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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If You Find A Tick: Why I Resorted To Mooching Pills To Fight Lyme Disease

A March 2002 file photo of a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. (Victoria Arocho/AP)

A March 2002 file photo of a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. (Victoria Arocho/AP)

I’ve never done anything like this before. I’m a good little medical doobie. I’m wary of pills, take them only with prescriptions, and follow the instructions to the letter. But last month, I “borrowed” a friend’s extra 200 milligrams of doxycycline — the onetime antibiotic dose shown to help prevent Lyme disease soon after a prolonged tick bite.

What brought me to that desperate point? A doctor declined to prescribe the pills, even though this is prime Lyme disease season and the patient, my family member, fulfilled every one of mainstream medicine’s requirements for the single dose aimed at preventing Lyme. To wit:

• The tick was a fully engorged deer tick that had been attached for more than 36 hours.

• We sought treatment within three days of removing it.

• The tick came from a Lyme-endemic area.

• And the patient had no medical reason to avoid antibiotics.

The antibiotics I “borrowed” from a generous friend (Carey Goldberg/WBUR)

The antibiotics I “borrowed” from a generous friend (Carey Goldberg/WBUR)

But still. The doctor argued that the chances of contracting Lyme from the tick were very small, perhaps 1 in 50, and that overuse of antibiotics contributes to the growing problem of drug-resistant bacteria. This is what he would do for his own family member, he said: skip the doxycycline, wait to see if Lyme develops, and treat it with a full 10-day course of antibiotics if it does.

I was frustrated and frankly a bit appalled. WBUR ran a series on Lyme disease in 2012, and I knew that controversy raged around many aspects of the disease, particularly the use of long-term antibiotics to treat long-term symptoms. But I was just trying to follow the widely accepted guidelines written by the Infectious Disease Society of America, to be found in reputable medical venues like UpToDate. And I knew from that same series that Lyme is rife in New England, and so are personal stories of health and lives ruined or seriously harmed.

Still, maybe I was overreacting? I’ve since sought a reality check from three experts, including the lead author of the guidelines. And here’s what I come away with: No, I was not unreasonable in seeking the preventive doxycycline. Arguably, though I hate to admit it, the doctor was not being totally unreasonable in declining it. The guidelines say a doctor “may” prescribe the antibiotic; it’s not a “must.”

In the end, I think, the crux of the question may lie in how you see the doctor’s role: Is it to lay out the risks and benefits and then let the patient choose? Or to impose his or her own best medical judgment on the patient? (You can guess where I come down on that one.) Also, “better safe than sorry” tends to rule when it comes to my loved ones. But what if the risk is small and the benefit uncertain? Continue reading

How Addiction Can Affect Brain Connections

As much of the country grapples with problems resulting from opioid addiction, some Massachusetts scientists say they’re getting a better understanding of the profound role the brain plays in addiction.

Their work is among a growing body of research showing that addiction is a complex brain disease that affects people differently. But the research also raises hopes about potential treatments.

Among the findings of some University of Massachusetts Medical School scientists is that addiction appears to permanently affect the connections between areas of the brain to almost “hard-wire” the brain to support the addiction.

They’re also exploring the neural roots of addiction and seeking novel treatments — including perhaps the age-old practice of meditation.

Meditation As Part Of Addiction Treatment

After spending 40 minutes lying on the floor with his eyes closed, being led through a meditation exercise, one of the students in a recent mindfulness class said something that many of the other students appeared to be thinking.

“I’m irritated,” he said, as several of the 30 other students murmured in agreement. Some giggled.

“I can’t really sit this long with my eyes closed without falling asleep,” he added. “I think this is overall positive. Maybe I just have a long way to go.”

Mindfulness has been touted as a way to boost quality-of-life issues, and the students in the class were there for various reasons: some to learn to relax, others to cope with health issues, and — at least one student — to support her recovery from alcoholism.
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In Search Of ‘Computational Psychiatry:’ Why Is It A Hot New Field?

By Suzanne Jacobs
WBUR Intern

It’s around 10 a.m. on a weekday when I walk into a coffee shop that apparently doubles as the preferred study spot of every student on the Boston University campus. My instinct is to leave immediately and find a quieter place to caffeinate, but I’m not here for the coffee. I’m here for information — information on what I’m hearing is one of the hottest new trends in brain science.

Winding my way through tables of frazzled co-eds, I search every face for that “Are you who I’m looking for?” stare, but no one acknowledges me. So I step back out onto the sidewalk and wait. I’m early anyway.

About five minutes later, a young man who would have otherwise been indistinguishable from the crowd of students locks eyes with me from about 20 feet away. “That’s my guy,” I think to myself.

Lights of Ideas (Andrew Ostrovsky)

(Andrew Ostrovsky)

Minutes later, coffees in hand, we’re seated at a small back table, and I put my digital recorder down on it. “Is it okay if I record this?” I ask. He says that’s fine.

At this point, what I really want to do is grab him by the shoulders and yell, “What are you people doing? Let me into your world!” For weeks, I’ve been looking into this new field of research called computational psychiatry, but for the life of me, I can’t figure out what it is. More frustratingly, I can’t figure out why I can’t figure it out, despite a strong science background and hours of reading what little I could find about the topic on the Internet.

But I hold back, press the little red circle on my digital recorder and let the man speak.

In computational psychiatry, “What you try to do is come up with a toy world…,” he begins.

This all started a few weeks earlier when I was perusing the latest edition of Current Opinion in Neurobiology. Don’t ask me why I was perusing Current Opinion in Neurobiology — I don’t know. To avoid doing something else, probably.

One article caught my eye. It was titled “Computational approaches to psychiatry.” A longtime subscriber to the drugs-and-therapy stereotype of psychiatry, I found the idea of new “computational approaches” intriguing, so I read on. Continue reading

For Rwandan Man In Boston, New Arms Replace Those A Father Destroyed

Greig Martino fits a new prosthetic on Patrick Mbarushimana at the United Prosthetics workshop in Dorchester. (Jesse Costa/WBUR)

Greig Martino fits a new prosthetic on Patrick Mbarushimana at the United Prosthetics workshop in Dorchester. (Jesse Costa/WBUR)

In the mid-1990s, following the Rwandan genocide, clashes between government forces and mostly Hutu rebels continued along the country’s border with then Zaire. One day, soldiers came to a mud brick home in a small village and questioned a father while his young son listened.

The father denied helping rebels, but the boy, then 6 years old, said yes, some men had slept in the house the night before. The soldiers took the father away.

When the father returned a day later, “he said that he’s going to do something that I won’t forget,” recalled Patrick Mbarushimana, now 22.

(Jesse Costa/WBUR)

(Jesse Costa/WBUR)

The details of Patrick’s punishment are murky. In one story that circulated through his village, the father tied Patrick by the arms to a tree. Gangrene set in before he was released. In Patrick’s memory, his father started a fire and sat on him, with his bound arms facing the blaze until rope burned through to the bone.

Patrick says his father left him to die, but he ran away to the soldiers and told them what happened. The father was arrested.
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How Childhood Neglect Harms The Brain

Like any new mother, the woman we’ll call Braille was full of hope and excitement the day she welcomed her son into her life seven years ago. “Peter” was 7 years old at the time of his adoption. He’d been living in foster care after being taken from his biological mother.

According to Braille, Peter and his siblings endured years of neglect and abuse living with their biological mother and her violent boyfriend. “It was physical, emotional and continual,” she says.

Peter, now 14, and his adoptive parents are very close now, but the years since the adoption have been challenging. His father recalls Peter’s unpredictable anger, and the times Peter would punch him, out of the blue. His mother says her son could be very sweet and affectionate one minute, but then “he would just fall apart and start banging his head against the wall or start screaming.”

Experts have long known that neglect and abuse in early life increase the risk of psychological problems, such as depression and anxiety, but now neuroscientists are explaining why. They’re showing how early maltreatment wreaks havoc on the developing brain.

Study Of Orphans Finds Smaller Brains

Dr. Charles Nelson, a Boston Children’s Hospital neuroscientist, studies how children’s early experiences shape the developing brain. Abuse and neglect, he says, can cause significant damage to the circuitry of the brain.

“Let’s say there are 1,000 neurons supposed to wire in a certain way, maybe only half wire that way and the other half wire in an incorrect way,” Nelson explains. “By altering the wiring diagram, you are altering behavior and altering psychological states.”

But what prevents the brain from wiring the right way, and how do early experiences get biologically embedded in the brain?
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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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