Most of us will be hunkered down at home over the next 24 hours, as a blizzard bears down on the state. But police, firefighters, hospital staff and workers at hundreds of nursing homes will be working. Listen above to a report from WBUR’s Martha Bebinger about how hospitals and senior care facilities are preparing to ride out the storm.
The latest cool stuff out of some of the nation's best labs; news on medical research and what it may mean for patients.
Staff at Brigham and Women’s hospital Wednesday were mourning the surgeon who was shot and killed Tuesday by the son of a former patient. As WBUR’s Fred Bever reports, Dr. Michael Davidson was remembered both for his skills as a surgeon and his rich personal life. Listen to his full report above.
Brigham and Women’s Hospital in Boston said it’ll review its safety measures and protocols Wednesday after the fatal shooting of a doctor there Tuesday. The doctor, Michael Davidson, 44, was pronounced dead late Tuesday.
Investigators say the gunman, identified by police as 55-year-old Stephen Pasceri, of Millbury, deliberately targeted Davidson. Police say Pasceri died from an apparent self-inflicted gunshot wound.
It’s the type of situation the hospital’s chief operating officer, Dr. Ron Walls, says all hospital staff have been carefully trained to address.
“There is no amount of preparation anyone can do that completely eliminates the prospect of this kind of tragic event happening,” Walls said. “But we do believe we have a responsibility, and we’re working hard to meet that responsibility to have all of our people completely prepared in the best way we can so that when something like this happens — if it happens, and whatever happens– our staff is able to respond.”
John Erwin, the executive director of the Conference of Boston Teaching Hospitals, joins Morning Edition to discuss safety measures at area hospitals.
To hear the full interview with Erwin, click on the audio player above.
The doctor from Holden who’s affiliated with UMass Medical School and contracted Ebola while working with a missionary organization in Liberia is now returning to that country for the first time since being cured of the disease.
Meanwhile, the medical school is ramping up efforts to train doctors and nurses in Liberia, to build a viable health care system there. Listen to Lynn Jolicoeur’s full report above.
By Judith G. Edersheim, JD, MD
This week marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing. Not a who-done-it, but a why-done-it.
If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will turn to a grave question, part jurisprudence and part moral philosophy: Is this defendant the most evil and culpable of all? A human being who deserves the most severe of all punishments?
One thing, I believe, is certain: If this case proceeds to the sentencing phase, the black box everyone will be talking about will be the cranium, and how the brain drives behavior will be the central story.
In these protracted sentencing hearings, the scales of justice balance lists of aggravators and mitigators, all outlined by law.
Aggravating factors in this case might include the political motive for the bombings, the risk posed to others during the course of the Tsarnaev brothers’ dramatic attempt to flee, the “heinous”, “cruel” or “depraved” manner of the crime’s execution, and the substantial planning and premeditation that might have preceded the bombings.
In the end, behavior trumps brain scans.
Mitigating factors — factors that weigh in favor of life in prison rather than a death sentence — cast the broadest net. Any aspect of a defendant’s background, record, character or circumstance is fair game for the defense team. It could try to demonstrate that Tsarnaev had some kind of impaired capacity to appreciate that his acts were wrong or illegal, or that he was under some kind of demonstrable duress. It could also bring to light hardships during his upbringing that limited his opportunities or narrowed his ability to choose wisely.
The defense team has already given public hints as to the central themes of its mitigators. They will feature life within the Tsarnaev family, including Dzhokhar’s relationship with his parents, his brother Tamerlan, and his sisters. Will anything in these family dynamics rise to the level of psychological duress or impaired capacity? There will likely be plenty of traditional testimony from forensic psychologists and psychiatrists regarding whether or not Tsarnaev was under the sway of his radicalized and perhaps dominant older brother, particularly after the Tsarnaev parents left the country. The prosecution will likely counter with a line of evidence regarding Dzohokar’s relative independence and his network of friends and activities outside of the family structure.
Then comes the brain.
Judy Clarke, lead defense attorney and one of the nation’s premier death penalty litigators, will surely not overlook the new body of neuroscientific evidence regarding the immaturity of adolescent brains. In a recent trilogy of cases (known as Roper, Graham, and Miller ) the U.S. Supreme Court was influenced by neuroscientific evidence about the juvenile brain when making sweeping changes in how adolescents are tried and sentenced. The court concluded that adolescent brains were less mature than those of adults in ways which warranted differential treatment under our criminal laws.
Although Tsarnaev was 19 at the time of the bombings, his lawyers might argue that much of this brain research applies, as it outlines a period of relative immaturity that stretches from mid-adolescence all the way into the early 20s. Generally speaking, this research shows that adolescents are less mature, and they are more likely to make ill-considered decisions. They bow to peer influences and respond excessively to thrill seeking and immediate rewards. Think money, sex, drugs and friends.
Beginning in the teens, there are major changes in brain architecture and function that temper these qualities — among them, synaptic pruning of the prefrontal cortex, improved connectivity and changes in dopamine receptors — all of which support self control, delayed gratification and the development of a moral compass.
Here’s the rub. What the research doesn’t show makes it problematic for defense attorneys. The research does not show that adolescents are incapable of making well-considered choices. Quite the contrary. Continue reading
It looks like the first medical marijuana dispensary will open in Salem. But Alternative Therapies Group, Inc. (ATG) must clear several hurdles before it rings up a sale of marijuana for medical use. The certificate announced Wednesday allows ATG to plant seeds at its cultivation site in Amesbury.
Assuming a three-month growing cycle, the storefront in Salem could begin selling marijuana in April. But the plants must be tested for mold, heavy metals, pesticides and potency. State officials say they will review dispensary labeling and transportation plans, as well as conduct unannounced inspections, before the dispensary is allowed to open for business.
Some patients have criticized the state for a slow roll-out of the medical marijuana law voters approved in 2012.
“While this process has taken some time, we wanted to make sure that we got it right, this is a brand new industry,” Secretary of Health and Human Services John Polanowicz said.
Fourteen dispensaries are still under review for certification.
Salem Mayor Kim Driscoll said in a statement she’s pleased that a dispensary in her city has received the state’s first medical marijuana certificate.
“Salem has long been a progressive, forward-thinking, and open-minded community and we look forward to ATC starting operation and providing yet another critical medical choice to patients for the entire North Shore,” Driscoll said.
And in Amesbury, “I am happy to see them [ATG] reach this milestone,” said Mayor Ken Gray. “I look forward to seeing ATG develop as a positive contributor to the Amesbury community.”
WBUR’s Martha Bebinger contributed reporting.
Among the groups on the forefront in the international effort to address the Ebola crisis in West Africa is Boston-based Partners in Health (PIH). The group is promising to keep staff and volunteers in Liberia and Sierra Leone for several more years to fight Ebola and address other public health concerns in those countries.
Helping to lead the PIH initiative is chief nursing officer Sheila Davis, who returned to Boston earlier this month and remains largely confined to her home in Roslindale.
She joins Morning Edition Wednesday to talk about how the ongoing crisis reveals how vital public health infrastructures are.
Sheila Davis: Many times more people are dying, not because of Ebola, but because of this weakened health system. So even the facilities that have been open to provide care for other things — such as malaria, safe child birth — those in most counties are closed. So more people are dying, because they’re not being able to get health care for other, non-Ebola reasons.
A lot of the attention to both countries has been just treating the acute Ebola. But, if we don’t work at the same time to build up this system, we’re going to see these acute outbreaks or hotspots for quite a long time.
On whether PIH had any idea how serious the Ebola outbreak would become:
SD: I don’t think we did. The first cases we heard about in probably March, April or May. Like all of the other previous Ebola outbreaks, the thought was it would show up and it would be quickly gone and a few hundred cases would be there worldwide, and we would stop hearing about it very quickly.
And then, during the summer, when we were hearing more and more about cases being found in Liberia, Sierra Leone, Guinea, we had two smaller nonprofits that we worked with in those areas, and we had been in contact with them. And they, as well as the governments of Liberia and Sierra Leone, asked us to come in and help.
The Department of Public Health on Tuesday signed off on the proposed closure of Quincy Medical Center, set for midnight on Friday.
Steward Health Care, the owner of the hospital, said Quincy Medical will halt operations on Dec. 26, at 11:59 p.m., with a satellite emergency facility set to open in the same location at 12 a.m. on Saturday, Dec. 27.
“Because of significant declines in patient volume, the Department has determined that this closure timeline is necessary and appropriate to protect the health and safety of patients served by QMC and the Department waives the remainder of the 90 day closure notice period,” Department of Public Health official Sherman Lohnes wrote in a Tuesday letter to Steward.
In a release, Steward said that Quincy Medical as of Tuesday no longer has any inpatients.
“We are appreciative of the thoughtful review of our transition plan and the guidance we received from the Department of Public Health,” Mark Girard, president of Steward Hospitals, said in a statement.
Local elected officials have criticized Steward for the speed with which the for-profit company has moved to close the hospital after it claimed in November that it suffered financial losses and a decreasing number of patients at the Quincy hospital. Attorney General Martha Coakley’s office has also raised the prospect of legal action in response to the closure.
The closure was originally set for Dec. 31, and then Steward said it would be willing to keep it open up to Feb. 4, 2015.
About nine months ago, John Polanowicz was in a hospital room at Brigham and Women’s watching his 44-year-old brother-in-law Bobby struggle to breathe. Bobby had advanced lung cancer. Now, with a tube down his throat, he was trying to respond to questions about his end-of-life wishes using a marker on a white board.
“We were all trying to decide,” Polanowicz recalled, “would we keep him trached and vented, and hope against hope that there would be some change in the disease process?”
Bobby was losing the battle with cancer. He had wanted to fight to the end, but no one had talked to Bobby about how to deal with the end.
“It would have been much easier for the family to have had some of these conversations before 4 in the afternoon on the day that he passed,” Polanowicz said.
On Friday, Polanowicz, Massachusetts’ secretary for health and human services, posts regulations designed to help patients like his brother-in-law avoid describing their final medical wishes with an erasable marker. Doctors, hospitals, nursing homes and other health providers in Massachusetts are now required to offer end-of-life counseling to terminally ill patients. The requirement, part of a 2012 law, takes effect Friday with the posting of rules about how it will work.
By Richard Knox
A couple of years ago, Ruben Meerman took off 40 pounds. And that got him wondering: What exactly happened to all that fat?
Conventional wisdom was that he “burned” it off. Or sweated it off. Or excreted it. None of that satisfied Meerman, who has a physics degree and makes his living explaining science to schoolkids and for the Australian Broadcasting Corporation.
So Meerman tackled the problem and eventually came up with a surprising answer: Most of the lost fat disappears into thin air.
More specifically, 84 percent of those fat molecules get exhaled as colorless, odorless carbon dioxide. The other 16 percent departs the body as H-2-O — plain old water.
Meerman says the discovery “got me really excited because I’d stumbled onto a gap in the knowledge. It struck me as remarkable that no one had thought this was interesting enough to pursue.”
The British Medical Journal thought so too. It has published a paper, co-authored by biochemist Andrew Brown of the University of South Wales, in its annual Christmas issue, which features off-beat (but peer-reviewed) research.
Weight Loss Realism
Meerman hopes the work will dispel misconceptions held by health professionals as well as the general public. And, he hopes it will provide a helpful dose of realism to counter the impossible expectations millions have about weight loss.
If people understand where the fat goes (and how), they’ll get “why there’s a limit to how quickly you can lose weight,” Meerman said in a Skype interview from Sydney. “And if you understand the limit, you won’t be so quickly depressed if you don’t lose 20 pounds in the first two weeks.”
First, the misconceptions. Meerman and Brown surveyed 150 professionals — split equally among family doctors, dietitians and personal trainers — about where they think the fat goes during weight loss.
By far the most common answer was that the fat was transformed into energy or heat — that is, “burned off.” About two-thirds of doctors thought so. A slightly higher proportion of dietitians did too, and about 55 percent of personal trainers.
But that would violate the Law of Conservation of Mass. It’s a basic precept of chemistry, formulated in 1789 by the French scientist Antoine Lavoisier, which holds that mass is neither created nor destroyed in chemical reactions. The total mass at the end must equal the mass at the starting point — even if matter is quite transformed in the process, from solid to liquid or gas.
The Energy Of A Bomb
Meerman points out that if fat were transformed into pure energy during weight loss, the results would be cataclysmic. Continue reading