Infographic by Reuben Fischer-Baum at Deadspin.com, reposted with permission.
I’ve never been prouder to be from a blue state. And by blue, I mean a state whose highest-paid public employee is not a football coach. Or a basketball coach, either.
I first came across this gorgeous infographic on a site called Addicting Info under the headline “Everything Wrong With America In One Simple Image.” It credited the map to “America The Stupid courtesy of WTHR TV,” but the WTHR folks pointed me to Deadspin.com, where Reuben Fischer-Baum actually created it here. The Deadspinners kindly permitted us to re-post it.
Readers, even sports-crazed Boston readers, really, do you think this national state of affairs is right?
As you compose your answer, I have a second point to discuss. Naturally, from my provincial Massachusetts point of view, I was curious about our state’s entry for the highest-paid public employee, “Med school chancellor.”
The University of Massachusetts dominated the list of state employees who made more than $100,000 last year, with 49 of the top 50 spots held by doctors, administrators, and coaches.
At $784,468, the top 2012 salary belonged to Michael F. Collins, who holds dual roles in the university, as chancellor of the medical school and senior vice president for health sciences at the university. He was also the state’s highest paid employee in 2011.
For the second year in a row, the number two salary went to Terence R. Flotte, the medical school’s dean, who was paid $712,041. Continue reading →
Kevin Fitzgerald, after the second of two eye surgeries, with his vision restored (George Hicks/WBUR)
By Rachel Zimmerman
Kevin Fitzgerald is parked in a wheelchair near a set of elevators at Boston Medical Center, tense with fear.
He’s a big guy, nearly six feet and about 280 pounds. But because of his severe autism, Kevin can’t verbalize his thoughts. He can only moan.
Dressed in her scrubs, Dr. Susannah Rowe, Kevin’s eye surgeon, sits on the floor next to him. While waiting for a heavy dose of anti-anxiety meds to calm her patient, Rowe practices what she calls “verbal anesthesia.” “It’s OK to be afraid,” she tells Kevin. “Want to hold my hand?”
Institutionalized since childhood, Kevin, now 56, has been losing his sight for the past two years to the point that doctors said he can see little more than shadows. He’s here at BMC awaiting cataract surgery, a fairly simple procedure that generally takes about 30 minutes in the operating room. But for Kevin, who has long feared doctors and has a history of aggressive, unpredictable behavior — like hitting himself or inadvertently hurting others or running away when he’s in distress — the procedure isn’t simple at all.
Dr. Susannah Rowe, anesthesiologist Oleg Gusakov and nurse anestheticst Dale Putnam in the pre-op room with Kevin. (George Hicks/ WBUR)
It’s not simple for the doctors, either. They’re practicing a special art: medical care for the disabled and mentally ill. It often breaks the rules of traditional care, loses money for their practices and can even put them at physical risk if a frightened patient spins out of control.
But there’s a huge need for such specialized care. As many as 50 percent of people with intellectual disability (defined as an individual with an IQ of 70 or less and difficulty functioning in daily life, among other criteria) have vision problems, according to state experts. And a far higher proportion of these disabled patients have severe vision problems compared to the general population.
With delayed or limited access to treatment, these men and women can begin to lose their already-tenuous connection with the physical world; and their behavior, driven by fear and the inability to understand why things are growing darker, can deteriorate further toward what looks like aggression. Rowe, the surgeon, says anyone with a disability or severe mental illness whose mood, anxiety or behavior gets worse should immediately have their vision checked.
Join doctors in the operating room for Kevin’s surgery. Warning: It gets graphic.
Kevin’s situation may seem exceptional but he’s not alone. According to the state Department of Developmental Services, there are about 32,000 adults and children with intellectual disability (what used to be called mental retardation) eligible for services in Massachusetts. About 9,000 of these adults live in group homes.
But not everyone with an intellectual or developmental disability is getting the care they need, experts say. Consider:
A recent Massachusetts study found that people with autism still face significant barriers in accessing medical care, and it’s worse for patients like Kevin, who can’t fully communicate.
A 2009 survey of eye specialists from around the state found that while most providers believe patients with intellectual disabilities require 30-60 minutes longer for a medical appointment, the vast majority of the specialists didn’t allot that extra time.
According to a 2004 Public Health Reports article: “Research indicates that most individuals with developmental disabilities do not receive the services that their health conditions require…[and] individuals with mental retardation face more barriers to health care than the general population.
Research has also demonstrated that many primary care providers are unprepared or otherwise reluctant to provide routine or emergency medical and dental care to people with developmental disabilities.”
Andrew Lenhardt, a primary care doctor in Hamilton, Mass., who treats many disabled patients, including Kevin, says: “The level of dignity and respect and basic medical care that’s given to people with disabilities is often meager…These people can’t advocate for themselves, they’re an easy target to be treated inadequately or poorly.”
No one has a closer view of the tragedies wrought by gun violence than doctors at a place like Boston Medical Center, which has the busiest emergency and trauma service in New England. Today, as gun control is front and center on the national stage, a group of BMC emergency doctors posted an open letter on the new Boston Trauma blog. It reads in part:
As witnesses to the consequences of gun violence on a daily basis and in response to the recent horrific events of December 14th, we feel strongly that a frank discussion of the role of firearms in our society is overdue.
Trauma providers see injuries and deaths due to firearms first-hand. The 16-year-old who will never again move his lower extremities after being shot multiple times will never become a statistic worthy of the media’s attention; his future is limited and punctuated by further suffering due to his condition. Or the 20-year-old shot multiple times in the head whose mother does not recognize him due to the damage to his face as the trauma team fights to save his life. This young man dies despite the heroic efforts of every component of the medical community. Such people come to us on a daily basis and for each one that dies there are hundreds more who are forever altered by sublethal firearm injuries and who go unnoticed by society at-large.
We do not want silence on our part to be interpreted as acceptance of the status quo. We insist on a meaningful discussion of the role of firearms in our society. We believe that military grade/assault type weapons and high-capacity ammunition clips that have the sole purpose of taking human life should have no role in a society at peace. The easy access to them by an individual represents an unnecessary and unacceptable threat to our society and to the individuals within it.
Nate Lawrence underwent induced pediatric hypothermia at birth. Here he is, at 1, with his parents, Elizabeth and TJ.
By Fran Cronin
Nate Lawrence was born in Winchester Hospital in Massachusetts, December 16, 2010, in severe distress. He was limp, purple and not breathing. Both his lungs had collapsed.
As his parents and grandparents began to descend into panic, the neonatology staff at Winchester went into action.
They took x-rays of Nate’s chest, put a breathing tube down his throat, wrapped a turban around his head and placed him in a clear acrylic transportation box. Children’s Hospital Boston, 13 miles to the east, had been alerted that Nate was on his way. The ambulance team was instructed not to turn on warmers or swaddle Nate. He was to arrive at Children’s a cool 92.3 degrees, more than six degrees below normal.
Nate was born hypoxic, which means that because of his collapsed lungs, insufficient oxygen was flowing through his blood and into his brain. Lack of oxygen, like Nate’s, can lead to cell injury or cell death and ultimately to irreversible brain damage. To halt this potential deterioration, Nate’s body needed to slow down. Cell metabolism had to be lessened and his demand for oxygen reduced. He needed to operate on less energy and to rest.
Since lab trials began almost a decade ago, so-called “cooling” has demonstrated that for every degree a baby’s body temperature is lowered, its body functions and demand for energy slow down by 10 to 15 percent. Continue reading →
Bad news for all the people who were upset at the Obama administration’s decision earlier this month requiring that teenage girls have a prescription to get the “Plan B” emergency contraceptive:
New research suggests that the broader context for that decision is even more troubling than previously known. It finds that many pharmacy staffers are blocking teen girls’ access to the “morning-after” pill even when the teenagers have a legal right to it. And those barriers are particularly bad in poor neighborhoods, where unintended pregnancies are especially common.
Lead researcher Dr. Tracey Wilkinson
“There’s a lot of misinformation and misunderstanding regarding this medication, and that’s universal,” said Dr. Tracey Wilkinson, a general pediatrics fellow at Boston Medical Center and lead author of a research letter just out online in the Journal of the American Medical Association. “We have a really efficacious form of pregnancy prevention that might not be accessible because of misinformation that’s out there.”
The Dec. 7 Obama administration decision concerned over-the-counter access to Plan B for girls under 17, but the research by Dr. Wilkinson’s team found that even for young women 17 and up, and even for teen girls who have a prescription, getting hold of emergency contraception can be a problem. The administration’s decision was disappointing, she said, but the study found that “even the way things stand is not working.”
The researchers called 943 pharmacies in five different cities — Nashville; Philadelphia; Cleveland; Austin, Texas; and Portland, Oregon — in late 2010, a solid year after the FDA had lowered the age of permission for over-the-counter access to 17. (Younger girls can also obtain emergency contraception but need a prescription.) Continue reading →
At the State House this morning, pediatricians and other health-promoters concerned about obesity officially launched a concerted campaign against sugary drinks and candy. Central to their efforts: a bill to remove the sales tax exemption on soda. Here, two leading Massachusetts pediatricians lay out their arguments.
By Dr. Lynda Young and Dr. Barry Zuckerman
Thirty years ago, a typical pediatrician in Massachusetts might see a single obese child in their office every day or so. Now we see as many as five a day and another four to five who are overweight.
Some of these young patients are already suffering from the health effects of obesity: high blood pressure, heart and liver issues, or Type II diabetes. If these trends are not reversed, many of these children will be destined to live shorter lives than their parents.
‘As pediatricians, we have never seen a medical problem of the breadth and scope of obesity.’
As pediatricians, we have never seen a medical problem of the breadth and scope of obesity. Over the last 15 years alone, obesity rates in Massachusetts have doubled, with one in every three children now either overweight or obese, leaving the state with the 33rd worst childhood obesity rate in the nation. Meanwhile, obesity-related medical costs will add some $1.8 billion a year to the Commonwealth’s already strained health care system.
Preventing and reversing the obesity crisis has become a paramount medical concern for pediatricians across the Commonwealth. As physicians and physician-educators, we see the devastating impact of obesity every day, despite our daily warnings to patients, their families and the public about the importance of taking immediate action to prevent unhealthy weight gain.
One opportunity before us right now is legislation to eliminate the tax exempt status on soft drinks and candy. Nearly fifty years ago, when Massachusetts adopted a sales tax, it decided to exempt the sale of food items. Other essentials of daily life, such as clothing, were exempted as well.
Of course, this was years before the obesity epidemic began to sweep the country. Today, soft drinks can hardly be considered essential food items. To the contrary, overconsumption of sugary beverages has become a major threat to public health, and obesity-related conditions will likely eclipse smoking as the leading preventable cause of death. Continue reading →
Looking for new sources of revenue and positioning itself for national health reform, Boston Medical Center is jumping into the commercial health insurance market with a new plan that looks to be one of the most affordable offered by The Connector.
I asked BMC for a few more details and here, slightly edited, is a response from Scott O’Gorman, Executive Director of BMC HealthNet Plan:
“BMC HealthNet Plan is entering the commercial market place for a few reasons…
We’ve been very successful with our traditional focus on government-subsidized coverage. BMC HealthNet Plan serves nearly 240,000 MassHealth and Commonwealth Care members across Massachusetts. We do, however, want to develop new sources of revenue and we believe we can offer high quality, affordable coverage to employers and individuals in the commercial market. We’ve been recognized for our quality as the #3 Medicaid health plan in the country in the 2011-12 rankings by the National Committee for Quality Assurance.
We also want to prepare BMC HealthNet Plan for success with the market place changes coming with full implementation of the federal Affordable Care Act in 2014. Continue reading →
Consider this slide of ice cream ingredients that Dr. Barbara Corkey, director of the Obesity Research Center at Boston Medical Center, used in a recent lecture. The few elements in yellow, she told her listeners, were ingredients that we normally think of as “food.”
There was a collective gasp from her American Diabetes Association audience, and a buzz of distaste.
In pink, Barbara went on, were some of the substances she was about to discuss. “Virtually none of these non-food compounds have been carefully assessed for a potential causative or contributing role in the obesity and diabetes epidemic,” she said.
In other words, if food additives are insidiously helping to make us fat, we have no way of knowing it.
Her lab is working to change that. It’s still very early days, and some obesity experts are skeptical of her hypothesis, but researchers she oversees are methodically screening hundreds — and perhaps eventually thousands — of food additives, from benign-seeming Bay Oil to unpronounceable chemical compounds, for their potential effects on human fat cells and insulin production.
And they have already discovered some intriguing leads on possible culprits, including artificial sweeteners, iron and an emulsifier common in dairy products, monoacylglycerols. Continue reading →
Such a troubling story this morning by Kay Lazar in The Boston Globe:
Doctors at a major Boston hospital report they are seeing more hungry and dangerously thin young children in the emergency room than at any time in more than a decade of surveying families. Many families are unable to afford enough healthy food to feed their children, say the Boston Medical Center doctors. The resulting chronic hunger threatens to leave scores of infants and toddlers with lasting learning and developmental problems.
The accompanying graphic shows things are getting worse:
By Fran Cronin
Imagine if your doctor were able to biopsy a plug of tissue from your belly fat and determine whether or not your body had the potential to fend off the known panoply of obesity-related diseases.
Well, that’s exactly what researchers at Boston University School of Medicine and Boston Medical Center have done. In a four-year study funded by the National Institutes of Health, researchers found that all fat is not created equal.
The study involved comparing the amount of inflammation present in samples of belly fat from 109 obese men and women with 17 lean
men and women. Surprisingly, thirty percent of the severely obese people sampled were found to have a fat type and vascular function comparable with a lean person — despite their obesity.
Dr. Noyan Gokce, a cardiologist at Boston Medical Center who led the study, says the findings suggest “it’s not just the quantity of fat but the quality of fat” that determines risk to obesity-related diseases.
Fat, despite its bad rap, may actually be an important defining factor to overall body heath. What differentiates good fat from bad fat, says Gokce, is the presence of inflammation. The combination of inflammation within fatty tissue is what makes obese people – those with a BMI above 30 – so susceptible to so many other complications and diseases, notably cardiovascular disease, type 2 diabetes,sleep apnea, fatty liver disease, high cholesterol and cancer. Continue reading →