How prepared is Massachusetts for Ebola? That was the question during a hearing at the State House Thursday.
Let’s face it, Ebola is scary. My kids are scared. The moms at school are talking about giving their children extra multi-vitamins to boost their immune systems in a desperate attempt to do something, anything, to protect their families. But we live in Boston and there are no cases here — yet. Still, that “yet” can make us crazy.
So, in a crisis, who do you call for comfort? The level-headed risk perception consultant: David Ropeik, who spoke with me briefly today about why such intense, prolonged worry and anxiety can backfire, make your body weaker and perhaps even damage your health:
Here, edited, is our short interview:
RZ: So, why is being scared of Ebola bad for your health?
DR: The health ramifications of this are profound. When we worry, that, biologically, is stress — that’s a mini fight-or-flight response going on in the body. When stress persists for more than several days (short-term stress is not the problems), it becomes damaging to our health. Chronic stress raises our blood pressure and increases the risk of cardiovascular problems; it suppresses our immune system and makes us more likely to catch infectious diseases or get sicker from them if we do. It interferes with neurotransmitters associated with mood, and it is strongly associated with clinical depression. Chronic stress interferes with digestion and memory and depresses fertility and bone growth (slows it down).
[The negative effects of chronic stress are widely reported, but Ropeik cites the book "Why Zebras Don't Get Ulcers," by the biologist Robert Sapolsky, as a key source here.]
So you think people are overreacting and we’re moving into some kind of widespread nation-wide chronic stress phenomenon here?
We’re on the cusp. It’s like what the fear of SARS did to people in Canada — it freaked [them] out for weeks: “Here it comes again,” is what they’re saying.
How do you see all this evolving?
In the last day and a half the criticism of how health officials have handled things and the mistakes they made in Dallas, real as those mistakes are, have become a focus, and it’s now starting to undermine trust in our health care system.
In a crisis, trust is the pivotal factor for how worried people are. Continue reading
As nurses raised alarms that they are untrained and ill equipped to handle cases of Ebola virus, Massachusetts hospital officials said Thursday that the health crisis emerging from West Africa demands a unique response.
At a Public Health Committee hearing, Massachusetts General Hospital Emergency Preparedness Chief Dr. Paul Biddinger said handling cases of Ebola is “fundamentally different” than regular medical care, and suggested hospitals should create a “highly trained expert cadre” to handle Ebola rather than attempting to train all staff equally.
Massachusetts has not had a confirmed case of the deadly disease, though there have been suspect cases and two nurses at a Texas hospital have been infected with the disease. Ebola is spread from the fluids of a person who is infected and symptomatic.
Massachusetts Nurses Association President Donna Kelly Williams said the training and equipment at Massachusetts hospitals is “inconsistent,” and nurses have said they have been provided with “flimsy” garments that Williams said would not adequately protect them against infection.
On Oct. 16, 1846, a flustered young man named William Morton raced up marble steps to the dome of Massachusetts General Hospital.
“He was late, and you don’t want to keep surgeons waiting,” said Dr. John Herman, a psychiatrist at Mass General who is steeped in the history of that day.
A group of physicians awaited Morton in the operating room, located high above other floors because “before ether, people screamed,” Herman said.
Morton, a dentist, had promised to put an end to those screams, to the pain patients endured during surgery.
That day, with a patient waiting, Morton pulled out a glass bottle of ether that he had colored red, according to Herman, to disguise the common gas. Morton told the patient to inhale. Moments later, a surgeon sliced into the neck of a relaxed man.
“As he came out of the anesthesia, the surgeon, John Collins Warren, said ‘Mr. Abbott, did you feel pain?’ and Abbott said, ‘Did you begin the procedure?’ ” Herman recounted. “The world changed. Within days, news of what happened here traveled by steamship and by locomotive … to the capitals of the world.” Continue reading
By Richard Knox
Americans are seriously confused about how Ebola spreads. And it’s no wonder.
A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.
Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.
And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.
Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.
In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.
The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.
More than a third worry they or someone in their immediate family will get Ebola. Continue reading
A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.
How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.
“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.
Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.
Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.
“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.
The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.
One of my original goals for this project was: “Lower my cholesterol and triglycerides.” I’ve been doing some serious thinking about that lately, along with a bit of research, and I’d like to share the results with you.
The serious thinking started last spring, when I ran across the current controversy about the risks of statins in postmenopausal women.
A growing number of physicians and researchers are arguing that, for some women like me, the risks of taking statins to lower cholesterol may outweigh the potential benefits. And the risks are scary: muscle pain (and, more rarely, permanent muscle damage), kidney and liver issues and – yikes! – increased risk of diabetes. Aside from being my own biggest fear, diabetes also, ironically, increases the risk of heart disease, the very thing statins are meant to prevent.
All this gave me pause, because my doctor had prescribed a statin a while ago, and my argument to the nurse practitioner (whom I actually see more often than the doctor) that I didn’t really want to take it had been met with a firm insistence that I should. Based on my numbers, she said – total cholesterol around 350, with an HDL (“good” cholesterol) of around 60 – there was no question.
So I took it for about a month, but I felt tired and achy – maybe just because of life in general, but the achiness felt worse than usual. So when I saw the new studies, I thought, “You know what? I’m just going to stop.”
And I did, and I felt better. But I’ve been avoiding going back to the nurse practitioner to tell her. All of which strikes me as the behavior of a naughty child, rather than a mature adult.
So, as a mature adult, this week I sought another opinion. My editor, Carey Goldberg, suggested I talk with Dr. Vikas Saini, a cardiovascular specialist and the president of the Lown Institute. He’s known for promoting the cause of “right care,” or “avoiding avoidable care” – that is, for arguing that modern medical practice too often overtreats patients, with frequently expensive and sometimes disastrous results. This seems self-evident to me, though it has been enough to create huge controversy in some circles.
In any case, I called Dr. Saini and talked with him about statins, in both general and personal terms. After noting that statins have become a fairly polarizing issue in the medical community, he asked a few questions about my personal and family history.
I gave him my numbers, which he agreed create a slightly increased risk – on paper, anyway. But when I told him that both my grandmothers had high cholesterol but lived into their 90s (and neither died of heart disease), and that neither of my parents, who also had high cholesterol, died of heart disease, either, he said that this history “makes me very, very suspicious of any attempt to paint your high cholesterol as a risk factor. It doesn’t add up.”
Well, hurrah. So I’m not being stupid to stop taking the statin?
“I don’t think that’s stupid at all,” Saini said. “I personally wouldn’t do much of anything except check your numbers.”
And, of course, keep increasing my commitment to exercise – “at least get it up to three times a week” – and eat your basic Mediterranean diet with plenty of olive oil, and work on stress reduction. All these factors, he noted, clearly help prevent heart disease. Continue reading
Could Massachusetts be the only government in the world trying to persuade citizens to shop for health care? I’m scanning Google, trying to come up with another country, province, city…maybe some remote island that has decided: It’s time to learn how to get the best deal you can on care.
Nope, I can’t come up with any other place.
But here it is: Get The Deal on Care. In addition to the website, you may see ads on the T, Twitter or Facebook that will encourage patients to become more savvy consumers of health care.
“We’re at the beginning of a movement here,” said Barbara Anthony, undersecretary for consumer affairs and business regulation, referring to a provision in a Massachusetts law that took effect Oct. 1. It requires all insurers to make real-time prices available to members online and over the phone, and provide members their cost for the service, taking into account co-pays and deductibles.
“We hear about the dawn of patient-centered care,” she said. “We want to put patients in the driver seat. Well, you can’t put consumers or patients in the driver seat if they don’t have information.”
I subscribe to the dentistry school of birthing babies. That is, I wouldn’t want to get a tooth filled without Novocaine, and I wouldn’t want to have a baby without an epidural.
I know that opinions — strong ones — vary on this, but for those of my ilk who’d like yet another data point to support the pain-relief side, here it is: A national study, one of the biggest yet, of complications from epidurals has just been presented at the annual conference of the American Society of Anesthesiologists now under way in New Orleans. And it suggests that epidurals are even safer than previously thought, with rates of the most-feared complications well under 1 percent.
Dr. Samir Jani, a senior resident in anesthesiology at Beth Israel Deaconess Medical Center, presented the findings, gleaned from a giant national database of anesthesiology cases, the National Anesthesia Clinical Outcomes Registry.
He found that among more than 80,000 cases of anesthesia during labor and delivery, 2,223 involved complications, for an overall rate of 2.78 percent. But most of those concerned medication errors — over-dosing, under-dosing, or use of expired drugs.
The rate of the complications that many women fear most — nerve damage or an excruciating “spinal headache” — were even lower than previously estimated, Dr. Jani said: .2 percent — that’s 2/10 of one percent — for the headache; .002 percent for spinal nerve damage and .14 percent for damage to other nerves.
“So it’s well under 1 percent for the kinds of complications that I think a lot of women worry about,” he said, not the 1-2 percent that he’s been quoting his patients based on textbook teachings.
An awkward question: But don’t anesthesiologists tend to be pretty pro-anesthesia? Mightn’t that bias the results?
“Actually,” Dr. Jani said, “Whenever I talk to all my patients, I tell them, ‘I’m not here to sell you an epidural. it’s your ultimate decision.’ And I think that that’s the mentality that almost all of us have. We aren’t ever going to force on a patient what they don’t want. But in that informed consent process, it’s important we quote not only possible complications but the rates to the best of our knowledge. At the end of the day, it’s good to be able to tell your patient that this is a safe and efficient method to be able to control labor pain.”
And what about the common belief that getting an epidural can hinder the pushing process in labor? Continue reading
Ebola has been dominating the headlines lately, raising concern about the disease potentially spreading to Massachusetts. And after two recent Ebola scares in Boston, local authorities are also trying to reassure the public.
Here’s what you need to know about Ebola: