Massachusetts General Hospital

Test Suggests Nine Ingredients Of Depression

A step toward useful biomarkers for depression? Wouldn’t that be great?

That was my reaction when I got word of a paper just out in the journal Molecular Psychiatry. It found that in a small pilot study, a test of nine biological measures — or “biomarkers” — in a patient’s blood, including levels of stress hormones and inflammation, could determine whether they were depressed with nearly 92% accuracy. (See a full list of biomarkers and details of the results below.)

You may scoff at my excitement. Who needs biomarkers? After all, you might say, how hard is it to tell if someone is depressed? They’re miserable. They can’t get out of bed or can’t sleep or can’t eat. Not rocket science.

My response: No, that’s not rocket science. But if there’s one thing psychiatry desperately needs and has been seeking for decades, it’s the biological markers of mental illness — the kind of reliable, lab-testable signatures that so many physical diseases have, and that could be used for better diagnoses and perhaps even to help decide which treatments to prescribe. The new study calls biomarker tests “the ‘holy grail’ of Psychiatry.”

The paper’s findings are just a first step and need to be replicated and confirmed among more subjects before there’s even any question of using them in the clinic. But I asked to speak with the study’s lead author, Dr. George Papakostas of Massachusetts General Hospital, because the findings made me wonder this: What does it mean that you can pretty much nail major depression using nine biomarkers? And that those markers measure oddly disparate processes like inflammation and the birth of new neurons and stress hormones and metabolism? Do we have, in effect, a sort of a recipe for depression, and if so, what does it tell us about what the darkness of depression is? Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Science, depression, Massachusetts General Hospital, mental illness

January 11, 2012 | 5:44 PM | By Carey Goldberg

Cardiac Reassurance For Marathon Runners

A new study brings reassuring news about marathoners and heart attacks. In the public mind, they may be linked like…like…rock stars and drug abuse, say, or boxers and brain damage. But research just out in the New England Journal of Medicine reports that marathoners face heart risks no higher than participants in other vigorous sports.

The lead researcher is Dr. Aaron Baggish, who’s in the video above and in the past has kindly shared with CommonHealth his wisdom on cool-downs and on “hands-only” CPR.

From the NPR report:

Running long-distance races isn’t going to hurt your heart any more than other vigorous sports, researchers say. Just make sure you’re fit enough to attempt the feat in the first place.

The average age of runners whose hearts stopped beating was 42. Most were men.

In the past decade, nearly 11 million runners participated in long-distance races, but only 59 suffered cardiac arrests, according to findings just published in the New England Journal of Medicine. Most of the cases happened to be in runners with undiagnosed, pre-existing heart problems.

“Certainly doing the run didn’t cause the heart conditions,” study author Dr. Aaron Baggish tells Shots, “but it was probably the stimulus that caused the near-fatal or fatal event.” Continue reading →

FILED UNDER: Medicine/Science, Personal Health, cardiovascular health, marathon, Massachusetts General Hospital, NEJM

January 5, 2012 | 11:04 AM | By Carey Goldberg

Opening Soon In Boston: Mass. General’s Museum Of Medical Innovation

The new museum of medical history and innovation on Cambridge St. in Boston

I was inching up Cambridge Street this morning, cursing the traffic as I got later and later for my dentist’s appointment, when suddenly my head whipped around and I muttered, “What the heck is that?”

In a spot in front of Massachusetts General Hospital that used to be completely unmemorable — judging by the fact that I can’t remember what was there — stood the gleaming little gem of a building you see above, all shining copper and glass. On the front, I made out “Museum of Medical History and Innovation.”

Who knew? Clearly I’ve been out of it, probably because I’ve been too assiduously ignoring all the big institutional birthdays around town, including Mass. General’s 200th. But the latest word, according to the hospital, is that the museum — named for transplant pioneer and history buff Paul S. Russell, MD — is expected to open to the public in March:

The museum’s ground floor will be home to permanent exhibits which highlight the evolution of medicine and clinical practice over MGH’s 200-year history, while the second story gallery will showcase changing exhibits, while also providing space for programs, lectures and special events.

My vote: Of course it’s a Mass. General institution, but it would be wonderful if it could also feature medical innovations beyond the hospital’s walls. Readers, any suggestions for exhibits?

For more background on the museum, a Beacon Hill-oriented section of the Boston Globe published a full account of the plans for it in February.

FILED UNDER: Medicine/Science, Personal Health, Massachusetts General Hospital, medical innovation

November 14, 2011 | 1:31 PM | By Carey Goldberg

Risks Of ‘Driving Under The Influence Of Adele’

Okay, the connection to health care is minimal, aside from the fact that the pop singer Adele did have a vocal cord operation at Massachusetts General Hospital last week. But this morning I belly-laughed half the way to work, so maybe this is a gift worth sharing.

The proximate cause of my laughter: On a quiet side-street, I happened to pass a thirtyish man, sitting in his parked car and belting out, along with the blaring radio, the chorus of the perniciously irresistible Adele hit “Someone Like You.” It would have struck me as comical anyway, but it hit me square on the funny-bone because over the weekend, I had watched the hilarious video above by author (and now Xtranormal virtuoso) Laura Zigman, who has some very personal connections to the song. In the video, a woman is pulled over by a police officer, and he explains why:

“You were singing ‘Someone Like You’ by Adele while driving. Which means I’m going to have to give you a DUIA, that’s Driving Under the Influence of Adele.”

“Were you pointing one of those radar speeding guns at me?”

“No. I could hear you. Even with the siren on. You were really belting it out. It was ridiculous. I was embarrassed for you.”

So what was she being cited for, exactly? Continue reading →

FILED UNDER: Medicine/Science, Personal Health, humor, Massachusetts General Hospital

November 11, 2011 | 12:04 PM | By Carey Goldberg

First Human Gene Therapy Trial Planned For Deadly Tay-Sachs Disease

A child who died of Tay-Sachs Disease

Imagine you have an adorable baby who’s oddly slow to start sitting up. You get the child tested and to your horror, the verdict is a genetic death sentence: Tay-Sachs Disease. Exceedingly rare, but inexorably fatal. You now know that your baby likely won’t live to kindergarten age, and instead of growing up will slide down into blindness, seizures, paralysis. No cure. No hope.

That is how Tay-Sachs Disease has tended to unfold, since it was first described in the late 19th century. But now, for the first time, scientists say, there is a chance — though it is far from certain — that in the foreseeable future, that merciless course could be altered.

If all goes as planned, in the second half of next year researchers from the University of Massachusetts Medical School, Massachusetts General Hospital and elsewhere will launch a clinical trial of a new gene therapy treatment in up to 12 children with Tay-Sachs Disease.

The treatment involves infusing, deep into the brain, engineered viruses that can effectively turn cells in the brain into “micro-factories” of the enzyme that is so lethally absent in people with the disease. Cats with a feline version of Tay-Sachs normally die by about age four months. The gene therapy treatment has kept them going strong beyond 18 months.

A cat with an untreated feline version of Tay-Sachs Disease

“This is the first time there’s a real prospect for a possible treatment for Tay-Sachs and similar genetic diseases that affect the brain,” said Susan Kahn, executive director of the National Tay-Sachs & Allied Diseases Association (NTSAD), a driving force behind the research along with other family foundations. “Parents who had affected children as far back as the 1950s are saying, ‘Wow, I never thought I would see this day.’”

Now for the inevitable cautions, from UMass researcher Miguel Sena-Esteves:

“Usually, in my first breath, I tell people about the great results we’re observing in the cats,” he said. “In the second breath, I tell them there’s absolutely no guarantee that because we’re getting these results in animals, we’ll see the same in a human. We know from experiments in many, many fields that what works in another species doesn’t necessarily work in a human. If it did, we would have cured cancer by now.”

Also, gene therapy, in particular, has a past marked by some major disappointments. Touted as a potential cure for just about anything in the 1990s, it all but crashed after an 18-year-old patient died of a massive immune reaction in 1999 and it turned out that the viruses used as “vectors” to carry the genes sometimes induced leukemia.

Lately, however, gene therapy has begun to rack up successes, said Dr. Terence Flotte, dean of the UMass School of Medicine and himself a gene therapy researcher. It helped restore some vision in blind people with a rare genetic disease of the retina, he noted, and seems to show particular promise for diseases of the brain and central nervous system.

Continue reading →

FILED UNDER: Medicine/Science, gene therapy, genetic disease, Massachusetts General Hospital, tay-sachs disease, university of massachusetts medical school

November 7, 2011 | 3:03 PM | By Carey Goldberg

Mass. General Voice Doc ‘Expects Adele To Make A Full Recovery’

This just in from Massachusetts General Hospital, about the singer Adele’s vocal cord microsurgery (for background, see this NPR piece):

Please see the statement below regarding Adele’s care at MGH. Unfortunately that is the only information we have been authorized to share and Dr. Zeitels is extremely busy with cancer patients and will be unavailable for comment.

Statement from Massachusetts General Hospital:

Adele underwent vocal cord microsurgery by Dr. Steven Zeitels to stop recurrent vocal cord hemorrhage (bleeding) from a benign polyp. This condition is typically the result of unstable blood vessels in the vocal cord that can rupture. Based on the advice of her doctor and voice therapist in the United Kingdom, Adele came to Boston to consult and undergo corrective voice surgery with Dr. Zeitels, the Director of the Massachusetts General Hospital Voice Center. Dr. Zeitels, who is also the Eugene B. Casey Professor of Laryngeal Surgery at Harvard Medical School, has pioneered many vocal cord surgical procedures including the use of specialized lasers to stop vocal cord bleeding in singers. He has performed this unique procedure for many vocalists including Steven Tyler, allowing him to return to full performance. Similarly, Dr. Zeitels expects Adele to make a full recovery from her laser microsurgery.

FILED UNDER: Medicine/Science, Massachusetts General Hospital, surgery

October 3, 2011 | 10:07 AM | By Carey Goldberg

Drug Shortage Crisis: The View From Mass. General

Just one other don’t-miss on-air highlight for today: The disturbing report from Dick Knox of NPR about shortages of critical medicines.

It includes extensive reporting from Massschusetts General Hospital that reveals just how dire the situation has become. The full report is here, and here’s the MGH segment:

Across town at the Massachusetts General Hospital, New England’s largest, pharmacist Paul Arpino says drug shortages were once rare. Now they’re routine.

Arpino often gets calls in the middle of the night from desperate doctors and nurses. “We try to react as quickly as possible to these shortages,” he says. “Sometimes there’s not a lot of notice. But when we’re informed of the shortage, we really get all hands on deck.”

He says drug shortages plague every corner of Mass General, from the emergency department to operating rooms to intensive care.

Currently, for example, intensive care doctors are coping with a shortage of a drug called labetalol that’s used to treat patients whose blood pressure is going through the roof. Labetalol is so scarce that the hospital recently decided to reserve it only for patients having a brain hemorrhage.

Dr. Taylor Thompson, medical director of the Mass General’s medical ICU, calls it rationing – something most people think happens only in socialized medical systems or developing nations, not in America. But experts say the problem has been building over the past decade, and has accelerated since 2006. Continue reading →

FILED UNDER: Medicine/Science, drug shortages, Massachusetts General Hospital

September 21, 2011 | 11:05 AM | By Carey Goldberg

Study: Use Ritalin To Wake Patients Up Sooner After Surgery?

Ritalin is famed as a drug for Attention Deficit Disorder, but a new study in rats suggests that its effects on the brain’s arousal circuits could also be used to wake patients up sooner after surgery.

Why bother? Several reasons, from saving health care money to possibly reducing post-operative delirium.

Dr. Emery Brown, a neuroscientist and anesthesia expert at MIT, Harvard and Massachusetts General Hospital, explains the new research, led by Mass. General’s Dr. Ken Solt, just out in the journal Anesthesiology. He is a co-author on the paper.

This is a major new result because it shows that we can wake the brain up from general anesthesia. Currently at the end of surgery, the anesthesiologist just lets the anesthetic drugs wear off and the patient regain consciousness.

We decided to study the possibility of devising a strategy to wake patients up from general anesthesia. In this paper we show that it is possible to administer to rats methylphenidate (Ritalin) -— the same drug that is used to treat attention deficit hyperactivity disorder (ADHD) in children. This drug actively induces emergence of the animals from general anesthesia.

‘This is an exciting experimental finding that has to be replicated in humans.’

It is not that the anesthesia is being reversed. Rather the arousal pathways, most likely the dopaminergic and noradrenergic pathways, are being activated to allow the brain to overcome the effects of the general anesthesia and the animal to awaken. It is known that Ritalin blocks the reuptake of dopamine to maintain the brain levels of this excitatory neurotransmitter.

This is an exciting experimental finding that has to be replicated in humans. If this pans out, it could change anesthesiology practice by initiating use of a drug that is already known to be safe to actively induce emergence from general anesthesia.

This would have important implications; possibly reducing cognitive dysfunction in the elderly and delirium in children after general anesthesia. Continue reading →

FILED UNDER: Medicine/Science, Money, anesthesia, attention deficit disorder, harvard medical school, Massachusetts General Hospital

September 20, 2011 | 12:59 PM | By Carey Goldberg

Kara Kennedy’s Death: Q&A On ‘Danger Zone’ After Exercise

Kara Kennedy speaking at the funeral of her father, Ted Kennedy.

Kara Kennedy’s wake is to be held this evening, and her funeral tomorrow. She was the 51-year-old daughter of the late Sen. Ted Kennedy, the mother of two and a long-time lung-cancer survivor. She died at her Washington, D.C. health club last Friday of an apparent heart attack, reportedly after her daily work-out.

Her death caught my attention for two reasons. First, the obvious: It was yet another Kennedy death at a tragically young age. The second was more personal: A close relative had just been caught in an oddly similar circumstance.

He’d started feeling woozy and weak right after a work-out, and may have saved his own life by going to the emergency room. It turned out an artery was almost entirely blocked, and he needed a catheterization and a stent. When I mentioned his experience to a colleague, I got an immediate echo: Yes, she said, our co-worker had exactly the same thing happen right after he got off the stairmaster.

Hmmm. Is there a danger zone right after exercise? Why would that be, when the greatest exertion load is already off? I spoke today with Dr. Aaron Baggish, a Massachusetts General Hospital cardiologist and expert on the effects of exercise on the heart and cardiovascular system. (Also himself a competitive runner, and the cardiologist for the Boston Marathon.)

‘Probably 25% of the total workout time should be spent in warm-up and cool-down.’

His edifying explanations follow, but here’s my own takeaway: I am never, ever going to work out again without allowing time for a cool-down period of at least 10 minutes or so. Constantly feeling pressed for time, I tend to skip the warm-up and shortchange the cool-down in favor of getting in my 30-plus minutes of hard cardio. No more.

Note: This is in no way to imply that Kara Kennedy may have failed to cool down properly. She sounds like she was doing everything right for her health. I’m just sharing what I’ve learned for myself, and what sticks in my mind most was the case of a man Aaron just saw in the ICU — a fit, middle-aged man who’d just had a heart attack after playing tennis. In a rush, the man jumped right into a super-competitive match, and the minute it ended, he got into his car, where he started having chest pain. The crux of the problem was that he hadn’t had time to warm up or cool down.

So is there a danger zone right after a workout?

The short answer is yes.

The more complete answer is that there’s no question that routine cardiovascular exercise is the best way to reduce your risk of having a heart problem. The paradox here is that if you do exercise, you’re most likely to have your heart problem either during or immediately after your workout.

There are two reasons for that. One is that people are more likely to notice symptoms, particularly of coronary disease, when exerting themselves. The second is that if people are going to have an acute closure of their coronary arteries, exercise can be the trigger for that.

Why would that be?

The reasons that a coronary artery would suddenly collapse or close up is that a blood clot would form at an area of prior instability.

The process of artery-narrowing involves a collection of cholesterol and blood cells in the wall of the artery. Those areas are weak, the artery wall is weak, and so with the stress of exercise, you’re actually likely to rupture those areas and a blood clot will form there. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, cardiovascular, exercise, heart disease, Massachusetts General Hospital

August 26, 2011 | 1:53 PM | By Rachel Zimmerman

The Saga Of The $23,000 Circumcision

The high cost of circumcision

*3:15 Update: See Below

On Wednesday, Stephanie Bottner of Somerville, Mass. posted a story on the new HealthCare Savvy website about trying to get a circumcision for her son.

The post begins this way: “I have recently had an interesting experience which left me completely shocked. This is not a posting about whether or not to get a circumcision, just at the astronomical costs involved.”

Stephanie continues:

My son was born 14 mo ago and because he was born in a Birth Center, he could not get circumcised at birth. Our hospital (Cambridge Hospital in Mass.) does not have a pediatric surgeon for this procedure so we were given a referral for a doctor at Mass General (Boston). When I called Mass General to get a quote on the price, I got the following:

$23,000
(includes Facility, Physician, Anesthesia)

This procedure is less than 30 minutes; the doctor himself even stated that this is one of the easiest procedures. I’ve researched prices for other countries and found a high of $1200. Continue reading →