Singing And Dancing The Flu Vaccine Lecture

You’d never call Dr. Lester Hartman and his associates at Westwood-Mansfield Pediatrics shy, but this musical version of the “get your flu shot” lecture takes the video oeuvre of this practice to new heights.

Challenge to other doctors and nurses: can you top this?  How far are you going this season to persuade patients to get vaccinated against influenza?

Research News Flash: Scientists Grow Cells For Possible Diabetes Cure

Human Stem Cell Beta Cells/Photo Courtesy Doug Melton, Harvard University

Human Stem Cell Beta Cells/Photo Courtesy Doug Melton, Harvard University

In what is being called a major advance on the road toward more effective diabetes treatment, Harvard researchers report that they’ve been able to grow large quantities of human, insulin-producing pancreatic “beta cells” from human embryonic stem cells. Why is this important?

As the leader of this massive, years-long effort, Doug Melton, the superstar Harvard stem cell researcher said in a news conference Tuesday: “This finding provides a kind of unprecedented cell source that could be used both for drug discovery and cell transplantation therapy in diabetes.” And as NPR’s Rob Stein put it: “The long-sought advance could eventually lead to new ways to help millions of people with diabetes.”

Reporter Karen Weintraub, writing for National Geographic, describes why the research, conducted in diabetic mice, has taken so long, with so many twists and turns:

The researchers started with cells taken from a days-old human embryo. At that point, the cells are capable of turning into any cell in the body. Others have tried to make beta cells from these human embryonic stem cells, but never fully succeeded. Melton’s team spent a decade testing hundreds of combinations before finally coaxing the stem cells into becoming beta cells.

“If you were going to make a fancy kind of raspberry chocolate cake with vanilla frosting, you’d pretty much know all the components you have to add, but it’s the way you add them and the order and the timing, how long you cook it” that makes the difference, Melton, also a Howard Hughes Medical Institute investigator, said at [the] news conference. “The solution took a long time.”

Here’s (a lot) more detail from the Harvard news release, written by B.D. Colen:

Harvard stem cell researchers today announced that they have made a giant leap forward in the quest to find a truly effective treatment for type 1 diabetes, a condition that affects an estimated three million Americans at a cost of about $15 billion annually.

With human embryonic stem cells as a starting point, the scientists are for the first time able to produce, in the kind of massive quantities needed for cell transplantation and pharmaceutical purposes, human insulin-producing beta cells equivalent in most every way to normally functioning beta cells.

Doug Melton, who led the work and who twenty-three years ago, when his then infant son Sam was diagnosed with type 1 diabetes, dedicated his career to finding a cure for the disease, said he hopes to have human transplantation trials using the cells to be underway within a few years.

“We are now just one pre-clinical step away from the finish line,” said Melton, whose daughter Emma also has type 1 diabetes.

A report on the new work has today been published by the journal Cell. Continue reading

Health Connector Website Update, By The Numbers

Confidence: That’s the mantra among state and private contractors working to replace the Health Connector website that failed so spectacularly last year.

Today, just over a month before the new site is set to go live, Gov. Deval Patrick’s special assistant, Maydad Cohen, will update the Connector board, using numbers to bolster confidence that the roll-out will go smoothly. Speaking of numbers…

91.5 percent — the current rate of site tests that end successfully — a hypothetical member enrolls.

12,671 — the number of concurrent users the new site will be ready to handle (or 46,036 per hour). “Concurrent,” in IT terms, means the number of people who could push a button on the site, triggering some kind of action, at the same time. Website managers say this is double the capacity they expect to need. They are aiming for “overkill.”

74,000 — the number of people who can browse the site (but not all clicking buttons at once) at any given time. This is double the 37,000 who visited the failed site last year on its opening day.

Under 3 seconds — the maximum time website managers say users will have to wait for a response after clicking to a new page. Continue reading

Join Us For A Health Care Shopping Contest

Do you get regular blood tests and wonder how much they cost?

If you are pregnant or thinking about having a baby, where are the least and most expensive hospitals within a short drive from your home?

Does your daughter need an MRI to diagnose a soccer injury? What’s the range from the lowest to highest cost test?

Today, in Massachusetts, you can find answers to these questions. As of Oct. 1, insurers are required to post prices online or give them to you when you call. This is a potentially dramatic change after years of guarding costs as secrets, protected by the contract between a hospital or doctor and each health insurer.

So try pulling back the curtain. Test the new health care shopping tool on your health insurer’s website, and tell us what you find. We’ll deliver a prize to the shopper who finds the biggest gap between their cheapest and most expensive option.

To enter, you’ll have to log on to the tool on your insurer’s website. They all have different names, so look for something that mentions a cost calculator. Post your entries in the comments section below, with a screenshot if you feel like it.

And if you have any trouble shopping, or a story to share, we’d love to hear about that too.

Enterovirus D68: Good News, Bad News, What To Do

(CDC)

(CDC)

Pick your viral anxiety: Do you want to focus your media-fueled jitters on Ebola or on enterovirus D68?

Personally, even with today’s news of the first U.S. death from Ebola, I pick the enterovirus every time. For one thing, it’s actually around; it’s not a single case in Texas. But I’d prefer no anxiety at all, and the best antidote tends to be knowledge. So here are some data points:

The Massachusetts Department of Public Health fact sheet on enterovirus D68 is here and the CDC’s here. At a news conference last week, Dr. Alfred DeMaria, the department’s medical director for the Bureau of Infectious Disease, told reporters that enterovirus D68 had probably been “the predominant cause of respiratory illness over the last four weeks.”

Mostly, that meant colds, he said, and he thinks he even had the bug himself. But reports of lung ailments have “decreased significantly over the past couple of weeks,” he said, so “enterovirus 68 seems to be going away.”

Let’s hope. But what the heck? Here & Now reports that the enterovirus has been connected to five deaths nationwide, most recently of a 4-year-old in New Jersey. Of course, we know that viruses can sometimes lead to deaths by unleashing bacterial infections; flu has been known to kill dozens of American children in a bad year. But still, what to make of all the coverage of this unfamiliar virus?

I asked Dr. Ben Kruskal, chief of infectious diseases at Harvard Vanguard Medical Associates. My takeaway: Yes, this is quite a bit like flu, only it’s drawing attention because it’s a virus that’s acting atypically, surprisingly. Our conversation, edited:

There are so many viruses around; why are we even hearing about this one and what should we make of the coverage?

We’re hearing about it because it is not just a strain of a virus we don’t see very often but because it’s causing unusual manifestations, and manifestations that have enough impact for us to pay attention to. It’s actually in 30 or 40 states now, and we don’t really know how widespread it is because it’s clinically not terribly distinctive. It’s a respiratory virus that looks like a lot of other respiratory viruses, including the flu and the cold viruses and a whole bunch of others. And the reason we’re paying attention is not just the fact that it’s an unusual strain — then it would be a sort of laboratory curiosity — but because it’s actually on a more severe end of the spectrum for some people.

So it’s been confirmed that it’s here in Massachusetts, and it sounds like we have had more kids being hospitalized for respiratory trouble than usual in recent weeks, right? For example, Tufts Medical Center tells us that they’ve had 54 hospital admissions of kids with repiratory problems this year, compared to 27 admissions by this date last year, and they’re tending to stay in longer and need more treatment.

I understand from Dan Slater, who’s the director of pediatrics here at Harvard Vanguard, that we went months without having to admit any kids with asthma to the hospital, and in the last few weeks we’ve had quite a few admissions.

So what’s your public health message then at this point? What do you say to parents?

It’s reasonable to think of this outbreak in most respects as being like a sort of a nastier flu season. The timing is different from the flu season but in terms of how it manifests itself, it’s pretty similar to a severe flu. Remember that the flu and this virus — like any infectious agent — have a spectrum of severity. So even though this one is on average more severe, there are still lots of people who will get just a regular old cold. And there are some people who will get kind of a nasty cold. And there are some people who will get more severe things, including asthma-like illness in people who don’t have pre-existing asthma or an exacerbation of underlying asthma in people who do.

So are there telltale symptoms to watch for? Continue reading

Mass. Becomes First State To Require Price Tags For Health Care

CLICK TO ENLARGE: Massachusetts residents can now shop for their health care online, seeing prices for procedures and visits. (screenshot)

CLICK TO ENLARGE: Massachusetts residents can now shop for their health care online, seeing prices for procedures and visits. (screenshot)

Massachusetts has launched a new era of shopping. It began last week. Did you notice?

Right this minute, if you have private health insurance, you can go to your health insurer’s website and find the price of everything from an office visit to an MRI to a Cesarean section. For the first time, health care prices are public.

It’s a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information — nothing. Occasionally over the years, I’d receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.

Then two years ago Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public. Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices.

“This is a very big deal,” said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. “Let the light shine in on health care prices.”

There are caveats.
Continue reading

DNA Linked To How Much Coffee You Drink

A woman holds a coffee drink outside a Starbucks in Chicago on May 31. (Gene J. Puskar/AP)

A woman holds a coffee drink outside a Starbucks in Chicago on May 31. (Gene J. Puskar/AP)

How much coffee do you drink every day? One cup in the morning? Or do you gulp it all day?

Scientists have long known that your DNA influences how much java you consume. Now a huge study has identified some genes that may play a role.

Their apparent effect is quite small. But variations in such genes may modify coffee’s effect on a person’s health, and so genetic research may help scientists explore that, said Marilyn Cornelis of the Harvard School of Public Health. She led the research.
Continue reading

‘Good Death’ Still Eludes U.S. Health System Despite Decades Of Debate

reclaimedhome/flickr

reclaimedhome/flickr

By Richard Knox

Death is back in the news again. And it should be.

Death comes to us all. And in the U.S. at least, it’s increasingly likely to be inhumane, institutional and full of misery. That’s according to a growing body of evidence, including:

•A report last month from The National Institute of Medicine called “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” It’s a 500-page indictment of U.S. end-of-life care.

•A new book by Boston writer-surgeon Atul Gawande on the subject called “Being Mortal: Medicine and What Matters in the End.”

•And recently, a must-read New York Times article — a powerful case study of how the American way of death has gone badly awry.

From these and other sources, one thing is clear: Too many Americans are still dying in hospitals and nursing homes; getting aggressive but futile care; and suffering more from the complications of treatment than from the pain of dying.

And with about 10,000 Baby Boomers turning 65 every day, it’s way past time to do something about it. “What is it going to take to ensure that patients in this country are receiving the right care at the right time in the right location, consistent with the right to choose?” Dr. Joan Teno wonders. “These are the things that keep me up at night.”

Teno, a Brown University faculty member, is among 21 authors of the recently issued Institute of Medicine report on dying in America. Continue reading

Mystery Author Cornwell Funds $500K Brain Research On Medical Pot At McLean

The administration building at McLean Hospital (Wikimedia Commons)

The administration building at McLean Hospital (Wikimedia Commons)

This just in from McLean Hospital, the Harvard-affiliated psychiatric hospital known as a major center for research on mental health:

Belmont, Mass. – Thanks to a $500,000 gift from international best-selling author and mental health advocate Patricia Cornwell, McLean Hospital and Harvard Medical School researchers will launch a landmark new program that will more fully explore the potential impact of medical marijuana on cognition, brain structure and function. This first-of-its-kind program, known as the Marijuana Investigations for Neuroscientific Discovery (MIND) Program, will also gauge study participants’ perceptions of their own quality of life as it relates to medical marijuana treatment.

“We are seeing the country’s view on marijuana shift dramatically and now is the time to allow science to inform our policies and our decisions,” said Cornwell, who is a member of McLean Hospital’s National Council and was presented with the hospital’s highest honor in 2012 for her mental health advocacy. “The MIND Program has the potential to revolutionize what we know about medical marijuana and what we think we know.” Continue reading

Sexting The ‘New Normal’ Among Teens?

(Wikimedia commons)

(Wikimedia commons)

By Alvin Tran
Guest Contributor

Sexting may be a new “normal” part of adolescent sexual development, reports a new study published Monday in the journal Pediatrics.

“The study results indicate that sexting may precede sexual intercourse in some cases and further cements the idea that sexting behavior is a credible sign of teenage sexual activity,” the study’s press release reports.

But what the study does not find is any link between sexting and high-risk sexual behavior. That lack of a link, the authors write, may suggest that “sexting is a new ‘normal’ part of adolescent sexual development and not strictly limited to at-risk adolescents.”

The researchers, based at the University of Texas Medical Branch at Galveston, analyzed data of an ongoing six-year study. It followed high school students in southeast Texas, who periodically completed anonymous surveys that measured various behaviors, including their history of sexting and sexual activity. After examining whether teen sexting predicted sexual behavior after a one-year follow-up, they found that the odds of being sexually active among those who sexted was 1.32 times larger than those who didn’t sext the previous year.

“In this temporal examination of the relationship between teen sexting and sexual behaviors, we found that sending naked pictures of oneself was associated with being sexually active one year later,” the authors wrote. But “counter to previous cross-sectional research, sexting was not temporally associated with risky sexual behaviors; and active sexting mediated the relationship between passive sexting and sexual intercourse,” they added.