Medicine/Science

The latest cool stuff out of some of the nation's best labs; news on medical research and what it may mean for patients.

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New England Governors Converge To Address Opioid Epidemic

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Seated from left are Vermont Gov. Peter Shumlin, Rhode Island Gov. Gina Raimondo, Connecticut Gov. Dannel P. Malloy, Maine Gov. Paul LePage, Hassan, and Massachusetts Gov. Charlie Baker. The governors met Tuesday in Boston to discuss strategies to deal with the opioid addiction problem in all their states. (Michael Dwyer/AP)

Pressing for the same or nearly the same limits on opioid prescriptions is one of the ways New England’s Republican and Democratic governors are working together to address the drug epidemic.

The six regional governors gathered in Boston Tuesday for an opioid panel.

There are some signs that efforts to slow the surge of opioid overdoses are working, but the death toll is grim. Narcan, or naloxone, the drug that reverses the effects of many overdoses, is becoming more widely available — and that’s a good thing, says Gov. Charlie Baker.

“We lost 1,500 people in Massachusetts in 2015, but my own speculation, based on the data I’ve seen, makes me think the number without Narcan would have been north of 5,000,” he said. “And it has a ton of, still, negative momentum.”

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Birth Control’s Next Frontier? Health Center Aims For Quick And Easy IUDs And Implants

Family Health Center of Worcester. (Jesse Costa/WBUR)

Family Health Center of Worcester. (Jesse Costa/WBUR)

Come in to the Family Health Center of Worcester for just about any reason and, if you’re a woman of child-bearing age, you’re all but certain to be asked “the one key question.” In Portuguese, if that’s what you speak, or Albanian or Vietnamese — or English:

“Are you planning to become pregnant in the next year?”

If you’re not, that’s an opening for a conversation about birth control options. Vietnamese medical interpreter Annie Huynh says that after just a few months of those conversations, she’s already seeing a dramatic shift away from the many accidental pregnancies she was seeing a couple of years ago.

“Now, I hardly ever hear [it’s] an accident anymore,” she says. “It’s something either they plan for, or they don’t get pregnant anymore because of the education that I got that I’m able to pass on to them.”

That education includes training on how to talk about birth control, says Jennifer Averill Moffitt, the health center’s perinatal services manager.

“Whereas before, perhaps the counseling was, ‘Here are these 12 methods, choose which one is best for you,’ ” she says. “Now, we’re saying, ‘Here’s the most effective method, and here are some other choices. Choose what’s best for you.’ ”

The most effective method is long-acting birth control. That includes intrauterine devices, or IUDs, and the Nexplanon hormonal implant — a matchstick-sized rod that’s implanted in a woman’s arm and prevents pregnancy for three years. They’re not for everyone, but for typical users, both have failure rates of well under 1 percent, compared to an annual pregnancy rate of 9 percent for women who take the pill. (That’s due mainly to user error: Pills are easy to miss, while the long-acting methods are “set and forget.”)

The long-acting methods are on the rise nationwide — about 12 percent of women on birth control now use them — and they’re getting a lot of the credit for the recent drop in unintended pregnancies to a 30-year low. But the rate is still strikingly high: Forty-five percent of all American pregnancies are unplanned.

“If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

– Mark Edwards, co-founder of Upstream USA

So why aren’t even more women using IUDs and implants, especially now that Obamacare makes them much more likely to be covered?

For one thing, they’re not always easy and quick to get — particularly for low-income women, whose unplanned pregnancy rate can be five times the rate of high-income women.

Enter Upstream USA. It’s a nonprofit that aims to remove the health care system’s remaining barriers to long-acting birth control.

“There are many health centers we work with that are literally not offering IUDs and implants at all. Period. So literally zero percent of women are getting access to these methods,” says Mark Edwards, the Boston-based co-founder of Upstream USA.

“From our point of view, that’s unconscionable,” he adds. “This is a method of contraception which research studies have shown is actually 20 times more effective than the pill in terms of real-world use, and yet health centers are not making these methods available. In any other form of medicine it would just be an outrage. If we had a stent that was 20 times more effective than another stent, it would be an outrage that we weren’t offering them.”

Upstream goes into health clinics like the Family Health Center of Worcester and helps them up their birth-control game. That means training just about the entire staff on birth control counseling, from the medical assistants and interpreters to the schedulers. Continue reading

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Diagnosing CTE In The Living: Massive Study Of Degenerative Brain Disease To Begin

Robert Stern, director of Clinical Research at BU's Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

Robert Stern, director of Clinical Research at BU’s Chronic Traumatic Encephalopathy Center, and former New England Patriot safety Tim Fox. (Jesse Costa/WBUR)

About 50 medical researchers from around the country converged on Boston Wednesday, as they prepare to launch a massive seven-year study into the brain disease known as chronic traumatic encephalopathy, or CTE, in July.

CTE is a degenerative disease similar to Alzheimer’s. It’s only found in people who’ve played football, boxed or taken part in other contact sports.

The researchers are recruiting 180 former NFL and college football players in order to study their brains. The goal is to develop ways to diagnose CTE in people while they’re alive. The only way to diagnose it right now is by studying the brain after death.

One of the lead researchers is Robert Stern, Ph.D. He’s a Boston University School of Medicine professor of neurology and neurosurgery and director of clinical research at BU’s Chronic Traumatic Encephalopathy Center.

Helping Stern champion the research is Tim Fox, a 62-year-old former NFL safety who played for the Patriots, Chargers and Rams. He thinks he has CTE.

Fox and Stern spoke with WBUR’s All Things Considered host Lisa Mullins about the disease. Stern says while much of the focus has been on concussions, CTE is caused by something that can seem more benign.

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At ‘Pain School,’ Veterans Learn To Manage With Fewer Pills

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA's Pain School. (Jesse Costa/WBUR)

Robert, a veteran who injured his back several times during a dozen years in the Navy, stopped using opioids to treat his pain and is now a student at the Bedford VA’s Pain School. (Jesse Costa/WBUR)

Today’s topic: stress. Psychologist Tu Ngo looks out at a small group of veterans seated around a classroom table. “Why would we be talking about stress when we’re here because of your pain?” she asks seriously, then smiles. “Lil’ pop quiz now.”

A man who’s sitting near the door, in case his PTSD flares up and he needs to leave, is ready with an answer. “Stress may increase your anxiety, the anxiety may increase your feeling of pain,” says Tom Schatz, “the feeling of pain may increase depression, etc. etc.”

“Very good, that’s a great description of the vicious cycle we know happens when you have pain,” says Ngo, who heads the pain program at the Bedford VA Medical Center. “Pain is a stress response, it’s a signal to the brain saying, ‘Hey, there’s something wrong.’ ” Continue reading

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New Addiction Treatment Implant Will Hit The Market Next Month At $4,950

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the new addiction treatment implant Probuphine is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

There’s a new tool in the fight against the nation’s raging opioid epidemic.

The FDA on Thursday approved an implantable version of the drug buprenorphine, which staves off opioid cravings. Labels for the new device are rolling off printing devices today, and trainings begin Saturday for doctors who want to learn to insert the four matchstick size rods into patients.

The implant, called Probuphine, is expected to be available by the end of June.

“This is just the starting point for us to continue to fight for the cause of patients with opioid addiction,” said Braeburn Pharmaceuticals CEO Behshad Sheldon.

But one day after the FDA approved this first long-acting delivery method for buprenorphine, debate continues about how effective the implant will be and whether insurers will cover it.

A Game Changer … Or Set Up For Failure? 

The head of the National Institute on Drug Abuse calls the new implant a game-changer because it will help addiction patients stay on their meds while their brain circuits recover from the ravages of drug use. And addiction experts say it will be much harder for patients prescribed the implant to sell their medication on the street, which is a problem for addiction patients prescribed pills.

“I think it’s fantastic news,” said Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital. “We need as many tools in the toolbox as possible to deal with the opioid epidemic.”

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Popping A Daily Baby Aspirin? Caution: New Guidelines, Amid Controversy

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

New recommendations from the USPSTF recommend aspirin for far fewer people. (M. Spencer Green/AP)

When an older woman arrived at a Cambridge medical clinic recently, Dr. Sarah Stoneking was surprised to learn that the patient was taking an aspirin every day.

The patient was nearly 80, and didn’t have a clear reason to take the medication. Aspirin in general, and especially in older patients, can have a lot of side effects, including serious bleeding.

Stoneking, an internist and also my colleague, suggested her patient stop taking the daily aspirin, but the woman refused. She thought aspirin “was a panacea,” Stoneking recalled, one that protected her from the strokes and heart disease that had affected most of her friends. “She took it religiously,” Stoneking said.

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The Promise And Price Of New Addiction Treatment Implant

Amid a raging opioid epidemic, there’s a plea for more treatment options. The Food and Drug Administration expects to have a decision on one by May 27.

It’s an implant. Four rods, each about the size of a match stick, inserted in the upper arm. This new device, called Probuphine, delivers a continuous dose of an existing drug, buprenorphine, but with better results, says implant maker Braeburn Pharmaceuticals.

A graphic shows how the implant is placed inside the skin of a person's upper arm. (Courtesy Braeburn Pharmaceuticals)

A graphic shows how the implant is placed inside the skin of a person’s upper arm. (Courtesy Braeburn Pharmaceuticals)

In clinical trials, 88 percent of patients with the implants abstained from opioids, as compared to 72 percent of those taking buprenorphine as a daily pill. (Buprenorphine is commonly referred to by its brand name, Suboxone.)

“I felt completely normal all the time,” said Dave, a paramedic in a small town outside Boston who was on the implant during a clinical trial. He does not want his last name made public so that coworkers won’t find out he is addicted to opioid pain pills.

Dave, 47, has been in recovery for four years with the help of buprenorphine. Dave said he prefers the implant to the pills for several reasons. With the pills he would sometimes feel the drug wear off. He worried about his 2-year-old granddaughter getting into the bottle. And sometimes Dave would just forget to take his medication, which he’s supposed to do in the morning, 15 minutes before he has anything to eat or drink.

“With the implant you didn’t have to worry about that, you just, it was just there and you felt good all the time,” Dave said.

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Boston Medical Center Launches First Comprehensive Transgender Medical Center In Northeast

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Dr. Joshua Safer speaks at a press briefing at Boston Medical Center as Kate Walsh, president and CEO of BMC, Dr. Gerard Doherty, chief of surgery, and Dr. Jaromir Slama, chief of plastic surgery, look on. (Jesse Costa/WBUR)

Boston Medical Center CEO Kate Walsh was in a meeting a few years ago when something about gender identity and health came up. She turned to Dr. Joshua Safer, who was treating many of the hospital’s transgender patients.

“I said, ‘So you really believe patients are born in the wrong bodies?’ ” Walsh recalls, looking at Safer across a conference room table as she tells the story. “You said, ‘Yes,’ and that’s how we started on this journey to help people live the lives they were meant to live.”

The journey lead to the creation of the Center for Transgender Medicine and Surgery at BMC, the first such comprehensive service in the Northeast. It brings together services the hospital has been building out for several years: primary care, hormone therapy and mental health support, as well as chest and facial reconstruction procedures. Later this summer, as part of the comprehensive center, the hospital will begin genital surgery for men transitioning to women.

“This is very exciting for me to see us stepping up to do this,” said Safer, who will direct the center. “If you look across North America, there are only a handful of surgeons doing this sort of thing.”

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Dartmouth Study Looks At When Doctors And Patients Clash Over ‘Unnecessary’ Care

A new Dartmouth study looked at whether or not doctors' actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

A new Dartmouth study looked at whether or not doctors’ actions are influenced by an interest in controlling health care costs. (Alex Proimos/Flickr)

What happens when you want a test that your doctor thinks won’t help? Has a national campaign against high-cost, low-value care helped physicians have these tough conversations? And what drives doctors to provide care that they don’t think a patient needs?

These are the sorts of questions that researchers at the Dartmouth Institute for Health Policy and Clinical Practice sought to answer in a new study that came out Tuesday. The researchers surveyed clinicians at Atrius Health, Massachusetts’ largest outpatient care provider, with over a million patients, to determine what drives physicians to order tests they don’t think are in a patient’s best interest, and whether doctors were interested in controlling costs.

While nearly all doctors (96.8 percent) in the survey agreed that they should “limit unnecessary tests,” one in three thought that it was “unfair” to ask physicians to consider cost, and nearly one in three (30.7 percent) thought there was too much emphasis on cost. Primary care doctors were more likely to report being pressured by patients to order unnecessary tests, while surgeons were more likely to be concerned about malpractice.

Dr. Tom Sequist, one of the study’s authors, said in an interview that the researchers found a big gap between physicians’ desire to limit costly and low-value care, and their ability to do so.

“The thing that strikes me the most about this study is that over 90 percent of physicians said they were interested in reducing unnecessary cost, but only a third said they understood the role of cost in the system,” Sequist said. “It’s like saying, ‘I’m really interested in physics, but I have no idea how physics works.’ ” Continue reading

7 Things To Know About The Nation’s First Penis Transplant

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

Surgical team members Dr. Dicken Ko, left, and Dr. Curtis Cetrulo address the media during a news conference at Massachusetts General Hospital, Monday. (Elise Amendola/AP)

From The New York Times to cable TV to here at CommonHealth, the country’s first penis transplant made major headlines Monday.

The patient, 64-year-old Thomas Manning, had part of his penis surgically removed four years ago after doctors found he had penile cancer. The news marked a step forward in transplant medicine, but as a resident physician and future primary care doctor, I wondered whether such an elaborate and expensive “proof-of-concept” operation would mean anything for my future patients.

The facts behind the big story:

What did the operation aim to accomplish?

The goals of this operation, according to Dr. Dicken Ko, who co-led the surgical team, were threefold: to reconstruct natural-appearing genitalia, to allow the patient to urinate normally and, hopefully, to help him regain sexual functioning.

They have achieved the first goal, and they are hopeful that Manning will be able to urinate normally in a few weeks. Finally, they did extensive reconstruction of the nerves as well, and are hopeful that he will have normal sexual function in the future.

How was this patient chosen?

For Manning, the motivation to volunteer for this experimental procedure was straightforward. “Because they cut off my penis. Very simple. Very, very simple,” he said in a phone interview. Manning volunteered for the operation and underwent extensive psychological evaluation, according to his team.

The type of injury he had was also an important factor: Because part of his penis had been surgically removed — rather than injured in an explosion — the rest of the vessels and nerves were preserved, which facilitated the operation. This was important, Dr. Ko said, because they wanted to pick a patient who was very likely to have a successful outcome to be the first to receive the transplant.

How difficult was this operation?

The main technical difficulties of the operation had to do with the vascular reconstruction involved, which is when doctors sew together the small blood vessels of the patient to the donor’s vessels.

Before the operation, they had only a vague idea if the vessels were big enough to connect. They also performed a vein graft, which is akin to a heart bypass and allows greater blood flow. That vein graft was the primary difference between the technical aspects of this operation and the first successful transplant, performed earlier this year in South Africa.

Who else could benefit from this surgery?

For now, the surgeons on this team are focusing on cancer and trauma patients, especially veterans returning with combat wounds from Iraq and Afghanistan.

The technical challenges for soldiers injured by explosions are likely to be more daunting, as the injuries are generally more extensive and their own vessels and nerves are less well-preserved. Nonetheless, the surgeons emphasized how motivated they were to work with veterans.

In a statement, Manning himself said he hoped the operation could soon be performed on “service members who put their lives on the line and suffer serious damage as a result.”

When asked about the potential for use with transgender patients, Dr. Curtis Cetrulo, a plastic surgeon and the second team leader, said it could be possible in the future. The approach, however, would have to be completely different and would require “a whole new effort” to be successful, he said. Continue reading

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