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Popping A Daily Baby Aspirin? Caution: New Guidelines, Amid Controversy

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

When an older woman arrived at a Cambridge medical clinic recently, Dr. Sarah Stoneking was surprised to learn that the patient was taking an aspirin every day.

The patient was nearly 80, and didn’t have a clear reason to take the medication. Aspirin in general, and especially in older patients, can have a lot of side effects, including serious bleeding.

Stoneking, an internist and also my colleague, suggested her patient stop taking the daily aspirin, but the woman refused. She thought aspirin “was a panacea,” Stoneking recalled, one that protected her from the strokes and heart disease that had affected most of her friends. “She took it religiously,” Stoneking said.

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When The Therapist Has A Fear Of Elevators

(Allen Lai/Flickr)

(Allen Lai/Flickr)

The cramped elevator in the office building where I practice psychotherapy makes me uneasy.

The carpet looks stained and worn, fraying in the corner. Faded yellow paint barely covers the walls. When the door slides open, a musty smell hits the nostrils of waiting passengers.

I rode this contraption for the first time nine years ago, the day I decided to rent my office. That first trip felt like a movie in slow motion. The machine noisily inched up its shaft, lurching and wheezing like a drunk asthmatic. The seconds dragged by. When the elevator reached the third floor, it grew oddly still. Nothing happened. While I waited for the door to spring to life, I felt my heart thumping in my chest. Silently, I willed that thick, motionless metal portal to move, imagining myself imprisoned in this tiny cell for hours, mouth parched and desperate for a sip of water.

Finally, the elevator car shuddered, and the door slid open. I bolted out, ran down the hall to my new office and tried to catch my breath.

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Exercise Addiction: How To Know If You’ve Crossed The Line Between Health And Obsession

Experts say it’s tricky to determine precisely how many people struggle with exercise addiction because it can masquerade behind socially acceptable intentions -- like getting fit at the gym. (Courtesy of Scott Webb/Unsplash)

Experts say it’s tricky to determine precisely how many people struggle with exercise addiction because it can masquerade behind socially acceptable intentions — like getting fit at the gym. (Courtesy of Scott Webb/Unsplash)

Lisa M. joined a gym as soon as she started college at Bridgewater State University, determined not to pack on an extra 15 pounds freshman year like her older sister.

“In my head there was that picture of my sister,” Lisa said in an interview. “I didn’t want that to happen to me.”

For the next six years, Lisa says, she never missed a day at the gym unless it was preplanned and she could make it up later. In order to fulfill her self-imposed exercise requirements, Lisa skipped Christmas Eve gatherings, birthdays, weddings and dates with someone she loved and “very likely lost” because of her illness, she says.

“Every aspect of my life was dictated by exercise and food and the need to control it all,” says Lisa, who asked that her last name not be used because she is still in treatment.

“Every aspect of my life was dictated by exercise and food and the need to control it all.”

– Lisa M.

The thought of missing even one daily workout triggered massive anxiety, she says. And as her exercise obsession deepened, she began restricting her food intake too, mostly to salads and vegetables. She had “fear foods” she’d avoid: no cake, brownies or cookies, of course, but also, no cheese or pasta. Thoughts about food and exercise consumed her: “Any extra energy I had would go to…thinking about my next meal, my next snack, what I’d be able to eat next. I’d plan meals a week ahead.”

Her weight dropped to 112 pounds on a 5-foot-6 frame. She hasn’t had a period in six years. Now, as a result, Lisa, who is 25, has osteoporosis in her lower spine and hip.

“I worked so hard to be healthy, but I’m not,” she says. “And I did this to myself.” Continue reading

Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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Dartmouth Study Looks At When Doctors And Patients Clash Over ‘Unnecessary’ Care

A new Dartmouth study looked at whether or not doctors' actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

A new Dartmouth study looked at whether or not doctors’ actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

What happens when you want a test that your doctor thinks won’t help? Has a national campaign against high-cost, low-value care helped physicians have these tough conversations? And what drives doctors to provide care that they don’t think a patient needs?

These are the sorts of questions that researchers at the Dartmouth Institute for Health Policy and Clinical Practice sought to answer in a new study that came out Tuesday. The researchers surveyed clinicians at Atrius Health, Massachusetts’ largest outpatient care provider, with over a million patients, to determine what drives physicians to order tests they don’t think are in a patient’s best interest, and whether doctors were interested in controlling costs.

While nearly all doctors (96.8 percent) in the survey agreed that they should “limit unnecessary tests,” one in three thought that it was “unfair” to ask physicians to consider cost, and nearly one in three (30.7 percent) thought there was too much emphasis on cost. Primary care doctors were more likely to report being pressured by patients to order unnecessary tests, while surgeons were more likely to be concerned about malpractice.

Dr. Tom Sequist, one of the study’s authors, said in an interview that the researchers found a big gap between physicians’ desire to limit costly and low-value care, and their ability to do so.

“The thing that strikes me the most about this study is that over 90 percent of physicians said they were interested in reducing unnecessary cost, but only a third said they understood the role of cost in the system,” Sequist said. “It’s like saying, ‘I’m really interested in physics, but I have no idea how physics works.’ ” Continue reading

MIT Researchers Aim To Create An On-Demand Pharmacy

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Hundreds of thousands of bright pink, white or blue tablets and capsules in all colors of the rainbow drop into bottles on sleek conveyors every hour in a sprawling building — somewhere. Each batch of pills may take a month or more to make.

But now, in a lab near Kendall Square, a team of MIT researchers can turn out 1,000 pills in 24 hours in a device the size of your kitchen refrigerator. It’s a whole new way of making drugs.

“We’re giving them an alternative to traditional plants, and we’re reducing the time it takes to manufacture a drug,” said Allan Myerson, professor of chemical engineering at MIT.

The Defense Department is funding this project for use in various places like field hospitals serving troops, jungles to help combat a disease outbreak, and strategic spots throughout the U.S.

“These are portable units so you can put them on the back of a truck and take them anywhere,” Myerson said. “If there was an emergency, you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed.”

Sound simple? It’s not. This mini plant represents a sea of change in both size and operation. Continue reading

Health Care And Civic Leaders Launch Serious Illness Care Coalition

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

A group of health care and civic leaders meets at the Kennedy Library Thursday morning with a mission: ensuring that Massachusetts residents live their final weeks or months as they choose. They’re launching a new statewide effort called the Serious Illness Care coalition.

The aim of the group is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness — the kind that could lead to death within a year.

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Policies For Transgender High School Athletes Vary From State To State

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Crack. A bright pink aluminum bat connects with a fluorescent yellow softball, sending it toward woods that border Ponaganset High School in northwest Rhode Island. The left fielder runs in and makes the catch.

“Two down ladies, two down,” a player calls.

This is home field for Ponaganset’s Lady Chieftains, except, it seems, the team is not all ladies.

Justin Bonoyer, a stocky 5-foot-5-inch player with a shock of blonde hair, plays right field. Justin was Elise to his coaches until a few weeks ago, although he’d already come out as transgender to most of his teammates.

“I’m a guy,” Justin says. “It’s the same as if a guy who’s not trans went and played on a girl’s softball team.”

Well, sort of. There are separate rules for transgender athletes. Rules so different from state to state that some high school athletes like Justin can try out for any team they choose while others need sex reassignment surgery before they can sign up.

There’s a lot of attention on bathrooms in the debate about transgender rights. The next battleground may be locker rooms, basketball courts and soccer fields. For high school students, the debate centers on Title IX, the federal law that bans discrimination based on gender. Does it also ban discrimination based on gender identity?

We’ll lay out the arguments in a minute. First, a little more about Justin. Continue reading

Narrating Medicine: Let’s Talk Bedpans, And Why Doctors Should Get Good With Them

As a doctor myself, writes Dr. Anna Reisman, I was embarrassed that I didn’t know how to help a patient with a bedpan. (Michaelwalk/Wikimedia Commons)

As a doctor myself, writes Dr. Anna Reisman, I was embarrassed that I didn’t know how to help a patient with a bedpan. (Michaelwalk/Wikimedia Commons)

I was visiting my friend in the hospital and she had to pee. Walking to the bathroom was not an option: She’d been told not to get out of bed, she felt weak and lightheaded, and she was attached to an IV and a monitor.

She pressed the call button and stated her problem. A voice: They’d let her nurse know. A few minutes later, I stuck my head outside the curtain and scanned the empty hallway, feeling guilty that all I could do was share her frustration.

Then someone pulled open the curtain and smiled in at us. “I need the bedpan, we’ve already called twice,” my friend said. The woman in scrubs, who turned out to be one of the doctors, said she’d take care of it. My friend and I sighed with relief.

But the doctor slipped back out. Taking care of it meant finding someone who knew how to do it. When she returned a couple of minutes later and saw that still nobody had showed up, the good doctor offered to do it herself. She fetched a bedpan and awkwardly slid the pink plastic container under my friend, the whole time apologizing that she didn’t know which end was up.

The current U.S. nursing shortage includes licensed practical nurses and certified nursing assistants, the people who usually manage bedpans. And so hospitalized patients feeling the urge to urinate may have to wait longer than is possible.

If you’re thinking this is a minor issue, think again: Holding one’s urine can set a patient up for a urinary tract infection; the physical discomfort can be a stress on an already sick body, driving up blood pressure and pulse; and waiting with a bursting bladder is a mental stress, too.

As a doctor myself, I was embarrassed that I didn’t know how to help. I didn’t learn bedpan basics in medical school.

The alternative isn’t any better: Consider the shame and discomfort of lying in cold, wet sheets until someone can change them, plus the serious health risks that include skin breakdown and infection. For patients who already have pressure sores, these complications can be life-threatening.

As a doctor myself, I was embarrassed that I didn’t know how to help. I didn’t learn bedpan basics in medical school, or at any other time during my training. I would guess that most doctors, like me, would rather volunteer to hunt for someone else to do this than just getting the job done.

No, it isn’t rocket science to place a bedpan, but it’s easy to bumble by making a mess, leaving the patient in an uncomfortable position, exposing and embarrassing, and so on. Continue reading

Some Doctors Say Focus Of Opioid Addiction Treatment Must Shift From Medication To Long-Term Recovery

While most say medication-assisted treatment for opioid addiction improves patient outcomes, some doctors are questioning seeking a cure from the same industry they say caused the problem. Pictured here, OxyContin, an opioid, is seen in a pharmacy in 2013. (Toby Talbot/AP/File)

While most say medication-assisted treatment for opioid addiction improves patient outcomes, some doctors are questioning seeking a cure from the same industry they say caused the problem. Pictured here, OxyContin, an opioid, is seen in a pharmacy in 2013. (Toby Talbot/AP/File)

While addiction treatment providers are increasingly recommending that medication be used to help wean people off opioids, some doctors are concerned there is now too much of a focus on medication and not enough on the harder work of long-term recovery from substance use disorder.

During the annual American Society of Addiction Medicine conference in Baltimore last month, a frequently heard statistic was that every 20 minutes someone in the U.S. dies from an opioid overdose.

“Imagine if we had someone in America dying from terrorism every 20 minutes,” Vermont Gov. Peter Shumlin said. “You wouldn’t have to just take your shoes off at the airport, you’d have to take everything off.”

Shumlin became a leading political voice on the opioid epidemic after dedicating his 2014 state of the state address to the problem in Vermont. Shumlin told the 1,800 people at the Baltimore conference that the nation needs their help to reduce the 250 million prescriptions written for opioid painkillers every year.

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