rejection

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. A note from Dr. [David. A] Grimes (my co-author)… “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.”

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 →

FILED UNDER: Medicine/Science, Personal Health, Angelina Jolie, breast cancer, mastectomy

May 15, 2013 | 11:29 AM | Lee H. Schwamm, M.D.

Specialist: My Prime Take-Home Points From ‘Dot Earth’ Reporter’s Stroke

This week, longtime New York Times reporter and popular “Dot Earth” blogger Andrew Revkin vividly describes his 2011 stroke in the first-person piece “My Lucky Stroke.” He includes these “prime take-home points”: “Take your body seriously. Time (wasted) is brain (lost). Question authority, but not too much. Old habits die hard.”

Dr. Lee Schwamm, chief of Massachusetts General Hospital’s stroke service and medical director of Mass General TeleHealth, would suggest that readers take away some rather different stroke lessons from Andy Revkin’s story. He shares them here.

By Dr. Lee H. Schwamm
Guest contributor

I congratulate the journalist and blogger Andy Revkin for courageously sharing the story of his stroke and his subsequent recovery. I also thank him for taking the time to share his personal experience for the benefit of his readers, and for the opportunity it presents to highlight some key learning points for patients, as we dissect his journey through the health-care system.

Mr. Revkin was relatively young and healthy, out for a run with his son, when he experienced stroke symptoms. All too often, when we think of stroke, we envision an older patient clutching their chest and being unable to move or speak. This stereotype is dangerous, both for patients and health-care providers, because it lowers our sensitivity to stroke-like symptoms in patients of any age.

Mr. Revkin and his son were concerned enough about his symptoms that he went home, but they didn’t appreciate the immediate seriousness of his condition and he took a shower, hoping his symptoms would resolve. Watch the video clip above showing a young news reporter having stroke-like symptoms, and ask yourself, would you have called 911 if you’d been present? You should have.

Without treatment to restore the blocked blood flow to the brain, 2 million nerve cells are dying every minute of continued stroke.

Then Mr. Revkin did what generations of doctors have advised us to do for a heart attack; namely, take some aspirin and call your doctor’s office. Unfortunately, when it comes to stroke, there are two types: those caused by blocked arteries (ischemic) and those caused by rupture of blood vessels (hemorrhagic). It’s not possible to tell just from symptoms if a stroke is ischemic or hemorrhagic; only a CAT scan or MRI can distinguish them.

Obviously, you don’t want to take an aspirin if you’re having bleeding in your brain, as it will make the bleeding worse. But it’s also not a great idea to take aspirin if it’s an ischemic stroke, especially not six aspirin, as Mr. Revkin did, because there are powerful clot-busting drugs that can be given to reverse the disability caused by ischemic stroke. These drugs — the main one is known as tPA — are only effective if they are given within the first 4.5 hours after the start of symptoms, and aspirin might increase the risk that the drugs could convert an ischemic stroke into a giant hemorrhage that could be fatal.

It’s also really important to realize, as Mr. Revkin mentions, that “time is brain.” Continue reading →

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

May 15, 2013 | 9:18 AM | Carey Goldberg

How Vermont Passed Assisted Suicide (And Can We Go There To Die?)

The Vermont State House in Montpelier (Wikimedia Commons/jonathanking)

Remember the physician-assisted-suicide referendum that came ever so close to passing last year in Massachusetts, failing in a 51-to-49 percent squeaker?

Well, where Massachusetts feared to tread, neighboring Vermont has now trodden, and the state is about to become the fourth to legalize physician-assisted suicide for terminally ill people, after Oregon, Washington and Montana. It is the first to do so through its lawmakers rather than a popular referendum or court.

The “end-of-life choices” bill rode a wild political roller-coaster before it was finally passed this Monday evening, and it’s now on its way to a supportive Gov. Peter Shumlin and expected to be signed soon.

Vermont Public Radio’s John Dillon has covered the bill all along the way, and I asked him for his insights into the political dynamics behind the action. But first, a brief note for us flatlanders: What will our neighbor to the north’s decision mean for us? Will we be able to drive with our doctors up to Brattleboro or Burlington if we’re fatally ill and want help taking control of our final days?

I sent a query to Patient Choices Vermont, the group that spearheaded the state’s “end-of-life choices” bill, and heard back from Jessica Oski of Sirotkin & Necrason, a government relations firm that has represented Patient Choices Vermont for a decade. She writes:

1. To be qualified to use the assistance of the Vermont Patient Choice at End of Life Bill, a person must be “18 years of age or older, a resident of Vermont, and under the care of a physician.” There is no specific guidance under the law as to who qualifies as a Vermont resident.

2. In order for a physician to benefit from the immunity under the law the physician must be “licensed to practice medicine under 26 V.S.A chapter 23 or 33.” In other words, licensed in Vermont.

Now for the politics. The tale I heard from VPR’s John Dillon suggests three possible lessons for the backers of physician-assisted suicide in Massachusetts: Stick with it. Compromise quickly when the right moment strikes. And you may fare better in a legislature than in a popular referendum.

The Vermont House had considered a “death with dignity” bill in 2007, John said, but it didn’t pass. Last year, a similar measure failed to pass in the state Senate. This year was different. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, assisted suicide

May 14, 2013 | 2:30 PM | Martha Bebinger

Northeastern U. Goes Smoke-Free — Inside And Out

WBUR’s Martha Bebinger reports that starting this fall, Northeastern University will join a growing number of college campuses that are smoke-free, both inside and out.

Northeastern Dean of Health Sciences Terry Fulmer says going smoke-free will save student’s lives.

“If you smoke when you’re younger, you’re more likely to be addicted for life,” Fulmer said. “So now is our opportunity to help them not get in a habit that will potentially be fatal.”

Northeastern will use peer pressure and a campus education campaign — as opposed to penalties — to enforce the new policy. There’s a free smoking cessation program for students and most faculty and staff can enroll through their insurance plan. Dean Fulmer says she does expect the ban on smoking to affect admissions.

(A partial list of Mass. colleges with some type of smoking ban. Source: The Association of Independent Colleges and Universities of Massachusetts)

Here’s more on new smoke-free policy from Northeastern:

The decision to go smoke-free dovetails with Northeastern’s focus on solving global challenges in health. According to the Centers for Disease Control and Prevention, some 443,000 people die each year from smoking or exposure to second-hand smoke. What’s more, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Continue reading →