Boston Patient Not At High Risk For Ebola, Health Officials Say

Beth Israel Deaconess Medical Center in Boston (Steven Senne/AP)

Beth Israel Deaconess Medical Center in Boston (Steven Senne/AP)

A man who travels frequently to Liberia caused a stir Sunday afternoon when he arrived at a Braintree clinic with Ebola-like symptoms. But doctors and public health officials say that the man is not considered at high risk for the often deadly virus. His case did, however, give us the first public look at how nurses, EMTs, hospital staff and others have prepared to respond when there is an Ebola alert.

WBUR’s Martha Bebinger spoke with WBUR’s Bob Oakes on Monday with more on the story.

Bob Oakes: How did this man, who has not been identified, become the focus of police escorts, press conferences and numerous statements on Sunday?

Martha Bebinger: The man called his primary care practice, Harvard Vanguard, in Braintree Sunday morning, complaining of a headache, muscle aches and some other problems. He was given an appointment in the afternoon. The man went to the Harvard Vanguard pharmacy to pick up a prescription for something else, then left.

But after that first call, Harvard Vanguard reviewed his medical record and noticed that the man traveled frequently to Liberia. The office staff then called the patient and “intercepted” him as he was coming in. They asked him to wait in his car while they called for an ambulance. The Harvard Vanguard office was closed for a period of time, while they disinfected surfaces in the pharmacy they believe he touched, and then reopened.

The man waited, cooperatively, we’re told, in his car, sort of a self-quarantine, until an ambulance arrived. What kind of precautions were in place there?

Brewster ambulance completed their Ebola response training about a week ago. Brewster’s director of training, Jeff Jacobson, says the company was on the scene in 15 minutes with two ambulances, one that had been sealed inside with plastic and three EMTs wearing hazardous materials suits.

“Once the patient is removed from the ambulance and into the hospital, two more folks get into the level B suits and remove all the plastic, put in sealed containers, then the vehicle is disinfected, following the Centers for Disease Control recommendations,” Jacobson said.

In all, Jacobson estimates there were 40 responders, including police, firefighters, local public health and Harvard Vanguard personnel.

Forty personnel arrived? And were all of those responders trained in Ebola safety practices?

I heard both yes and no. Only people who may come in contact with the patient or his body fluids need to wear gloves and protective gear. But I also heard there was a call Sunday, after this incident, on which some participants felt the response was too much while others thought that a maximum effort is warranted as responders test and adjust their reaction to Ebola.

The ambulance took the patient to Beth Israel Deaconess Medical Center, where I imagine there were a few nervous staff members. Earlier Sunday, the CDC confirmed that a nurse who treated a man who died from Ebola in Dallas has come down with the virus. Continue reading

Project Louise: The Zombie Workout Adds Strength Training

Louise's new role model: Rob Zombie. Note the muscle tension achieved by the squat.

Louise’s new role model: Rob Zombie. Note the muscle tension achieved by the squat. (Alfred Nitsch via Wikimedia Commons)

Back to the gym at last! I’ve been working out, far too sporadically and half-heartedly, at home, mostly doing my zombie workout on the treadmill. But as the cooler temperatures have been reminding me that year’s (and Project’s) end draws ever nearer, I knew it was time to get serious. And that meant a call to Trainer Rick.

Rick DiScipio is a kind, patient trainer who always manages to push me without making me feel guilty for not having pushed myself. So, even though I’d been neglecting him for months, he happily scheduled a session and walked me through a simple routine. Because he knew I’ve managed to do some cardio on my own, we decided to focus on some very simple strength training.

The key this time is that it’s all something I can do at home – no more using “no time to get to the gym” as my excuse for not doing a real workout. And Rick suggested that I set a small goal for the first couple of weeks. “Just do it twice a week,” he said. “That’s all. Just twice a week. What you need is to develop the habit.”

What I also need, I’m discovering, is a sense of community – a sense that other people are on this journey with me. So here’s my routine. I hope you’ll join in (assuming your doctor wouldn’t object, of course). Just twice a week.

First, a couple of notes. I don’t know about you, but I have torn out pages of suggested workouts from magazines, bookmarked routines online, bought videos, picked up flyers … and never done any of them. So I am deliberately not making this fancy, because I don’t want you to bookmark it or print it out and then never do it.

Instead, I want you to read through it, realize how ridiculously simple it is, and then try it just once. Continue reading

Rethinking Cancer Research Through ‘Exceptional Responder’ Patients

Grace Silva and her oncologist, Jochen Lorch (Photo: Sam Ogden, Dana-Farber Cancer Institute.)

Grace Silva and her oncologist, Jochen Lorch (Photo: Sam Ogden, Dana-Farber Cancer Institute.)

By Richard Knox

By all odds, Grace Silva should have died more than three years ago. Instead, this 58-year-old grandmother is helping scientists rethink cancer treatment and research.

Silva’s case, detailed in this week’s New England Journal of Medicine, is one of only three recently published accounts of what cancer doctors call “exceptional responses” to a drug called everolimus (brand name Afinitor).

It was approved two years ago to treat certain breast cancers and is also used against some kidney and pancreas tumors. A couple of months after Silva started taking the drug, her thyroid tumors, which had spread to her lungs, melted away to nearly nothing. That basically never happens with this aggressive tumor, known as anaplastic thyroid cancer. “It was a near-complete response,” says her oncologist at Dana-Farber Cancer Institute, Dr. Jochen Lorch. “That in itself is exceptional. When we saw it, it was one of the better days around here.”

Studying The Exceptions

More remarkable still, Silva’s tumor stopped growing for 18 months. We’ll come back to what happened after that. But first, you should understand this story isn’t about everolimus or any particular cancer drug. It’s about how cancer specialists are learning how cancer works at the most basic level — by studying exceptional responders like Grace Silva.

And to appreciate why her case is important, you need to know how researchers figured out why she was an exceptional responder. It’s partly due to a five-year-old technology called next generation sequencing. It’s a cheap and rapid way of spelling out the genetic code of, in this case, individual patients’ tumors. Researchers can then look for gene mutations that are driving the uncontrolled growth that is cancer.

Continue reading

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