Daily Rounds: Medical Board Turnover; Meningitis Dispute; More Pharmacy Shutdowns; Martha Stewart’s Salmonella

State’s medical panel chief steps down (The Boston Globe) – “The staff director of the Board of Registration in Medicine resigned Tuesday, and the departure, combined with turnover among board members this year, indicates a probable shift in focus at the agency that oversees licensing and discipline for more than 34,000 physicians in the state. Every seat on the seven-member board has been filled with someone new in the past 18 months or left empty after resignations. And Dr. Stancel Riley, who had been the agency’s top executive for three years, had somewhat different priorities than the board’s new leader, according to their public remarks. When Riley took the job, he talked about serving patients while also listening to the needs of doctors, while the new leader of the board said Thursday that she is passionately focused on protecting patients.”

Lawyer: Sandy destroyed clues (The Boston Herald) – “Wind and water damage from superstorm Sandy may have blown away any chance for victims of a nationwide outbreak of fungal meningitis to prove that the Framingham building where New England Compounding Center mixed suspect spinal injections was contaminated, a company lawyer said, even as the Centers for Disease Control report bacteria and mold have been discovered in unopened, recalled vials of heart, eye and skin medicines distributed by the family-owned company. At a hearing in U.S. District Court in Boston yesterday, Magistrate Judge Jennifer C. Boal said she will allow civil lawyers and experts for more than a dozen victims to probe the shuttered facility in search of mold and bacteria. NECC lawyer Judi Abbott Curry, however, said: “There’s no way the plaintiffs’ experts can ever ascertain what failures were in the building’s envelope before the hurricane. It’s an impossible task. Too much has changed.” Attorney Michael Hugo, chairman of the Framingham Board of Health, said he was stunned Curry was suggesting NECC was in a building “susceptible to hurricane damage.”

State orders closing of 3 more drug compounding pharmacies (The Boston Globe) – “Three compounding pharmacies found to have problems in how they prepared or stored drugs have ­received cease-and-desist notices from the state Department of Public Health, as part of its ongoing surprise inspections of pharmacies that prepare sterile drugs used in injections. But none of their products has been recalled. At the same time, the state announced Thursday the appointment of three new pharmacy board members from a variety of health care backgrounds and said a commission that plans to make recommendations to Governor Deval Patrick by the end of the month is considering changes in the board’s structure that could ensure that more members come from outside the pharmacy industry.”

Salmonella: Martha Stewart sickened last month after ‘handling so many turkeys’ (The Huffington Post) – “Martha Stewart was confined to her bed for several days last month because of salmonella infection, the New York Post’s Page Six reported. “I never get sick, but I came down with salmonella. I think I caught it because I was handling so many turkeys around Thanksgiving,” Stewart told Page Six. “I was on the ‘Today’ show, I did a number of other [Thanksgiving] appearances. It really hit me hard and I was in bed for days. It was terrible.’ Salmonella is the most common source of food poisoning, and causes the infection salmonellosis, according to the United States Department of Agriculture.”

Daily Rounds: Cutting Health; Sexuality Questions; Legal Pot; Duchess Discharged

Patrick Budget Cuts Deal Blow To Rates Paid To Health Care Providers (State House News Service, via Wicked Local) “The bulk of Gov. Deval Patrick’s emergency budget cuts hit providers of care to Medicaid recipients, with over half of the spending reductions being taken from rates paid to MassHealth providers. Managed care organizations, nursing homes and fee-for-service providers saw the pot of money available for payments slashed by over $128 million on Tuesday. On Wednesday, state health officials interviewed by the News Service said the cuts should not impact patient access to care. “Nobody is getting paid less than they did in 2012,” Health and Human Services Secretary JudyAnn Bigby said, noting the savings are achieved by reducing increases in the reimbursement rates baked into the fiscal 2013 budget. While Patrick’s hand was forced by tax receipts that fell short of budget needs, some providers worry that a trend of turning to Medicaid rates to solve the state’s budget troubles could lead to patient access problems in the future if rates are not increased in the coming years.”

Answers About Female Sexuality, Part Two (The New York Times) — “Q. At 71 obviously my vagina is neither as tightly constructed nor as sensitive as in younger days. Until my current relationship with a slightly older partner having a narrow penis, this was never an issue; unfortunately, I am finding this a turnoff more and more, losing interest in him as a partner. I can barely feel him inside me! Is there any recommended position that might enhance my/our experience? — Ryn Writer, Due South A. Certainly changes associated with aging bodies, including vaginas and penises, can present challenges in the realm of sexuality. To enhance your sensation during sex, you may try to strengthen your pelvic floor muscles by contracting them (the Kegel exercise) several times a day on your own and then do the same around your partner’s penis as he moves in and out of the vagina. For positioning, you may also place your legs straight, close together and parallel instead of widely apart while you are in the “missionary” or side-lying position. Last, use just enough water-based (rather than an oil- or silicone-based) lubricant to facilitate comfortable entry, but not so much that it eliminates pleasurable skin-against-skin friction.”

Smokers Celebrate As Washington Legalizes Marijuana (The Boston Herald) — “The crowds of happy people lighting joints under Seattle’s Space Needle early Thursday morning with nary a police officer in sight bespoke the new reality: Marijuana is legal under Washington state law. Hundreds gathered at Seattle Center for a New Year’s Eve-style countdown to 12 a.m., when the legalization measure passed by voters last month took effect. When the clock struck, they cheered and sparked up in unison. A few dozen people gathered on a sidewalk outside the north Seattle headquarters of the annual Hempfest celebration and did the same, offering joints to reporters and blowing smoke into television news cameras. “I feel like a kid in a candy store!” shouted Hempfest volunteer Darby Hageman. “It’s all becoming real now!”

Catherine leaves Hospital After Acute Morning Sickness Treatment (CNN) — “Catherine, Duchess of Cambridge, left hospital Thursday morning, three days after being admitted for acute morning sickness. She emerged from the hospital accompanied by her husband Prince William and was driven away by a waiting car. A St. James’s Palace spokesman said: “The Duchess of Cambridge has been discharged from the King Edward VII Hospital and will now head to Kensington Palace for a period of rest.‬ “Their Royal Highnesses would like to thank the staff at the hospital for the care and treatment The Duchess has received.” News of her pregnancy was announced Monday when Catherine was admitted to King Edward VII Hospital with hyperemesis gravidarum, a condition which involves nausea and vomiting more severe than the typical morning sickness many women suffer during early pregnancy.”

Daily Rounds: More Women Docs; Partners Goes Personal; Polio Outbreak; Risky Ibuprofen

Women Notch Progress: Females Now Constitute One-Third of Nation’s Ranks of Doctors and Lawyers (The Wall Street Journal) –‘Despite women’s greater presence in law and medicine, wage gaps between men and women persist in both fields. In 2007, the median income—the point at which half earn more and half earn less—of female lawyers was $90,000, compared with $122,000 for male lawyers, according to research by Harvard economists Claudia Goldin and Lawrence Katz. The median income of female physicians was $112,128, compared with $186,916 for male physicians. Those differences are largely explained by individual choices, including women taking off time to raise children or opting for less-demanding career tracks or positions that pay less, said Mr. Katz. But a small portion of the gap exists for unclear reasons, he said. Discrimination could also be a factor, though it isn’t clear how much, he said. Ms. Goldin said women’s gains in medicine have coincided with the rise of corporate-owned hospitals and medical practices, in many cases making it easier for women to balance work and family. Health-care companies have bought up many small, previously male-owned independent practices and raised women’s wages closer to men’s, while offering more flexible work schedules, Ms. Goldin said.’

Partners Going Personal (The Boston Globe) — “Starting next month, Boston-based Partners will launch a “whole genome” sequencing and interpretation service for patients at its nine hospitals across Eastern Massachusetts, including Massachusetts General and Brigham and Women’s. The service, which will cost about $9,000, is intended to help doctors and patients make critical decisions about treatments — for example, which breast cancer drug could work best based on a patient’s genetic makeup. Once it is up and running, the genetic screening and interpretation service — using a suite of proprietary Partners software — could be extended to hospitals elsewhere. Partners hopes the bulk of the cost in most cases will be picked up by private and government insurers that would otherwise pay more for trial-and-error treatments that may ultimately prove less effective.”

A Polio Outbreak In Pakistan Reveals Gaps In Vaccination (NPR) — “The World Health Organization says 10 cases of so-called vaccine-derived polio were reported in Pakistan between the end of August and the end of October. What’s that? The oral polio vaccine contains a weakened version of the virus. In very rare instances — and when a population isn’t well immunized — the weakened virus can circulate in the community, mutate and infect unvaccinated people, causing paralysis. This is known as a vaccine-derived polio. Fully immunized kids are protected against both vaccine-derived and wild polio. So the problem isn’t so much with the vaccine as it is with gaps in immunization.”

For Athletes, Risks Of Ibuprofen Use (The New York Times) — “…the Dutch study is not the first to find damage from combining exercise and ibuprofen. Earlier work has shown that frequent use of the drug before and during workouts also can lead to colonic seepage. In a famous study from a few years ago, researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream. Ironically, this bacterial incursion resulted in “higher levels of systemic inflammation,” said David C. Nieman, a professor of health and exercise science at Appalachian State University who conducted the study and is himself an ultramarathoner. In other words, the ultramarathon racers who frequently used ibuprofen, an anti-inflammatory, wound up with higher overall levels of bodily inflammation. They also reported being just as sore after the race as runners who had not taken ibuprofen.”

Daily Rounds: Untaxed Health Insurance; Lifesaving Diet; Digital Diagnoses; Royal Morning Sickness

The (huge and rarely discussed) health insurance tax break (NPR-Shots) – “What’s the largest tax break in the federal tax code? If you said the mortgage interest deduction, you’d be wrong. The break for charitable giving? Nope. How about capital gains, or state and local taxes? No, and no Believe it or not, dollar for dollar, the most tax revenue the federal government forgoes every year is from not taxing the value of health insurance that employers provide their workers. Yet most people don’t even realize that they don’t pay taxes on the value of those health benefits. That’s too bad, saysMIT health economist Jonathan Gruber, because it represents a whole lot of money. “If we treated health insurance the same way we treat wages,” says Gruber, “we would raise about $250 billion per year more.” That not only makes the health insurance exclusion the federal government’s largest tax break, but it’s also “the third largest health care program in the U.S., after Medicare and Medicaid.'”

Diet’s role in lowering risk of repeat heart attacks (The Wall Street Journal) – “Patients with heart disease frequently assume that medication is enough to forestall a repeat heart attack or stroke, but a large new study shows the preventive power of a healthy diet. The findings from a report, released Monday, looked at the impact of diet in addition to the medicines routinely used to treat cardiovascular disease. Although it is widely accepted that healthy diets are powerful tools to prevent cardiovascular disease, less is known about the impact of diet on people who already have the disease. People with the healthiest diets—those with the highest intakes of fruit, vegetables, whole grains, nuts, and a higher intake of fish relative to meat poultry and eggs—were 35% less likely to die from a repeat heart attack or stroke during the length of the study, compared with those with the least healthy diets, according to the five-year study of 32,000 people in 40 countries.”

For second opinion, consult a computer? (The New York Times) – “Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition? The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data. And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

A royal spotlight on a rare condition (The New York Times) -“News that the Duchess of Cambridge, the former Kate Middleton, is pregnant spurred headlines and excitement around the world on Monday, but the exuberance was tempered by word that the mother-to-be has been hospitalized with a rare form of severe morning sickness. Most people have never heard of the condition, called hyperemesis gravidarum or H.G., now getting worldwide attention. To learn more, we spoke with Dr. Marlena Fejzo, an obstetrics researcher at the University of California, Los Angeles. Dr. Fejzo twice experienced H.G. during her own pregnancies and is an adviser and board member for the Hyperemesis Education and Research Foundation. We talked about the risks of H.G., why it happens and whether its occurrence can predict the sex of the baby. Q. What is hyperemesis gravidarum? A. It’s severe, debilitating nausea and vomiting in pregnancy that generally leads to more than 5 percent weight loss and requires fluid treatment. Sometimes, in more extreme cases, it requires nutritional supplements.”

Daily Rounds: 3D Digital Breasts; Medical Cost Detective; Facebooking Diabetes; Hot Fitness Gifts

Digital 3-D mammograms show promise (The Boston Globe) – “With mammograms coming under harsh scrutiny in recent years for failing to detect some breast cancers while also raising false alarms that warrant biopsies, imaging device manufacturers have been racing to get better breast cancer screening tools into clinical practice. So far, a new digital 3-D mammogram — called breast tomosynthesis — has shown the most promise in dramatically reducing the number of women called back for suspicious-looking findings that turn out to be benign and detecting tumors not revealed on the traditional 2-D X-ray. But the potential benefits of the new technology remain up for debate, since it arrives as the value of mammography screening is being questioned.”

A health insurance detective story (The New York Times) – “After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year? The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.”

Social media helps diabetes patients (and drugmakers) connect (NPR) – “When Kerri Sparling was 7 years old, she was diagnosed with Type 1 diabetes. Her family didn’t know anyone with the disease, so they sent her to diabetes camp — “where every single camper had Type 1 diabetes,” she says. “That was my first sense of not only other people who had diabetes, but a true community,” says Sparling. Things are very different today. About 26 million Americans have diabetes — mostly Type 2 — and the Centers for Disease Control and Prevention predicts that as many as one-third of adults could have diabetes by 2050. People living with diabetes have created a vibrant online community. Big drug companies are certainly taking notice — and some advocacy groups feel that the Food and Drug Administration should as well.”

Holiday fitness gifts trend from high-tech to basic (Reuters) – “Looking for the perfect holiday present for a fitness fan? Gift offerings this year range from apps that can store a run in the country to be viewed later to gadgets so sophisticated they measure quality of sleep as well as calories burned. There is also the revival of the humble foam roller, which experts say, like old-time push-ups, squats and planks, has never been more popular. Anita Golden, fitness manager at a Crunch gym in New York City, said she’ll be giving clients a foam roller called the GRID.”

Daily Rounds: Glassy Lipitor; AIDS-Free Generation; Fast-Melting Ice Sheets; Starbucks’ $7 Grande

Maker of Generic Lipitor Halts Production (The New York Times) “Ranbaxy Pharmaceuticals, the largest producer of the generic version of Lipitor, has halted production of the drug until it can figure out why glass particles may have ended up in pills that were distributed to the public, the Food and Drug Administration announced Thursday. The agency said it had not received any reports of patients being harmed by the particles, which are about the size of a grain of sand. Earlier this month, Ranbaxy recalled more than 40 lots of the drug because of the glass contamination. The company has declined to say where the drug was manufactured or why the problem occurred, but a spokeswoman for the F.D.A. said Thursday that the company would stop making the pill’s active ingredient, which is made in India, until the investigation is completed.”

Clinton Reveals Blueprint For Reaching An ‘Aids-Free’ Generation (The Washington Post) — “The world can control the AIDS epidemic in four or five years and set it on a trajectory to become a small, if permanent, problem, according to a State Department document made public Thursday. An “AIDS-free generation” — a goal that Secretary of State Hillary Rodham Clinton touted a year ago — could be reached by starting more infected people on AIDS drugs, circumcising men in high-prevalence countries and making sure that every HIV-positive pregnant woman is treated.”

Polar Ice Sheets Melt Faster (The Wall Street Journal) — “Higher temperatures over the past two decades have caused the polar ice sheets to melt at an accelerating rate, contributing to an almost half-inch rise in global sea levels, according to the most comprehensive study done so far. Scientists long have struggled to get a fix on whether the permanent ice sheets of Greenland and Antarctica are gaining or losing ice. Past satellite-based measurements either were limited in scope or suffered from methodological inconsistencies. The new study, published Thursday in the journal Science, estimates that the melting of the ice sheets as a whole has raised global sea levels by 11.1 millimeters (0.43 inch) since 1992. That represents one-fifth of the total sea-level increase recorded in that period.”

Starbucks $7 Cup of Joe’s Jolting (The Boston Herald) — “How deep are coffee lovers willing to dig for a cup? Starbucks is pushing the limit with the latest offering from its “Reserve” line of premium coffee. A 16-ounce “grande” cup of its Costa Rica Finca Palmilera is selling for $7. The Seattle java giant attributes the jolting price to the rarity of the Geisha coffee, a naturally low-yielding, heirloom varietal that only grows at extremely high altitudes. “This price is based on limited availability and appeals to a particular audience, like one who loves sampling boutique wines that are available in limited quantities,” spokeswoman Alisa Martinez said. The coffee is only being sold in 46 Starbucks in Seattle and Portland, Ore. Good thing, because bean-heads in South Boston’s Seaport District roasted the new offering yesterday. “It’s ridiculous,” said Vanessa Eusse of Everett, a 23-year-old restaurant server and self-described Starbucks fanatic who prefers lattes. “That’s way too much — unless it had little pieces of gold in it.”

Daily Rounds: Medicare Electronic Flaws; Mayor Works On Walking; Cough Vaccine Fades; Immortal Jellyfish

Medicare is faulted on shift to electronic records (The New York Times) – “The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators…The report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.”

Menino in 3 hours of physical therapy a day (The Boston Herald) – “Mayor Thomas M. Menino is walking “with assistance” and is doing three hours of physical therapy daily as he tries to regain mobility lost during a monthlong hospital stay. “He’s not walking as well as he wants to, but he’s walking,” said Menino spokeswoman Dot Joyce. “With his therapy, he’ll be better than he was before (his hospitalization).” Menino was hospitalized Oct. 26 after returning home early from a vacation in Italy. The mayor had a flulike virus and a blood clot and suffered a compression fracture in his back while in the hospital. He also sustained an infection in his back, the source of which has not been determined, Joyce said. Doctors also discovered he has type 2 diabetes, which was exacerbated by the stress of his illness.”

More evidence suggests shortcomings for whooping cough vaccine (NPR-Shots) – “Whooping cough went on a tear in California back in 2010. There were more than 9,000 pertussis infections in the state, a 60-year high. In recent years, there has been a resurgence of the disease across the country.Why? Some people aren’t getting immunized. And it’s also probably the case that more sensitive tests and greater awareness of whooping cough are spurring doctors to do a better job of diagnosing it. Another factor may be that the vaccines kids get to protect them against the respiratory illness appear to be losing their effectiveness faster than expected. Results from a study that compared California kids who got whooping cough with some who didn’t adds more weight to that hypothesis.”

Can a jellyfish unlock the secret of immortality? (NYT Magazine) “One of the paper’s authors, Ferdinando Boero, likened the Turritopsis to a butterfly that, instead of dying, turns back into a caterpillar. Another metaphor is a chicken that transforms into an egg, which gives birth to another chicken. The anthropomorphic analogy is that of an old man who grows younger and younger until he is again a fetus. For this reason Turritopsis dohrnii is often referred to as the Benjamin Button jellyfish. Yet the publication of “Reversing the Life Cycle” barely registered outside the academic world. You might expect that, having learned of the existence of immortal life, man would dedicate colossal resources to learning how the immortal jellyfish performs its trick. You might expect that biotech multinationals would vie to copyright its genome; that a vast coalition of research scientists would seek to determine the mechanisms by which its cells aged in reverse; that pharmaceutical firms would try to appropriate its lessons for the purposes of human medicine; that governments would broker international accords to govern the future use of rejuvenating technology. But none of this happened.” Continue reading

Daily Rounds: Tobacco Lies; $332M Lab Scandal; Doctor Shortage; Grapefruit Danger

Tobacco companies are told to correct lies about smoking (AP in NYT) — “A federal judge on Tuesday ordered tobacco companies to publish corrective statements that say they had lied about the dangers of smoking and that disclose smoking’s health effects, including the death on average of 1,200 people a day. The judge, Gladys Kessler of United States District Court for the District of Columbia, previously said she wanted the industry to pay for corrective statements in various types of advertisements. But Tuesday’s ruling is the first time she laid out what the statements will say. Each corrective ad is to be prefaced by a statement that a federal court has concluded that the defendant tobacco companies “deliberately deceived the American public about the health effects of smoking.”

Cost soars in Mass. drug lab scandal (The Boston Globe) – “The state’s public defender agency estimates it could need up to $332 million to represent thousands of people who faced criminal penalties or civil sanctions based on evidence potentially tainted at the now-closed state drug laboratory in ­Jamaica Plain.The Committee for Public Counsel Services developed the budget projection as it seeks money from the Patrick administration to deal with the fallout from the drug lab scandal linked to chemist Annie Dookhan, who allegedly told State Police she falsified ­results.”

Will there be enough doctors to care for newly insured Americans? (Houston Bizblog) – “An estimated 50 million uninsured Americans soon will be eligible for health insurance coverage — most through Medicaid expansion or state health insurance exchanges — but a recent study to be published in the American Journal of Medical Quality finds there may not be enough doctors willing to care for them. Researchers from Mongan Institute for Health Policy at Massachusetts General Hospital found a significant percentage of the primary care physicians who are most likely to care for those soon-to-be insured under the Affordable Care Act may not be accepting new patients. About 28 percent of so-called safety-net physicians — doctors who see a significant number of Medicaid or uninsured patients — are not accepting new patients, according to the study.”

More drugs cited as a risky mix with grapefruit (NPR-Shots) – “Grapefruit sprinkled with a little sugar has just the right amount of kick for a morning meal. But when the bitter fruit is mixed with medication, things can get a bit tricky. Compounds in grapefruit can dramatically change how some popular drugs work in the body. And the number of drugs that can have severe side effects when combined with grapefruit has more than doubled in the last four years, says a study published Monday in the Canadian Medical Association Journal. Consuming grapefruit while taking certain drugs can produce an overdose effect. “Taking one tablet with a glass of grapefruit juice is like taking five tablets with water,” says David Bailey, a pharmacologist at the Lawson Health Research Institute in London, Ontario.”

Daily Rounds: Speedy Teen Birth Control; Robotic Arm Struggles; Sex Trafficking Survivor; Peanut Butter Crackdown

Prescribe Morning After Pill For Teens Before They Need It, Doctors Say (NPR) — “The nation’s largest group of pediatricians is urging its members to write prescriptions in advance to enable teenagers to have fast access to the so-called morning-after birth control pill. “Emergency contraception is an important backup method for all teenagers,” says a policy statement issued by the American Academy of Pediatrics. “Advanced provision increases the likelihood that teenagers will use emergency contraception when needed, reduces the time to use and does not decrease condom or other contraceptive use.”

Learning To Accept, And Master, A $110,000 Prosthetic Arm (The New York Times) — “While prosthetic leg technology has advanced rapidly in the past decade, prosthetic arms have been slow to catch up. Many amputees still use body-powered hooks. And the most common electronic arms, pioneered by the Soviet Union in the 1950s, have improved with lighter materials and microprocessors but are still difficult to control. Upper limb amputees must also cope with the critical loss of sensation. Touch — the ability to differentiate baby skin from sandpaper or to calibrate between gripping a hammer and clasping a hand — no longer exists. For all those reasons, nearly half of upper limb amputees choose not to use prostheses, functioning instead with one good arm. By contrast, almost all lower limb amputees use prosthetic legs. But Corporal Gallegos, 23, is part of a small vanguard of military amputees who are benefiting from new advances in upper limb technology. Earlier this year, he received a pioneering surgery known as targeted muscle reinnervation that amplifies the tiny nerve signals that control the arm. In effect, the surgery creates additional “sockets” into which electrodes from a prosthetic limb can connect.”

From Victom To Survivor To Leader, A Former Sex Trafficking Victim Speaks Out (The Boston Globe) — “Graves, a victim of savage exploitation by a child prostitution ring, left her hometown in 2009 following her crucial testimony in a federal case against the pimps who abused her and other girls. She hoped anonymity and several hundred miles of separation would keep retribution at bay. The 24-year-old woman still has scars — most visibly the one on her cheek left by a pimp with a potato peeler, marking her as his property. And she still steers clear of Boston, with its dark memories and, for her, special risks. But she is no longer in hiding. Instead, Graves is speaking out, a crusader against the commercial exploitation of children. “I got over the fear of becoming of a victim of trafficking,” she said during a recent interview. “If one girl sees my story and it impacts one girl’s life, I am doing something productive.”

FDA suspends operations at New Mexico peanut butter plant linked to salmonella (Fox News) — “The Food and Drug Administration is cracking down on a New Mexico peanut butter plant that had repeated food safety violations over several years, using new authority to halt operations at facilities that may be producing unsafe food. The agency on Monday suspended the registration of Sunland Inc., which is the country’s largest organic peanut butter processor. FDA officials found salmonella in numerous locations in Sunland’s processing plant after 41 people in 20 states, most of them children, were sickened by peanut butter manufactured at the Portales, N.M., plant and sold at the Trader Joe’s grocery chain. The company had announced plans to reopen its peanut processing facility on Tuesday after voluntarily shutting down earlier this fall. The FDA gained the new authority to suspend companies’ registrations in a food safety law signed by President Barack Obama in early 2011, and this is the first time the agency has used it.”

Daily Rounds: Neurology Cuts; Pot Shop Bans; Bouncy House Risk; From Harvard To Heaven?

Medicare payment changes draw fire (The Boston Globe) – “Neurologists criticize cuts in payment from Medicare Neurologists in Boston and nationwide are objecting to a plan that would pay them less for certain diagnostic tests, a change meant to cut Medicare costs and direct more money to primary care physicians whose pay is widely seen as inadequate even before they take on more work under the national health care overhaul. The neurologists are asking federal regulators to reconsider the plan and argue that the cuts, made under a provision of the Affordable Care Act, could undermine patient care and limit access to neurology services. The debate highlights the short-term pain and pressure expected from changing the way health care is paid for, a process certain to produce winners and losers.”

Some Bay State towns look to ban pot shops (The Boston Herald) – “City and town leaders feeling burned by the state’s new medical marijuana law are rolling out bans and restrictions to keep pot shops out of their neighborhoods. Wakefield and Reading banned dispensaries last week and Melrose held a public hearing to consider a similar law earlier this week. Peabody also is reportedly mulling a ban. Boston City Councilor Rob Consalvo told the Herald he plans to introduce a proposal Wednesday to keep medical marijuana stores near hospitals. They’re all rushing to beat the Jan. 1 pot law.”

Child injuries skyrocket on inflatable bouncers (USA Today) – “The rate of injuries to children on inflatable bouncers increased fifteenfold from 1995 to 2010, according to a report Monday in the journal Pediatrics.The moonwalks, slides and bounce houses are popular entertainment at young children’s birthday parties and carnivals, but the toll they are taking on the young is “epidemic,” says lead author Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. In 2010 alone, 30 children a day were treated for these injuries in hospital emergency departments, the report says. The number of injuries increased from 702 in 1995 to 11,311 in 2010. Falls were the most common cause, followed by stunts and collisions. Smaller children are a greater risk.”

And in the older set: After dozens of deaths, inquiry into bed rails (The New York Times)

Readers join doctor’s journey to the afterworld’s gates (The New York Times) – “For years Dr. Eben Alexander III had dismissed near-death revelations of God and heaven as explainable by the hard wiring of the human brain. He was, after all, a neurosurgeon with sophisticated medical training. But then in 2008 Dr. Alexander contracted bacterial meningitis. The deadly infection soaked his brain and sent him into a deep coma. During that week, as life slipped away, he now says, he was living intensely in his mind. He was reborn into a primitive mucky Jell-o-like substance and then guided by “a beautiful girl with high cheekbones and deep blue eyes” on the wings of a butterfly to an “immense void” that is both “pitch black” and “brimming with light” coming from an “orb” that interprets for an all-loving God. Dr. Alexander, 58, was so changed by the experience that he felt compelled to write a book, “Proof of Heaven,” that recounts his experience.”