Mass. Town Considers First-In-The-Nation Ban On All Tobacco Sales

Brian Vincent poses in front of a large display of tobacco products at Vincent's Country Store in Westminster on Nov. 6. Local officials are contemplating what could be a first: a blanket ban on all forms of tobacco and e-cigarettes, leaving some shop owners fuming. (Elise Amendola/AP)

Brian Vincent poses in front of a large display of tobacco products at Vincent’s Country Store in Westminster on Nov. 6. Local officials are contemplating what could be a first: a blanket ban on all forms of tobacco and e-cigarettes, leaving some shop owners fuming. (Elise Amendola/AP)

Updated 5:43 p.m.

BOSTON — A town in north-central Massachusetts is considering banning the sale of all tobacco products — the first such sweeping measure in the country.

The proposal has Westminster businesses up in arms, while the town’s health board says it’s concerned about the effects of smoking and minors having access to tobacco products.

At a public hearing tonight, the board of health will hear comments about the proposed ban. The town’s health agent, Elizabeth Swedberg, was unavailable for comment today.

In its proposal, the Westminster Board of Health outlined the harmful effects of tobacco, including evidence that it leads to cancer and respiratory and cardiovascular diseases. The board also said that e-cigarettes could normalize smoking behavior and “serve as a gateway” for ex-smokers to begin smoking again. And the board expressed concern about the allure of tobacco products to minors, saying that despite state laws prohibiting sales to youths under the age of 18, the access to tobacco products by minors is “a major public health problem.”

The proposed ban would prohibit the sale of any product containing, made or derived from tobacco or nicotine that is intended for consumption. Should the ban move forward, first-time violators could be fined $300, and have board of health permits suspended or revoked for further violations.

The American Lung Association and the Massachusetts Public Health Association each said they do not have a position on this specific proposal.

Tami Gouveia, the executive director of the advocacy group Tobacco Free Mass, called the Westminster proposal an important approach to protecting public health. She said boards of health in all communities should look at different policies and approaches to keep their residents healthy.

“It’s important for us to be taking a real hard look at that and to continue to find ways to reduce youth use of cigarettes as well as adult use,” Gouveia said. “When we learned that lead was dangerous when people were exposed and when children were exposed, we removed lead from paint and we removed it from gasoline.”

Gouveia also said the Westminster proposal could help those struggling with nicotine addiction and make it easier for them to quit smoking when they realize the store they frequent can no longer sell tobacco products.

Opponents of the ban say it would hurt local businesses by driving customers — and profits — to neighboring communities. Continue reading

Mass. Parents Report Early Logjam In Care For Mentally Ill Kids

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Lisa Lambert of PPAL (Courtesy)

It usually happens in spring, the annual back-up of mentally ill kids who need beds in Massachusetts psychiatric hospitals or residential care centers.

But Lisa Lambert, executive director of the Parent/Professional Advocacy League, which works on behalf of mentally ill children and their families, reports that already this fall, the waits are unusually long and the resulting crises severe. (Imagine: a child in severe emotional distress, stuck in an Emergency Room for days. Or stuck in a hospital far from home, because there are no local beds.)

What’s happening? It’s not exactly clear. Might it be that state social service agencies are putting kids into residential care more than usual in the wake of the Jeremiah Oliver case? Is it a longer-term effect of having more community-based treatment for kids? Community care is widely considered a good thing, but it could mean that because children in crisis stay at home longer, their needs are more acute when they’re brought in for care. Lambert writes that the bottom line is that no one seems to be taking responsibility for alleviating the back-up, and the situation is getting dire:

At my office, the phone and emails are nonstop. Often, they spill over to the weekend. A few days ago, we heard from a mom whose 14 year old son had swallowed a bottle of Tylenol. This was his third suicide attempt. She rushed him to the emergency room and got medical treatment right away. But once that was completed, he needed inpatient mental health care. “You have to wait, his mother was told twice a day. “There are no beds.” She’s a smart and proactive parent and was trying every avenue to budge a system that told her there was nowhere to admit her son for treatment. When she called us he’d been waiting for four days and counting.

We are hearing a new term this year: boarding at home.

We are not the only state grappling with this issue. Last summer, the Sacramento Bee reported that hospitalizations for California children and teens had spiked 38% between 2007 and 2012. Nationally, hospitalizations have also increased but at a slower pace than California. Connecticut also reports an increase in children and teens coming to emergency rooms in psychiatric crisis. Data from the state’s behavioral health partnership shows that the number of children and teens stuck in emergency rooms rose by 20 percent from 2012 to 2013. Continue reading

Boston Nurse Records 'Desperately Sad' Experiences Treating Ebola Patients In Liberia

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

A growing number of doctors, nurses and public health specialists across the U.S. are putting their lives on hold and heading to Ebola-ravaged regions of West Africa. Today, and in the months to come, we bring you the story of one man who is on the ground in Liberia.

John Welch, 33, is a nurse anesthetist at Boston Children’s Hospital, and works with Partners in Health (PIH) in Haiti. At least that was his life before he opened an email from the organization in late September. It was a call for volunteers and support as PIH moved into Liberia and Sierra Leone to try and stop Ebola’s spread. Welch told a supervisor he’d be happy to help if needed.

That decision, says Welch, “was about being on the right side of history. I think I would have trouble looking back, knowing that I had an opportunity, and had not stepped up.”

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he's going to Liberia. (Courtesy of John Welch)

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he’s going to Liberia. (Courtesy of John Welch)

Calming worried friends and family members was not so easy.

“How does your mother feel?” asks Lindsay Waller, an old friend and fellow anesthetist, who helps Welch prepare to discuss the decision with his family.

She’s upset and worried, Welch says, but “I am who I am because she’s my mother. [My parents] taught me these feelings of altruism and taking care of the people around you and helping out.”

The next day, on a quick trip from Boston to Columbus, Ohio, Welch makes a pitch he knows will resonate with his mother, aunt and sister: 70 percent of deaths from Ebola are women, the caregivers.

He asks his family to sit with him and watch a “Frontline” episode on Ebola. Fear and pain in the faces of patients with Ebola made the point for Welch.

“At first, I wanted to just say, ‘No, don’t go, it’s too dangerous,’ ” says Heidi Christman, Welch’s sister. But then, in the video, Christman says she saw “the brothers and sisters, friends and family that have been lost because of Ebola. And it made me realize that it’s not about me or my fears. It’s about helping these people. They deserve people like my brother.”

Her brother flew to Alabama for a CDC Ebola treatment training and in mid-October, three weeks after Welch said, “I’m in,” he was on his way to Liberia.

It wasn’t an easy journey. There are very few flights in and out of Liberia these days. Welch had several cancellations, spent an extra day in Casablanca, and his luggage was lost in transit.

When he finally lands in Liberia, Welch must take his temperature and wash his hands in chlorine, something he’ll get used to doing at least a dozen times a day. On the drive into Monrovia, a building, all lit up, stands out from a distance. Welch realizes it’s the large Doctors Without Borders Ebola Treatment Unit that he’s read about and seen in pictures. Suddenly, his assignments feels real.

After a few hours sleep, Welch leaves Monrovia and heads inland to a clinic in rural Bong County run by the International Medical Core. Welch is here to learn what it will take for PIH to set up a similar Ebola Treatment Unit in another rural county with few roads, power lines and little running water.

Continue reading

Silent Wars: Helping Vets Fight Mental Health Battles At Home

By Evan Bick
Guest Contributor

The movies have it wrong. Combat, at least in my experience, was not non-stop or action-packed. Those who have experienced it know that modern warfare usually involves a lot of starting and stopping. Long stretches of quiet, even boredom, can be broken in an instant.

I was deployed to Iraq as an infantry platoon leader in 2008-2009. During that time, there may not have been constant action but there was tension — my fellow soldiers and I were on edge most of time, soldiers among civilians, going on patrols in the northwest corner of Baghdad.

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

Evan Bick, a veteran of the Iraq war, now works with other vets struggling with mental health problems. (Courtesy)

On our first day in the city, the leaders from the unit we were replacing took us on a walk through their area of responsibility. We saw the sidelong glances from civilians as Americans walked through their streets, hidden behind rifles and sunglasses, and weighed down by cumbersome body armor. We also saw an area filled with stark contrasts — stucco houses with gated courtyards in one neighborhood, and refugee camps for Iraqis displaced by ethnic violence in the next.

Deployment is a challenging experience even when it’s boring. Whether you are patrolling ‘outside the wire’ or working behind the scenes, the sense of danger is real and omnipresent. While deployed, soldiers typically work far longer hours, and with less opportunity for relaxation than they experience at their home station. Isolation from loved ones, of course, is an important challenge both for the deployed soldier and family members back home.

Even with all those challenges, the bigger battle for many veterans begins when they return home. Without a unit that shared in your experience of war, you can feel lost — more lost than you would ever feel on patrol. It’s easy to get trapped inside your own head, and to dwell on what did not go well, and what you should have done differently. The quick reflexes and adrenaline that may have helped keep you alive overseas are probably no longer helpful.

Strategies that kept you and your fellow soldiers safe, like driving fast and straight down the middle of a road, become dangerous, and loud noises or crowds may make some part of you feel like you’re back in the desert. Continue reading

Judge Appears Skeptical About Partners HealthCare Deal

Outgoing Massachusetts Attorney General Martha Coakley, a key player in the Partners deal. (Steven Senne/AP/File)

Outgoing Massachusetts Attorney General Martha Coakley, a key player in the Partners deal. (Steven Senne/AP/File)

In a packed courtroom on the 10th floor of Suffolk Superior Courthouse, the question on the docket appeared to be a simple matter: Should a judge in the Business Litigation Division say yes or no to a deal negotiated between Partners HealthCare and Attorney General Martha Coakley?

In any standard consent judgment, the judge would default to the attorney general.

But again Monday, as she did in September, Judge Janet Sanders made clear she will not say yes, no, or come back with a revised deal until she understands the details and possible consequences. Sanders wants to determine if consumers and the state would benefit from Partners’ proposed expansion.

She asked dozens of questions that suggest she is skeptical. And at the end of the day, she and Coakley engaged in what came across as a politely combative exchange. More on that later.

For an example of Sanders’ questions, let’s take the price caps. Under the agreement, payments to Partners could not increase more than inflation for six-and-a-half years.

Would Partners still have the highest-paid hospitals in the state? Sanders asked.

Yes, probably, said the AG’s office, except for Boston Children’s Hospital. This agreement doesn’t claim to correct historical problems, said Will Matlack, chief of the AG’s anti-trust division.

What happens, Sanders continued, if Partners jacks up prices in year seven? By then, Partners will be even bigger, and could demand more money than they can now, she suggested.

That’s speculation, said the AG’s office. And it’s not reasonable speculation, said an attorney for Partners, because there are lots of dynamics that could change the market between now and then. Continue reading

UMass Medical School Sending Team To Fight Ebola In Liberia

Dr. Rick Sacra, a UMass Medical School faculty member who contracted the Ebola virus in Liberia, walks out of a media availability with Chancellor Michael Collins Sept. 4 in Worcester. (Stephan Savoia/AP)

Dr. Rick Sacra, a UMass Medical School faculty member who contracted the Ebola virus in Liberia, walks out of a media availability with Chancellor Michael Collins Sept. 4 in Worcester. (Stephan Savoia/AP)

UMass Medical School this week launches a formal effort to fight Ebola in Liberia.

The school is familiar with the West African nation. It leads a collaborative of institutions, including Boston Children’s Hospital, that has been sending faculty and staff to Liberia to train doctors and nurses since 2006. The school recently received a $7.5 million grant from the Paul G. Allen Family Foundation to send doctors and nurses to help care for Ebola patients and reopen health care facilities.

On Thursday, one faculty member from UMass Medical School and a doctor from Boston Children’s will head to Liberia to asses what’s needed for the months-long effort.

Chancellor Michael Collins says faculty members will be under 21-day voluntary quarantine when they return, but many are signing up for the work.

Continue reading

Confessions Of A Physician Sugar Addict

(Mel B via Compfight)

(Mel B via Compfight)

By Terry L. Schraeder, M.D.
Guest contributor

In medical research, the “n” value is the number of people in a study. If n = 1, it is not generally considered a very powerful study. But when you are the “1” in “n = 1,” it somehow becomes more significant.

It all started with a can of soda disguised as sparkling orange juice. It had become my “go to” treat. My pick-me-up when I was low. In fact, it gave me a rush of energy every time I drank it. One day, I looked at the label to see if it contained caffeine. No caffeine, just added sugar. In fact, it contained 32 grams of sugar — eight teaspoons per can — with sugar second only to water as the largest ingredient. The World Health Organization recommends women not consume more than six teaspoons of added sugar per day — or about 5 percent of total calories as added sugar. Men can have up to nine teaspoons.

How much sugar was I consuming a day? I was also adding honey to my coffee, maple syrup to my oatmeal, consuming corn syrup in my “healthy” flavored yogurt (some brands add as much as 30 grams per serving) and enjoying muffins as a snack and dessert many evenings. Along with my routine stop for a drive-through flavored coffee drink, and occasional cookies or candy, I had officially joined our nation of fellow sugar addicts.

In the US, we are consuming on average 88 grams or 22 teaspoons of added sugar a day. (There are four grams of sugar per teaspoon.) My guess is that I was eating even more. Like many, I needed my fix of high fructose corn syrup or other sugar source every few hours.

For the last several years, there has been an increasing drumbeat of warnings linking sugar to obesity, diabetes, heart disease, cancer and nonalcoholic fatty liver disease from experts such as endocrinologist Dr. Robert H. Lustig at the University of California at San Francisco and media doctor Dr. Sanjay Gupta at CNN. But somehow the message had missed me. I did not think of myself, especially as a physician, as a high sugar consumer.

I have tried to stop the hourly IV drip of added sugar I was consuming throughout the day.

I have passed my 50th birthday and have a normal body weight and exercise regularly. I am not on any medication. My blood pressure and fasting blood glucose are normal. But last year, my triglyceride level was high. One reason might be that the high fructose corn syrup I was consuming is converted to triglycerides in the liver – hence the high level.

There were other concerns. I noticed that I felt shaky and had food cravings two hours after eating. I also noticed an afternoon slump of low energy, a growing bulge of belly fat, and plaque that needed to be vigorously scraped from my teeth every six months. How long had my sugar intake been so high?

Sugar consumption in the US has climbed into the stratosphere in the past three decades. Our added sugar consumption increased by 30 percent from 1977 to 2010, according to a study presented last week at ObesityWeek, a major obesity conference, in Boston. It seems we are slurping, sucking and chewing 300 calories of added sugar daily (up from 228) and far more than the recommended limit of 100 calories of added sugar per day. Continue reading

4 More Mass. Medical Marijuana Dispensaries Approved

The Massachusetts Department of Public Health has given three companies provisional approval to open four medical marijuana dispensaries in the state.

Patriot Care Corp., which already has a Lowell dispensary in the works, was approved for dispensaries at 21 Milk St. in Boston and 7 Legion Ave. in Greenfield. Coastal Compassion Inc.’s proposed facility at 2 Pequod Rd. in Fairhaven and Mass Medicum Corp.’s on Revolutionary Drive in Taunton were also approved to enter the inspection and permitting phase.

The four dispensaries are proposed in counties that did not previously have any provisionally approved medical marijuana dispensaries.

Eleven other dispensaries that have already been provisionally approved are currently going through the permitting and inspection process. No dispensaries have received final registration certificates yet.

“We’re really in a fabulous spot,” in terms of the progress DPH is making, medical marijuana program director Karen van Unen said. She added that the first dispensaries are expected to open in late winter.

But the program is considerably behind timetables set under the state law approved by Massachusetts voters in November 2012. DPH has come under fire from patient advocates who say the state isn’t doing enough to ensure patient access to medical marijuana.

As WBUR’s Lynn Jolicoeur reported earlier this year, the DPH has faced widespread criticism for not thoroughly vetting applicants before provisionally approving 20 dispensaries in January:

After revelations of false or misleading claims on applications, and accusations of political favoritism, DPH launched a more thorough verification process and nine of the original 20 dispensaries were eliminated.

There are still no planned medical marijuana dispensaries for four counties — Dukes, Nantucket, Berkshire and Hampden. By law, each county is required to have at least one, but no more than five, dispensaries. There’s also a large swath of the state including Worcester and the surrounding area that has no planned dispensary.

Van Unen acknowledged she’s concerned about the slower-than-expected rollout of the medical marijuana program.

“It’s just as important to us as it is to patients to make sure that access is there, but we also felt very strongly that we need to do this diligently and do it right,” van Unen told WBUR. “We’re able to now start focusing on how we’re going to move forward to ensure that we meet the voters’ will and ensure that we have at least one dispensary in every county, as well as serving the under-served areas.”

DPH recently unveiled its physician and patient medical marijuana registration program and plans to report its first data in February, which van Unen says will allow the agency to better pinpoint areas that need dispensaries.

The state plans to open a new round of dispensary applications sometime next year.

More Medical Marijuana Coverage:

Studies: It May Be Better For Kids Who Are Overweight Not To Know It

feetonscale

According to the scale, the 18-year-old girl is severely obese. But she doesn’t think so.

“I know I’m big, but I’m not obese,” she says. “I don’t take up three seats. My weight is high, but no higher than lots of people’s. It’s no problem.”

If you’re her doctor or school nurse or parent, what do you do? Do you bombard her with Body Mass Index charts and warnings of the health risks she faces? Knowledge is power, right? Certainly, that’s the principle behind the “BMI report cards” — colloquially known as “fat letters” — that schools send home in some states.

But research just presented at ObesityWeek, a major conference on obesity, suggests that it may not be wise to persuade that young woman that she has a problem.

One study found that overweight teens who “misperceive” their weight as normal end up gaining less weight over the next decade or so than teens who are overweight and know it. Another study found that those “misperceivers” blind to their extra pounds were also less likely to become depressed in later years.

The findings are at odds with the basic assumption behind BMI report cards, that it is helpful to inform kids and their families of their weight status, says researcher Kendrin Sonneville, an assistant professor at the University of Michigan School of Public Health who is also affiliated with Harvard and the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital.

Kendrin and IdiaXXX

Dr. Kendrin Sonneville and Dr. Idia Thurston at the Obesity Week conference, where they presented studies that found that weight “report cards” may backfire. (Carey Goldberg/WBUR)

“I think we can say the jury is still out,” she says. “Weight misperception is not something we should assume is harmful, and in the spirit of doing no harm, I think we need to proceed with caution on any type of programming that involves correcting weight misperception.”

The study she led, which followed more than 2700 young people beginning in high school, found that after about a decade, the overweight teens who had perceived their weight accurately gained more than one BMI unit — very roughly about 10 pounds — more than those overweight teens who had falsely believed their weight to be normal.

Why might this be? That’s one of the next avenues of research that need to be explored, but clinical psychologist Idia Thurston, an assistant professor at the University of Memphis, says the key could be the emotional baggage that comes with being told you’re overweight or obese.

More accurate weight perception may translate into more feelings of stigma and lower satisfaction with your own body, she says, “and that could affect your ability to cope — hence, depressive symptoms or hence, engaging in harmful eating behaviors.”

“So when we think about weight report cards and telling kids, ‘This is what your weight status is,’ you really need to think about how that information is being disseminated, and what kinds of protections are put into place, rather than just sending report cards home to kids and not knowing how kids will act on that information.”

Dr. Thurston’s study, also presented at ObesityWeek, found that overweight high-school-aged boys who accurately perceived their own weight as high were significantly more likely to develop depressive symptoms over the next decade or so. (The findings in girls were not statistically significant.) Once again, a false sense of being a normal weight appeared to be protective for overweight young people.

The idea of having schools screen kids for obesity began in 2003 in Arkansas during then-Gov. Mike Huckabee’s anti-obesity efforts, Dr. Sonneville says, and spread around the country without ever having a solid research base on what its effects might actually be.

About one-fourth of states track schoolchildren’s height and weight, and last year U.S. News reported that nine sent weight “report cards” home, including Massachusetts. But last October, facing pushback from nurses, parents and others, the state’s Public Health Council voted to stop sending the letters home, though the schools still gather the information. U.S. News reported that decision under the headline “Massachusetts Schools To Stop Sending ‘Fat Letters:'” Continue reading

After A Death, Should We Get A Dog? Brain Study Signals ‘Yes’

(Greg Westfall/Flickr)

(Greg Westfall/Flickr)

Let’s be clear: I need a dog like a hole in the head.

I’m a recently widowed working mother with a small house, no trust fund and two extremely active young daughters: if it’s Thursday, it must be rock-climbing, piano and Taekwondo before track practice across town. You get the picture.

Still, lately I’ve been thinking the unthinkable: a Maltipoo, Goldendoodle or some other ridiculously named, hypoallergenic, low-maintenance (does that exist?), cute-as hell puppy for my daughters — and for me — to love.

I know full well this is a risky prospect. “There is no rational reason to get a dog,” says my Basset Hound-owner friend. “They are work, expense and add to the list of beings in your home who have needs to be attended to. It is sort of like deciding to have a kid — no rational reason to do that either but big pay off on love, general hilarity and a constant reminder of the joy in everyday small things.” Or, as another friend put it: “What have dogs done for me? They make me more human.”

“What have dogs done for me? They make me more human.”
– A dog-loving friend

It’s that truly profound, but tricky to pinpoint, human-pet bond that drives Lori Palley’s research. She’s assistant director of veterinary services at Massachusetts General Hospital’s Center for Comparative Medicine and has recently become fascinated by why people’s relationships with their dogs can be so very significant.

Her latest research, published in the medical journal PLOS ONE, involved scanning the brains of mothers while they were looking at images of their own children and their dogs. Surprise: similar areas of the brain were activated — regions involved in emotion and reward — whether it was the kids or dogs on view.

It was a small study using fMRI: only 14 mothers (dog owners) who had at least one young child. And in case you jump to some conclusion about moms loving their dogs as much as, or more than, their kids, wait: the research also found that in other areas of the brain involved in attachment and bonding, the mother’s brains were more activated when viewing their children.

In a small study, mothers viewed images of their own children and their dog. Similar areas of the brain involved in emotion and reward were activated. Source: PLOS ONE: "Brain Activation when Mothers View Their Own Child and Dog: An fMRI Study

In a small study, mothers viewed images of their own children and their dog. Similar areas of the brain involved in emotion and reward were activated. (Source: PLOS ONE: “Brain Activation when Mothers View Their Own Child and Dog: An fMRI Study”)

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