Study: Bullying By Siblings May Double Risk Of Depression, Self-Harm

(Wikimedia Commons)

(Wikimedia Commons)

By Nicole Tay
CommonHealth intern

When I was growing up, I used to complain about the loneliness of being an only child. “I want an older brother like Mandy!” I would plead to my parents. I just wanted an older, cooler playmate; I never considered the potential downside.

Now, at 22, I’ve heard my share of horror stories; the sibling bullies who called my friends “butt face” or “stupid” or “brat;” the burnt Barbie dolls; the bag of caterpillars dumped on my poor friend’s head.

Is sibling bullying just a harmless rite of passage — or can it actually entail developmental repercussions?

A new study published today by the American Academy of Pediatrics targets that very question. After surveying more than 6,900 young people in the UK, researchers found that victims of frequent sibling bullying were twice as predisposed to depression, anxiety, and self-harm in young adulthood as non-bullied controls. This British-based study comes on the heels of similar findings in an American study last year. From the paper:

Of the 786 children who reported that they had been bullied by a sibling several times a week (55.3% female), depression was reported by 12.3% at age 18 years, self-harm occurred in 14.1%, and anxiety was reported by 16.0%.

And from the abstract: Continue reading

Mass. Study: Limited Health Insurance Networks Save Money, Cause No Harm

Jonathan Gruber of MIT (Courtesy MIT)

Jonathan Gruber of MIT (Courtesy MIT)

Most patients, myself included, do not like to be told, “You can’t see that doctor or go to that hospital.” But the message is becoming more common as we, patients, or our employers choose what are known as “limited” or “narrow” network plans (note the not-so-subtle name change).

These plans are often cheaper than other options because they cut out expensive hospitals and because insurers negotiate better prices with hospitals and doctors who are promised our business.

But there’s a backlash that’s both real and hyped. Some of the hype is refuted by a study out today.

It looks at a broad movement toward limited network plans in Massachusetts in 2011, when state employees got a three-month “premium holiday” if they switched from more traditional coverage to the lower-cost option.

State employees who chose to switch reduced their health care spending by 36 percent.

“Clearly, this was a big cost-saver for the state,” says study co-author Jon Gruber.

The savings, says Gruber, occurred because patients with limited network coverage relied more on primary care and less on specialists. There is no sign that patients received lower quality care or that their health deteriorated.

Gruber, who had a hand in creating both the Massachusetts coverage law and the Affordable Care Act, claims the political implications of this Massachusetts limited network experiment are profound.

“There’s a lot of discussion about ObamaCare leading to more ‘limited’ choices,” says Gruber, and “isn’t that a shame.” But Gruber says people in these plans “don’t appear to be suffering.” Continue reading

Primary Cheat Sheet On Mass. Governor Candidates’ Health Care Positions

Judging by your presence at this url, you are, perhaps, not entirely indifferent to health care? And you may, in fact, live in the lovely Bay State, according to the results of an unscientific reader survey we did once. So, in case you plan to vote in the 2014 state gubernatorial primaries, we’ve compiled a health care cheat sheet. We requested brief position statements from the five candidates facing a primary contest. In alphabetical order, and with a link to the full campaign site on each name:

Charlie Baker:
Massachusetts had a health care system that worked, with nearly every citizen having access to the high quality care they preferred, but the disastrous Health Connector website launch and the burdensome federal health overhaul disrupted that for far too many Massachusetts families. As Governor, I will fight for a waiver from the federal health law to protect Massachusetts’ exemplary health care system. I have also proposed a plan to improve the quality of health care, increase transparency and reduce costs for families. My proposals will allow patients to act as informed consumers, prioritize primary care – giving patients with multiple illnesses better treatment – and protect Massachusetts’ health system from federal burdens.

Don Berwick:
Massachusetts needs a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. Don is a pediatrician and an executive who has spent 30 years working to make health care work better, at a lower cost. He is the only candidate for governor supporting single payer health care – Medicare for all. Health care is now 42% of our state budget, up 59% in the last decade alone. Every other major line item in our budget is down. Single payer health care would be simpler, more affordable, more focused on the patient, and it would be a huge jobs creator.

Martha Coakley:
As Governor, Martha will have three goals for our healthcare system: expanding access, maintaining quality, and driving down cost. She has already taken the lead on controlling costs, publishing a series of groundbreaking reports that shed light on the cost-drivers in our system, and going forward she will focus on investing in proven prevention, promoting the role of community health centers, and increasing transparency. She is especially committed to improving care for those struggling with mental and behavioral illness and substance abuse; she has called for higher reimbursements for community-based services, more coverage from private insurance, and incentives for greater coordination of care. She believes we must end the stigma associated with mental and behavioral health.

Mark Fisher:
Did not respond but his campaign’s Web page on health care is here.

Steve Grossman:
We need to revolutionize the delivery of health care services to reduce or eliminate health disparities, primarily by significantly increasing our commitment to and investment in community hospitals and health centers. We must also use every appropriate tool to rein in excessive price increases at our largest medical institutions that could severely undermine achieving the goals of Chapter 224. That’s why I oppose the Partners HealthCare deal Martha Coakley has negotiated, which according to the Health Policy Commission, would raise costs by tens of millions of dollars and harm Massachusetts families and businesses. As governor, I plan to lead a serious conversation with the people of Massachusetts concerning single payer as a vehicle for reforming our health payment system, a conversation that the Boston Globe described in its editorial endorsement of me as “precisely what’s in order.”

Note: We don’t include the independents because we focused on the candidates running in the primary.

We’re No. 1, Not In A Good Way: Highest Hospital Administrative Costs

(Connor Tarter/Flickr via Compfight)

(Connor Tarter/Flickr via Compfight)

By Alvin Tran
Guest Contributor

When it comes to hospital administrative costs, a new Health Affairs study finds, our country is No. 1 and we’re way ahead of the curve — unfortunately.

In the study, researchers analyzed hospital accounting data to compare administrative costs across eight countries: Canada, England, France, Germany, the Netherlands, Scotland, the United States and Wales. They found that administrative costs accounted for more than 25 percent of total U.S. hospital expenditures — far ahead of the pack.

“We were surprised by just how big the differences have grown. The U.S. is in another league than every other country,” said Dr. David Himmelstein, the study’s lead author and a professor at the City University of New York’s School of Public Health.

Himmelstein and his colleagues also found that countries operating under a single-payer health system, such as Canada and Scotland, had the lowest administrative spending, and calculated that the U.S. could save $150 billion a year if it had a system like theirs.

“You’re pulverizing all this money on something that does not make people better.”
– Economist Uwe Reinhardt

Based on Medicare Costs Report data from 2011, hospital administrative spending in the U.S. amounted to $667 per capita — more than double what the Netherlands and England spend.

In the Netherlands, administrative costs consumed just 19.8 percent of hospital budgets — compared to 25.3 percent in the U.S. —  and in England, just 15.5 percent.

In a phone interview, Himmelstein said American hospital administrative costs have doubled over the last decade. “We anticipate that they’ll continue to go up because we’re continuing to pursue health policies that stimulate administration,” he added.

Uwe Reinhardt, a health economist and professor at Princeton University, sees high hospital administrative costs as a moral question. “You’re pulverizing all this money on something that does not make people better — doesn’t improve their health,” he said.

Reinhardt, who said he had once believed the new federal health law would lower administrative costs, now thinks Obamacare has become too challenging and complex, especially with the addition of navigators and health exchange administrators.

“I think the administration of the American health system has outpaced our ability to cope with it. Even the best IT people cannot cope with it anymore,” he said, adding that “Obamacare, if anything, adds to the administrative overhead.” Continue reading

So Much For The Killer Bra: Study Finds No Link With Breast Cancer

(canonsnapper via Compfight)

(canonsnapper via Compfight)

If you’re a bra-wearing woman, maybe you know this feeling: You exhale with relief as you unhook your band at the end of a long day. Looking over your shoulder into the mirror, you see the slight indentation the elastic has left on your torso, and think: “Constriction like this just can’t be good.”

That intuition resonates with popular theorizing that bras can lead to breast cancer by blocking the healthy drainage of waste products from the breast area. Hence the higher breast cancer rates in developed countries.

But give me good hard data over feelings and pop theories every time. A big new study, funded by the National Cancer Institute, finds no link at all between bras and breast cancer.

The study, published in the journal “Cancer Epidemiology, Biomarkers & Prevention,” found that whether women wear bras just a few hours a day or more than 16, whether they wear underwires or wireless, whether they have big cups or small cups, brassieres are guiltless: They just do not seem to be linked to the two most common forms of breast cancer.

The research involved hundreds of postmenopausal women: 454 with invasive ductal carcinoma, 590 with invasive lobular carcinoma, and 469 without breast cancer, who served as controls. Each woman answered questions about everything from her pregnancy history to the age at which she started wearing a bra, whether it had an underwire, cup size, band size and how many hours a day she wore it.

Bottom line: It looks like your bra won’t kill you unless someone strangles you with it. Which contradicts a 1995 book that added gallons of fuel to the theory that bras are harmful: “Dressed To Kill: The Link Between Breast Cancer and Bras.”

The new paper’s senior author, Dr. Christopher Li, head of the Translational Research Program at the Fred Hutchinson Cancer Research Center, says “Dressed To Kill” provided some of the impetus for the study. Our conversation, lightly edited:

Why did you think this study was worth doing?

The whole theory about bra-wearing and breast cancer came to my attention years ago, when there was this book published called “Dressed to Kill.” The whole premise of the book was that bra-wearing is the primary culprit for breast cancer in the world. Being a breast cancer researcher, I had never heard of this theory, and people, friends of mine who had seen it, were saying, ‘What’s going on with this?’ Continue reading

Project Louise: The Dog Ate My Homework

(Girl.In.the.D via Flickr)

(Girl.In.the.D via Flickr)

Hmm, was that me last week, waxing rhapsodic about that great “back to school” feeling? So, here we are, near the end of my kids’ first week back at school, and I have to say: What was I smoking?

Yeah, it’s lovely to get out the pencil cases and pick out the first-day outfit and meet the teachers and see old friends and try to spot new ones. But it’s also a flat-out crazy week of adjusting to new routines, getting back in the groove, filling out more paperwork than anyone should have to deal with in this electronic age and, oh yeah, getting to work more or less on time.

Unsurprisingly, I find all this a bit stressful. (Can I get an amen?) And that’s why it seemed like such a great idea last week to promise that I would interview an expert on stress, and then let you all know all the great things I learned.

Only here’s the thing: I was too stressed out to get it done. Sure, I could tell you that her book didn’t arrive in the mail as quickly as it was supposed to (which it didn’t), and that therefore I didn’t get back in touch with her publisher to set up the interview before the long weekend (which I didn’t), and that then I came up with a backup plan (which I did) to interview someone else (which I didn’t), but essentially that all boils down to the adult equivalent of “the dog ate my homework.”

So, look, I’m sorry, and I promise – I swear – I more than swear, I’ve told my editor! – to have real information on dealing with stress next week. But meanwhile, let’s just talk about stress for a quick minute. I’ve told you some of mine, but here’s a more complete list:

  • Taking care of a teenager and a 6-year-old
  • Working full-time-plus at a job that requires evenings out fairly often, and even the odd weekend
  • Trying to hold the family finances together in spite of some real (and private) challenges
  • Resolving some seemingly intractable problems in a key relationship (also private, so I wouldn’t even mention it but it’s a huge stressor)
(Wikimedia Commons)

(Wikimedia Commons)

  • Learning to navigate this strange new electronic world we all live in – and, for example, figuring out those lines between public and private, to say nothing of taming an email inbox that daily threatens to crash from its own weight; this sounds trivial compared to everything else, but it’s surprising how much angst it causes
  • Wondering how I’m ever going to fix up the “charming,” “needs TLC” old wreck I live in, enough to either be happy in it or put it on the market
  • Fretting about my health, not just the tired old song-and-dance you’ve been hearing about my weight and cholesterol and so forth, but also that funny-looking mole on my back
  • And did I mention the three dogs and the gecko?

Continue reading

Mass. Doctor Working In Liberia Diagnosed With Ebola

A family physician from Massachusetts has become the third American aid worker infected with Ebola.

Dr. Rick Sacra, of Holden, was volunteering at a hospital in Liberia run by a Christian missionary group when he became infected with the virus.

An undated photo of Dr. Rick Sacra (simusa.org)

An undated photo of Dr. Rick Sacra (simusa.org)

The 51-year-old was scheduled to return to Liberia last week, but moved his trip up to the beginning of August.

“When he said he was going back early I wasn’t surprised,” said Frances Anthes, who runs the Family Health Center of Worcester where Sacra is a family physician. “We all knew it was a difficult situation. He asked for prayers and I know I promised them.”

Sacra, his wife and his three sons have spent years in the country as medical missionaries, and Sacra had been in close touch with colleagues in Liberia all summer about the unfolding health care catastrophe there.

“Dr. Sacra is probably the closest thing that a living human-being can be to being a saint,” said Dr. Gregory Culley, Sacra’s supervisor at the Worcester health center.

Culley says he received an email from Sacra last week. “It was bad news and good news. He said the epidemic is zero controlled, it’s chaos and anarchy in Monrovia, and the entire medical system has broken down.”

Continue reading

Why To Exercise Today: It Could Make Your Wine Work For You

Another setback for the much-hyped compound resveratrol

Another setback for the much-hyped compound resveratrol

Ah, this study is as delicious as a heady red Burgundy. Just presented at the European Society of Cardiology conference in Barcelona, it found that both red and white wine are good for your health — but only if you exercise. The Atlantic reports here on the study, titled “In Vino Veritas”:

Among those who worked out twice per week and drank wine, there was significant improvement in cholesterol levels (increased HDL and decreased LDL) after a year of wine—red or white, no matter.

“Our current study shows that the combination of moderate wine drinking plus regular exercise improves markers of atherosclerosis,” said Táborský, “suggesting that this combination is protective against cardiovascular disease.”

The Atlantic piece is redolent of other rich flavors, and worth a full read — but for now, just think, if these findings are borne out, your workout could transform your (moderately consumed) mead into medicine.

When One Twin Baby Lives But The Other Dies

(stitches1975 via compfight)

(stitches1975 via compfight)

By Dr. Karen O’Brien
Guest contributor

Never before in my obstetric practice have I taken care of so many twin pregnancies. What I witness in my own office is part of a nationwide trend: Over the last two decades, the twin birth rate in the United States rose 76 percent, from 19 to 33 per 1,000 births.

And never before have I taken care of so many twin pregnancies with complications.

The specific complication that has given me pause in the last year or two is the loss of one twin, either during or after pregnancy.

This doesn’t happen often, but I have taken care of a number of patients recently who have lost a twin during or shortly after pregnancy. And I’ve learned that though outsiders might see a glass half full, this experience is uniquely devastating, both emotionally and medically.

We must all understand that the life of one twin does not eradicate grief for the sibling who died.

The hope and anticipation of bringing home two healthy babies comes grinding to a halt. The joy of delivery is clouded by sibling loss.

As early as 18 weeks, Melissa’s identical twins showed signs of a complication called twin-to-twin transfusion syndrome, which occurs when one of the twins essentially donates blood to the other.

At 19 weeks, Melissa underwent surgery to try to correct the problem. Unfortunately, two days after the surgery, one of the twins passed away. Melissa remained pregnant for 13 more weeks and ultimately underwent cesarean section at 32 weeks.

She and her husband were able to hold the deceased twin for several hours after delivery. Her live twin did well; she spent a few weeks in the neonatal intensive care unit (NICU) and is now home and thriving.

Samantha’s twins were not identical, and were conceived through in vitro fertilization. At 14 weeks, we found that one of the twins, a boy, had several serious abnormalities. Even at that early gestational age, we knew that he would not live for long after birth, and might pass away during the pregnancy. The other twin, a girl, appeared normal throughout the pregnancy. Continue reading

A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading