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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Medical Marijuana 101: Mass. Doctors Head To The Classroom

“I’d like to start helping people get their mind wrapped around what are we talking about today with a case,” Dr. Alan Ehrlich said, looking out over an auditorium packed with doctors, lobbyists and advocates for medical marijuana. They’d gathered for the Massachusetts Medical Society’s first continuing education course on the use of marijuana to treat medical issues.

“Marilyn is a 68-year-old woman with breast cancer,” said Ehrlich, the senior deputy editor at DynaMed, a website that reviews medical research for doctors.

Marilyn’s cancer had spread and she was undergoing chemotherapy. She did not have any energy, she’d lost her appetite and she was having a lot of back pain.

“So she comes in to a visit with you as a primary care physician,” Ehrlich continued, and “wants to talk about the possibility of using marijuana to alleviate the symptoms of nausea, pain and fatigue. How many people think this is a good woman to certify for the use of marijuana?”

About three-quarters of the audience raised a hand. Well, Ehrlich said, let’s look at the evidence.

For this course, Ehrlich gathered studies on the benefits and risks of marijuana for medical treatment. The U.S. government controls the use of medical marijuana for medical research. There are more studies on the risks than on the benefits.

For Marilyn, who wants to relieve nausea and vomiting, two effects of chemotherapy, there are “no randomized trials of smoked cannabis versus placebo,” Ehrlich said. “So everything I’m going to present from now on, if you’re thinking about using smoked marijuana for this, you’re talking about extrapolations.”

In other words, tests the FDA would require before approving a drug to treat Marilyn’s nausea have not been done for marijuana. Doctors may hear stories from patients who find that marijuana helps, Ehrlich said, but there is almost no scientific proof.

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‘I’m Not Stupid, Just Dyslexic’ — And How Brain Science Can Help

Sixth-grader Josh Thibeau has been struggling to read for as long as he can remember. He has yet to complete a single Harry Potter book, his personal goal.

Growing up with dyslexia: Josh Thibeau, 12, imagines his brain as an ever-changing maze with turns he must learn to navigate. Here he is with his mother, Janet. (George Hicks/WBUR)

Growing up with dyslexia: Josh Thibeau, 12, thinks of his brain as an ever-changing maze with turns he must learn to navigate. Here he is with his mom, Janet. (George Hicks/WBUR)

When he was in first grade, Josh’s parents enrolled him in a research study at Boston Children’s Hospital investigating the genetics of dyslexia. Since then, Josh has completed regular MRI scans of his brain. Initially, it seemed daunting.

“When we first started, I’m like, ‘Oh no, you’re sending me to like some strange, like, science lab where I’m going to be injected with needles and it’s going to hurt,’ I’m like, ‘I’m never going to see my family again,’ ” says Josh, who lives in West Newbury, Mass.

Josh and his three biological siblings all have dyslexia to varying degrees. Pretty much every day he confronts the reality that his brain works differently than his peers’. He’s even shared scans of his brain with classmates to try to show those differences. Some kids still don’t get it.

“There was a student that said, ‘Are you stupid?’ Because my brain was working in a different way,” Josh says. “And I’m just like, ‘No, I am not stupid…I’m just dyslexic.’ ”

The Pre-Reading Brain 

On average, one or two kids in every U.S. classroom has dyslexia, a brain-based learning disability that often runs in families and makes reading difficult, sometimes painfully so.

Compared to other neurodevelopmental disorders like ADHD or autism, research into dyslexia has advanced further, experts say. That’s partly because dyslexia presents itself around a specific behavior: reading — which, as they say, is fundamental.

Now, new research shows it’s possible to pick up some of the signs of dyslexia in the brain even before kids learn to read. And this earlier identification may start to substantially influence how parents, educators and clinicians tackle the disorder.

Until recently (and sometimes even today) kids who struggled to read were thought to lack motivation or smarts. Now it’s clear that’s not true: Dyslexia stems from physiological differences in the brain circuitry. Those differences can make it harder, and less efficient, for children to process the tiny components of language, called phonemes.

And it’s much more complicated than just flipping your “b’s and “d’s.” To read, children need to learn to map the sounds of spoken language — the “KUH”, the “AH”, the “TUH” — to their corresponding letters. And then they must grasp how those letter symbols, the “C” “A” and “T”, create words with meaning. Kids with dyslexia have far more trouble mastering these steps automatically.

For these children, the path toward reading is often marked by struggle, anxiety and feelings of inadequacy. In general, a diagnosis of dyslexia usually means that a child has experienced multiple failures at school.

But collaborations currently underway between neuroscientists at MIT and Children’s Hospital may mark a fundamental shift in addressing dyslexia, and might someday eliminate the anguish of repeated failure. In preliminary findings, researchers report that brain measures taken in kindergartners — even before the kids can read — can “significantly” improve predictions of how well, or poorly, the children can master reading later on.

Implicated in dyslexia: The arcuate fasciculus is an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language (left). Researchers found that kindergarten children with strong pre-reading scores have a bigger, more robust and well-organized arcuate fasciculus (bottom right) while children with very low scores have a small and not particularly well-organized arcuate fasciculus (top right). (Zeynep Saygin/MIT)

Implicated in dyslexia: The arcuate fasciculus is an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language (left). Researchers found that kindergarten children with strong pre-reading scores have a bigger, more robust and well-organized arcuate fasciculus (bottom right) while children with very low scores have a small and not particularly well-organized arcuate fasciculus (top right). (Zeynep Saygin/MIT)

Pinpointing The White Matter Culprit

Using cutting-edge MRI technology, the researchers are able to pinpoint a specific neural pathway, a white matter tract in the brain’s left hemisphere that appears to be related to dyslexia: It’s called the arcuate fasciculus.

“Maybe the most surprising aspect of the research so far is how clear a signal we see in the brains of children who are likely to go on to be poor readers.”
– MIT neuroscientist John Gabrieli

“It’s an arch-shaped bundle of fibers that connects the frontal language areas of the brain to the areas in the temporal lobe that are important for language,” Elizabeth Norton, a neuroscientist at MIT’s McGovern Institute of Brain Research, explains.

In her lab, Norton shows me brain images from the NIH-funded kindergartner study, called READ (for Researching Early Attributes of Dyslexia).

“We see that in children who in kindergarten already have strong pre-reading scores, their arcuate fasciculus is both bigger and more well organized,” she says. On the other hand: “A child with a score of zero has a very small and not particularly organized arcuate fasciculus.”

She says we’re not quite ready to simply take a picture of your child’s brain and say “Aha, this kid is going to have dyslexia,” but we’re getting closer to that point. Continue reading

To Beat Heroin Addiction, A Turn To Coaches

Two young men sit in a car outside a church or union hall where they just attended a Narcotics Anonymous meeting. Both men are addicted to heroin. But they haven’t used the drug since they finished a residential treatment program a week or so earlier.

“This happens a lot, there’s the two of us sitting together,” says Jeremy Wurzburg, a thin, pale 21-year-old who became addicted to heroin two years ago.

Gosnold recovery coach Kristoph Pydynkowski, right, takes Jeremy Wurzburg kayaking, building a life of healthy, positive activities in early recovery. (Courtesy Pydynkowski)

Gosnold recovery coach Kristoph Pydynkowski, right, takes Jeremy Wurzburg kayaking, building a life of healthy, positive activities in early recovery. (Courtesy)

“We both,” Wurzburg pauses, “we’re not sure whether we’re going to use or not and someone makes like a half joke: ‘We could just go out and drink right now’ or something and the other one’s like, ‘Yeah, let’s do that, sounds good.’ And then it’s off.”

That moment, for Wurzburg, could lead right back to his drug of choice, heroin. Most recovery programs, he says, don’t — and maybe can’t — prepare patients in early recovery to fight that urge alone.

“Once I got out of treatment into the real world, it was a big shock,” Wurzburg says. “It’s easy not to use while you’re in rehab. It’s not put in front of you or anything. But then once I got out into the real world, it’s like, I had the knowledge of what to do, but I didn’t have the, those skills yet, or the tools to say ‘no.’”

Of patients addicted to heroin who stop, 40 to 60 percent relapse within the first year. For many it happens soon after finishing a recovery program.

‘Custom-Tailored’ Recovery Help

The next time Wurzburg walked out of a treatment facility, he stepped into a new young adult recovery program. It’s a one-year pilot project at Gosnold, which runs a network of addiction treatment services on Cape Cod.

Wurzburg agreed to live in a sober house, attend daily 12-step group meetings and get individual counseling. Participants can download a smartphone app that has a panic button, a list of addiction services and GPS tracking if patients want their coaches to know when they are near common heroin sale and use sites. There are group trips to ski, hike and listen to the symphony. Perhaps most importantly, Wurzburg has help daily, sometimes hourly, from a recovery coach.
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Unlocking The Brain: Are We Entering A Golden Age Of Neuroscience?

"We still haven’t unlocked the mystery of the three pounds of matter between our ears. That knowledge could be -- will be -- transformative,” President Obama said in announcing the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative on April 2, 2013, at the White House. (Charles Dharapak/AP)

“We still haven’t unlocked the mystery of the three pounds of matter between our ears. That knowledge could be — will be — transformative,” President Obama said in announcing the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative on April 2, 2013, at the White House. (Charles Dharapak/AP)

President John F. Kennedy set the nation’s sights on the moon. Fifty years later, President Obama announced his signature science project: neuroscience, the study of the brain.

“As humans,” he said last April, “we can identify galaxies light years away, we can study particles smaller than an atom, but we still haven’t unlocked the mystery of the three pounds of matter between our ears.”

The president committed an initial $100 million to BRAIN, an acronym for Brain Research through Advancing Neurotechnologies, to fund the development of better tools for studying how the brain works. “That knowledge could be — will be — transformative,” he said.

Over the next two months, WBUR will present a weekly series about brain science advances — many happening in Boston, a major hub for neuroscience research. Today, the overview.

If you click the “Play” arrow above, you’ll hear the hissy, Morse-Code-on-steroids sound of neurons firing, sending signals to each other.

So is this what a thought of yours would sound like, if it were played through an audio monitor like this? No. What you’re hearing is far, far simpler. These neurons belong to a crab; they make up a simple circuit of about 30 neurons that control how it chews and digests food. Their steady, rhythmic cycle is more like what your neurons do to control your breathing.

“Imagine now,” says Brandeis University neuroscientist Eve Marder, “an orchestra with billions of neurons firing in different patterns depending on what you were seeing, what you were hearing, what you were thinking and what you were feeling, so those rhythms would be changing in a tremendous symphony. If you could hear all of the neurons in your brain, it would be very hard to hear patterns, because there would be so many instruments, if you will, playing at the same time. It might sound like a cacophony.”

Making sense of that cacophonous complexity, she says, will be a lot harder than JFK’s moon shot.

“Unlike putting [a] man on the moon, where you knew exactly where the goal was and the problem was largely an engineering problem,” she says, “understanding the brain is a series of engineering problems and a series of intellectually creative, imaginative understandings, and it’s going to require the coordination of creativity across every scientific discipline that we know.”

But even if we give it everything we’ve got, can the human brain ever understand itself?

That’s the monumental gamble of Obama’s BRAIN initiative — and other major neuroscience efforts now getting under way around the world. They’re not trying to solve philosophical questions. They’re responding to the growing realization that brain disorders — from autism to mental illness to dementia — are a worldwide scourge, affecting at least a billion people.

“The global cost from brain disorders is about $2.5 trillion, and will go up more than double over the next two decades,” says Tom Insel, director of the National Institute of Mental Health. “So policymakers look at these numbers and say, ‘Oh my God, we have got to begin investing to make sure we don’t incur those kinds of costs.’ ”

Neuroscientists have been studying the brain for more than a century, and better treatments for brain diseases have been desperately needed for a lot longer than that. What’s different now is that for the first time, researchers say, we’re beginning to get a handle on the workings of the brain’s billions of neurons and trillions of connections. We’re starting to understand how groups of neurons interact, in smaller circuits or bigger networks — and that scale, out of reach even just a few years ago, is what we need if we ever hope to understand how we have a thought, or a memory, or a mental illness.

“This is an exciting time to be a neuroscientist. I’m not sure there’s ever been a more exciting time,” Larry Swanson, president of the Society for Neuroscience, told an audience last fall at the society’s annual conference of about 30,000 scientists. Continue reading

Could Medical Marijuana Help Stem The Opiate Addiction Crisis?

Marijuana is touted as a treatment for chronic pain, multiple sclerosis and anxiety — and some say it may be a way to help alleviate Massachusetts’ opiate crisis. But that idea is causing some tension in the addiction treatment community.

A Less Potent Alternative? 

Shelley Stormo is a clinical psychologist at Gosnold, the largest addiction treatment facility on Cape Cod. She has secured provisional approval to open a medical marijuana dispensary in Fairhaven called Compassionate Care Clinics, and the state is now verifying her application. Stormo hopes by this fall, she’ll be able to help patients avoid opiates by using marijuana.

“I’m changing my efforts a bit to really focus on how to prevent addiction,” Stormo said. “Through offering the medical use of marijuana as an alternative to potentially much more harmful and deadly opioids.”

Stormo says marijuana is safer for several reasons.

“Marijuana does not have the physical addictive components that opiates do,” she said. “It does not have the propensity, as opiates do, for overdoses. There’s no documented death by overdose of marijuana.”

Although Stormo does not advocate using marijuana to treat addiction, other medical marijuana professionals say the so-called gateway drug may one day be used as part of an exit strategy.

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Patrick Endorses Plan To Address Opiate Addiction ‘Public Health Emergency’

The Patrick administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. The details are in a task force report endorsed by Gov. Deval Patrick Tuesday.

“We have a public health emergency,” Patrick said, repeating the reason he created the task force in late March.

To combat that emergency, the state will spend $4 million on new residential treatment programs for adolescents, young adults, families with children, and two that will give priority to Latinos. There’s an enhanced prescription monitoring program. The state plans to spend $3 million on treatment for inmates, including Vivitrol, a drug that blocks the effects of opiates.

Gov. Deval Patrick, in an April 29 file photo (Josh Reynolds/AP)

Gov. Deval Patrick, in an April 29 file photo (Josh Reynolds/AP)

The state will also establish regional walk-in assessment centers, “which I thought was one of the more creative findings,” said Public Health Commissioner Cheryl Bartlett, who chaired the task force. The centers will be staffed by professionals who can assess anyone who stops by and offer ongoing support groups.

Anyone who decides to check into a detox or rehab program will be able to call a 1-800 number that lists locations statewide with openings, and there are hopes to expand it to throughout New England.

That’s critical, said Dr. Paul Jeffrey, director of pharmacy for the Office of Clinical Affairs at UMass Medical School, and a member of the opiate task force.

“There’s a golden moment,” Jeffrey explained. “Imagine how frustrating it would be if you made a decision that you wanted to get clean and you couldn’t find a way to do that.”

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Can Brain Science Help Lift People Out Of Poverty?

Five years ago Lauretta Brennan was a single mom on welfare with a pack-a-day smoking habit, stuck in a “bad” relationship and living in the South Boston projects where she grew up.

Now, she’s still living in the projects with her young son, but the bad boyfriend is gone and Brennan’s got a job as an administrative assistant after receiving a business management degree. And she quit smoking.

Her childhood in the projects was marked by alcoholism and violence all around, Brennan said; “having no adult role model was the norm, being with a man who’s ignorant, that was the norm.”

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

Lauretta Brennan graduated from Bunker Hill Community College with an Associates Degree in Business Management in June 2013 (Courtesy)

But now, thanks to a novel program that uses the latest neuroscience research to help women dig themselves out of poverty, Brennan says: “I don’t want to live off welfare. I want to make money and be around people who work and go to school. In five years, the program got me to think more like an executive — I have goals, I’m an organizer managing my family well. I’m not scared anymore.”

This shift in thinking — from chaotic, stressed-out, oppressed and overwhelmed to purposeful and goal-oriented — may not sound like brain science. But it fits into an emerging body of research that suggests that the stress of living in poverty can profoundly change the brain: it can undermine development and erode important mental processes including executive function, working memory, impulse-control and other cognitive skills.

To fix that damage, the new thinking goes, people must engage in activities and practices that strengthen this diminished functionality and, exploiting the brain’s ability to change (plasticity in neuroscience lingo) re-train themselves to think more critically and strategically.

“Poverty whacks executive function and executive function is precisely what’s needed to move people out of poverty,” says Elisabeth Babcock, chief executive of the nonprofit Crittenton Women’s Union, a Boston-based group that draws on the latest brain research to help families achieve economic success. “What the new brain science says is that the stresses created by living in poverty often work against us, make it harder for our brains to find the best solutions to our problems. This is a part of the reason why poverty is so ‘sticky.’”

In a recent paper, “Using Brain Science To Design New Pathways Out Of Poverty,” Babcock makes the case that living in an impoverished environment “has the capacity to negatively impact the decision-making processes involved in problem-solving, goal-setting and goal attainment.” In other words, this type of stress can “hijack” the brain.

As other researchers, including Jack Shonkoff, director of the Center on the Developing Child at Harvard, have noted, this chronic vise of pressure — to pay the bills, function at work, raise the kids, and simply survive in an atmosphere rife with social bias and harsh living conditions — “places extraordinary demands on cognitive bandwidth.” Babcock writes:

“The prefrontal cortex of the brain — the area of the brain that is associated with any of the analytic processes necessary to solve problems, set goals and optimally execute chosen strategies — works in tandem with the limbic system, which processes and triggers emotional reactions to environmental stimuli…When the limbic brain is overactive and sending out too many powerful signals of desire, stress, or fear, the prefrontal brain can get swamped and the wave of emotion can drown out clear focus and judgement…”

How does this play out in real life? Chuck Carter, senior VP of research at Crittenton Women’s Union, explains:

“One of the things the brain science brings is something of an ‘aha’ in terms of why things are sometimes harder than we expect them to be. When you’re looking at a family that is struggling and making decisions that you don’t really understand, having that research helps you reassess…it adds another perspective. A lot of nonprofit organizations look at the social determinants [of poverty] but not a lot look at the science that says, ‘What else is at play?’

“I think that, on the ground, it gives us creative ways to think about the work and how we might approach it…Often families are in a lot of crises…and they feel they need to do things ‘right now.’ So, for instance, we’ve got a family, and they’re in a hallway and they’ll have to talk to the case manager ‘right now.’ And we ask whether it’s a true emergency, and if not, can we talk about this the next morning, and not in the hallway. It’s a problem with executive function and poor impulse control, but we can help them slow down and figure out the right time to figure this out and what information do they need. It’s about not responding so impulsively in other parts of their lives. So, in thinking about what to do with money, it can be a question of, ‘Do I buy cigarettes now or save the money for some new furniture when I move?’”

So how do you begin to fix all of this?

I asked Babcock a bit about the science behind her organization’s Mobility Mentoring program, in which low-income — mostly single — mothers apply to get training, professional mentoring, financial and other support for three to five years, in hopes of attaining economic independence.

Here, edited, is our discussion:

RZ: What does the research say about how poverty changes the brain? And how does a “hijacked” brain function compared to a brain not experiencing intense, chronic stress?

EB: Poverty hits what scientists call our executive functioning skills: our ability to problem-solve, set priorities and goals, juggle and multi-task, focus and stick to things. And it does this in at least two very important ways. First, the stress of dealing with new problems every day and never having enough to make ends meet overwhelms our heads and swamps us. It overloads the circuits in our brains and compromises our decision-making in the moment. Continue reading

Report: Fewer Infections Overall At Mass. Hospitals (But Problems Remain)

(UCI Irvine/flickr)

(UCI Irvine/flickr)

For the most part, patients are contracting fewer infections inside Massachusetts hospitals — but some problem spots remain, according to numbers from the state’s Department of Public Health.

WBUR’s Martha Bebinger reports:

It’s almost impossible to compare the quality of specific hospital procedures, but you can make a few hospital system comparisons.

For instance, the latest data show lower rates for three types of hospital infections — central line and surgical site infections for hysterectomies and colon operations. On the other hand, rates for urinary tract infections from catheters have increased.

Still, required reporting is spurring change, says Patricia Noga, VP for Clinical Affairs of the Massachusetts Hospital Association.

“When there is reporting and particularly when there is public reporting, people stand up and take notice of it,” Noga says. “Sometimes more than they would otherwise.”

Here are some specifics from the state Center for Health Information and Analysis:

•Central line-associated blood stream infections in Massachusetts have declined by 47%. In Massachusetts’ Intensive Care Units and neonatal ICUs, [such infections] declined by 57% and 49%, respectively.

•Surgical site infections related to abdominal hysterectomy declined by 23% in Massachusetts hospitals. While 8% of reporting hospitals had an observed to expected ratio greater (worse) than the national ratio, overall Massachusetts’ improvement is on track with positive national trends.

•Surgical site infections related to colon surgery declined by 19%. Massachusetts’ ratio of observed to expected infections is in line with the nation’s.

•Catheter-associated urinary tract infections have increased by 45% in the Commonwealth. In Massachusetts ICUs, [these types of infections] have increased by 64%. Among reporting hospitals, 15% had an observed to expected ratio greater (worse) than the nation’s. Massachusetts significantly lags national performance on this measure.

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Pregnancy Woes: Why Did The Price Of My Progesterone Skyrocket?

(Photo: Rekha Murthy)

(Photo: Rekha Murthy)

By Rekha Murthy
Guest Contributor

Update: KV Pharmaceutical changed its name to Lumara Health, two days after this post was published.

I’m 34 weeks pregnant and working hard to keep this baby inside me for as long as possible. As with my last pregnancy, there’s a real risk that the baby could come too early. But we’re both holding on so far, thanks to a combination of luck, modified bed rest and medical science.

The science is my biggest concern right now. I will spare you much of it because, man or woman, you will instinctively cringe and close your legs. However, one critical medical intervention that has been proven to work for countless women and babies is again under threat, and I must speak up.

Every week, my husband injects me with 250 mg (1 ml) of 17 alpha-hydroxyprogesterone caproate (“progesterone” for short). Leaving aside what this does to an otherwise tender and loving marriage, these injections have been found to significantly lower the risk of preterm birth.

Two weeks ago, my insurance co-pay for progesterone went from $5.50 per dose to $70 per dose. Just like that. For those without insurance (or with a deductible), the medication went from $32.50 per dose, according to my local compounding pharmacy, to…wait for it…$833 per dose, according to the new pharmacy my insurer is now requiring me to use.

$833. Per. Dose.

Pricing varies somewhat across pharmacies and insurers, but not enough to make this price change any less breathtaking. In fact, the drug’s list price is $690 per dose.

The 12-fold leap in my co-pay sent an epic shock through my (natural and synthetic) hormone-laden system. I immediately called both pharmacies, my insurer, and my doctor, and started digging around online. I soon learned that the price increase came from a new requirement to buy expensive brand-name progesterone, instead of the affordable compounded version I had been getting. A disturbing picture came into focus. Continue reading

A Bittersweet Graduation For Patients At The Mass. Hospital School

Brian Devin, CEO of The Massachusetts Hospital School, speaks with student Miguel M. in the cafeteria after lunch. (Jesse Costa/WBUR)

Brian Devin, CEO of The Massachusetts Hospital School, speaks with student Miguel M. in the cafeteria after lunch. (Jesse Costa/WBUR)

By Gabrielle Emanuel

CANTON, Mass. — It’s lunch break and there’s a wheelchair traffic jam in the school hallway.

Friendly shouts of “Beep! Beep!” and “You’re blocking traffic” interrupt chatter about one kid’s new backpack and another guy’s birthday plans.

It’s a typical school scene, except a bunch of the kids are using computers to talk and others breathe through ventilators.

Like students across the country, many of these kids are getting ready for graduation. It’s a bittersweet time for graduates of all stripes, but perhaps nowhere is it more bittersweet than here.

All of the 91 students in these hallways are also patients. When they graduate – as about a dozen will this year – they’re not only leaving their friends and teachers, they’re leaving the hospital they’ve called home for years, and in some cases, a decade or more.

The campus’ main entrance is on a rural road in Canton, where a flashing sign reads: The Massachusetts Hospital School.

Brian Devin, the CEO, says that when cars zip past drivers often “think it’s a school where they teach people to work in hospitals.”

Devin says it’s a fair assumption, but completely wrong. This facility is part pediatric hospital, part elementary and secondary school. It serves children with severe disabilities — muscular dystrophy, cerebral palsy, brain injuries — and is run jointly by the state Department of Public Health and the Department of Education.

Children as young as 6 or 7 can be admitted to the hospital and they often stay at this lakefront campus until the kid’s clock strikes 22 years old, when it’s time to graduate and it’s time to go, regardless of whether there is another alternative place to go.

A Non-Institutional Hospital

As the hallway traffic starts moving, the students wheel themselves out into the brisk spring air. They race down covered ramps toward horseback riding lessons, speech therapy sessions and wheelchair hockey practice.

Those white ramps create a web that connects all the brick buildings on this idyllic, 160-acre facility.

“The kids are all over the place. They are not always with staff — we don’t want them to always be with staff,” Devin says. “We want them to be with themselves and with other kids as much as possible. There is no real institutional flavor.”

The Massachusetts Hospital School’s ultimate goal is to cultivate as much independence as possible for these children. Continue reading