Monday night, rescheduled from earlier in March: #ConjoinedTwins: At the Crossroads of #Surgery, Medicine and Ethics.”

In order to separate these two babies, who were joined at the chest, one had to die. The doctors told their story to   a group of health writers last year. One detail stood out: when the babies were rolled into the operating room, each one was holding a rattle.

Free, but registration required. 

 

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ICYMI: The #Boston Globe series on race included a look at our #hospitals, where “the color line persists.”

Hospitals story, quoted below,  here. Entire series here. 

CapturePatients fly in from all over the country to get care at Massachusetts General Hospital. Yet, most black Bostonians don’t travel the five to 10 miles from their neighborhoods to take advantage of the hospital’s immense medical resources. Just 11 percent of Bostonians admitted to the city’s largest hospital are black, far less than its peers.

The picture is similar at Dana-Farber Cancer Institute, one of the world’s top oncology centers. Nearly 2 in every 5 white Boston residents diagnosed with cancer are treated there, but, among black residents with the disease, it’s 1 in 5.

Across town, meanwhile, white residents of the South End are more likely than black residents to leave the neighborhood for inpatient care rather than go to nearby Boston Medical Center, once a public hospital. Blacks account for half of Boston patients at the former Boston City Hospital — by far the most of any hospital in the city.

Though the issue gets scant attention in this center of world-class medicine, segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white.

 

Massachusetts Department of Public Health reports that flu cases are going down. But, they warn that the flu is “unpredictable.”

This following an early spike.

The latest weekly flu report shows that rates of flu-like illness have dropped in the past seven days. However, flu is unpredictable and it’s too soon to know whether we’ve seen its peak this season. The one thing we know for sure is that it’s not too late to get a flu shot if you haven’t gotten one yet. Call your health care provider or visit a local pharmacy which offers flu vaccinations.flu

Boston researcher in NYTimes on why the US spends so much on health care. The answer is same as it was in 2003 — prices.

33586416554_c4c88c0477_zAustin Frakt,  director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System writes in The New York Times today:

A large part of the answer can be found in the title of a 2003 paper in Health Affairs by the Princeton University health economist Uwe Reinhardt: “It’s the prices, stupid.

He goes on to quote a JAMA  study:

Over all, the researchers found that American personal health spending grew by about $930 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion (amounts adjusted for inflation). This was a huge increase, far outpacing overall economic growth. The health sector grew at a 4 percent annual rate, while the overall economy grew at a 2.4 percent rate.

You’d expect some growth in health care spending over this span from the increase in population size and the aging of the population. But that explains less than half of the spending growth. After accounting for those kinds of demographic factors, which we can do very little about, health spending still grew by about $574 billion from 1996 to 2013.

Did the increasing sickness in the American population explain much of the rest of the growth in spending? Nope. Measured by how much we spend, we’ve actually gotten a bit healthier. 

For more on Dr. Frakt’s work, see his blog, The Incidental Economist.

 

Tuesday, Globe series targets racial disparities in health care. Conclusion: The color line exists in sickness as in health.

CaptureThe Boston Globe’s series on race focuses on health disparities on Tuesday.

Though the issue gets scant attention in this center of world-class medicine, segregation patterns are deeply imbedded in Boston health care. Simply put: If you are black in Boston, you are less likely to get care at several of the city’s elite hospitals than if you are white.

Also, check out the paper’s Q&A from 2014 between Kate Walsh , the chief executive of Boston Medical Center, and Dr. Paula Johnson , executive director of the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.

Walsh: What would you say are the biggest health issues facing the minority community in Boston?

Johnson: There are a number, and they really occur across th

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e life span. For example, black infants are 1.5 to 4 times more likely to die prematurely in the first year of life. If we looked at those likely to die below the age of 74, blacks are twice as likely to die.

Then you look at the disparities in chronic disease. They are pretty significant. Heart disease, stroke, cancer. And there also are a lot of inequities in people being able to make the right choices. That is a very significant health issue for minorities. For example, being able to make healthy food choices, being able to let your children out on the playground and get adequate exercise.

 

 

Two babies, two rattles, one heart. The complicated decision to separate conjoined twins when only one will survive

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by Nora Valdez. Used by Permission.

Oscar J. Benavidez, MD, the MGH pediatric cardiologist  involved in a difficult separation of conjoined twin girls, remembers a painful moment on the day of surgery. When the joined babies were rolled into the OR, each was holding a rattle.

He and the others knew: only one of them would leave the operating room alive. And even that wasn’t certain.

Benavidez and two others recalled the case at a Tuesday gathering of members of the Association of Health Care Journalists. It was a case the described rather clinically in an article behind the paywall in  The New England Journal of Medicine  and more conversationally in STAT. The Globe’s sister health site hosted the event in their new downtown offices.

The twins had separate brains, lung and hearts, but only one heart was functioning.

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Ethicist Brian M. Cummings, MD,  was also at the event  along with pediatric surgeon Allan M. Goldstein. In Cummings’ contribution to the NEJM article, he noted  “In this case, to do nothing would most likely result in the death of both girls but to intervene could save only one child. Can observation of both of their deaths be defended? Can an interventional killing be rationalized?”

The decision was left to the parents, a couple from rural Africa.  Their voices, in English, come in at the  end of the NEJM article. Life for them had been “very unpleasant. Conjoined twins are not seen frequently, and because of the stigma associated with this condition, it was very difficult to seek treatment or even just to go out in public.”

They agreed to the surgery and, as expected, one twin survived.

Writing in Stat — The Boston Globe’s sister health news site  — Cummings described how he felt after the surgery.

“…Twin B arrived in the intensive care unit. I felt a profound mixture of relief and sadness, suddenly feeling the burden of facilitating this emotional process. Even though it had become clear what we needed to do, it had been harder than I thought. I had only a few moments to say my own goodbye to Twin A and I could not hold back my tears. I wasn’t alone.”

 

Can hospitals be leaner?@STATnews take you insides the Brigham’s “struggle to cut costs.”

More here.

Over the past three months, the Brigham provided STAT unbrigham

usual access to meetings of its top management and internal deliberations and documents. 

This inside look shows how one of the nation’s leading hospitals is confronting the daunting financial and marketplace forces buffeting academic medical centers across the U.S.

“This wasn’t about ordinary cost-cutting,” Walls said. “It was very clear we had to become a much leaner, more efficient organization.”

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