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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Cancer Patient Receives Nation’s First Penis Transplant At MGH

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital via AP)

In this photo provided by Massachusetts General Hospital, Thomas Manning gives a thumbs up after being asked how he was feeling following the first penis transplant in the United States. (Sam Riley/Mass General Hospital/AP)

Back in 2012, Thomas Manning of Halifax, Massachusetts, suffered a serious groin injury when a heavy cart fell on him at work. As he was being treated for it, his doctors found an aggressive cancer growing in his penis, and amputated most of it.

“He’s really an incredible person that after that surgery, totally unprovoked, said, ‘Doc, if I can have a penile transplant, I’m your patient,’ ” Manning’s doctor, MGH urologic oncologist Adam Feldman, told reporters on Monday. “And then shortly afterward was when the program started and I said, ‘You know … there just might be something here for you.’ “

It took more than three years for all the pieces to come together, but Manning, 64, has now received the country’s first penis transplant. Surgeons in South Africa and China have performed similar operations.

The operation at Mass. General took place overnight on May 8, and lasted more than 15 hours in total. The organ came from a deceased anonymous donor whose family gave special permission for the transplant.

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MIT Researchers Aim To Create An On-Demand Pharmacy

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Students and postdocs at MIT who were part of the pharmacy on demand (a small scale pharmaceutical manufacturing unit) team. (Courtesy of MIT)

Hundreds of thousands of bright pink, white or blue tablets and capsules in all colors of the rainbow drop into bottles on sleek conveyors every hour in a sprawling building — somewhere. Each batch of pills may take a month or more to make.

But now, in a lab near Kendall Square, a team of MIT researchers can turn out 1,000 pills in 24 hours in a device the size of your kitchen refrigerator. It’s a whole new way of making drugs.

“We’re giving them an alternative to traditional plants, and we’re reducing the time it takes to manufacture a drug,” said Allan Myerson, professor of chemical engineering at MIT.

The Defense Department is funding this project for use in various places like field hospitals serving troops, jungles to help combat a disease outbreak, and strategic spots throughout the U.S.

“These are portable units so you can put them on the back of a truck and take them anywhere,” Myerson said. “If there was an emergency, you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed.”

Sound simple? It’s not. This mini plant represents a sea of change in both size and operation. Continue reading

State’s Opioid Epidemic Is Vividly Seen On Boston’s ‘Methadone Mile’

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

On “Methadone Mile,” a one-mile stretch of Massachusetts Avenue in Boston, it is not uncommon to witness people using drugs. Here, we’ve digitally blurred this person’s face to prevent identification. (Jesse Costa/WBUR)

The ravages of the state’s opioid epidemic are perhaps nowhere more visible than in an area of Boston known as “Methadone Mile” — a one-mile stretch of Massachusetts Avenue in the shadow of Boston Medical Center. Continue reading

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Health Care And Civic Leaders Launch Serious Illness Care Coalition

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

Dr. Atul Gawande, a co-chair of the Serious Illness Care coalition, is a surgeon at Brigham and Women’s Hospital and a professor at Harvard Medical School and the Harvard School of Public Health. (Courtesy)

A group of health care and civic leaders meets at the Kennedy Library Thursday morning with a mission: ensuring that Massachusetts residents live their final weeks or months as they choose. They’re launching a new statewide effort called the Serious Illness Care coalition.

The aim of the group is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness — the kind that could lead to death within a year.

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Opinion: Pediatrician Asks, Why Can’t I Talk To You About Guns In The Home?

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

A Seattle public health official demonstrates the use of a gun lock box during a news conference on Jan. 21. (Elaine Thompson/AP)

Here’s a conversation I was in on recently between a pediatric intern and the parents of a healthy, 1-day-old baby. It occurred in the Yale-New Haven Hospital well baby nursery.

“Your daughter’s physical exam is perfect,” the intern said. “She’s eating well, peeing and pooping well. I want to talk to you a little about how to help you keep her safe and healthy.”

Next came a standard discussion about the baby’s sleeping position and whether she’s got a car seat. Then, the next question:

“Do you have any guns in the home?”

Suddenly, the genial tone changed.

“I don’t think you should ask that question,” said the child’s father.

“Should I take that as a ‘yes’?” the intern pressed.

“I just don’t think you should ask.”

“Sir, we ask because we want to make sure that your baby is as safe as she can be, making sure you keep any guns locked up and away from her.”

“It’s none of your business.”

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Judge Rejects Injunction To Stop Construction On Children’s Hospital Healing Garden

Visitors relax in the Prouty Garden in this file photo. (Robin Lubbock/WBUR)

Visitors relax in the Prouty Garden in this file photo. (Robin Lubbock/WBUR)

A Suffolk Superior Court judge has denied a request for a preliminary injunction that would have stopped Boston Children’s Hospital from continuing any construction-related work on the site of its planned new clinical building. The plans call for the demolition of Prouty Garden, a healing garden that was bestowed to the hospital 60 years ago.

A group of people opposed to the development project — plaintiffs include family members of patients who’ve used Prouty Garden and physicians — had asked the judge to issue the injunction, saying the hospital has illegally started work on the site before the state Department of Public Health issues its approval.

The judge ruled the plaintiffs didn’t meet the burden of proving they’re likely to succeed in a lawsuit, but can still press forward with a suit challenging the project. Continue reading

Earlier:

Policies For Transgender High School Athletes Vary From State To State

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Justin Bonoyer stands in the athletic fields at Ponaganset High School in North Scituate, Rhode Island. Justin was Elise to his coaches until a few weeks ago. (Jesse Costa/WBUR)

Crack. A bright pink aluminum bat connects with a fluorescent yellow softball, sending it toward woods that border Ponaganset High School in northwest Rhode Island. The left fielder runs in and makes the catch.

“Two down ladies, two down,” a player calls.

This is home field for Ponaganset’s Lady Chieftains, except, it seems, the team is not all ladies.

Justin Bonoyer, a stocky 5-foot-5-inch player with a shock of blonde hair, plays right field. Justin was Elise to his coaches until a few weeks ago, although he’d already come out as transgender to most of his teammates.

“I’m a guy,” Justin says. “It’s the same as if a guy who’s not trans went and played on a girl’s softball team.”

Well, sort of. There are separate rules for transgender athletes. Rules so different from state to state that some high school athletes like Justin can try out for any team they choose while others need sex reassignment surgery before they can sign up.

There’s a lot of attention on bathrooms in the debate about transgender rights. The next battleground may be locker rooms, basketball courts and soccer fields. For high school students, the debate centers on Title IX, the federal law that bans discrimination based on gender. Does it also ban discrimination based on gender identity?

We’ll lay out the arguments in a minute. First, a little more about Justin. Continue reading

Opinion: In Simulation Era, Your Doc’s First Try At A Procedure Should Not Be On You

A mannequin for practicing open heart surgery at the Boston Children’s Hospital’s recently unveiled simulation center. Called “Surgical Sam,” it has a life-sized “heart” that accurately mimics the beating motions of a healthy or abnormal human heart. (Jesse Costa/WBUR)

A mannequin for practicing open-heart surgery at the Boston Children’s Hospital’s recently unveiled simulation center. Called “Surgical Sam,” it has a life-sized “heart” that accurately mimics the beating motions of a healthy or abnormal human heart. (Jesse Costa/WBUR)

Most doctors never forget the paralyzing terror of their first invasive procedure.

Dr. Charles Pozner, of Boston’s Brigham and Women’s Hospital, recalls the first time he placed a central line, which involves sticking an eight-inch-long needle into a patient’s jugular vein to place an intravenous line. He had never even seen it done before, but a chief resident offered him the opportunity after a long day working together.

“When I was a medical student, the last thing you wanted to say when someone offered a procedure to you was ‘no.’ You wanted to learn, to be part of the team,” Pozner told me. The chief resident walked him through it without mishap, but “it was an unsafe thing for the patient, and an unsafe thing for me, because I was potentially harming the patient,” he said.

Twenty years later, in 2013, I went through a similar process. I watched a colleague place a central line during my first week as an intern. A couple of days later, I placed my first one, as my senior resident supervised. Thankfully, everything went fine. But that doesn’t mean I’m comfortable with the idea of wielding eight-inch-long needles after only watching someone do a procedure once.

“See one, do one, teach one” is the ancient medical adage for this: that after doctors in training have seen one procedure or operation, they’re qualified to do the next one. It has been the model for teaching physicians for generations.

But in the age of robotic surgery and simulation medicine, is this concept really acceptable anymore?

The short answer is no. Clearly, doctors in training should practice on computers and simulated patients, not real ones. Particularly when, according to a study out this week, medical errors are the No. 3 cause of death nationwide.

The longer answer is more complicated. No one openly defends the concept in medical journals — in fact, experts talk about “see one, practice many, do one.” But the “see one, do one, teach one” culture still persists in hospitals around the country, and it remains routine for physicians in training to practice their first procedure on real patients. (As a patient, what can you do about it? See the tips below.)

“Would you fly on an airplane if they say, ‘We’ll drop the price of our tickets but our pilots will opt out of flight simulation?'”

– Dr. Antonio Gargiulo

But that is changing, as more hospitals and medical schools invest in high-tech simulation centers like the $12 million center unveiled by Boston Children’s Hospital this week.

Dr. Pozner, who is medical director of the Brigham’s STRATUS Center for Medical Simulation, says that in time, medical simulation will mean the death of “see one, do one, teach one.”

The Pilot Analogy

Consider pilots. Chesley “Sully” Sullenberger, the pilot who remarkably landed his plane on the Hudson River, is often mentioned in the medical literature on simulation, as are his hundreds of hours practicing simulated emergencies. If Dr. Atul Gawande famously brought the pilot’s checklist to surgery, simulation proponents think more pilot-style simulation should be brought to medicine.

“It’s called procedural memory,” Dr. Pozner said.

And studies show that simulation works in medicine. One small study trained doctors in robotic surgery, showing that they could reach expert level proficiency by the time they operated on their first real patient.

“The main advantage of this tool is you can get technically perfect before you even touch a patient,” said Dr. Antonio Gargiulo, medical director of the Center for Robotic Surgery at Brigham and Women’s Hospital. Continue reading

Narrating Medicine: Let’s Talk Bedpans, And Why Doctors Should Get Good With Them

As a doctor myself, writes Dr. Anna Reisman, I was embarrassed that I didn’t know how to help a patient with a bedpan. (Michaelwalk/Wikimedia Commons)

As a doctor myself, writes Dr. Anna Reisman, I was embarrassed that I didn’t know how to help a patient with a bedpan. (Michaelwalk/Wikimedia Commons)

I was visiting my friend in the hospital and she had to pee. Walking to the bathroom was not an option: She’d been told not to get out of bed, she felt weak and lightheaded, and she was attached to an IV and a monitor.

She pressed the call button and stated her problem. A voice: They’d let her nurse know. A few minutes later, I stuck my head outside the curtain and scanned the empty hallway, feeling guilty that all I could do was share her frustration.

Then someone pulled open the curtain and smiled in at us. “I need the bedpan, we’ve already called twice,” my friend said. The woman in scrubs, who turned out to be one of the doctors, said she’d take care of it. My friend and I sighed with relief.

But the doctor slipped back out. Taking care of it meant finding someone who knew how to do it. When she returned a couple of minutes later and saw that still nobody had showed up, the good doctor offered to do it herself. She fetched a bedpan and awkwardly slid the pink plastic container under my friend, the whole time apologizing that she didn’t know which end was up.

The current U.S. nursing shortage includes licensed practical nurses and certified nursing assistants, the people who usually manage bedpans. And so hospitalized patients feeling the urge to urinate may have to wait longer than is possible.

If you’re thinking this is a minor issue, think again: Holding one’s urine can set a patient up for a urinary tract infection; the physical discomfort can be a stress on an already sick body, driving up blood pressure and pulse; and waiting with a bursting bladder is a mental stress, too.

As a doctor myself, I was embarrassed that I didn’t know how to help. I didn’t learn bedpan basics in medical school.

The alternative isn’t any better: Consider the shame and discomfort of lying in cold, wet sheets until someone can change them, plus the serious health risks that include skin breakdown and infection. For patients who already have pressure sores, these complications can be life-threatening.

As a doctor myself, I was embarrassed that I didn’t know how to help. I didn’t learn bedpan basics in medical school, or at any other time during my training. I would guess that most doctors, like me, would rather volunteer to hunt for someone else to do this than just getting the job done.

No, it isn’t rocket science to place a bedpan, but it’s easy to bumble by making a mess, leaving the patient in an uncomfortable position, exposing and embarrassing, and so on. Continue reading

Harvard Study: Shopping For Health Care Fails To Lower Costs

A new study is bad news for the push for health care shopping. (Caden Crawford/Flickr)

A new study is bad news for the push for health care shopping. (Caden Crawford/Flickr)

I hate it when there’s more bad news about the health care costs that are devouring our family, municipal and national budgets. (Latest number: $3 trillion, or 17.5 percent of America’s GDP.)

But here it is: A Harvard study just out in JAMA finds that when health care consumers use price-comparison tools, they don’t end up spending less. In fact, they may even spend a bit more, perhaps because they think higher prices mean better quality.

So much for the idea that if you just let people shop for cheaper care, prices will surely go down.

The study’s senior author, Dr. Ateev Mehrotra of Harvard Medical School, says the findings do not mean that health care price transparency mandates — which have passed here in Massachusetts and more than half of states overall — are a bad idea. Rather, he says, the message is that “It isn’t that easy just to fix this problem.”

About the study: It looks at nearly 150,000 employees at two big companies that gave their workers access to an online health care shopping tool, and compares them to nearly 300,000 status-quo employees. It found that among the employees who got the tool, outpatient spending on average went up a couple of hundred dollars, from $2,021 to $2,233.

The control group’s spending also went up slightly, but among the workers with the shopping tool, spending went up a bit more: by an average of $59 for outpatient care, including $18 out of pocket.

“Some of it is benefits design. …[And] we should also recognize that not everything in health care is shoppable.”

– Dr. Ateev Mehrotra

“Not A Panacea For High Health Care Costs,” says the headline of an accompanying editorial in JAMA. No kidding. Surely no one expected price transparency to solve our $3 trillion problem, but still, these results are also surely disappointing to anyone who hoped health care shopping might at least make a dent.

Or perhaps it will, someday. I spoke with Dr. Mehrotra, an expert on consumerism in health care, about what the results mean. Our conversation, lightly edited:

How would you sum up what you found?

There’s a lot of enthusiasm in the health care system about increasing price transparency, to both help patients become better consumers and to decrease health care spending. And unfortunately, in our results, we do not find that providing price transparency decreases health care spending.

I think there’s been this general idea that, ‘Oh, all we need to do is give people high deductibles, give them prices, and magic will happen, and people will start switching their providers to lower-cost providers.’ And one main message from this is that this should temper that enthusiasm, and it’s more complicated than that.

I don’t think it’s that patients think shopping for care is a bad idea. People generally realize that prices in health care are high and they should switch. But there are other factors that are playing a role.

Dr. Ateev Mehrotra (Courtesy)

Dr. Ateev Mehrotra (Courtesy)

Some of it is benefits design. We have these really complicated health care benefits designs that people really struggle to master, and under our current benefit design you might go to such a website and say, ‘Oh, I’m thinking of having my knee operated on and I’ll pay the same amount at every hospital, so it doesn’t matter.’ And a lot of the surgeries were for things that were relatively higher cost and therefore it didn’t matter. So that’s an issue.

And also, a lot of health care is emergent: When you’re having a heart attack and you’re in an ambulance, you’re not going to say, ‘Oh, let me see where it’s cheaper for me to go for care.’ So we should also recognize that not everything in health care is shoppable. Continue reading