C. (Courtesy)

By Rivka Solomon
Guest Contributor

Last week, the National Institutes of Health announced a welcome change: They promised to help the more than 1 million Americans who have the devastating disease commonly known as chronic fatigue syndrome.

This is akin to the NIH finally recognizing multiple sclerosis or Parkinson’s disease, two other debilitating neurological illnesses that also have no known cause or cure.

The name chronic fatigue syndrome, which trivializes the true horrors of the disease, was adopted by the government decades ago and has been truly detrimental to the patients. The stigmatizing name has allowed doctors, the media and even families whose loved ones got sick to dismiss patients as mere lazy malingerers.

After all, who isn’t fatigued in today’s hustle and bustle world? Take a nap. Get over it. Exercise it away.

Well, I tried. But napping didn’t help, and exercise made me significantly sicker.

So for the last 25 years in which I have had myalgic encephalomyelitis, or ME — the name the World Health Organization uses and the name most patients prefer — I have been forced to spend much of my life in or near bed.

Try doing that for a quarter of a century.

Myalgic encephalomyelitis means, literally, pain and inflammation of the brain and spinal cord. But what does that translate to in the real world? I often struggle with exhaustion so crushing it is hard to get to the bathroom, let alone lift my arms to shampoo my hair; brain fog so thick that formulating and finishing thoughts is a struggle; vertigo that makes it hard to see or stand up straight; numb hands; Jello-like legs; joint and muscle pain; and a hyper sensitivity to chemicals and perfumes that turns me into a canary in the coal mine.

The hallmark of the disease, though, is the inability to exert any energy — physical or intellectual — without a relapse or flare of unknown length. Sometimes it can take days or weeks to regain my strength after a phone conversation. It is as if my body can’t replace the cellular energy required to do, well, just about anything.

All this came on after mono. That was all it took. Mononucleosis. Other patients have gotten myalgic encephalomyelitis/chronic fatigue syndrome — abbreviated as ME/CFS — from other assaults that apparently slapped down their immune systems, too, and/or triggered an autoimmune response. The result? With no commonly accepted diagnosis and no FDA-approved treatments, many of us have been languishing for years.

Then, in 2014 and 2015, the NIH sponsored two initiatives: a report generated by the Pathways to Prevention program and a report from the prestigious Institute of Medicine. Between the two, they found ME/CFS was a serious disease that can significantly impair the lives of those who get it. They also found that research into ME/CFS was seriously underfunded and there is an urgent need to invest in it.

How true.

For years, the NIH has been allocating a pittance to ME/CFS research. This is most strikingly seen when compared to other neuro-immune diseases. Multiple sclerosis, with 400,000 U.S. patients, gets funded $102 million per year. ME/CFS, with more than 1 million U.S. patients, gets a paltry $5 million per year. The NIH gives more money to research on hay fever than ME/CFS. And yet people with hay fever don’t spend decades in bed, too weak to function.

The question is why? Continue reading

U.S. Breast Cancer Deaths Falling Steadily — But Black Women Increasingly At Risk

Breast cancer is becoming an ever more-survivable disease, but there's bad news for African-Americans. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

Breast cancer is becoming an ever more-survivable disease, but there’s bad news for African-Americans. Here a woman is screened in Los Angeles in 2010. (Damian Dovarganes/AP/File)

By Richard Knox

With all the recent controversy over how often women should get mammograms, you might not realize that breast cancer is becoming an ever more-survivable disease.

But, alas, that’s not the case among black women in this country. Historically they’ve had the highest risk of dying if they get breast cancer among any ethnic group. And now, data from the American Cancer Society show that African-Americans have nearly caught up with whites over the past three years in their risk of getting breast cancer in the first place.

Given black women’s higher risk of dying from breast cancer, that’s particularly bad news.

Breast cancer accounts for one in every three malignancies among U.S. women — it’s the most common type if you don’t count non-melanoma skin cancers, which are usually inconsequential. More than 230,000 American women will get a breast cancer diagnosis this year, and about 40,000 will die of the disease.

But over the past 26 years, the overall U.S. breast cancer death rate has dropped by more than a third, according to recent research. That’s nearly a quarter-million living women who would have died from breast cancer at rates that prevailed among their mothers’ generation.

“Whether people realize it or not, breast cancer mortality rates have been dropping since about 1990,” says Carol DeSantis of the American Cancer Society, lead author of an update on the disease published Thursday in CA: A Cancer Journal for Clinicians.

Part of that success is due to widespread mammograms, which can find breast cancers at an early stage, although the contribution of regular mammogram screening is unclear.

“Screening has clearly contributed to lowering mortality, but we can’t say by how much,” DeSantis says.

Better treatments are clearly a big part of this success story — more effective chemotherapy, the estrogen-blocking drug tamoxifen, and drugs targeted at the protein HER2 and other growth promoters on the surface of some women’s breast cancer cells.

Put it together with our aging society — more women reaching the most breast cancer-prone years, and fewer women dying of the disease — and the result is record numbers of breast cancer survivors.

More than 3.1 million American women with a history of breast cancer are alive today, and the great majority of them are cancer-free, DeSantis says.

The number of survivors will reach 4 million within the coming decade.

But a closer look at the numbers shows that not all women are benefiting equally. Continue reading


Vomiting Up Brunch? Your Angry Tweet May Save Others From Food Poisoning

When you're in this position, you likely don't want to call health officials and report food poisoning. (Irina Souiki/Flickr)

When you’re in this position, you likely don’t want to call health officials and report food poisoning. (Irina Souiki/Flickr)

By Chelsea Rice

One of the last warm Saturdays in September, my boyfriend and I planned to celebrate his birthday at a Cambridge restaurant that friends had praised as their favorite brunch spot. The food tasted great: We shared a plate of oysters to start, and he enjoyed eggs Benedict for his main course while I opted for a breakfast take on the classic BLT sandwich, mainly because it was served on a croissant, a buttery weakness of mine.

But upon arrival back home…our brunch backfired.

I ran out to pick up the birthday cake. When I returned, I found the birthday boy almost paralyzed by stomach pain, feverish and violently ill. While he spent the rest of his birthday in a migratory pattern between the bathroom and bedroom, I waited to see if I would get sick and searched online to learn how to report the food poisoning.

Turns out that here in the Boston environs, residents call a special number at the Boston Public Health Commission. It connects with a public health nurse who asks questions about symptoms, what you ate over the past few days, and where you ate it. On that memorable day, I shouted this option into the bathroom at my sick partner, but he was so nauseous he could barely talk to me. Reliving what he had eaten in the past 48 hours was the last thing he wanted to do.

As a health journalist, I know it’s important to report food poisoning — one in six Americans gets it every year. But as a consumer, filing a public health report can be an intimidating and impersonal process for a very personal — and vulnerable — experience.

We told all our friends and canceled the rest of the festivities, vowing never to return to the scene of the crime, but I still wondered: Were we selfish? Could we have helped others with our story? Have other diners had a similar experience at that restaurant?

According to the restaurant’s worst reviews on Yelp, the list is long. (I’m not naming it to give it the benefit of the doubt — maybe it was having an off day? — but the picture is grim.) The worst reviews include bugs in the plates, under-cooked proteins and foreign objects that broke a tooth. There are even a few that reported diners getting sick after eating there. And those are just the brave few who posted. I was alarmed that this restaurant still had a line and a reservations list with complaints like that. There’s no way a health department could ignore claims like these, I thought, if they were written up in an official report.

Little did I know, there’s a new bridge between social media and public health that is finally crossing that divide.

In 2011, a research group out of Boston Children’s Hospital published a study using extracted, keyword-related Yelp reviews, showing that the ingredients people described in their reviews about food-borne illness matched up with relevant ingredients that the CDC reported were involved in food-borne outbreaks for that time.

An excerpt from HealthMap's tool to track tweets related to foodborne illness (Courtesy of HealthMap)

An excerpt from HealthMap’s tool to track tweets related to foodborne illness (Courtesy of HealthMap)

Now, that team is taking their work to help cities across the country address and more accurately monitor food-borne illness with HealthMap Foodborne Illness, part of a larger social media disease-tracking initiative based at Boston Children’s.

“When someone talks about diarrhea on Twitter they are really looking for people to care, and that’s really what it’s all about.”

– Dr. John Brownstein

Dr. Elaine Nsoesie and Dr. John Brownstein, who co-founded the project, are working with New York City, Chicago, St. Louis and other major cities to customize their foodborne disease tracking tool for each city’s needs.

“It’s hard to make people come to you,” said Brownstein. “People aren’t engaged necessarily in public health.” But if you can tap in to their online voices, he said, “you can actually get a huge amount of information that would not come from another vehicle.”

In Chicago, the city’s public health department monitors Twitter in a social media tracking initiative that HealthMap customized for them called FoodborneChicago. The tool filters tweets that are geocoded to a specified area through a system that recognizes key words related to food poisoning. Think “sick,” “food,” “vomiting,” “diarrhea,” “poisoning” and various combinations like “restaurant made me sick” or “vomiting after that lunch.”

A public health official can monitor the filtered tweets live, and sort them into “relevant” (ambulance icon), “questionable” (question mark) and “irrelevant” (trash can), as in the image above. Continue reading

Haunted House Science: You Don’t Need Gore To Terrify, If You Know The Brain

Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. (Courtesy of

Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. (Courtesy of

It’s a classic Halloween activity: the homemade haunted house, replete with cold spaghetti “worms” and bowls of peeled-grape “eyeballs.” Remember?

That old tradition gets a 21st-century scientific twist at an elaborate haunted house in Newton that opens for just one night a year — the night before Halloween — to raise money for charity. And it is elaborate not just in its multitudes of living ghouls, its gaggles of graves and squads of skeletons.

It is an exercise in scare tactics informed by brain science.

“You can be really artful about how you scare people without a lot of gore,” says Northeastern University professor Lisa Feldman Barrett. “And I thought, well, who better to do that than a lab that studies the science of emotion? We can use research to predict what the effects will be, to make it super-scary without a lot of blood and guts.”

Barrett leads the Interdisciplinary Affective Science Lab at Northeastern and Massachusetts General Hospital. For the last 10 Halloweens, she and her family have created a haunted basement in their Victorian home, helped by her lab colleagues — grad students, post-docs and other researchers who play monsters for the night.

Some of their scare techniques may not seem to differ much from those of amusement park haunted houses, but they’re devised by neuroscientists who live and breathe the brain.

“What your brain is doing is making predictions based on past experience,” Barrett says as she leads the way into the labyrinth in her basement. “So if we set up things to look really kitschy at the beginning, with a lot of props, your expectation is, ‘This is going to be pretty lame, this is not going to be very scary.’ And when you walk in, we will violate that expectation.”

Indeed they do. You walk into a dimly lit room and notice some skulls, some bats and what seems to be a statue of a human-sized monster sitting on a table. You’re not sure, though, if it’s a statue or a live person, until it — or rather, he — opens his eyes very wide and stares into yours. Yikes.

Barrett says the effect carries a wallop in part because the brain is wired to pay huge attention to whether an object is alive or inanimate. (You can imagine why that would be important for survival.)

When visitors are unsure whether a figure is alive or a statue, they often “freeze in uncertainty,” she says, just like a rat in an experiment when it’s not sure whether it’s about to receive a small electric shock.

Also, certain special effects fire up specific parts of the brain, Barrett says, including the amygdala, an area important for detecting uncertainty or novelty. The neurons in the amygdala are very tuned to eyes, “to whether the eyes are open or shut or moving, and how much white. The more white there is, especially in a still face, the scarier people find it.”

Here’s another brain-science trick: It’s scarier when you first see something out of the corner of your eye, because your peripheral vision involves more uncertainty.

Many of the the haunted house effects are aimed at increasing uncertainty, Barrett says, “because uncertainty enhances arousal — I don’t mean sexual arousal, I mean feeling activated and worked up and jittery.” Continue reading


In NYC, More Severe Injuries After Painted Bike Lanes Installed, Study Finds

A study found that the severity of injuries among bicyclists hit by cars appeared to go up after New York City installed painted bike lanes. Here, the author of that report, Dr. Stephen Wall, finds a blocked NYC bike lane. (Courtesy of Stephen Wall)

A study found that the severity of injuries among bicyclists hit by cars appeared to go up after New York City installed painted bike lanes. Here, the author of that report, Dr. Stephen Wall, finds a blocked NYC bike lane. (Courtesy of Stephen Wall)

This may not surprise you if you’re a regular cyclist: Those painted bicycle lanes that are proliferating as the number of bike commuters rises? They don’t seem to make a dent in injuries and may even worsen their severity, according to a study presented in Boston this week at a national gathering of the American College of Emergency Physicians.

The study found that the severity of injuries among bicyclists hit by cars actually appeared to go up after New York City installed those painted bike lanes, at least among patients brought to Bellevue Hospital Centers’ emergency department.

Dr. Stephen Wall of New York University and Bellevue offers an immediate caveat, though: Bike lanes lead to increased volumes and may also lead to faster speeds.

“I don’t want people to look at this data and say, ‘Oh, bike lanes are bad,’ ” Wall said. “They’re not. They’re definitely beneficial.”

But, he said, design flaws in the bike lanes may increase risks, and behaviors by drivers, cyclists and pedestrians can still cause problems. The findings, Wall says, show how important it is to analyze the designs of bike lanes and make sure they do prevent injuries, especially as the numbers of bikers rise.

Ideally, Wall said, police, hospitals and emergency services would all share and integrate their data to create a map of where injuries occur. When cities make choices on how to protect cyclists, they must be analyzed as well, to be sure money is spent wisely.

In New York City, he said, it’s becoming ever more clear that there are major problems — “hot spots” — at the exits of bridges and tunnels, and more barriers may be needed there. Boston may have a similar issue, he said; he’d like to examine the city’s data.

I immediately thought of this story from last week: “Scientist Killed In Bike Crash, But Her Thyroid Stem Cell Work Lives On.” The Beacon Street ghost bike in memory of Dr. Anita Kurmann is right at the bottom of the Massachusetts Avenue bridge and it’s a known danger spot for bikers.

From the study’s abstract: Continue reading