medicaid

Budget Victim: Inspections For Compounding Pharmacies. Really?

Remember all that outrage last year when we learned that a Framingham compounding pharmacy, the New England Compounding Center, was at the heart of national meningitis outbreak? And remember what followed: a flurry of new government oversight measures, tough public health safeguards, pledges of “Never again.”

So what happened?

Kevin Outterson, a professor at the Boston University School of Law and co-director of the Health Law Program, reports today that additional money that was supposed to be used to inspect compounding pharmacies around the state was cut to zero.

(WBUR)

Blogging for The Incidental Economist, he reminds us why the inspections are important: “fungal meningitis from improperly compounded products killed 55 people and infected more that 600.” But apparently, in the latest state budget proposal, money for inspections has been cut, Outterson writes:

All of these products originated in Massachusetts, but all of the injuries occurred in other states. But Massachusetts felt some responsibility for the failures at NECC, as acknowledged by both Gov. Patrick and the Interim Commissioner of Public Health. The DPH enacted emergency regulations on Nov. 1, 2012 and the Governor’s special commission delivered a comprehensive set of recommendations. Both efforts informed the Governor’s proposed legislation in January 2013 and several bills pending in the Massachusetts House and Senate. Continue reading →

FILED UNDER: Medicine/Science, Money, Politics, budget, compounding pharmacies, meningitis, public health

May 20, 2013 | 2:19 PM | Rachel Zimmerman

It’s The Carbs: ADHD In Childhood Linked To Adult Obesity, Study Finds

(Tobyotter/flickr)

Ned Hallowell is a Sudbury, Mass. psychiatrist and expert on ADHD who suffers from the condition himself. Today, he spoke with NPR about a new study in the journal Pediatrics that found boys with ADHD are more likely to become obese men compared to children without the condition. Hallowell is quoted saying the results seem reasonable:

“It makes sense, because they’re self-medicating with carbohydrates. Carbs do the same thing that stimulant medications do — promote dopamine,” says Hallowell, who wasn’t involved in the latest study. “So you get the gallon of ice cream at midnight.”

With impulse control often a problem for people suffering from the disorder, Hallowell also says that nutrition should be part of an ADHD treatment plan. Continue reading →

FILED UNDER: Medicine/Science, ADHD, children's health, men's health, obesity

May 20, 2013 | 10:07 AM | Rachel Zimmerman

Mapping The Ever-Shifting Mass. Hospital Landscape

Thanks to health policy guru John McDonough for highlighting the Blue Cross Blue Shield of Massachusetts’ new Health Care Delivery System Map which offers a snapshot of the state’s medical industrial complex as it becomes increasingly concentrated. There’s great data here, and it’s fairly easy to sort, from hospital revenue, ownership and geography to the latest info on mergers, acquisitions and new partnerships.

This online, interactive site won’t tell you where to get the best colonoscopy or most specialized cancer care, for instance, but it does offer insight into the scope and breadth of the marketplace. It essentially provides a baseline view of the state-of-the-industry for all the Mass. hospitals and hospital systems, medical groups, doctor networks and community health centers.

(Blue Cross Blue Shield Foundation of Massachusetts)

As McDonough writes:

For example, if you want to begin to understand why Partners Healthcare is so dominant in the state’s healthcare market, don’t go to this page, Hospital Systems by Size, on which Partners is #2 after Steward Health Care System. Go this this page: Physician Networks and Major Medical Groups, where the size of Partners’ physician network (called Partners Community Healthcare Inc., PCHI, or “peachy”) is larger than #2 (Steward) or #3 (Atrius), combined.

Or look at hospitals by Net Patient Service Revenue, and see that Partners total NPSR in 2010 ($4.2 billion) was the same as #s 2 (UMass Memorial), 3 (Steward), and 4 (Beth Israel Deaconess) combined.

Don’t forget this helpful page of Recent Changes in the Massachusetts health care market.

Readers, please roam around the site and let us know what’s interesting or useful to you.

FILED UNDER: Medicine/Science, Money, Blue Cross Blue Shield of Massachusetts, hospital systems, hospitals, partners healthcare, steward health care system

May 17, 2013 | 9:48 AM | Rachel Zimmerman

Is It ‘Unethical’ To Prescribe Bed Rest For Pregnant Women?

(cscott2006/flickr)

It seems so intuitively right. You’re facing the risk of delivering your baby early and the doctor prescribes bed rest. What could be more cozy and safe? Why wouldn’t you endure a little extra annoyance (you’re pregnant, after all) if it would help keep your tiny, oh-so-vulnerable fetus floating inside the fortress of your womb as long as possible? Even the words “bed” and “rest” feel so inherently soothing and therapeutic.

Think again.

Bed rest, a growing body of research suggests, may be bad for you. And for physicians to blithely prescribe it is, in a word, “unethical,” argue a trio of doctors from the University of North Carolina School of Medicine.

In a paper called “‘Therapeutic’ Bed Rest in Pregnancy: Unethical and Unsupported by Data” recently published in the journal Obstetrics and Gynecology, Dr. Christina A. McCall and her colleagues make a powerful case against the practice many perceive as cuddly and innocuous.

They cite the medical paradox in which bed rest remains widely used despite no evidence of benefits and, on the contrary, “known harms.” They further suggest that in its current form, strict bed rest should either be discontinued or else viewed as a “risky and unproven intervention” requiring rigorous testing through formal clinical trials.

“If we have anything to learn from the history of medicine it is that instincts and good intentions are a highly fallible compass without the check of scientific controls.”

In an email exchange, Dr. McCall clarifies that she is talking about strict bed rest here and adds:

“If a woman feels that increasing her daily rest lessens anxiety or improves symptoms (whatever they may be), then we are not suggesting this should be discontinued. We are merely suggesting that every woman receive INFORMED CONSENT regarding the literature on bed rest and the autonomy to make her own decision.”

Research suggests that the potential harms for women on bed rest (a broad term that can include everything from total inactivity to limits on strenuous endeavors like household chores, exercise and sex) can be significant. They range from potentially dangerous blood clots and bone demineralization to muscle and weight loss, financial harship due to restrictions on working and a range of psychological suffering, notably depression. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, bed rest, childbirth, obstetrics, pre-term labor, pregnancy

May 17, 2013 | 8:48 AM | Dr. Sharon Seibel and Dr. Mache Seibel

Not To Be Ignored: BRCA Genes And ‘Silent Killer’ Pancreatic Cancer

(Markus Schreiber/AP)

By Dr. Sharon Seibel and Dr. Mache Seibel
Guest Contributors

Angelina Jolie’s decision to undergo a prophylactic double mastectomy to limit her genetic risk for breast cancer demonstrated a lot of courage. It also demonstrates that genetic testing is a real part of disease prevention. But though the discussion she has prompted is helpful, it is not going far enough.

Although the “BRCA” type of gene she inherited is named for BReast CAncer, mutations in those genes also affect other organs, particularly the ovaries. Your lifetime risk for ovarian cancer increases from about 1.5% to Jolie’s estimated risk of about 50%.

But nobody is talking about the increased risk of other cancers that BRCA mutations cause, such as the “silent killer,” pancreatic cancer.

They should. Sharon, who is BRCA2-positive, was diagnosed with it a year ago, and we believe more BRCA-positive women can — and should — be screened for pancreatic cancer.

This differing opinion means many women are not being given the option to be screened for a silent killer.

Sharon has a strong family history for ovarian cancer: Her great grandmother, grandmother and aunt died young from it. Sharon grew up with the belief that she would suffer a similar fate.

Until she read an article over ten years ago discussing the BRCA1 and 2 genes. It was the first study reporting that women with BRCA1 and BRCA2 genes could reduce their risk of breast and ovary cancer by 75% by having their tubes and ovaries removed. We arranged for genetic testing, and Sharon tested positive for BRCA2.

While the positive results brought on a sinking feeling initially, relief followed, because there was something that could be done to potentially alter destiny and avoid ovarian cancer. A month later, Sharon underwent surgery to have her tubes and ovaries removed. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, BRCA, cancer, genetics

May 16, 2013 | 1:30 PM | Lisa Lambert

Silence As Kids’ Psych Beds Cut; What If Cancer Or Burn Beds?

The CDC has just released a report on the prevalence of mental illness among American children. It notes: “A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing.”

Yet as that prevalence increases, treatment options are decreasing, writes Lisa Lambert, executive director of the Parent/Professional Advocacy League, which advocates for Massachusetts families with mentally ill children. Below, she discusses one particular pending loss, of Cambridge Hospital children’s psychiatric beds long especially valued by families. The hospital announced last month that it would consolidate two units with 27 beds into just one with 16 beds. It cited tight budgets, declining utilization and cyclical demand. The details are still in play.

By Lisa Lambert
Guest contributor

When Aiden was seven, it seemed like he would never be safe.

At home and in his second-grade classroom, he repeatedly talked about killing himself. He barely slept, raced from one spot to another and threatened to harm his younger sister. His parents stayed glued to his side, barely taking time to eat, shower or sleep.

One day, his mother caught him lighting a fire in his bedroom. Aiden ended up in the emergency room, and later in a bed in Cambridge Hospital. The staff had seen young patients like him before and they knew what treatment would work and what kind of follow-up care a seven-year-old needs. Without that hospital stay, his mother says, ”We don’t know where our family would be.”

Lisa Lambert of PPAL (Courtesy)

No one likes the idea of admitting a young child to an inpatient psychiatric program. It is a last resort, something to be avoided at all costs. Parents will tell you, however, that when they’ve exhausted all the options, Cambridge Hospital has provided the best possible care. Now, it seems that a major piece of that care is coming to a close, unless a miracle happens.

Last week, the Department of Public Health held a hearing to receive comments about closing the Cambridge Hospital child psychiatric unit and eliminating beds. Nurses stood shoulder to shoulder to tell stories of families they’ve helped and of their pride in the wonderful care they’ve given. Parents came to say that this place was a lifesaver and without it, their children would never have improved.

The Child Assessment Unit is one of a kind, they all said, where parents can visit anytime and even stay overnight. Since PPAL is a grassroots organization, we surveyed families about this and want their voices to be part of the public conversation. Continue reading →

FILED UNDER: Medicine/Science, Money, Personal Health, Cambridge Health Alliance, cambridge hospital, pediatrics, psychiatry

May 16, 2013 | 12:01 PM | Rachel Zimmerman

The Yuck Factor: CDC Says Pools Are Full Of Poop

Finally, after a week of wool socks and extra blankets, today is feeling like a groovy summer day. But don’t get too excited yet. With summer comes pools, and for many of us, public pools that are, according to a new report from the CDC, chock full of poop.

(bcmom/flickr)

In the inimitably dry language of the nation’s public health authorities: “A study of public pools done during last summer’s swim season found that feces are frequently introduced into pool water by swimmers.”

Moreover, the study found:

“Fifty-eight percent of the pool filter samples tested were positive for E. coli, bacteria normally found in the human gut and feces. The E. coli is a marker for fecal contamination. Finding a high percentage of E. coli-positive filters indicates swimmers frequently contaminate pool water when they have a fecal incident in the water or when feces rinse off of their bodies because they do not shower thoroughly before getting into the water.”

(Be honest, does anyone really shower before getting into the pool? Maybe it’s time to start.)

So, what’s a swimmer to do?

The CDC offers these tips: Continue reading →

FILED UNDER: Medicine/Science, Personal Health, children's health, E. coli, environment, public health

May 16, 2013 | 10:04 AM | Jessica Alpert

What Not To Say To Parents Of Twins

“Did you do IVF?”

“You had a C-section, right?”

“Are they natural?”

Questions that may seem odd—even offensive — to some new mothers. Unless you are the mother of twins. Then you’re used to them.

The “babyrazzi” can be relentless, and the appearance of multiples in public can create an instantaneous barrage of questions. Earlier this year, I was in line at the Mothers of Twins sale (a huge biannual event in Winchester that is akin to the running of the bulls) comparing notes with other moms. Some of the more seasoned moms were used to the forward questioning, while the rest of us were still adjusting to the public’s keen interest in our multiples and our pregnancies.

Here’s my favorite. Upon seeing my boy and girl twins, “Are they identical?”

So when the hilarious cartoon above appeared in my Facebook feed on Mother’s Day, I didn’t mind the peering grandmothers at Costco later that afternoon. It captures just about every inquiry I’ve ever received and somehow it was validating to know that I’m not alone. I must say, all in all it’s a pretty special club.

Readers, any other cringe-worthy twin questions or comments you’d like to share?

FILED UNDER: Medicine/Science, Personal Health, obstetrics, pediatrics, pregnancy

May 16, 2013 | 6:33 AM | Martha Bebinger

Paying Tribute To A Doctor’s Invaluable Teacher: A Dead Body

For many doctors, the most important person on their journey from pre-med to licensed healer is dead.

“When you start medical school, you begin to learn the details of cells and tissues and development and disease,” said Jared Wortzman, president of the Tufts University School of Medicine class of 2016. “But if you ask anyone here they’ll tell you, you don’t really become a medical student until the moment you meet your cadaver.”

Edmund Chilcoate in his Coast Guard days (Courtesy)

Wortzman spoke at an unusual gathering last week — a memorial service for the men and women who donated their bodies to the anatomy lab at Tufts and a reception for their families.

One of the donors was 83-year-old Edmund Chilcoate.

“This is when he was a baby. He was cute, wasn’t he cute?” said Kim Begin, one of Chilcoate’s two daughters. Begin flips the plastic-covered pages of a brown leather photo album while three of the first-year medical students who probed and dissected Chilcoate’s body lean in to look.

Continue reading →

FILED UNDER: Medicine/Science, Science, anatomy, death, medical school, practicing medicine

May 15, 2013 | 5:08 PM | Cathy Corman

My ‘Personal Fantasy’ For Angelina Jolie (Hint: It’s All About Genes)

By Cathy Corman
Guest contributor

Back in 1998, I tested positive for the same genetic mutations that led Angelina Jolie to have a double mastectomy. When I talked with my doctor about the surgery to remove my healthy breasts and ovaries, I asked her what would be left of my femininity. “You still have your brain,” she told me.

I’ve thought about that exchange as I’ve read commentaries weighing in this week on the meaning of Angelina Jolie’s decision to undergo prophylactic mastectomies and to go public with the details. Most have focused on the impact of Jolie’s decisions on her film career and on women’s assessment of cancer risks. They have missed an important point: Jolie’s revelation is ultimately as much about her brain as her body.

Ivan Tortuga/flickr

There’s a reason Jolie has been the highest paid actress in Hollywood, earning up to $30 million a year. Sure, she’s got bee-stung lips, big boobs, a tiny waist and comely hips. But she’s not just beautiful. She’s brainy. Jolie has cannily put her physical assets to work in roles that have allowed her to link sex and power: as video-game heroine Lara Croft, a super spy in Mr. and Mrs. Smith, and as a daring CIA agent in the film Salt. Jolie has taken her body to the bank by choosing to be seen as active and able.

Jolie consciously continues in her role as action/adventure hero in the way she shapes her decisions to undergo genetic testing and surgery.

Here’s how:

• She remains powerful because she controls the flow of information. She managed to keep her mastectomies private until she was ready to share. And when she chose to share, she “bared all” on the opinion page of what is arguably the most respected newspaper in the world. Continue reading →