There’s another milestone in the storied history of Salem. On Wednesday, the state’s first dispensary for medical marijuana opened on the ground floor of a former factory here, a few blocks off a busy thoroughfare. Continue reading
For 10 years, Jeff Gold showed up to a job he wanted to love: being a family doctor.
“I was busy as a bee,” says Gold, 39, with up to 2,500 patients, seeing 20 or so a day.
Rushing from one patient to the next, calling insurers who wouldn’t approve prescriptions, filling out paperwork that didn’t seem relevant to his patients, Gold kept asking himself, is this what I signed up for?
“I thought I was gonna help everybody and spend time with everybody and it’s impossible to do,” Gold says.
So Gold quit, wrote a business plan to be a doctor who does not take insurance, hired one staff member (a nurse), and borrowed almost $400,000 to outfit a two-exam-room office next to a candy shop and café in Marblehead.
Gold may be the first physician in Massachusetts practicing under a model called direct primary care. For a flat monthly fee, Gold offers patients one-hour same-day appointments, no wait. The doctor is available 24/7 in person, at the office, at the patient’s home, via text, email or Skype. Continue reading
It’s just the crumb of a muffin, but Martha Galvis must pick it up. Lips clenched, eyes narrowed, she goes after the morsel, pushing it back and forth, then in circles, across a slick tabletop.
“I struggle and struggle until,” Galvis pauses, concentrating all her attention on the thumb and middle finger of her left hand. She can’t get them to close. Oh well.
“I try as much as I can. And if I do it I’m so happy, so happy,” she says, giggling.
Galvis, 62, has just finished a session of physical therapy at Boston’s Brigham and Women’s Faulkner Hospital, where she goes twice a week. She’s learning to use a hand doctors are still reconstructing. It’s been two years to the day since she almost lost it.
On April 15, 2013, Martha and her husband Alvaro Galvis headed for Cleveland Circle — mile 22 on the Boston Marathon route. This would be the first of three spots from which they’d enjoy the race and the boisterous crowd. Their last stop would be at or near the finish line in Boston. Continue reading
MIT neuroscience professor Pawan Sinha still gets goosebumps when he thinks about it, he says: “Things just happened so perfectly, so well-timed.”
Back in 2002, Sinha was grappling with a deep scientific question: How do we learn to recognize the objects we see? How do our brains know, “That’s a face”? Or “That’s a table”?
A fateful taxi ride set his research — and his life — onto a new road.
He was back visiting New Delhi, where he grew up on the elite campus of the Indian Institute of Technology before coming to America for graduate school. He was on his way to see a friend one evening, when the taxi he was riding in stopped at a traffic light.
“I noticed, by the side of the road was this little family, a mother and her two children,” he says. “And it felt really terrible to see these two children, who were barely wearing any clothes, very young children on this cold winter day. So I called over the mother to give her a little bit of change.”
When she approached, Sinha noticed that both of the children holding on to her sari had cataracts clouding their eyes.
It was the first time that he had seen children with cataracts. When he looked into childhood blindness in India, he learned that it is a widespread problem, often caused by rubella during the mother’s pregnancy. Blind children in the developing world suffer so much abuse and neglect that more than half don’t survive to age 5, he says.
Sinha wanted to help, but he figured that what he could contribute on his academic salary would be just a drop in the ocean.
“And that’s when the realization struck me that in providing treatment to those children, I would have exactly the approach that I had been looking for in my scientific work,” he says.
“If you have a child, say, a 10-year-old child who has not seen from birth, has only seen light and dark, and in a matter of half an hour you’re able to initiate sight in this child, then from the very next day, when the bandages are removed, you have a ringside seat into the process of visual development.”
Sinha applied for a federal grant to pay for cataract operations, which are relatively simple, and for studying the children who got them. Usually, American research money stays in America, “but I took a chance because I completely, honestly believed, and believe, that in providing that surgery, we are benefiting science that belongs to all of mankind, it’s not just specifically India.”
That grant eventually came though and to continue the work, Sinha founded a nonprofit based in New Delhi. He named it Project Prakash; Prakash means “light” in Sanskrit. Since 2005, he says, nearly 500 Indian children have gained sight through the project.
Now, at 48, Sinha is planning a major expansion of Project Prakash, to create a center that includes a hospital, a school and a research facility. The goal is to serve many more children than the current 40 to 50 a year. Continue reading
First in an occasional series we’re calling “Suicide: A Crisis In The Shadows“
BOSTON — More than two years after her son’s suicide, Susan LaCaire, of Spencer, still has a hard time opening up about it with those outside her closest circle.
“I always say we lost Luke. I never tell people how we lost Luke, unless they ask me,” LaCaire explains. “There is a stigma, and I think a lot of people look at Luke’s death as senseless. He could have lived and he chose not to.”
But the LaCaires are on a mission to bring suicide out of the shadows.
“I don’t hold back anymore. My brother died by suicide. My brother struggled,” says Justine Barnes, Luke’s sister.
“People don’t know what to say to us. They don’t know how to console us. If I told them that he had a heart attack, they’d be like, ‘Oh, I’m so sorry, that must have been so sudden.’ If you tell somebody that [your loved one] died of suicide, that wall goes up, and they don’t know how to deal with you. And then unfortunately for those of us left, that leaves you feeling even worse.”
“I don’t hold back anymore. My brother died by suicide. My brother struggled.”
Barnes says she wishes her brother Luke, who was 35 when he died, also could have had an easier time talking with those around him about his life struggles and mental health issues. Luke was going through marital problems, and his young daughter had brain cancer. And, his sister says, when he tried to open up, some friends would tell him to toughen up.
“When my brother died, people had the nerve to come to say to me what a coward he was,” Barnes recalls. “My brother was a firefighter. My brother went to Afghanistan. My brother fought for his country. He goes into burning buildings to save people’s lives, and he’s a coward? My brother had a weak moment with a lifetime of depression.” Continue reading
By Judith G. Edersheim, JD, MD
This week marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing. Not a who-done-it, but a why-done-it.
If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will turn to a grave question, part jurisprudence and part moral philosophy: Is this defendant the most evil and culpable of all? A human being who deserves the most severe of all punishments?
One thing, I believe, is certain: If this case proceeds to the sentencing phase, the black box everyone will be talking about will be the cranium, and how the brain drives behavior will be the central story.
In these protracted sentencing hearings, the scales of justice balance lists of aggravators and mitigators, all outlined by law.
Aggravating factors in this case might include the political motive for the bombings, the risk posed to others during the course of the Tsarnaev brothers’ dramatic attempt to flee, the “heinous”, “cruel” or “depraved” manner of the crime’s execution, and the substantial planning and premeditation that might have preceded the bombings.
In the end, behavior trumps brain scans.
Mitigating factors — factors that weigh in favor of life in prison rather than a death sentence — cast the broadest net. Any aspect of a defendant’s background, record, character or circumstance is fair game for the defense team. It could try to demonstrate that Tsarnaev had some kind of impaired capacity to appreciate that his acts were wrong or illegal, or that he was under some kind of demonstrable duress. It could also bring to light hardships during his upbringing that limited his opportunities or narrowed his ability to choose wisely.
The defense team has already given public hints as to the central themes of its mitigators. They will feature life within the Tsarnaev family, including Dzhokhar’s relationship with his parents, his brother Tamerlan, and his sisters. Will anything in these family dynamics rise to the level of psychological duress or impaired capacity? There will likely be plenty of traditional testimony from forensic psychologists and psychiatrists regarding whether or not Tsarnaev was under the sway of his radicalized and perhaps dominant older brother, particularly after the Tsarnaev parents left the country. The prosecution will likely counter with a line of evidence regarding Dzohokar’s relative independence and his network of friends and activities outside of the family structure.
Then comes the brain.
Judy Clarke, lead defense attorney and one of the nation’s premier death penalty litigators, will surely not overlook the new body of neuroscientific evidence regarding the immaturity of adolescent brains. In a recent trilogy of cases (known as Roper, Graham, and Miller ) the U.S. Supreme Court was influenced by neuroscientific evidence about the juvenile brain when making sweeping changes in how adolescents are tried and sentenced. The court concluded that adolescent brains were less mature than those of adults in ways which warranted differential treatment under our criminal laws.
Although Tsarnaev was 19 at the time of the bombings, his lawyers might argue that much of this brain research applies, as it outlines a period of relative immaturity that stretches from mid-adolescence all the way into the early 20s. Generally speaking, this research shows that adolescents are less mature, and they are more likely to make ill-considered decisions. They bow to peer influences and respond excessively to thrill seeking and immediate rewards. Think money, sex, drugs and friends.
Beginning in the teens, there are major changes in brain architecture and function that temper these qualities — among them, synaptic pruning of the prefrontal cortex, improved connectivity and changes in dopamine receptors — all of which support self control, delayed gratification and the development of a moral compass.
Here’s the rub. What the research doesn’t show makes it problematic for defense attorneys. The research does not show that adolescents are incapable of making well-considered choices. Quite the contrary. Continue reading
Here’s a rare treat: potential good news about antibiotic resistance.
For years, the drumbeat of warnings has grown increasingly dire: The bugs are evolving more and more resistance to our biggest antibiotic guns. Some bacteria — strains of tuberculosis and gonorrhea among them — have even become resistant to all antibiotics. Remember the bad old days before these wonder drugs, when bacterial infections were so often death sentences? No one wants to go back there.
So today’s report in the journal Nature offers a nicely contrasting ray of antimicrobial hope: It reports the discovery in soil of a potentially powerful new antibiotic, dubbed teixobactin (pronounced takes-o-bactin), that appears to be less vulnerable to evolving resistance than other antibiotics.
“Early on, we saw that there was no resistance developed to teixobactin, and this is of course an unusual and intriguing feature of the compound,” says Northeastern professor Kim Lewis, senior author on the Nature paper. The methods used to discover and develop the compound have “a good chance of helping revive the field of antibiotic discovery,” he says.
Teixobactin worked “exceptionally well” to kill resistant bacteria in mice, Lewis says, but it will take several years and probably over $100 million to develop it into a drug that could be prescribed to human patients. It’s among two dozen other compounds that he and colleagues have turned up using a novel method to develop substances found in soil that could be useful as antibiotics.
Teixobactin works by attacking the biological building blocks of the bacteria’s cell walls, says co-author Tanja Schneider of the University of Bonn. That basic target, which is hard for the cell to modify, may help explain why the bacteria seem unable to develop resistance, she says. Continue reading
By Richard Knox
This flu season is shaping up to be a bad one. And this year’s vaccine doesn’t work very well against the most common flu virus going around. So should you even bother getting a flu shot?
Yes. Putting it a different way: My wife, my daughters and I will. And the evidence says you’d be somewhere between slightly foolish and dangerously blasé if you don’t — depending on your personal risk factors.
I know there are naysayers — the Internet is full of them. “I recommend that my patients of all ages not take these incessantly promoted immunizations, primarily because of their lack of effectiveness,” writes blogger Dr. John McDougall. He says he’s not one of those across-the-board vaccine deniers but just doesn’t think flu vaccines (of any given year) are worth taking.
To understand why I think he’s wrong — even this year, when vaccine effectiveness is expected to be even lower than usual — you need to know something about the situation we’re all in.
Several viruses circulate during any given flu season. And flu viruses are always changing — sometimes not so much from year to year; sometimes in a bunch of little ways (a phenomenon called genetic “drift”); and sometimes in a big, sudden way, called a “shift,” which touches off pandemics.
Drifts Or Shifts?
Public health researchers constantly monitor flu virus mutations. But even the smartest flu dudes can’t know in advance when they’ll happen, or whether mutations will be drifts or shifts.
This year, one of the flu viruses outwitted them. Or, since viruses can’t have intentions, it’s better to say that random genetic drift in that viral strain, called H3N2, happened in late March. That’s a bad time in the annual cycle of vaccine production.
Just a few weeks earlier, leading flu specialists gathered at the World Health Organization in Geneva and decided that this season’s vaccine (for the Northern Hemisphere) should contain the same viruses as last year’s — two type-A viruses (an H1N1 that caused the pandemic of 2009 and has stuck around since, and an H3N2 that first appeared in Texas two years ago) and two type-B flu viruses.
Making each year’s flu vaccine is a complicated business that waits on no virus. The recipe has to be decided in February to get the chosen viruses growing in hundreds of millions of special chicken eggs, the first step in vaccine production. Continue reading
…to finish the sentence in the headline: But it was not the simple no-brainer that you might think.
Lung cancer is the biggest cancer killer of all, causing 160,000 American deaths a year. But should we use lung scans to screen longtime smokers en masse for it? That question has been vigorously debated of late in medical circles, as Medicare has weighed whether to pay for the scans.
This week, Medicare announced that it did indeed propose to cover annual low-dose CT scans for smokers and former smokers, ages 55 to 74, with a smoking history equivalent to a 30-year pack-a-day habit. (More details here.)
People say ‘You deserve this because you brought it on yourself, and thus, suffer the consequences.’
The draft decision now gathers public comment for a month and will still need to be finalized, but cancer activists and some doctors are already hailing it as a victory. Laurie Fenton Ambrose, president of the Lung Cancer Alliance, which had helped lead the push for the coverage, predicted that the scans would save tens of thousands of lives.
Well, first, the pendulum has been swinging lately towards greater skepticism about routine cancer screening, from mammograms to prostate tests.
At issue is the pivotal question of whether some forms of cancer screening do more harm than good, given that some of the tumors they pick up would never have caused any trouble. Routine blood tests for prostate cancer have fallen out of favor, for example, and the New England Journal of Medicine just published a cautionary tale from Korea about how mass ultrasound scans for thyroid cancer saved no lives.
So that’s the broader medical context. Then there’s the money. I recently heard a Medicare official say with pained realism at a public forum, “We can’t cover everything good.” Close to 5 million people on Medicare would be eligible for the screening, NPR reports, and the scans cost an estimated $241 each.
So at a time of greater emphasis on health costs and greater doubts about cancer screening, “We just found ourselves caught in that crossfire,” said Fenton Ambrose of the Lung Cancer Alliance.
With lung cancer, there’s also the question of special stigma. People say “You deserve this because you brought it on yourself, and thus, suffer the consequences,” Fenton Ambrose said. “It has always had that type of stigma, that even carried through in some of the public comments that came forth during the Medicare consideration.”
Dr. Chrisopher Lathan, a medical oncologist at the Dana-Farber Cancer Institute, similarly cited stigma as a source of “hesitation” on the coverage. “This is a cancer that’s heavily linked to a behavior,” he said. “The amount of data needed to convince everyone that this was a good screening tool — that hurdle was much higher. And also, we are in a more skeptical time, academically, when we look at screening. We know that screening is good, but it’s good in certain circumstances.”
Which circumstances, when it comes to lung scans? This is the moment for the Public Service Announcement that says, “Talk with your doctor.”
“At the end of the day, this is about the relationship between doctors and patients,” Fenton Ambrose said. And in particular, there are some gray areas that require discussion, she noted. What if, for example, you’re a bit younger, or smoked a bit less than the cut-off? Research is now under way on that “second tier” of potential scan subjects, she said. Continue reading
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.”
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.