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8 Things You Need To Know About Ebola

Cpl. Zachary Wicker shows the use of a germ-protective gear in Fort Bliss, Texas, Tuesday, Oct. 14, 2014. About 500 Fort Bliss soldiers are preparing for deployment to West Africa where they will provide support in a military effort to contain the Ebola outbreak. /Juan Carlos Llorca/AP)

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.

Here’s what you need to know about Ebola:

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Boston Patient Not At High Risk For Ebola, Health Officials Say

Beth Israel Deaconess Medical Center in Boston (Steven Senne/AP)

Beth Israel Deaconess Medical Center in Boston (Steven Senne/AP)

A man who travels frequently to Liberia caused a stir Sunday afternoon when he arrived at a Braintree clinic with Ebola-like symptoms. But doctors and public health officials say that the man is not considered at high risk for the often deadly virus. His case did, however, give us the first public look at how nurses, EMTs, hospital staff and others have prepared to respond when there is an Ebola alert.

WBUR’s Martha Bebinger spoke with WBUR’s Bob Oakes on Monday with more on the story.

Bob Oakes: How did this man, who has not been identified, become the focus of police escorts, press conferences and numerous statements on Sunday?

Martha Bebinger: The man called his primary care practice, Harvard Vanguard, in Braintree Sunday morning, complaining of a headache, muscle aches and some other problems. He was given an appointment in the afternoon. The man went to the Harvard Vanguard pharmacy to pick up a prescription for something else, then left.

But after that first call, Harvard Vanguard reviewed his medical record and noticed that the man traveled frequently to Liberia. The office staff then called the patient and “intercepted” him as he was coming in. They asked him to wait in his car while they called for an ambulance. The Harvard Vanguard office was closed for a period of time, while they disinfected surfaces in the pharmacy they believe he touched, and then reopened.

The man waited, cooperatively, we’re told, in his car, sort of a self-quarantine, until an ambulance arrived. What kind of precautions were in place there?

Brewster ambulance completed their Ebola response training about a week ago. Brewster’s director of training, Jeff Jacobson, says the company was on the scene in 15 minutes with two ambulances, one that had been sealed inside with plastic and three EMTs wearing hazardous materials suits.

“Once the patient is removed from the ambulance and into the hospital, two more folks get into the level B suits and remove all the plastic, put in sealed containers, then the vehicle is disinfected, following the Centers for Disease Control recommendations,” Jacobson said.

In all, Jacobson estimates there were 40 responders, including police, firefighters, local public health and Harvard Vanguard personnel.

Forty personnel arrived? And were all of those responders trained in Ebola safety practices?

I heard both yes and no. Only people who may come in contact with the patient or his body fluids need to wear gloves and protective gear. But I also heard there was a call Sunday, after this incident, on which some participants felt the response was too much while others thought that a maximum effort is warranted as responders test and adjust their reaction to Ebola.

The ambulance took the patient to Beth Israel Deaconess Medical Center, where I imagine there were a few nervous staff members. Earlier Sunday, the CDC confirmed that a nurse who treated a man who died from Ebola in Dallas has come down with the virus. Continue reading

Enterovirus D68: Good News, Bad News, What To Do

(CDC)

(CDC)

Pick your viral anxiety: Do you want to focus your media-fueled jitters on Ebola or on enterovirus D68?

Personally, even with today’s news of the first U.S. death from Ebola, I pick the enterovirus every time. For one thing, it’s actually around; it’s not a single case in Texas. But I’d prefer no anxiety at all, and the best antidote tends to be knowledge. So here are some data points:

The Massachusetts Department of Public Health fact sheet on enterovirus D68 is here and the CDC’s here. At a news conference last week, Dr. Alfred DeMaria, the department’s medical director for the Bureau of Infectious Disease, told reporters that enterovirus D68 had probably been “the predominant cause of respiratory illness over the last four weeks.”

Mostly, that meant colds, he said, and he thinks he even had the bug himself. But reports of lung ailments have “decreased significantly over the past couple of weeks,” he said, so “enterovirus 68 seems to be going away.”

Let’s hope. But what the heck? Here & Now reports that the enterovirus has been connected to five deaths nationwide, most recently of a 4-year-old in New Jersey. Of course, we know that viruses can sometimes lead to deaths by unleashing bacterial infections; flu has been known to kill dozens of American children in a bad year. But still, what to make of all the coverage of this unfamiliar virus?

I asked Dr. Ben Kruskal, chief of infectious diseases at Harvard Vanguard Medical Associates. My takeaway: Yes, this is quite a bit like flu, only it’s drawing attention because it’s a virus that’s acting atypically, surprisingly. Our conversation, edited:

There are so many viruses around; why are we even hearing about this one and what should we make of the coverage?

We’re hearing about it because it is not just a strain of a virus we don’t see very often but because it’s causing unusual manifestations, and manifestations that have enough impact for us to pay attention to. It’s actually in 30 or 40 states now, and we don’t really know how widespread it is because it’s clinically not terribly distinctive. It’s a respiratory virus that looks like a lot of other respiratory viruses, including the flu and the cold viruses and a whole bunch of others. And the reason we’re paying attention is not just the fact that it’s an unusual strain — then it would be a sort of laboratory curiosity — but because it’s actually on a more severe end of the spectrum for some people.

So it’s been confirmed that it’s here in Massachusetts, and it sounds like we have had more kids being hospitalized for respiratory trouble than usual in recent weeks, right? For example, Tufts Medical Center tells us that they’ve had 54 hospital admissions of kids with repiratory problems this year, compared to 27 admissions by this date last year, and they’re tending to stay in longer and need more treatment.

I understand from Dan Slater, who’s the director of pediatrics here at Harvard Vanguard, that we went months without having to admit any kids with asthma to the hospital, and in the last few weeks we’ve had quite a few admissions.

So what’s your public health message then at this point? What do you say to parents?

It’s reasonable to think of this outbreak in most respects as being like a sort of a nastier flu season. The timing is different from the flu season but in terms of how it manifests itself, it’s pretty similar to a severe flu. Remember that the flu and this virus — like any infectious agent — have a spectrum of severity. So even though this one is on average more severe, there are still lots of people who will get just a regular old cold. And there are some people who will get kind of a nasty cold. And there are some people who will get more severe things, including asthma-like illness in people who don’t have pre-existing asthma or an exacerbation of underlying asthma in people who do.

So are there telltale symptoms to watch for? Continue reading

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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