Rounding up the year’s health news

Theirs and ours:

You can read Commonhealth’s list or listen to it on Radio Boston:

Or listen to Carey Goldberg on WBUR

MassDevice offers : The top medical device stories of the year, Part I

From sweeping regulatory changes promised, but never delivered, by the FDA, to the industry and regulatory backlash against the impending 2.3% excise tax, the industry didn’t move the chains too far in the past twelve months.

The Globe offers Top Ten Health Apps and health advice from “prominant Bostonians.” The list includes dog walking, hoops to stave off Alzheimer’s,  meditation, all things in moderation, no desserts  –this did not come from the restaurateur –and volunteerism –this did come from a museum director.

The Globe on alarm fatigue, HIT and a hit to the hospital association

From The Globe:

Boston hospital CIO Halamka on his wife’s diagnosis: “We have cancer”

Beth Israel CIO John Halamka usually blogs about health information with posts like “The EHR/HIE Interoperability Workgroup,” and very occasionally, his life as a vegan or his plan to  retire to a small family farm to raise organic vegetables.

Today he reports the disturbing news of his wife’s breast cancer. They’ve decided to document her treatment in real time.

The headline “We have cancer.”

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

New look and new name for Nature Boston

So, the renamed Nature Boston is up and running. Check out this week’s calendar of event and a “Storify” post on last weeks visits by science journalist Carl Zimmer   He  was t the Coolidge Corner Theatre on talking about viruses at a screening of the film 12 Monkeys.

He also spoke at Harvard about his  book on science tattoos.

Also see a post on an event at Catalyst, a trendy new restaurant in Kendall Square with a back room named for Watson and Crick. The idea is to offer meeting space for the biotech and tech companies that have set up shop in the square.

Lack of autopsies = missed medical errors: a Pro Publica investigation

This story notes that “when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.”

So, it is bad news that all of the New England states report low autopsy rates in cases of unexpected deaths. Personally, it’s sad that NC also reports a low rate.  The Raleigh News & Observer  did a similar same story in 1995.

Without Autopsies, Hospitals Bury Their Mistakes

by Marshall Allen ProPublica, Dec. 15, 2011, 12:36 Marshall Allen, ProPublica, Dec. 15

When Renee Royak-Schaler unexpectedly collapsed and died on May 22, no one ordered anautopsy.

Not the doctors at Howard County General Hospital in Columbia, Md., where the 64-year-old professor and cancer researcher was pronounced dead.

Not the Maryland Office of the Chief Medical Examiner, which passed on the case because no foul play was involved.

And not Royak-Schaler’s physicians at Johns Hopkins University School of Medicine who had diagnosed cancer in her hip two days beforehand but acknowledged they didn’t know what had caused her unforeseen death.

A half-century ago, an autopsy would have been routine. Autopsies, sometimes called the ultimate medical audit, were an integral part of American health care, performed on roughly half of all patients who died in hospitals. Today, data from the Centers for Disease Control and Prevention show, they are conducted on about 5 percent of such patients.

As Royak-Schaler’s husband, Jeffrey Schaler, discovered, even sudden unexpected deaths do not trigger postmortem reviews. Hospitals are not required to offer or perform autopsies. Insurers don’t pay for them. Some facilities and doctors shy away from them, fearing they may reveal malpractice. The downward trend is well-known — it’s been studied for years.

What has not been appreciated, pathologists and public health officials say, are the far-reaching consequences for U.S. health care of minuscule autopsy rates.

Diagnostic errors,which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost tolearn about the effectiveness of medical treatments and the progression ofdiseases. Inaccurate information winds up on death certificates, undermining thereliability of crucial health statistics.

It was only because of Royak-Schaler’s connections that her case ended differently. Her colleagues at the University of Maryland School of Medicine urged her husband to authorize an autopsy and volunteered to conduct it for free.

In her case, as in so many, the autopsy revealed a surprise: Royak-Schaler, the renowned cancer researcher, had cancer ravaging her body — in her lungs, kidneys ,abdomen and the marrow of her bones. A blood clot, likely related to thetumors, caused her sudden death.

Jeffrey Schaler has wrestled with anger that his wife wasn’t diagnosed sooner but said knowing how she died was better than not.

“There’s a sense of peace that accompanies that knowledge,” he said.

For the last year, ProPublica, PBS “Frontline” and NPR have probed America’s deeply flawed system of death investigation [1], focusing primarily on forensic autopsies, which are conducted by coroners’ offices and medical examiners when there is suspicion of an unnatural death. State laws vary, but the preponderance of deaths that occur in hospitals are considered natural. Whendeaths are unexplained, unobserved or within 24 hours of admission, hospitalsmay be required to report them to local coroners or medical examiners, but such  agencies rarely take hospital cases.

Continue reading

Did news reports miss the message on IOM breast cancer/environment study?

Earlier this week, we cast this IOM study as offering little new news.  But, as Julia Brody of  The Silent Spring Institute points out, that’s not quite true.  From the environmental Health News website:

…(M)ost of the news media missed the significance of the assessment on environmental chemicals. The real news is that the report is an authoritative statement that a cascade of scientific evidence plausibly links consumer product chemicals and pollutants with biological activity suggesting breast cancer risk.

Instead of saying what is in the report, glass-empty stories said that the IOM “failed” to “definitely” link any chemicals to breast cancer or find “clear” environmental links. Some incorrectly said the report tells women to stop worrying about consumer product risks. These stories ignore the report’s important explanation that definitive evidence is not attainable and lack of human evidence of harm doesn’t mean something is safe.

From original NYTimes story on the report:

The report, 364 pages long and two years in the making, was issued on Wednesday by the Institute of Medicine, an independent group that is part of the National Academy of Sciences and advises the government and public. The work was done by a committee of 15 outside experts, mostly from universities, and nine institute staff members. The sole sponsor was a breast cancer advocacy group, Susan G. Komen for the Cure, which requested the report and spent $1 million on it.

For women who were hoping for definitive safety information about the huge number of chemicals to which people are exposed — from air pollution and cosmetics to cleaning products, food and drinking water — the report may come as a disappointment. It is based largely on a review of existing research, and its limited advice reflects the lack of solid scientific information in many areas of concern to the public.

Women should take note on Cape Cod, where the breast cancer rate is higher than average.  The Silent Spring Institute, one of the few groups doing research on environmental links to breast cancer, recently reporting finding 27 chemicals in well water on the Cape.

The 27 contaminants detected included 12 pharmaceuticals (the most common being one antibiotic and one epilepsy drug); five perfluorinated chemicals (found in non-stick and stain-resistant household products); four flame retardants; two hormones; one skin care product; one artificial sweetener; one insect repellent; and one plastics additive. Health-based guideline values were available for only four detected chemicals (PFOS, PFBS, DEET, carbamazepine), and no samples approached or exceeded these values. The most frequently detected chemical was acesulfame, an artificial sweetener, which was found in 85 percent of wells, and perfluorinated chemicals were detected in 70 percent of wells.

“While the levels of pharmaceuticals, flame retardants, and other emerging contaminants in drinking water are not currently regulated, we still think that it is prudent to find ways to prevent discharges from septic systems and wastewater treatment plants from impacting drinking water supplies, as we don’t fully understand the potential health impacts,” lead investigator Laurel Schaider said.

For more on health and the Massachusetts environment see  SSI or the Massachusetts Environmental Public Health Tracking (MA EPHT) Program Website

This website is designed to provide you with access to current and accurate health and environmental information available for Massachusetts. You can use Massachusetts Environmental Public Health Tracking (MA EPHT) information to learn about the health of your community and access information about your environment.





Hounded ex-Medicare chief Berwick back in Boston

Donald Berwick, who was hounded out of Washington for saying something nice about the UK health system, is back in town and on WBUR today.

Also check out today’s NTYimes op/ed by Joe Nocera:

Dr. Donald Berwick was already in Massachusetts when I spoke to him Sunday afternoon. He was back in the Newton home where he’d lived for 30 years, being pleasantly interrupted during our conversation by his 2-year-old grandson. His last day in Washington as the administrator of the Centers for Medicare and Medicaid Services had been Thursday. Friday was packing day. Saturday was moving day. And, by Sunday, he was already talking about his too-short, 17-month tenure as the nation’s top Medicare official in the past tense. Which, alas, it was.       

Dr. Berwick, I’m here to tell you, was the most qualified person in the country to run Medicare at this critical juncture, and the fact that he is no longer in the job is the country’s loss.