Ouch. That’s what I was saying during several of the graphic tooth-pulling and surgery scenes of “The Ether Dome,” a play about the origins of modern anesthesia now running at the Calderwood Pavilion in the South End through Nov. 23.
And that’s also what I said when I read this devastating but (in my opinion) perfectly on-point line in Carolyn Clay’s review of the show on WBUR’s arts blog, “The Artery”: “…it seems clear that the dramatist needs to administer some pain balm to herself, pick up scalpel and saw, and hack a few limbs off baby.”
Clay’s review begins:
BOSTON — You won’t require anesthesia to get through “Ether Dome,” Elizabeth Egloff’s relatively new play built on the introduction of ether — right here at Massachusetts General Hospital in 1846 — to alleviate the horrific pain of surgery. But neither will you be held to the edge of your lecture-hall seat (we the audience are medical-student observers in the dome). The three-act play is so diffuse, with at least four questionable protagonists, that there is really no one to root for — except, of course, the ether, which both transformed Hippocratic barbarism into a pretty smooth ride and started the medical ball rolling in the direction of big business.
As an utterly amateur theater-goer who was drawn to the show by the medical history, I humbly concur. It was a great pleasure to watch some of the grand old men of Massachusetts General, men whose names now grace the hospital’s buildings, brought to life in all their quirky, grumpy, brilliant glory. But I did wish for more of an editorial scalpel. Read the full “Artery” review here: The Huntington’s Ether Dome Won’t Put You To Sleep.
By Alvin Tran
Becoming a doctor was never easy. There’s stress, there’s no sleep, there’s life and death. But now, that already tough career path will get even more complicated with the introduction of a new, far longer version of the Medical College Admission Test, aka, the MCAT.
Just ask premed Charles Denby, who panicked when he recently went online to sign up for the test and found all the sites in the U.S. were booked into January 2015. Why is that a problem? Well, that’s when the old, familiar four-hour MCAT takes a short hiatus and then morphs into a newfangled, nearly 7-hour version of the test that most students must take in order to get into medical school.
Denby, a 36-year-old consultant who is now pursuing a medical career, was not amused by the prospect of facing the new test. It’s “a curveball I wasn’t expecting,” he said in an interview from his home in Providence, R.I. Denby is hoping someone local will opt out of taking the test at the last minute so he can get a spot; though he briefly considered getting on a plane to avoid the new exam. “Germany and Israel are available for January right now,” he said.
Germany? Israel? Isn’t the MCAT stressful enough without getting on a plane and switching time zones?
Barbara Moran, a pre-med student in Brookline, Mass., who recently completed Kaplan’s MCAT prep class, was stunned to hear that her classmates were planning to travel to Indiana and South Dakota to take the exam. Moran, who took the exam October 21, had reserved her seat in Boston months ago. “I suddenly realized I was sitting on the hottest ticket in town,” said Moran. “It was like having a seat at a Yankees-Boston World Series game.”
The soon-to-be-extinct four-hour exam now tests students’ knowledge of chemistry, physics, biology, organic chemistry and verbal reasoning; and also their nerves, as they watch the clock tick down while struggling to recall obscure equations. Now they’ll have to endure that anxiety even longer: the new test is nearly 7 grueling hours long.
The Association of American Medical Colleges (AAMC), which administers the MCAT, approved changes to the test in 2012.
One of the most significant changes is the inclusion of the new section that tests students’ understanding of the socio-contextual determinants of health — essentially asking students to think beyond the specifics of the patient’s body, and consider how income and social status, education, home and work environments and other factors shape health outcomes.
“Testing students’ understanding of these areas is important, because being a good physician is about more than scientific knowledge,” Dr. Darrell Kirch, AAMC President and CEO, stated in a 2012 online letter to premed students. It is about understanding people — how they think, interact, and make decisions.”
Other big changes to the MCAT include new introductory biochemistry questions and a section that asks students to critically analyze written passages from non-medical arenas — humanities and social sciences, philosophy and ethics.
“The new exam is really designed to help medical school admissions people select students who are academically prepared for the curriculum they’ll experience in 2016,” said Karen Mitchell, the AAMC’s senior director of admissions testing services. “The exam kind of shifts the focus from testing what students know to testing how well they can use what they know.”
Still, she acknowledges the impulse to take the more familiar exam: “The devil you know is better than the one you don’t,” she says.
Moran, of Brookline, says that many of her fellow students are desperate to take the current exam, because nobody knows exactly what the new MCAT holds in store. “I talked to a pre-med advisor about it and she said, ‘No matter what you do, take the current exam.’” Also, she adds, “seven hours, seriously? I’d pass out from dehydration!”
The AAMC surveyed more than 2,700 medical faculty, residents, and students to help formulate the new test, Mitchell says.
“It’s good practice in standardize testing to look at your test every 10 or 15 years to make sure that it continues to measure the most important things in the most capable ways and that time had come for the MCAT,” Mitchell said.
The AAMC did, in fact, announce a new date for the old test: December 6th, 2014. Now, it seems, due to popular demand, more spots for the old test may open up.
From the website:
To address the recent spikes in registration for the current MCAT exam, the AAMC added one additional administration date on Saturday, December 6. With this additional date, we will have added 50,000 seats between September 2014 and January 2015 to accommodate examinees who wish to take or re-take the current version of the exam. Nearly all of these seats have been available for registration since February 2014 so that students could plan accordingly. We will also be adding a very limited number of additional seats to the existing January exam dates in key locations to meet the high demand listed below. Adding seats takes time to set up and will be added to the MCAT Scheduling and Registration System in early November. We will send out an announcement via Twitter (@AAMC_MCAT) when these seats become available. The last administration of the current exam will be January 23, 2015.
And on Wednesday night, this message appeared on Twitter:
UPDATE: Adding #MCAT seats takes time to set up. ALL seats for Jan dates will be added in ~2 weeks & will be announced accordingl[y]
According to Eric Chiu, Kaplan Test Prep’s executive director of pre-medical programs, students generally take their MCAT in the spring semester of their third year of college. This year, however, he’s seeing many students scrambling to take the test before it changes.
Barbara Moran said her experience with the Oct. 21 MCAT underscored just how seriously the test is taken. She and her fellow wannabe doctors were searched and finger-printed as they entered the testing room, she said; her socks were checked, and her sleeves, and she was told that she could bring in an extra pony-tail holder on her hair or her wrist, but not in her pocket.
“I felt like a criminal,” she said.
But all that is behind her now. “Thank God I’m done,” she said. “I’m so glad I never have to think about that test again..”
A new study commissioned by the U.S. Army has found that the mental health of soldiers isn’t as different from civilians as the researchers previously thought.
Earlier this year, researchers said that soldiers, who were surveyed at different times during their Army careers, had higher rates of mental disorders before they enlisted than the rates of mental illness in the general population.
The new study says the soldiers are more likely to have only certain mental illnesses. But it raises questions about military service causing suicidal tendencies to become chronic.
One of the researchers, Ronald Kessler, a professor of health policy at Harvard Medical School, joined WBUR’s All Things Considered to discuss the findings. Listen to the full conversation above.
If you used Uber in Boston today, you may have noticed a new feature. The car service company was offering what it calls UberHEALTH to bring free flu shots to users’ doors.
The service was part of a one-day pilot program in Boston, New York and Washington D.C., the company announced on its blog.
“We thought Boston, D.C., New York are big health care hubs [with] high populations of people and we are all experiencing the same nor’easter as we speak, signalling the start of flu season, so we thought this could be a few interesting cities to launch an Uber health program and see how it went,” Uber Boston general manager Meghan Joyce said in an interview.
The pilot lasted from 10 a.m. to 4 p.m. Here’s how it worked: When you opened the Uber app there was a health option in addition to the regular car service options. If you selected the health option and requested a car, a driver would arrive at your location with a registered nurse from Passport Health, which provides mobile immunization services. At that point you would receive a flu prevention pack and could get a flu shot from the nurse. According to Uber, each car request could serve up to 10 people and the flu shots were available for those ages 4 and up. Any paperwork and consent forms were handled by the nurses. Uber said it would donate $5 to the Red Cross for every shot given.
It is unclear how well the program did. Joyce said they “don’t release specific numbers,” but said the demand was overwhelming. She said the company will discuss extending the pilot program.(Note: I tried to access UberHealth for more than two hours today, but was unable to request the service. It appears I’m not the only one either and others could not access it.)
For today’s health program, Uber collaborated with medical professionals around Boston, including Dr. John Brownstein, an associate professor at Harvard Medical School. Brownstein runs a research group that created a tool called Vaccine Finder, which provides information about where you can get a vaccine. The UberHEALTH project has been in the works for months and his research group collaborated with the Centers for Disease Control, the U.S. Department of Health and Human Services and Passport Health. Brownstein said his group decided to connect with Uber to utilize the reach of their platform and deliver health care in a different way.
“This is really an exciting mechanism to take through, where you can distribute this kind of prevention or medical care without having to have the population move around the city and crowd in places or deal with lack of supply in particular locations,” Brownstein said. “This is really a paradigm shift in the way we think about distribution of prevention.”
A spokeswoman for the Massachusetts Department of Public Health said the agency was not involved in UberHEALTH and state approval was not needed for the program. The spokeswoman also said the department encourages everyone 6 months of age or older to get a flu shot.
While this is the first time Uber has offered such a health program, the company has used the app to offer everything from lunch to ice cream to pharmacy goods in other cities, Joyce said. Last summer Uber Boston partnered with Boston Harbor Cruises to offer UberBOAT, which provided water transportation services.
Did you try UberHEALTH today? If so, tell us about your experience in the comments below.
By Jon D. Lee
Nearly five years ago, during the peak of the H1N1 — Swine Flu — pandemic, a joke appeared on the Internet based on the nursery rhyme “This Little Piggy.”
The joke (clearly for public health insiders) was intended to comment on the similarities between Swine Flu and Avian Flu, and it concluded this way:
And this little piggy went “cough, sneeze” and the whole world’s media went mad over the imminent destruction of the human race, and every journalist found out that they didn’t have to do too much work if they just did “Find ‘bird’, replace with ‘swine’” on all their saved articles from a year ago, er, all the way home.
The punch line makes an important point about the recycling of stories. But for all of its insight into this phenomenon, the joke doesn’t end up taking the lesson far enough.
Because it’s not just the media that recycles stories — it’s all of us.
In An Epidemic of Rumors: How Stories Shape Our Perceptions of Disease, I conducted an extensive study of the narratives — the rumors, legends, conspiracy theories, bits of gossip, etc.—that circulated during the H1N1, SARS, and AIDS pandemics.
The results showed that all three pandemics were rife with rumors that, though created decades apart, had striking similarities. Every disease had a story claiming a government conspiracy or cover-up. Every disease had a list of sure-fire cures and treatments “they” don’t want you to know about. Every disease had false and inaccurate stories about where it had spread to and who was infected.
But mostly, and perhaps most damaging, every disease had stories about who was ultimately to blame, and these usually devolved into racism and xenophobia with terrifying rapidity. AIDS was blamed on homosexuals, SARS was blamed on the Chinese, H1N1 was blamed on Latinos. And the members of those groups were stigmatized and treated differently as a consequence.
One SARS story came from a woman in Toronto, Canada, who said when her Chinese roommate (who did not have the disease) “was on the subway…she’d describe several times sitting down beside somebody and having them get up and move over.” I collected similar stories from Latinos during H1N1. And anyone who lived through the ’80s will remember the stories about AIDS being a punishment from God against the gay community.
When I began the research for this book, I was surprised at the amount of narrative repetition I uncovered. But I ultimately concluded that such repetition makes sense: when confronted with an unfamiliar disease, it seems only logical that, consciously or unconsciously, we return to the narratives of familiar diseases to learn how to cope with the unfamiliar.
Now a new disease has captured our attention: Ebola. The media coverage is everywhere, as is the public panic — there have been at least 5,000 Ebola false alarms since late September. The disease has even become so important that some political pundits claim that November’s general elections may be won by whichever party appears to be better controlling (or perhaps just assuaging the public’s fear about) the outbreak.
When I wrote An Epidemic of Rumors, the current Ebola epidemic hadn’t even begun. But the similarities I found between the AIDS, SARS, and H1N1 narratives are quickly mapping themselves onto this new disease, and the stories people are telling are unsurprisingly familiar.
Consider the conspiracy theories alone. In August and September of this year, a rumor spread throughout Nigeria blaming Europe and America for creating the disease. A similar story from Liberia specifically points its finger at the U.S. Department of Defense for funding Ebola trials on humans.
Closer to home, both right-wing radio talk show hosts Michael Savage and Rush Limbaugh have claimed on air that President Obama is deliberately encouraging the outbreak — Savage because it’s part of Obama’s “war on white people”, and Limbaugh because Obama is getting back at Americans for their history of slavery. Right-wing commentator Morgan Brittany takes the discussion one step further by claiming that Obama is attempting to create a national panic so that he can declare martial law, seize Americans’ guns, and control the population.
These stories bear a marked resemblance to the rumors that Saddam Hussein and/or the New World Order created SARS to decimate and control the world, that the spread of H1N1 was similarly encouraged by the government to control the population, and that the AIDS virus was purposely introduced into the gay community to control its spread.
Another Ebola conspiracy theory states that the outbreak is being encouraged by pharmaceutical companies as a money-making scheme, as well as a smokescreen to cover up new studies which “prove” that the MMR vaccine causes autism. At least the former claim was also made during H1N1, with rumors that then-Secretary of Defense Donald Rumsfeld was stimulating the outbreak because of his status as the former CEO of Gilead, producer of a key H1N1 vaccine.
At the heart of many of these conspiracy theories, as well as other Ebola rumors, are deep-seated overtones of racism and blame. The Obama-Ebola links alone providing overwhelming evidence of this, but it extends far beyond the President. Similar racist narratives have peppered almost every major modern outbreak: in September of 2012, when the World Health Organization first identified the MERS-CoV outbreak in Saudi Arabia, one of the first CNN news articles detailing the story had as its opening reader comment, “More proof that Muslims are dirty people ruining the planet.” And I collected dozens of SARS narratives warning people to “Avoid going to ASIAN areas!!!”
Of course, what underlies all of these narratives, regardless of the disease, is a single emotion: fear. It’s fear that drives the creation of these stories, fear that leads to their continued circulation, and fear that will bring around the next batch of rumors for the next big outbreak, whatever that happens to be.
And I’ll bet those rumors are going to be eerily familiar as well.
Jon D. Lee has a Ph.D. in Folklore, and lectures at Suffolk University and Stonehill College.
Colleges remain inconsistent in the way they handle athletes’ concussions, according to a Harvard University study that comes more than four years after the NCAA began requiring schools to educate their players about the risks of head trauma and develop plans to keep injured athletes off the field.
In a survey that included responses from 907 of the NCAA’s 1,066 members, researchers found that nearly one in five schools either don’t have the required concussion management plan or have done such a poor job in educating their coaches, medical staff and compliance officers that they are not sure one exists.
“Collectively, the institutions without a concussion management plan are responsible for the well-being of thousands of college athletes each year,” according to the study co-written by Harvard researcher Christine Baugh and published this week in the American Journal of Sports Medicine. “For stakeholders to follow an institution’s concussion management plan – or to have confidence that others are following the plan – they must first know that it exists.”
The findings in the study reinforce the images fans have seen in stadiums since the problem with concussions became more widely known: Wobbly players are sent back onto the field without proper medical clearance as coaches remain ignorant to their injury – perhaps willfully. The authors recommend that the NCAA bolster its 2010 policy to require schools to make their plans public, to better educate coaches about concussion symptoms and to require that schools not only come up with plans but actually apply them.
“As written, the NCAA concussion policy only requires the presence of a plan and not that the plan is actually implemented,” the study says. “Perhaps the most important next step is for the NCAA to revise the language of its concussion policy to reflect the necessity of plan implementation.”
The most troubling implication of the study, though one its authors stopped short of concluding, may be found in the gap between the 90 percent of schools where athletes were told of their duty to report concussion symptoms and the 71 percent where athletes were educated about concussions themselves. The discrepancy creates a suspicion that schools are more interested in avoiding concussion lawsuits than sincerely educating their players.
“Athlete acknowledgement may function as a means through which member schools aim to limit their institutional liability or as a strategy to encourage positive athlete concussion reporting behaviors,” the study said, adding that for the latter to succeed “acknowledgement should be paired with appropriate education.”
The examination of the NCAA concussion policy involved a survey that was sent to more than 32,000 coaches, compliance officials and members of the sports medicine staff at all 1,066 member schools. The 2,880 responses revealed wide gaps in the way the policy has been implemented.
The authors received responses from five schools reporting that they do not have a concussion management plan, from 19 others schools where individuals were unsure and from 138 schools where the answers were inconsistent. The authors called for better education and communication, “at minimum.”
The study also noted that the NCAA policy is unlikely to be effective if violations are discovered only when a school turns itself in. The authors also encourage the NCAA to require schools to make public their concussion management plan; it’s now voluntary.
Another red flag: About 15 percent of those who responded to the survey said coaches or athletes had the final say in deciding when it was safe to return to play; either a physician or someone designated by a physician is supposed to have that authority. The researchers said they could not conclude that this was a problem, because it’s possible that players and coaches could decide to stay out even after receiving medical clearance.
Although almost all – 98.7 percent – of those responding said the school’s concussion plan protected athletes either well or very well, more than three-quarters of the total also said their school needed improvement in coach or athlete education or better staffing in the sports medicine department.
“Although providing athletes with any information about concussions is a positive step, it is concerning that even minimal levels of information” are not universally provided, the authors wrote. As a solution, they recommended that the education be standardized and include content on the possible short- and long-term effects of concussions.
It is no wonder that we get a large number of questions about landlord-tenant law at the Law Library of Congress, in light of the fact that residential leasing, and the rights and obligations that stem from such agreements, is a pressing legal issue for many of our patrons. Much of landlord-tenant law is state-specific, and as such, those wanting to do detailed legal research in this area might want to visit their local public law library. However, we have collected some information below regarding books, websites, and other resources, that might help a researcher just beginning their landlord-tenant research.
- Landlord and Tenant Law in a Nutshell, by David S. Hill & Carol Necole Brown
- Friedman on Leases, by Milton R. Friedman
- Real Estate Leasing Practice Manual
- Landlord Tenant Law Bulletin
- Leases & Rental Agreements
- American Law of Landlord and Tenant, by Robert S. Schoshinski
- Real Property Leases: A Complete Forms & Drafting Guide
- Single-Family Lease Options: Opportunities and Hazards, by John T. Reed
- The Complete Book of Real Estate Leases, by Mark Warda
- Renters’ Rights: The Basics, by Janet Portman & Marcia Stewart
- Every Tenant’s Legal Guide, by Janet Portman & Marcia Stewart
- American Tenant: Everything U Need to Know About Your Rights as a Renter, by Trevor Rhodes
- Your Rights as a Tenant, by Margaret C. Jasper
- Every Landlord’s Legal Guide, by Marcia Stewart, Ralph Warner & Janet Portman
- The Complete Landlord & Property Manager’s: Legal Survival Kit, by Diana Brodman Summers
- Secrets to a Successful Eviction for Landlords and Rental Property Managers: The Complete Guide to Evicting Tenants Legally and Quickly, by Carolyn Gibson
- Landlord Legal Forms Simplified, by Daniel Sitarz
- The Weekend Landlord: From Credit Checks to Evictions and Everything in Between, by James A. Landon
- The Landlord’s Book of Forms and Agreements, by Cliff Roberson
- Real Estate Law, by Robert J. Aalberts & George J. Siedel
As mentioned above, many of the laws in the area of rental leasing are state-specific. Thus, to find more resources regarding this topic, you might want to search the WorldCat catalog, or your local law library’s catalog, to find more resources specific to your area. We suggest the following subject headings:
- Landlord and tenant–[State Name]
- Landlord and tenant–United States
- Landlord and tenant–United States–Forms
- Leases–[State Name]
- Leases–United States
- Leases–United States–Forms
- Rental housing–United States–Management
- Landlords–United States–Handbooks, manuals, etc.
To locate additional resources using these subject headings in the Library of Congress catalog, please click here to use our catalog and browse subject headings. Click “browse” and use the drop-down to select “SUBJECTS beginning with” or “SUBJECTS containing,” and then input a subject heading using one of the examples shown above. Finally, click on a result and you can browse the materials classified under that subject heading.
Luckily, there are also many free websites that offer helpful information about landlord-tenant law, including:
- Landlord-Tenant Law, Cornell Legal Information Institute – Wex Legal Encyclopedia
- Tenant Rights, U.S. Department of Housing and Urban Development
- Overview of Landlord-Tenant Laws In Your State, Nolo
- Landlord and Tenant, Justia
- Landlord Tenant Law, FindLaw
- LawHelp provides a directory of legal aid organizations, many of which handle landlord-tenant issues
In addition, we urge researchers to use the internet search engine of their choice to search for landlord-tenant law for their area. Many state and local governments have produced landlord-tenant handbooks, guides, and other similar resources, that clearly explain the landlord-tenant laws in their jurisdiction.
We wish you the best of luck with your research regarding landlord-tenant law. If you have any questions regarding your legal research, please contact the Law Library of Congress. Also, if there are any other landlord-tenant law resources you have found to be helpful, let us know by making a comment below!
One of the country’s leading medical journals is withdrawing support for a Brigham and Women’s Hospital physician nominated by President Obama to become the next surgeon general.
Although we believe that Vivek Murthy would bring much to the job, the harsh political environment in Washington is unlikely to allow his confirmation. Given this impasse, and in these critical times, the Obama Administration should select another candidate to be the nation’s public health leader.
Murthy’s nomination has languished for months, a target of the National Rifle Association which objects to Murthy’s view that gun violence is a public health issue.
The NEJM editorial says the country needs a surgeon general now who can speak to the public with authority about Ebola, the coming flu season and various viral outbreaks such as Enterovirus D68.
There is no response yet from Murthy or the White House.
Dr. Greg Curfman, NEJM’s executive editor, joined WBUR’s All Things Considered to explain the abrupt change. Listen to his full conversation with WBUR’s Deborah Becker above.
I’m not young or edgy enough to hang out with anyone who smokes e-cigarettes, but I’ve been vaguely aware that they’re a big and growing thing, and the focus of a big and growing controversy. To wit: Do they end up a net positive, because they help people quit the classic “cancer sticks,” or a net negative, because they act as “gateway” cigarettes just when we’ve finally beaten our smoking rates down?
Answer: We don’t know yet. That’s my takeaway from a major multi-media project on electronic cigarettes on Boston University’s new research Website. But it’s such an important question that it’s even a source of debate between prominent researchers on campus — though both strongly concur that more research is needed. From “Behind The Vapor:”
At Boston University, Avrum Spira, a pulmonary care physician and School of Medicine associate professor of pathology and laboratory medicine and bioinformatics who studies genomics and lung cancer, was one of the first scientists to receive funding from the FDA to investigate the health effects of e-cigarettes. “In theor y—- and how they’re marketed — e-cigarettes are a safer product because they don’t have tobacco, which has known carcinogens,” Spira says. “The question is: does safer mean safe?”
Across BU’s Medical Campus from Spira, Michael Siegel, a physician and professor of community health sciences at the School of Public Health, has emerged as perhaps the country’s most high-profile public health advocate for e-cigarettes. Siegel, who is not currently researching e-cigarettes, says he believes that the device could potentially help large numbers of smokers quit, or drastically decrease, a habit that is the leading cause of preventable deaths in the US. He points out that despite all the existing smoking cessation products on the market, only a small fraction of cigarette smokers manage to quit. Only 4 to 7 percent break the habit without some nicotine replacement or medication, according to the American Cancer Society. At the same time, Siegel says, more research is needed on the health effects of e-cigarettes as well as their effectiveness in helping people quit smoking.
Check out the full project here, including the video above, “7,000 Flavors of Addiction.” And while you’re on the new Website, a couple of other particularly grabby features: The Secret’s In The Spit (the gluten-saliva link — who knew?) and The Secret Life of Neutrinos.
KHN reporter Jordan Rau spoke on NPR about data that say about 75,000 patients per year die from infections they got in the hospital. Nearly 700 hospitals around the U.S. have higher than expected infection rates.
Listen below to the interview:
It’s confusing. You hear that Ebola victim Thomas Eric Duncan was so contagious that two Dallas nurses in protective gear caught the virus. But then you hear, in more recent days, that apparently nobody else did, including the inner circle who lived with him and cared for him. The CDC announced today that all of Mr. Duncan’s “community contacts” have completed their 21-day monitoring period without developing Ebola.
How to understand that? And how to address alarmists’ claims that for the nurses and so many West Africans to have caught Ebola, it must have gone “airborne”?
I turned to Dr. Elke Muhlberger, an Ebola expert long intimate with the virus — through more than 20 years of Ebola research that included two pregnancies. (I must say I find this the ultimate antidote for the fear generated by the nurses’ infections: A researcher so confident in the power of taking the right precautions that she had no fear — and rightly so, it turned out — for her babies-to-be.)
Dr. Muhlberger is an associate professor of micriobiology at Boston University and director of the Biomolecule Production Core at the National Emerging Infectious Diseases Laboratories (widely referred to as the NEIDL, pronounced “needle”) at Boston University. Our conversation, lightly edited:
Is it really true you worked on Ebola through two pregnancies?More Ebola Coverage From CommonHealth:
- Opinion: Why America’s Ebola Fears Are Dangerously Misplaced
- Poll On Ebola Risk Finds Public Dazed
- For Hospitals And Clinics: Insurance To Protect Against Losses From Ebola
- 8 Things You Need To Know About Ebola
- What The Boston Marathon Response Can Teach Us About Ebola: 5 Lessons
- Boston Prepares Intensively For What-Ifs
- Partners In Health Leaps Into Ebola Crisis
Yes, but in the proper protective gear. That makes a huge difference, if you’re protected, if you know how to protect yourself, and that is the case in a Biosafety Level 4 lab, of course. If you compare the protective gear we’re wearing in a Biosafety Level 4 lab and the gear they’re wearing in West Africa now treating patients, it’s like comparing a stainless steel vault to a cardboard box.
But on the other hand, if you look at the nurses in Dallas, you say, ‘How did they get infected?’ It makes you worry that maybe protective gear isn’t good enough — but you’re proof of the opposite.
A Biosafety Level 4 lab is such a high-end lab, it is not possible to use protective gear like that in every hospital in the U.S.
Could you please lay out a brief primer on the biology of how Ebola is transmitted?
We know from previous outbreaks, and also from the current outbreak, that Ebola is transmitted by having very close contact to infected patients. So we know that it is transmitted by bodily fluids, which include blood, first of all — because the amount of virus in the blood is very, very high, especially at late stages of infection — but it’s also spread by vomit, by sputum, by feces, by urine and by other bodily fluids.
The reason for that is that at late stages of infection, the Ebola virus affects almost all our organs — it causes a systemic infection. One main organ targeted by Ebola virus is the liver, and that could be one of the reasons that we see these very high concentrations of viral particles in the blood. But I would like to emphasize that that occurs late in infection.
Early infection is the other way around. The primary targets — the first cells that come in contact with Ebola virus and get infected — are cells that are part of our immune system. And these cells most likely spread the virus throughout our body. But there are not so many cells infected at the very beginning of the infection, which might be the reason why Ebola virus patients do not spread virus at the very beginning of infection. And that’s why it’s safe to have contact with these patients, because the viral titers in their blood are so low that we cannot even detect them with methods like PCR, which is one of the methods we use to diagnose Ebola virus.
Is a virus only contagious when it reaches a certain level of “titer” or load?
That’s very difficult to answer because we know that for some viral infections most likely one viral particle is enough to infect somebody. So then the answer would be no. But we also know that some viruses are not really good spreaders, so you do need a certain amount of viruses to transmit this virus to another person.
Is that true for Ebola?
For Ebola virus, it seems to be true, because from experience, we know that this virus is not transmitted early in infection. If the viral titers are very low, if you’re not able to detect free viruses in the blood, then it seems Ebola virus is not transmitted to other people. Which is very good because, theoretically, that makes it really easy to control Ebola virus infection. And the reason why we have such a disaster right now, with almost 10,000 infected in West Africa and more than 4,000 already dead, is not so much the transmissibility of Ebola but rather the lack of infrastructure in these countries.
Some people are claiming that to infect so many people, the virus must have moved from just bodily fluids to “airborne”…
I think there’s some confusion here. We know that some viruses — like influenza virus, and measles — are transmitted before the patient shows symptoms. Especially the measles virus, which is the winner in terms of being contagious. What these viruses do is infect the respiratory tract — that is their first target organ. That’s how they start the infection, and then they replicate or amplify themselves in cells of the upper respiratory tract. And then when we breathe, we release these viruses because they’re part of our ‘breathing air.’ There are tiny, tiny, tiny little droplets, and these droplets contain the virus. They can stretch pretty far, like a couple of feet. And that is what we call an airborne infection. If we breathe and then we shed virus with our breath.
So you don’t even need visible droplets, it’s just air?
They’re tiny little droplets in our breath. And these viral particles are part of it. This is completely different from Ebola virus. First of all, Ebola virus does not begin an infection by infecting our upper respiratory tract. The route of infection starts with little lesions in our skin, and then the virus gets in our skin, and then in our blood system, and then in these immune cells I mentioned before, which are the primary target cells. It’s also able to get into our eyes and mucosal membranes, but it does not infect the cells which we need to get infected to have an infection be airborne. Late in the infection, when the Ebola virus patients have very high viral loads, they are really really ill, way too ill to get on a train and sit there.
So you’re saying that when they’re so ill that it could be in the respiratory system, they’re super-ill, not able to go anywhere?
Exactly. The cells in the lung can be infected by Ebola virus but really late in the infection. That’s very important. As far as we know, the infection starts with the immune cells — for those who know a little more about the immune system, it’s dendritic cells and macrophages. Then it goes to lymph nodes. Then very quickly to the liver, and there it goes crazy. The liver is very crucial in Ebola virus infections because it is so heavily affected. Ebola virus also spreads to the spleen, to other organs, and then later in infection it tends to infect the cells that coat the blood vessels, and of course we have these cells in the lung as well.
So when we are infected with Ebola virus and we are really sick, then we spread the virus through all our body fluids, which includes blood, sputum, feces urine, breast milk, urine and semen. Again, then we have Ebola virus in little droplets, which is the reason we talk about infection via droplets, but these droplets are much bigger — though they are tiny, of course — but these are much bigger than the droplets which cause aerosol-borne disease. So it’s a matter of size. And if they are bigger they cannot be transmitted over a large distance.
So if they’re bigger they can’t just float in your breath? But you could perhaps project them?
Of course you have them in your sputum — as you speak, you kind of shed virus — but then the droplets drop to the ground pretty quickly because they are heavier. It’s really a matter of size and weight.
The CDC recently tweeted an answer to a common Ebola question: It said yes, if someone with Ebola sneezes on you and the droplets land in your eyes or mouth, then conceivably you could catch Ebola. But that doesn’t count as airborne?
Exactly, and it’s all about timing. When someone is infected with measles and then sneezes or coughs, and is not sick at this point, they can transmit the virus to others and you’re not even aware that someone with the disease is contacting you. That’s the big difference with Ebola virus and these bigger droplets — but nevertheless droplets, of course. When Ebola virus patients start to transmit the virus, they have already developed a fever and are obviously sick.
So that helps explains why more people haven’t been infected in the U.S.?
Exactly. It’s very unfortunate, what happened in Dallas — that’s already the worst-case scenario for the U.S. It already happened to us. First, the patient came into the country without being identified as infected. That could happen again, just because of travel activity. Also, if the outbreak in West Africa is not controlled, more and more people will become infected. This makes it likely that infected patients will get into other countries. So that was the first thing that happened, which most likely is not easy to avoid.
Second — and this is something that could have been avoided — is that the infected person was not quarantined immediately, though we knew he had already gotten sick. He had contact with other persons who were not protected during his illness.
Finally, the nurses, who contracted the virus from the patient and eventually became ill, were not immediately quarantined and could have infected more people. And that is the worst-case scenario we can think of with Ebola virus.
Although what’s interesting is that, at least so far, aside from the two nurses, none of the people around Thomas Eric Duncan or the nurses has caught it.
Exactly. And that’s exactly what we know about Ebola virus: You really need close contact, especially contact with those who are severely ill, and that is because of of this special mode of transmission. Even early in infection it is not so contagious. Those who are at risk to get infected are those who take care of the ill patients — health care workers or relatives at home — and then the second group who got really hard hit by Ebola virus infections is those who care for the deceased, like relatives who washed the deceased, which is not really our funeral rites. So that is not a real risk for us, especially if you know someone died of Ebola virus.
Speculating, what do you think happened with the two nurses?
It’s a very interesting question. Since we know how to avoid Ebola virus infection, my assumption — but it’s really just an assumption — is that they did not wear the correct protective gear or, most likely, they were not trained to wear the protective gear correctly. Because you have to make sure that you protect every little bit of your skin, that’s so important. We talked about these droplets — if tiny little parts of your skin are not covered, and the patient is bleeding, and you get these droplets somewhere on your skin and then you have a tiny, tiny little scratch —
That maybe you can’t even see —
Exactly. And we all have little scratches, or your eyes are not properly protected. Even a little bit of unprotected skin — because of these little lesions we have in our skin — is enough to get infected. And it’s also important to think about how you take off your protective gear, because if you’re covered in the bodily fluids of the patient and then you have to take it off, how do you do that without touching your skin at one point?
So we are in a very fortunate position in the Biosafety Level 4 labs because we have chemical showers — and this is exactly why we have the chemical showers, to make sure that every part of us is somehow wetted with disinfectant, that we have contact with disinfectant everywhere. In the field, it’s very difficult to do that because you obviously don’t have chemical showers. Taking off the protective gear is something that needs a lot of training and very importantly, it needs a buddy system, you need somebody to help you to take off your protective gear. I don’t know if that happened in Dallas but that’s something that’s very, very important. That is really the most dangerous part of it: even if you wear this protective gear, at one point you have to take it off, and how do you do that without touching somewhere on your skin?
In some ways, Ebola transmission seems reminiscent of HIV. Could you please compare the two?
Comparing Ebola to HIV is like comparing a a bulldozer to a high-end intelligent robot. Because Ebola is not at all adapted to us, so it just infects us, it kills us pretty quickly or at least causes severe disease, and then when we are done, the virus is done as well because if the host is dead, the virus is dead as well. Ebola virus causes what we call an acute infection: It lasts about two weeks and then it’s over one way or the other.
HIV is completely different. HIV manages to get its little tiny genome into our genome in the cells, and some of these cells survive forever, and that’s the big issue with HIV. It becomes part of our own genomic equipment and so if these cells, which carry these little fragments, little HIV genomes, if they get activated, it really is not important how, then HIV starts to replicate its own genome and the infection starts again. That’s what we call a persistent infection, which is much, much harder to fight. With the Ebola virus, my guess is it’s much simpler to fight the infection.
And in terms of transmission?
I already mentioned that Ebola virus causes a systemic infection, so the entire body is affected by the infection. HIV is much more picky about the cells it would like to infect; it only infects a special subset of our immune cells — T cells — and it stays in these cells forever; until the cells die, it’s there. And since it is only in this special subset of blood cells, it’s only transmitted by blood and fluids, but not by sputum, for example, not by feces, not by saliva. The highest risk with HIV is sexual intercourse — it’s almost the only risk, and contact with blood, of course. And that makes it so different.
But nevertheless, because HIV lasts in our body forever once we are infected, that’s the reason why if you are infected with HIV and you don’t get treatment that helps you get the viral concentration down, then you theoretically can spread the virus as long as you live. And that is different from Ebola virus because Ebola is cleared after two weeks. You’re virus free and maybe even protected from a new Ebola virus infection. There’s a lot of speculation about that — we don’t know for sure if Ebola patients are protected going forward.
The news lately has been that in Dallas, people are coming off of quarantine after 21 days — that’s solid, that after 21 days you’re clear?
We know for Ebola virus the longest incubation period — the time from when you get infected to the time you show symptoms, that’s the incubation period — we ever heard about is 21 days. So if you’re healthy for 21 days, you do not have the infection.
And that’s different from having the infection and clearing it?
Then you have to do tests with these patients — you have to look at their blood and see if there’s still virus. Once you see there’s no virus in the blood — and you should repeat that at least two or three times to make sure there’s really no virus anymore — if this is the case then the patients are cleared and safe. With one exception — semen. That is a little bit strange, but it is as it is — it seems that Ebola virus can last in the body a little bit longer, because there are reports that it has been transmitted by sexual intercourse after seven weeks or so. But patients, if they know about that, they can easily take care of it.
Do we have any idea why that would be, biologically?
Sorry, no! it’s very weird, it was completely unexpected but it happened, unfortunately.
Was it a single case report? Or more?
I know about one report of a very similar virus — Marburg virus — so that was a very well-controlled outbreak in 1967 in Germany, in Marburg, and exactly that happened. And one of the patients who survived the infection then infected his wife, and that’s why we know about that. There have also been reports of detection of Ebola virus in semen almost three months after the infection.
As you’ve watched media coverage and public reaction, any other scientific corrections you’ve especially wanted to make, or additions to public understanding of how Ebola is transmitted?
I think we really should focus on the outbreak in Africa. To make it crystal clear, we do not have an Ebola virus outbreak in the U.S. We do have an Ebola virus outbreak in West Africa. We have to do all we can do to stop this outbreak for our own good because we do not want to have a similar situation as the Dallas patient.
I also want to make clear that this virus is not transmitted by the air, and this virus will not be transmitted by the air. In virology, we are not aware of a single virus which changed its transmission route so dramatically. I’ve asked a lot of my colleagues: Are you aware of any virus which changed its transmission route? Any virus which went from blood-borne or transmitted by bodily fluids to airborne? And nobody knew of any virus.
Ever. In 100 years of virology. I would be glad to learn if that happened but I talked to a number of people and nobody could tell me a single example of that. It’s nature, you never know, a scientist never says never, but it’s very, very, very, very, very unlikely.
And I also want to mention, because we have cases not only here in the U.S. but I also heard about incidents in Europe — that there was somebody sitting on the train, throwing up, and people surrounded this person — a black person, which gives it some racist element too — and completely freaked out and called 911, ‘It’s Ebola, it’s Ebola!’ And that won’t happen because Ebola virus patients are really sick, and that’s also something you should keep in mind. They do not walk around happily and all of a sudden they start to throw up, that is not the case. It’s a deadly disease, and deadly means deadly, so you are ill and you won’t be able to walk around and infect people so easily.
You can’t really get out of bed by the time your fluids would be contagious?
Are there people who have been basically immune to Ebola virus?
That’s a very interesting question. There’s a very nice study by a French and African group, published in 2000, in which they identified what they called asymptomatic Ebola virus patients. There were people who had very close contact to Ebola virus patients but they did not become ill. They looked more closely at these people and they found that they had a very effective and well-regulated immune response to Ebola virus infection. They developed antibodies and they did not show any signs of infection. Obviously they were infected because they developed antibodies, but they were able to clear the infection.
So there are people like that…
Yes, but we don’t know why that is the case. One possibility could be that there are genetic differences, of course. Another possibility could be that they were infected with only very very tiny little amounts of virus and the immune system was able to clear the infection before the concentration goes up like crazy. But we don’t know the mechanism, not at all. That’s something that’s very important to learn: Why do some people get infected but not develop the disease?
Most media coverage says clearly that Ebola is not airborne, but there was one piece in the Los Angeles Times with the headline, “Some Ebola experts worry virus may spread more easily than assumed.” It referred to a monkey study in which monkeys that caught Ebola from each other were in close quarters and raised the question of whether it might be airborne.
If it’s the paper I think it is, there were no controlled conditions. It’s not really clear how the virus was transmitted. That’s scary. But we don’t know how that happened.
There is another study that was published more recently, with Ebola virus Zaire, by Gary Kobinger in Winnipeg: His team infected pigs with Ebola virus Zaire and then monkeys in the same room as the pigs got infected. They obviously transmitted the virus but pigs are not the most clean and neat animals and they were in the same room.
What is really important is then they did exactly the same study with monkeys only: They infected monkeys with Ebola virus and they had another set of monkeys in the same room in another cage. In this case, the monkeys were not infected with the Ebola virus. So it was pig to monkey but not monkey to monkey, with Ebola virus Zaire.
I feel so much better…
You should get your flu vaccine, that’s much more important. That’s my last message to everybody: Please get your flu vaccine.
Readers, lingering questions?
A selection of health policy stories from Maine, Arizona, Missouri, Oregon, California, Florida, Pennsylvania, New Jersey, Kentucky and Connecticut.
The Associated Press: Sparks Fly Throughout Last Maine Governor Debate
The three candidates for governor clashed Tuesday in their final debate, highlighting their differences on a wide range of issues, including health care and welfare. Partisan sparks flew early and often between Republican Gov. Paul LePage and Democratic U.S. Rep. Mike Michaud, who are running in a dead heat in the race, far ahead of independent Eliot Cutler, two weeks before Maine residents go to the polls (10/21).
Arizona Central-Republic: Ducey, DuVal On Health Care
The two major candidates for governor, Democrat Fred DuVal and Republican Doug Ducey, are answering questions about issues explored in The Arizona Republic's "New Arizona" project. The project identified key issues in building a better Arizona. Today, the fourth in the occasional series, we focus on biotech and health care (10/21).
Kansas City Star: Missouri Senate: Two Doctors, Two Different Views On Medicaid Expansion
The two men running for the Missouri Senate in the 34th District are both doctors. Both cited experiences they had as physicians as motivation to run. But they come down on very different sides of a medically focused debate in Missouri: whether the state should expand Medicaid as envisioned in the federal Affordable Care Act. Rob Schaaf, the incumbent in the 34th District, which includes Platte County, said that expanding Medicaid in Missouri would be too expensive for the state. Robert Stuber said that expanding Medicaid is one of his top priorities. Doing so, he said, would create more jobs and salaries, which would increase state tax revenue. Refusing to expand Medicaid, he said, puts rural health care systems at risk for a hefty financial burden as federal subsidies to rural hospitals decrease (Pointer, 10/21).
Oregonian: State Announced $150,000 Contract To Wife Of Key Kitzhaber Adviser Before Competitive Bidding
Oregon Health Authority officials announced the selection of the wife of a former top aide to Gov. John Kitzhaber for a $150,000 contract before any formal bidding took place, The Oregonian has learned. A state manager internally announced the hiring of Kate Raphael to produce videos about the governor's health reforms on July 31, documents show. That was eight days before a formal competitive-bidding solicitation was issued, and nearly a month before a contract was signed (Budnick, 10/21).
Los Angeles Times: Lawyers Versus Doctors In Costly Prop. 46 Campaign Wars
A ballot initiative that pits lawyers against doctors has set off one of this year's fiercest campaign wars, a costly clash over increasing state limits on malpractice damages and imposing drug testing on physicians. Proposition 46 would raise the cap on pain-and-suffering awards in malpractice lawsuits and require that hospitals randomly test their doctors for drug and alcohol use. Backers say the measure would rein in negligent doctors; opponents charge that it's a money grab by the lawyers who helped put it on the ballot (Mason, 10/21).
Miami Herald: Miami Physician Assistant Gets 15 Years For Nation’s Biggest Medicare Therapy Scam
A Miami physician's assistant who was described by his lawyer as a “bit player” in a nearly $200 million mental health scheme to swindle Medicare was sentenced to 15 years in prison on Tuesday. But it could have been worse for Roger Bergman, 65, of Miami, who was facing up to 25 years under federal sentencing guidelines for his supporting role in the biggest mental-health clinic scam ever orchestrated against the taxpayer-funded Medicare program. Bergman, convicted in July of a fraud conspiracy, conducted bogus evaluations of hundreds of patients and falsified their records to dupe Medicare into believing they needed the costly therapy services, according to trial evidence (Weaver, 10/21).
Philadelphia Inquirer: Overdose Deaths Rise In Pa., N.J.
Because of that surge, New Jersey's ranking in drug-death rates soared from 41st in 2010 to 18th. The new statistics predate New Jersey's most recent moves to attack the problem. Several months ago, it changed state law to encourage people who witness an overdose to call 911 without fear of arrest. It also permitted first responders, family, and friends to carry medication that can quickly reverse an overdose due to heroin or opioid prescription painkillers. Families and police around the state have since reported more than 230 "saves," according to the Drug Policy Alliance, including 47 in Camden (Sapatkin, 10/21).
Modern Healthcare: Ky. Cardiologists Settle False Claims Allegations
Two Kentucky cardiologists have agreed to pay $380,000 to settle allegations that they violated the False Claims Act by entering into bogus management agreements with an area hospital in exchange for referring their patients to that hospital, the Department of Justice announced Tuesday. The government alleged that Drs. Satyabrata Chatterjee and Ashwini Anand, who owned cardiology physician group Cumberland Clinic, London, Ky., entered into sham management agreements with Saint Joseph Hospital. The two were paid to provide management services but never actually provided them, according to the government. Instead, they allegedly agreed to refer their clinic's patients to the hospital for cardiology and other services in violation of the Stark Law and the anti-kickback statute, according to a Department of Justice news release (Schencker, 10/21).
Connecticut Mirror: Public Gets First Look At Health Industry Payments To Doctors
Pharmaceutical companies and medical-device manufacturers paid more than $6 million to about 5,400 Connecticut doctors for various services during the last five months of 2013, a Connecticut Mirror examination of a newly released federal database shows. The information was collected under a provision of the Affordable Care Act that is designed to help consumers understand the financial relationships between the health care industry and the nation’s physicians. Though only a five-month snapshot, the new data provides the public with the ability to search actual payments to their own doctors for the first time (Radelat, 10/22).
Oklahoma Republican Sen. Tom Coburn's list includes various programs that continue to receive funding even as National Institutes of Health officials express concern about the slowing of disease research.
Politico: Tom Coburn Skewers NIH In Final 'Wastebook'
This particular study on rodent rubdowns cost $387,000 -- a tiny fraction of the National Institute of Allergy and Infectious Diseases’ more than $4 billion budget. But the ranking member of the Senate’s Homeland Security and Governmental Affairs Committee cites many “unnecessary” spending programs that continue while NIH officials argue that important disease research has slowed (Everett, 10/22).
Also in the news, another congressional committee is examining possible waste in the Medicare Advantage program --
Center for Public Integrity: GAO Takes On Medicare Advantage Spending
A Congressional committee has taken aim at waste in the popular Medicare Advantage health insurance program for seniors, ordering an extensive audit of billing errors and overcharges by insurers -- mistakes estimated to cost taxpayers billions of dollars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of the House Ways and Means Committee. Results are due next spring (Schulte, 10/20).
Health care continues to be a big issue, though not as important as the economy.
The Associated Post: AP-GfK Poll: Most Expect GOP Victory In November
But the survey suggests many will cringe when they cast those ballots. Most likely voters have a negative impression of the Republican Party, and 7 in 10 are dissatisfied by its leaders in Congress. … What’s deeply important to likely voters after the economy? About three-quarters say health care, terrorism, the threat posed by the Islamic State group and Ebola (10/21).
Meanwhile, MPR examines the ideas for replacing the health care law put forward by Republican Senate candidate Mike McFadden -
Minnesota Public Radio: Experts Say McFadden’s Health Insurance Ideas Don’t Hold Up
Republican Senate candidate Mike McFadden takes advantage of every opportunity to slam the Affordable Care Act as bad for the nation. In advocating for a replacement for the federal health care law, McFadden opposes a national solution. He would leave most of the decisions up to states, including whether to require people to buy health insurance. But McFadden would force states to keep some of the most popular benefits of the heath care law. ... Experts, however, say much of what McFadden proposes has been tried before and left millions of Americans without health insurance (Zdechlik, 10/22).
A Pew Research Center survey finds 41 percent of Americans say they worry they or someone in their families will be "exposed" to the Ebola virus, up from 32 percent two weeks ago. Public confidence in the government's ability to combat the disease has also dropped, finds a Gallup poll. Meanwhile, GOP doctors in the House of Representatives seek a temporary travel ban for West African countries affected by Ebola.
Los Angeles Times: Public Concerns About Ebola Increase Faster Than Cases
Public concerns about Ebola have grown much faster than the actual number of cases of the illness in the U.S. A Pew Research Center survey released Tuesday found that 41% of Americans said they worried that they or someone in their families would be "exposed" to the Ebola virus, up from 32% two weeks ago (Lauter, 10/21).
Politico: Poll: Drop In Faith In Government On Ebola
Americans have become less confident in recent weeks in the federal government’s ability to fight Ebola in the United States, according to a new poll. According to the Gallup poll, 52 percent of Americans said that they were “very” or “somewhat confident” in the government’s ability to handle the virus. That’s down nine percent from Oct. 5, when 61 percent of Americans expressed confidence, and Oct. 12, when Gallup found that 60 percent of Americans were confident in government to handle the situation (Breitman, 10/22).
Politico: GOP Doctors In House Seek Travel Ban
The Republican Doctors Caucus is calling on the White House to put in place a temporary travel ban for West African countries affected by Ebola. The letter, sent Tuesday to President Barack Obama, was signed by 16 members of the group, including co-chairs Reps. Phil Gingrey of Georgia and Phil Roe of Tennessee (Topaz, 10/22).
USA Today: West Africa Travelers Must Go To 1 Of 5 Airports
The Department of Homeland Security announced Tuesday that all travelers from Ebola outbreak countries in West Africa will be funneled through one of five U.S. airports with enhanced screening starting Wednesday. Customs and Border Protection within the department began enhanced screening — checking the traveler's temperature and asking about possible exposure to Ebola — at New York's John F. Kennedy International Airport on Oct. 11 (Jansen, 10/21).
Hospital ownership of physician groups increased patient care costs by as much as 20 percent, according to the UC Berkeley study. Meanwhile, another study by Harvard researchers finds that switching to for-profit status may boost hospitals' financial health but has no effect on quality of care.
Los Angeles Times: Medical Costs Up To 20% Higher At Hospital-Owned Physician Groups, Study Finds
Raising fresh questions about healthcare consolidation, a new study shows hospital ownership of physician groups in California led to 10% to 20% higher costs overall for patient care. The UC Berkeley research, published Tuesday in the Journal of the American Medical Association, illustrates the financial risks for employers, consumers and taxpayers as hospital systems nationwide acquire more physician practices (Terhune, 10/21).
Modern Healthcare: Hospitals Switching To For-Profit See No Drop In Quality
Switching to for-profit status generally boosts hospitals financial health and has no effect—good or bad—on the quality of care they deliver, according to a new analysis of what happened in the years after more than 200 conversions. “For-profit hospitals have often argued that conversion will provide resources that will lead to better care,” wrote Harvard University researchers Dr. Karen Joynt, Dr. Ashish Jha and John Orav in a study published in JAMA. “Our study failed to find any evidence to support this notion,” they concluded. ... Some states have limited the entry of for-profit hospital operators out of fear that the profit motive would undermine hospitals' quality and their commitment to serving the uninsured and patients covered by Medicare and Medicaid (Rice, 10/21).
In other hospital news -
Kaiser Health News: Hospitals’ Struggles To Beat Back Familiar Infections Began Before Ebola Arrived
While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show. Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined. A Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention. In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than average for at least one infection category, the KHN analysis found (Rau, 10/21).
The Ohio governor is engaged in a spat with The Associated Press after the news outlet published comments in which he said he didn't think the health law would be repealed. He has since offered further explanation, saying that he doesn't think the Medicaid expansion -- which he views as separate from the overhaul -- should be undone.
Politico: Gov. John Kasich’s View On Medicaid Fuels Two-Day Spat With AP
What, exactly, is Obamacare? According to Ohio Gov. John Kasich, it doesn’t include Medicaid expansion, a major facet of the law. It’s a view held by virtually no one else. Kasich’s unorthodox view of the Affordable Care Act — and the hunger the Republican base has for the health law’s repeal — are behind a two-day public spat between the possible 2016 contender and The Associated Press (Wheaton, 10/21).
Meanwhile, in Tennessee, health advocates press for expanding Medicaid -
The Associated Press: Advocates Continue Call For Medicaid Expansion
Members of the state chapter of the NAACP and other health care advocates held a mock funeral across from the state Capitol on Tuesday to characterize lives they say will be lost if Medicaid is not expanded in Tennessee. About 100 people attended the event, which included a processional with a casket. Organizers say many people have died because they don't have health care and that there will be more deaths if Medicaid is not expanded. "The suffering is profound," said Margaret Ecker, an outreach coordinator with the Tennessee Justice Center, a leading advocate for enrollees in TennCare, Tennessee's version of Medicaid. "These are human beings who will all care for. It's about doing the right thing." Gov. Bill Haslam, a Republican, has been criticized by Democrats for refusing last year to agree to $1.4 billion in federal funds to cover about 180,000 uninsured Tennesseans under the terms the money was offered (Johnson, 10/21).
University of Pennsylvania researchers find that the variations are significant. Other news about the online health marketplaces that open next month include Oregon's decision to ditch the old system for Medicaid enrollment, a review of navigators' roles in Georgia and Maryland officials' assurances that their system will be read.
Politico Pro: Wide State Differences Seen In Obamacare EHBs
ACA exchange enrollees in almost every state will find that chiropractic care is a covered benefit under their health plan, but they won’t have as much luck with acupuncture and weight loss programs, a new report from University of Pennsylvania researchers shows. The report, which was funded by the Robert Wood Johnson Foundation, finds that significant state variation exists in the ACA essential health benefits that insurers must cover to offer plans on the exchanges (Pradhan, 10/21).
Georgia Health News: Navigators Aided Consumers In Need, Report Shows
Consumers in Georgia and three other states who were helped by navigators for the 2014 insurance exchanges tended to be people of color who were not financially secure, a recently released report says. Navigators, who are specially trained in the provisions of the Affordable Care Act, provide face-to-face, in-person help for consumers seeking information about health insurance policies in the state exchanges, also called marketplaces (Miller, 10/21).
Denver Post: Disconnect For Health Consumers In Colorado Who Passed On Insurance Through State Exchange
A sign placed out on the 16th Street Mall beckoned people in late March to sign up for health insurance through the Affordable Care and Connect for Health Colorado. Colorado was one of 16 states that set up its own health insurance exchange under the Affordable Care Act and one of 27 states to expand Medicaid. Between the two, Colorado had enrolled more than 300,000 in one or the other by March 31. Among the state exchanges, Colorado had the fourth-highest number of people sign up for private insurance through its marketplace, Connect for Health Colorado. That was estimated to be 25 percent of eligible individuals. The Colorado Health Foundation hired the RAND Corporation to study why the rest hadn't signed up. The foundation released the report, "Barriers to Enrollment in Health Coverage in Colorado," in mid-October (Draper, 10/21).
Baltimore Sun: Md. Is In ‘Good Shape’ For Health Exchange, Official Says
Less than three weeks before uninsured Marylanders get their first look at health plans offered under the Affordable Care Act, officials say preparations are on track. The state's health exchange website crashed on its first day last year and tangled thousands in technological troubles for months. But in a briefing to members of the exchange board Tuesday, the site's top technical officer said it has been fully revamped and appears to be working properly. Though preparations continue, tests show it can handle thousands of users at a time and complex cases (Cohn, 10/21).
Kansas City Star: Coming Soon: Obamacare Take II
It was a near disaster last year when the Affordable Care Act’s health insurance plan marketplaces opened for business. The healthcare.gov website for online enrollment crashed on day one. Political opponents rose in a gleeful chorus of “I told you so.” The public was frustrated and confused. But ultimately, more than 7 million people enrolled in the ACA’s health insurance plans, meeting original predictions. Now, it’s time for round two. Open enrollment for the ACA’s 2015 marketplace insurance plans starts Nov. 15. And this time, the organizations promoting enrollment are optimistic it will go a lot more smoothly. The regional coalition of foundations, social service organizations and safety net clinics will try to better coordinate their work and focus on groups — African-Americans, Latinos, the LGBT community, rural residents — that have been hard to reach (Bavley, 10/21).
Salem Ore. Statesman Journal: Oregon Seeking To Use Different State's Medicaid System
The state has cut its final ties between Cover Oregon and Oracle, the company that was hired to build Oregon's state health insurance exchange. After the two entities failed to launch a working insurance marketplace, the state distanced itself from Oracle and instead piggy-backed on the federal health care exchange for private insurance. Oregon officials had hoped to build on existing work of Oracle's to create an automated system for Medicaid enrollments, but continued disagreements have led to the state giving up on any plans involving the corporation. ... A list of criteria are being developed to help guide the decision on which state Medicaid system to use (Yoo, 10/21).
The Oregonian: Oregon Gives Up On Oracle Technology, Will Use Another State's Medicaid System
State officials have given up on trying to salvage a portion of the troubled Cover Oregon technology project, essentially abandoning all hope of getting any lasting benefit from the $240 million paid Oracle America on the health insurance exchange and related work. ... The state had been planning to use salvaged Oracle technology for enrollment in the Oregon Health Plan, but has now halted that effort (Budnick, 10/21).
The Washington Post: Obamacare’s Small-Business Exchanges To See Major Changes In The Coming Months
One year in, the new small-business insurance marketplaces born out of the new federal health-care law have fallen short of their promise in nearly every state, both in terms of functionality and enrollment. However, many are scheduled to see some important updates heading into year two — ones that health officials say should make them much more useful and appealing to small employers and their workers (Harrison, 10/20).