2 Boston studies: Breast cancer costs and medical records benefits

After pushing mammograms for years, breast cancer advocates have had a hard time pulling back. Still the evidence keep piling up that message about surviving breast cancer is more complicated than early detection.  What this study by Boston researchers doesn’t measure: the scores of women who say — If there’s a chance it’s cancer, I want to know.  From the AP, in the back pages of the Globe A section; buried in the web site.

Sharpening a medical debate about the costs and benefits of cancer screening, a new report estimates that the United States spends $4 billion a year on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems.

On a lighter note, another study centers on the benefits of giving patients their own records. From the NYTimes.

ONC_PSA_BannerAd_300x250_Red_Button_1Some of the most advanced medical centers are starting to make medical information more available to patients. Brigham and Women’s, where Mr.  (Steven) Keating had his surgery, is part of the Partners HealthCare Group, which now has 500,000 patients with web access to some of the information in their health records including conditions, medications and test results.

Other medical groups are beginning to allow patients online access to the notes taken by physicians about them, in an initiative called OpenNotes. In a yearlong evaluation project at medical groups in three states, more than two-thirds of the patients reported having a better understanding of their health and medical conditions, adopting healthier habits and taking their medications as prescribed more regularly.

Here’s the Globe’s take.

Some patient advocates have been pushing for this for years, and having a little fun with it.

Coping with life in the snow maze #BOSnow

1st BOSnow Jan 27From CommonHealth

Debating Vitamin D: Leading Docs Still Wrangling On Best Dose For Patients

Globe on Snow Shoes for exercise. (It’s too deep to x-country ski.) 

Strap on your snowshoes and head out. Snowshoeing is one of the best winter exercises for staying fit, says Matt Heid, a contributing editor and blogger for the Appalachian Mountain Club. The cardio workout burns 420 to 1,000 calories per hour, depending on the conditions, according to a study conducted by the University of Vermont. Here are a few trappings for the newbies and experienced, with tips from Heid.

2nd BOSnow Feb  9From Our Bodies Ourselves:

What’s the Connection Between Snowfall in Boston and Health and Human Rights?

First, the health effects of extreme temperatures hit those with fewest resources — money, housing, safety, good health — hardest. It makes sense if you think about it: If you’re already sick, or living in a violent home or neighborhood, added difficulty getting around is much more serious than for healthy people who are safe at home.

Team Rubicon to the rescue:3rd BOSnow Feb 15

Team Rubicon has begun to receive requests for assistance with emergency snow removal across eastern MA and southern NH, focusing on the elderly and those who are not physically able to remove snow. Many of these residents have found themselves unable to move to/from their homes, or are not able to receive critical heating oil deliveries, a potentially dangerous situation with temperatures dropping across the region.

We are currently collecting availability for volunteers to assist with snow removal this weekend for part of or all of these days: Friday, 2/20, Saturday, 2/21, and Sunday, 2/21. We plan to shovel snow to clear pathways and potentially rake snow from roofs to prevent structural damage or collapse.

We are working with a range of other organizations (FEMA, VOADs, and various cities and towns throughout the impacted areas) to assess needs. A decision on whether to deploy strike teams will also depend on weather and safety considerations. Based on the response to this form, we will determine the appropriate area(s) of operation and timing. We could potentially have teams located in multiple areas. We will provide an update NLT 2100 on Thursday, February 19 to those who register their availability.

Can’t join in these areas this weekend? No problem. You can still participate in the #TRBigDig to ensure that first responders are able to access fire hydrants to operate safely and effectively during emergencies and to clear storm drains to prevent flooding when the snow melts. Let us know you took part by checking in athttp://bit.ly/TRbigdig.

 

 

Crumbs of pleasure: How to carry on after an unspeakable loss #grief

Tips on how to survive a sudden, life-altering loss.IMG_0376 Sleep, sing, love. go outside and ban perfection.

More from the CommonHealth blog.

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

@CommonHealth: Wikipedia and “energy” therapist clash over definition of “respectable scientific journals”

ss We link to a CommonHealth guest post by a Spaulding Rehab doc Eric Leskowitz. He promotes new age approach to pain known as “energy medicine “ and says he’s  been dismissed by Wikipedia as a “quack” despite his peer-reviewed work and Harvard cred

Hard to disagree with the first part of Wikipedia’s response to a petition supporting Leskowitz…

 If you can get your work published in respectable scientific journals – that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately..

.…except to say: What’s defines a “respectable”  journal.  True, not all peer review is equal, but who makes that call?

Wikipedia errs on the safe side and sets a high evidence bar. Still, Wikipedia’s ‘s citation of  Quackwatch — a virulently  anti-alt medicine web site — seems shaky. That site casts its net widely, ragging on everything from faith healers to acupuncture and massage therapy.

And the rest of Wikipedia’s response seemed kind of harsh…

What we won’t do is pretend that the work of lunatic charlatans is the equivalent of “true scientific discourse”. It isn’t.

At the same time, Leskowitz doesn’t do himself any favors by citing Dr. Mehmet Oz’s endorsement.  Dr. Oz has been known to promote less than substantiated therapies.

Energy Psychology has even gotten some fairly mainstream attention, from television’s Dr. Oz to The Huffington Post.

 

 

Could lunch lady fare be healthier than school lunch from home?

Seems the fluffernutter  has moved from the cafeteria to the lunch sack. The Globe offers a story about the joys of getting a kid to eat a healthy lunch.   Tufts found that the contents of those brown bags sometime fall short on the nutrition scale.

fruit-photo

The nutritional shortcomings of school lunches have been a matter of national debate for decades — but the focus has been on what schools serve, not on what moms and dads pack in the lunch bags.

Now Tufts University researchers have looked inside all those bags — and discovered that none of the lunches met all five National School Lunch Program standards, which emphasize fruits, vegetables, whole grains, and low- or nonfat dairy, and only 27 percent of the lunches met at least three of the goals.

So, now that the lunch lady has moved beyond tater tots, lets give him or her some credit.

 

 

NYTimes Magazine: Recalling the debate over repressed memories

ssThis weekend’s profile of Boston Dr. Bessel van der Kolk brought up some bad memories of the debate over what is clinically known as “dissociative amnesia.” The story profiles van der Kolk’s approach to treating Post Traumatic Stress Disorder, known as psychomotor therapy.  

“Trauma has nothing whatsoever to do with cognition,” he says. “It has to do with your body being reset to interpret the world as a dangerous place.” That reset begins in the deep recesses of the brain with its most primitive structures, regions that, he says, no cognitive therapy can access. “It’s not something you can talk yourself out of.” That view places him on the fringes of the psychiatric mainstream.

Not the first time, the story notes, as it recalls the doctor’s past support of repressed memories – a much debated concept that came into play when charges of sexual assault were levied against day care workers and priests in the ‘80s and ‘90s. Dr. van der Kolk’s Harvard colleague, psychologist Richard McNally, called the concept “the worst catastrophe to befall the mental-health field since the lobotomy era.”

From the Times:

For a time, judges and juries were persuaded by the testimony of van der Kolk and others. It made intuitive sense to them that the mind would find a way to shield itself from such deeply traumatic experiences. But as the claims grew more outlandish — alien abductions and secret satanic cults — support for the concept waned. Most research psychologists argued that it was much more likely for so-called repressed memories to have been implanted by suggestive questioning from overzealous doctors and therapists than to have been spontaneously recalled. In time, it became clear that innocent people had been wrongfully persecuted. Families, careers and, in some cases, entire lives were destroyed.

After the dust settled in what was dubbed “the memory wars,” van der Kolk found himself among the casualties. By the end of the decade, his lab at Massachusetts General Hospital was shuttered, and he lost his affiliation with Harvard Medical School. The official reason was a lack of funding, but van der Kolk and his allies believed that the true motives were political.

Not clear what the story means by “political,” but the implication is that he was banished for promoting an unpopular concept.

It didn’t help critics of repressed memory that the concept was being used in cases against alleged pedophiles. Most notoriously, lawyers defending defrocked priest Paul Shanley,  who was convicted of raping a young boy, used doubts about the concept to discredit the grown-up victim who testified that he had repressed memories of abuse. Shanley — who was the subject of numerous complaints to the church —  was found guilty in 2005. His lawyers filed an appeal, again based on the shakiness of the repressed memory concept.

From a Times story on the appeal

You have prominent scientists, psychologists and psychiatrists saying this is not generally accepted. So why allow it in a court of law in a criminal proceeding?” Mr. Stanley’s lawyer, Robert F. Shaw Jr., asked the state’s highest court Thursday.

The debate over repressed memory — the idea that some memories, particularly traumatic ones, can be inaccessible for years — has simmered since the 1980s, when some patients in therapy described long-past scenes of sexual abuse. Some of those experiences turned into high-profile legal cases. The scientific controversy boiled over in the 1990s — as experts raised questions about many claims — and then died down.

Recently, scientists have begun to spar again over the theory. New studies suggest, and many scientists argue, that what people call repression may just be ordinary forgetting; memory is not “blocked.” Others say the process is more complex and may involve a desire to forget.

“My impression is there continues to be a few scientists who honestly believe that it is actually possible for someone to be involved in a traumatic event and not be able to remember it at all,” said Dr. Harrison G. Pope Jr., a professor of psychiatry at Harvard. “But you cannot possibly argue that it’s generally accepted, which is the criteria for it to be admissible from a legal standpoint.”

In 2010, The Globe reported that the request for a new trial was thrown out

Jan 16, 2010: “In sum, the judge’s finding that the lack of scientific testing did not make unreliable the theory that an individual may experience dissociative amnesia was supported in the record, not only by expert testimony but by a wide collection of clinical observations and a survey of academic literature,” Justice Robert Cordy wrote for the SJC.

Shanley, now in his late 70s, was originally prosecuted by Martha Coakley, who is now attorney general and a Democratic candidate for US Senate. Her successor, Middlesex District Attorney Gerard T. Leone Jr., whose prosecutors defended the conviction before the SJC, applauded the ruling.

“As the SJC recognized, repressed memories of abuse is a legitimate phenomenon and provided a valid basis for the jury to find that the victim, a child at the time of the assaults, repressed memories of the years of abuse he suffered at the hands of Paul Shanley, someone who was in a significant position of authority and trust,” Leone said.

But Shanley’s appellate attorney, Robert F. Shaw Jr. of Cambridge, said the SJC had made a grievous mistake. Shaw, who argued in court papers that recovered memory was “junk science,” said Shanley deserved a new trial.

The SJC noted – literally in a footnote – that repressed memories alone may not be enough to convict a defendant. From the Globe:

The court also said that it may decide in the future to throw out a conviction where the only evidence is based on recovered memories.

“We do not consider whether there could be circumstances where testimony based on the repressed or recovered memory of a victim, standing alone, would not be sufficient as a matter of law to support a conviction,” Cordy wrote in a footnote.

But, the debate goes on. A review in the current issue of the American Psychological Association’s journal Psychiatric Bulletin, tries the put the issue to rest. Harvard’s McNally is one of the authors.  The article is in response to a 2012 paper in the same journal supporting the concept of repressed memories.

 (Although) a key assumption of the TM (Trauma model) is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma–dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorder. 

 

Storify: The Boston skinny on fat

Follow

Get every new post delivered to your Inbox.

Join 1,447 other followers

%d bloggers like this: