217 Suspected Massachusetts Heroin Overdose Deaths This Year

Massachusetts state police are reporting more than 200 suspected heroin overdose deaths during the first three months of this year, a figure that doesn’t even include the state’s three largest cities.

According to the statistics provided by the state police, there were 72 suspected heroin overdose deaths in March. The totals for the first two months of the year were similar: 72 deaths in February and 73 in January.

Among the March deaths, 54 were men and 18 women. The average age of those who died was 36.

The 217 fatalities were recorded in every region of Massachusetts, but state police noted they don’t keep the records of suspected heroin deaths in Boston, Worcester and Springfield, so the statewide total was almost certainly higher.

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Why To Exercise Today: For Long-Term Weight, It May Matter More Than Diet

feetonscale

The usual wisdom goes: You really need to be active for your health, but you can’t count on exercise as a weight-loss method. Some people even gain weight when they ramp up exercise — and not just muscle mass.

But if you look at the big picture and the long haul, people who succeed at long-term weight loss tend to have high levels of physical activity. Now a new study of more than 5,000 Americans in the journal Medicine & Science in Sports & Exercise finds a strikingly strong link between exercise and weight — arguably stronger than the link to diet.

The American College of Sports Medicine offers this summary:

The study found that moderate-to-vigorous physical activity was significantly associated with two measures of weight status – body mass index and waist circumference.
For both men and women and in all age groups, higher levels of moderate-to-vigorous physical activity were associated with lower BMI and smaller waist circumference.
The associations of diet quality with weight status were much less consistent; higher diet quality was associated with lower weight variables in only a few gender and age groups.

Which groups? From the paper’s abstract: “Diet quality was inversely associated with the weight status variables only in men age 30–39, 40–49 (BMI only), and 50–59 and women age 50–59.”

And of course, if you’re in one of those cohorts now, you won’t be forever. More from the summary:

“The study also found that, as age increased, physical activity declined, diet improved, and BMI and waist circumference increased.”

In other words, even as we get more virtuous in our diets, we tend to exercise less and gain weight. Continue reading

Dana-Farber Cancer Institute Head To Retire

Dr. Edward Benz, the longtime president and CEO of the Dana-Farber Cancer Institute, will retire next year, the hospital confirmed early Wednesday.

In a letter to colleagues, Benz said that he will retire on June 30, 2016 — a month after his 70th birthday. At that point, he will have led the prestigious cancer institute for almost 16 years.

Edward Benz, in a 2005 file photo (John Deputy/AP)

Edward Benz, in a 2005 file photo (John Deputy/AP)

“With longevity in the lead role comes the risk of becoming stale, especially in this dynamic and disruptive period in our history,” Benz wrote in the letter. “Before that happens, DFCI should identify someone new to take the tiller, someone who will bring the fresh experiences, perspectives and skills that we will need for a challenging future.”

After his retirement as president and CEO, Benz said he’ll return full time to “research, clinical, and teaching activities at Dana-Farber.”

Under Benz’s tenure, Dana-Farber grew in size and fundraising ability, as The Boston Globe reported Wednesday morning. “DFCI is in excellent condition,” Benz wrote in his letter.

He’s the second health care leader to depart in recent months. In October, Gary Gottlieb announced he was leaving Partners HealthCare, the state’s largest private employer.

Viewpoint: Doctors Respond To Home Births That End Up In Hospital

By Shirie Leng, M.D. and Cindy Ku, M.D.

As physicians we are concerned about a recent post on CommonHealth — “What to Expect When You’re Birthing At Home: A Hospital C-Section (Possibly)” — that focuses on planned home births that end up in the hospital.

While we respect the right of women to labor and deliver in the environment of their choosing, requiring medical intervention in childbirth is neither shameful nor a moral failing. Life-threatening complications which, 100 years ago, would have meant a death sentence for mothers and babies, are now treatable and even preventable in the modern hospital maternity ward. Suggesting that women are unduly traumatized by transfer to and treatment in a medical facility does a disservice to the obstetricians, nurses, anesthesiologists, and neonatologists who work so hard to save these lives.

Here’s an example of the kind of case that could possibly result from a home birth that goes awry. While on a routine morning on the obstetrics unit, the usual routine was interrupted by a phone call from the emergency room. A laboring mother was in distress and needed an emergency caesarean, and she was about to arrive into the trauma OR. Since caesareans are not normally performed in the emergency room trauma room, everyone dropped their plans and hurriedly prepared the trauma OR. One minute later a petite young woman on a stretcher crashed through the door along with the obstetrician. “Get the baby out of me!” she screamed, writhing and crying in agony as the team transferred her to the operating table. Between her moans and her desperate outbursts, she could barely understand the questions as the anesthesiologist tried to ascertain three things: did she have heart or lung problems, did she have allergies, and did she have any potential problems with her airway?

 (meme_mutation/flickr)

(meme_mutation/flickr)

We had no other information to go by – no laboratory data, no history, not even her name. All we knew was the baby was in breech position (legs down, not head down) and was in distress. We had five seconds to decide how we would help to save the two lives in front of us. We told her as gently as we could (though it likely didn’t register with her at all) that she needed to breathe in oxygen for herself and her unborn child, that she would be unconscious for about an hour, and we would see her and her baby in the recovery room. Vaginal delivery is not the standard of care for breech presentations because of the significantly elevated risk of shoulder entrapment in the birth canal and stillbirth. Months after this case we all still wonder how we could have done better and what would’ve happened if she hadn’t arrived in time.

Thankfully, our team — the obstetricians, anesthesiologists, nurses and neonatologists — worked together successfully and both mother and child did well. We don’t know for sure if this case began as a home birth, but it does represent the sorts of difficulties that we medical staffs wrestle with when a home birth becomes complicated and ends up at the hospital.

Childbirth always brings with it an element of danger. While everything usually goes right, when it goes wrong it usually does so quickly and seriously. To expect the idealized experience in every case is to deny reality. In 1900, when women were having the arguably blissful natural birth experience home birthers seek, the maternal mortality rate was more than 800 deaths per 100,000 births. According to the CDC, in 1997 that number was 7 per 100,000. This statistic, an upwards of 99 percent decrease in mortality rate, was not achieved by midwives and doulas with the latest technology in birthing balls and labor tubs. It was achieved through advances in science and medicine. Continue reading

Medicated (And Unmedicated) Women Are Talking

By Alicair Peltonen
Guest Contributor

I think a crucial step in decreasing the stigma surrounding mental illness is talking about it openly. And it seems readers want to talk.

My post, “The Medicated Woman: A Pill To Feel Better, Not Squelch Feelings,” on mental health and medication, was shared on Facebook more than 15,000 times and now has over 200 comments, so I thought it was worth a follow-up.

One thing readers wanted to discuss is the safety of antidepressants during pregnancy, a complicated topic which has been covered here and here on CommonHealth. Safety studies are mixed in many cases so women should consult their doctors. Here’s what it says on the Mayo Clinic website:

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Other comments underscored that stigma still exists but may be slowly diminishing.

(Flickr Creative Commons)

(Flickr Creative Commons)

Jackie wrote: “It took me until I was in my 50’s to accept that medication wasn’t the ‘weak”‘ way. I now see how much I lost and am living through a tremendously stressful life without those urges to accelerate into other cars or cement walls.”

“It’s in our family, but I was the first to seek help, and was probably the worst off. It was a secret that my grandfather had committed suicide,” wrote lilycarol.

And here’s a comment from helentroy4: “My mother was much like me. But to her dying day she never acknowledged that her behaviors were anything but ‘perfect mothering.’ I think had she been able to take advantage of this medication (or others of its kind), she would have been able to have the calming of her heart and soul that I have been blessed to have.”

There were many who suggested that lifestyle changes, including more exercise and sleep, meditation or yoga might be safer and more beneficial than medication. Continue reading

Boston’s Health, By T Stop: Neighborhoods Near But ‘Health Worlds Apart’

BPHC data posted in Dr. Sandro Galea’s “Dean’s Note” on Boston health disparities.

BPHC data posted in Dr. Sandro Galea’s “Dean’s Note” on Boston health disparities.

If you went on a little T ride with Dr. Sandro Galea, the new dean of the Boston University School of Public Health, the urban landscape would never look quite the same to you, I bet. You wouldn’t just see neighborhoods, anymore; you would see health neighborhoods.

In his latest “Dean’s Note” post, Dr. Galea uses images like the one above to illustrate the yawning gaps in health statistics among Boston’s neighborhoods. (Get off at Dudley Square, the diabetes rate is 11 percent; get off at Arlington, it’s just 3 percent.) He also posts T-stop numbers on low birth weight, physical activity and homicide, among other health-related stats. And he writes:

Inured as we are to inequalities in health, we might well shrug off these health differences as ones between far-apart worlds. But are they? In fact, the geographic space we are talking about here is remarkably small. We are dealing with geographic differences of roughly four miles, or about an hour’s walk. In many respects, it is remarkable that areas so close to one another should have such dramatically different health indicators—“health worlds apart” that are simply down the street from one another.

Those health worlds may be far apart indeed. A new “Child Opportunity Index” suggests that Boston may be the worst city in the country for Hispanic kids in terms of healthy development.

Developed by researchers at Brandeis University’s Heller School for Social Policy and Management and Ohio State University’s Kirwan Institute for the Study of Race and Ethnicity, the index finds that 58 percent of Hispanic children in Boston live in neighborhoods with the lowest level of access to “healthy development resources,” from parks to high-quality child care.

The index also found Boston to be the sixth-worst metro area in the country for African-American children.

From the press release, headlined, “Boston has the Highest Concentration Nationally of Hispanic Children Living in the Worst Neighborhoods for Healthy Development:” Continue reading

The Medicated Woman: A Pill To Feel Better, Not Squelch Emotions

By Alicair Peltonen
Guest Contributor

I am a medicated woman. I take 50mg of Sertraline (the generic form of Zoloft) a day. I don’t take it to be more tolerable to my husband. I don’t take it because I’m embarrassed by my emotions. And I definitely don’t take it to quietly fit into a polite societal mold. I take an anti-depressant every day to quell my anxiety simply because it feels better. I feel better.

I grew up in a talk therapy household. My father began group therapy for anger management issues in 1984, when I was 10, breaking a cycle of rage and avoidance that tends to swallow people whole, particularly men. He would come home feeling calmer and then he would implore my sister and me to explore our feelings and talk about our problems. Begrudgingly at times, I learned to think analytically. And thankfully, I learned that asking for help is not only acceptable, it’s downright healthy.

I started seeing therapists here and there in my 20s and then regularly several months after my first daughter was born. Medication had never been suggested by any of my previous therapists but this time was different. I couldn’t shake the feelings of inadequacy, the certainty that my daughter didn’t like me and I was just a glorified dairy cow. Post-partum depression is a hell of a thing.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

When my therapist suggested I see a psychiatrist to discuss the possibility of medication, I went home and cried for an hour. I felt ashamed, defeated, embarrassed, weak. Even though I had seen medication transform my father from a man who growled and dragged to one who laughed and hugged, it still stung to feel like I couldn’t pull myself together.

But, remembering my father’s bravery, I thought I should at least give it a try. If I didn’t like it, I could always stop taking it. The first pill was swallowed through tears. And each successive pill went down easier. For a full year, I could go days without yelling or wanting to break things and entire weeks without crying. And I felt better.

After a year, I decided to go off the medication. Things had been much better and I wanted to see if I could “go back to normal.” And things did go back to normal. But it turns out my normal wasn’t very comfortable.

There have been many discussions and articles recently asking if modern psychiatry is over-medicating women. A recent op-ed in the New York Times by psychiatrist Julie Holland suggested that many of the symptoms for which women are treated with antidepressants are natural and healthy. “We have been taught to apologize for our tears,” she writes, “to suppress our anger and to fear being called hysterical.”

Here’s the thing, though. Breaking down into uncontrollable tears because you stubbed your toe and it’s the straw that broke the stress-camel’s back doesn’t feel good. Continue reading

House Passes Bill To Fix Medicare's Doctor Payments. What's In It?

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

The troubled payment formula for Medicare physicians is one step closer to repeal.

The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.

According to a summary of the bill, unveiled by Republican and Democratic committee leaders earlier this week, the current system would be scrapped and replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.”

Hundreds of state and national physician groups are urging Senate passage.

“It will relieve many years of frustration and uncertainty for all physicians by eliminating that sword of Damocles, that’s been hanging over our heads with regards to cuts and replacing it with a predictable albeit small increase in fees over the next four to five years,” said the Massachusetts Medical Society’s president-elect, Dr. Dennis Dimitri.

There’s enough in the wide-ranging deal for both sides to love or hate.

Senate Democrats have pressed to add to the proposal four years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. The House package extends CHIP for two years. In a statement Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years” but others have suggested they may support the package.

Some Democratic allies said the CHIP disagreement should not undermine the proposal. After the House approved the package by a vote of 392-37, Ron Pollack, executive director of the consumers group Families USA, urged the Senate to “adopt a CHIP funding bill as soon as possible. Families USA believes that a four-year extension is preferable to two years. We also know that time is of the essence, and it is crucial that the Senate act quickly.”

Some senators have also raised concerns about asking Medicare beneficiaries to pay for more of their medical care, the impact of the package on women’s health services and cuts to Medicare providers.

In a letter to House members before Thursday’s vote, the seniors group AARP said the legislation places “unfair burdens on beneficiaries. AARP and other consumer and aging organizations remain concerned that beneficiaries account for the largest portion of budget offsets (roughly $35 billion) through greater out-of-pocket expenses” on top of higher Part B premiums that beneficiaries will pay to prevent the scheduled cut in Medicare physician payments.

Hospitals, nursing homes and rehabilitation centers would see lower rates of increase, but are largely backing the legislation.

“Although nothing’s perfect, at a time when it’s so difficult to reach accord on really complicated issues, broad support for this solution is really impressive,” said Tim Gens, executive vice president at the Massachusetts Hospital Association. “And if it fails, we go back to these temporary patches that only solve the problem in a very expensive way for months at a time.”

Some GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $200 billion package. The Congressional Budget Office Wednesday said the bill would add $141 billion to the federal deficit.

For doctors, the package offers an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times. In a statement Sunday, the American Medical Association urged Congress “to seize the moment” to enact the changes.

Here are some answers to frequently asked questions about the proposal and the congressional ritual known as the doc fix. Continue reading

Suicide Prevention Campaign Approaches Men ‘On Their Own Terms’

Franklin Cook, project manager of the MassMen campaign, and Candice Porter, executive director of Screening for Mental Health, using the MassMen website. (Lynn Jolicoeur/WBUR)

Franklin Cook, project manager of the MassMen campaign, and Candice Porter, executive director of Screening for Mental Health, using the MassMen website. (Lynn Jolicoeur/WBUR)

Franklin Cook of Watertown knows the issue of suicide among men all too well. In 1978, when Cook was 24, his father killed himself.

After that Cook struggled with addiction and found recovery, suffered from depression but got treatment, and built a career in suicide prevention and suicide grief support.

He knows many men struggle to seek help for mental illness.

More men than women die by suicide, and across the country middle-aged white men have the highest suicide rate of any age group.

“But the care-giving world also doesn’t market or doesn’t design programs specifically around our species, if you will,” Cook says. “[Some men] might not want to sit down face-to-face and talk to somebody for 55 minutes about their feelings. I’ve done that hundreds of times with a counselor, and it works for me, but it doesn’t work for all men.”

Now Cook is helping lead a Massachusetts suicide prevention campaign centered around a new website called MassMen.org. It was created by the Wellesley-based organization Screening for Mental Health, with funding from the state Department of Public Health.

On the site, people can complete an anonymous mental health screening in about two minutes to find out whether their feelings and behaviors are consistent with depression or another mental health disorder. They get results immediately and after the screening a “video doctor” does an interactive assessment.

“I’m concerned about your symptoms. I want to be sure you’re aware of the impact this can have on your health and well-being,” the video doctor, portrayed by an actor, says in one portion of the segment. “To help me understand how you feel about taking steps to feel less depressed, I have a question for you. On a scale of one to nine, how ready would you say you are to take steps to feel better?”

Candice Porter is executive director of Screening for Mental Health and a clinical social worker. She points out that while middle-aged men have the highest suicide rate, many of them may not be “moping around,” appearing overtly sad or depressed.

“They might mask their symptoms in a lot of ways that we’re not recognizing, and they’re not seeking the help,” Porter says. But she adds that even though the men might not seek counseling or treatment, many people who die by suicide visit their doctor for some physical ailment in the months leading up to their death.

“We do know that the primary care physicians are not asking the question, ‘How are you feeling? Are you depressed? Have you had thoughts of wanting to end your life?'” Porter explains. “So part of what we’re also trying to do is just increase awareness that these questions should be asked.”

The MassMen site also directs users to resources including mental health services in their communities.

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Patient Empowerment: Why Angelina Jolie’s Menopause Matters

Angelina Jolie (Gage Skidmore/flickr)

Angelina Jolie (Gage Skidmore/flickr)

You’ve probably never linked Angelina Jolie Pitt and menopause in a single thought before.

But there they were, connected on the opinion page of The New York Times Tuesday: The actress and filmmaker whose fecund family life and sexy beauty seem to embody female fertility, and the hormonal changes that mark female fertility’s end.

Jolie Pitt, 39, explained in her piece that because she carries a genetic cancer mutation and a strong family history of fatal ovarian cancer, she decided to get preventative surgery — the removal of her fallopian tubes and ovaries — to reduce her cancer risk. (Jolie Pitt previously underwent a preventive double mastectomy to lower her risk of developing breast cancer.)

Due the recent surgery, she writes: “I am now in menopause. I will not be able to have any more children, and I expect some physical changes. But I feel at ease with whatever will come, not because I am strong but because this is a part of life. It is nothing to be feared.”

Needless to say, the Times piece has triggered a media storm of opinion (“Hollywood will finally have to start talking about menopause”) and praise (for her “eye-watering courage”), including a thoughtful medical discussion on Here & Now.

Here, an expert on sexual health after cancer weighs in. Sharon Bober, Ph.D. is the director of the Sexual Health Program at the Dana-Farber Cancer Institute and assistant professor of psychology in the Department of Psychiatry at Harvard Medical School. She writes about the need for more education and frank talk about how patients can have a healthy sexual life after cancer and cancer-related surgeries:

Angelina Jolie Pitt has issued a resounding call for women at high risk for hereditary breast/ovarian cancer to learn about their options, “take control” and make decisions to manage their cancer risk. Jolie carries a mutation and has strong family history of this lethal disease. Because there is no effective screening for ovarian cancer, she has decided to follow her doctors’ recommendation to remove her ovaries at the age of 39.

But, as Jolie Pitt explained in her New York Times editorial, this blunt instrument of cancer risk-reduction comes with a high cost: immediate surgery-induced menopause.

One of the primary reasons that many high risk women do not move ahead with the same recommendation to remove their ovaries is fear of menopause and worry about quality of life.

Young women are understandably distressed about losing their sex life, their sense of femininity and are worried about the impact of these changes on dating or relationships. Unfortunately, these fears often go unaddressed and women assume that profound side effects are part of the high cost they must pay for undergoing potentially life-saving surgery.

In fact, for both high-risk women contemplating risk-reducing surgery like Jolie, as well as for young women who have been treated for cancer, it has been shown that sexual health is one of the most common and distressing treatment-related concerns. And yet, women’s sexual health is rarely discussed in most treatment settings.

Jolie Pitt declares that knowledge is power and I agree. I believe strongly that all women should have the information and education needed to address the side effects of treatment-induced menopause including how to manage changes in sexual health. For example, Jolie’s decision to use a regimen of hormone replacement to manage the shift into menopause makes sense for her but it is not a course of action that would be recommended for women who previously had breast cancer. However, breast cancer survivors struggle with treatment-induced changes like vaginal dryness, atrophy and loss of libido.

I recently worked with a 40-year-old breast cancer survivor who had been having painful sex with for 4 years and had no idea that help was available. Her first comment was that because no one ever spoke about it, she assumed this problem was supposed to get better on its own and when things got worse, she concluded that nothing could be done. Continue reading