Gov. Baker Fills 2 Connector Board Seats

After sweeping out four Connector Board members, Gov. Charlie Baker on Thursday morning named insurance executive Mark Gaunya and business consultant Rina Vertes to serve on the Massachusetts Connector Authority Board.

Vertes and Gaunya were appointed minutes before a scheduled board meeting and the governor’s office reported they plan to participate in that gathering in Boston.

Gaunya is co-owner and chief information officer at Borislow Insurance. Vertes is president of Marjos Business Consulting.

Baker during the 2014 campaign for governor complained that there had been no major personnel changes at the Connector Authority despite major problems with the rollout of an expensive website intended to help people comply with requirements of the new federal insurance law.

“Our administration believes these health care professionals with decades of experience will continue the turnaround effort of the Connector, and provide the people of Massachusetts with an efficient, well run exchange,” Lt. Gov. Karyn Polito said in a statement.

Gaunya is filling a seat reserved for a member of the broker community on the 11-member board, with Vertes taking a seat set aside for a health insurance actuary. Continue reading

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Medical Marijuana 101: Cheese? White Widow? What’s Up With The Names?

I’m standing in a medical marijuana dispensary in Colorado, reading the list of available strains.

There’s Cheese, recommended for patients with multiple sclerosis, insomnia, a lack of appetite or constipation.

Neon Super Skunk is supposed to help with menstrual cramps, fibromyalgia and back pain.

Kind of silly, whatever.

Then I see White Widow, for patients with PTSD and hepatitis C. And Jack the Ripper is billed as relief from chronic pain, depression and anxiety.

Really? My vet buddies are going to try White Widow to ease symptoms of PTSD?

And a patient with anxiety would put their faith in Jack the Ripper for relief?

Several websites caution patients that “it can be hard to put aside the names and focus on what really counts — symptom relief.”

But Dr. Paul Bregman, who runs Medical Cannabis Consulting in Denver, disagrees.

“People are not put off by a name,” Bregman says. “If someone tells you that Jack the Ripper will help your rheumatoid arthritis, people will use it, despite the name.”

Strains are named by their breeder, the person who uses cross-pollination to create a new plant variety. Pretty much anything goes, although some dispensaries do not stock strains that contradict the image of marijuana as a healing agent (like Green Crack and Alaskan Thunder F—).

There does not appear to be any real movement to align recommended medical use with a name. Continue reading

Growing Burden: Toll Of Major Depression Now Put At $210 Billion A Year

(Wikimedia Commons)

(Wikimedia Commons)

For more than two decades, Boston economist Paul Greenberg has been calculating the costs of depression — the mood disorder, that is, not the economic downturn.

His latest study, now out in the Journal of Clinical Psychiatry, finds that major depression is costing the American economy $210.5 billion a year — boosted dramatically by the toll of the recent recession. And rates of depression particularly shot up among people over 50.

I asked Greenberg, head of the health care practice at the Boston economic consulting firm Analysis Group, to elaborate. Our conversation, lightly edited:

First, what would you most highlight from your latest findings?

There are many highlights but I’d focus on two. The first is that the costs of depression are large and growing. And the second is that costs of depression are borne in the workplace in a very dramatic way. There’s no employer that’s exempt from the costs of depression. And I think both the magnitude of costs generally, as well as the costs that are specific to the workplace, are worthy of further attention, further thought, further research.

What are a couple of the specific numbers that you find most striking?

Let’s start with the overall finding: We find the costs of depression to be approximately $210 billion per year. One of the interesting aspects is that only 40 percent of those costs are actually attributable to depression itself.

Could you explain that?

That means that 60 percent is attributable to elevated costs that, in the data, don’t show up as directly connected to depression, but they’re associated with depressed people to a greater extent than with non-depressed people.

Economist Paul Greenberg (Courtesy)

Economist Paul Greenberg (Courtesy)

To be more concrete, on the mental-illness side, there are an awful lot of co-morbid anxiety disorders, a lot of co-morbid PTSD-associated costs — those are examples where the same person who suffers from depression tends to have a higher likelihood of also incurring costs in these co-morbid categories.

But should those costs really count toward depression, when it’s technically another disorder that’s causing them?

Fair enough. That’s part of the age-old question of to what extent is this cause and what’s effect. Take the example of someone who suffers from cancer. It could be that in some instances, there’s an elevated cost of depression when you suffer from cancer. That’s one causal pathway where the depression likely follows the physical disorder. But in another instance, it could be that back pain or sleep disorders or migraines – those are examples of elevated physical disorder costs that accrue to depressed patients, likely as a result, at least in part, of the depression.

Here’s why it matters. If we’re more successful at treating the depression, there’s little or no hope it will alleviate any of the cancer costs. But if we’re more successful at treating depression, there’s a great opportunity to alleviate some or even a large part of those back pain, sleep disorder and migraine kinds of costs that are currently co-morbid with depression. Continue reading

An App For That: iPhones As Medical Research Tools

WBUR’s Martha Bebinger reports that two Boston hospitals are among the first users of new Apple software that turns iPhones into tools for medical research:

Massachusetts General Hospital helped develop the tool (called ResearchKit) and is using it to study diabetes. Patients download an app that tracks the impact of diet, movement and medication on blood glucose levels.

Dr. Stanley Shaw, at MGH, says the app helps patients monitor their health while contributing to research.

“It changes from a one-sided exchange to a new culture where they are also benefiting from the study data that they’re personally contributing,” he says.

Shaw says stored data is not linked to a patient’s ID or Apple accounts.

(Kārlis Dambrāns/Flickr)

(Kārlis Dambrāns/Flickr)

Dana-Farber Cancer Institute has an app that tracks recovery rates and symptoms for breast cancer survivors. Dr. Ann Partridge is using the Apple software in an app that tracks fatigue, mood changes and sleep patterns among breast cancer survivors.

“Patients really control both what they tell us and we can measure what they’re doing through the application and their Smart phones,” Dr. Partridge, of Dana-Farber, says.

Marketplace reporter Adam Allington quotes Jeff Williams, a senior vice president of operations at Apple, saying that the key benefit of the ResearchKit is to help doctors and researchers increase the sample size in clinical studies:

“They often have to pay people to participate, which by the way doesn’t give you the best cross section of the population. But, the bigger issue is small sample sizes, sometimes 50-100 people,” says Williams. Continue reading

Lawsuits Move Forward, Brought By Women Hurt By Vaginal Mesh

With all of the complications related to vaginal mesh — which we reported on several years ago — the influential doctors group the American College of Obstetricians and Gynecologists recently issued an article, “What Is New in the Use of Mesh in Vaginal Surgery?” offering data published in the past year on the topic.

One notable point about the implants, used to lift sagging pelvic organs back into place, is that removing a vaginal mesh implant that has been causing problems doesn’t always fix the problems. The article, by John R. Fischer, M.D. of the Department of Obstetrics and Gynecology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, says:

Complications from placement of permanent synthetic mesh for vaginal prolapse repair are well-documented, but there is little to guide physicians regarding outcomes after surgical removal of trans-vaginal mesh. This is a retrospective review of patients who underwent excision of trans-vaginal mesh owing to complications. The most common issues were pelvic and vaginal pain, mesh exposure, and a bulge sensation…After removal, 51% of patients reported complete resolution of their symptoms, with mesh exposure mostly likely to respond to treatment. Of those who presented with pain, 51% reported persistent pain after excision.

Fischer concludes: “…of the many symptoms that are treated with mesh excision, persistent pain may be the most difficult. Patients with a history of chronic pain may not be ideal candidates for the use of synthetic mesh.”

Dr. Peter Rosenblatt, Director of Urogynecology at Mount Auburn Hospital in Cambridge, Mass., says that use of the mesh implants has, indeed, gone down. In an email, he writes:

There has certainly been a decline in the use of transvaginal mesh to treat prolapse, although many pelvic reconstructive surgeons still offer this treatment to patients who are at high risk of failure from traditional surgical repair of pelvic organ prolapse. The FDA safety update in 2011 raised concerns that some of the complications that are unique to these procedures, especially erosion (or more accurately “exposure”) of the mesh through the vaginal wall, are “not rare” and that physicians needed to counsel their patients about the potential risks of using mesh. Surgeons and their patients should weigh these risks versus the potential benefits of transvaginal mesh, which includes improved anatomic success rates. There is also no question that the ubiquitous and never-ending television ads by law firms have instilled a real sense of fear and apprehension among women who are suffering with these problems.

Meanwhile, myriad lawsuits brought by women who say they were harmed by the mesh implants, made by a Ethicon, a subsidiary of the drug giant Johnson & Johnson, continue.

Earlier this month, a California jury returned a $5.7 million verdict in favor of the plaintiff in a vaginal mesh case, according to a local TV news report.

And a West Virginia jury last year awarded $3.27 million to a woman who underwent surgery to remove a vaginal mesh device, reports the National Law Journal. Continue reading

From McDonald’s To Obama To Prizes, Efforts Ramp Up To Save Antibiotics

antibiotics

You know the antibiotics issue is really getting serious when even the biggest fast food chain in the world gets on the bandwagon — joining the president of the United States, among a great many others.

Last week, McDonald’s announced that it would phase out serving chicken raised with medically important antibiotics. Slate argues that we can surely thank Chipotle, which has long offered antibiotic-free meat, for this move. But whatever the motive, Slate writer Alison Griswold says that when the fast-food behemoth that buys up to 4 percent of the nation’s chicken “decides it’s done with certain antibiotics, you can bet that the agriculture industry is going to listen.”

Meanwhile, President Obama recently proposed doubling the federal funding for research on how to fight antibiotic-resistant bacteria, to $1.2 billion. The CDC estimates that 23,000 Americans die each year from antibiotic-resistant infections. And a headline last week in the journal Science asks if we’re headed back to the bad old pre-penicillin days: A Return to the Pre-Antimicrobial Era?

Got your attention yet? If so, now is the moment to read “Preventing An Antibiotic Apocalypse,” an interview with Boston University health law professor Kevin Outterson. He co-authored a recent Health Affairs piece on economic reforms needed to spur development of more new antibiotics, a theme also explored in a recent New York Times op-ed. Two of Outterson’s most striking excerpts:

If superbug bacteria become endemic in US hospitals, it will shake our health care system at its foundations. Why would you get a hip replacement, or a cardiac stent, or do anything else in a hospital that wasn’t a life-saving emergency, if you knew these infections could kill you?

We have MDR (multidrug-resistant) gonorrhea in the US and around the world. Only one drug remains against the nastiest strains. On the CDC’s threat assessment list in 2014, gonorrhea made the list of the three most dangerous resistant pathogens. We’re close to having no effective treatment for gonorrhea.

We’re almost back to the 1930s. The same is true with XDR (extensively drug-resistant) tuberculosis. Our best treatments for malaria are showing signs of resistance, too. For a number of serious hospital infections, we are down to the last-ditch treatment. Continue reading

Cautionary Tale: Vomiting Bouts And False Positive On Urine Test For Pot

Hollis Tufts, the teen who tested positive -- incorrectly -- for cannabis use in a cautionary tale published in the journal Pediatrics (Courtesy of the family)

Hollis Tufts, the teen who tested positive — incorrectly — for cannabis use in a cautionary tale published in the journal Pediatrics (Courtesy of the family)

The title got me: “13-Year-Old Girl With Recurrent, Episodic, Persistent Vomiting: Out of the Pot and Into the Fire.”

What pot? What fire? Oh, dear, recurrent vomiting. What troubling case report was this, in this week’s Pediatrics journal?

The case, written up by Dr. Diana Felton of Boston Children’s Hospital and colleagues, was indeed troubling, but also instructive, on two counts:

First, its main lesson: a medication for gastrointestinal problems — a proton pump inhibitor called pantoprazole — can cause a false positive result on a urine test for marijuana use.

And second, though marijuana is generally known to have anti-nausea effects, it has been increasingly recognized over the last decade that heavy, long-term use can bring on cycles of vomiting, a phenomenon called Cannabinoid Hyperemesis Syndrome. (It can also bring on compulsive bathing in hot water. I know. Sounds crazy. But I’m not making it up. More on that later.)

She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”

Dr. Felton and colleagues write that as the use of organic and synthetic cannabinoids — pot-like compounds — increases, “the number of patients with Cannabinoid Hyperemesis Syndrome will surely grow.”

Now to their tale. The patient was a 13-year-old Massachusetts girl who suffered from recurrent bouts of vomiting, a condition known as Cyclic Vomiting Syndrome. She was on her fourth bout of vomiting in six weeks when she was brought in to the Emergency Department, retching.

Hit by a stroke while still in the womb, the girl could not speak, and had been hospitalized repeatedly for such vomiting attacks. This time, among other tests, “the treating physician opted to send a urine toxicology screen to evaluate for possible Cannabinoid Hyperemesis Syndrome.” It came back positive for cannabinoids. Social services got involved. A protective order was filed.

“Given the patient’s severe physical and developmental limitations, it was clear that she was unable to access or administer the cannabinoids herself,” the paper says.

Let’s just pause for a moment to put ourselves in the place of the patient’s parents. I imagine myself exploding: “So you’re accusing us of giving our disabled daughter so much pot that it made her throw up? Are you out of your mind???”

Not too far off, says Jessica Tufts of Topsfield, whose daughter, Hollis, now almost 15, was the patient in the paper. She remembers the thought, “What on earth are they saying? This is crazy! All we’ve ever done is care for our child…”

“They bring me into a room and they say, ‘We just wanted to let you know that Hollis has tested positive for cannabinoids,” she recalls. “I said, ‘How on earth could she be getting it? We don’t smoke it. We don’t cook it. We never even touched it. So how is she getting it?’ I flew into a panic because she can’t say, ‘Somebody at school is feeding me pot brownies or whatever.’ We were trying to figure out all the points of contact that could possibly explain it.”

And, “We got progressively more terrified, because, as the mom of a child who’s going to be limited all her life and can’t tell you what’s going on, your worst nightmare is that some caregiver who is out of your control has done something to her.” Continue reading

Do You Really Need That Tetanus Booster? One Man’s Ordeal

A patient suffering from tetanus (painting by Sir Charles Bell, 1809, via Wikimedia Commons)

A patient suffering from tetanus (painting by Sir Charles Bell, 1809, via Wikimedia Commons)

By David C. Holzman
Guest Contributor

I didn’t think it was a big deal. I’d stepped on a shell in Wellfleet Harbor, and it had sliced into my foot, and drawn blood. Heck, I didn’t even think tetanus bacteria hung out in salt water — they like soil, especially if the icing atop its cake is manure. But my anguished Jewish mother was all “get over to AIM [the local health clinic] right away, before lockjaw has a chance to set in.”

Of course, the power of the Jewish Mother to inflict fear and guilt is legendary. So I ultimately hauled my derriere over to AIM. But there was a problem.

I had first learned I was allergic to tetanus shots when I was 17 — two decades earlier. I don’t remember what I’d stepped on, but I’d ended up having to go back to AIM a couple of hours after the tetanus shot, so that they could check out the hives that had sprouted from feet to nether regions to scalp. While I was in no immediate danger, I was advised that the specter of anaphylactic shock loomed over any future tetanus shots.

But now at AIM once again, I wasn’t anticipating a problem because a year after the hives, I’d stepped on something on a trip in England. But the nice doctor who had given me that injection swore that he’d quit the profession if the preventive shot he’d given me with the tetanus shot failed to protect me from hives, or any other reaction.

So I figured the docs at AIM would also know what to give me to prevent a reaction. But instead, they gave me some gobbledygook about how I should really wait until I got home — which was Washington, D.C. at the time — and let my own doc give me the shot. But the docs at Group Health, my then-HMO, were equally stymied by my predicament. Continue reading

Baker Deputies Outline Plan To Tame MassHealth Costs

Leaning heavily on the extraction of savings from MassHealth to balance their state budget proposal, top Baker administration health officials on Thursday said that changes to benefits for patients were mostly taken off the table, but the administration may look at co-payments or other commercial market solutions to control cost growth in the future.

According to the Baker administration, MassHealth will cost the state $14.5 billion this fiscal year. The program covers low- and moderate-income adults and children, and is projected to service 1.7 million enrollees in fiscal 2016. Under Baker’s $38.1 billion state budget, the program’s cost will grow to $15.3 billion next fiscal year. Continue reading

Why To Exercise Today: Avoid Brain Shrinkage As You Age

MilitaryHealth/flickr

MilitaryHealth/flickr

Middle-age adults take note: the exercise you shirk today may lead to shrunken brain tissue in a couple of decades.

This, according to research presented at the American Heart Association Epidemiology/Lifestyle meeting in Baltimore this week.

After reviewing exercise data taken from more than 1,200 adults who were around 40 years old — a subset of the Framingham Heart Study — researchers found that twenty years later when these same individuals underwent MRI scans, those with “lower fitness levels in midlife also had lower brain tissue levels in later life,” said Nicole L. Spartano, Ph.D., lead author and a postdoctoral fellow at the Boston University School of Medicine.

Though the findings are preliminary, Spartano says it looks like there’s a link between lower fitness levels and faster brain aging. Since the MRI’s in this study were done on people about 58 years old, the researchers didn’t expect to see high rates of dementia, but they did detect “the beginning of shrinkage,” Spartano said. “We look at the brain MRI as an early warning sign for deterioration. This may give us some idea of decreased cognition a decade or so later.”

Specifically, the researchers evaluated fitness based on how the heart changes in the early stages of exercise. Continue reading