#NEJM #Relman obit: “A master in the use of the bully pulpit” #HCR

A not entirely objective perspective on the  career of the journal’s storied editor. Here’s the last paragraph:

In the increasingly complex world of health care, Bud Relman was a prophetic figure, larger than life. He acted nejmas our conscience. In his writing and speaking, he always reminded us that the medical profession is far more than a business and that as physicians, we have the responsibility to do what is right for patients and for the community as a whole. As distinguished as he was as a researcher, clinician, editor, teacher, and administrator, Bud Relman will be most remembered for the way he fought for a fundamental reshaping of our nation’s health care system. His passionate commitment to that cause will forever secure his position in the pantheon of leaders in medicine.

 

 

Boston Globe reports: Biolab & ebola

Two recent Boston Globe items of note:

Local hospitals prep for ebola

emergencyIn response to the West African outbreak of the deadly Ebola virus, some Boston hospitals are instructing clinical staff to ask patients as soon as they arrive about their travel histories, and reminding doctors and nurses of the symptoms.

But hospital officials say they would be ready to quickly identify the illness and prevent its spread if an infected patient showed up, using protocols and equipment already in place.

Column : Local biolab sits mostly empty as the CDC copes with its own lab safety crisis.

Over a decade of community protests, Boston University has beaten back lawsuits aimed at closing the lab and won City Council backing. Final approvals are still pending from the Boston Public Health Commission and the federal Centers for Disease Control and Prevention.

Its critics, though, have been given fresh ammunition: The CDC confessed earlier this month to sloppy handling of anthrax and avian flu at its laboratories elsewhere, exposing dozens of employees to the deadly bacteria. The mistake was the kind that proponents of the Albany Street lab had called nearly impossible.

“The CDC example is a wake-up call, if you needed a wake-up call,” said David Ozonoff, a Boston University professor and the longtime dean of its department of environmental health who opposes the lab.

How to feel a little bit better about ordering a $42 steak

Some need the excuse of a birthday or anniversary to splurge at celeb chef Jody Adams’ Rialto. Entrees at the Harvard Square restaurant run from $26 for roasted eggplant agrodolce (golden raisins, pine nuts, mozzarella, saffron tomatoes, chickpea arancini ) to $43 for grilled Tuscan sirloin steak (portabella, arugula, Parmigiano Reggiano, truffle oil).

For those interested in global health, here’s another. Louinique Occean, Rialto’s hePHIad baker, and Adams, James Beard Award-winning chef, are working with Partners in Health to create healthy meals with local ingredients at University Hospital in Mirebalais.


“Occean, who is Haitian-American, and Adams, a PIH trustee, have come at the request of the medical team to help the kitchen staff make healthier meals for patients, using locally sourced ingredients.

In Haiti, lack of access to nourishing food is at the root of many health problems. About 22 percent of young Haitian children show signs of chronic malnutrition. Doctors and nurses often see poor nutrition exacerbating the effects of other health problems, including tuberculosis, HIV, and diabetes. Malnutrition puts women at greater risk of dying in pregnancy and childbirth.”

Link here to her recipes.

Here is another tip for PHI supporters. For everyone who takes PIH’s 3-question, online quiz, a donor will contribute 50 cents to PIH’s maternal health efforts.

 

Hospital de la Santa Creu i Sant Pau: Medical tourism, Barcelona style

Boston Health News goes on vacation to Hospital de la Santa Creu i Sant Pau

A few blocks from the busy Sagrada Familia, tourists and historians can now visit the Hospital de la Santa Creu i Sant Pau, described as one of the oldest medical institutions in Europe and the largest Art Nouveau complex in the world. Unlike the church down the road, is has yet to be swarmed by tourists. Instead, find a quiet spot to explore both medical and architectural history. Three of the modernista pavilions and an exhibit space are open to the public during the ongoing renovations.

Where to put health stories in the paper and why it matters

The Boston Globe has taken to playing stories on medical research findings — like today’s digital mammography report —  on Page 2. For the writer, good play, but not great. To the reader, this suggest important, but not front page important.  This is commendable – often stories about complicated or incremental developments make  the front page,  giving readers the false impression that they need to stop eating eat this food or start taking that drug.

photo (3)A front page story on a research paper suggests a major development. (Good health writers try not to use the hyperbolic word “breakthrough.”)  So, the 1A Vertex story on a new CF drug rates as both a business and medical story. It could be life changing for people with cystic fibrosis and for the company’s bottom line, which is suffering from the arrival of new Hep C drugs. What we don’t like about the CF story – it could use a comment from someone not involved in the research. It’s a business story, so they seek out an analyst,  but he gushes. And his agenda is investing, not health.  It needs a CF scientist or clinician not involved in the study. Still, we get how hard it is to pull these stories together on deadline.

The Page 2 story on digital mammography offers such a comment. The JAMA article was accompanied by an editorial from Dr. Etta Pisano, a breast imaging radiologist at the Medical University of South Carolina who has done a lot of work in this area. Could have been a bit higher in the story but it works:

“There’s a debate about the harms of screening and overdiagnosis of breast cancers from mammograms and to me, this doesn’t resolve that,” she said.

Want to see how it shouldn’t be done? Check out the Health News Review. The list of stories that resorted to sensational language – breakthrough, game-changer, best way of detection, any woman should have this, lifesaver – was long.”

What’s the Boston play online? By late morning, neither story was high on the home page. At least you can click on the Business section from the home page. Health? Still no home on the home page. Click on “News” to find the link.

 

Berwick stays in the Massachusetts race for governor, supports single-payer

Former Medicare Chief and Democratic gubernatorial candidate Don Berwick apparently got a boost at a recent state convention, coming in third behind two front-runners.  Former political editor Peter Canellos writer notes Berwick’s support for single payer in the Globe’s new “Capital” section:

When his rivals claimed he wasn’t really offering anything new — just another health care commission — Berwick doubled down by calling it “Medicare for all,” a description that pretty much suggests he’d eliminate private inberwicksurance.

Now, with the Democratic race down to three candidates — Berwick, and two party regulars with histories of failing to excite voters — single-payer will finally get the attention it merits as essentially the only markedly different policy proposal to emerge from either party. A bold move to show the Obama administration what real reform looks like? A takeover that will roil the system? A vehicle for finally bringing about equality in health care? A threat to Massachusetts’ world-class doctors and hospitals? Single-payer could be all those and more. And if Massachusetts were to broadly restructure its health system, yet again, reverberations would be felt across the nation.

The Globe tagged along with him earlier this week, starting with a scene at the WBUR studios.

Can Berwick, who ran Medicare and Medicaid in the Obama administration for 1½ years, appeal to voters outside the left wing of the Democratic Party?

 He’d face the question twice more Monday, once from a Boston Herald reporter and again that evening at a Democratic gubernatorial forum in Jamaica Plain.

 For Berwick, the question is misplaced because, he says, it underestimates the liberal impulse of the entire state — a state that elected Governor Deval Patrick and Senator Elizabeth Warren.

 “This is a place where people really want to honor the idea that we are in this together, community by community,” he said in the WBUR interview. “And no, I don’t feel this is confined to some kind of fringe progressive wing.”

A bit here from Berwick on some of the Republican ideas for Medicare from out 2012 post.

 

 

 

 

 

 

Former NEJM editor Arnold Relman dies at 91

RelmanSee Storify for updates. 

Arnold Relman, the former New England Journal of Medicine editor, has died. From Bryan Marquard at the Globe: 

Eloquent and forceful on the page or the podium, Dr. Arnold Relman led the New England Journal of Medicine for more than 13 years, raising a sometimes lonely voice to warn about the dangers of for-profit medicine when many in politics and his profession raced to embrace a free market approach.

Dr. Relman also was one of the nation’s foremost writers about the rising cost of health care. Persistent to the end, he received the galleys of his final article just a few days before he died of cancer in his Cambridge home early Tuesday, on his 91st birthday.

 

When he suffered a catastrophic fall last year, he wrote about it in The New York Review of Books:

 

Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.

 

What he reported was not flattering to Spaulding Rehab, the hospitals that has won praise for working with so many marathon bombing survivors.

What did this experience teach me about the current state of medical care in the US? Quite a lot, as it turns out. I always knew that the treatment of the critically ill in our best teaching hospitals was excellent. That was certainly confirmed by the life-saving treatment I received in the Massachusetts General emergency room. Physicians there simply refused to let me die (try as hard as I might). But what I hadn’t appreciated was the extent to which, when there is no emergency, new technologies and electronic record-keeping affect how doctors do their work. Attention to the masses of data generated by laboratory and imaging studies has shifted their focus away from the patient. Doctors now spend more time with their computers than at the bedside. That seemed true at both the ICU and Spaulding. Reading the physicians’ notes in the MGHand Spaulding records, I found only a few brief descriptions of how I felt or looked, but there were copious reports of the data from tests and monitoring devices. Conversations with my physicians were infrequent, brief, and hardly ever reported.

What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

More on that piece from The NYTimes. 

 

Relman often commented on the influence of money on medicine. In 20o9,  he crashed the inaugural meeting of the Association of Clinical Researchers and Educators (ACRE) “an organization of medical professionals dedicated to the advancement of patient care through productive collaboration with industry and its counterparts.”

So, we asked for his thoughts about the presentations. Here they are:

“I sat through the whole program, which was a sustained diatribe against conflict-of-interest regulations rather than a scholarly, balanced discussion of the issues. There was practically no time for audience questions or comments, but instead an almost unrelenting barrage of ideological and anecdotal criticism of what was said to be a misguided “belief system” that worries excessively over relations between industry and the medical profession. There was an occasional informative and reasonable contribution, but for the most part sarcasm and anger prevailed.
 
The heavily industry-related audience loved the performance, but the obviously biased, self-serving, and often grossly flawed presentations should have embarrassed the organizers. Although neither Harvard Medical School nor the Brigham & Women’s Hospital sponsored or formally endorsed the meeting, the HMS Dean did give the initial welcoming remarks, and the Hospital offered its facilities for the event. One can only hope that they are now having second thoughts.”
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