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What are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?

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Opinion: American-Muslim Doctor Reflects On Bigotry At Some Top Hospitals, And Beyond

By Altaf Saadi, M.D.
Guest Contributor

Recently, the wife of a prominent Boston businessman — one of my many wealthy, white patients at Massachusetts General Hospital — greeted me this way: “So what foreign medical school did you go to anyway?”

For background, I’m a petite, Middle Eastern young woman with a headscarf, and I’m guessing I do not resemble her vision of what a doctor “should” look like. That image is probably taller, whiter, male and not Muslim.

My answer (in perfect, unaccented English) to her question about where I was trained? “Harvard Medical School.” After that, her lips remained pursed shut for the rest of our encounter.

As the daughter of Iraqi and Iranian immigrants, such interactions unfortunately have been common for me and my family members since we moved to America weeks before 9/11. When former President Bush declared war on Iraq the following year, for example, my sister and I heard classmates scream, “Go back to your country!” from their pickup truck on our walk home from high school.

I thought that attending college and medical school at Yale and Harvard, respectively, would be my golden ticket to America’s meritocratic dream, that my prestigious diplomas would shield me from future experiences with racism and bigotry. As a neurology medical resident in “liberal” Boston, (and working at a hospital ranked No. 1 by U.S. News & World Report) I also thought that I would be judged based on my medical acumen, not by the color of my skin or the scarf I wear on my head. But I was wrong.

Dr. Altaf Saadi (Courtesy of the author)

Dr. Altaf Saadi (Courtesy of the author)

Another time in the hospital, a male patient told me that his religion is superior to mine. While I was listening to his lungs to help in the management of his shortness of breath, he added, “Why do you wear that thing on your head anyway?” Despite his abrasive behavior, I politely informed him of his treatment plan and told him that I am praying for his speedy recovery.

Another day,  an 80-year old patient with dementia began hitting me on the head when I checked in on her for my daily visit. Pointing to my headscarf, she said, “I don’t want someone with that taking care of me.” Despite her mental condition, the racism still stung as I continued to strive to provide her the best care possible.

My experiences are not isolated. A recent study in the American Journal of Bioethics found that 24 percent of Muslim physicians have experienced religious discrimination in the workplace.

This election year has made it harder to be a Muslim in America. Republican front-runner Donald Trump has advocated for registering Muslims inside the United States and banning those of us who reside abroad. Unfortunately, the majority of Republican Party members agree with him and the number of hate crimes against Muslims have tripled in recent weeks. Yet, I also recognize that Muslims are just America’s newest “outsiders.” Throughout our history, Catholics, Irish, Italians, women, African-Americans, Jews, Latinos and gays have all been targets of nativist fear-mongering. Many of these groups still face significant prejudice today, and hospitals are not immune from such discrimination, whether implicit or explicit.

When I was a third-year medical student, it appeared to me that the pediatric residents and attending physicians would spend extra time caring for the white infants and children during morning rounds. The two African-American babies and one Arab infant admitted to the inpatient pediatrics service at the time were never “oohed and aahed” at and received noticeably less attention. “Have you noticed that only the white children are called ‘cute’?” I asked my friend after our third day on the pediatrics rotation. My friend, an African-American medical student, had his own grievance. He had overheard a doctor refer to an African-American father as an “angry black man.” “I don’t understand,” my friend said. “His daughter is dying, he is upset, and has questions. He’s not asking any more questions than the other parents.”

Our observations were also not isolated incidents. Multiple peer-reviewed studies have shown that physicians unconsciously prefer and spend more time with white patients than African-American ones.

I also recall the occasional episode of overt racism in the hospital. One surgeon — prominent and stern in his crisp white coat — said the following about a Hispanic patient who was coming to have her melanoma examined for excision: “I can’t believe these people! They have been here for a decade, can’t bother to learn English, and we’re stuck waiting for an interpreter.”

But the episodes of implicit racism have been more commonplace. Continue reading

Mass. Launches Partnership Aimed At Boosting Digital Health Sector

Gov. Charlie Baker speaks at a press conference at Boston Children's Hospital Thursday announcing a new public-private partnership to boost the state's digital health care sector. (Greta Jochem for WBUR)

Gov. Charlie Baker speaks at a press conference at Boston Children’s Hospital Thursday announcing a new public-private partnership to boost the state’s digital health care sector. (Greta Jochem for WBUR)

Updated 5:40 p.m.

BOSTON — If you own a smartphone and use it to track your steps, count calories, check your blood pressure or monitor your health savings account, you’re helping to build the digital health sector. A recent Goldman Sachs report says the sector will grow to $32 billion within a decade.

A new public-private partnership announced Thursday aims to make sure much of that growth is in the Bay State, where leaders argue the elements are already in place.

“Massachusetts has a wealth of capabilities,” Boston Children’s Hospital CEO Sandy Fenwick said at a press conference Thursday announcing the new digital health initiative — a wealth of knowledge and talent, Fenwick added, in biotech, pharma and technology.

Fenwick has been part of a two-year working group, formed by the Massachusetts Competitive Partnership (MAPC), that included the leaders of area companies, hospitals and universities. MAPC reached out to Gov. Charlie Baker, members of his cabinet, Boston Mayor Marty Walsh and House Speaker Robert DeLeo to form the public side of this joint venture after deciding that digital health offered the best potential for job growth in the tech sector.

On the private side, MAPC has a four-part plan.

1. Financing: Startups in Massachusetts routinely complain they can’t find financing, and the numbers show they’re right.

(Source: MAPC)

(Source: MAPC)

No firm dollar amount has been pledged yet. Vertex CEO Jeff Leiden, who led the working group for MAPC, says there will be an announcement about several innovative strategies and an investment commitment within the next six months.

2. Standard Agreements: All the software and tech licensing agreements as well as sponsored research agreements used in the state’s digital health initiative will use standard language. MAPC says MIT, Harvard, Northeastern, UMass and Partners HealthCare have agreed to use the agreements, which may be a first for academic institutions in the U.S.

3. Mentoring: There are lots of stories about young entrepreneurs getting advice from CEOs in Silicon Valley while standing in line at the coffee shop. Massachusetts may not get quite that loose, but MAPC is planning a speakers series that would give startups access to CEOs for support and guidance.

4. Space: MAPC will work with the state and MassChallenge, a nonprofit that runs a competition and programs for startups, to create a digital health innovation accelerator. Mayor Walsh says the city is working to help the project find space.

The Right Mix Of People

Startups will have the opportunity to test ideas in hospitals and other health care settings around the state, something Jacqueline Thong, who launched Klio Health here, which helps those with chronic conditions track symptoms and treatments, says will be invaluable.

Continue reading

Patient Demand Surges In Opening Year Of Medical Marijuana Dispensaries In Mass.

In 2015, medical marijuana took root in Massachusetts, with four dispensaries now open in Salem, Brockton, Ayer and Northampton more than two years after voters approved a ballot question on the issue. (Jesse Costa/WBUR)

In 2015, medical marijuana took root in Massachusetts, with four dispensaries now open in Salem, Brockton, Ayer and Northampton more than two years after voters approved a ballot question on the issue. (Jesse Costa/WBUR)

By the numbers, the first year of medical marijuana dispensaries in Massachusetts looks pretty dramatic.

The latest data released by the Department of Public Health shows that 16,510 patients had obtained a certificate from a physician and registered through the state as of Nov. 30.

That’s up from 1,423 in January, a nearly 12-fold increase.

This chart shows the sharp increase in both active and certified medical marijuana patients since October 2014. (Screenshot via DPH)

This chart shows the sharp increase in both active and certified medical marijuana patients since October 2014. (Screenshot via DPH)

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Boston Raises Legal Age For Buying Tobacco Products To 21

Cigarette packs are displayed at a convenience store in New York. (Mark Lennihan/AP)

Cigarette packs are displayed at a convenience store in New York. (Mark Lennihan/AP)

You’ll soon have to be 21 to buy cigarettes in Boston.

By a unanimous vote on Thursday, Boston’s Board of Health approved the mayor’s proposal to raise the minimum age for buying tobacco or nicotine products in the city from 18 to 21. The rule, which will go into effect on Feb. 15, 2016, will also cover e-cigarettes.

Eighty-five other Massachusetts communities have already raised their tobacco purchasing age.

“We know the consequences of tobacco use are real and can be devastating,” Boston Mayor Marty Walsh said in a statement. “These changes send a strong message that Boston takes the issue of preventing tobacco addiction seriously, and I hope that message is heard throughout Boston and across the entire country.”

The American Lung Association of the Northeast commended the move, saying it will help prevent youth from becoming addicted to tobacco.

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State Legislature Hears From Both Sides On Doctor-Assisted Suicide Bill

Compelling arguments on both sides of the doctor-assisted suicide debate were presented at a State House hearing Tuesday afternoon.

The Legislature’s Committee on Public Health is once again considering a bill that would allow doctors to prescribe lethal doses of medication to terminally ill patients.

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Lawmakers To Hold Hearing On Physician-Assisted Suicide Bill

State lawmakers on Beacon Hill will hear arguments Tuesday afternoon on a proposed measure to legalize physician-assisted suicide.

The bill would require a terminally ill patient — specifically, a person with an incurable illness or condition that can reasonably be expected to cause death within six months — be assessed by two doctors and a counselor before being prescribed life-ending medication. Continue reading

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Romneycare, Obamacare, Now Jebcare: Candidate Bush Presents His Health Plan

Former Florida Gov. Jeb Bush acknowledges the crowd while being introduced before speaking at the National Automobile Dealers Association convention in San Francisco in January. (AP)

Former Florida Gov. Jeb Bush acknowledges the crowd while being introduced before speaking at the National Automobile Dealers Association convention in San Francisco in January. (AP)

By Fred Bever

​For what was ​expected to be a major policy speech on the thorny issue of health care reform, the event was a pretty low-key affair.

When Florida Gov. and Republican presidential candidate Jeb Bush laid out his plan for a post-Obamacare health system on Tuesday, roughly 50 people turned out, many of them associated with the venue — St. Anselm College in New Hampshire.

But at the start, Bush ​did open with a sharply partisan attack on Democratic candidates Hilary Clinton and Bernie ​​Sanders​, whom he condemned​ for their support of Obamacare and its mandates.

“For the Democrats, this is what they want, this is how they roll,” he said. “They like the power of deciding these things from up above. This is their essence and I believe the top-down driven approach is not the one for our country.”

Mandates, Bush says, stifle innovation.

Like most Republicans, Bush wants to do away with Obamacare. He objects to its mandate that all Americans carry health coverage or face a tax penalty. He’d get rid of federally-mandated plan designs. He’d give states more control over federal health care assistance programs such as Medicaid.

And while he’d reduce the value of employer health benefits that workers can write off on their income taxes, Bush would also provide a tax credit to encourage the purchase of low-cost catastrophic coverage.

“That should be the national focus,” he said. “Making sure that people have catastrophic coverage so their lives are not turned upside-down by an adverse event that could have real devastation for their family.” Continue reading

AG Says State Must Do More To Control Health Care Costs

Attorney General Maura Healey says Massachusetts will miss a self-imposed health care spending target this year. (Jesse Costa/WBUR)

Attorney General Maura Healey says Massachusetts will miss a self-imposed health care spending target this year. (Jesse Costa/WBUR)

It looks like Massachusetts will miss a self-imposed health care spending target again this year. This warning from Attorney General Maura Healey comes just a few weeks after a state agency announced that Massachusetts failed to keep spending below 3.6 percent last year, as recommended in a 2012 law.

The forecast for this year is in a report produced by Healey’s office. It finds little change in problems that have been building for years: some hospitals are paid a lot more than others, patients frequent the expensive hospitals and efforts to shift the way we pay for health care aren’t closing the price gaps.

The attorney general's report finds that some of the most expensive hospitals in the state are also the busiest, a pattern that drives up health care spending. (Courtesy Attorney General's Office)

The attorney general’s report finds that some of the most expensive hospitals in the state are also the busiest, a pattern that drives up health care spending. (Courtesy Attorney General’s Office)

“These trends, coupled with new growth in pharmacy costs and utilization of health care services, point to a likely failure to hold health care spending increases below the 3.6 percent benchmark the Commonwealth set for 2015,” according to the latest Examination of Health Care Cost Trends and Cost Drivers from the office of the Attorney General. It’s the fifth such report and the first from Healey.

For many in the health care industry, the factors driving up health care costs sound familiar. The gap between high and low cost hospitals is not new, nor is the finding that expensive hospitals care for a large share of patients. Continue reading

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Where Does Life Begin, And Other Tough Abortion Questions For Doctors In Training

Our recent post on how residents training to be OB-GYNs think about providing abortions (or not providing them) went viral earlier this month and triggered a broader conversation among readers. The topic was also featured on Radio Boston and WBUR’s All Things Considered.

I asked Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program, and the person who organized the initial discussion among the residents, to follow up. She, in turn, ​asked Jennifer Villavicencio, a third-year resident​, to lead a discussion digging even more deeply into the topic.

Two of the residents ​in the discussion ​perform abortions, two have chosen not to do so. ​But they are colleagues and friends who have found a way to talk about this divisive issue in a respectful and productive way. ​Here, edited, is ​a transcript of ​their discussion, which gets to the heart of a particularly fraught question: When does life truly begin? ​Three of the residents have asked that their names not be included, for fear of hostility or violence aimed at abortion providers.

Jennifer Villavicencio (Resident 3): Let’s talk about a woman who comes in, has broken her water and is about 20 to 21 weeks pregnant and after counseling from both her obstetricians and the neonatologist [a special pediatrician who takes care of very sick newborns] has opted for an abortion. Let’s talk about how we each approach these patients.

Resident 2: As a non-abortion provider I will start just by saying that a patient of this nature in some ways is on one extreme of the spectrum. As an obstetrician, I view the loss of her pregnancy as an inevitability. I think we would all agree with that. So, taking part in the termination [another word for abortion] of her pregnancy is different to me than doing that for someone whose pregnancy, but for my involvement, would continue in a healthy and normal fashion.

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

Opponents and supporters of an abortion bill hold signs outside the Texas Capitol on July 9 in Austin. (Eric Gay/AP)

JV: Would your opinion change if she were 22 or 23 weeks and theoretically could make it to viability [the concept that a fetus could survive outside of the mother. Currently, in the U.S., the generally accepted definition of viability is 24 weeks gestation or approximately six months pregnant]?

Resident 2: Personally, it wouldn’t, because I feel there is a very slim chance of an intact survival [refers to an infant not having significant mental or disabilities] of an infant. If she were 22 or 23 weeks gestation and could potentially make it to the point of a survivable child, that likelihood is so rare. But for my involvement, she will still lose this pregnancy. My point is, if I help terminate this pregnancy, I am not playing an integral role in the loss of this pregnancy. I feel that supporting her in proceeding in the safest possible way, protecting her while accepting the loss of her pregnancy, is my job.

Future Health Of The Child

JV: Does the future health of the child really play a role in it for you?

Continue reading

Thousands Ruled Ineligible For Mass. Medicaid

Tens of thousands of people have been removed from the state’s Medicaid program during the first phase of an eligibility review, according to figures from Gov. Charlie Baker’s administration obtained by The Associated Press.

The eligibility checks, required annually under federal law but not performed in Massachusetts since 2013, began earlier this year as part of Baker’s plan to squeeze $761 million in savings from MassHealth, the government-run health insurance program for about 1.7 million poor and disabled residents.

At $15.3 billion, MassHealth is the state’s single largest budget expense.

Based on the results of the redetermination process so far, the state was on track to achieve the savings it had hoped for in the current fiscal year without cutting benefits for eligible recipients, said Secretary of Health and Human Services Marylou Sudders. Continue reading